Verifiable CPD paper: factors that influence the dental attendance pattern and maintenance of oral health for people with multiple sclerosis

Multiple sclerosis and its impact on dental care

Multiple sclerosis affects approximately 130,000 people in the UK. Due to the wide variation in the symptoms associated with this condition and their variable severity, the provision of dental care for affected patients must be determined by an individual's specific needs. This will often vary significantly over time. This paper reviews the aetiology, presentation and current management of multiple sclerosis, and explores the impact of these on oral health and the provision of dental care.

Identifying Barriers to and Facilitators of Health Service Access Encountered by Individuals with Multiple Sclerosis

Background

The symptoms of multiple sclerosis (MS) can be diverse, complex, and progressive, creating a need for frequent and long-standing health care services. The purpose of this scoping review was to identify the barriers people with MS encounter when attempting to access multidisciplinary health services and the reported facilitators for better access to health services.

Methods

The MEDLINE, Embase, and CINAHL databases were searched, without date or geographic restrictions, using the following terms: multiple sclerosis, health services accessibility, health care access, health care delivery, and delivery of health care. After screening based on exclusion criteria, 23 articles were included in the final review.

Results

Five main themes were identified as barriers and facilitators to accessing health services: 1) information (information available to people with MS, health care provider knowledge of and familiarity with MS), 2) interactions (interactions between health care providers and people with MS, social networks and support of people with MS, collaboration among health care providers), 3) beliefs and skills (personal values and beliefs, perceived time to travel to and attend appointments, and self-assessment of symptoms and needs of people with MS), 4) practical considerations (wait times, physical barriers, affordability of services), and 5) nature of MS (complexity and unpredictability of disease symptoms).

Conclusions

People with MS and their health care providers may benefit from structured and comprehensive MS-specific education to address barriers to accessing health care services. The education can ultimately facilitate the process of addressing unmet health care needs and contribute to a greater quality of life for people with MS.

A systematic review of oral health in people with multiple sclerosis

OBJECTIVES

Despite more than 25 years of research focused on this topic, it remains unclear whether people with multiple sclerosis are more likely to present with oral health problems. The aim of this study was to provide the first systematic review of this literature.

METHODS

A literature search for studies focused on oral health and multiple sclerosis was conducted using PRISMA guidelines. Electronic databases (PubMed, Scopus, Web of Science, MEDLINE and CINAHL) were searched up until February 2019. Two independent coders extracted data, and study quality graded using the Newcastle-Ottawa Scale (NOS).

RESULTS

From 1281 articles identified, 17 met all the eligibility criteria. Of the seventeen studies, more than half included a nonclinical control group, and the majority were observational studies. The included studies were of poor to moderate quality. Taken together, the results provided only very limited evidence that people with multiple sclerosis are more likely to present with dental caries and gingival disease. There was suggestive evidence that people with multiple sclerosis may be at higher risk of periodontal disease and present with poorer oral hygiene, and moderate evidence for an association between multiple sclerosis and temporomandibular disorders.

CONCLUSIONS

This systematic review provides evidence of an association between multiple sclerosis and at least some oral health problems. When temporomandibular disorders and periodontal status specifically have been assessed, most studies provide evidence of an association with multiple sclerosis. However, this review also clearly highlights the need for further, high-quality studies in this area.

Investigating the relationship between multimorbidity and dental attendance: a cross-sectional study of UK adults

Introduction

Regular dental attendance is related to better oral health. However, long-standing health conditions (LSHCs) may be related to dental attendance and this relationship may vary by socioeconomic status.

Method

Data were collected from wave two (2013–2015) of the Yorkshire Health Study (n= 7,654). Data included dental attendance, LSHC, age, gender, education-level, smoking, body mass index, and area-level deprivation. Logistic regression (attend or not) was used to analyse associations with LSHC and multimorbidity.

Results

Overall, 63.1% (n = 4,826) of individuals attended the dentist. Of these, 37.8% (n =2894) had no LSHC, 26.0% (n = 1987) had one LSHC and 36.4% (n = 2784) had two or more LSHC. The presence of a singular LSHC was not associated with dental attendance(OR = 0.91 [0.81, 1.04]), however, those with two or more LSHCs were more likely to attend the dentist (OR = 0.81 [95% CI 0.72, 0.92]). Interactions between individual-level education, as a marker of socioeconomic status, and LSHC revealed few associations with dental attendance.

Conclusion

Multimorbidity was associated with dental attendance such that those with multimorbidity were more likely to attend. These important findings highlight the increasing challenge of multimorbidity for global healthcare systems.

Oral health and behaviours of people living with Multiple Sclerosis in Australia

OBJECTIVES

The literature describing the oral health of people with Multiple Sclerosis (MS) is scant and the findings equivocal. The aim of this study was to describe the oral health and oral self-care behaviours of people living with MS and compare it to the Australian population.

METHODS

Participants enrolled with the Australian MS Longitudinal Study (AMSLS) were invited to participate in the survey using an online or paper-based questionnaire. Data were collected on level of disability, oral health, oral self-care and factors influencing attendance for oral health care.

RESULTS

Completed questionnaires were received for 1523 respondents. Over one-fifth (n = 320; 22%) rated their oral health as fair or poor, and more than half (n = 840; 57%) reported toothache in the last 12 months. These proportions were higher than those for the general Australian adult population (oral health prevalence ratio (PR) = 1.25 [1.12, 1.40]; toothache PR = 3.63 [3.39, 3.88]), and this is despite comparable or better self-maintenance habits and dental attendance reported by respondents. People with MS reported high rates of mouth dryness (68.4%), teeth sensitivity (64.7%), change of taste (40.5%) and orofacial pain (39.0%); fewer than 10% experienced none of these. There was a lower prevalence of self-reported need for treatment (extraction or filling) than in the Australian adult population (15.8% vs 32.9%).

CONCLUSIONS

People with MS have a greater oral health burden, demonstrated by their poorer self-reported oral health than the Australian adult population. Furthermore, they experience high rates of toothache, mouth dryness, teeth sensitivity, change of taste and orofacial pain. These findings are contrary to their self-reported good oral self-care and dental attendance habits and suggest some of the oral health impacts are due to MS rather than dental behaviours.

How do Australians living with MS experience oral health and accessing dental care? A focus group study

OBJECTIVES

The symptoms of multiple sclerosis (MS) can affect oral care and access to dental services, but there is limited literature describing the oral health and perceived oral healthcare needs of people with MS. This study aimed to explore the oral health experiences, oral health behaviours and barriers to accessing dental care perceived by people living with MS in Australia.

METHODS

Six focus groups were held across two metropolitan areas (Brisbane, Queensland and Melbourne, Victoria) and one regional area (Toowoomba, Queensland). Focus group data were analysed using thematic analysis.

RESULTS

Living with MS was a highly individual experience due to the range of symptoms that may be experienced. In addition to having different symptom experiences to others with MS, individual symptoms also differed on a daily basis as the disease relapsed and remitted. The physical expressions of MS directly and indirectly affected the oral health of participants. Additionally, oral health was affected by the side effects of medications and orofacial pain symptoms. Depending on the symptoms experienced by the individual, personal oral hygiene was affected and professional dental appointments were difficult. Participants also experienced structural barriers to accessing professional dental care including difficulty accessing transport to-and-from dental appointments, space limitations in the dental surgery and financial barriers to care.

DISCUSSION

Dental care was perceived to be inflexible and was not tailored to individual experiences of MS, which contributed to perceptions of poor quality and appropriateness of care. It is important for dental professionals to offer tailored and individualized dental care when treating people with MS. Our findings suggest that there needs to be greater interprofessional communication and referral to manage atypical dental pain symptoms. Oral health education for people with MS should include altered strategies to performing daily oral hygiene, the management of xerostomia and advice regarding low cariogenic diets suitable for dysphagia. Additionally, policy and strategies to improve the oral health of people with MS should focus on enhancing access through transport, reducing the cost of dental services to the individual and providing domiciliary oral health care.

The value of education in special care dentistry as a means of reducing inequalities in oral health

People with disability are subject to inequality in oral health both in terms of prevalence of disease and unmet healthcare needs. Over 18% of the global population is living with moderate to severe functional problems related to disability, and a large proportion of these persons will require Special Care Dentistry at some point in their lifetime. It is estimated that 90% of people requiring Special Care Dentistry should be able to access treatment in a local, primary care setting. Provision of such primary care is only possible through the education and training of dentists. The literature suggests that it is vital for the dental team to develop the necessary skills and gain experience treating people with special needs in order to ensure access to the provision of oral health care. Education in Special Care Dentistry worldwide might be improved by the development of a recognised academic and clinical discipline and by providing international curricula guidelines based on the International Classification of Functioning, Disability and Health (ICF, WHO). This article aims to discuss the role and value of promoting and harmonising education in Special Care Dentistry as a means of reducing inequalities in oral health.

Multiple sclerosis: an update for oral health care providers

Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating disease of the central nervous system. The disease mostly affects young adults and is increasing in prevalence and incidence. Multiple sclerosis is characterized by periods of activity and remission which, after numerous relapses, cause permanent neurologic deficits. Diagnosis of MS is based on patient history and clinical examination supplemented by the findings of radiologic and laboratory tests. Numerous motor and sensory disturbances occur in MS and may present in the orofacial region. This medical management update highlights issues that are important to the oral health care provider, including orofacial manifestations of MS and dental considerations for patients with MS.

Giving low priority to oral health care. Voices from people with disabilities in a grounded theory study

OBJECTIVE

Our knowledge of how people with disabilities look upon oral health and dental care is limited. The aim of this study was thus to explore how the people with disabilities experience the encounter with dental health care.

MATERIAL AND METHODS

With a focus on dental care and oral health, qualitative interviews with 16 informants with cognitive and/or physical disabilities were analysed in accordance with the qualitative method of grounded theory.

RESULTS

A core category identified and labeled "giving low priority to oral health care" was found to be related to four other categories: "being afraid of losing control", "having difficulties complying with instructions", "having a desire for continuity", and "wishing to be just like everyone else". The results show that oral health and dental care are important, but are not considered a priority by the people with disabilities. General health issues have much higher priority but do not include oral health, which consequently can affect oral health negatively.

CONCLUSIONS

Of several factors identified that could be improved to make dental visits more pleasant for patients are enhancing a sense of control in the patient and improving continuity.