Inter-rater reliability of the Oral Assessment Guide for oral cancer patients between nurses and dental hygienists: the difficulties in objectively assessing oral health

Image diagnosis models for the oral assessment of older people using convolutional neural networks: A retrospective observational study

AIMS

The purpose of this study was to construct a model for oral assessment using deep learning image recognition technology and to verify its accuracy.

BACKGROUND

The effects of oral care on older people are significant, and the Oral Assessment Guide has been used internationally as an effective oral assessment tool in clinical practice. However, additional training, education, development of user manuals and continuous support from a dental hygienist are needed to improve the inter-rater reliability of the Oral Assessment Guide.

DESIGN

A retrospective observational study.

METHODS

A total of 3,201 oral images of 114 older people aged >65 years were collected from five dental-related facilities. These images were divided into six categories (lips, tongue, saliva, mucosa, gingiva, and teeth or dentures) that were evaluated by images, out of the total eight items that comprise components of the Oral Assessment Guide. Each item was classified into a rating of 1, 2 or 3. A convolutional neural network, which is a deep learning method used for image recognition, was used to construct the image recognition model. The study methods comply with the STROBE checklist.

RESULTS

We constructed models with a classification accuracy of 98.8% for lips, 94.3% for tongue, 92.8% for saliva, 78.6% for mucous membranes, 93.0% for gingiva and 93.6% for teeth or dentures.

CONCLUSIONS

Highly accurate diagnostic imaging models using convolutional neural networks were constructed for six items of the Oral Assessment Guide and validated. In particular, for the five items of lips, tongue, saliva, gingiva, and teeth or dentures, models with a high accuracy of over 90% were obtained.

RELEVANCE TO CLINICAL PRACTICE

The model built in this study has the potential to contribute to obtain reproducibility and reliability of the ratings, to shorten the time for assessment, to collaborate with dental professionals and to be used as an educational tool.

Oral Health Management and Rehabilitation for Patients with Oral Cancer: A Narrative Review

Surgery is the current first choice for oral cancer treatment. Intensity-modulated radiation therapy, molecular targeted drugs, and immune checkpoint inhibitors are still used as adjuvant therapy for advanced cancer. In addition, postoperative rehabilitation and multidisciplinary treatment have also been developed in recent years. Multidisciplinary team approaches and supportive care in oral cancer treatment reportedly shorten the time to treatment and improve outcomes. Although there is enough evidence confirming the role of oral and maxillofacial surgeons, dentists, and dental hygienists in supportive care in oral cancer treatment, there are very few systematic studies. In particular, oral health management is a concept that encompasses oral function management, oral hygiene management, and oral care during oral cancer treatment. We provide a narrative review focusing on oral health management from a multidisciplinary and supportive care perspective, applicable in oral cancer treatment.

Effectiveness of green tea mouthwash for improving oral health status in oral cancer patients: A single-blind randomized controlled trial

BACKGROUND

Painful oral mucositis or trismus, caused by cancer therapy, reduces patients' willingness to maintain basic oral hygiene and eventually results in a poor oral health status. Using mouth rinses and cleaning the tongue are popular ways to improve the oral health status.

OBJECTIVES

To evaluate the effectiveness of green tea mouthwash for improving the oral health status in oral cancer patients undergoing cancer treatment.

DESIGN

This was a prospective, single-blind, randomized, controlled trial.

SETTINGS

Patients were recruited from a major regional teaching hospital that provides specialist cancer care services in Chia-Yi, Taiwan, from July 2018 to June 2020.

PARTICIPANTS

A total of 63 patients met the following criteria: > 20 years old; newly diagnosed with oral cancer by a physician; treated with oral surgery within one month prior; and completion of follow-up, with or without chemotherapy or radiation therapy. The exclusion criteria were mental illness; an acute and severe illness; complete edentulism; and inability to open the mouth more than 1 cm.

METHODS

Patients were randomly assigned to 2 groups: the mouthwash with green tea (intervention) group or the tap water (control) group. After each teeth-brushing procedure, those in the intervention group rinsed the mouth with 100 ml of a green tea solution for 60 seconds, and those in the control group rinsed the mouth with 100 ml of tap water for 60 seconds. The primary outcome was the oral health status, which was evaluated according to the Oral Assessment Guide and measured at baseline and at every monthly outpatient follow-up until six months by the same nurse.

RESULTS

There were 31 subjects in the intervention group and 30 subjects in the control group in the final analysis. The results of t-test showed that compared with baseline, the improvement in the oral health status in the intervention group was significantly better than that in the control group at 4 months after the intervention began. At 4 to 6 months after the intervention began, the oral health status score in the intervention group significantly decreased, by 1.71, 2.97 and 2.93 points, respectively, compared with that in the control group.

CONCLUSIONS

The oral health status can be improved and maintained for a long time with the continuous use of green tea mouthwash. Green tea mouthwash is a simple, natural, effective and safe intervention that should be recognized as a nonpharmacological treatment option for protecting the oral mucosa.

TRIAL REGISTRATION

clinicaltrials.gov identifier NCT04615780.

Quality of life of Japanese elderly oral cancer patients during the perioperative period

Japan's aging society has an increasing incidence of oral cancer. This study investigated perioperative changes in quality of life (QoL) among 172 oral cancer patients (elderly ≥75 years vs non-elderly <75 years), pre-treatment, at treatment completion, and at 1, 3, and 6 months post-treatment, using the following Functional Assessment of Cancer Therapy - Head and Neck (FACT-H&N) subscales: physical well-being (PWB), social/family well-being (SWB), emotional well-being (EWB), functional well-being (FWB), additional head- and neck-specific concerns (H&N). SWB (P=0.026), H&N (P=0.024), and total FACT-H&N (P=0.009) scores were significantly lower in the elderly group than in the non-elderly group at 6 months post-treatment, especially for mastication items (H&N1, P=0.047; H&N11, P=0.004), but not for swallowing items (H&N5 and H&N7, both P> 0.05). PWB (P= 0.004), EWB (P< 0.001), and FWB (P= 0.022) scores in the non-elderly group were significantly higher at 6 months post-treatment than before treatment. In the elderly group, no subscale showed a better score at 6 months post-treatment. Post-treatment QoL in elderly oral cancer patients did not improve, unlike in non-elderly patients.

Factors associated with nurses' performance of oral assessments and dental referrals for hospital inpatients

BACKGROUND

Nurses' oral assessment and dental referral performance for inpatients are important to provide appropriate oral care services in hospitals. The purpose of this study was to investigate the knowledge, attitudes, and performance of oral assessments and dental referrals for their inpatients among nurses and to identify factors associated with that performance to promote oral health care in hospitals.

METHODS

All nurses (n = 919) who worked at five hospitals in Japan were recruited as responders. A questionnaire regarding their performance of oral assessments and dental referrals was distributed to the subjects in each hospital. The data were collected from August 2018 to September 2018.

RESULTS

A total of 757 (82.4%) nurses (82 males and 675 females) responded to the questionnaire. With respect to each of the 8 oral assessment categories, 16.2-41.2% of the nurses performed oral assessments for more than 50% of their inpatients, and 20.3-29.9% had encouraged more than one inpatient to see a dentist within the previous 3 months. Significant differences were found by ward and hospital in their performance of oral assessments for inpatients. Additionally, their oral assessment performance, knowledge of the usage of oral assessment tools, wards, and hospitals were significantly associated with their dental referral performance.

CONCLUSIONS

The performance of oral assessment and dental referral was not developed sufficiently in the hospitals. Thus, oral health professionals should support oral assessment education for nurses, including usage of assessment tools, to promote dental referral by nurses. These results may contribute to promotion of dental referral performance by nurses and provision of oral health care by oral health professionals for hospital inpatients.

Oral health-related quality of life and oral hygiene condition in patients with maxillofacial defects: A retrospective analysis

PURPOSE

The purpose of this study was to evaluate the effect of oral rehabilitation (maxillofacial prosthetic intervention and oral hygiene instruction) on oral health-related Quality of Life (OHRQoL) and oral hygiene condition in patients with maxillofacial defects and to explore the correlation between them in these patients.

METHODS

Twenty-five patients with maxillofacial defects who had been treated since April 2016 to March 2018 were included in this study. The scores of the Oral Health Impact Profile (OHIP) and O'Leary's Plaque Control Record (PCR) were also identified as the scores of OHRQoL and oral hygiene condition, respectively. Statistical analyses were performed to compare between the scores of "pre" and "post" prosthetic treatment and to evaluate patient-related factors influencing these variables (age, the number of residual teeth and occlusal supports, and occlusal units (OUs)). The effect of combined chemo-radiotherapy (CRT) on each score was also assessed statistically. Furthermore, the correlation of OHIP and PCR scores was explored statistically.

RESULTS

Both oral rehabilitations could significantly improve OHIP and PCR scores. Significant correlations of the change of OHIP scores with age and OUs were detected. CRT had no significant effect on OHIP and PCR scores. No correlations between OHIP and PCR were observed.

CONCLUSIONS

Although oral rehabilitation such as maxillofacial prosthetic treatment and oral hygiene instruction would be highly effective for improvement of OHRQoL and oral hygiene condition in patients with maxillofacial defects, there was no correlation between them.

Relationship between Oral Assessment Guide score and hypoalbuminemia in newly hospitalized patients

This cross-sectional study investigated the relationship between Oral Assessment Guide (OAG) scores and malnutrition in newly hospitalized patients. A total of 880 hospitalized adults were enrolled. Hypoalbuminemia was defined as serum albumin less than 3.5 g/dL. Patients with hypoalbuminemia were older (P < 0.001), had a higher prevalence of respiratory diseases (P < 0.01), a higher prevalence of digestive diseases (P < 0.01), a lower prevalence of oral feeding (P < 0.001), a lower body mass index (P < 0.001), and higher OAG scores (P < 0.001) than those without hypoalbuminemia. Multivariate logistic regression analyses showed that the prevalence of hypoalbuminemia was significantly related to age (odds ratio [OR] = 1.05, P < 0.001), absence of oral feeding (OR = 2.72, P < 0.001), presence of respiratory diseases (OR = 2.53, P < 0.01), presence of digestive diseases (OR = 1.64, P < 0.01), and OAG scores (OR = 1.14, P < 0.01). Regarding OAG scores, the OR of hypoalbuminemia was greater in patients with disorders (scores 2 or 3) of swallowing (vs. score 1, OR = 1.83, P < 0.05) and saliva (vs. score 1, OR = 1.51, P < 0.05). There appears to be a positive association between OAG scores and hypoalbuminemia in hospitalized patients.

Effect of interprofessional education on oral assessment performance of nursing students

Objectives

The purpose of this study was to investigate the effect of interprofessional educational programmes on the improvement of nursing students' oral assessment performances by comparing their attitudes, confidence, abilities, and self‐performance before and after the education.

Materials and methods

The subjects included 112 first‐year nursing students in a Japanese nursing school. They participated in the oral assessment educational programmes, which were supported by dentists and introduced into the 1‐year curriculum. The first programme was a 1.5‐hr lecture with a self‐oral assessment training in May 2018, and the second was a 1‐hr oral assessment training in October 2018. The questionnaire surveys investigating nursing students' attitudes, confidence, and self‐performance regarding oral assessment and the tests measuring their oral assessment abilities were conducted before and after the programmes. The total scores on the tests were 0–9 points.

Results

A total of 101 (90.2%) nursing students responded to all the questionnaires and tests. Their attitudes and confidence regarding oral assessment were significantly improved after the programmes. The total average scores on the tests were significantly increased from 6.8 points at baseline to 7.9 points after the programmes. The percentage of their performance of self‐oral assessment every day significantly increased from 15.8% at baseline to 32.7% after the programmes.

Conclusions

These results suggested that the educational programme might be effective in improving not only the students' attitudes and confidence regarding oral assessment but also their oral assessment abilities and self‐oral assessment performance. Therefore, future programmes must focus on training them to improve oral health care referrals.

Oral Hygiene Care in Patients With Advanced Disease: An Essential Measure to Improve Oral Cavity Conditions and Symptom Management

BACKGROUND

Oral problems are frequent in palliative care and can cause disabling symptoms such as orofacial pain, dysgeusia, and xerostomia. Even if oral care is an essential aspect of nursing, it is often not considered as a priority, especially when various complex patients' needs have to be managed.

OBJECTIVE

The aim of this study was to describe oral conditions and evaluate the impact of standard oral care on symptom control and patient's perceived comfort in a sample of terminally ill patients.

METHOD

A prospective cohort study was carried out among 415 patients who were admitted to hospice. Patients were recruited before undergoing standard assisted procedure for oral hygiene care. Oral cavity condition, symptoms, and comfort were assessed at the recruitment (T0) and after 3 days (T2).

RESULTS

Seventy-five eligible patients were recruited. The Oral Assessment Guide score was significantly decreased after oral standard care (P value <.0001). The average time spent by nursing staff for oral hygiene care was 5.3 minutes. Dysgeusia and xerostomia were significantly decreased after oral standard care (P = .02 and P = .03). Patients reported a high level of comfort (86.6%) after the procedures for oral hygiene care.

CONCLUSION

Patients admitted to hospice had frequent alterations in oral cavity with partial loss of its functions that can compromise their quality of life. Standard procedures for oral hygiene care are simple and fast to perform, and they may improve oral cavity conditions, symptoms control, and patients' comfort.