Health Literacy in Oral Health and Hygiene

Health literacy is an important tool for health promotion and behavior among patients. In this study, association of health literacy and oral health among Slovak population has been evaluated. It has been found women and respondents with higher education reported better oral health promoting behaviour (OHPB). However, age is not found associated with both oral health promoting behavior and health literacy. Health literacy  is associated with adoption of effective disease-prevention methods, successful adherence to a treatment regimen thus improves oral health promotion behavior. It was concluded health literacy is an important factor which could be incorporated in  future oral health intervention for improving oral health .

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World Health Organization’s 7th Global Conference on Health Promotion listed health literacy as one of the five key tracks for promoting health. Oral health literacy (OHL) has on the other hand has gained prominence in the dental literature during the last decade which has proved to be critical in reducing oral health disparities and in promoting oral health. Lower oral hygiene literacy has been linked to a higher risk for oral diseases and problems related to other diseases problems with higher health care costs.

Increasing OHL among all groups is critical in addressing poor oral health worldwide. Communicating the right management of dental infection/diseases can be done more effectively with patients to overcome the barriers and assist in empowering patients to make positive oral health decisions. Disseminating through the Telemedicine system in view of the current pandemic can help in educating dental professionals and hygenist on effective communication techniques thereby increasing OHL to integrate this content into professional health education curricula improving the adherence to medical instructions, self-management skills and the overall treatment outcomes.

The development of an OHL instrument and health promotion practice is current focus areas in dental public health research, and the development and psychometric evaluation of a comprehensive OHL instrument may be the next frontiers in the field of OHL. Dental Health informatics platform can be the forefront to bridge this gap in healthcare system in most of the developing countries.

Health Literacy in Oral Health and Hygiene

Fake news is used to convey misinformation on a variety of topics in order to misrepresent the truth. In dentistry, there has been an increase in bogus news reports about homemade whitening treatments and incorrect advice on how to strengthen your teeth. Stories like these abound on YouTube and other social media platforms. Because evidence-based dentistry does not have all of the answers, patients and health professionals are quick to seek out material that supports their own beliefs. There are technologies that may be used to verify the accuracy of such information and aid in the debunking of fake news. ^[1]

The subject is timely, so the European Commission gathered a panel of specialists to better grasp the consequences of the fake news crisis. They describe disinformation as "any types of false, incorrect, or misleading information disseminated and pushed for the purpose of causing public harm or profit," according to their report. While the general public is beginning to realise how the propagation of false news articles may affect elections, people's habits, and beliefs around the world, the problem persists, and it appears to be here to stay. [1]

Apart from social media misinformation, there is a lot of lack in health literacy which goes around in the common circles. For example, very common misinformation is that “extraction can affect the patient’s eyesight” or “ scaling can weaken the tooth structure”. These need to be addressed by professionals and dealt with great experience and sensitivity.

Reference

1. da Silva MA, Walmsley AD. Fake news and dental education. British dental journal. 2019 Mar;226(6):397-9.

Oral health is an integral part of overall health and well-being. It represents far more than a healthy mouth, a pleasing smile, and freedom from pain and infection. It also contributes positively to self-esteem and personal success. US Surgeon General has referred to dental and oral diseases as a "silent epidemic" affecting our most vulnerable citizens (which includes populations with lower incomes and less education, the uninsured and underinsured, the elderly, and racial and ethnic minorities). Oral diseases are common because people often do not adopt practices that have been scientifically shown to be effective in maintaining oral health. Other contributing factors include limited access to care, limited funds, or low health literacy.   

Oral health literacy, as defined by Healthy People 2010, is "the degree to which individuals can obtain, process and understand basic health information and services needed to make appropriate oral health decisions."As a practitioner myself, I have observed along with many of the practicing dental surgeons that the limited health literacy in terms of oral health, has been detrimental to the oral health of many patients, despite the health determinants such as age, gender, and financial capabilities. Limited health literacy is associated with poor self-ratings of health, poor adherence to medical instructions, poor self-management skills, increased mortality risks, poor health outcomes, and higher healthcare costs.

There are many barriers to the utilization of health care and to the adoption of healthy oral health practices. These range from financial issues, lack access to providers, and adequate preventive care to a spectrum of biological, behavioral, community, and cultural factors. Low health literacy is also one of these factors.

Oral health-related highlights of the pre-pandemic years include activities of the NASEM Roundtable on Health Literacy (Roundtable), which reviewed oral health literacy. The 2013 workshop investigated the importance of community support for health literacy, particularly in relation to:

• the health problems of vulnerable populations,

• the role of dental providers in communicating with a diverse patient population, and

• the role of health delivery systems in advancing an understanding of the patient's needs in order to obtain necessary care.

The Roundtable commissioned an environmental scan to assess ways in which health literacy promotes the integration of oral health in primary care. During a 2018 workshop, the discussion addressed changes needed in the health system, pointing to:

• the lack of interprofessional collaboration,

• payment systems that minimize prevention, and

• the need for consumer involvement.

Although healthcare professionals generally assume that the health explanations and instructions given to patients and families are readily understood, in reality, these instructions are frequently misunderstood, sometimes resulting in serious errors. A common reason for misunderstanding health instructions may be the patient’s low health literacy skills.

In a systematic review of 10 cross-sectional studies, a weak association was found for lower parental/caregiver OHL and dental caries in the primary dentition. A lower level of OHL in adults was associated with more missing teeth and clinical attachment loss. Results were inconclusive for treatment needs and dental plaque. In a systematic review of 11 studies, dental caries prevalence and experience were greater for children if their parents had low OHL. However, no association was found for oral health behaviors, parental perceptions, or dental visits. In a subsequent review, low OHL was associated with dental anxiety and bottle-feeding at night, while high OHL was associated with greater oral health knowledge. No association was found between OHL and the frequency of dental visits by adults. In addition, results were inconclusive for OHL and dental treatment outcomes, oral health behaviors, and oral health perception. Twenty-one of 25 studies were cross-sectional and found to be at high risk of bias.

Better health literacy develops the competencies of the individual to assimilate, comprehend and adapt to healthy practices and reduce risk behaviors. The level of communication between the provider and the patient both in the clinical setting, as well as community level, can be improved by early detection of patients with inadequate OHL. At the community level, it is important in order to appropriately design educational materials and community intervention programs that coincide with the literacy level of the target population.

Improving OHL

Strategies to improve OHL include tailoring communication to patients’ OHL and making the system and dental setting more understandable and navigable.

Communication techniques and teach-back are considered basic techniques. Plain language includes but is not limited to providing key information first, breaking down complex information, and using simple language.

 Using plain language and confirming that patients understood what you have communicated through teach-back, whereby patients are asked to repeat information received, fosters understanding.

 Other methods fall under the categories of patient-friendly, assistance, and use of materials (such as visual diagrams, models, videos, or DVDs).

 Consideration should be given to a patient’s preferred method(s) of learning. Using written information if a patient prefers visual or verbal information creates a barrier.

 In a systematic review investigating techniques used for patients with low health literacy, the use of visual and verbal tools including adding icons to improve patients’ understanding of numerical data, showing videos, and presenting key information first/alone improved understanding.

 Additionally, programs and communication should be culturally sensitive.

In a review of studies with indigenous populations, improvements in OHL to reduce health disparities were associated with culturally-adapted strategies and included involvement by members of the community in delivering programs and research.

 Collaborative programs involving public health, institutions, schools, and companies, such as ‘Bright Smiles, Bright Futures’, also play a role in improving OHL, dental knowledge, and oral health in children and adults.

For Dental Health Professionals:

Dental professionals can assess their office for patient friendliness, cultural competency, ability to effectively communicate, and use of plain language.

Integrated electronic health records and motivational interviewing have also been found to be helpful with low-OHL patients.

Further, the adoption of digital technology has presented an opportunity for patient-friendly communication. Examples include the use of intraoral images, scans, visually-oriented risk assessment tools, and online videos. Public health and community programs have been adopted that help children and adults improve their OHL and oral health.

According to ADA, "Oral health literacy is defined as the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions." Lower health literacy has been linked to various issues such as use of preventive services, poor adherence to medical treatment and instructions, poor self-management skills, delayed diagnoses of medical conditions, increased mortality and morbidity risks, poor health outcomes, and higher health care treatment costs. Therefore, using simple communication with the patient and clear comprehension thereby reducing the risk of miscommunication can have better health impact on patients health. Multiple strategies can support patients' efforts to improve their oral health such as making the dental office environment and health care system easier to access.

References:

1. //www.ada.org/en/public-programs/health-literacy-in-dentistry
2. //www.ncbi.nlm.nih.gov/pmc/articles/PMC6201552/

Health literacy is directly proportional to an individual health behavior and health outcomes. It's  is the ability of a person to understand instructions on prescription, appointment cards, health education pamphlets, doctor’s directions and consent forms.World Health Organization’s (WHO’s) 7th Global Conference on Health Promotion also list’s health literacy as one of the five key tracks for promoting health.Oral health literacy (OHL) has gained prominence in the dental literature in the last decade.

Oral health literacy (OHL) is the degree to which individuals have the capacity to obtain, process, and understand basic oral health information  to make appropriate oral health decisions.

Lower literacy has been linked to problems with:

1. Poor health literacy is associated with problems in using preventive services
2. delayed diagnoses of medical conditions,
3. poor adherence to medical instructions,
4. poor self-management skills,
5. increased mortality risks,
6. poor health outcomes and
7. higher health care costs.

Similarly individuals with limited Oral health literacy were reported to be at higher risk for oral diseases like dental caries , poor periodontal health due to 

• • missing dental appointment
  • not adhering to dental instructions
  • delayed treatment/ interrupted treatment

 Adolescent life is a critical period of transition with personal responsibility. Students in this period can be targeted for preventing dental disease and building future oral health. Assessing the effect of oral health literacy among this age group is a crucial component in development prevention oriented oral health programs in the future targeted towards improving oral health literacy which in turn can lead to improved oral health

Health literacy has been shown to function as a mediator between socioeconomic factors, cultural , language disparities for better health outcomes. Oral health literacy do have an association with socioeconomic status and oral health behavior .It is suggested that the complexity of both verbal and written oral health communications create a significant barrier to improving oral health . Improving the OHL of patients may help in the efforts to improve the adherence to medical instructions, self-management skills and the overall treatment outcomes.

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