Oral health education and the relationship between oral health and general health in an at-risk population

Abstract

Background: Poor oral health can negatively affect the rest of the body, not just the mouth. To achieve satisfactory oral health, it is necessary to include oral health education as a vital part of dental treatment care to educate populations, especially those at higher risk for poor oral health.

Aims: In this thesis, two separate study projects were conducted to achieve the following main aims. Firstly, to investigate the effectiveness of a personalised oral health education program, in addition to routine dental treatment on oral and general health, targeted to participants from a low socio-economic community. Secondly, to develop, implement and determine the effectiveness of a short video which included the integration of general health-related information of the relationship between oral health and diabetes management, with oral hygiene instructions as effective way to encourage positive change in oral health -related behaviours in patients with type 2 diabetes mellitus.

Materials and Methods: Chapter 1 provides a broad background of the importance of good oral health and introduces the epidemiology of oral health and risk factors. This is followed by a focus on oral health education based on psychological and behavioural theories. Study 1 covered the analysis of the data from a pragmatic randomised controlled trial of a personalised oral health education program (OHEP), combined with routine dental treatment over a follow-up period of 3 years. The study was conducted at the Logan Hospital Oral Health Care Clinics, Queensland, Australia. A total of 579 participants (aged 18–60 years) were randomly assigned into the intervention group (n = 292) and received a personalised oral health education program in combination with routine dental care, and the control group (n = 287) received routine dental care. Oral health-related behaviours, dental plaque, and periodontal status were assessed at baseline, 12 months, and 24 months. The serum biomarkers of general health changes, including a lipid profile, high sensitivity C-reactive protein (hs-CRP), and glycated hemoglobin (HbA1c) levels, were assessed at baseline and 12 months.

In Study 2, A total of 304 participants ( ≥18 years of age ) diagnosed with type 2 diabetes were recruited from the Family Medicine department in King Fahad Armed forces (KFAFH) Hospital, Jeddah, Saudi Arabia, based on inclusion and exclusion criteria. All participants' demographic and medical information records were obtained from the patient's files. Participants completed an oral health questionnaire and a periodontal questionnaire. Participants were randomly grouped into two groups: the intervention group, which included 152 participants who received a short video containing information about oral health, the relationship between oral health and diabetes, and the importance of oral hygiene instructions. The standard care group included 152 participants who received a standard oral health information through a short video containing oral hygiene instructions. The participants were contacted after three months via telephone to collect answers on possible changes in oral health-related behaviour.

Results: Study1 found that although the clinical parameters of periodontal health were improved in both study groups over the study period, there was a lack of significant additional effects of the personalised oral health education program used in the current study on oral health-related behaviours, dental plaque, and periodontal health compared with routine restorative dental care per se. We found a significant reduction in hs-CRP levels after dietary behavioural changes in the intervention group. Study 2 found that there were more participants in the intervention group who started to increase the time needed for teeth brushing (P=0.031), used interdental cleaning (p=0.001), and used interdental cleaning at least once per day (p=0.003).

Conclusion: Future oral health education research can utilise these findings and approaches in designing, implementing, and evaluating oral health education interventions, especially in the groups at higher risk of poor oral health.