A Comprehensive Oral Preventive Care Protocol for Caring for the Renal Transplant Population

Candidates and recipients of kidney transplants are at high risk for oral infections due to systemic co-morbidities, and disease and drug-induced immunosuppression. Developing oral infections while on the waiting list can jeopardize candidacy for receiving a kidney, and post-operatively increases the chance for organ rejection. Therefore, it is imperative to minimize oral disease risks in this population. A comprehensive, oral preventive care protocol is presented to guide dental professionals with patient management throughout the process of care. Proper dental and dental hygiene care can help to prevent oral infections, optimize oral health, and enhance overall health and quality of life for the renal transplant population.

Managing Intraoral Lesions in Oral Cancer Patients in a General Dental Practice: An Overview

As medical technology advances in the area of cancer therapeutics, dental practitioners will encounter patients with active cancer or a history of cancer. Typically, these patients may have had or are undergoing therapies such as surgery, radiation, chemotherapy or a combination of therapies. These patients may present with multiple side effects that dental practitioners can manage or prevent. We discuss some of these concerns and provide management strategies.

[Non-communicable disease and their significance for dental medicine]

Non-communicable diseases (NCDs), such as cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes mellitus, are responsible for most deaths worldwide. In view of the rising prevalence and the long-term consequences of NCDs, their prevention is a public health priority. Dentistry plays an important role in this endeavor. Since oral and general diseases share common risk factors (e.g., poor oral hygiene, unhealthy diet, alcohol abuse, tobacco consumption, distress), preventive measures may target both oral diseases (e.g., dental caries, periodontal diseases, oral tumors) and medical NCDs. Consequently, dental medicine assumes an important medical and social role, which has been recognized by the World Health Organization and the General Assembly of the United Nations. To fulfill its mission successfully, consideration of the principles of evidence-based dentistry is a prerequisite. At the same time, the new development provides dentistry with the opportunity to critically reflect on its current and future orientation.

The changing epidemiology of oral diseases in the elderly, their growing importance for care and how they can be managed

This article provides an overview of the changing epidemiology of oral diseases and the impacts for the population. Considerable improvements have occurred in oral health, and many more people are retaining teeth for longer. However, the conditions of teeth and mouth are varied, and all older people are at risk of future oral disease. With the increased prevalence of other more general health conditions, the risks of poor oral health are increasing. Poor oral health gives rise to considerable problems that impact both on an individual's well-being and qualities of life as well as increasing the risks of general health issues. To ensure that the risks of such adverse impacts are minimised, a more collaborative approach involving all care workers is required, addressing the determinants of health and ensuring that better care management arrangements for older people are developed.

Practical use of povidone-iodine antiseptic in the maintenance of oral health and in the prevention and treatment of common oropharyngeal infections

AIMS

To better inform medical practitioners on the role of antiseptics in oropharyngeal health and disease, this article focuses on povidone-iodine (PVP-I), an established and widely-available antiseptic agent.

METHODOLOGY

Review of the anti-infective profile, efficacy and safety of PVP-I in managing common upper respiratory tract infections such as the common cold, influenza and tonsillo-pharyngitis, as well as oral complications resulting from cancer treatment (oral mucositis), and dental conditions (periodontitis, caries).

RESULTS

Antiseptics with broad-spectrum anti-infective activity and low resistance potential offer an attractive option in both infection control and prevention. While there is some evidence of benefit of antiseptics in a variety of clinical settings that include dental and oral hygiene, dermatology, oncology, and pulmonology, there appears to be discordance between the evidence-base and practice. This is especially apparent in the management and prevention of oropharyngeal infections, for which the use of antiseptics varies considerably between clinical practices, and is in marked contrast to their dermal application, where they are extensively used as both a prophylaxis and a treatment of skin and wound infections, thus minimising the use of antibiotics.

CONCLUSION

The link between oral and oropharyngeal health status and susceptibility to infection has long been recognised. The high rates of antibiotic misuse and subsequent development of bacterial resistance (e.g. increasing vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA)) in large parts of the world, especially across Asia Pacific, highlight the need for identifying alternative antimicrobials that would minimise the use of these medications. This, together with recent large-scale outbreaks of, for example, avian and swine influenza virus, further underline the importance of an increasing armamentarium for infection prevention and control.

Advances in the prevention of oral disease; the role of the International Association for Dental Research

BACKGROUND

Since its foundation in 1920, prevention of oral disease has been a priority for the International Association for Dental Research (IADR) and the commitment of the organisation to the subject area is clearly expressed in its mission to improve oral health worldwide. The IADR has a current global membership of almost 11,000 people who share an interest in oral and craniofacial research.

CONTRIBUTION OF IADR

This paper provides an overview of the contribution of IADR to supporting research and associated activities in disease prevention, in disseminating knowledge and in advocating for better oral health for all citizens of the world. It looks back over time and summarises current supports. Two more recent initiatives in disease prevention are described in more detail, the Global Oral Health Inequalities Research Agenda (GOHIRA) and the proceedings at the 2013 World Conference on Preventive Dentistry (WCPD, 2013), a joint initiative between IADR and WHO. Through organisational structure, meetings, publications, scientific groups and networks and external relations, IADR has been at the forefront of advancing research for the prevention of oral diseases. IADR is committed to ensuring research advances get disseminated and implemented and at the same time encourages and advocates for basic, clinical and translational research across disciplines so that we may uncover the major breakthrough in prevention of oral disease.

Skill-mix in preventive dental practice--will it help address need in the future?

BACKGROUND

Population health needs are changing. The levels of dental caries and periodontal disease across the population as a whole is falling. The proportion of adults with a functional dentition in many developed countries has increased substantially and edentulous rates have dropped to some of their lowest levels. Despite this, a pronounced social gradient still exists, many adults do not attend dental services regularly and disease in young children remains intransigent amongst the poorest. New challenges are emerging too as the growing number of older people, above sixty-five years of age, retain their teeth.

METHODS

Ensuring "the right number of people with the right skills are in the right place at the right time to provide the right services to the right people" is critical for future dental service provision, both to meet the new challenges ahead and to ensure future services are cost-effective, efficient and reduce health-inequalities. Greater use of "skill-mix" models could have a substantial role in the future, as dentistry moves from a "cure" to a "care" culture.

DISCUSSION

The provision of dental services in many countries currently adopts a "one-size-fits-all", where the dentist is the main care-giver and the emphasis is on intervention. As needs change in the future, the whole of the dental team should be utilised to deliver primary, secondary and tertiary prevention in an integrated model. Growing evidence suggests that other members of the dental team are effective in providing care, but introducing this paradigm shift is not without its challenges. The provision of incentives within funding systems and social acceptability are amongst the key determinants in producing a service that is responsive to need, improves access and delivers equity.

Economic models for prevention: making a system work for patients

The purpose of this article is to describe alternative means of providing patient centered, preventive based, services using an alternative non-profit, economic model. Hard to reach, vulnerable groups, including children, adults and elders, often have difficulties accessing traditional dental services for a number of reasons, including economic barriers. By partnering with community organizations that serve these groups, collaborative services and new opportunities for access are provided. The concept of a dental home is well accepted as a means of providing care, and, for these groups, provision of such services within community settings provides a sustainable means of delivery. Dental homes provided through community partnerships can deliver evidence based dental care, focused on a preventive model to achieve and maintain oral health. By using a non-profit model, the entire dental team is provided with incentives to deliver measurable quality improvements in care, rather than a more traditional focus on volume of activity alone. Examples are provided that demonstrate how integrated oral health services can deliver improved health outcomes with the potential to reduce total costs while improving quality.

Dental Care in the Frail Older Adult: Special Considerations and Recommendations

Frail older adults disproportionately suffer from untreated dental problems. Age-related biological changes to hard and soft dental tissues, existing medical conditions, polypharmacy, diet and uncontrolled plaque exacerbate the problem. All of these factors increase the complexity of treatment and will differ greatly from standard treatment of younger adults. This article discusses the key considerations and suggestions for risk assessment, disease management, treatment planning and palliative care to maintain the patient's comfort and quality of life.

Rehabilitation of oncology patients with hard palate defects. Part 1: The surgical planning phase

This article is the first in a series of three papers that will discuss the conventional non-implant retained prosthodontic rehabilitation of oncology patients with surgically acquired hard palate defects. In this first paper, the dental challenges posed by the oncology patients will briefly be discussed. The interface between the specialist restorative dentist and the maxillofacial surgeon when planning the conventional dental rehabilitation of an oncology patient with a hard palate defect will be discussed in detail. Clinical Relevance: To highlight the importance of the restorative dentistry/surgical interface when planning a treatment for a patient requiring a maxillectomy and conventional obturation.

The efficacy of Italian guidelines in promoting oral health in children and adolescents

AIM

The purpose of the study was to evaluate the efficacy of the guidelines on oral health published by the Italian Health Ministry.

STUDY DESIGN

1239 patients (582 girls and 657 boys) with a mean age of 4.46 (SD 2.81) years were evaluated before application of the guidelines by paediatricians (T0) for the presence of caries, gingivitis, diseases of the oral mucosa, and malocclusion. Only patients aged 6 months, 3 years, 6 years, and 9 years at T0 were taken into consideration. All patients were reevaluated after application of the ministerial guidelines (T1).

METHODS

the study took place over a 3-year period. Enrolled patients referred to the outpatient clinics of three paediatricians of the Province of Genoa who strictly applied the ministerial guidelines.

STATISTICS

Chi square test analysis was performed to evaluate a statistically significant decrease in the incidence of caries, gingivitis and diseases of the oral mucosa.

RESULTS

After a 3-year follow-up collected data underlined a statistically significant decrease in the incidence of dental caries, gingivitis and oral mucosal diseases after implementation of the recommended ministerial guidelines. A statistically significant decrease of malocclusions was also evident in the elder patients (12 years old at T1).

CONCLUSION

The accurate implementation of the Guidelines is supported. Only collaboration and increased synergy between paedodontists and paediatricians can fulfill the objectives which were the reason for publishing the "National guidelines for the promotion of oral health and the prevention of oral diseases in developmental age".

Integrating Oral Health with Non-Communicable Diseases as an Essential Component of General Health: WHO's Strategic Orientation for the African Region

In the context of the emerging recognition of non-communicable diseases (NCDs), it has never been more timely to explore the World Health Organization (WHO) strategic orientations on oral health in the WHO African region and to raise awareness of a turning point in the search for better oral health for everyone. The global initiative against NCDs provides a unique opportunity for the oral health community to develop innovative policies for better recognition of oral health, as well as to directly contribute to the fight against NCDs and their risk factors. The WHO African region has led the way in developing the first regional oral health strategy for the prevention and control of oral diseases integrated with NCDs. The support of the international oral health community in this endeavor is urgently needed for making a success story of this initiative of integrating oral health into NCDs.

A competency matrix for global oral health

The Lancet Commission on Education of Health Professionals for the 21(st) Century calls for enhancing health education for the needs and challenges of the 21st century to improve health status globally. To complement the Lancet report, this article makes recommendations for including core global health competencies in the education of health care professionals and specific groups of the public who are relevant to oral health in a global context in order to tackle the burden of oral diseases. Experts from various professional backgrounds developed global oral health competencies for four target groups: Group 1 was defined as dental students, residents/trainee specialists (or equivalent), and dentists; Group 2 was community health workers, dental hygienists, and dental therapists (or the equivalent); Group 3 was health professionals such as physicians, physician assistants, nurses, nurse practitioners, and pharmacists; and Group 4 was non-health professionals in the public arena such as parents, teachers, decision makers, key opinion leaders, and health and consumer advocates. Key competencies for members of each of the four target groups are presented in a matrix. The suggested competency matrix shows that many other health professions and groups in society have potentially crucial roles in the prevention, control, and management of oral diseases globally. Workforce models including a wider range of professionals working together as a team will be needed to tackle the burden of oral diseases in an integrated way in the broader context of non-communicable diseases. Further discussion and research should be conducted to validate or improve the competencies proposed here with regard to their relevance, appropriateness, and completeness.

Preventive care delivered within Public Dental Service after caries risk assessment of young adults

OBJECTIVES

To study preventive care provided to young adults in relation to their estimated risk category over a 3-year period.

METHODS

The amount and type of preventive treatment during 3 years was extracted from the digital dental records of 982 patients attending eight public dental clinics. The baseline caries risk assessment was carried out by the patient's regular team in four classes according to a predetermined model, and the team was responsible for all treatment decisions. Based on the variables 'oral health information', 'additional fluoride' and 'professional tooth cleaning', a cumulative score was constructed and dichotomized to 'basic prevention' and 'additional prevention'.

RESULTS

More additional preventive care was provided to the patients in the 'low-risk' and 'some risk' categories than to those classified as 'high' or 'very high' risk (OR = 2.0, 95% CI 1.4-3.0; P < 0.05). Professional tooth cleaning and additional fluorides were most frequently employed in the 'low-risk' and 'some risk' categories, respectively. Around 15% of the patients in the high-risk categories did not receive additional preventive measures over the 3-year period. There was an insignificant tendency that patients with additional prevention developed less caries than those that received basic prevention in all risk categories except for the 'very high-risk' group.

CONCLUSION

The caries risk assessment process was not accompanied by a corresponding targeted individual preventive care in a cohort of young adults attending public dental service. Further research is needed how to reach those with the greatest need of primary and secondary prevention.

[Oral health among the elderly]

A large proportion of our population is ageing with own teeth in the mouth. Good oral health and an adequate number of teeth improve the functional capacity of an elderly person. Oral diseases are, however, becoming more common among the elderly population with the accumulation of risk factors such as insufficient self-care, cariogenic diet, reduced salivation, smoking and systemic diseases. Dryness of the mouth due to the adverse effects of drugs or systemic diseases makes eating and cleaning of the mouth more difficult. Prevention of oral diseases with good self-care and regular dental examinations is essential.

Management of soft tissue irritation around exposed zygomatic implant in a hemimaxillectomy patient: a technical report

Patients missing portions or all of the maxillary alveolar bone who are restored with zygomatic implants frequently have threads exposed that can be a mucosal irritant. If such irritation is reported, covering the threads with a highly polished titanium sleeve is recommended. The technique of placing said custom sleeve is described. This adjunctive treatment method has eliminated mucosal irritation.