A survey of the knowledge of junior doctors in managing oral conditions in adult inpatients

The rosetta stone of successful ageing: does oral health have a role?

Ageing is an inevitable aspect of life and thus successful ageing is an important focus of recent scientific efforts. The biological process of ageing is mediated through the interaction of genes with environmental factors, increasing the body's susceptibility to insults. Elucidating this process will increase our ability to prevent and treat age-related disease and consequently extend life expectancy. Notably, centenarians offer a unique perspective on the phenomenon of ageing. Current research highlights several age-associated alterations on the genetic, epigenetic and proteomic level. Consequently, nutrient sensing and mitochondrial function are altered, resulting in inflammation and exhaustion of regenerative ability.Oral health, an important contributor to overall health, remains underexplored in the context of extreme longevity. Good masticatory function ensures sufficient nutrient uptake, reducing morbidity and mortality in old age. The relationship between periodontal disease and systemic inflammatory pathologies is well established. Diabetes, rheumatoid arthritis and cardiovascular disease are among the most significant disease burdens influenced by inflammatory oral health conditions. Evidence suggests that the interaction is bi-directional, impacting progression, severity and mortality. Current models of ageing and longevity neglect an important factor in overall health and well-being, a gap that this review intends to illustrate and inspire avenues for future research.

Awareness and attitude of ENT surgeons towards various dental implants or oral surgery procedures: a cross-sectional survey in the UK

OBJECTIVE

To assess the level of awareness and attitude of ENT surgeons towards dental implants and oral surgery procedures that involve the maxillary sinus.

METHODS

A cross-sectional survey was conducted using a closed-ended questionnaire on 40 UK-based ENT surgeons.

RESULTS

Within the study population, 45 per cent of ENT surgeons were not aware of sinus lift augmentation in implant dentistry. Only 25 per cent of respondents were aware of the two subtypes of sinus lift techniques. Thirty per cent of the respondents were aware of or had heard of benign positional paroxysmal vertigo following dental treatment. Fifty-two per cent of respondents came across a dental foreign body, most commonly a tooth that had been displaced into the maxillary sinus. It was also reported that 82.5 per cent of respondents had liaised with an oral surgeon for an oroantral communication problem or a dental infection.

CONCLUSION

Dental awareness among ENT surgeons needs to be raised for optimum interdisciplinary communication and patient safety.

A Dentist-Led Oral Care System Can Prevent Stroke-Associated Pneumonia: The Effects of Early Intervention by Dental Team

Background

Our facility's dental team consists of a full-time dentists and dental hygienists who work exclusively in the wards to implement best practices in oral healthcare. We executed the dental care system (DCS) that includes lectures and practical training for nurses conducted by dentists and dental hygienists, the introduction to oral assessment, standardization of oral care procedures, a process for nurses to request the dental team, and early bedside oral screening conducted by the dental team. This study investigated the DCS's effects on the incidence of stroke-associated pneumonia (SAP).

Methods

This single-center retrospective cohort study included 2,771 acute stroke patients who were newly hospitalized between April 1, 2012, and March 31, 2020. The 8-year period was divided into four phases at two-year intervals as follows: Pre (N=632), Post-1 (N=642), Post-2 (N=716), and Post-3 (N=781). Pre was prior to DCS practice. Post-1 was an early introduction to DCS. Post-2 simplified dental team requests from nurses, and Post-3 added bedside oral screening within 72 hours of admission by the dental team. Statistical analysis was performed using the Cochran-Armitage trend test, followed by multivariate logistic regression.

Results

A decrease in SAP rates was observed across the four groups (P<0.0001). Logistic regression analysis revealed a significant difference for respiratory disease (odds ratio 7.74, 95% confidence interval 5.49-10.90), hypertension (2.28, 1.39-3.73), cardiac failure (1.72, 1.04-2.85), and diabetes (1.59, 1.11-2.26), 3-digit code on the Japan coma scale (3.57, 2.53-5.05 [reference ≤2-digit code]), age ≥90 years (2.34, 1.15-4.77 [reference 18-59 years]), male (1.86, 1.31-2.67), and the Post-1 (0.49, 0.31-0.76 [reference Pre]), Post-2 (0.38, 0.25-0.61 [reference Pre]), and Post-3 (0.24, 0.15-0.40 [reference Pre]) periods.

Conclusion

The suppression of SAP is effectively achieved through early intervention and education of nurses by dental professionals.

Differences in Korean adult inpatients' oral care behaviour in daily life and hospitals

OBJECTIVES

The objectives of the study were to identify the differences in oral care methods between current and past hospitalizations and to investigate the need for inpatient oral care education for South Korean adults who have been hospitalized for more than 24 h.

METHODS

This study employed a cross-sectional design. Between 23 December 2019 and 4 May 2020, a questionnaire was administered to 200 adult inpatients awaiting treatment and their guardians at university hospitals or clinics. Of these, the data of 195 patients were analysed. Frequency analysis, descriptive statistics and chi-square tests were used for data analysis.

RESULTS

In daily life, the participants reported brushing their teeth thrice a day (52.3%) for 2 min (60%). A single product was the most used (51.3%). During hospitalization, 40% of the participants brushed their teeth thrice or more a day, 84.1% brushed for <1 min, and 83.6% did not use additional oral care products.

CONCLUSIONS

Differences were observed between South Korean adults' oral care behaviours in daily life and those performed in hospitals. Oral hygiene habits, the frequency and duration of tooth brushing, and the use of oral care products decreased during hospitalization. Our findings can be applied to the development of oral care interventions for inpatients, while considering changes in the hospitalization environment and physical activity levels during hospitalization.

Oral health ambassador scheme: training needs analysis in the community setting

Introduction Successful oral health promotion relies on resource availability, adequate training and stakeholder engagement. Community nursing teams are in a unique position to promote oral health due to their vulnerable service users who have increased oral health concerns. This article will share results from a training needs analysis.Aims To understand the previous oral health promotion experience of staff within community nursing teams, including identification of previous training and barriers to oral health promotion.Materials and methods An electronic training needs analysis was distributed to non-dental, patient-facing staff within Birmingham Community NHS Foundation Trust.Results In total, 91% (n = 120) of staff members had seen a patient who displayed oral health concerns, 68% (n = 90) of responders had never received training for assessing a patient's mouth and providing mouth care and 9% (n = 12) of staff had received internal trust training regarding oral health. Lack of training impeded 56% (n = 74) of participants from providing oral care and 92% (n = 121) of participants expressed they would benefit from further oral health training.Conclusion Community nursing teams should be supported to engage with oral health promotion to encourage reduced knowledge and confidence deficits, which will support holistic patient management to encourage improvement of oral and general health.

Perception and Attitude of Dental Students and Interns Regarding the Diagnosis and Management of Oral Mucosal Lesions and Salivary Glands Hypofunction

Background:

The perception and attitude of dental students/graduates regarding diagnosing/managing oral medicine cases are scarcely investigated.

Objective:

The aim of this investigation was to evaluate the level of confidence in diagnosing/managing cases of oral mucosal lesions and salivary glands hypofunction.

Methods:

A 29-items questionnaire descriptive survey was distributed among dental interns and sixth-year students in the city of Jeddah during March-April of 2020.

Results:

A total of 136 (81 interns and 55 sixth-year students) completed the questionnaire, of which 69.9% were from a government school, and 30.1% were from private schools. For oral mucosal lesions [i.e., aphthous/herpes simplex virus ulceration], the majority of government and private schools’ participants reported being confident in their ability to diagnose (88.4% and 87.8%, respectively) and provide treatment (63.2% and 56.1%, respectively). For oral candidiasis, the majority were confident in their ability to diagnose (government: 95.8%; private: 59.1%) and treat (government: 77.9%; private: 65.9%). The confidence in diagnosing lesions suspicious for dysplasia/premalignancy was high in 77.9% of government and 80.5% of private schools. Similar reporting was found regarding salivary hypofunctions (government: 93.7%; private: 90.2%). For the likeness to refer, the majority of participants were likely to refer to oral medicine, as the 1st choice, followed by oral surgery.

Conclusion:

Dental interns/sixth-year students seemed to have high levels of confidence in diagnosing/managing oral mucosal lesions and salivary hypofunctions. However, the partial participation and the subjectivity of reporting may have hindered capturing the full/precise picture.

Oral health training for general practitioners and general practice teams

The role of oral health in promoting general health and wellbeing is recognised, but there is minimal oral health training for doctors, including GPs. The Directorate of Multi-Disciplinary Dental Education (DMDE) at Health Education England North East and North Cumbria has introduced oral health training for GPs, incorporating training recommended by NICE oral health guidance. DMDE oral health training for GPs and general practice teams covered the diagnosis, prevention and management of oral disease, relevant prescribing and accessing dental care. Training has been shown to be worthwhile, positively impacting upon the clinical practice of GPs and thereby improving patient care. General health benefits are anticipated. Interactive training, as outlined in the DMDE lesson plan, was deemed effective. 1-hour courses conveniently delivered within general practices were most popular with GPs. Online courses have been less popular. Barriers to training were overcome through producing a promotional brochure and gaining the support of NHS medical leaders, who assisted with its distribution. A shift to training the trainer will improve the cost-effectiveness and sustainability of training. It is recommended that all GPs receive oral health training.