Survey of Michigan dentists and radiation oncologists on oral care of patients undergoing head and neck radiation therapy

BACKGROUND

Oral complications of radiation therapy for head and neck cancer (HNC) are associated with a significant decline in oral health-related quality of life (OHQOL). The dentist, working with the radiation oncologist and the rest of the health care team, plays an important role in the prevention and management of these complications, but patients do not always receive care consistent with current guidelines. This study investigated barriers to recommended care.

HYPOTHESES

There is variability in knowledge and practice among dentists and radiation oncologists regarding the dental management of patients treated with head and neck radiotherapy (HNRT), and inadequate communication and collaboration between members of the patient's health care team contribute to inconsistencies in application of clinical care guidelines. There is on interest and need for continuing dental (CDE) and medical education (CME) on this topic.

MATERIALS/METHODS

A questionnaire was developed to assess dentists' knowledge and practice of dental management of HNC patients and their interest in CDE on this topic. All members of the Michigan Dental Association (MDA) with email addresses were asked to complete the survey online, and a random sample of MDA members without email addresses was invited to complete a paper version of the same survey. All Michigan members of the American Society for Radiation Oncology (ASTRO) were invited to complete an online version of the survey modified for radiation oncologists.

RESULTS

The response rate for dentists was 47.9% and radiation oncologists was 22.3%. Of the dentists who responded, 81% reported that a major barrier to providing dental treatment before radiotherapy was a lack of time between initial dental consultation and the start of radiation; inadequate communication between health care providers was blamed most frequently for this. Ten percent of the dentists and 25% of the radiation oncologists reported that they did not treat HNC patients because they lacked adequate training, and 55% of dental respondents said that they did not feel adequately trained in dental school to treat patients who have had head and neck radiation therapy. Most respondents (radiation oncologists 67%; dentists 72%) were interested in CDE and CME on this topic.

CONCLUSIONS

These results suggest a need for CDE and CME for Michigan dentists and radiation oncologists on the oral management of HNC patients. Improved training and communication between health professionals could improve patient outcomes and more consistent application of clinical care guidelines.

The platform for better oral health in Europe--report of a new initiative

Public health practitioners are required to apply their competencies at a range of levels from governmental to small community groups. A recurring theme at BASCD conferences has been the need to influence policy at the highest level if improvements to oral health and better treatment of oral ill-health are to occur. This paper presents a clear example of such dental public health action at a European level. This report outlines the reasons why it is necessary to try to improve oral health within Europe, in general, and the European Union in particular. It goes on to describe how the newly formed Platform for Better Oral Health in Europe is trying to work at a macro level, and bring interested associations, groups and individuals together. Collectively they can then alert European institutions and national governments to oral health problems and promote policies to improve the current situation. It describes the current problems, their resource implications, the objectives of the Platform, its actions so far and its plans for the immediate future. It suggests that, if the problems are to be addressed, it will be necessary for all interested parties to work together at a European level to raise oral health issues higher on the E.U. agenda.

Factors associated with preventive care practice among adults with diabetes

Adherence to annual preventive care (foot, eye, and dental examinations) in this group of study participants with diabetes (n=253) was suboptimal. Participants were 2.6-5.8 times more likely to have a specific preventive care in the past 12 months if they were told to do so by a health care professional.

The paradigm shift to prevention and its relationship to dental education

The past seventy-five years have witnessed an extraordinary growth of scientific knowledge related to oral health and the development of evidence-based dentistry. The centrality of prevention to the control of oral diseases and the maintenance of good oral health has become increasingly recognized by the scientific community, dental educators, dental practitioners, and the public at large. Yet, despite significant improvements in the overall oral health of Americans, important disparities exist, and large segments of the population are disproportionately burdened by oral diseases. Despite the proven effectiveness of various preventive modalities, such as fluoridation and dental sealants, these have not been universally disseminated and implemented. This review will highlight the challenges remaining in completing the decades-long paradigm shift to prevention and the important role to be played by the dental education community in this process.

Role of friendly bacteria in oral health - a short review

Probiotics are defined as live microorganisms which, when administered in appropriate amounts, confer a health benefit to the host. Although these organisms are naturally present in food and water, they can also be deliberately added to some foods because of their beneficial effects for human health. The potential application of probiotics for oral health has recently attracted the attention of several teams of researchers. However, only a few clinical studies have been conducted so far, and the results to date suggest that probiotics could be useful in preventing and treating oral infections, including dental caries, periodontal disease and halitosis. This article summarises the currently available data on the potential benefits of probiotics for oral health.

Effect of in-water iodine supplementation on weight gain, diarrhea and oral and dental health of nursery pigs

A farm trial was conducted to evaluate the effect of in-water iodine on piglet growth, the incidence of diarrhea, and the development of deleterious oral and dental conditions. A total of 208 weaned piglets were included in the study. Piglets were weighed 3 times: within 24 h of weaning, and 3 wk and 6 wk after weaning. A concentration of 1 ppm iodine was provided in their drinking water. Swabs were taken from all water nipples and water lines and pooled fecal samples were collected from all pen floors. Fecal samples were also collected from sows at weaning. The swabs and fecal samples were tested for the presence of Salmonella and Escherichia coli. Within 24 h of each weighing, a complete oral examination was performed on each piglet. No significant difference in growth (P > 0.05) or dental conditions (P > 0.05) was found among treatment groups during the period that iodine was added to the drinking water. After weaning, all deleterious oral conditions increased (oral lesions from weaning to 6 wk, staining and caries from weaning to 3 wk, gingivitis from 3 wk to 6 wk; P < 0.05). Only gingivitis was found to be negatively associated with piglet weight (P < 0.05). Salmonella was cultured only twice from fecal samples and never from water nipples. Only 1 sow tested positive for Salmonella and E. coli O139: K82 and O157:K"V17 were cultured only rarely from the water nipples. No signs of diarrhea were noted throughout the study. Adding an aqueous iodine supplement to nursery pigs, therefore, did not provide an advantage for either growth or oral condition. Deleterious oral conditions do increase after weaning, with gingivitis being associated with lower piglet weight.

Study of antibiotic prescribing among dental practitioners in Shiraz, Islamic Republic of Iran

Inappropriate prescribing of antibiotics by health care professionals is a worldwide concern. This study evaluated the knowledge and practices of dental practitioners in the city of Shiraz, Islamic Republic of Iran regarding their therapeutic use of antibiotics for patients with dentoalveolar infections. Of 219 (48.6%) dentists responding to the questionnaire more than 40% would prescribe antibiotics for localized fluctuant swelling and for problems for which antibiotics are not required according to good practice guidelines (acute pulpitis, chronic apical infection, periodontal abscess, chronic gingivitis, chronic periodontitis, pericoronitis and dry socket). A majority correctly prescribed antibiotics for acute periapical infection (77.2%), cellulitis (75.3%) and acute ulcerated gingivitis (63.0%). Amoxicillin was the most frequently prescribed antibiotic for all clinical conditions but there was a wide variation in dosage, frequency and duration for all antibiotics used. Guidelines on rational antibiotic use are needed for dental practitioners in the Islamic Republic of Iran.

Raising oral health awareness among nephrology nurses

PURPOSE

The complexity of care for patients with chronic kidney disease (CKD) reinforces the need for collaboration between health care providers. The purpose of this study was to raise oral health awareness by providing educational seminars to health care providers, specifically nephrology nurses.

METHODS

Educational seminars entitled "Oral Health and Chronic Kidney Disease" were delivered by calibrated dental hygiene educators to nurses in 3 different regions in the United States. The nurse participants (n=106) were given randomly assigned pre- and post-tests, assessing their knowledge of oral health and its relation to CKD.

RESULTS

Pre-tests revealed that nurses had little knowledge of oral health and its relation to CKD. Regardless of questionnaire order, a significant increase of knowledge was observed for both groups (p-value ≤ 0.015), increasing from 61 to 76% on average.

CONCLUSION

Incorporating interdisciplinary education increases nurses' knowledge and may lead to greater quality of life outcomes and improved overall health in patients with CKD.

Dentists' perceptions of barriers to providing dental care to pregnant women

PURPOSE

The purpose of the study was to understand US dentists' attitudes, knowledge, and practices regarding dental care for pregnant women and to determine the impact of recent papers on oral health and pregnancy and guidelines disseminated widely.

METHODS

In 2006 and 2007, the investigators conducted a mailed survey of all 1,604 general dentists in Oregon; 55.2% responded). Structural equation modeling was used to estimate associations between dentists' attitudes toward providing care to pregnant women, dentists' knowledge about the safety of dental procedures, and dentists' current practice patterns.

RESULTS

Dentist's perceived barriers have the strongest direct effect on current practice and might be the most important factor deterring dentists from providing care to pregnant patients. Five attitudes (perceived barriers) were associated with providing less dental services: time, economic, skills, dental staff resistance, and peer pressure. The final model shows a good fit with a chi-square of 38.286 (p = .12; n = 772; df = 52) and a Bentler-Bonett normed fit index of .98 and a comparative fit index of .993. The root mean square error of approximation is .02.

CONCLUSION

Findings suggest that attitudes are significant determinants of accurate knowledge and current practice. Multidimensional approaches are needed to increase access to dental care and protect the oral health of women during pregnancy. Despite current clinical recommendations to deliver all necessary care to pregnant patients during the first, second, and third trimesters, dentists' knowledge of the appropriateness of procedures continues to lag the state of the art in dental science.

Prevention of oral disease for long-term care and homebound elderly

Despite the fact that many oral diseases afflicting the long-term care or homebound elderly are preventable or treatable, many older people do not seek available treatment, or their oral health care needs are not being met. The dental profession must, therefore, increase the preventative dental awareness of elders and make preventative and treatment services more accessible to this population. Interdisciplinary training and collaborative efforts among the dental profession, medical profession and caregivers are necessary in preventing oral disease for this geriatric population, which would improve not just oral health, but overall systemic health as well, thereby improving their quality of life.

Nutrition and oral health considerations in children with special health care needs: implications for oral health care providers

Children with special health care needs are at increased risk for oral diseases. The purpose of this article was to discuss: nutritional and oral health factors routinely observed in most chronic childhood disorders; dietary modifications associated with select systemic disorders and how they may impact oral health in children; and the following factors common to chronic disorders associated with diet modifications-decreased appetite and increased nutritional risk; frequency of food intake; parental overindulgence; long-term use of cariogenic medications; and xerostomia. Characteristics of childhood disorders that require dietary modifications (congenital heart disease, cystic fibrosis, cancer, AIDS/HIV, diabetes mellitus, and phenylketonuria) are summarized. In addition, healthy dietary modifications and oral health recommendations are suggested. Implementation of these recommendations can assist the dentist and dental team as they join physicians and nutritionists in delivering the best possible care to children with special health care needs.

Prenatal dental care: a review

Good oral health during pregnancy is necessary for the health of both the mother and the baby. Dental care during pregnancy is safe, effective, and recommended, yet many dental professionals delay treatment due to concerns for fetal safety. This article discusses common dental findings and treatment considerations during pregnancy. Oral health professionals should promote the safety of dental care during pregnancy.

General dentistry's role in the care for children with special needs: a review

Children with special health care needs include those with behavioral issues, developmental disorders, cognitive disorders, congenital or genetic disorders, or systemic disease. These conditions may place them at increased risk for oral diseases, making it important to establish preventive oral health strategies at an early age. These children should have an established dental home, through which preventive care can be initiated and maintained, by 12 months of age. Dentists can establish prevention-based care from a young age by understanding the child's condition and how that condition influences the delivery of oral health care. This article outlines common conditions among children with special needs, focuses on their influence on dental health, and describes how these conditions influence preventive, operative, surgical, and behavior management strategies. The goal is to provide an overview that will help guide practicing dentists to understand their role in the care of children with special health care needs.

[Management and prevention of oral manifestations for blood dyscrasia and viral pathology]

The study outlines the dentist's attitude in dealing with two of the many serious diseases throughout the body, HIV infection and acute leukemia. Many systemic diseases have oral manifestations which may appear at the beginning of any developed pathology, thus early detection can occasionally occur at the dental clinic. Gingival lesions are the most common oral phenomenon known for leukemia and HIV infection. In this case an early detection of pathology at the dental clinic was based on an uncommon and single presenting sign of massive spontaneous gingival bleeding. The objectives are demonstrate this unusual sign of blood dyscrasia and HIV infection in oral cavity and establishing management and prevention of oral manifestations for blood dyscrasia and pathology with viral etiology.

MATERIAL AND METHOD

We investigated 225 cases had pathology with viral etiology. The patients entered the study HIV/AIDS in Botosani, Suceava, Neami during 2004-2008. All patients had a detailed medical history and examination as well as a thorough oral examination, which were all done without prior knowledge of the patient's HIV serostatus.

RESULTS

Oral disease is frequently associated with HIV. While nearly all oral disorders associated with HIV infection also occur in other conditions characterized by immunosuppression, no other condition is associated with as wide and significant a spectrum of oral disease as is HIV infection. Many HIV associated oral disorders occur early in HIV infection, not infrequently as the presenting sign or symptom. Thus, early detection of associated oral disease should, in many cases, result in earlier diagnosis of HIV infection. Likewise, awareness of the variety of oral disorders which can develop throughout the course of HIV infection, and coordination of health care services between physician and dentist, should improve overall health and comfort of the patient. This paper reviews the clinical, diagnostic and therapeutic aspects of HIV associated oral disorders.

CONCLUSIONS

Diseases with a particular viral etiology infectiousness have a special resurgence. For the dentist, their recognition has a particularly importance for the quick and accurate determination of the diagnose and for the establishing, together with the infectious disease physician, of the appropriate treatment. Working with the department of epidemiology is useful to define the preventive measures among the community.