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Doughty J, Tran C, Santella AJ, Fitzgerald R, Burns F, Porter S, Watt RG. Point of care HIV testing in dental settings in high-income countries: A mixed-methods systematic review. Community Dent Oral Epidemiol 2024. [PMID: 38822596 DOI: 10.1111/cdoe.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVES Expanding HIV testing beyond specialized services has been a key strategic approach to eliminating the transmission of HIV. In recent years, dental settings have been identified as offering an opportunity for delivering point of care HIV testing (POCT) interventions. Intervention components and implementation strategies have varied across studies and there is uncertainty about the prevalence of undiagnosed HIV in the dental patient population. Therefore, this systematic review aimed to synthesize the HIV testing outcomes of intervention studies, identify the core components of POCT interventions implemented in dental settings; and understand the barriers and facilitators to intervention implementation. METHODS A mixed-methods systematic review was undertaken. Two authors reviewed abstracts and full papers for inclusion and appraised the studies using the Mixed Methods Appraisal Tool. A convergent integrated mixed methods study design underpinned the synthesis. Outcomes were presented using descriptive statistics. Intervention components were mapped to the Template for Intervention Description and Replication (TIDieR) checklist. Barriers and facilitators were described using a narrative thematic analysis. RESULTS POCT was offered to 22 146 dental patients, 62.5% accepted POCT. Intervention studies that reported higher uptake of testing utilized a dedicated dental or researcher staff member to provide testing, integrated testing and provided results within the routine dental appointment and adopted a provider-initiated universal approach to offering testing. Six themes emerged that were pertinent to the barriers and facilitators to HIV testing in dental setting. CONCLUSIONS POCT uptake in dental settings was comparable with other non-specialized health settings. Key to the operationalization of the intervention were perceptions about its value and relevance to the dental patient population, attitudes toward the intervention, logistical barriers to its implementation, the risk of HIV testing stigma to the patient-practitioner relationship and maximising the fit of the intervention within the constraints of the dental setting.
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Affiliation(s)
- J Doughty
- Department of Epidemiology & Public Health, Faculty of Pop Health Sciences, University College London, London, UK
- School of Dentistry, University of Liverpool
| | - C Tran
- Oral and Maxillofacial Surgery department, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - A J Santella
- Marion Peckham Egan School of Nursing & Health Studies, Fairfield University, Fairfield, Connecticut, USA
| | - R Fitzgerald
- Department of Special Care Dentistry, Surrey and Sussex Healthcare Trust
| | - F Burns
- Institute for Global Health, University College London, London, UK
| | - Stephen Porter
- Eastman Dental Institute, Faculty of Medical Sciences, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology & Public Health, Faculty of Pop Health Sciences, University College London, London, UK
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2
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Santella AJ. HIV testing in the dental setting: A global perspective of feasibility and acceptability. Oral Dis 2020; 26 Suppl 1:34-39. [PMID: 32862538 DOI: 10.1111/odi.13388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HIV is no longer a death sentence with early diagnosis and effective treatment contributing to a good prognosis. Surveillance data, however, suggest that one in four people globally living with HIV are unaware of their HIV infection and remains at risk of transmitting their infection if having unprotected sex. A wider array of testing opportunities and settings are thus needed to address this issue of public health significance. Evidence suggests there is a role for the dental team, particularly dentists, in offering chairside point-of-care HIV screening to patients during their dental appointments. Dentists, dental hygienists, and other members of the dental team may still have a role in helping to identify new cases of HIV with the goal of improving health outcomes, addressing health inequalities and improving the quality and quantity of life. This paper reviews the global epidemiology of HIV/AIDS, summarizes the point-of-care HIV testing process, highlights key findings of international studies (from high-, middle-, and low-income countries) on the role of dental professionals in point-of-care HIV testing, and offers suggestions for what additional evidence is needed to make point-of-care HIV testing a routine part of dental care.
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Affiliation(s)
- Anthony J Santella
- Department of Health Professions, Hofstra University, Hempstead, NY, USA
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3
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Riddle MW. HIV screening in dental settings: Challenges, opportunities, and a call to action. Oral Dis 2020; 26 Suppl 1:9-15. [PMID: 32862545 DOI: 10.1111/odi.13468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/19/2020] [Accepted: 06/09/2020] [Indexed: 01/03/2023]
Abstract
HIV is responsible for tremendous suffering and loss around the world, but many advances in HIV screening, diagnosis, treatment, and prevention provide hope for an end to the HIV epidemic. Global and national campaigns facilitate access to these HIV advances, but some individuals and communities still lack access, particularly in developing countries. To reach those who remain under-served, campaigns encourage greater integration of HIV services with non-HIV services. As members of the healthcare team with a clinical stake in HIV, dental care providers have a unique contribution to make. Much research on the role of dental care providers in HIV has focused on HIV screening in the dental setting, and researchers have identified possible ways forward but also daunting challenges. Approaches for screening, brief intervention, and referral to treatment used in primary care and dental care settings for other health risks may help overcome challenges related to provider scope of practice and need for training. Approaches to managing distress and uncertainty in other clinical contexts may help overcome challenges related to patient acceptability, equipping providers to manage sensitive topics and emotional aspects of HIV screening. While not panaceas, these approaches may be useful to dental care providers interested in answering the global "call to action" for contributing to ending the HIV epidemic.
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Affiliation(s)
- Melissa Wiseman Riddle
- Division of Extramural Research, Behavioral and Social Sciences Research Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA
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4
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Chung R, Leung SYJ, Abel SN, Hatton MN, Ren Y, Seiver J, Sloane C, Lavigne H, O’Donnell T, O’Shea L. HIV screening in the dental setting in New York State. PLoS One 2020; 15:e0231638. [PMID: 32298336 PMCID: PMC7161960 DOI: 10.1371/journal.pone.0231638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/29/2020] [Indexed: 12/14/2022] Open
Abstract
While primary care providers in New York State (NYS) are mandated to offer all patients a HIV test, still many NYS residents miss the HIV screening opportunity. To fill the gap, and as the CDC recommends, this study aimed to examine the feasibility of implementing HIV screening in dental setting, identify patient characteristics associated with acceptance of HIV rapid testing, and discuss best practices of HIV screening in dental setting. New York State Department of Health (NYSDOH) collaborated with the Northeast/Caribbean AIDS Education and Training Center (NECA AETC) and three dental schools in New York State to offer free HIV screening tests as a component of routine dental care between February 2016 and March 2018. Ten clinics in upstate New York and Long Island participated in the study. HIV screening was performed using the OraQuick™ In-Home HIV Test. 14,887 dental patients were offered HIV screening tests; 9,057 (60.8%) were screened; and one patient (0.011%) was confirmed HIV positive and linked to medical care. Of all dental patients, 33% had never been screened for HIV; and 56% had not had a primary care visit or had not been offered an HIV screening test by primary care providers in the previous 12 months. Multi-level generalized linear modeling analysis indicated that test acceptance was significantly associated with patient's age, race/ethnicity, gender, country of origin, primary payer (or insurance), past primary care visits, past HIV testing experiences, and the poverty level of patient's community. HIV screening is well accepted by dental patients and can be effectively integrated into routine dental care. HIV screening in the dental setting can be a good option for first-time testers, those who have not seen a primary care provider in the last 12 months, and those who have not been offered HIV screening at their last primary care visit.
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Affiliation(s)
- Rakkoo Chung
- New York State Department of Health, AIDS Institute, Albany, New York, United States of America
- * E-mail:
| | - Shu-Yin John Leung
- New York State Department of Health, AIDS Institute, Albany, New York, United States of America
| | - Stephen N. Abel
- School of Dental Medicine, University at Buffalo, Buffalo, New York, United States of America
| | - Michael N. Hatton
- School of Dental Medicine, University at Buffalo, Buffalo, New York, United States of America
| | - Yanfang Ren
- Eastman Institute for Oral Health, University of Rochester, Rochester, New York, United States of America
| | - Jeffrey Seiver
- School of Dental Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Carol Sloane
- School of Dental Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Howard Lavigne
- Northeast/Caribbean AIDS Education and Training Center, Syracuse, New York, United States of America
| | - Travis O’Donnell
- New York State Department of Health, AIDS Institute, Albany, New York, United States of America
| | - Laura O’Shea
- New York State Department of Health, AIDS Institute, Albany, New York, United States of America
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Irarrázabal LP, Levy JA, Cianelli R, Norr KF, Issel LM, Pérez CM. Chilean Health Care Providers' Perceived Comfort in Performing Oral Rapid Testing for HIV: A Cross-Sectional Study. HISPANIC HEALTH CARE INTERNATIONAL 2020; 18:191-197. [PMID: 31906721 DOI: 10.1177/1540415319896249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To understand key factors influencing Chilean health care providers' perceived comfort performing oral rapid HIV testing. DESIGN One hundred and fifty health care providers completed a self-administered questionnaire that included a five-item scale measuring self-perceived comfort in conducting HIV pretest counseling, oral rapid testing, finger-prick testing, and delivering test results. RESULTS Most participants (60%) envisioned good overall comfort performing oral rapid HIV testing (mean score of 16.21; range 0-20), including doing at least four of the five steps. They perceived least comfort delivering HIV-positive test results during posttest counseling. HIV stigmatizing attitudes reduced self-perceived comfort. CONCLUSIONS Providing training to counter HIV stigmatization while increasing comfort in performing oral rapid testing would help facilitate its successful implementation.
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Affiliation(s)
| | - Judith A Levy
- 14681University of Illinois at Chicago, Chicago, IL, USA
| | - Rosina Cianelli
- 28033Pontifícia Universidad Católica de Chile, Santiago, Chile.,14681University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Carlos M Pérez
- 28033Pontifícia Universidad Católica de Chile, Santiago, Chile
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Feng I, Brondani M, Chong KL, Donnelly L. Evaluating Point-of-Care HIV Screening in Dental Hygiene Education Settings: Patient, Faculty, and Student Perspectives. J Dent Educ 2018; 82:819-827. [PMID: 30068770 DOI: 10.21815/jde.018.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 01/08/2018] [Indexed: 11/20/2022]
Abstract
Although HIV screening is needed at a wider range of sites, dentists have shown reluctance to incorporate screening in their practices, but dental hygiene settings may be better suited for such screenings. The aim of this mixed-methods study was to determine the feasibility and acceptability of point-of-care (POC) HIV screening in dental hygiene education community settings from the patient, faculty, and student perspectives. After training, dental hygiene students and faculty at a Canadian dental school offered POC HIV screening to patients as part of routine dental hygiene care over 36 weeks at four sites in 2015-16. Of the 199 patients offered screening, 78 agreed; no positive results were found. Of the 199 patients, 97 completed an 11-item survey (49% response rate), with 80 (82%) agreeing HIV screening was within the scope of practice of a dental professional. Of the 57 patients who were screened, 48 (84%) agreed POC HIV screening should be part of regular dental check-ups, and 52 (91%) perceived dental settings were appropriate sites for screening. The main reasons for patients' agreeing to screening were that it was free and convenient and the results were delivered quickly. Those who refused screening had been tested recently or did not perceive themselves at risk for HIV. In two focus groups with 12 dental hygiene students, one focus group with five faculty members, and individual interviews with five other faculty members, participants agreed on the importance of offering POC HIV screening in the dental setting as a public health service. Faculty members thought students were well prepared and increased in confidence with testing. Students expressed a desire to offer screening throughout their careers and to educate patients about the importance of HIV testing.
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Affiliation(s)
- Iris Feng
- Iris Feng, BDSc, is a graduate student, Faculty of Dentistry, University of British Columbia; Mario Brondani, DDS, MSc, MPH, PhD, is Associate Professor, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia; Kerri-Lyn Chong, BHSc, is a senior DMD student, Faculty of Dentistry, University of British Columbia; and Leeann Donnelly, BDSc, MSc, PhD, is Assistant Professor, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia
| | - Mario Brondani
- Iris Feng, BDSc, is a graduate student, Faculty of Dentistry, University of British Columbia; Mario Brondani, DDS, MSc, MPH, PhD, is Associate Professor, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia; Kerri-Lyn Chong, BHSc, is a senior DMD student, Faculty of Dentistry, University of British Columbia; and Leeann Donnelly, BDSc, MSc, PhD, is Assistant Professor, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia
| | - Kerri-Lyn Chong
- Iris Feng, BDSc, is a graduate student, Faculty of Dentistry, University of British Columbia; Mario Brondani, DDS, MSc, MPH, PhD, is Associate Professor, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia; Kerri-Lyn Chong, BHSc, is a senior DMD student, Faculty of Dentistry, University of British Columbia; and Leeann Donnelly, BDSc, MSc, PhD, is Assistant Professor, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia
| | - Leeann Donnelly
- Iris Feng, BDSc, is a graduate student, Faculty of Dentistry, University of British Columbia; Mario Brondani, DDS, MSc, MPH, PhD, is Associate Professor, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia; Kerri-Lyn Chong, BHSc, is a senior DMD student, Faculty of Dentistry, University of British Columbia; and Leeann Donnelly, BDSc, MSc, PhD, is Assistant Professor, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia
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Elizondo JE, Treviño AC, Violant D, Rivas-Estilla AM, Álvarez MM. Hombres que tienen sexo con hombres y detección del virus de la inmunodeficiencia humana en odontología. GACETA SANITARIA 2018. [DOI: 10.1016/j.gaceta.2017.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Bradley ELP, Vidot DC, Gaul Z, Sutton MY, Pereyra M. Acceptability of oral rapid HIV testing at dental clinics in communities with high HIV prevalence in South Florida. PLoS One 2018; 13:e0196323. [PMID: 29702677 PMCID: PMC5922539 DOI: 10.1371/journal.pone.0196323] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/11/2018] [Indexed: 11/19/2022] Open
Abstract
Background Expanding HIV screening for populations at risk necessitates testing in nontraditional settings. We assessed HIV testing in dental clinics in South Florida, an urban area with the highest rates of HIV diagnoses in the United States in 2015. Aims We explored patients’ acceptance of oral HIV rapid tests administered by dental providers and identified reasons for accepting or declining HIV testing. Methods During 2014 and 2015, dentists and hygienists at two federally qualified health center (FQHC) dental clinics who serve racial/ethnic minority patient populations in South Florida were trained to administer oral HIV rapid tests as a part of a routine dental visit. Patients presenting for dental services were offered a rapid HIV test and brief survey regarding their demographics, HIV testing history and behaviors. Results We enrolled 600 patients (median age = 43 years; IQR: 29–56 years), 45% non-Hispanic black and 35% Hispanic/Latino, 83% graduated high school, and 50% unemployed. Most (85%) accepted oral HIV rapid testing (none tested HIV-positive); 14% had never been tested for HIV. The most common reasons for testing were a desire to know HIV status (56%) and free testing (54%). Among 93 (15%) patients who declined testing, 58% were tested recently and 31% felt confident that they were HIV-negative; however, 74 (80%) who declined testing said they would feel comfortable discussing HIV prevention with their dentist. Additionally, 290 of 600 patients (48%) reported condomless vaginal or anal sex in the past 6 months. Further, among 119 patients who had condomless sex with an HIV-positive partner and/or one whose HIV status was unknown, 98 (82%) accepted the oral HIV test. Conclusion Dental clinics may provide expanded opportunities for oral HIV rapid testing and conversations about HIV prevention in high HIV prevalence communities.
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Affiliation(s)
- Erin L. P. Bradley
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Denise C. Vidot
- School of Nursing and Health Studies, University of Miami, Miami, FL, United States of America
| | | | - Madeline Y. Sutton
- Division of HIV/AIDS Prevention, National Centers for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Margaret Pereyra
- Sociomedical Sciences at the Columbia University Medical Center, Columbia University, New York, NY, United States of America
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Parish CL, Siegel K, Liguori T, Abel SN, Pollack HA, Pereyra MR, Metsch LR. HIV testing in the dental setting: perspectives and practices of experienced dental professionals. AIDS Care 2017; 30:347-352. [PMID: 28819982 DOI: 10.1080/09540121.2017.1367087] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The dental setting is a largely untapped venue to identify patients with undiagnosed HIV infection. Yet, uptake of rapid HIV testing within the dental community remains low. This study sought to better understand the experiences of dental professionals who have administered the test and how these experiences might inform efforts to promote greater uptake of rapid HIV testing in dental settings. Qualitative interviews were conducted with United States dentists (N = 37) and hygienists (N = 5) who offered rapid HIV testing in their practices. The data revealed both the impeding and facilitating factors they experienced in implementing testing in their setting, as well as the reactions of their staff, colleagues, and patients. Overall, participants viewed rapid HIV testing favorably, regarding it as a valuable public health service that is simple to administer, generally well accepted by patients and staff, and easily integrated into clinical practice. Many had experience with a reactive test result. Participants described facilitating factors, such as supportive follow-up resources. However, they also cited persistent barriers that limit acceptance by their dental colleagues, including insufficient reimbursement and perceived incompatibility with scope of practice. The widespread adoption of routine HIV testing amongst dental professionals will likely require an expanded notion of the proper scope of their professional role in overall patient health, along with greater support from national dental organizations, dental education, and dental insurance companies, especially in the form of sufficient reimbursement.
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Affiliation(s)
- Carrigan L Parish
- a Department of Sociomedical Sciences , Columbia University, Miami Research Center, Mailman School of Public Health , Miami , FL , USA
| | - Karolynn Siegel
- b Department of Sociomedical Sciences , Columbia University, Mailman School of Public Health , New York , NY , USA
| | - Terri Liguori
- a Department of Sociomedical Sciences , Columbia University, Miami Research Center, Mailman School of Public Health , Miami , FL , USA
| | - Stephen N Abel
- c School of Dental Medicine , University at Buffalo , Buffalo , NY , USA
| | - Harold A Pollack
- d School of Social Service Administration , University of Chicago , Chicago , IL , USA
| | - Margaret R Pereyra
- a Department of Sociomedical Sciences , Columbia University, Miami Research Center, Mailman School of Public Health , Miami , FL , USA
| | - Lisa R Metsch
- b Department of Sociomedical Sciences , Columbia University, Mailman School of Public Health , New York , NY , USA
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10
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Abstract
Recent evidence suggests there is a role for the dental team, particularly dentists, in offering chairside HIV screening to patients during dental appointments. HIV is no longer a death sentence with early diagnosis and effective treatment contributing to a good prognosis. Despite the availability of both venipuncture diagnostic and rapid saliva/finger prick screening tests for HIV infection, 25% of people living with HIV in the United Kingdom are undiagnosed and remain at risk of transmitting their infection if having unprotected sex. This paper highlights the international evidence that supports dentists' willingness to conduct HIV screening and dental patient acceptance, and explores whether this is an opportunity or a step too far.
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Abstract
Tooth wear is a condition that affects a substantial cohort of dental patients. It has a measurable impact on patients' satisfaction, and overall quality of life. Recently, with growing evidence, our understanding of the aetiology, progression, and management of tooth wear has evolved. The paper argues that pathological tooth wear should not be solely considered as a dental condition, but rather a dental manifestation of other mental and medical disorders. As such, successful management of tooth wear, and its underlying aetiology, requires a holistic, multidisciplinary management approach, involving dental, medical, and mental healthcare providers.
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Affiliation(s)
- Khaled E Ahmed
- Operative/Conservative Dentistry University of Hong Kong Faculty of Dentistry
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12
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Greenberg BL, Kantor ML, Bednarsh H. American dental hygienists' attitudes towards chairside medical screening in a dental setting. Int J Dent Hyg 2016; 15:e61-e68. [PMID: 27021627 DOI: 10.1111/idh.12217] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Targeted screening for medical conditions in a dental setting can be an effective strategy for early identification of individuals at increased disease risk. Dentists, patients and physicians have a favourable attitude towards this strategy. Given that dental hygienists (DHs) are involved in preventive and educational activities, this seems like a natural extension to their roles. We report on the attitudes of American DHs towards chairside medical screening. METHODS A 5-point Likert scale (1 = very important/willing, 5 = very unimportant/unwilling) survey was mailed to a nationwide random sample of US practicing DHs. Descriptive statistics were used for all questions, and the Friedman nonparametric analysis of variance was used for multi-element questions. RESULTS A total of 3133 respondents returned the completed questionnaires for an effective response rate of 49.2% and a margin of error 1.8%. The majority of respondents felt it was important to perform/conduct chairside screening for hypertension (94%), diabetes mellitus (89%), cardiovascular disease (85%), HIV (79%) and hepatitis infection (78%); were willing to refer a patient for medical consult (94%), conduct screening that yields immediate results (85%); and were willing to collect the data/samples needed (57-95%). The most important considerations were dentist/owner support (98%), training (97%), patient willingness (98%) and time (98%). CONCLUSION Similar to dentists, physicians and patients, the majority of the DHs had a favourable attitude towards chairside medical screening. Integrating the DH into screening activities is likely to require additional training and education regarding the diseases of interest, something that could be accomplished through continuing education courses and eventually incorporation into the educational curriculum.
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Affiliation(s)
- B L Greenberg
- School of Health Science and Practice, New York Medical College, Valhalla, NY, USA
| | - M L Kantor
- Institute for Health Sciences, University of Wisconsin-Eau Claire, Eau Claire, WI, USA
| | - H Bednarsh
- HIV Dental Ombudsperson Program, HIV/AIDS Services Division, Boston Public Health Commission, Boston, MA, USA
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Abstract
The United States is currently experiencing a primary care shortage. One solution to improving health care is to increase the utilization of existing health care providers, particularly dentists, an opportunity that has been largely ignored. By employing mid-level providers for less complex procedures to deliver more accessible dental care at lower cost, dentists can redistribute tasks to their office workforce. They can then serve as oral physicians who can provide limited preventive primary care, including screening for chronic diseases, while continuing to oversee all dental care, whether provided by dentists or non-dentists. Thus, they could improve the health of the US population as well as increase access to dental care at lower cost, while partially alleviating the primary care shortage by filling a need for the screening aspects of primary care.
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Pollack HA, Pereyra M, Parish CL, Abel S, Messinger S, Singer R, Kunzel C, Greenberg B, Gerbert B, Glick M, Metsch LR. Dentists' willingness to provide expanded HIV screening in oral health care settings: results from a nationally representative survey. Am J Public Health 2014; 104:872-80. [PMID: 24625163 DOI: 10.2105/ajph.2013.301700] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Using a nationally representative survey, we determined dentists' willingness to provide oral rapid HIV screening in the oral health care setting. METHODS From November 2010 through November 2011, a nationally representative survey of general dentists (sampling frame obtained from American Dental Association Survey Center) examined barriers and facilitators to offering oral HIV rapid testing (n = 1802; 70.7% response). Multiple logistic regression analysis examined dentists' willingness to conduct this screening and perceived compatibility with their professional role. RESULTS Agreement with the importance of annual testing for high-risk persons and familiarity with the Centers for Disease Control and Prevention's recommendations regarding routine HIV testing were positively associated with willingness to conduct such screening. Respondents' agreement with patients' acceptance of HIV testing and colleagues' improved perception of them were also positively associated with willingness. CONCLUSIONS Oral HIV rapid testing is potentially well suited to the dental setting. Although our analysis identified many predictors of dentists' willingness to offer screening, there are many barriers, including dentists' perceptions of patients' acceptance, that must be addressed before such screening is likely to be widely implemented.
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Affiliation(s)
- Harold A Pollack
- Harold A. Pollack is with the School of Social Service Administration, University of Chicago, Chicago, IL. At the time of the study, Margaret Pereyra, Richard Singer, and Lisa R. Metsch were with the Department of Epidemiology and Public Health, and Shari Messinger was with the Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL. Carrigan L. Parish is with the Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY. At the time of the study, Stephen Abel was with Nova Southeastern College of Dental Medicine, Fort Lauderdale, FL. Carol Kunzel is with the Division of Behavioral Science, Columbia University College of Dental Medicine, New York, NY. At the time of the study, Barbara Greenberg was with the Departments of Diagnostic Sciences and Community Health, University of Medicine and Dentistry of New Jersey, Newark. Barbara Gerbert is with the Center for Health Improvement and Prevention Studies, University of California, San Francisco. Michael Glick is with the University at Buffalo School of Dental Medicine, Buffalo, NY
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