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Borgnakke WS. Current scientific evidence for why periodontitis should be included in diabetes management. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 4:1257087. [PMID: 38274772 PMCID: PMC10809181 DOI: 10.3389/fcdhc.2023.1257087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024]
Abstract
This Perspective provides a brief summary of the scientific evidence for the two-way links between periodontal diseases and hyperglycemia (diabetes mellitus [DM] and pre-DM). It delivers in a nutshell current scientific evidence for manifestations of hyperglycemia on periodontal health status and effects of periodontal diseases on blood glucose levels and in turn incidence, progression, and complications of diabetes. Of outmost importance is presentation of scientific evidence for the potential of routine periodontal treatment to lower blood glucose levels, providing a novel, economical tool in DM management. Non-surgical periodontal treatment ("deep cleaning") can be provided by dental hygienists or dentists in general dental offices, although severe cases should be referred to specialists. Such therapy can decrease the costs of DM care and other health care costs for people with DM. The great importance of a healthy oral cavity free of infection and subsequent inflammation - especially periodontitis that if untreated will cause loosening and eventually loss of affected teeth - has largely gone unnoticed by the medical community as the health care curricula are largely void of content regarding the bi-directional links between oral health and systemic health, despite elevation of blood glucose levels being an integral part of the general systemic inflammation response. The importance of keeping disease-free, natural teeth for proper biting and chewing, smiling, self-esteem, and pain avoidance cannot be overestimated. Medical and dental professionals are strongly encouraged to collaborate in patient-centered care for their mutual patients with - or at risk for - hyperglycemia.
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Affiliation(s)
- Wenche Sylling Borgnakke
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI, United States
- Department of Periodontics and Preventive Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Davies K, McGowan K, Dover T, McGowan T, Tadakamadla SK. Dental referrals for patients with diabetes: survey of barriers and enablers for medical and health professionals. Aust Dent J 2023; 68:273-281. [PMID: 37676007 DOI: 10.1111/adj.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Oral health care improves diabetes management; however, medical and other health practitioners do not commonly refer their patients with diabetes for oral health care. This study aimed to understand barriers to and enablers of dental referrals for patients with diabetes. METHODS Quantitative data were collected from a cross-sectional survey of health care providers attending a virtual Grand Rounds on the relationship between oral health and diabetes. Attendees were invited to complete and share a Forms survey. Barriers to and enablers of dental referrals were compared for 18 health professionals working in inpatient/ward settings to 23 working in community/primary care settings using the chi-square test. RESULTS Across both work settings, only 12% of respondents often or always discussed the importance of oral health and only 8% often or always referred their patients with diabetes for dental care. Time barriers, awareness and knowledge of how/where to send dental referrals were significant barriers, while online referral pathways, more education and availability of brochures for the patient to take home were identified as key enablers for dental referrals. CONCLUSIONS Online referral pathways, targeted oral health education and resources for medical and health professionals caring for patients with diabetes may increase the number of patients being referred for dental care as part of their diabetes managements. © 2023 Australian Dental Association.
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Affiliation(s)
- K Davies
- West Moreton Oral Health, Queensland Health, Ipswich, Queensland, Australia
- Griffith University, School of Medicine and Dentistry, Gold Coast Campus, Gold Coast, Queensland, Australia
| | - K McGowan
- West Moreton Oral Health, Queensland Health, Ipswich, Queensland, Australia
| | - T Dover
- West Moreton Hospital and Health Service, Queensland Health, Ipswich, Queensland, Australia
| | - T McGowan
- The University of Queensland, School of Dentistry, Herston, Queensland, Australia
- Central Queensland University, School of Health, Rockhampton, Queensland, Australia
| | - S K Tadakamadla
- Dentistry and Oral Health, Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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Berg RL, Glurich I, Panny A, Scannapieco FA, Miecznikowski J, VanWormer J, Acharya A. Modeling longitudinal oral health status and pneumonia risk: secondary data analyses of an integrated dental-medical cohort. BMC Oral Health 2023; 23:950. [PMID: 38041050 PMCID: PMC10690969 DOI: 10.1186/s12903-023-03629-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Mounting evidence indicates potential associations between poor oral health status (OHS) and increased pneumonia risk. Relative pneumonia risk was assessed in the context of longitudinally documented OHS. METHODS Electronic medical/dental patient data captured from 2007 through 2019 were retrieved from the integrated health records of Marshfield Clinic Health Systems. Participant eligibility initiated with an assessment of OHS, stratified into the best, moderate, or worst OHS groups, with the additional criterion of 'no pneumonia diagnosis in the past 90 days'. Pneumonia incidence was longitudinally monitored for up to 1 year from each qualifying dental visit. Models were assessed, with and without adjustment for prior pneumonia incidence, adjusted for smoking and subjected to confounding mitigation attributable to known pneumonia risk factors by applying propensity score analysis. Time-to-event analysis and proportional hazard modeling were applied to investigate relative pneumonia risk over time among the OHS groups. RESULTS Modeling identified associations between any incident pneumonia subtype and 'number of missing teeth' (p < 0.001) and 'clinically assessed periodontal status' (p < 0.01), which remained significant following adjustment for prior pneumonia incidence and smoking. The hazard ratio (HR) for 'any incident pneumonia' in the best OHS group for 'number of missing teeth' was 0.65, 95% confidence interval (CI) [0.54 - 0.79] (unadjusted) and 0.744, 95% CI [0.61 - 0.91] (adjusted). The HR for 'any incident pneumonia' in the best 'clinically assessed periodontal status' group was 0.72, 95% CI [0.58 - 0.90] (unadjusted) and 0.78, 95% CI [0.62 - 0.97] (adjusted). CONCLUSION/CLINICAL RELEVANCE Poor OHS increased pneumonia risk. Proactive attention of medical providers to patient OHS and health literacy surrounding oral-systemic disease association is vital, especially in high-risk populations.
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Affiliation(s)
- Richard L Berg
- Office of Research Computing and Analytics, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Ingrid Glurich
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield, WI, USA.
| | - Aloksagar Panny
- Clinical Informatics, Methodist Health System, Dallas, TX, USA
| | - Frank A Scannapieco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, Foster Hall, Buffalo, NY, USA
| | - Jeffrey Miecznikowski
- Department of Biostatistics School of Public Health and Health Professions, University at Buffalo, Kimball Tower, Buffalo, NY, USA
| | - Jeffrey VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Amit Acharya
- Advocate Aurora Health, 3075 Highland Parkway, Suite 600, Downers Grove, IL, 60515, USA.
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Surlari Z, Ciurcanu OE, Budala DG, Butnaru O, Luchian I. An Update on the Interdisciplinary Dental Care Approach for Geriatric Diabetic Patients. Geriatrics (Basel) 2023; 8:114. [PMID: 38132485 PMCID: PMC10743251 DOI: 10.3390/geriatrics8060114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/14/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Diabetes mellitus is a prevalent health issue escalating worldwide that gives rise to numerous problems. Periodontal disorders are recognized as the sixth consequence associated with diabetes mellitus. Research shows that dental health affects overall health, and this knowledge is changing the dental field. The correct choice of glucose goal levels and the optimal selection of glucose-lowering medications are determined by a comprehensive geriatric assessment, an estimate of life expectancy, and a rationale for therapy at regular intervals in elderly diabetics. This article provides an overview of the correlation between diabetes and oral health, with a specific emphasis on xerostomia, periodontal disease, and dental caries. Thus, dentists play a significant role within the allied health profession by contributing to the provision of oral care for those diagnosed with diabetes, with a special focus on geriatric patients.
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Affiliation(s)
- Zenovia Surlari
- Department of Fixed Prosthodontics, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universității Street, 700115 Iasi, Romania;
| | - Oana Elena Ciurcanu
- Department of Dental Surgery, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania;
| | - Dana Gabriela Budala
- Department of Implantology, Removable Prostheses, Dental Prostheses Technology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitătii Street, 700115 Iasi, Romania
| | - Oana Butnaru
- Department of Biophysics, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Ionut Luchian
- Department of Periodontology, Grigore T. Popa University of Medicine and Pharmacy, Universitatii Street 16, 700115 Iasi, Romania
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Nelson S, Kim E, Kaelber D. Integrating Oral Health into Primary Care: Perspectives for Older Adults. J Dent Res 2023; 102:849-853. [PMID: 37085982 PMCID: PMC10399081 DOI: 10.1177/00220345231165011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Affiliation(s)
- S. Nelson
- Department of Community Dentistry and Population and Quantitative Health Sciences, Case Western Reserve University School of Dental Medicine and School of Medicine, Cleveland, OH, USA
| | - E.G.R. Kim
- Departments of Family Medicine and the Center for Clinical Informatics Research and Education, The Metrohealth System and Case Western Reserve University, Cleveland, OH, USA
| | - D.C. Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Science and the Center for Clinical Informatics Research and Education, The MetroHealth System and Case Western Reserve University, Cleveland, OH, USA
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Gomez FR, Kinsler JJ, Love-Bibbero L, Garell C, Wang Y, Pike NA. Mixed methods evaluation of an oral health education program for pediatric dental, medical and nursing providers. J Dent Educ 2023. [PMID: 36942748 DOI: 10.1002/jdd.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/20/2022] [Accepted: 02/17/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE To evaluate the application of knowledge, attitudes, and skills learned in an oral health education program among pediatric dental and medical residents, and pediatric and family nurse practitioners (PNPs and FNPs). METHODS A mixed methods study design included a year-end online survey and focus groups. Eighty participants completed the survey (94%) and seven focus groups were conducted (n = 69) representing each of the four cohorts in 2020-2022. Analysis of variance was used to assess differences in survey responses by dental/medical specialty. Focus group audio recordings were analyzed using Atlas.ti.22 to identify common themes. RESULTS The program increased knowledge and skills in oral health core competencies and positive attitudes regarding oral health education. All PNPs (100%) and most pediatric medical residents (94%) and FNPs (91%) strongly agreed/agreed that the oral health program led to an increase in screening for early childhood caries, more confidence in applying fluoride varnish and providing oral health anticipatory guidance during patient visits. Most pediatric medical residents, PNPs and FNPS (98%) strongly agreed/agreed that primary care providers should incorporate oral health into their practice and provide referrals to dental professionals as part of well-child visits. CONCLUSIONS The program improved oral health-related knowledge, attitudes and skills among dental and medical primary care providers. Future oral health education programs for health care professionals can use this model to help bridge the gap between dental and primary care and ultimately improve access to preventive oral health care for children and families.
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Affiliation(s)
- Francisco Ramos Gomez
- Division of Pediatric Dentistry and Director of the Pediatric Dentistry Preceptorship Program, School of Dentistry, University of California, Los Angeles, California, USA
| | - Janni J Kinsler
- School of Dentistry, University of California, Los Angeles, California, USA
| | | | - Cambria Garell
- Department of Developmental-Behavioral Pediatrics, University of California, Los Angeles, California, USA
| | - Yan Wang
- Section of Public and Population Health, Division of Oral and Systemic Health Sciences, University of California, Los Angeles, California, USA
| | - Nancy A Pike
- School of Nursing, University of California, Los Angeles, California, USA
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Vernon LT, Teng KA, Kaelber DC, Heintschel GP, Nelson S. Time to integrate oral health screening into medicine? A survey of primary care providers of older adults and an evidence-based rationale for integration. Gerodontology 2022; 39:231-240. [PMID: 34050554 PMCID: PMC9162478 DOI: 10.1111/ger.12561] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/20/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Primary care providers were assessed regarding their training and interest to screen oral conditions in patients ≥55 years old. BACKGROUND Oral health (OH) is an essential component of overall health and can affect systemic health. Medical/dental integration in older adults is underdeveloped. METHODS A brief survey assessed primary care providers' self-reported skills, practices and barriers towards integrating OH screening into adult primary care. Data were collected using Survey Monkey® . Respondents were physicians and advanced practice providers (APPs) working at a large mid-western safety-net hospital. Descriptive statistics, T-tests and Chi-squared tests were reported. RESULTS Eighty-two of 202 participants (41%) completed the survey. Most respondents were female (75%). A majority were physicians (68%); the remainder APPs. All providers (100%) reported OH was important or extremely important to overall health. More physicians (93%) reported not being well-trained to address adult OH issues and perceived less medical-oral health integration in their practice (16%) compared to APPs (P < .05). Time was more of a barrier with APPs (74%), compared to physicians (51%), to integrate OH screening activities (P < .05). Most providers reported other barriers such as inadequate OH training and insurance coverage. Providers endorsed that OH should be assessed frequently (56%) including providing referrals to dentists (77%) and educating patients on oral-systemic issues (63%). More female than male providers endorsed dental referrals and educating patients (P < .05). CONCLUSION Primary care providers embraced greater medical/dental integration for older adults. Instituting OH activities appears to be supported. Future interventions that are feasible in primary care settings are examined.
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Affiliation(s)
- Lance T Vernon
- Veteran Affairs Quality Scholar's Program, Cleveland VA Medical Center, Cleveland, OH, USA
- The MetroHealth System, Cleveland, OH, USA
- Mid-America Health, Columbus, OH, USA
| | - Kathryn A Teng
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Adult Health and Wellness Service line in The MetroHealth System Cleveland, Cleveland, OH, USA
| | - David C Kaelber
- Pediatrics and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
- Center for Clinical Informatics Research and Education, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - Gregory P Heintschel
- Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
- Department of Dental Medicine, The MetroHealth System, Cleveland, OH, USA
| | - Suchitra Nelson
- Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
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Nagarajan R, Panny A, Berg R, Acharya A, Nycz G. Variations in temporal trends in non-traumatic dental condition related emergencies. J Public Health Dent 2022; 82:289-294. [PMID: 35642100 DOI: 10.1111/jphd.12528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 03/25/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study was to investigate temporal trends in non-traumatic dental condition (NTDC) related emergency visits at Emergency Department (ED), urgent care (UC), and at a Federally Qualified Health Center (FQHC) that providing dental services to a mid-sized rural community. METHODS Temporal trends over a 9-year period (2008-2016) in NTDC rates at ED, UC, FQHC and in a region around the FQHC were determined. Statistically significant changes (α = 0.05) in the proportion of NTDC visits between FQHC and UC across each of the time points were investigated. RESULTS Proportion of NTDC ED visits was relatively stable over the study period; whereas those at FQHC exceeded those at UC site beginning 2012 and were significantly (α = 0.05) higher than that of UC subsequently (2015-2016). CONCLUSIONS NTDCs are preventable dental conditions and the care provided in treating NTDCs in emergency settings is palliative and does not address the underlying conditions resulting in poor outcomes. The results presented elucidate the critical role of FQHCs in significantly reducing NTDC visits. These might be precursors to a potential shift in NTDC care seeking behavior and expected to favorably impact oral health outcomes.
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Affiliation(s)
- Radhakrishnan Nagarajan
- Center for Oral-Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Aloksagar Panny
- Center for Oral-Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Richard Berg
- Office for Research Computing Analytics, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Amit Acharya
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, Illinois, USA
| | - Greg Nycz
- Family Health Center of Marshfield Inc., Marshfield, Wisconsin, USA
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Kuwamura Y, Yoshida S, Kurahash K, Sumikawa M, Yumoto H, Uemura H, Matsuhisa M. Effectiveness of a Diabetes Oral Nursing Program Including a Modified Diabetes Oral Health Assessment Tool for Nurses (M-DiOHAT©) : A 12-Month Follow-Up Intervention Study. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:86-96. [PMID: 35466152 DOI: 10.2152/jmi.69.86] [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: 11/14/2022]
Abstract
PURPOSE This study aimed to evaluate the effectiveness of a diabetes oral nursing intervention program for individuals with diabetes. METHODS Fifty-six participants with diabetes underwent a diabetes oral nursing intervention program. The program's effect was evaluated through questionnaires and small interviews. The modified diabetes oral health assessment tool (M-DiOHAT©) was used to assess and educate four factors;oral conditions, behaviors, perceptions and knowledge about diabetes and periodontal disease, and health information-sharing, among participants at baseline, 3, 6, and 12 months later. Primary outcomes included changes in the M-DiOHAT© total scores. Secondary outcomes included scores on the motivation stage of changes in oral health behaviors' scales, dental visits, number of present teeth, hemoglobin A1c (HbA1c), and participants' comments. RESULTS The M-DiOHAT© total score and the motivation stage score significantly improved with the narrative comment of "being motivated to practice oral health behaviors" between the baseline and 12 months later. Eight participants visited the dentist, whereas no differences were observed in the number of present teeth or HbA1c. CONCLUSIONS This program improved participants' M-DiOHAT© total score, motivation stage score, and dental visits. These results suggest the program improved oral health perceptions and behaviors among individuals with diabetes. J. Med. Invest. 69 : 86-96, February, 2022.
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Affiliation(s)
- Yumi Kuwamura
- Department of Women' Health Nursing, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Sumiko Yoshida
- Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kiyoe Kurahash
- Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Masuko Sumikawa
- Department of Nursing, School of Health Sciences, Sapporo Medical University, Hokkaido, Japan
| | - Hiromichi Yumoto
- Department of Periodontology and Endodontology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hirokazu Uemura
- Department of Health and Welfare System, College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
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de Sam Lazaro SL, Karger TR, Despres BR, McPherson RC, Minor EJ. An approach to developing oral health knowledge for allied health students. J Dent Educ 2021; 86:581-591. [PMID: 34850391 DOI: 10.1002/jdd.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/31/2021] [Accepted: 11/12/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Oral health competency-based education approaches have been proposed as a mechanism to address oral health outcomes and equity issues. Recommendations for oral health education for allied health professional students include practices to increase team members' knowledge and skills in the integration of oral health and primary care practice (IOHPCP) initiative's oral health clinical competencies for primary care providers. AIMS This study aimed to examine changes in self-reported knowledge of occupational students in the topics of oral health, the dental profession, and dental healthcare systems following participation in a series of webinars and a community-engaged learning project. MATERIALS AND METHODS This study utilized an oral health education program through webinars and a community-engaged learning project for occupational therapy students. Program evaluation measures were utilized to assess the oral health education activities through self-reported knowledge in oral health topics aligned with IOHPCP domains along with topics identified by the community partner organization. RESULTS Findings demonstrate that asynchronous webinars can increase self-reported knowledge in occupational therapy students. DISCUSSION Recommendations for inclusion of oral health education for allied health students related to knowledge of oral health, the dental profession, and dental healthcare systems are shared. CONCLUSIONS Asynchronous webinars have the potential to increase self-reported oral health knowledge for allied health professionals.
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Affiliation(s)
| | - Taylor R Karger
- Department of Occupational Therapy, St. Catherine University, St. Paul, Minnesota, USA
| | - Brittanee R Despres
- Department of Occupational Therapy, St. Catherine University, St. Paul, Minnesota, USA
| | - Rachel C McPherson
- Department of Occupational Therapy, St. Catherine University, St. Paul, Minnesota, USA
| | - Ellen J Minor
- Department of Occupational Therapy, St. Catherine University, St. Paul, Minnesota, USA
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Shimpi N, Panny A, Glurich I, Chyou PH, Acharya A. Knowledgeability, Attitude and Practice Behaviors of Dental Providers Toward Provisions of Integrated Care Delivery for Patients With Prediabetes/Diabetes: Wisconsin Statewide Survey. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.674178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: To conduct a statewide survey among Wisconsin-based dental providers evaluating current knowledgeability, attitudes and practice behaviors surrounding management of patients with diabetes/prediabetes in the dental setting. The study explored perceptions on feasibility, value, barriers, and current status of integrated care model (ICM) adoption by dental practicesMaterials and Methods: A 32-question paper-based survey was mailed to all licensed dentists and dental hygienists practicing in Wisconsin. The study was conducted over a 4 week period in 2019. The survey instrument was adapted from a previous validated survey and was expanded to include questions on ICM adoption. Content and validity analyses and beta testing were conducted prior to dissemination of the survey. Descriptive statistics and chi-square tests were applied for data analyses. Thematic analyses was performed on open-ended questions.Results: Survey response rate was 12% (N = 854/7,356) representing 41% dentists and 59% dental hygienists. While 68% reported educating patients on oral health-diabetes association, only 18% reported medical consultations to inform dental treatment, and “frequent” (22%) or “occasional” (40%), medical triage. Knowledge-based questions were correctly answered by >70% of participants. While 50% valued chair-side glycemic screening and 85% supported non-invasive chair-side screening to identify at-risk patients,>88% relied on patient-reported diabetic status. Barriers to ICM adoption included time investment (70%), patient activation/cooperation (62%), cost (50%), insurance coverage (50%), infrequent interdisciplinary communication (46%), lack of equipment (33%) and provider (31%).Conclusion: Low rates of ICM adoption, chair-side testing, medical consultation and triage, and need for educational curricula reform were identified.
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Yuen HK, Shultz HL, Davis MM, Vogtle LK. Perspectives of diabetes educators and dental hygienists regarding strategies to improve oral health for people with diabetes. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2021; 28:232-241. [PMID: 35935002 PMCID: PMC9355461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AIMS This study aims to explore the opinions of dental hygienists and diabetes educators on improving oral health for people with diabetes. METHODS Registered dental hygienists (RDHs) and certified diabetes educators (CDEs) who provided written responses to the same open-ended question from two state-wide mailing surveys (one for RDHs and the other for CDEs) "what more can you tell us to help improve oral health for people with diabetes?" were included in this study. The surveys were sent to all RDHs (n=2237) and CDEs (n=250) in the state of South Carolina, United States. RESULTS Of the 1125 valid returned questionnaires from both surveys, 474 provided written responses to this question. Qualitative analysis revealed three main themes from participants' written responses which were: Education (3 subthemes: resources for patients, educate the public, and professional practice resources), interprofessional collaborative care (3 subthemes: role of medical and dental professionals in oral health promotion for people with diabetes, and role of dental and diabetes professional organizations, and companies in the oral healthcare industry), and dental insurance. CONCLUSIONS The three themes that emerged are interrelated indicating that strategies to improve oral health for people with diabetes are multi-faceted.
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Affiliation(s)
- Hon K. Yuen
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL 35294, USA,,Correspondence to: Hon K. Yuen, PhD., OTR/L, Professor and Director of Research, Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL 35294, USA,
| | - Hannah L. Shultz
- Department of Occupational Therapy, School of Health Professions Building, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL 35294
| | - Martin M. Davis
- Department of Occupational Therapy, School of Health Professions Building, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL 35294
| | - Laura K. Vogtle
- Clinical Doctorate in Occupational Therapy, Department of Occupational Therapy, School of Health Professions Building, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL 35294, USA
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Laniado N, Cloidt M, Altonen B, Badner V. Interprofessional Oral Health Collaboration: A Survey of Knowledge and Practice Behaviors of Hospital-Based Primary Care Medical Providers in New York City. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1211-1218. [PMID: 34675748 PMCID: PMC8523314 DOI: 10.2147/amep.s332797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The siloed delivery of oral and medical health care in the United States has contributed to a lack of awareness of the consequences of poor oral health and has hampered effective interprofessional education and collaboration. The aim of this study was to assess the knowledge and practice behaviors of primary care medical providers in an urban safety-net hospital regarding collaboration with dentists and integration of oral health into overall health-care delivery. METHODS A 36-item survey was designed in a web-based platform (Survey Monkey®) and electronically distributed in September 2020 to 181 primary care medical providers (physicians, nurses, physician assistants) within a municipal hospital in the Bronx, New York. The questionnaire included sections on demographics, current practices, oral health knowledge, and opinions regarding interprofessional collaboration. Descriptive statistics and bivariate analyses using the chi-square and Fisher's exact test were performed with a significance level of 0.05. RESULTS The response rate was 66% (119 respondents). The vast majority (80%) reported little or no training in oral health and 85% reported no team experience with oral health professionals. Medical providers' confidence in examining the oral cavity was positively associated with previous additional training (p = 0.001) and with team experience (p = 0.005). The two most commonly reported barriers to willingness to collaborate were lack of formal relationships with dental providers (74%) and competing priorities (69%). CONCLUSION Overall, there is very limited awareness and integration of oral health into the clinical practice of medical providers at this safety-net hospital. However, those providers with previous training and team experience had greater oral health confidence. Given the critical importance of oral health to overall health, increased efforts should be directed to further educate and train medical providers and address barriers to interprofessional care.
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Affiliation(s)
- Nadia Laniado
- Department of Dentistry, Health+Hospitals/Jacobi Medical Center Bronx, New York, NY, 10461, USA
| | - Megan Cloidt
- Department of Dentistry, Health+Hospitals/Jacobi Medical Center Bronx, New York, NY, 10461, USA
| | - Brian Altonen
- Department of Research Administration, Health+Hospitals/Central Office, New York, NY, 10013, USA
| | - Victor Badner
- Department of Dentistry, Health+Hospitals/Jacobi Medical Center Bronx, New York, NY, 10461, USA
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Borgnakke WS, Poudel P. Diabetes and Oral Health: Summary of Current Scientific Evidence for Why Transdisciplinary Collaboration Is Needed. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.709831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This Perspective provides a brief summary of the scientific evidence for the often two-way links between hyperglycemia, including manifest diabetes mellitus (DM), and oral health. It delivers in a nutshell examples of current scientific evidence for the following oral manifestations of hyperglycemia, along with any available evidence for effect in the opposite direction: periodontal diseases, caries/periapical periodontitis, tooth loss, peri-implantitis, dry mouth (xerostomia/hyposalivation), dysbiosis in the oral microbiome, candidiasis, taste disturbances, burning mouth syndrome, cancer, traumatic ulcers, infections of oral wounds, delayed wound healing, melanin pigmentation, fissured tongue, benign migratory glossitis (geographic tongue), temporomandibular disorders, and osteonecrosis of the jaw. Evidence for effects on quality of life will also be reported. This condensed overview delivers the rationale and sets the stage for the urgent need for delivery of oral and general health care in patient-centered transdisciplinary collaboration for early detection and management of both hyperglycemia and oral diseases to improve quality of life.
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Shimpi N, Glurich I, Maybury C, Wang MQ, Hashimoto K, Acharya A, Horowitz AM. Knowledge, Attitudes, Behaviors of Women Related to Pregnancy, and Early Childhood Caries Prevention: A Cross-Sectional Pilot Study. J Prim Care Community Health 2021; 12:21501327211013302. [PMID: 33949227 PMCID: PMC8114310 DOI: 10.1177/21501327211013302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Health education interventions during pregnancy can influence maternal oral health (OH), maternal OH-behaviors and children's OH. Interventions that can be delivered at anytime and anywhere, for example mobile-health (mHealth) provides an opportunity to address challenges of health education and support activation of women in underserved and rural communities to modify their health behavior. This pilot study was undertaken as a part of a mHealth initiative to determine knowledge, attitudes, and behaviors related to pregnancy and ECC prevention among women attending obstetrics/gynecology (OB/GYN) practices at a large rurally-based clinic. METHODS A cross-sectional survey study was voluntarily engaged by women (n = 191) aged 18 to 59 years attending OB/GYN visits, over a 3-week period from 12/2019 to 1/2020. Survey results were analyzed applying descriptive statistics, X2 and Fisher's Exact tests. The significance level was set at P < .0001 for all analyses. RESULTS Approximately half of respondents were between 18 and 29 years (53%), had a college degree (55%), and 100% reported cell phone use. Whereas 53% and 31%, respectively, indicated that they were "somewhat" or "very" sure of how to prevent ECC in their children, only 9% recognized evidence of early decay and 30% did not know the purpose of fluoride. Overall, only 27% of participants correctly answered the knowledge-based questions. Further, only 57% reported their provider explained things in a way that was easy to understand. Only 24% reported seeing a dentist during their current pregnancy. CONCLUSIONS Study results suggested potential gaps in knowledge and behaviors related to ECC prevention and provided baseline data to inform future interventions to improve ECC prevention practices. Notably, majority of participants used their cell phones for making medical/dental appointments and reported using their phones to look up health-related information. This demographic represents a potentially receptive target for mHealth approaches to improve understanding of oral health maintenance during pregnancy and ECC prevention.
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Affiliation(s)
- Neel Shimpi
- Marshfield Clinic Research Institute, WI, USA
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17
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Donoff RB, Daley GQ. Oral health care in the 21st century: It is time for the integration of dental and medical education. J Dent Educ 2020; 84:999-1002. [PMID: 32436218 DOI: 10.1002/jdd.12191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/10/2022]
Abstract
Major issues exist in the provision of oral health care in America, especially to underserved populations. Access to care, health disparities, an aging population with higher chronic disease burden, and rising healthcare costs continue to impact health outcomes for millions. The marginalization of oral health care, like that of behavioral health care, is a contributor. This perspective presents an idea whose time has come: putting the mouth back in the body. Several national reports stress the imperative to better integrate the practice of medicine and dentistry, including the first-ever Surgeon General's Report on Oral Health in 2000. A plan to lead a multifaceted integration of oral health into overall health is proposed. Leaders will come from new educational and practice models stressing teamwork, interprofessional education, innovative residency training programs and even dual degree options.
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Affiliation(s)
- R Bruce Donoff
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - George Q Daley
- Faculty of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Abdelrahim A, Shimpi N, Hegde H, Kleutsch KC, Chyou PH, Jain G, Acharya A. Feasibility of establishing tele-dental approach to non-traumatic dental emergencies in medical settings. AMERICAN JOURNAL OF DENTISTRY 2020; 33:48-52. [PMID: 32056416 PMCID: PMC7354845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Non-traumatic dental condition visits (NTDCs) represent about 1.4% to 2% of all Emergency Department (ED) visits and are limited to palliative care only, while associated with high cost of care. Feasibility of establishing a tele-dental approach to manage NTDCs in ED and Urgent care (UC) settings was undertaken to explore the possibility of utilizing remote tele-dental consults. METHODS Participants with NTDCs in ED/UCs were examined extra and intra-orally: (1) directly by ED provider, (2) remotely by tele-dental examiner (trained dentist) using intra-oral camera and high-definition pan-tilt-zoom (PTZ) camera, (3) directly by treating dentist post ED/UC visit (if applicable) and, (4) secondary assessment by tele-dental reviewer. Comparisons were drawn between differential diagnoses and recommended managements provided by ED/UC providers, tele-dental examiner, treating dentist, and tele-dental reviewer. RESULTS 13 patients participated in the study. The overall inter-rater agreement between the tele-dental examiner and tele-dental reviewer was high while it was low between tele-dentists and the ED providers. The preliminary testing of tele-dental intervention in the ED/UC setting demonstrated potential feasibility in addressing the NTDC landing in ED/UC. Larger interventional studies in multi-site setting are needed to validate this approach and especially evaluate impact on cost, ED/UC workflow and patient outcomes. CLINICAL SIGNIFICANCE Using tele-dentistry to triage non-traumatic dental visits to the emergency room may be a promising approach. Once this approach is validated through a larger study, tele-dental outreach could help in directing non-traumatic dental emergency patients to the appropriate dental setting to provide treatment for the patients.
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Affiliation(s)
- Adham Abdelrahim
- Post-doctoral fellow, Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
- Computational and Informatics in Biology and Medicine program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Neel Shimpi
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Harshad Hegde
- Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Katelyn C Kleutsch
- Dental student, Arizona School of Dentistry & Oral Health, A.T. Still University, Arizona, USA
| | - Po-Huang Chyou
- Office of Computing and Analytics, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Gaurav Jain
- Medford Dental Center, Family Health Center, Inc., Medford, Wisconsin, USA
| | - Amit Acharya
- Marshfield Clinic Research Institute and Scientist, Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA,
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