Primary care dentistry: An Australian perspective

INTRODUCTION

Primary care dentistry is the first point of contact that someone has with the dental system and is predominantly focused on the treatment and prevention of dental caries and periodontal disease. The aim of this paper was to review the Australian primary dental care system.

METHODS

This paper reviews the primary dental care system in Australia, drawing on data reporting on the dental workforce, funding sources for dental care, oral health outcome measures and dental visiting patterns.

RESULTS

Primary dental health care in Australia is predominantly provided by dentists working in private practice, with the number of dentists per 100,000 people in Australia increasing from 46.9 in 2000 to 65.1 in 2022. However, there has been a gradual shift over the past twenty years towards greater service provision by other members of the dental team who now represent one quarter of the dental workforce, and some expansion of publicly funded dental care. Despite this dentistry remains isolated from the rest of primary health care, and the lack of government funding means that many people continue to miss out of necessary dental care, particularly those living in regional and rural Australia and from low-income groups.

CONCLUSIONS

Australians should be able to access primary dental care services when and where they need it with adequate financial protection, from services that are well integrated into the broader primary health care system to ensure they are able to achieve optimal oral and general health. For many Australians, this is not currently the case.

CLINICAL SIGNIFICANCE

Australia is at a crossroads with respect to access to dental care, and there is a need for stronger advocacy from stakeholders to improve oral health outcomes and reduce inequalities.

Relationship Between Oral Health and Glaucoma Traits in the United Kingdom

PRCIS

In this cross-sectional analysis of UK Biobank participants, we find no adverse association between self-reported oral health conditions and either glaucoma or elevated intraocular pressures.

PURPOSE

Poor oral health may cause inflammation, which accelerates the progression of neurodegenerative diseases. We investigated the relationship between oral health and glaucoma.

PATIENTS

United Kingdom Biobank participants.

METHODS

This is a cross-sectional analysis of participants categorized by self-reported oral health status. Multivariable linear and logistic regression models were used. Primary analysis examined the association with glaucoma prevalence. Secondary analyses examined associations with IOP, macular retinal nerve fiber layer (mRNFL), and ganglion cell inner plexiform layer (mGCIPL) thicknesses, and interaction terms with multitrait glaucoma polygenic risk scores (MTAG PRS) or intraocular pressure (IOP) PRS.

RESULTS

A total of 170,815 participants (34.3%) reported current oral health problems, including painful or bleeding gums, toothache, loose teeth, and/or denture wear. A In all, 33,059, 33,004, 14,652, and 14,613 participants were available for analysis of glaucoma, IOP, mRNFL, and mGCIPL, respectively. No association between oral health and glaucoma was identified [odds ratio (OR): 1.04, 95% CI: 0.95-1.14]. IOPs were slightly lower among those with oral disease (-0.08 mm Hg, 95% CI: -0.15, -0.009); specifically, among those with loose teeth ( P =0.03) and denture-wearers ( P <0.0001). mRNFL measurements were lower among those with oral health conditions (-0.14 μm, 95% CI: -0.27, -0.0009), but mGCIPL measurements ( P =0.96) were not significantly different. A PRS for IOP or glaucoma did not modify relations between oral health and IOP or glaucoma ( P for interactions ≥​​​​0.17).

CONCLUSIONS

Self-reported oral health was not associated with elevated IOP or an increased risk of glaucoma. Future studies should confirm the null association between clinically diagnosed oral health conditions and glaucoma.

Impact of oral health management by nurses and dental professionals on oral health status in inpatients eligible for the Nutrition Support Team: A longitudinal study

OBJECTIVE

As the participation of dental professionals in multidisciplinary care is often limited, instructions on oral health management provided by dental professionals to other professionals are important to achieve transdisciplinary oral health management; however, the effectiveness of such instructions remains unclear. In this longitudinal study, we aimed to determine the impact of oral health management provided by dental professionals and nurses instructed on oral health management by dental professionals on the oral health of inpatients eligible for a Nurition Support Team (NST).

METHODS

The study participants were 117 patients (66 men and 51 women, mean age: 71.9 ± 12.5 years) who received oral health management during the NST intervention period. The participants received oral health management from nurses (Ns group) or dental professionals (D group). The nurses who conducted the oral health management received instructions from dental professionals. Oral health was assessed at the beginning and end of the NST intervention using the Oral Health Assessment Tool (OHAT).

RESULT

The Ns and D groups showed significant improvements in the total OHAT scores at the end of the NST intervention. Both groups showed significant improvements in the OHAT subitems of lip, tongue, gums and tissues, saliva, oral cleanliness and dental pain, while only the D group showed a significant improvement in the denture subitem.

CONCLUSION

Effective oral health management provided by dental professionals or by nurses trained by them improved the oral health status of inpatients eligible for NST at an acute-care hospital.

Using Standardised International Oral Health-Related Datasets in 6 Countries

INTRODUCTION

Oral diseases affect a significant proportion of the world's population, yet international comparisons involving oral health outcomes have often been limited due to differences in the way country-level primary data are collected. In response to this, the World Dental Federation (FDI) Oral Health Observatory project was launched with the goal of collecting and producing standardised international data on oral health across countries. The aim of this descriptive cross-sectional study was to examine associations between self-reported general health and a range of factors (sociodemographics, oral health-related behaviours, oral impacts, clinical variables) using these standardised international datasets.

METHODS

Dentists within FDI member National Dental Associations who chose to take part in the project were selected using a multistage sampling method. The number of dentists in each cluster was set according to the proportion of the national population living in the area, and 50 patients per dentist were systematically approached to take part. Patients and dentists completed 2 separate questionnaires on a mobile app. Ordinal logistic regression (conducted in December 2022) was used to analyse the linked patient and dentist data from 6 countries: China (n = 2242); Colombia (n = 1029); India (n = 999); Italy (n = 711); Japan (n = 1271); and Lebanon (n = 798). Self-reported general health was the dependent variable, with age, sex, education, self-reported oral health-related behaviours, self-reported oral impacts, and clinical variables acting as the independent variables.

RESULTS

The results demonstrated a different pattern of associations in the different countries. Better self-reported general health was associated with degree-level education in all 6 countries and with reporting no oral impact and no sensitive teeth in 4 countries. Several country-specific patterns were also found, including the importance of tooth brushing in Colombia, periodontal health in Italy, and differing associations with sugary drinks consumption in India and Japan.

CONCLUSIONS

These descriptive findings provide a basis for further research and, importantly, for advocacy in identifying patient oral health care needs according to both person-reported and clinical aspects. This can facilitate optimisation of service provision and potentially influence policy and investments.

Oral frailty, appetite and dietary variety in late-stage older adults: A cross-sectional study (the STudy of lAte-stage oldeR adulTs in Tottori; START Tottori)

AIM

Efforts to combat frailty and preserve good health in older adults have highlighted oral frailty as an early indicator of overall frailty. Individuals showing oral frailty are at an elevated risk of insufficient nutritional intake compared with those without oral frailty; however, underlying mechanisms remain poorly explored. In this cross-sectional study, we aimed to examine the link between oral frailty and undernutrition, especially regarding poor appetite and low dietary diversity.

METHODS

The analysis included 2727 late-stage older adults (mean age 79.9 ± 4.3 years) who underwent dental checkups in a prefecture in Japan from 2016 to 2020. The examination involved a questionnaire survey (covering basic information, frailty screening index, appetite index: Simplified Nutritional Appetite Questionnaire; and dietary variety: Dietary Variety Score) and a measurement survey (including intraoral confirmation, oral diadochokinesis and masticatory efficiency test). Individuals with three or more indications of poor oral function, identified through oral function assessment, were defined as showing oral frailty. Binomial logistic regression and path analyses examined associations among oral frailty, Simplified Nutritional Appetite Questionnaire and Dietary Variety Score.

RESULTS

Among those analyzed, 1208 (44.3%) participants were categorized into the oral frailty group. Binomial logistic regression analysis showed that Simplified Nutritional Appetite Questionnaire (odds ratio for oral frailty per 1-point increase 0.88, 95% confidence interval 0.84-0.93) and Dietary Variety Score (odds ratio 0.95, 95% confidence interval 0.92-0.98) were significantly associated with oral frailty. The path analysis showed individual associations between each examined factor.

CONCLUSIONS

Oral frailty was associated with decreased appetite and dietary variety in late-stage older adults. Geriatr Gerontol Int 2024; 24: 626-633.

Some young adults can maintain good oral health despite socioeconomic challenges

The association between dental caries experience and socioeconomic status, as reflected in income and educational level, is well known. However, some individuals maintain good health despite socioeconomic disadvantage. The aim of this qualitative study was to explore salutogenic (health-promoting) factors among healthy caries-free young adults of low socioeconomic status. Seventeen participants (11 women), 19-23 years of age, who were caries-free and of low socioeconomic status were interviewed in-depth. The interviews were transcribed verbatim and analysed using qualitative content analysis with an inductive approach. The theme revealed was 'Building trust and shifting responsibility from parent to child throughout children's development lays the salutogenic foundation for oral health', comprising three categories: (i) a basis for health; (ii) creating one's own path by testing wings; and (iii) developing resources for health. A feeling of trust was expressed, participants were confident in the unconditional support of their caregivers, and caregivers were trusting participants to be able to take control over their own oral health. Health-promotive factors were established not only by instilling healthy habits during childhood, but also by parental guidance through adolescence, enabling young adults to develop resources and assets to take control over their own health independently.

Use of oral health care services among older home care clients in the context of an intervention study

BACKGROUND

An increasing number of care-dependent older people living at home need external support to receive regular dental care.

OBJECTIVES

To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self-care and nutrition.

MATERIALS AND METHODS

This study employed data from the multidisciplinary Nutrition, Oral Health and Medication (NutOrMed) intervention study with a population-based sample of 245 home care clients (74% female) aged 75 or more divided in intervention (n = 140) and two control groups (n = 105). The data were collected through interviews at baseline and 6-month follow-up.

RESULTS

At baseline, 43% of participants reported visits to oral health care within the previous year. At 6-month follow-up, this proportion was 51%. In the intervention group, the corresponding figures were 46% and 53%, and in the controls 39% and 48%. Adjusted regression analyses showed that this change was statistically significant (p = 0.008). In addition, higher education and toothache or other discomfort related to teeth or dentures at baseline were associated with increased use after the 6-month follow-up (OR = 1.1, 95% CI = 1.0-1.2; OR = 3.4, 95% CI = 1.5-7.9) but being edentulous indicated the opposite (OR = 0.2, 95% CI = 0.1-0.4). Belonging to the intervention group was not associated with increased use.

CONCLUSIONS

In older adults, any efforts to raise awareness of oral health are of great potential to increase use of services.

Older people's preferences and expectations of preventive oral care in the home

OBJECTIVE

The aim of the study was to assess older people's preferences and expectations for preventive oral care in their own home.

BACKGROUND

With increasing age, the use of dental services declines and oral health becomes secondary, yet good oral health contributes to quality of life and has a positive impact on general health. Thus, the healthcare system should offer a care structure in which oral health can be maintained into old age. To provide patient-centred care, patient preferences in additional preventive oral care need to be explored.

MATERIALS AND METHODS

In this qualitative study, semi-structured interviews were conducted with community-dwelling individuals aged ≥65 years to understand their preferences and expectations for oral care in a home-based setting. Interviews were recorded, transcribed verbatim and analysed thematically.

RESULTS

Fourteen dental patients were included. Three overarching themes were identified. The desire for independence was predominant when addressing their future capability to perform oral hygiene. When addressing possible future oral health support, self-determination and independence were important to them. Concerns about dependency in inpatient care facilities and the associated reduction in oral care were evident. Frequency, costs and the practice environment played a decisive role when thinking about additional preventive measures for their future.

CONCLUSION

The results of this study provide important information about older people's preferences and expectations for preventive oral care in the home environment and relate to three core themes of (1) changes in oral hygiene skills and perceptions, (2) support and (3) organisational factors. These must be considered when planning and implementing preventive oral care.

Advancing oral health: Harnessing the potential of chitosan and polyphenols in innovative mouthwash formulation

This paper explores the therapeutic perspectives of polyphenols and chitosan as potential anticancer agents in the mouthwash formulations. Taking into account the high incidence of squamous cell carcinoma (SCC) among oral cancers, this discussion will concentrate on the potential advantages of these compounds in oral care, focusing on their impact on improving oral health and cancer prevention. According to the data, it appears that the mixture of BACs extract and chitosan may increase the efficiency of the apoptosis of cancer cells while reducing the undesired side effects. The cytotoxicity assays demonstrate a significant reduction in squamous carcinoma cell viability after incubation with BACs extract, with a marked decrease observed over 24-72 hours up to 76%. The anti-cancer properties of the BAC extract are related to luteolin, which is a predominant compound. The addition of 0.025% chitosan reduced the metabolic activity of cancer cells by 37.5%, suggesting a synergistic interaction between the compounds. This research highlights the potential of BACs and chitosan in modulating important molecular targets associated with cancer cell.

The oral health of adults with learning disabilities: A secondary analysis of the Adult Dental Health Survey 2009

OBJECTIVES

Adults who have learning disabilities are a vulnerable group, little is known about their oral health and how this affects their quality of life. The aims of this secondary analysis of data from the 2009 Adult Dental Health Survey (ADHS) were to describe the oral health status of adults with learning disabilities, determine if severity of learning disability is associated with oral health and identify some of the methodological complexities of working with this population. The survey yields the most recent representative data on the oral health of adults with learning disabilities in England and importantly, contains information about oral health related quality of life (OHRQoL).

BASIC RESEARCH DESIGN

Secondary analysis of data from a supplemental survey of adults with learning disabilities collected alongside the 2009 ADHS.

PARTICIPANTS

607 participants with a diagnosed learning disability aged 18 years and over.

RESULTS

Adults with learning disabilities had similar levels of active dental caries, fewer natural teeth, and fewer fillings than comparable participants from the general population. Self-reported oral and general health were worse for adults with learning disabilities than the general population. Possible associations between the severity of learning disability and the numbers of decayed, missing or filled teeth were identified. However, large amounts of missing data limited the analysis.

CONCLUSIONS

There are important questions relating to the accessibility of existing self-reported oral health questionnaires and the reliability of proxy-reported questions about OHRQoL that should be addressed to give a fuller picture of the oral health of adults with learning disabilities.

Effect of family cohesion on oral health predictors in children and adolescents: A systematic review

OBJECTIVE

The family environment influences oral health conditions and the utilization of dental services. The emotional link between the family members and the degree to which they are resilient and close to each other is represented as family cohesion and adaptability. This systematic review critically appraises and synthesizes existing evidence on the effect of family cohesion on oral health predictors in children and adolescents.

METHODS

The protocol was registered in PROSPERO (CRD42023453608). Databases such as PubMed, Embase, and Scopus were electronically searched in September 2023. No restriction of time frame was allowed. Risk of bias was assessed using the Agency for Healthcare Research and Quality tool.

RESULTS

Initially, 272 records were identified from PubMed (133), Embase (122) and Scopus (10) databases and other sources, finally leading to 12 cross-sectional studies to be included. Eleven studies were carried out in Brazil and one in USA. Only one study reported moderate risk, whereas the others all reported low risk of bias. The studies were carried out from 2013-2023. The frequency of dental visits, oral health literacy, and self-perceived need for dental treatment were reported to be higher in families with the better cohesive ties. An inconsistent direct association was reported between dental caries and family cohesion.

CONCLUSIONS

Family dynamics are important in shaping oral health behaviors and outcomes during a pivotal phase of development. Further exploration through longitudinal studies in this field can elucidate causal pathways and potential moderators.

Perceptions and experience of rural older people in oral health management in China: a qualitative study

BACKGROUND

To explore the perceptions and experience of oral health management among rural older people in China.

METHODS

Qualitative methodologies were used in this study. Face-to-face semi-structured interviews were conducted. Thirteen older adults in rural areas were purposively sampled at two metropolitan hospitals in Hunan, China. The data were transcribed and thematically analyzed, and MAXQDA software was used to assist with coding.

RESULTS

Three overarching major themes and ten sub‑themes capturing the perceptions and experience of oral health management among rural older people were identified. Three themes emerged from the thematic analysis: oral health cognitive bias, poor management behaviors, and limited oral health services. Oral health management as a whole is negative, oral health behaviors are poor, oral health service utilization is limited.

CONCLUSIONS

Based on these findings, there is great scope here for improving the current status of oral health for rural older people around awareness, behavior, and access. Oral health education, improved oral health services and primary oral health promotion are warranted.

IDEA tool: Establishing a prioritisation matrix for oral health improvement interventions

Initial impetus for action: Oral health is not equitably distributed. More deprived areas experience appreciably worse oral health outcomes. Oral health improvement programmes in Local Authorities (LA) seek to reduce these inequalities but have diminished in recent years following the COVID-19 pandemic. LAs have also endured funding cuts to public health budgets, placing a greater emphasis on the need for establishing a clear prioritisation matrix for oral health improvement interventions. Solution: A prioritisation matrix that considered both the importance and do-ability of oral health improvement interventions was developed. Both are composite measures. The importance comprised evidence of benefit, impact on inequalities, alignment with national/local priorities and cost-effectiveness of the intervention. The do-ability considered the available support from stakeholders, building/equipment requirements, workforce issues and investment funding. A working group was necessary to inform the do-ability aspect of the prioritisation matrix. Scores were assigned to each criterion, the sum of the scores informed whether the intervention was eliminated, aspirational or implemented based on predetermined thresholds. Outcome: The prioritisation matrix ensured a transparent and systematic approach for intervention selection, which reflected local resources and priorities. Moreover, this tool should help ensure the most effective, equitable, practical and sustainable interventions are chosen having the greatest impact on improving oral health outcomes.

Adverse alcohol use and oral health

OBJECTIVE

To determine whether different alcohol intake dimensions: average alcohol volume consumed (AVC), binge drinking (BD), and alcohol-related consequences (ARC) are associated with self-rated oral health (SROH).

METHODS

Secondary cross-sectional analysis of The Brazilian National Health Survey of 2019 data. BD was considered when an individual reported a past-month heavy drinking episode. ARC referred to experiences such as past-year blackouts, concerns from others, or failure in routine activities. Adjusted multivariate Poisson regression models with robust variance were employed to calculate the prevalence ratios (PR) and 95% confidence intervals (CI) of SROH across the entire sample and stratified by sex and age.

RESULTS

The sample comprised 88,531 participants aged 18 years or older. Individuals experiencing at least one past-year ARC had an 11% (95% CI: 1.07, 1.15) higher prevalence of poor SROH than their abstainers' counterparts. Associations were more pronounced among men aged less than 50 (PR = 1.09; 95% CI: 1.03, 1.15) and women aged 50 years or more (PR = 1.15; 95% CI: 1.01, 1.30).

CONCLUSION

Alcohol-related consequences predicted poor SROH. Oral health inquiries should include the screening for ARC in addition to traditional measurements of AVC or BD, since such exposures may not fully capture the role of alcohol on oral health impairment.

Tobacco advertising and oral health among never smokers: the mediating role of secondhand smoke exposure

OBJECTIVE

To determine whether the association between tobacco advertising (TA) exposure and poor self-rated oral health (SROH) is mediated through secondhand smoke (SHS) exposure in Brazilian adults who have never smoked.

METHODS

Secondary cross-sectional analysis of The Brazilian National Health Survey 2019 data. The daily, weekly, or monthly exposure to SHS at home or at work was set as the mediator. Mediation analysis within a counterfactual approach used adjusted binary logistic regressions for both poor SROH and SHS exposure, to estimate the natural direct effect (NDE), natural indirect effect (NIE) through SHS exposure, and marginal total effect (MTE) of TA exposure on poor SROH. To assess the robustness of the results, we calculated the E-value for the MTE.

RESULTS

The sample comprised 53,295 never smoker adults. The MTE of TA exposure on poor SROH was 1.09 (1.03, 1.16), with the indirect effect through SHS exposure responsible for only 16.6% of the total (NIE: 1.01 [1.01, 1.02] and NDE: 1.08 [1.02, 1.14]). An effect of 1.42 would be required for an unmeasured confounder to explain away the association between TA and SROH.

CONCLUSION

More individuals exposed to TA have poor SROH than those unexposed, with secondhand smoke exposure explaining only a small portion of this effect. Upstream tobacco policies should consider oral health outcomes.

Effect of planning interventions on parent supervised oral health behaviors in primary school-age children: a randomized controlled trial

OBJECTIVE

To compare the effect of planning interventions on self-reported changes in parents supervised oral health-related behaviors (OHRBs) and associated clinical oral health parameters for primary school-age children.

METHOD AND MATERIALS

In total, 110 parent-child pairs (children aged 3 to 8 years) were randomly assigned to either of the two groups. In the "action planning" group, parent participants of the pair were asked to make an "action plan" using the "how, when, where" format for their child OHRBs. In the "implementation intention" group, parents were asked to form an "if-then plan" to improve OHRBs for their child. Self-reported changes on target OHRBs, change in plaque scores, change in plaque stagnation areas, and change in caries status of tooth surfaces were observed at 2, 8, and 12 weeks.

RESULTS

Overall OHRBs scores changed significantly from baseline to 12 weeks for both interventions. The scores were significantly better with "if-then" planning than "action planning" (z = 4, P < .001) at 12 weeks. Plaque scores also changed significantly from baseline to 12 weeks for both interventions, and improved significantly more with "if-then" planning (16.20 ± 5.24) than "action planning" (50.66 ± 11.24) at 12 weeks. The number of plaque stagnation areas also changed significantly from baseline to 12 weeks for both interventions, and improved significantly more with "if-then" planning at 12 weeks (12.80 ± 5.33) than "action planning" (42.76 ± 10.34) (t = -11.55, P < .001). There was significant change in the caries status of sound tooth surfaces with "action planning" at 12 weeks (z = 116.50, P = .023). There were no new caries lesions reported with "if-then" planning at 12 weeks.

CONCLUSION

The study observed significant improvement in OHRBs and associated oral health parameters with planning interventions, preferring "if-then" planning over "action planning." It also elicited significant barriers to behaviors in action.

Validation of an Arabic version of the short form of the health literacy in dentistry scale: a cross-sectional study

BACKGROUND

The Arabic version of the short form of the Health Literacy in Dentistry scale (HeLD) had not yet been developed in previously published studies. This study aims to test the reliability and validity of an Arabic version of the short form of the HeLD questionnaire.

METHODS

The short version of HeLD was translated into Arabic and the psychometric properties were evaluated in a sample of 1,889 female students in their first year of secondary school. Test-retest reliability was assessed using the intra-class correlation coefficient (ICC), and internal consistency reliability was assessed using Cronbach's alpha. Content validity was investigated by creating a correlation matrix between the individual items of the HeLD-14, and criterion validity was determined using Pearson's correlation between the HeLD-14 score and an overall oral health rating. Sensitivity analysis was assessed by testing the associations of the HeLD-14 score with oral health-related behaviours and residential area.

RESULTS

The Arabic version of HeLD-14 (A-HeLD-14) had acceptable ICC (0.54) and excellent internal consistency (Cronbach's alpha: 0.92). The correlations between the items of the A-HeLD-14 varied from 0.3 to 0.9. The A-HeLD-14 showed a statistically significant correlation with the overall oral health rating (r = 0.37, p < 0.001). The median A-HeLD-14 score was significantly higher in participants who brushed their teeth frequently (51.31), visited the dentist regularly (52.00), consumed fresh fruit frequently (51) and consumed soda or energy drinks infrequently (51.00) than participants who brushed their teeth infrequently (41.50), visited the dentist irregularly (49.00), consumed fresh fruit infrequently (47) and consumed soda or energy drinks frequently (48.00).

CONCLUSION

The A-HeLD-14 instrument demonstrates sufficient validity, reliability, and sensitivity for measuring oral health literacy among the Arabic-speaking population.

Oral health in youth with visual impairment: A longitudinal survey

This longitudinal survey aims to demonstrate improvement in oral hygiene among a group of youth with visual impairment (VI) achieved by repeated oral hygiene training, compare their progress with healthy peers (CG) and assess their oral health knowledge. In 100 VI (55♀, 45♂; ± 17.8 years) and 45 CG (23♀, 22♂; ± 17.2 years) oral hygiene training and a Quigley-Hein Plaque Index (QHI) rating were repeated six times at three-month intervals. The VI were divided into four subgroups according to the toothbrush hardness/type. A questionnaire was given to both groups. Appropriate statistical analyses were performed at 5% significance level. Both groups showed reduction in QHI, the VI had overall higher QHI values than CG. Use of an electric toothbrush in VI led to lower QHI in the last examination (p < 0.03). 69% of participants recommended dental specialists to improve communications by acquiring more illustrative aids. VI changed toothbrush less often (p < 0.02). A higher incidence of dental plaque was confirmed in VI compared to CG. After education and individual training, gradual plaque reduction has occurred in both groups. Using an electric toothbrush in VI resulted in better QHI outcomes. Repetitive preventive intervention in youth with VI helped them to adopt healthier oral hygiene habits.

A scoping review on the use of traditional medicine and oral health in Africa

BACKGROUND

This review aimed to chart the landscape of literature concerning the precise applications of traditional medicine in managing specific oral diseases and, in doing so, to pinpoint knowledge gaps surrounding the use of traditional medicine for oral disease management in the African context.

METHODS

A systematic search of the literature was conducted on PubMed, Web of Science, Scopus, and CINAHL. The search was conducted from the inception of the database till September 2023. A search of related citations and references was also carried out. Only English language publications were included. A summary of studies that met the inclusion criteria was conducted.

RESULTS

Of the 584 records identified, 11 were duplicates and 12 studies, published between 2006 and 2021, met the inclusion criteria. The studies were published from eight countries located in the five sub-regions on the continent. All the studies were either experimental designs or ethnobotanical surveys and they all utilized plant-based remedies. The five experimental studies aimed to assess the impact of whole plants or plant extracts on the three microorganisms responsible for dental caries and seven responsible for periodontal diseases. The number of plant species identified by the seven ethnobotanical surveys ranged from 29 to 62 while the number of plan families ranged from 15 to 29. The remedies were either topical applied, use as mouth rinses, gargled, or chewed. The systemic routes of administration identified were inhalation and drinking. The remedies were used for the treatment of hard such as dental caries and tooth sensitivity, to soft tissue lesions such as mouth ulcers, gingival bleeding, and mouth thrush. Other oral disorders managed include halitosis, jaw fracture, and oral cancer.

CONCLUSIONS

Given the increasing prevalence of oral diseases within the region, the shortage of oral healthcare professionals and limited access to financial resources, it becomes imperative to support the generation of empirical evidence to enhance the provision of traditional medicine for oral healthcare in Africa.

Health policy and regulations in Seychelles - barriers and opportunities for oral health inclusion

BACKGROUND

Successful and inclusive policies that embrace oral health as part of the health agenda have the potential to alleviate the burden of oral diseases and to promote dental public health. This study aimed to understand the factors influencing the inclusion of oral health in health and public policy and regulations in the Seychelles. The barriers and opportunities for inclusion / non-inclusion as well as the impact thereof were explored.

METHODOLOGY

A qualitative approach was adopted using document analysis and interviews as data collection strategies to allow for a complete analysis of the research problem. Using a purposive sampling approach, individual face to face interviews were conducted with patients, dental staff and representatives of the upper management. Policy and related oral health statistical documents were reviewed to ascertain how oral health was located and implemented from a national to a district level. Thematic analysis and content analysis were used to analyse and interpret the qualitative data.

RESULTS

The study provided insight on how oral health is contextualised in the Seychelles and how public policy and strategic documents influences the oral health outcomes. There is fragmentation in how the health and oral health agendas are managed and it is coupled with a severe lack of involvement and commitment to address the latter.

CONCLUSION

Oral health needs to be integrated in all relevant policies and public health programmes as part of the broader national NCDs in Seychelles in order reduce the incidence of oral diseases in the population.

Oral frailty: a concept analysis

BACKGROUND

Oral frailty has become a worldwide problem among older adults. Although researchers have conducted various studies on oral frailty, its definition remains controversial.

PURPOSE

To clarify the concept of oral frailty.

METHODS

Online databases PubMed, Web of Science, CINAHL, Cochrane Library, ProQuest, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang database were searched from inception to September 20, 2023. The reference lists of relevant studies were searched manually. Eligible articles, theses, and books were analyzed using Walker & Avant's concept analysis model.

RESULTS

The attributes of oral frailty were abnormal oral structure and/or decline in multi-faceted oral function and coexisting decline in physical, cognitive and social functions. Its antecedents were aging, social frailty, and severe periodontitis, whereas its consequences were decline in physical health and mental health, social withdrawal, lower quality of life and systemic frailty.

CONCLUSION

Oral frailty could result in worse conditions among older adults physically, psychologically and socially. Tools based on the concept analysis need to be developed to comprehensively assess oral frailty.

A theory of oral healthcare decision-making in Appalachia

INTRODUCTION

People make oral healthcare decisions regardless of having partial information, misinformation, sources that deliberately mislead, or information that is culturally influenced. This is particularly true in the Appalachian culture where oral healthcare decision-making practices are not well understood by researchers and dental professionals. Despite efforts to improve dental care utilization, the Appalachia region remains low in oral healthcare utilization. There is a need for a theory to identify concepts in decision-making when seeking oral healthcare. The theory could be useful in creating oral health interventions. The study objective is to develop a theory to identify concepts that influence oral healthcare decision-making in Appalachia (OHDA).

METHODS

The researchers used a grounded theory qualitative study design to explain data for a theory of OHDA. Participants from Appalachia, in 20-minute interviews, provided insights into concepts that influence OHDA from August 22, 2017 to May 26, 2022. Notes/memos were written during and after the interviews and coding was conducted after the interviews. Open coding categories emerged through constant comparison of responses.

RESULTS

Five overarching concepts that embody OHDA were discovered: Affect (Level of Pain/Emotion/Stress involvement), Awareness, Trust/belief, Resources, and Risk Perception. All participants discussed the impact of social media toward these concepts.

CONCLUSION

To influence a person's OHDA, public health officials and researchers need to address the person's affect, level of awareness, trust/belief, available resources, and risk perception. Social media is very important in awareness concerning oral health information. These factors are important to consider for similar research in oral healthcare utilization at the population level.

Factors associated with oral health care behavior of people with type 2 diabetes mellitus: A hospital-based, cross-sectional study

BACKGROUND

Oral healthcare behavior determines oral health status and the incidence of oral diseases. People with type 2 diabetes mellitus (T2DM) are at-risk of having low oral healthcare behavior and disease-related oral health.

OBJECTIVE

To investigate the oral health status and factors associated with oral healthcare behavior among people with T2DM in Thailand.

METHODS

In total, 401 people with T2DM participated in the study based on their attendance at a non-communicable disease clinic at sub-district health promotion hospitals in Bueng Kan, a north-eastern province in Thailand. A structured questionnaire was used to obtain variables of interest. Linear regression analysis at the 95% confidence interval (CI) was applied.

RESULTS

The majority of participants were female (73.8%). More than three-quarters had more than 20 permanent teeth (77.6%), a decay missing filling tooth index was 10.6 teeth/person. Many participants had four permanent occlusal pairs (69.6%), had tooth decay (74.6%), and some participants had tooth filling (32.2%). Statistically significant factors associated with oral healthcare behavior were: having complications associated with diabetes mellitus (Beta = -0.097, 95%CI = -1.653, -0.046), oral health literacy (Beta = 0.119, 95%CI = 0.009, 0.150), educational level (Beta = 0.123, 95%CI = 0.103, 0.949), oral healthcare attitude (Beta = 0.258, 95%CI = 0.143, 0.333), and oral health services (Beta = 0.430, 95%CI = 0.298, 1.408).

CONCLUSIONS

People with T2DM had good oral health status. People with T2DM with low oral health literacy, low attitude, and low level of oral health services were at a higher risk of poor oral healthcare behavior.

Supporting post-pandemic recovery: a qualitative study of the capabilities, opportunities and motivations to deliver oral health behaviour change messages to parents of young children in community settings

BACKGROUND

The COVID-19 pandemic exacerbated vulnerabilities and inequalities in children's oral health, and treatment activity virtually ceased during periods of lockdown. Primary care dentistry is still in the post-pandemic recovery phase, and it may be some years before normal service is resumed in NHS dentistry. However, opportunities to support the dental workforce through offering some preventative care in outreach settings may exist. This has the additional benefit of potentially reaching children who do not routinely see a dentist. The aim of this research was therefore to explore views around upskilling practitioners working in early years educational and care settings to support families of pre-school aged children to adopt and maintain preventative oral health behaviours.

METHODS

Using the Capability, Opportunity and Motivation model of behaviour (COM-B) to structure our data collection and analysis, we conducted semi-structured interviews with 16 practitioners (dental and non-dental) and analysed the data using deductive framework analysis.

RESULTS

The data were a good fit with the COM-B model, and further themes were developed within each construct, representing insights from the data.

CONCLUSION

Early years practitioners can reach vulnerable children who are not usually brought to see a dentist, and have the capability, opportunity and motivation to support the oral health behaviours of families of children in their care. Further research is needed to identify training needs (oral health and behaviour change knowledge and skills), acceptability to parents, and supporting dental practice teams to work in partnership with early years settings.

Development of a nomogram for identifying periodontitis cases in Denmark

Although self-reported health outcomes are of importance, attempts to validate a clinical applicable instrument (e.g., nomogram) combining sociodemographic and self-reported information on periodontitis have yet to be performed to identify periodontitis cases. Clinical and self-reported periodontitis, along with sociodemographic data, were collected from 197 adults. Akaike information criterion models were developed to identify periodontitis, and nomograms developed based on its regression coefficients. The discriminatory capability was evaluated by receiver-operating characteristic curves. Decision curve analysis was performed. Smoking [OR 3.69 (95%CI 1.89, 7.21)], poor/fair self-rated oral health [OR 6.62 (95%CI 3.23, 13.56)], previous periodontal treatment [OR 9.47 (95%CI 4.02, 22.25)], and tooth loss [OR 4.96 (95%CI 2.47, 9.97)], determined higher probability of having "Moderate/Severe Periodontitis". Age [OR 1.08 (95%CI 1.05, 1.12)], low educational level [OR 1.65 (95%CI 1.34, 2.23)], poor/fair self-rated oral health [OR 3.57 (95%CI 1.82, 6.99)], and previous periodontal treatment [OR 6.66 (95%CI 2.83, 15.68)] determined higher probability for "Any Periodontitis". Both nomograms showed excellent discriminatory capability (AUC of 0.83 (95%CI 0.75, 0.91) and 0.81 (95% CI 0.74, 0.88), good calibration, and slight overestimation of high risk and underestimation of low risk. Hence, our nomograms could help identify periodontitis among adults in Denmark.