Care pathways and provision in bariatric dental care: an exploration of patients' and dentists' experiences in the North East of England

Stigmatizing attitudes and beliefs about obesity among dental team members

Background

Weight stigma is prevalent within healthcare settings and is an aspect of the lived experience of people living with obesity. There is international evidence of weight stigma in the dental setting, where currently there is also evidence indicating limited training amongst dental professionals regarding obesity or obesity-related stigma. There has been Australian research and none have included dental support staff.

Aims

This cross-sectional survey aimed to assess stigmatizing attitudes and beliefs of dental professionals (registered general dentists, oral health therapists) and support staff (dental assistants, dental receptionists) working in private and public regional practices in New South Wales and specialists in Special Needs Dentistry across Australia toward people living with obesity.

Methods

An anonymous electronic validated survey was administered through REDCap™ to assess stigmatizing attitudes and beliefs held amongst respondents in relation to people living with obesity.

Results

Fifty-three participants completed the survey (n = 33 clinicians, n = 20 support staff). The majority 47/53 (88.7%) held positive attitudes toward people living with obesity. Of the clinicians, 15/33 (45.5%) reported 1 hour or less and 14/33 (42.4%) reported two to 5 hours of obesity-related education. 14/20 (70%) of the support staff reported no prior education or training about obesity. Of responses reflecting weight stigma, only three clinicians reported negative reactions toward the appearance, or discomfort during examination, of a patient with obesity, or a perception of laziness, compared with normal weight individuals. A higher proportion 4/20 (20%) of support staff reported responses indicating negative attitudes for people with obesity compared with normal weight individuals.

Conclusion

Survey responses reflected evidence of weight stigma in both dental professionals and support staff. Professional development targeting weight stigma reduction in the dental setting is needed for both clinicians and support staff.

Unique dietary and oral hygiene behaviors in a cohort with clinically severe obesity: A cross sectional study

BACKGROUND

An association between increased risk of dental caries with increased levels of clinically severe obesity has been reported. Data linking body mass index (BMI) and dietary behaviors, including at-risk dietary factors and oral hygiene habits, are lacking in a cohort with clinically severe obesity. This study aimed to explore the dietary and oral hygiene behaviors in individuals with clinically severe obesity attending a hospital-based obesity service.

METHODS

Adult patients attending a hospital-based obesity service in Greater Western Sydney with clinically severe obesity were invited to participate in a self-administered survey, which collected data on their nutritional and oral hygiene behaviors. Demographic data (age, gender) and BMI were extracted from the participants' medical records. The primary outcome was the relationship between BMI and frequency of toothbrushing. RESULTS: Of the 82 individuals who consented to participate, 81 (98.8%) completed the study questionnaire. The median BMI of the cohort was 49.1 kg/m2 (interquartile range [IQR]: 43.2-57.3 kg/m2) and median age 51 (IQR: 39-63) years. BMI was not significantly correlated with individual oral health behaviors (p > .05). Many participants reported dietary risk behaviors, which have the potential to influence their oral health.

CONCLUSIONS

While oral health behaviors were not associated with increasing BMI, patients with clinically severe obesity in this study reported unique dietary behaviors and mixed oral hygiene habits that may complicate nutritional and dental management. Awareness of these behaviors among clinicians including dental professionals is required in this cohort.

Poor dental service utilization in those with clinically severe obesity: A neglected issue with solutions needed

Data linking body mass index (BMI) and dental service utilization with oral and general health, quality of life, wellbeing, and mental health are lacking. Adult patients with clinically severe obesity attending a hospital-based obesity service in Greater Western Sydney were invited to participate in a cross-sectional survey that collected data on dental utilization and visiting patterns, dental anxiety, and oral health-related quality of life (OHRQoL). General health data were obtained from participants' medical records. Of the 82 individuals who consented to participate, 81 (98.8%) completed the study questionnaire, and 74 (91.3%) answered additional screening questions related to their general wellbeing and mental health. Of the participants, 50 (61.7%) reported that their last dental visit was more than 1 year ago, 43 (53.1%) visited only as needed and 22 (27.2%) participants reported favourable dental visiting patterns. Twenty-four (29.6%) participants reported high levels of dental anxiety, and low levels of OHRQoL compared with national data. Screening questions suggested low general wellbeing and poor mental health in this patient cohort. Within this group, BMI was not significantly correlated with any of the variables of dental service utilization, dental anxiety, OHRQoL, wellbeing, or mental health (p > .05). There was a negative correlation between dental anxiety and dental utilization (p < .05). Patients with clinically severe obesity reported poor dental utilization, low OHRQoL, and high levels of dental anxiety. This study highlighted the frequency of medical complications, lack of wellbeing, and poor mental health, which were evident in this cohort and may complicate dental management.

Weight stigma among dental professionals and in the dental setting: a scoping review

Background Weight stigma refers to discriminatory acts and ideologies targeted towards individuals because of their body weight and/or size. Weight stigma in healthcare settings generates major health disparities. To date, there have been no previous reviews exploring the issue of weight stigma among dental professionals (DPs) and in the dental setting.Aims To synthesise current evidence on weight stigma among DPs and in dental care settings via a scoping review.Methods A comprehensive search was carried out across four relevant electronic databases (Medline, Scopus, Psychinfo and Cinahl). A total of 25 full-text papers were included in the scoping review.Results Most papers addressed the subject of weight stigma as a secondary finding (20 papers). Both quantitative and qualitative study methods were used to explore weight stigma across the broad categories of attitudes and beliefs about obesity, weight-based discussions, obesity education and training and service implications of obesity. Recommendations regarding weight stigma among DPs and in the dental setting were proposed but have not been formally assessed.Conclusion Further studies addressing weight stigma in dental settings, including causes and consequences among DPs, are required to better inform and address this issue.

Clinical considerations in providing intravenous sedation with midazolam for obese patients in dentistry

The widespread prevalence of obesity continues to rise. Obesity and dental disease share common risk factors and so the demand for dental care for obese patients is escalating. For some of these patients, there is a corresponding need to be able to provide intravenous sedation safely when it is necessary and appropriate to do so. However, obesity often presents with multiple comorbidities and airway complexities, leading to more challenging management and potentially increased risk. The risk assessment process as well as patient monitoring and management strategies will be explored in this article. By reviewing the literature from dentistry and other medical specialties, we also aim to establish the potential benefit in administering supplemental oxygen and the use of capnography in monitoring this cohort of patients.

A disability-based exploration of psychosocial barriers and enablers to accessing dental services for people with clinically severe obesity: A qualitative study

This qualitative study aimed to explore psychosocial barriers and enablers to accessing dental services for people with clinically severe obesity (PwCSO). Eight focus groups were conducted by one researcher with 40 adult participants at the Adult Healthy Weight Clinic within a hospital-based obesity service. Thematic analysis of focus group transcripts was performed to reveal insights relating to how PwCSO experience dental care and view oral health. A total of 11 participants were male, 29 female, all between the ages of 23 to 74 (mean age of 50). The body mass index of participants ranged from 31.6 to 84.6 kg/m² . The results highlighted four key themes, including "disempowerment to act to improve oral health", "weight-related stigma and discrimination", "unpredictability of the dental environment" and a "lack of tailored services for PwCSO". A number of subthemes were identified, which reflect the six categories of barriers to access from the disability literature: availability, affordability, acceptability, accommodation, accessibility and appropriateness. These were explored to further appreciate the unique psychosocial considerations for this group. This study concluded that PwCSO face significant barriers to accessing dental services across all six categories highlighted in the disability literature. The study findings provide valuable patient-based information regarding the psychosocial barriers to accessing dental services, which are relevant for all healthcare professionals. The study reflected an increased need for promotion of the dentist's role in obesity management and obesity-related dental training, including familiarization with the biopsychosocial domains of obesity to reduce weight related stigma and discrimination, as an area for further study. The findings also guide the design of Specialized Bariatric Dental Services in the future, with a focus on enablers to access.

The state of bariatric dental care in Australia: a silent disability crisis?

In the absence of dental related guidelines available in Australia specific to obesity and minimal awareness of the clinical implications on local dental practice, bariatric dental care can be perceived as a 'silent disability crisis'. This opinion piece and brief clinical note aims to question and raise awareness amongst dental professionals surrounding the current limited availability of bariatric dental chairs, difficulties in access, the safety of dental care delivery and ethical considerations for the dental management of people with obesity.