Project research activities

Oral Health Education Activities

First interactive education lesson on oral health behavior among teenagers

First Oral Health education lesson:
The lesson took place in School no. 19 „T. Arghezi” and National College “Gheorghe Lazar” from Bucharest during 25-28 November 2015 on the experimental group of 63 subjects (the initial group included 76 subjects, 13 dropped out) included in the oral health education Erasmus + “Com4You” project with mean age of 14.3 years (±1.6), 19 (30.2%) boys and 44 (69.8%) girls.

The lesson took place in the schools, offered by dental students and teaching staff from Faculty of Dentistry and TES trainers, in small groups of schoolchildren, lasting 45-50 minutes, presenting oral health information, using experiential education. This lesson was the first from a series of 3, the topics of the next two are: diet, and regular dental visits.

The main topics of the lesson:
Etiology of dental caries and gingivitis, risk and protective factors for tooth decay and appropriate tooth brushing technique for teenagers. In December we assessed the improvement in oral health behavior after an interactive, age-adapted oral heath education lesson in a group of teenagers, using the same type of self-administered questionnaire as in baseline evaluation, with 37 opened and closed items. The response rate was 100%.

Regarding oral hygiene behavior, statistically significant differences were found in terms of frequency of subjects using proper brushing technique: 9 (14.3%) before and 28 (44.4%) after the lesson, z=3.7, p=0.00; frequency of subjects using mouth wash: 33 (52.4%) before and 50 (79.4%) after, z=3.5, p=0.00 and the frequency of mouth rinsing per week: 3.3±3.9 before and 4.5±3.2 after, t test, p=0.03. Two thirds of the subjects brushed at least twice daily before the lesson: 45 (71.4%) and their number increased to 47 (74.6%), statistically insignificant (z=1.3, p=0.18). Regarding diet-related behavior, there were registered no improvements (frequency consumption of fruits: p=0.42, citrus fruits: p=0.19, sweetened drinks: p=1.78, sugar-free drinks: p=0.24) or worsening (consumption frequency of pastries: p=0.00, chocolate: p=0.02, beverages: p=0.03). For dental services – related behavior were found statistically insignificant improvements of frequencies: z = 0.93, p=0.35.

Oral health behavior was improved by the lesson offered but only regarding hygiene, which was the topic of this first lesson. There is a necessity of emphasis on the interdental brushing and of raising awareness about the importance of diet and regular dental check-ups.

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Mobility and Training activities for dental students


Training of medical students and youth workers in public oral health at KI. Swedish model in oral-hygiene education and oral health care is recognized as one of the most efficient in Europe.

Engaging Medical Students and Youth workers from the Dentistry schools is critical for the project's objectives and underscores the need for a concerted and intentional effort to engage all resources in community. The training will have a particular emphasis on community problem solving: academically based community service, civic education, environment-based education, place-based learning, service learning, and work-based learning. If all students are to succeed, the training must pay attention to community-based learning as a strategy for engaging and motivating dental students and for strengthening the relationship between dental schools and communities.

6 dental students from UMF were trained at KI in Sweden between 28 sept-01 october 2015 for the first year. The students were trained in public health dentistry and participated in discussion with Swedish dental students and youth worker.

Programme for the Education and Training 28.09.-2015- 01.10.2015


Coffebreak and Lunch between 12.00-13.00
The lectures will be held in English and Romania.

The students will prepare by reading (2 days) several scientific articles regarding communication and motivational interviewing from several aspects (I will attach a list of the papers).

Monday 28/9
09.00 - Introduction to Education and Training week, Practical things, Annsofi Johannsen, Associate professor, Dental Hygienist, Dept. of Dental Medicine, Karolinska Institutet.
09.30 – 11.30 The Swedish Dental care system - practice and prevention! Yvonne Nyblom, Dental Hygienist. President of the Swedish Dental Hygienist´s association and the European Dental Hygienist´s Federation.
13.00 – 15.00 Prevalence of dental erosion and association to lifestyle in a group of 15 and 17 year olds in Stockholm County, Maria Jarkander, Dentist, Specialist in Pediatric, Dept. of Pediatric Dentistry, Public Dental Health, Stockholm.
15.15 - 17.00 Oral health Promotion in Public dental health service in Uppsala County, Eva Hedman, Dental Hygienist, PhD, Dept. of Health, Quality and Development, Public Dental Health, Uppsala.
17.00 – 18.00 Discussion, reflection and questions

Tuesday 29/9
9.00 – 12.00 Effective dentist-patient communication– an introduction to a patient centred approach - Birgitta Jönsson, Dental Hygienist, PhD, Researcher at The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway.
13.00 - 16.00 Auscultation at the Dental Clinic, Institute of Odontology, level 6 - Annsofi Johannsen
16.00 – 17.00 Discussion, reflection and question

Wednesday 30/9
9.00 – 10.00 Evidence based communication in dentistry and a clinical application, Annsofi Johannsen
10.00 - 11.45 Dental care for children in Sweden – population strategies and individual risk assessment Pia Gabre, Dentist, Professor, General Dental Care, Uppsala
13.15 - 15.00 Pediatric dentistry in Sweden - every child’s right to a healthy smile. Görlin Swessar, Dental Hygienist, Dept. of Orthodontics, General Dental Care, Uppsala
15.15 – 16.45 International guidelines- A Child's Smile - curative and preventive dental care for children in vulnerable areas - Linda Moutou, Dental Hygienist, Chariwoman & Founder A Child's Smile

Thursday 1/10
8.30 - 12.00 Communication: Motivational interviewing, Workshop – Video (molaren) Annsofi Johannsen, Ann-Christin Johansson MD, Dental hygienist, Dept. of Dental Medicine, Karolinska Institutet, and students from the Supplementary Program for Dental Hygienist.
13.00 - 14.30 Team work: Dentist and Dental hygien- Gunnar Johannsen, PhD, Specilaist in Parodontotlogy, Dept. of Dental Medicine, Karolinska Instittutet.
15.00 – 16.30 Children's dental care of General practitioners in Uppsala, knowledge of dental health and dental care habits among children and adolescents in Sweden. News about fluoride - Maria Nicolescu, Dentist, Dental Public Care, Knivsta.
16.30 - 17.15 Presenting and discussion evidence based Motivational interviewing, reflection and how can we use this in the clinical practice? The Dental students from Rumania.
17.15 - 17.30 Discussion, reflection and questions.
17.30 - Closing educational week, Annsofi Johannsen

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YCBOHL Database design and organisation


To get a detailed overview of the current situation concerning the oral health knowledge, attitudes and behavior and oral health literacy and its correspondence to the oral health status of young population in Romania, a baseline data framework was developed at the beginning of the project in order. We have got the approval of the study from Ethical Committee of UMF Carol Davila, from ASMB (Hospitals Administration of Bucharest city). UMF and INSP have got the written consent from managers of schools and informed consent of parents of youth and from young parents until 30 yrs. We have selected subjects from the following target groups: - 60 Students of Dental Faculty, UMF (level 1) - 120 School children organized in groups of age 13 - 15; 15-18 from Bucharest and a group of 50 youth from disadvantaged groups from Galati (level 2) . Selection of participating schools and colleges : from Bucharest “Tudor Arghezi” School (no.19), “Mihai Eminescu” National College, “Gheorghe Lazar” National College and a foster care center from DGASPC Galati (level 2).

Criteria for recruiting participants to baseline data assessment were established: -students enrolled in Faculty of Dental Medicine, U.M.F. “Carol Davila”, Bucharest, wich have graduated the Preventive Dentistry classes (on 3-rd year); -schoolchildren aged 13 – 15yrs and 15-18 yrs from schools with dental offices in Bucharest and youth (13-18 yrs) from disadvantaged groups ( foster care center with dental office) from Galati (DGASPC); 50 Young parents and their children (level 3); Dental Faculty staff and schoolteachers (level 4); Oral Health providers- 3 dentists, 2 dental nurses (level 5).

Research instruments

A. For target group level 2, students from Faculty of Dental Medicine, we assessed the level of knowledge about oral health education methods and oral health program’s structure, using a questionnaire with 12 open questions

  1. For target group level 2- School children organized in groups of age 13 - 14; 15-18 and group of youth from disadvantaged groups

B1. Clinical Examination Form (World Health Organization 1997 Form)

We are choosing for oral health evaluation the clinical oral health forms (World Health Organisation form, 1997). Group level 2 needs a dental status examination, including caries and gingivitis profile and hygiene status, in order to correlate it to the education level, including youth from socioeconomically deprived groups. In order to reach our goals, for baseline study, we designed a cross-sectional study which was applied in Bucharest and Galati between May and June 2015. Oral examinations were performed in the dental schools offices, using dental examination tools, by researchers included in the project, and for the filling of the dental chart there were involved dental students. Prior to the baseline study, a caries diagnostic standardization was performed between the examiners. There was used the WHO dental chart which consist of 4 sections: personal data, dental status, gingival status and level of dental plaque. Caries and oral hygiene indexes used: DMFT (Decay-Missing-Filling Teeth), DMFS (Decay-Missing-Filling Surfaces), ICDAS(International Caries Detection and Assessment System), Bleeding Index and OHIS Index. After the examinations, the children were offered short information and demonstrations about the proper oral hygiene technique and they received oral hygiene products from Blend-a Med.

B 2. Questionnaire regarding oral health knowledge and behavior (Questionnaire Nr. 1) is a structured questionnaire with both Closed-ended and Open-ended questions

Information on school children´s knowledge and behavior on oral health care included:

  • source of information about oral health
  • level of knowledge about caries and gingivitis risk factors
  • oral hygiene habits (frequency, methods) and attitudes towards them
  • use of professional dental services.

B 3. Oral Health Literacy/ Reading Comprehension (Questionnaire Nr. 2)

B 4. Interviews – Both Audio and Written Interviews. For Target group level 1, 2 and 3 it is necessary group interviews and face-to-face Questionnaires answers

  1. For target group level 3 (Young parents and their children) there are used questionnaire for assessing their level of knowledge about their children caries risk factors, proper diet and brushing techniques
  2. For target group level 4 (schoolteachers) there are used questionnaire for assessing their level of knowledge about their school children caries risk factors, proper diet and brushing techniques
  3. For target group level 5 (dentists, dental nurses) there are used questionnaire for assessing their involvement in oral health education of schoolchildren about caries risk factors, proper diet and brushing techniques.

C. Qualitative and Quantitative Statistical Analysis and Evaluation of Field studies and collected data were performed using descriptive analysis and bivariate analyses ( simple cross-tabulations to identify trends and examine possible associations between one variable and another). It was evaluated the validity, reliability and acceptability of the answers, selection of coding scheme i.e., converting questionnaire data into meaningful categories to facilitate analysis.

The data analyses were performed with SPSS software 19.0.

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Oral Health Education Activities

Dental Students

Inventory of Needs and Requirement for Oral Health Education

Target group level 1

A total number of 60 students , aged between 22-25 yrs, 62% girls, were assessed for determine their level of knowledge about oral health methods used in schoolchildren communities.

Only 35.7% know the definition of oral health education, and 46% know what health -related behaviors that can be changed through education.

Asked about the problems that lead to the emergence and maintenance of health risk behaviors, only 15.6% know some (34%) of the problems that lead to the emergence and maintenance of health risk behaviors,

Asked about Education strategies are available to address these problems, 19.8% know only 2 (information and demonstrations) from all 5 education strategies.

26.7% know a quarter (24.7%) of suitable education methods and strategies for each education problems, mostly oral presentations, group discussions, demonstrations and mass media education. Asked about what target group they choose the in the context of increasing efficiency of oral health education message, the majority (76%) knows only as target schoolchildren, only 4% respond about parents, pregnant mothers, teachers and other school staff.

The majority (68%) do not know what information is required and what behavior analysis methods are used to their collection, 36.8% know only two (providing an information and practical demonstration of technique)of the four essential stages of education.

Asked about how can motivate health behavior change, only 32% know that by evoking fear and rewards can motivate behavior change.

Training of Dental Students

In the process paradigm of community education, both the process and the outcome are important. The process is important in terms of “empowering” the people involved to successfully embrace change and enhance their ability to deal with both the immediate issue and future situations. The outcome is important in that particular issues are successfully addressed.

Community- based learning model in oral health is shaped and shared by all members of the community. Requirements for oral health E&T&C for each target group were delivered, forming the base for curricula, and learning material development. The model main components are:
1) community target groups (2) communication channels, (3) the baseline for target group, (4) stakeholders, (5) Database, (6) E&T material and information material, (7) pilot study, (8) structure of workshops and seminars for dissemination (9) YCBOHL model quality assessment indicators and revision rules.

On November 4th 2015 the students in 6th grade from Dental Medicine Faculty were trained in Oral Health Education Methods using experimental learning techniques.

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Adolescents 13-18 years

According to the assessed needs regarding oral health knowledge attitudes and behaviors of school children from Bucharest and Galați we created the first lesson which contains the following main topics: Etiological factors of dental caries; Risk vs. Protective caries factors; Brushing techniques using the right steps. The lessons took place in Bucharest on November 25th.

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