Associations between early-life behaviours, current oral health behaviours and oral health among children in Brunei Darussalam and the recommendations for oral health prevention strategies

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2025Author:
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Haji Awang Bakar, Haji Majidi, Associations between early-life behaviours, current oral health behaviours and oral health among children in Brunei Darussalam and the recommendations for oral health prevention strategies, Trinity College Dublin, School of Dental Sciences, Dental Science, 2025Abstract:
Background: There is limited evidence of inequalities in dental caries in deciduous dentition among children in Brunei Darussalam. Moreover, there is no evidence assessing the associations of early-life behaviours and current oral health behaviours with the prevalence and severity of caries experience among these children. Aims: The primary aims were: 1) to examine the prevalence of caries experience (i.e., prevalence of dmft > 0) and the severity of caries experience (i.e., mean dmft) in 5-year-old children participating in the 2015 Child National Oral Health Survey (CNOHS) and current oral epidemiological surveys; 2) to assess the associations of early-life and current oral health behaviours with dental caries experience among children aged 5 years during the two surveys. Meanwhile, the secondary aims were 1) to assess the associations of sociodemographic characteristics with dental caries experience in 5-year-old children during both surveys; and 2) to provide recommendations for oral health prevention strategies to be implemented for child population in Brunei Darussalam. Methods: Study 1 involved conducting a secondary analysis of all data related to 355 children aged 5 years from the 2015 CNOHS dataset. Study 2 involved primary data collection through an oral epidemiological survey in 2023, comprising of a parental questionnaire and dental examination of 345 children aged 5 years in Brunei Darussalam, followed by data analysis. In both studies, descriptive analysis and regression analyses (logistic and zero-inflated negative binomial) were used to explore the associations of caries experience with oral health behaviours, adjusting for sex, district, school type, parental education and household income. In study 3, in-depth interviews with 5 parents from varying backgrounds were conducted using semi-structured questions to investigate parents' understanding of the associations between children's oral health and their oral health behaviours. The interview data was analysed thematically to generate key themes and subthemes. Results: The prevalence of 5-year-old children with caries experience in 2015 was 73.2%, with a mean dmft of 5.12. In 2023, a lower prevalence was identified as 59.0%, with a mean dmft of 3.63. Although the analysis in Study 1 only identified significant associations of caries experience with school types and ethnic background, Study 2 revealed additional significant associations with parental education level and household income. These two studies also demonstrated that caries experience in children was significantly associated with the age of stopping breastfeeding, the frequency of daily sugary sweetened beverages (SSB) consumption, age of started toothbrushing, the status of parental supervision during the ages of 2 to 3, frequency of daily brushing at ages 2 to 3 and 5, the type and quantity of toothpaste used, as well as the age of started dental visits. Study 3 further explored these associations and found that parents had a good understanding of the associations between children's oral health and their oral health behaviours. These oral health behaviours included using the correct amount of toothpaste, brushing teeth twice daily, ensuring proper brushing duration, monitoring oral hygiene after brushing and attending the preventive dental visits. Additionally, these parents recognised the importance of other oral health behaviours for maintaining good oral health, such as consuming healthy beverages and foods, using feeder cups before age 1, giving water after breastfeeding and offering appropriate bottle contents. Conclusion: The thesis results showed a significant reduction in caries experience among 5-year-old children in Brunei Darussalam from 2015 to 2023. Considering that the surveys were conducted on two different groups of children, results on decreasing prevalence and severity of caries experience should be reported with caution. These findings, together with the significant associations between caries experience and various sociodemographic factors and oral health behaviours, highlight the need for comprehensive dental public health strategies. Such strategies should aim to improve children's oral health and reduce oral health inequalities across different sociodemographic groups by raising oral health awareness among parents.
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https://tcdlocalportal.tcd.ie/pls/EnterApex/f?p=800:71:0::::P71_USERNAME:HHAJIAWADescription:
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Author: Haji Awang Bakar, Haji Majidi
Advisor:
Duane, BrettLewney, Jonathan
Jones, Clare
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Clinical Doctorate in Dental Surgery (D.Ch.Dent) in Dental Public HealthPublisher:
Trinity College Dublin. School of Dental Sciences. Discipline of Dental ScienceType of material:
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