1
|
Sharif H, Hammash M, Anwer W, Hassan N, Seemi T, Sheikh SS. Evaluation of oral health among people with multimorbidity in the marginalized population of Karachi, Pakistan: A multicenter cross-sectional study. J Taibah Univ Med Sci 2024; 19:500-515. [PMID: 38571699 PMCID: PMC10987933 DOI: 10.1016/j.jtumed.2024.03.008] [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] [Received: 10/19/2023] [Revised: 02/12/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024] Open
Abstract
Background Oral health is linked to physical and mental well-being. Oral disease is common among poor and socioeconomically disadvantaged people in developing and industrialized countries. Objectives This study assessed the oral health disease burden among people with multimorbidity in marginalized populations. Methods This cross-sectional study was conducted across 16 locations in the slums of Karachi, Pakistan, to assess oral health disease problems among adults aged 18 to 70 with comorbidity or multimorbidity. The questionnaire covered the socioethnic, demographic, and disease status of people with oral health status. Data analyses were performed using SAS version 9.4. Results Of the 16 designated slum locations, 870 individuals were considered for oral health screening. Gingivitis was highly prevalent, 29% among slum dwellers with multimorbidity of diabetes, hepatitis, and hypertension. Dandasa was widely used as a tooth-cleansing agent in 35% of the study population. By contrast, 45.4% of people showed unsatisfactory oral hygiene conditions. Pathan ethnicity showed the highest prevalence (i.e., 29.8% of dental problems with disease multimorbidity in 26.8% of Baldia Town residents of Karachi). Of the 870 individuals, the highest frequency of dental problems was found in the age group of 18-38 years (28-42.9%) and among female participants (53.8%). Conclusion There is an urgent need for the global enhancement of public health programs, specifically focusing on implementing effective strategies to prevent oral illnesses, promote oral health, and address other chronic diseases in basic healthcare settings. Enhancing oral health poses significant difficulties, especially in less developed nations.
Collapse
Affiliation(s)
- Hina Sharif
- Research & Publication Department, SINA Health Education & Welfare Trust, Karachi, Pakistan
- Community Health Sciences Department, the Aga Khan University, Karachi, Pakistan
| | - Muhammad Hammash
- Community Health Sciences Department, the Aga Khan University, Karachi, Pakistan
- Dow University of Health Sciences, Karachi, Pakistan
| | - Wajiha Anwer
- Community Health Sciences Department, the Aga Khan University, Karachi, Pakistan
- Dow University of Health Sciences, Karachi, Pakistan
| | - Nayma Hassan
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Tooba Seemi
- Research & Publication Department, SINA Health Education & Welfare Trust, Karachi, Pakistan
| | - Sana S. Sheikh
- Research & Publication Department, SINA Health Education & Welfare Trust, Karachi, Pakistan
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| |
Collapse
|
2
|
Serban S. Expert view: Stefan Serban. Br Dent J 2024; 236:391. [PMID: 38459314 DOI: 10.1038/s41415-024-7210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Affiliation(s)
- Stefan Serban
- Senior Clinical Lecturer and Honorary Consultant in Dental Public Health, University of Glasgow, UK.
| |
Collapse
|
3
|
Beukers NGFM, Su N, van der Heijden GJMG, Loos BG. Periodontitis is associated with multimorbidity in a large dental school population. J Clin Periodontol 2023; 50:1621-1632. [PMID: 37658672 DOI: 10.1111/jcpe.13870] [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] [Received: 04/22/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 09/03/2023]
Abstract
AIM To investigate whether and which diseases co-occur with periodontitis (PD) to assess the prevalence of comorbidities and multimorbidity and to identify patterns and profiles of comorbidity and multimorbidity and the influence of demographic and lifestyle factors to identify distinct groups of multimorbid patients. MATERIALS AND METHODS A database from the Academic Centre of Dentistry Amsterdam (ACTA) with 37,801 adult individuals containing information about demographic (age, sex, socio-economic position [SEP]) and lifestyle factors (smoking, alcohol use and addictive substance use) and PD and systemic diseases was constructed. PD assessment was based on clinical information by the use of claim codes and systemic diseases data were derived from self-reported medical history. For analyses, univariable and multivariable (adjusted for age, sex, SEP, smoking, alcohol use and addictive substance use) logistic regression analyses and cluster analysis were used. RESULTS Individuals with PD more often had one or multiple diseases. The adjusted odds ratio (OR) for PD patients having up to four systemic diseases ranged from 1.46 to 1.20. Co-occurrence of PD with several systemic diseases and a higher prevalence of multimorbidity was found (adjusted OR comorbidity = 1.36; 95% confidence interval (CI): 1.30-1.43; multimorbidity = 1.18; 95% CI: 1.11-1.25). Four clusters existed: cluster 1 was defined as a periodontal and systemically healthy group and cluster 4 as burdened with PD but not containing any systemic diseases. Individuals in cluster 1 were of the lowest age (44.9 [SD: 15.5]) and had the lowest prevalence of the lifestyle factors of smoking (13.6%) and alcohol use (3.9%). Clusters 2 and 3 contained both PD and had several systemic diseases but were different from each other. Cluster 2 contained 34.5% of PD individuals and had mainly respiratory tract, immune system and digestive system diseases. Cluster 3 contained 45.9% of PD individuals and had mainly cardiometabolic diseases. Cluster 2 had the highest prevalence of females (63.1%) and the highest prevalence of smokers (23.8%) and addictive substance users (8.9%). Cluster 3 included individuals of the highest age (63.5 [SD: 11.9]), and had highest prevalence of alcohol users (17.7%) and lowest prevalence of addictive substance users (3.8%). CONCLUSIONS This study shows that individuals with PD are more often burdened with comorbidity and multimorbidity. Presence of distinct clusters suggests overlap in pathophysiology between certain types of PD and specific systemic diseases. Therefore, PD can be considered as part of multimorbidity, as one of the systemic diseases co-occurring in certain groups of individuals.
Collapse
Affiliation(s)
- Nicky G F M Beukers
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Naichuan Su
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Geert J M G van der Heijden
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bruno G Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Larvin H, Kang J, Aggarwal VR, Pavitt S, Wu J. Periodontitis and risk of immune-mediated systemic conditions: A systematic review and meta-analysis. Community Dent Oral Epidemiol 2023; 51:705-717. [PMID: 36377800 DOI: 10.1111/cdoe.12812] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/22/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of this review is to examine and quantify the long-term risk of immune-mediated systemic conditions in people with periodontitis compared to people without periodontitis. METHODS Medline, EMBASE and Cochrane databases were searched up to June 2022 using keywords and MeSH headings. The 'Risk of Bias in Non-Randomised Studies of Interventions' tool was used to assess bias. Cohort studies comparing incident metabolic/autoimmune/inflammatory diseases in periodontitis to healthy controls were included. Meta-analysis and meta-regression quantified risks and showed impact of periodontitis diagnosis type and severity. RESULTS The search retrieved 3354 studies; 166 studies were eligible for full-text screening, and 30 studies were included for review. Twenty-seven studies were eligible for meta-analysis. The risks of diabetes, rheumatoid arthritis (RA) and osteoporosis were increased in people with periodontitis compared to without periodontitis (diabetes-relative risk [RR]: 1.22, 95% CI: 1.13-1.33; RA-RR: 1.27, 95% CI: 1.07-1.52; osteoporosis-RR: 1.40, 95% CI: 1.12-1.75). Risk of diabetes showed gradient increase by periodontitis severity (moderate-RR = 1.20, 95% CI = 1.11-1.31; severe-RR = 1.34, 95% CI = 1.10-1.63). CONCLUSION People with moderate-to-severe cases of periodontitis have the highest risk of developing diabetes, while the effect of periodontal severity on risk of other immune-mediated systemic conditions requires further investigation. More homologous evidence is required to form robust conclusions regarding periodontitis-multimorbidity associations.
Collapse
Affiliation(s)
| | - Jing Kang
- Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | | | - Susan Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| |
Collapse
|
5
|
Ngu ACS, Arora S, Reher P. Medical profile of patients referred to an Australian postgraduate oral surgery clinic. Clin Exp Dent Res 2023; 9:899-905. [PMID: 37680041 PMCID: PMC10582212 DOI: 10.1002/cre2.781] [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] [Received: 07/26/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Thorough knowledge of a patient's medical history and medications is necessary for providing safe oral surgery care, and may be considered a form of risk management. This study investigated the prevalence of medical conditions and medication types in patients referred to an Australian postgraduate oral surgery clinic over 2 years. MATERIALS AND METHODS A retrospective cross-sectional study of the clinical records of 233 randomized patients referred to the Griffith University (Queensland, Australia) postgraduate oral surgery clinic in 2018 and 2019 was performed. Medical conditions and medications were counted and categorized, and descriptive statistics were generated. RESULTS In all, 133 patients (57%) had at least one medical condition. 58% of them (77) had two or more categories of medical conditions, representing nearly a third (33.0%) of all sampled patients. The most prevalent category of medical conditions was psychiatric (25.3%), followed closely by cardiovascular (24.5%) diseases. Cardiovascular medications were the most prevalent, comprising 23.6% of all medications recorded, followed by psychotropics (18.3%). CONCLUSION Over half of patients referred to the postgraduate oral surgery clinic had at least one systemic medical condition. Nearly a third of patients referred had at least two distinct systemic medical conditions. With an ageing population and the accompanying rise in multimorbidity globally, dental school curricula must adapt to prepare students to meet these challenges in their careers.
Collapse
Affiliation(s)
| | - Sitanshu Arora
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Peter Reher
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| |
Collapse
|
6
|
Chapman LS, Vinall-Collier K, Siddle HJ, Mustufvi Z, Mankia K, Serban S. 'It surprised me a lot that there is a link': a qualitative study of the acceptability of periodontal treatment for individuals at risk of rheumatoid arthritis. RMD Open 2023; 9:rmdopen-2023-003099. [PMID: 37156573 PMCID: PMC10174022 DOI: 10.1136/rmdopen-2023-003099] [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: 02/22/2023] [Accepted: 04/06/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES Current evidence suggests that periodontal disease could be a causal risk factor for rheumatoid arthritis (RA) onset and progression. Earlier periodontal intervention in individuals at risk of RA could provide a unique opportunity to prevent or delay the onset of RA. This study aimed to explore the acceptability of periodontal treatment as a measure to potentially prevent RA among at-risk individuals and healthcare professionals. METHODS Semistructured interviews were conducted with anti-CCP positive at-risk individuals (CCP+ at risk) and a range of healthcare professionals. At-risk participant data were analysed using reflexive thematic analysis; subsequent coding of healthcare professional data was deductive, based on a preidentified set of constructs. RESULTS Nineteen CCP+ at-risk and 11 healthcare professionals participated. Three themes (six subthemes) were identified: (1) understanding risk (knowledge of shared at-risk factors; information and communication); (2) oral health perceptions and experiences (personal challenges and opportunities for dental intervention and oral health maintenance; external barriers) and (3) oral health treatment and maintenance (making oral health changes with the aim of preventing RA; acceptability of participation in periodontal research). CONCLUSIONS Periodontal disease is common in individuals at risk of RA, but the impact of poor oral health may not be well understood. Oral health information should be tailored to the individual. CCP+ at-risk participants and healthcare professionals identified seeking dental treatment can be hindered by dental phobia, treatment costs or inability to access dentists. While CCP+ at-risk individuals may be reluctant to take preventive medications, a clinical trial involving preventive periodontal treatment is potentially acceptable.
Collapse
Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Karen Vinall-Collier
- Department of Dental Public Health, School of Dentistry, University of Leeds, Leeds, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Zhain Mustufvi
- Department of Dental Public Health, School of Dentistry, University of Leeds, Leeds, UK
| | - K Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Stefan Serban
- Department of Dental Public Health, School of Dentistry, University of Leeds, Leeds, UK
- Public Health Directorate, NHS England North West Region, Manchester, UK
| |
Collapse
|
7
|
Joury E, Kisely S, Watt RG, Ahmed N, Morris AJ, Fortune F, Bhui K. Mental Disorders and Oral Diseases: Future Research Directions. J Dent Res 2023; 102:5-12. [PMID: 36081351 DOI: 10.1177/00220345221120510] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The poor physical health (including oral health) of people with mental disorders is a global problem. The burden of oral diseases among this group is substantial given their high prevalence and ability to increase the personal, social, and economic impacts of mental disorders. This article summarizes causes of mental disorders and oral diseases, critically reviews current evidence on interventions to reduce the burden of oral diseases in people with mental disorders, and suggests future research directions. The relationship between mental disorders and oral diseases is complex due to the shared social determinants and bidirectional interaction mechanisms that involve interconnected social, psychological, behavioral, and biological processes. Research has, to date, failed to produce effective and scalable interventions to tackle the burden of oral diseases among people with mental disorders. Transformative research and actions informed by a dynamic involvement of biological, behavioral, and social sciences are needed to understand and tackle the complex relationship between mental disorders and oral diseases, as well as inform the design of complex interventions. Examples of future research on complex public health, health service, and social care interventions are provided. The design and testing of these interventions should be carried out in real-world settings, underpinned by the principles of coproduction and systems thinking, and conducted by a transdisciplinary team. We propose this starts with setting research priorities and developing complex intervention theory, which we report to support future research to improve oral health and hence physical and mental health in this disadvantaged group.
Collapse
Affiliation(s)
- E Joury
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, The Royal London Hospital, London, UK
| | - S Kisely
- PA-Southside Clinical Unit, School of Clinical Medicine, Faculty of Medicine, the University of Queensland, Woolloongabba, QLD, Australia
| | - R G Watt
- Research Department of Epidemiology & Public Health, University College London, London, UK
| | - N Ahmed
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - A J Morris
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - F Fortune
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, London, UK
| | - K Bhui
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| |
Collapse
|
8
|
Donoff RB. Predoctoral Dental Education: The Changing Role and Growing Importance of Oral and Maxillofacial Surgery and Surgeon Teachers Innovation Versus Incumbency. Oral Maxillofac Surg Clin North Am 2022; 34:489-493. [PMID: 36224078 DOI: 10.1016/j.coms.2022.03.010] [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] [Indexed: 11/18/2022]
Abstract
This article highlights the needs in dental education for more general medicine and scientific information. The author suggests that oral and maxillofacial surgeons could have an important role to play in this education beyond surgical procedures. The Educational Committee of AAOMS has made this point prepandemic, and it is more important now. As the patient population ages, this role assumes greater importance. Patients now have more chronic diseases and take more medicines, and the repertoire and scope of practice for dentists should be improved to care for the general health of patients. Our specialty should play a leadership role in the transformation of the profession.
Collapse
Affiliation(s)
- Robert Bruce Donoff
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, USA.
| |
Collapse
|
9
|
Atkin PA, Simms ML, Ravindran N. Consolidating human disease learning in the Dental Emergency Clinic. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022. [PMID: 35713002 DOI: 10.1111/eje.12829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/18/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Dental undergraduates typically learn and are assessed on aspects of human disease (HD) in the early part of their programme, but it is not until later in the programme that their HD knowledge is put into practice when they provide courses of treatment for numerous patients over multiple visits. The teaching of HD provides core knowledge on medical conditions and medications and is therefore essential in allowing newly graduated dentists to provide safe treatment for medically compromised patients or those taking medications. We wanted to examine the medical complexity of patients attending a university hospital dental emergency clinic to determine whether this was a suitable group that would help students to consolidate their HD learning in the context of a single visit where treatment was also provided. MATERIALS AND METHODS We examined the medical history of 200 patients attending the dental emergency clinic in the University Dental Hospital, Cardiff, using a previous study as a benchmark. Anonymous data were collected using the medical history proforma, and included age, gender, medications, types and number of medical conditions/disorders. RESULTS Patients attending the clinic were more medically complex than those in the comparator study and the demographics reflect wider population data showing increasing numbers of older patients with greater medical morbidity. DISCUSSION/CONCLUSIONS The emergency dental clinic is the place where most patients are new to the hospital, have a dental history, medical history, investigations, diagnosis and treatment in a single visit, and offers excellent opportunities for consolidating HD learning in a one-stop clinical treatment episode, guided by suitable instructors.
Collapse
|
10
|
Larvin H, Kang J, Aggarwal VR, Pavitt S, Wu J. Systemic Multimorbidity Clusters in People with Periodontitis. J Dent Res 2022; 101:1335-1342. [PMID: 35678074 PMCID: PMC9516606 DOI: 10.1177/00220345221098910] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
This study aimed to identify systemic multimorbidity clusters in people with periodontitis via a novel artificial intelligence-based network analysis and to explore the effect of associated factors. This study utilized cross-sectional data of 3,736 participants across 3 cycles of the National Health and Nutrition Examination Survey (2009 to 2014). Periodontal examination was carried out by trained dentists for participants aged ≥30 y. The extent of periodontitis was represented by the proportion of sites with clinical attachment loss (CAL)≥ 3 mm, split into 4 equal quartiles. A range of systemic diseases reported during the survey were also extracted. Hypergraph network analysis with eigenvector centralities was applied to identify systemic multimorbidity clusters and single-disease influence in the overall population and when stratified by CAL quartile. Individual factors that could affect the systemic multimorbidity clusters were also explored by CAL quartile. In the study population, the top 3 prevalent diseases were hypertension (63.9%), arthritis (47.6%), and obesity (45.9%). A total of 106 unique systemic multimorbidity clusters were identified across the study population. Hypertension was the most centralized disease in the overall population (centrality [C]: 0.50), followed closely by arthritis (C: 0.45) and obesity (C: 0.42). Diabetes had higher centrality in the highest CAL quartile (C: 0.31) than the lowest (C: 0.26). "Hypertension, obesity" was the largest weighted multimorbidity cluster across CAL quartiles. This study has revealed a range of common systemic multimorbidity clusters in people with periodontitis. People with periodontitis are more likely to present with hypertension and obesity together, and diabetes is more influential to multimorbidity clusters in people with severe periodontitis. Factors such as ethnicity, deprivation, and smoking status may also influence the pattern of multimorbidity clusters.
Collapse
Affiliation(s)
- H Larvin
- School of Dentistry, University of Leeds, Leeds, UK
| | - J Kang
- Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | - V R Aggarwal
- School of Dentistry, University of Leeds, Leeds, UK
| | - S Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | - J Wu
- School of Dentistry, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| |
Collapse
|
11
|
Prasad R, Edwards J, Newton P, Gerbasi Rodrigues T, Curl C. Impact of a geriatric assessment and optimisation-based preoperative clinic on the management of older patients receiving dental treatment under general anaesthetic or conscious sedation: A service evaluation. Gerodontology 2022; 40:192-199. [PMID: 35460087 DOI: 10.1111/ger.12632] [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: 08/23/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The main objectives of the study were to review patient characteristics, recommendations made and treatment outcomes of frail/older patients referred to a specialist multidisciplinary geriatric assessment and optimisation-based preoperative clinic (PROKARE), prior to patients receiving dental treatment under general anaesthesia (GA) or conscious sedation (CS). BACKGROUND Although the use of preoperative comprehensive geriatric assessment to improve pre/peri and postoperative mortality has been reported for many surgical domains, its use prior to dental surgery has not been reported previously. METHODS The data were collected retrospectively from the dental notes of 52 patients referred from the Special Care Dental (SCD) Department to the PROKARE service for optimisation prior to dental treatment under GA/CS using a case note study approach. The data extracted included patient demographic characteristics, medical history, clinical management and the treatment outcomes for each patient. The data extracted was analysed with descriptive statistics. RESULTS Key reasons for referral were caries management, retained roots and poor co-operation. Multiple co-morbidities were noted among the patients referred, with 14 (27%) having four or more co-morbidities. The PROKARE assessment identified issues such as treatment could be carried out under CS instead of GA; consent; and the need for medication change and/or further medical investigations. As per recommendations from PROKARE, 39 patients (75%) received dental treatment while five (10%) did not receive treatment, and a further eight (15%) died prior to treatment. CONCLUSION Geriatric assessment and optimisation-based preoperative clinics in the dental management of frail, elderly patients having treatment under GA or CS techniques is valuable, but further research and assessment of current service provision are needed to increase the evidence base.
Collapse
Affiliation(s)
- Ria Prasad
- Department of Special Care Dentistry, King's College Hospital NHS Foundation Trust, London, UK
| | - Julie Edwards
- Department of Special Care Dentistry, King's College Hospital NHS Foundation Trust, London, UK
| | - Paul Newton
- Faculty of Education and Human Sciences, School of Health Sciences, University of Greenwich, London, UK
| | - Taianny Gerbasi Rodrigues
- Faculty of Education and Human Sciences, School of Health Sciences, University of Greenwich, London, UK
| | - Charlotte Curl
- Department of Special Care Dentistry, King's College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
12
|
Halling F, Weigl K. Medical status of elderly patients consulting two oral and maxillofacial surgery departments in Germany. Br J Oral Maxillofac Surg 2022; 60:1097-1101. [DOI: 10.1016/j.bjoms.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/20/2022] [Accepted: 04/20/2022] [Indexed: 01/04/2023]
|
13
|
van der Heijden EM, Klüter WJ, van der Maarel-Wierink CD, Gobbens RJJ. Exploring associations between multidimensional frailty and oral health in community-dwelling older people. A pilot study. SPECIAL CARE IN DENTISTRY 2022; 42:361-368. [PMID: 35014046 PMCID: PMC9545350 DOI: 10.1111/scd.12691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 12/02/2022]
Abstract
Objective To determine the associations between four validated multidimensional self‐report frailty scales and nine indices of oral health in community‐dwelling older persons. Materials and Methods This pilot study was conducted in a sample of 208 older persons aged 70 years and older who visited two dental practices in the Netherlands. Frailty status was measured by four different self‐report frailty questionnaires: Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI), Sunfrail Checklist (SC), and the Sherbrooke Postal Questionnaire (SPQ). Oral health was assessed by two calibrated examiners. Results The prevalence of frailty according to the four frailty measures TFI, GFI, SC, and SPQ was 32.8%, 31.5%, 24.5%, and 49.7%, respectively. The SC correlated with four oral health variables (DMFT, number of teeth, percentage of occlusal contacts, Plaque Index), the TFI with three (number of teeth, percentage of occlusal contacts, Plaque Index), the GFI only with DPSI, and the SPQ with the number of teeth and the number of occlusal contacts. Conclusion Of the studied multidimensional frailty scales, the SC and TFI were correlated with most oral health variables (four and three, respectively). However, it should be noticed that these correlations were small. Clinical relevance The SC and TFI might help to identify older people with risk of poor oral health so that preventive care can be used to ensure deterioration of oral health and maintenance of quality of life. Vice versa early detection of frailty by oral care professionals could contribute to interprofessional management of frailty.
Collapse
Affiliation(s)
| | - Wim J Klüter
- BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, Netherlands.,College of Dental Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Claar D van der Maarel-Wierink
- BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, Netherlands.,Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Robbert J J Gobbens
- BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, Netherlands.,Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
14
|
Multimorbidity and tooth loss: the Brazilian National Health Survey, 2019. BMC Public Health 2021; 21:2311. [PMID: 34930189 PMCID: PMC8691078 DOI: 10.1186/s12889-021-12392-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/07/2021] [Indexed: 12/26/2022] Open
Abstract
Background Little is known about the presence of two or more chronic conditions (multimorbidity) on tooth loss between adults and older adults. Understanding the mechanisms of multimorbidity on tooth loss is essential to inform policy development. This study aims to investigate the association between multimorbidity and severity of tooth loss in Brazilian adults and older adults. Methods We analysed data from a nationally representative sample of 88,531 Brazilian individuals aged 18 and over who participated in the 2019 Brazilian Health Survey. Tooth loss was the outcome by two different classifications: functional dentition (lost 1–12 teeth) and severe tooth loss (lost 23–32 teeth). The presence of multimorbidity was the main exposure and based on 13 self-reported doctor-diagnosed chronic diseases that were further categorised into two groups, i.e., ≥2 or ≥ 3 comorbidities. Sociodemographic covariates included sex, age, race, income, level of education and tobacco smoking and geographic region of residency. Multivariate logistic regression models estimated the OR (Odds Ratios) and 95%CI of the associations between multimorbidity and tooth loss. Results For 65,803 adults (aged 18 to 59), the presence of multimorbidity (≥2) was associated with 32% higher odds of having severe tooth loss (95% CI, 1.17; 1.49) and 33% lower odds of having functional dentition (95% CI, 0.60; 0.75). For the 22,728 older adults (aged 60 and older), multimorbidity (≥2) was associated with a 17% higher odds of severe tooth loss (95% CI, 1.06; 1.29) and 23% lower odds of having functional dentition (95% CI 0.70; 0.85). The sensitivity analysis, excluding hypertension, confirmed our findings. Conclusions Brazilian adults and older adults with multimorbidity are more likely to have severe tooth loss and less likely to have functional dentition. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12392-2.
Collapse
|
15
|
Serban ST, Simon SE, Vinall-Collier K, Douglas GVA. Foundation dentists supporting vaccination programmes in England. Br Dent J 2021:10.1038/s41415-021-3758-5. [PMID: 34907335 PMCID: PMC8670617 DOI: 10.1038/s41415-021-3758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/27/2021] [Indexed: 11/15/2022]
Abstract
Background In 2020/21, as part of the COVID-19 pandemic response and for the first time in England, newly qualified foundation dentists (FDs) were trained to participate in flu and COVID-19 vaccination programmes to offer additional workforce capacity. The largest of these efforts was in Yorkshire and the Humber where 106 FDs were trained and ready to mobilise. The aim of this service evaluation was to appraise the use of FDs in delivering vaccinations.Methods Mixed methods using an online questionnaire to FDs and in-depth remote interviews conducted with host organisations, Public Health England, Health Education England and others.Results The questionnaire response rate was 89% (n = 94), with 54 FDs having participated in vaccinations at a rate of 50-100 vaccines per day. All were confident with flu vaccine administration and most (n = 44/54) with COVID-19 vaccination. Eleven stakeholder interviews were conducted. Main barriers included the siloed delivery of dental care from other health services, resulting in collaborative barriers and a lack of understanding about the profession's skillsets. Facilitators included host organisations' capacity to hold multiple honorary contracts and provide competency sign-off.Conclusion Utilising the dental workforce to deliver vaccinations was feasible at a time of crisis and when trainees' access to dental patients was limited.
Collapse
Affiliation(s)
- Stefan T Serban
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, LS2 9LU, UK.
| | - Sally Eapen Simon
- Public Health England, North East and Yorkshire Region, Blenheim House, Duncombe Street, Leeds, LS1 4PL, UK
| | | | - Gail V A Douglas
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, LS2 9LU, UK
| |
Collapse
|
16
|
Association of Oral Health with Multimorbidity among Older Adults: Findings from the Longitudinal Ageing Study in India, Wave-1, 2017-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312853. [PMID: 34886581 PMCID: PMC8657905 DOI: 10.3390/ijerph182312853] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 01/05/2023]
Abstract
India is witnessing an increase in the prevalence of multimorbidity. Oral health is related to overall health but is seldom included in the assessment of multimorbidity. Hence, this study aimed to estimate the prevalence of oral morbidity and explore its association with physical multimorbidity using data from Longitudinal Ageing Study in India (LASI). LASI is a nationwide survey amongst adults aged ≥ 45 years conducted in 2018. Descriptive analysis was performed on included participants (n = 59,764) to determine the prevalence of oral morbidity. Multivariable logistic regression assessed the association between oral morbidity and physical multimorbidity. Self-rated health was compared between multimorbid participants with and without oral morbidity. Oral morbidity was prevalent in 48.56% of participants and physical multimorbidity in 50.36%. Those with multimorbidity were at a higher risk of having any oral morbidity (AOR: 1.60 (1.48–1.73)) than those without multimorbidity. Participants who had only oral morbidity rated their health to be good more often than those who had physical multimorbidity and oral morbidity (40.84% vs. 32.98%). Oral morbidity is significantly associated with physical multimorbidity. Multimorbid participants perceived their health to be inferior to those with only oral morbidity. The findings suggest multidisciplinary health teams in primary care should include the management of oral morbidity and physical multimorbidity.
Collapse
|
17
|
How much is an NHS dentist worth? BDJ IN PRACTICE 2021. [PMCID: PMC8646334 DOI: 10.1038/s41404-021-0977-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Mustufvi Z, Serban S, Chesterman J, Mankia K. Should We Be Screening for and Treating Periodontal Disease in Individuals Who Are at Risk of Rheumatoid Arthritis? Healthcare (Basel) 2021; 9:1326. [PMID: 34683006 PMCID: PMC8544588 DOI: 10.3390/healthcare9101326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/24/2021] [Accepted: 09/30/2021] [Indexed: 12/21/2022] Open
Abstract
There is increasing evidence supporting an association between periodontal disease (PD) and rheumatoid arthritis (RA), both mechanistically and clinically. Trials have shown that treating PD in people with RA may improve RA disease activity. Patients with musculoskeletal symptoms without arthritis, who test positive for cyclic-citrullinated protein antibodies, are at risk of RA (CCP+ at-risk), with seropositivity preceding arthritis onset by months or years. Importantly, there is evidence to suggest that periodontal inflammation may precede joint inflammation in CCP+ at-risk and, therefore, this could be a trigger for RA. There has been increased research interest in RA prevention and the phenotyping of the pre-RA disease phase. This review will examine the merits of identifying individuals who are CCP+ at-risk and performing screening for PD. In addition, we discuss how PD should be treated once identified. Finally, the review will consider future research needed to advance our understanding of this disease association.
Collapse
Affiliation(s)
- Zhain Mustufvi
- Leeds Teaching Hospitals NHS Trust, National Institute for Health Research, School of Dentistry, University of Leeds, Leeds LS2 9LU, UK
| | - Stefan Serban
- School of Dentistry, University of Leeds, Leeds LS2 9LU, UK;
| | - James Chesterman
- Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Worsley Building, Clarendon Way, Leeds LS2 9LU, UK;
| | - Kulveer Mankia
- National Institute for Health Research Biomedical Research Centre, Chapel Allerton Hospital, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapeltown Road, Leeds LS7 4SA, UK;
| |
Collapse
|
19
|
Jo O, Kruger E, Tennant M. GIS mapping of healthcare practices: do older adults have equitable access to dental and medical care in the UK? Br Dent J 2021:10.1038/s41415-021-3406-0. [PMID: 34552210 DOI: 10.1038/s41415-021-3406-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/02/2020] [Indexed: 11/09/2022]
Abstract
Introduction Considering an ageing population with increasing comorbidities, access to oral and general healthcare is a growing concern. This study aimed to identify and compare access to dental and general practices. This study further aimed to ascertain if there exists a socioeconomic distribution of dental and general practices among older adults.Materials and methods A total of 13,007 dental practices and 13,759 general practices were mapped using geographic information system software, and overlaid with the UK older adult population and deprivation data by health areas. Data analysis was carried out by creating a geographical distribution map and by using descriptive statistics, Gini coefficients and Lorenz curves.Results NHS Central London Clinical Commissioning Group (CCG) held the highest dental practice-to-population ratio of 958 practices per 100,000 older adults, while NHS Manchester CCG held the highest general practice-to-population ratio of 264.4 general practices per 100,000 older adults. England had the highest Gini coefficients for general and dental practice at 0.214 and 0.195, respectively. Both dental and general practices were socioeconomically distributed among older adults in England, Wales and Northern Ireland, but not in Scotland.Conclusions An increasing proportion of older adults need access to healthcare that is based on clinical need, not the ability to pay; a founding principle of the NHS. This nation-wide study captures inequities in the spatial accessibility for older adults in the UK.
Collapse
Affiliation(s)
- Olivia Jo
- School of Human Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, 6009, Australia.
| | - Estie Kruger
- Department of Anatomy, Physiology and Human Biology, University of Western Australia, 35 Stirling Highway, Nedlands, Perth, 6009, Australia; International Research Collaborative Oral Health and Equity, University of Western Australia, Crawley, 6009, Australia
| | - Marc Tennant
- Department of Anatomy, Physiology and Human Biology, University of Western Australia, 35 Stirling Highway, Nedlands, Perth, 6009, Australia; International Research Collaborative Oral Health and Equity, University of Western Australia, Crawley, 6009, Australia
| |
Collapse
|
20
|
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.
Collapse
|
21
|
Serban S, Chapple ILC, D'Aiuto F, Douglas GVA, Pavitt S. Letter to the Editor: "Methodological Gaps in Studying the Oral-Systemic Disease Connection". J Dent Res 2021; 100:1299. [PMID: 34151634 DOI: 10.1177/00220345211024215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- S Serban
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, UK
| | - I L C Chapple
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - F D'Aiuto
- Eastman Dental Institute, University College London, London, UK
| | - G V A Douglas
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, UK
| | - S Pavitt
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, UK
| |
Collapse
|
22
|
Multimorbidity. Br Dent J 2021; 230:324. [PMID: 33772163 DOI: 10.1038/s41415-021-2854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
23
|
Hearnshaw S, Serban S, Mohammed I, Zubair A, Jaswal D, Grant S. A Local Dental Network Approach to the COVID-19 Pandemic: Innovation Through Collaboration. Prim Dent J 2021; 10:33-39. [PMID: 33302790 DOI: 10.1177/2050168420980979] [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] [Indexed: 06/12/2023]
Abstract
STRUCTURE We present the principles for selecting and initiating hubs, the integration with secondary care services and the supply of personal protective equipment. PROCESS The main elements are communication, the development of referral processes to manage complex cases and data collection. OUTCOME Through work with local dental stakeholders, 23 clusters and 36 hubs were set up covering a large geographical area.The integrated network of hubs and clusters has strengthened collaboration between providers and policy makers. Various leadership approaches facilitated the readiness for the transition to recovery. The new local collaborative structures could be used to support local programmes such as flexible commissioning, peer-led learning and integration with primary care networks.
Collapse
Affiliation(s)
| | - Stefan Serban
- NIHR Clinical Lecturer and Specialty Registrar in Dental Public Health, University of Leeds, School of Dentistry, United Kingdom
| | - Imran Mohammed
- Clinical Leadership Fellow and Specialty Registrar in Oral Surgery, Health Education England Yorkshire and Humber, Leeds, United Kingdom
| | - Ajmal Zubair
- Foundation Dentist, Health Education Yorkshire and Humber, United Kingdom
| | - Deksha Jaswal
- Foundation Dentist, Health Education Yorkshire and Humber, United Kingdom
| | - Siobhán Grant
- Consultant in Dental Public Health, Yorkshire & Humber, Public Health England, United Kingdom
| |
Collapse
|
24
|
Serban S, Mustufvi Z, Kang J, Simon SE, Grant S, Douglas G. The Dental Team: An Additional Resource for Delivering Vaccinations. Front Med (Lausanne) 2020; 7:606242. [PMID: 33240912 PMCID: PMC7677565 DOI: 10.3389/fmed.2020.606242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stefan Serban
- School of Dentistry, University of Leeds, Leeds, United Kingdom
- Public Health England, North East and Yorkshire Regional Office, Leeds, United Kingdom
| | - Zhain Mustufvi
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Jing Kang
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Sally Eapen Simon
- Public Health England, North East and Yorkshire Regional Office, Leeds, United Kingdom
| | - Siobhan Grant
- Public Health England, North East and Yorkshire Regional Office, Leeds, United Kingdom
| | - Gail Douglas
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| |
Collapse
|