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Youth Community-based Oral Health Learning Model (YCBOHL)

Ref nr. 2014-2-RO01-KA205-013237
Key action: Cooperation for innovation and the exchange of good practices
Field: Strategic Partnerships for youth


Education, communication and training are the means of raising public awareness and achieving social change in Oral-Hygiene high status among youth. In order to achieve the desired impact, the Com4You will strive that Community as a whole, families, community members, the private and not-for-profit sectors, government, faith communities, and students themselves, along with schools, shares responsibility in improving the health literacy of young people. A growing number of schools and community partners will adopt the YCBOHL curricula that allow target groups to learn and be trained in their communities. This link between schools and community partners is a critical element for offering youth and direct stakeholders ways to develop the skills and knowledge necessary for improving their health literacy. The aim of YCBL model is to more fully engage young people and community partners, by harnessing their natural interest in oral health education and by using their own community as a source of learning and action. The project's oral health literacy improving actions has the purpose of enabling young people to increase control over and to improve their patterns of oral health by empowering them with knowledge concerning the prevailing oral health problems and methods for their prevention and control, besides providing them with the skills, social support, and environmental reinforcement they need to adopt long-term healthy behaviors. Therefore, the impact will be measured both from a short-term as well from a long-term perspective.

Oral Health Research Studies Conducted in Romania Oral health is an important component in maintaining the physical, mental and social comfort, being necessary to evaluate it permanently and to establish new methods of restoring and maintaining it in normal limits. An important aspect of the current concerns in the field of dental public health is the disparities in health status of the population, caused mainly by differences in socioeconomic status. For children, oral health inequalities are caused by socio-economic status of the families from which they come, despite the fact that all children receive free dental services to offices where there is a contract with the National Health Insurance (until 2013). Besides the social aspects, an important role in this situation is held by the parents' educational level regarding oral health. Although the oral health status of populations around the world has seen a marked improvement, oral diseases, however, continue to be a major public health problem, especially in communities belonging to disadvantaged groups in developed countries and developing ones, who are still experiencing high levels of impaired oral health status. Knowing the determinants of health, oral health trends and risk factors involved are of real importance to establish effective methods to improve oral health, with significant impact on quality of life of the individual. Socio-economic level is consider one of the key indicators for children health, being demonstrated that subjects from families with low income and educational level have a higher number of caries lesion than subjects from families with higher socio-economic level. The need and demand for clear scientific evidence to support the oral health policy making is higher than ever. Field of social determinants of health is very complex and challenging. It covers key aspects of the life of individuals, such as working conditions and lifestyle.Quality of life in relation to the armonious and simultaneous satisfaction of all human needs: health, dignified conditions of life, economic and social security, leisure time, culture, education, a dignified, interesting and satisfying job, supportive and positive interpersonal relationships, a rationally organized society based on liberty, democracy and constructive morality. Oromaxilofacial problems may influence these parameters, leading to negative changes in self-perception, self-esteem and well-being of a person. At a personal level, it influences the decision of the patient or that of the physician regarding the choice of treatment, while at a social level it contributes to the understanding of the needs of the others. The study of quality of life may also influence political decisions. For example, the increase of the DMFT index (Decayed/Missing/Filled Teeth) among children may indicate nutrition problems, due to their inability to masticate certain aliments, as well as sleep and attention disorders caused by the pain which is a consequence of dental problems. Thus, DMFT may represent an indictor of the health care need of a population for the decision-makers. In this context quality of life becomes a means for understanding and shaping clinical practice, research and education, not only at an individual level, but also on a broader scale, that of the community as a whole. From the health point of view, the quality of life reflects the feeling of physical and mental health, as well as the ability to react to factors of the physical and social circumstances and is characterized by a higher degree of subjectivity as opposed to life expectancy and, thus, it may be difficult to measure.


I. A recent study published in 2013 investigates the prevalence and experience of dental caries among children from public middle schools in Bucharest in relation to socioeconomic status and access to school-based dental care from 1,595 schoolchildren aged 10-17 years from Bucharest. The dental caries were scored according to the World Health Organization (WHO), clinical criteria and expressed based on tooth and surface levels (DMFT/DMFS). The caries prevalence was 75 percent, and 64 percent had untreated caries. The mean DMFT value for the entire sample was 2.8, and its highest component was decayed teeth (mean DT= 2). Parental education level had the strongest influence on the caries scores; 70 percent of children whose parents had not completed a university degree had untreated caries (% DT) compared to only 49 percent of children whose parents had a higher level of education (P < 0.05). Children with access to school-based dental care had significantly better dental health (P < 0.05). In conclusion, compared to previous national surveys, the caries rates among schoolchildren in Bucharest are slowly declining. However, there was still a high proportion of untreated caries with a clear socioeconomic gradient, and a change in the school-based oral preventive strategy is needed to meet the needs of the children. (J Public Health Dent, Caries experience in schoolchildren in Bucharest, Romania: The PAROGIM study. Authors:Funieru C, Twetman S, Funieru E, Dumitrache AM, Sfeatcu RI, Baicus C).

II. Another study was conducted at national level in 2012, on schoolchildren aged 6-11 yrs from 5 cities in Romania, being part of the national educational program „Smile Romania”, which is included in an European program – „Platform for a Better Oral Health”, developed by cooperation between the Association for Dental Education in Europe (ADEE), the Council of European Chief Dental Officers (CECDO), the European Association of Dental Public Health (EADPH) and the International Dental Health Foundation (IDHF). Objectives: the study was developed to assess oral health status, oral hygiene level, preventive dental sealants and the orthodontic treatment need among 6-11 years old school children in Bucharest. There was involved a number of 6786 schoolchildren from 5 cities. On decidual teeth dental caries prevalence is about 75,3%, caries free teeth about 24,7%. Defs index was about 6,08 because of 4,88 surfaces with untreated decays and only 0,63 extracted and 0,59 filled. Deft was about 3,38 with 2,83 decays, 0,15 extracted and 0,42 filled. On permanent teeth caries prevalence is about 39% with 61% caries free teeth. The DMFS index is 1,19 with 1,05 surfaces with untreated decays and 0,13 filled. The DMFT index is about 0,99 with 0,87 dental caries and 0,12 teeth with fillings. In Bucharest there were included in the study 2599 children, 49.9% girls an 50.1% boys. Oral examinations were performed in the classroom, using disposable dental examination tools, based on WHO 1997 examination criteria and dental chart. For temporary dentition that caries prevalence is very high (71.1%), we found a medium to high value of defs =5.44 and deft= 3.18, both based mostly on the ds value. For permanent dentition, the prevalence was smaller, of 31.8%, the mean value of DMFS was 0.92 and DMFT is 0.82. We found that sealing were applied on only 8.5% of examined molars, there are only 25% of subjects that keep the tooth surfaces plaque-free. (Medicine in Evolution, Volume XXI, No. 2, 2015, Oral health profile of schoolchildren included in national programme „Smile Romania” in Bucharest. Authors: M A Dumitrache, R I Sfeatcu, M Caramida, C Funieru, A Galuscan, E Ionescu). These results shows that, in comparison with the study conducted in 1992 by Prof Petersen PE (WHO), there is a decrease in the dmft index in all 5 cities; the most marked decrease was recorded in Bucharest where the value decreased from 5,20 in 1992 to 2,65 in 2011. A significant decrease was recorded also in Tg. Mures, where dmft value decreased from 4,9 in 1992 to 2,95 in 2011 . Not the same can be said about the other three cities: Iasi, Cluj and Timisoara, where, although there are decreases in the values of dmft index, but not statistically significant, values remain high, in comparison to WHO objectives for 2020, stating that for the age of 5-6 years, 90% of children have no caries.

III. Socio-economic status of parents affects the level of oral health knowledge and attitudes of the young population, which is sustained by previous studies (Evghenikos, Mihailovich, Maxim), that sustain the fact that parents with high socioeconomic status have children with oral status noticeable better than children coming from poor socio-economic families. Subjects participating in the study were questioned regarding the frequency of visits to the dentist by the age of 6 years and the reason for the visit. Most subjects (89, 57%) responded affirmatively, subjects in Tg. Mures with the higher percentage of positive responses (21, 95%) and the lowest in Timisoara. There were 10.47% of the participants who have never had a dental checkup by the age of 6 years. An important factor in the pathogenesis of dental caries is represented by the frequency of sweets consumption. In case of study, 61.7% of subjects consume sweets between meals, which can explain the increased prevalence of dental caries, this result supporting previous results of studies abroad and in Romania. Another important element in assessing attitudes was the frequency of toothbrushing performed by children of 6-11 years old group. A large number of subjects from Tg. Mures (89%), Bucharest (86%) and Cluj Napoca (73%) responded that hey brush their teeth twice a day. It is noted the small number of children who answered that they brush their teeth 3 times/day in all five centers and also that in Iaşi children responded in equal proportions (40%) that brush their teeth twice/day and when they remember. In Iasi, most subjects (54%) brush their teeth once/day and in Timisoara a total of 32 subjects who responded "when they remember”.

IV. A cross-sectional survey was carried out in 2008 in Bucharest on 418 schoolchildren aged 11-13 yrs and 483 aged 6-8 yrs . For children of 6-8 yrs the average of caries index was deft=4.3 ± 3.36, SIC= 8.519 and 26% of population evaluated was caries free. For children of 11-13 yrs the results shows that the prevalence of dental caries in the sample was moderate: 44,7% were caries free and DMFT scores range from 0 to 13, with a mean for all the sample of DMFT =2,08 (±2,11) . The prevalence of gingival bleeding was 14,45% and O’Leary plaque index scores had a mean of 54,41%, indicated a moderate level of oral hygiene. The prevalence of oral impacts on daily performance was 57,4%, eating was the most performance affected (46,1% of children), followed by cleaning teeth (21,9%) and emotional stability (13%). Related to intensity of impacts, 43,8% of schoolchildren had point out very severe intensity of effects, 3,8% severe intensity , 14,1% moderate level of intensity, 8,7% little intensity and 45% very little impacts on daily performance. The main causes of negative impacts on daily performances were tooth decay (57,4%), erupting permanent tooth (39,8%), exfoliating primary tooth (37,7%), toothache (36,5%) and sensitive tooth (31,6%). Most of the children (42,6%) had no impact on daily performances and 52,5% reported 1-4 performances. The severity of impacts was high for eating and emotional stability and low for study and social contacts. (Quality of life related to oral health for schoolchildren in Bucharest, Authors: M.A. Dumitrache, C. Comes, E. Teodorescu, L. Dumitrascu, M. Cuculescu, E. Ionescu, Rev. Rom. Bioetics).

V. A cross sectional survey was performed on caries’ prevalence and oral hygiene knowledge of teenagers in Cluj-Napoca. A sample on 367 teenagers (191 boys), aged between 15–18 years (mean age 16.3±0.81 years). It was carried out by 10 calibrated examiners, in ten randomly selected Cluj-Napoca dental offices. The teenagers were recruited when they attended for dental care. In the opinion of the authors, the sample was representative of the 15 – 18 year-old population of Cluj Napoca. There were no non-responders. Ethics approval and parents’ informed consent were obtained. Plaque index (O’Leary, 1967) and D3MFT were recorded together with four items completed by parents regarding socio-demographic data(SES level)-(four questions regarding parents education, monthly income, parent’s jobs, children’s neighborhood/downtown schools), oral hygiene knowledge, oral hygiene habits and recall visits attended/year. A total of 43 teenagers (11.7%) were caries free, mean PI was 45.7% in teenagers having more than one surface decayed, Significant Caries (SiC) was 5.3±0.48, Mean DMFT was 3.63±1.56 (boys:3.93±1.90; girls:3.33±1.11). 109 teenagers (29.7%) had pulp involvement, there were no significant differences between gender. The mean number of subjects with better oral health was higher in those having parents with middle and high SES status (mean SES 152.16⇔/month/family member), (p<0.05). Multivariate regression analysis showed that only age and PI had an influence on caries. It was independent of other factors (gender, socio-demographic data). The prevalence of dental caries in Cluj-Napoca was high. Those with parents with better SES status had lower caries experience. The findings suggest more dental hygiene information should be provided to teenagers so they may be motivated to seek dental treatment on regular basis.

VI. A study conducted in Iasi, in 2013, was set out to determine caries experience, caries prevalence, dental treatment need in 6‑8 and 11‑13 year‑old school children in Iasi, using the International Caries Detection and Assessment System (ICDAS II). A cross‑sectional oral health survey of school children (310 6‑8 yr‑old and 278 11‑13yr‑old ones, respectively) was conducted in Iasi in 2012. Clinical examinations were performed by a trained dentist using the ICDAS II system. Out of the 6‑8 year‑old patients (mean age: 7.3 years, SD: 0.53), 88.4% had caries experience (87.7% without carious lesions codes 1 and 2) with mean d1‑6 mft and d 3‑6 mft of 5.12 (SD=3.16) and 4.94 (SD=3.11), respectively. No gender differences in caries experience or in its components were found (p>0.05 in all cases). Among the 11‑13 year‑old ones (mean age: 12.7 years, SD: 0.52), 96.4% had caries experience (91.4% without carious lesions codes 1 and 2), with mean D1‑6MFT and D3‑6MFT of 5.27 (SD=3.66) and 4.04 (SD=2.88), respectively. Significant differences were observed in caries experience by gender, girls having the highest values of DMF at both levels. The ratio of fist‑ and sixth‑grade children with treatment need was of 85.8% and 82.7%. Conclusions: Caries prevalence was very high in both age groups. The established carious lesions were the main contributors to children’s caries experience, with hardly any restorations or extraction, indicating an increased need for preventive and restorative treatment in both age groups. (Dental caries experience and treatment need among school children in Iasi, using ICDAS II criteria. Dana Baciu, I. Danila, Adriana Balan, Carina Balcos International Journal of Medical Dentistry volume 3, issue 3 July / September 2013).

Project goal

To develop a Youth Community-Based Oral Health Learning (YCBOHL) Model for enhancing the oral health literacy of young population and to prove how the implementation of the model can improve oral health of youth.