Date: 06 December 2018
Dr Kristina Wanyonyi is a research lead and senior lecturer in dental public health at the University of Portsmouth Dental Academy. She is also the NIHR CRN Wessex oral and dental specialty lead. Kristina focuses her time on exploring the links between general and oral health and developing effective health services. She works to understand patient populations so that trials and interventions are patient focussed and outcome driven. Her latest study is entitled: Does the delivery of tooth brushing in reception years at underprivileged schools in Portsmouth make a difference in oral health knowledge and practice?
"Dental care has often been an overlooked part of the bigger public health picture. Until recently, there wasn’t a lot of information available to people about the impact of neglecting your teeth and gums beyond the message that you simply have bad teeth and gums. We know an awful lot more now about how it affects individual health in the long term. There’s strong research evidence that your oral health profile under the age of two can impact on your future health profile. Conditions like diabetes, heart disease and obesity are all linked strongly to dental health.
"For me, it’s so important. The mouth is the gateway to the body – the food you put in it, how you smile, your confidence and the pain you can experience when something is not right. It’s easy for people to ignore issues with their dental health, or think that maintaining good oral hygiene isn’t important, because they just see them as teeth. But the link to the rest of the body is hugely important in helping us establish good levels of general health."
TOOTH BRUSHING FOR CHILDREN
"We wanted to explore the link between early interventions to improve tooth brushing in young children, and the potential to significantly impact on overall healthy behaviours for themselves and their families. We know that 30% of children have tooth decay by the time they are five years-old and the majority of this can be solved by brushing teeth effectively. In addition to that, only 58.5% of children in England are being seen by an NHS dentist each year. The potential to prevent serious health conditions later on in life and improve dental health significantly is huge. The University of Portsmouth Dental Academy has been doing outreach community work since 2010, but we wanted to take our work a step further and evaluate the impact that we could have on changing behaviours and expanding knowledge about oral
hygiene in disadvantaged communities.
"The tooth brushing study took ten underprivileged schools in Portsmouth and worked with 700 children, all in Reception year, giving them a toothbrush and toothpaste to be kept at school. The children were given an examination in school, with consent from their parents, and we trained teachers to deliver advice and tooth brushing techniques, making sure that the children were brushing their teeth every day while they were at school. We examined them at the beginning of the academic year and then, after 12 months of tooth brushing and advice in school, we began to collect data around the children’s tooth brushing habits and knowledge of dental care. We’re currently still collecting that data, and hope it will be ready in early 2019. In the future we also hope to do a clinical evaluation on the children who have taken part in the study, so we can see whether there has been a significant improvement in their dental and general health as well as an improvement in their knowledge."
"Our initial research and data collection before the trial began pointed to significant knowledge gaps in more deprived communities around dental hygiene. There was a lack of understanding around when teeth should be brushed, how they should be brushed, when parents needed to take their children to the dentist and from what age. We could also see the ripple effect from parents who were scared to attend the dentist, and the impact this was subsequently having on their children.
"From our wider research we knew that there were apps available for timing tooth brushing for children but nothing that offered advice on techniques to help them brush effectively. Knowing that we needed to be able to communicate messages around these issues, we wanted to explore how we could do that. We asked a group of disadvantaged mothers in Portsmouth for their biggest barriers to getting advice on health issues and they commonly told us that the lack of time health professionals had was a real problem.
"Building on the tooth brushing in school, the next phase of our research is to work with stakeholders in the region to begin to look at the creation of videos with families so that we can disseminate informative advice on tooth brushing easily and make it accessible. By providing this additional advice to their contact with health professionals, we hope that it will give families the power to look after their dental health from a very early stage. It’s also important for me that we encourage the message around prevention and this is also reflected in how we train dental professionals, so that their work becomes as much about prevention and giving advice as it is about correcting things when they need it.
"We’re doing a lot of work at the University of Portsmouth Dental Academy to ensure that when our dental professionals are trained, they are exploring their communication skills. We are trialling the use of virtual reality to simulate how some vulnerable patients feel at the dentists as we want to place as much emphasis on soft skills, like communication and empathy, as we do on their clinical skills and physiological training."
Investigating community health promotion by Portsmouth Dental Academy is funded by the Oral and Dental Research Trust and sponsored by the University of Portsmouth. Developing and evaluating an animated oral health promotion video in concert with disadvantaged families in Portsmouth is funded by Public Health England and sponsored by University of Portsmouth. This study has been included on the NIHR portfolio following the changes to the eligibility criteria to support research in non-NHS settings. For more information, see www.nihr.ac.uk/funding-and-support/
Find out more about public health research in Wessex by viewing the latest issue of VISION magazine.
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