Access to special care dentistry, part 1. Access

Assessment of structural and functional profile of dental centers for people with disabilities

AIMS

People with disabilities (PWD) often face more significant oral healthcare needs than the general population. This study, conducted in response to the urgent and pressing need for improved dental care for PWD, aims to assess the infrastructural and work process flow of dental centers in Delhi that provide specialized dental care for PWD.

METHODS AND RESULTS

A descriptive cross-sectional study was conducted across primary, secondary, and tertiary healthcare centers in Delhi, evaluating their infrastructure adaptations and work processes in delivering oral healthcare to PWD. The findings, which highlight the disparities in adaptations and work processes among different healthcare centers, are crucial for understanding the current state of oral healthcare for PWD in Delhi. The study reveals that while secondary and tertiary healthcare centers exhibit better adaptations for PWD than primary centers, challenges persist with insufficient accessibility and smooth functioning of the work process.

CONCLUSION

This study underscores the need for dentists to be equipped with the competence to address the unique needs of PWD. It also highlights the significant potential for improvement in oral healthcare for PWD, as dentists should become more aware of the importance of designing clinics that are accessible for PWD.

Acceptability of teledentistry use among residents and staff in aged residential care facilities in the Otago region of New Zealand

OBJECTIVES

To assess ARC residents' and staff perceptions of the benefits of, and comfort with, teledentistry use in ARC facilities in the Otago region of NZ, and identify end-user-level factors associated with its use.

BACKGROUND

Difficulty in accessing oral healthcare services is a key barrier to aged residential care (ARC) residents' oral health and well-being. Teledentistry offers a possible solution, yet studies on its acceptability in ARCs are sparse, especially in New Zealand (NZ). This study assessed ARC residents' and staff perceptions of the benefits of, and comfort with, teledentistry use in ARC facilities in the Otago region of NZ and identified end-user-level factors associated with its use.

MATERIALS AND METHODS

Rest home-level residents and care staff in ARC facilities in the Otago region of NZ were surveyed to assess their awareness of teledentistry, perceptions of benefit and comfort using teledentistry, and end-user-level factors associated with the feasibility of using it in ARCs.

RESULTS

One hundred residents and 77 care staff from 14 facilities participated. Three-quarters of resident participants thought that teledentistry was beneficial. Three in five resident participants were comfortable receiving remote dental consultations and care advice through teledentistry. Acceptability, as measured by perceived benefits and comfort, was lower among older participants. Staff participants were receptive to teledentistry use for residents and were comfortable facilitating remote dental consultations and care through teledentistry. No staff participants disagreed with the potential benefits of teledentistry for ARC residents.

CONCLUSION

Teledentistry would likely be acceptable to residents and staff in ARC facilities in NZ, contributing to residents' improved access to oral health care and improved oral health and well-being.

Dental care provision for people with neurodevelopmental disorders in Iran; a qualitative study of barriers

INTRODUCTION

One of the most underserved populations among dental patients is the people with Neurodevelopmental Disorders (PNDs). This study aimed to explore the barriers to dental care provision for PNDs from the viewpoint of stakeholders in provision in Iran.

METHODS

We arranged a qualitative study based on an individual in-depth, semi-structured interview between October 2019 and February 2020. We interviewed 30 participants using a snowball sampling strategy with three groups: dentists who provided dental care for PNDs, dental public health professionals, and policymakers/managers in dental care provision in Iran. The interviewer used an interview framework based on Levesque's model of patient-centered access. The main question was: "How do you assess the barriers to the provision of dental services to PNDs in Iran?" The data were analyzed by the qualitative content analysis method described by Graneheim and Lundman.

RESULTS

From the 30 interviewees (11 women), there were 11 dentists, nine dental public health professionals, and 10 participants who worked as policymakers/managers. They were aged 35-62 years and had working experience between 4 and 25 years. In the content analysis, 60 meanings units were extracted, and later classified into 14 subthemes, and four main themes.

CONCLUSION

Four main barriers were traced regarding access, financial, competency-related, and policy-making aspects.

Complications and treatment errors in periodontal therapy in medically compromised patients

Patients who are medically compromised may be at an increased risk of complications and treatment errors following periodontal therapy. A review of the evidence on the topic is presented, in relation to the type of complication reported, of periodontal treatment, and of patients' medical status. Further, a framework for risk assessment and appropriate treatment modifications is introduced, with the aim of facilitating the management of patients with existing comorbidities and reducing the incidence of treatment complications.

Analysis of Health Profile and Treatment Needs of Patients with Special Health Care Needs at a Malaysian Teaching Hospital: A 6-Year Observation

Aims and Objectives

Special care dentistry (SCD) provides oral health care to disabled individuals in an environmental, cultural or social setting that supports their oral health. This study aimed to analyze the profiles of patients managed at an SCD clinic in a teaching hospital based on their sociodemographic background, medical condition or disability, dental diagnosis and treatment provided.

Materials and Methods

This retrospective audit study included patients seen from the clinic's inception in January 2017 until June 2022, retrieved from the faculty's record management system. The pattern of patients seen was arranged on an Excel sheet and analyzed using SPSS. Quantitative data were analyzed via descriptive analysis (frequency) and chi-square test (P < 0.05).

Results

A 220% surge in the number of patients treated between January 2017 and June 2022, from two to 91 years old, with more male patients seen. Most patients had an intellectual disability (49.7%), followed by medical compromised (16.4%) and genetic conditions or syndromes (12.0%). 43% of had caries, which is more prevalent in women, and 31.6% had periodontal disease, with the majority being between the ages of 21 and 40. Periodontal treatment accounted for most of the dental treatment (76.1%). Even though only a small percentage of endodontic therapy was performed (2.4%), a significant association was found between the treatment, gender and age group of patients seen in the clinic.

Conclusion

Considering their health profile, oral diagnosis and therapy, this study demonstrated the varied sorts of patients encountered in an SCD specialist clinic. This useful information will be beneficial in the development of a comprehensive care dentistry center for this community.

Are adults with autism receiving regular preventive dental services?

PURPOSE/AIM

To investigate the frequency of preventive dental care among adults with autism and explore factors associated with receiving regular preventive care.

MATERIALS AND METHODS

De-identified data was collected from electronic health records of 18-year-old or older patients with autism that had at least one preventive dental procedure recorded. The data was then analyzed to describe the frequency of preventive dental procedures provided for this population and investigate what variables are associated with regular care.

RESULTS

Sample size was 119, 67% were males, average age was 30.8 years, and 58% had Medicaid. Average BMI was 42.8, the prevalence of diabetes and heart disease were 16% and 34%, respectively, and 86% reported mental health problems. Recreational drug use was 6.8%, alcohol use was 19%, and tobacco use 16%. Xerostomia was reported by 32%, and the average number of medications was 7.2 ± 5.5. The average number of preventive dental visits was 7.9 ± 10.6, and 35% of the patients had at least one preventive dental visit per year. Only number of medications had a statistically significant association with number of preventive dental visits.

CONCLUSIONS

Only one in every three adults with autism had at least one preventive dental visit per year.

Dental procedures in children with or without intellectual disability and autism spectrum disorder in a hospital setting

BACKGROUND

This population-based cohort study investigated dental procedures in the hospital setting in Western Australian children with or without intellectual disability (ID) and/or autism spectrum disorder (ASD) aged up to 18 years. Considering previously reported disparities in dental disease between Indigenous and non-Indigenous Australian children, this study also investigated the effect of Indigenous status on dental procedures.

METHODS

Data on Western Australian live births from 1983 to 2010 from the Midwives Notification System were linked to the Intellectual Disability Exploring Answers database and the Hospital Morbidity Data collection. Primary admissions for relevant dental diagnoses were identified, and treatment procedures for dental hospitalization were investigated. Descriptive statistics and Pearson's chi-squared test of independence were used for analysis.

RESULTS

Overall, 76 065 episodes of dental hospitalization were recorded. Amongst children with ID and/or ASD, Indigenous children experienced more extractions and fewer restorations (68.7% and 16.2%) compared to non-Indigenous children (51.5% and 25.9%). After 6 years, extraction occurred less often in children with ID and/or ASD than in those without, where most surgical dental extractions were in the age group of 13-18 years.

CONCLUSIONS

This study indicates a need for further improvements in access to dental services and the quality of care provided in hospitals for children with ID/ASD. There is also concern that more vulnerable Indigenous and all disadvantaged children are receiving an inadequate level of dental services resulting in more emergency dental hospitalization and invasive treatment.

Oral health needs of U.S. children with developmental disorders: a population-based study

Background

Children with Special Health Care Needs (CSHCN) have higher rates of oral diseases and tooth decay compared with the general population. Children with developmental disorders/ disabilities (DD) are a subset of CSHCN whose oral health has not been specifically addressed. Therefore, this study had two objectives: to describe the oral health needs (OHN) of children with DD compared with children without DD; and to assess barriers to access to care, utilization of dental services, and their association with oral health needs for children with DD.

Methods

This cross-sectional study utilized a sample of 30,530 noninstitutionalized children from the 2018 National Survey of Children’s Health (NSCH). Analysis was conducted using descriptive and inferential statistics.

Results

The analysis identified 6501 children with DD and 24,029 children without DD. Children with DD had significantly higher prevalence of OHN (20.3% vs. 12.2%, respectively), unmet dental needs (3.5% vs 1.2%), and utilization of any dental visits (86.1% vs 76.1%), (P-value < . 001). The adjusted logistic model identified four factors that contributed to the higher odds of OHN among children with DD: poverty (< 100% of the Federal Poverty Level (AOR = 2.27, CI: 1.46–3.51), being uninsured (AOR = 2.12, 95% CI: 1.14–3.95), a high level of disability (AOR = 1.89, CI: 1.23–2.78), and living in the western United States (AOR = 1.61, CI: 1.09–2.37.

Conclusion

Despite higher utilization of dental services, children with DD had poorer oral health and more unmet dental needs than children without DD. Advocacy efforts and policy changes are needed to develop affordable access that assesses, as early as possible, children with DD whose conditions impact their ability a great deal so that their potential OHN may be alleviated more effectively.

What can a dentist learn from an astrophysicist? A photographic evaluation of the long-term impact of amyotrophic lateral sclerosis on the orofacial sphere, using the example of Stephen Hawking: A historical case report

Aims

The present historical case report aims to characterize the long‐term orofacial repercussions of amyotrophic lateral sclerosis (ALS), a rare neurodegenerative disease with poor prognosis and relatively short life expectancy following initial diagnosis.

Methods

Here we focus on the long‐term orofacial evolution seen in the example of Stephen Hawking, one of the greatest personalities in the scientific world, using publicly‐available photographic documentation. The fact that Stephen Hawking lived several decades following his diagnosis of ALS presents one with a unique opportunity to characterize and follow‐up the evolution of the ALS on the orofacial sphere. Through this article, we want to show him and his family, and all those living with this disease, our deepest respect, without intending in any way to intrude or misuse the privacy of the late universally‐respected astrophysicist.

Results

Photographic documentation analyzed longitudinally shows changes towards the development of a Class III malocclusion, lower incisor protrusion, and a concave profile. Moreover, tooth wear has occurred, accompanied by posterior tooth loss and aberrant tongue and lip posture.

Conclusion

The causes of such changes remain speculative but could be due to changes in the soft tissue equilibrium, changes in head and tongue posture, loss of oral function, respiratory needs, and a general deterioration of dental health. Our sincere thanks to the Hawking family who took the time to read the article and approve its publication for scientific and educational purposes. We are also deeply grateful to them for providing us with some photographs from their family collection.

Specialist Networks Influence Clinician Willingness to Treat Individuals with Special Needs

BACKGROUND

The South Australian Dental Service's Special Needs Network was established to support oral health professionals working within their statewide government-funded dental service to treat patients with special needs. This study aimed to investigate how a structured network relationship with specialists in special needs dentistry influenced the willingness of dentists to treat this group of patients.

METHODS

Semi-structured interviews were used to explore the views of specialists and dentists involved in the South Australian Dental Service's Special Needs Network. Inductive thematic analysis identified emerging themes enabling completion of a SWOT (strengths, weaknesses, opportunities, threats) analysis.

RESULTS

Dentists felt that a strength of the Network was a greater sense of collegiality, particularly for those working in rural areas. Although the inability to get immediate advice was seen as a weakness, dentists felt a more structured relationship with specialists improved communication pathways and resulted in more timely care. The aging workforce, systemic barriers in the public dental system, such as productivity pressures and infrastructure, and the lack of support from other health professionals were seen as ongoing barriers and threats. Regardless, dentists identified the use of telehealth and visiting specialists as future opportunities. Specialists felt that the Network was a valuable resource but were skeptical about its effectiveness, feeling that a limitation was the ability of dentists to recognize the complexity of cases.

CONCLUSIONS

Ongoing support from and communication with specialists in special needs dentistry through a structured network improved the perceived ability and willingness of dentists to treat patients with special needs.

KNOWLEDGE TRANSFER STATEMENT

This research suggests that providing support to dentists through a hub-and-spoke network that facilitates additional training, professional interaction, and improved communication with specialists in special needs dentistry may help overcome some of the current barriers to access to care experienced by individuals with special needs, particularly those associated with the willingness and capability of clinicians treat them.

Ten years on: an online questionnaire evaluation of the UK special care dentistry specialist workforce

Aims To provide information on the demographics and work patterns of the UK special care dentistry (SCD) specialist workforce.Design A self-administered electronic questionnaire.Setting All UK-based SCD specialists on the membership of the British Society for Disability and Oral Health and the British Society of Gerodontology.Materials and methods An electronic questionnaire was distributed to a potential 301 SCD specialists. Responses were descriptively analysed.Results One hundred responses (33%) were received. The majority of respondents were female (74%) and/or of white ethnicity (86%). Three-quarters (78%) were based in England and a third (37%) were based in South East England. Two-thirds (66%) worked in the community dental service. Forty-eight percent work part-time and 32% have had a career break. Forty-three percent are planning to retire by 2026 and approximately half (53%) plan to retire by 2031. A significant minority (44%) do not feel appropriately paid.Conclusions Workforce planners should anticipate the impact on specialist provision due to a combination of a predominantly female workforce with associated working patterns, an anticipated loss of numbers and experience, and the effect financial dissatisfaction may have on attracting trainees. Efforts should be made to increase racial diversity.

A bio-behavioral intervention combining task analysis with skill-based training to train toothbrushing among children with intellectual disability

AIMS

Individuals with intellectual disability (ID) have special health care needs. Teaching self-care behaviors like toothbrushing helps reduce their dependence on adult caregivers. We present a bio-behavioral intervention combining task analysis with skill-based teaching of toothbrushing behavior aimed to promote autonomy in children with various types of ID.

METHODS

One hundred twenty children with ID enrolled at a special school in the State were included in the study. After baseline measurements using task analysis, four methods were used to train the children - instruction, three-phase modeling, physical guidance, and descriptive praise. The caregiver was trained and given instructional videos for reinforcement. After 4 weeks, the children were asked to brush their teeth and performance was evaluated.

RESULTS

There was increased independence in the performance of toothbrushing behavior, the mild and moderate ID groups showing the most improvement. Steps like oral manipulation of the toothbrush showed the greatest improvement in these groups. The severe ID group showed improvement in certain skills, while requiring assistance for others that demanded dexterity.

CONCLUSION

This intervention can be implemented by special schools and special care dentistry centers to foster autonomy in oral self-care skills in the mild and moderate ID children, and complemented with other methods for severe ID children.

Radiological Evaluation of Stainless Steel Crowns Placed on Permanent Teeth in Patients Treated under General Anaesthesia

Evidence-based evaluations of dental treatment are needed to support the development of special care dentistry services. This retrospective study was designed to collect and analyse X-ray images of permanent teeth restored with stainless steel crowns (SSC) in patients treated under general anaesthesia. Between 2013 and 2019, 360 permanent molars were crowned with SSCs in 198 adult patients. One calibrated investigator used an original validated tool to evaluate four radiographic criteria for molars restored with SSCs: (i) marginal adaptation; (ii) interdental proximal contact; (iii) the presence of glass ionomer cement overflow; and (iv) the loss of alveolar bone. Overall, no defect or a minor defect was reported for the majority of SSCs for the criteria “Marginal adaptation” (62.5%, n = 320), “Proximal contact” (82.2%, n = 236) and “Cement overflow” (95.8%, n = 337). Alveolar bone resorption was reported in 8.3% of cases, n = 14, after a mean period of 8.9 ± 14.3 months. It was shown that the restoration of permanent teeth using SSCs placed under general anaesthesia presents a low risk of periodontal morbidity in the medium term when assessed radiographically.

A scoping review on dental clinic accessibility for people using wheelchairs

AIMS

We aimed to explore the scientific literature on accessible dental clinics for wheelchair users. More specifically, we sought out literature addressing how the human environment and physical space shape the dental services of accessible dental clinics.

METHODS

We conducted a scoping review (May 2019) in Embase, PubMed, Web of Science, and the Avery index of architectural Periodicals (3994 articles). We followed Arksey and O'Malley's recommended procedures; after screening, we retained 17 articles. We performed a critical appraisal, followed by thematic content analyses of extracted data.

RESULTS

The articles originated mainly from the United States and United Kingdom. Only three reported original research. We illustrated the results within a three-step dental care pathway cycle. In each step, the interaction between accessibility of the physical and human environments (ie, the layout/design of the clinic and the attitudes and skills of the dental professional, respectively) contributed to the overall accessibility. We also found that empirical evidence on clinics' accessibility was lacking: many articles resorted to broad "one size fits all" recommendations and fragmented information on accessibility. Finally, the voice of wheelchair users was missing.

CONCLUSION

There are knowledge gaps in terms of dental clinics' accessibility. We thus invite researchers to conduct original studies with dental professionals, wheelchair users, and their caregivers.

A rapid review of barriers to oral healthcare for people with protected characteristics

Introduction The Equality Act 2010 sets out nine protected characteristics and serves to protect every individual against discrimination. The Act places emphasis on the need to reduce inequalities. An understanding, therefore, of existing barriers to oral healthcare for people with protected characteristics is required to inform policy and the commissioning of services.Aim To conduct a rapid review of current UK literature on barriers to oral healthcare for people with protected characteristics.Methods Electronic searching using Medline via Ovid limited to publications in English from the UK. Publication types included primary and secondary evidence from peer-reviewed journals and reports.Results From a total of 462 citations, 52 articles were included in the final review. Common barriers experienced across the protected characteristic groups were identified in addition to specific barriers experienced by those with protected characteristics.Conclusion This rapid review identified barriers to oral healthcare for people with protected characteristics at individual and organisational levels. Gaps identified in the literature include a lack of information available for barriers experienced by people due to sexual orientation, marital/civil partnership status and gender reassignment. Additionally, there is a gap in the evidence available on policy barriers to oral healthcare for people with protected characteristics.

Effectiveness of an individually tailored oral hygiene intervention in improving gingival health among community-dwelling adults with physical disabilities in Thailand

AIMS

Persons with physical disabilities require specific methods for sustaining good oral health. This study aimed to evaluate an individually tailored oral hygiene intervention program (IT-OHI) for improving gingival health among adults with disabilities.

METHODS AND RESULTS

A single group, quasi-experimental design with pre- and post-tests, conducted at a community club for disabled people in Thailand. This study included 145 adults with disabilities, aged 18-74 years. Trained caregivers provided IT-OHI program to all participants. Calibrated dentists assessed the gingival bleeding and dental plaque at baseline/pre-intervention (T0) and at 6 (T1) and 12 (T2) weeks post-intervention. The outcomes were analyzed using the Friedman test, Cochran's Q test, and Binary logistic regression. There were significant decreases in bleeding on probing scores (P < .001) and plaque control record scores (P < .001) throughout the study. However, considering the individual periods, values between T1 and T2 did not improve. Additionally, the IT-OHI program's protective effect was more substantial among the male participants at 12 weeks post-intervention (odds ratio = 0.094, P = .027) than among the females.

CONCLUSION

The IT-OHI program had partial effectiveness in improving gingival health and reducing dental plaque accumulation in a group of Thai people with physical disabilities; however, the long-term impact remains unclear.

Specialized dental care for people with disabilities in Brazil: profile of the Dental Specialty Centers, 2014

OBJECTIVE

To describe the oral health care services for people with disabilities treated within the Dentistry for Patients with Special Needs (PSN) specialty.

METHODS

This was a cross-sectional study with data from the Program for Improving Access and Quality of Dental Specialty Centers (PMAQ-CEO) in 2014.

RESULTS

Of the total of 932 services evaluated, 89.8% did provide care for PSNs, 30.4% had physical accessibility, 59.7% provided referral to hospital care and most guaranteed complete treatment. Only a third of the Dental Specialty Centers planned 40 or more hours a week for providing clinical care to PSNs.

CONCLUSION

The care network for people with disabilities is being formed but, even with specific financial incentives, it has limitations. Services need to eliminate physical and attitudinal barriers to ensure universal accessibility. Protocols based on risk classification are necessary, prioritizing care at DSCs for complex cases not attended to in Primary Care and organizing the dental health care network for people with disabilities.

Barriers in Access to Dental Services Hindering the Treatment of People with Disabilities: A Systematic Review

Background

People with disabilities tend to have greater oral health problems compared to those without disabilities. This may be due to barriers they come across in accessing dental services.

Objectives

The objective of this systematic review was to provide a critical digest of the scientific literature concerning barriers and facilitators of access to oral health services for people with disabilities.

Methods

The electronic databases PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS), and Brazilian Library of Dentistry (BBO) were searched using keywords relevant to the subject. The search was not restricted to specific languages or years of publication; all relevant studies were translated and reviewed.

Results

Sixteen studies including 14 articles, a doctoral thesis, and a monograph were selected, and their quality was analysed using the Downs and Black assessment tool. Barriers to dental services were divided into physical or nonphysical based on the dentist's perspective, as per the perception of parents/guardians or by the persons with disabilities. The barriers that emerged included the dentist's lack of preparation to assist people with disabilities, structural problems of access to dental offices, communication difficulties, and lack of awareness regarding the need for dental treatment for the disabled person.

Conclusion

It is concluded that people with disabilities continue to run into complex physical, behavioural, or multidimensional barriers in accessing dental services. Improved training of dentists for the care of this population is hereby emphasized. The legal framework enabling access to dental care for people with disabilities must also be respected in each country.

"I have been refused to be treated by three dentists": Barriers to patient care

BACKGROUND

Factor X deficiency (known as; Stuart-Prower factor deficiency or F10 deficiency) is a rare inherited bleeding disorder. It affects one per 1 million individuals worldwide. Patients with inherited bleeding disorder reported difficulty in accessing primary dental care either due to their medical diseases or their related barriers.

AIM

This article aims to identify barriers to oral health as perceived by the patient with factor X deficiency who had been refused treatment by three dentists. A further aim is to provide dentists with the knowledge required to manage patients diagnosed with factor X deficiency.

METHODS AND CASE REPORT

A 30-year-old male with the inherited, severe factor X deficiency (<1%) was asked to complete a survey which includes 22 semistructured, validated questions to assess his perceived barriers to dental services. Dental examination revealed that the patient required having nonsurgical periodontal therapy under local anesthesia. The treatment plan was discussed with the patient and his hematologist. The patient's hematologist advised performing dental treatment shortly (ie, 1-2 h) after hematological cover with a prothrombin complex concentrate (1000 U; Octoplex^® ) via intravenous infusion. The hematologist also prescribed tranexamic acid mouthwash (250 mg in 5 mL) and the patient was instructed to rinse his mouth for 3-5 min with 500 μg (10 mL) in case of bleeding following treatment.

FINDINGS

The patient reported several barriers to dental services such as high anxiety levels regarding oral bleeding, difficulty in finding a suitable dental clinic, high cost of dental treatment, and the need for hematological cover prior to dental treatment.

CONCLUSIONS

The proper communication between dentist and hematologist was a vital step to render safe and effective dental care and to reduce the patient's anxiety toward the dentist.

Validation of Thai version of the Health Literacy in Dentistry scale: Validation among Thai adults with physical disabilities

AIM

To validate the Thai version of the Health Literacy in Dentistry scale (HeLD-Th) among Thai adults with physical disabilities.

METHODS

The original Health Literacy in Dentistry (HeLD) was translated into Thai (HeLD-Th). The final version of the HeLD-Th was evaluated through a cross-sectional study of 160 participants in Thailand. Interview questionnaires and oral examination were performed. The reliability and validity of the HeLD-Th were determined.

RESULTS

The internal consistency was acceptable, with an overall Cronbach's alpha of 0.76. The face and content validity were confirmed. Sufficient construct validity was revealed by exploratory factor analysis. The convergent validity (P ≤ .013) and discriminant validity (P = .017) were estimated. The concurrent validity and predictive validity were confirmed by significantly higher HeLD-Th scores (P < .001). Multiple linear regression analyses indicated that approximately 60% of the variation in the HeLD-Th scores was explained by the final model.

CONCLUSION

The HeLD-Th has sufficient psychometric properties to assess the oral health literacy of Thai adults with mild to moderate disabilities. There are some limitations of the study due to the small sample size, and the results are specific to Thai adults with disabilities. Future studies using the HeLD-Th scale are recommended.

Contextualising disability and dentistry: challenging perceptions and removing barriers

This paper explores the contextualised relationship between disability and oral health, locating questions about the oral health and oral health care of disabled people within wider debates about the material, social and cultural barriers that disabled people face when accessing health care. Sociological and disability studies research is drawn on to highlight potential barriers to oral health for disabled people and outline alternative ways of looking at, thinking about and challenging these barriers. Starting with a brief look at definitions and understandings of disability and the impact of this on attitudes, research on the multi-level barriers faced by disabled people within oral health care is then highlighted. The article concludes with some thoughts on how research from other disciplinary traditions can be useful in helping to make dentistry more prepared to appropriately and successfully meet the needs of disabled people, both in a special care setting but also, more crucially, in a general dental setting.

Oral hygiene interventions for people with intellectual disabilities

BACKGROUND

Periodontal (gum) disease and dental caries (tooth decay) are the most common causes of tooth loss; dental plaque plays a major role in the development of these diseases. Effective oral hygiene involves removing dental plaque, for example, by regular toothbrushing. People with intellectual disabilities (ID) can have poor oral hygiene and oral health outcomes.

OBJECTIVES

To assess the effects (benefits and harms) of oral hygiene interventions, specifically the mechanical removal of plaque, for people with intellectual disabilities (ID).

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases to 4 February 2019: Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Register of Studies), MEDLINE Ovid, Embase Ovid and PsycINFO Ovid. ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. The Embase search was restricted by date due to the Cochrane Centralised Search Project, which makes available clinical trials indexed in Embase through CENTRAL. We handsearched specialist conference abstracts from the International Association of Disability and Oral Health (2006 to 2016).

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and some types of non-randomised studies (NRS) (non-RCTs, controlled before-after studies, interrupted time series studies and repeated measures studies) that evaluated oral hygiene interventions targeted at people with ID or their carers, or both. We used the definition of ID in the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). We defined oral hygiene as the mechanical removal of plaque. We excluded studies that evaluated chemical removal of plaque, or mechanical and chemical removal of plaque combined.

DATA COLLECTION AND ANALYSIS

At least two review authors independently screened search records, identified relevant studies, extracted data, assessed risk of bias and judged the certainty of the evidence according to GRADE criteria. We contacted study authors for additional information if required. We reported RCTs and NRSs separately.

MAIN RESULTS

We included 19 RCTs and 15 NRSs involving 1795 adults and children with ID and 354 carers. Interventions evaluated were: special manual toothbrushes, electric toothbrushes, oral hygiene training, scheduled dental visits plus supervised toothbrushing, discussion of clinical photographs showing plaque, varied frequency of toothbrushing, plaque-disclosing agents and individualised care plans. We categorised results as short (six weeks or less), medium (between six weeks and 12 months) and long term (more than 12 months).Most studies were small; all were at overall high or unclear risk of bias. None of the studies reported quality of life or dental caries. We present below the evidence available from RCTs (or NRS if the comparison had no RCTs) for gingival health (inflammation and plaque) and adverse effects, as well as knowledge and behaviour outcomes for the training studies.Very low-certainty evidence suggested a special manual toothbrush (the Superbrush) reduced gingival inflammation (GI), and possibly plaque, more than a conventional toothbrush in the medium term (GI: mean difference (MD) -12.40, 95% CI -24.31 to -0.49; plaque: MD -0.44, 95% CI -0.93 to 0.05; 1 RCT, 18 participants); brushing was carried out by the carers. In the short term, neither toothbrush showed superiority (GI: MD -0.10, 95% CI -0.77 to 0.57; plaque: MD 0.20, 95% CI -0.45 to 0.85; 1 RCT, 25 participants; low- to very low-certainty evidence).Moderate- and low-certainty evidence found no difference between electric and manual toothbrushes for reducing GI or plaque, respectively, in the medium term (GI: MD 0.02, 95% CI -0.06 to 0.09; plaque: standardised mean difference 0.29, 95% CI -0.07 to 0.65; 2 RCTs, 120 participants). Short-term findings were inconsistent (4 RCTs; low- to very low-certainty evidence).Low-certainty evidence suggested training carers in oral hygiene care had no detectable effect on levels of GI or plaque in the medium term (GI: MD -0.09, 95% CI -0.63 to 0.45; plaque: MD -0.07, 95% CI -0.26 to 0.13; 2 RCTs, 99 participants). Low-certainty evidence suggested oral hygiene knowledge of carers was better in the medium term after training (MD 0.69, 95% CI 0.31 to 1.06; 2 RCTs, 189 participants); this was not found in the short term, and results for changes in behaviour, attitude and self-efficacy were mixed.One RCT (10 participants) found that training people with ID in oral hygiene care reduced plaque but not GI in the short term (GI: MD -0.28, 95% CI -0.90 to 0.34; plaque: MD -0.47, 95% CI -0.92 to -0.02; very low-certainty evidence).One RCT (304 participants) found that scheduled dental recall visits (at 1-, 3- or 6-month intervals) plus supervised daily toothbrushing were more likely than usual care to reduce GI (pocketing but not bleeding) and plaque in the long term (low-certainty evidence).One RCT (29 participants) found that motivating people with ID about oral hygiene by discussing photographs of their teeth with plaque highlighted by a plaque-disclosing agent, did not reduce plaque in the medium term (very low-certainty evidence).One RCT (80 participants) found daily toothbrushing by dental students was more effective for reducing plaque in people with ID than once- or twice-weekly toothbrushing in the short term (low-certainty evidence).A benefit to gingival health was found by one NRS that evaluated toothpaste with a plaque-disclosing agent and one that evaluated individualised oral care plans (very low-certainty evidence).Most studies did not report adverse effects; of those that did, only one study considered them as a formal outcome. Some studies reported participant difficulties using the electric or special manual toothbrushes.

AUTHORS' CONCLUSIONS

Although some oral hygiene interventions for people with ID show benefits, the clinical importance of these benefits is unclear. The evidence is mainly low or very low certainty. Moderate-certainty evidence was available for only one finding: electric and manual toothbrushes were similarly effective for reducing gingival inflammation in people with ID in the medium term. Larger, higher-quality RCTs are recommended to endorse or refute the findings of this review. In the meantime, oral hygiene care and advice should be based on professional expertise and the needs and preferences of the individual with ID and their carers.

Oral health status of athletes with an intellectual disability competing in the Special Olympics GB National Games 2017

Background The aim of this paper is to describe the oral health status of athletes with intellectual disabilities competing in the Special Olympics, GB National Games, held in Sheffield in August 2017.Methods and materials A convenience sample of athletes who participated in the Special Olympics Special Smiles screening programme was used. All data was recorded on validated Healthy Athletes screening forms.Results Of the 692 athletes that participated, 14% had untreated decay, 51.9% had at least one filling and 28.6% had signs of gingivitis. Furthermore, 6.2% reported pain from their mouth and 2.7% were found to require urgent treatment. Overall, 90.3% reported to clean their mouths at least once per day and 0.7% were found to be edentulous.Discussion The findings from this screening highlighted lower rates of decay, pain and urgent treatment need in comparison to Special Olympic screenings worldwide.Conclusion The oral health of athletes competing in the GB National Games 2017 was better than noted at most Special Olympic events throughout the world. There is little data published on the oral health of individuals with learning disabilities in the UK. These results provide valuable baseline data to monitor and review the oral health of Special Olympic athletes within Great Britain.

Oral health-related quality of life of Portuguese adults with mild intellectual disabilities

Individuals with disabilities are regarded as a highly vulnerable population group, particularly as far as oral health is concern. However, few studies have assessed the impact of the oral condition on the quality of life of these individuals. Therefore, the aim of this study is to expand knowledge on the oral health status of the Portuguese adults with mild intellectual disability, and to assess how the patient's oral health is related to their quality of life. A sample of 240 adults with mild intellectual disabilities linked to the Portuguese Federation for Intellectual Disability, were interviewed using a previously validated version of the Oral Health Impact Profile. An oral health examination was also conducted using three oral health indexes: Clinical Oral Health Index (COHI); Clinical Oral Care Needs Index (COCNI) and the Clinical Oral Prevention Index (COPI). Sociodemographic characteristics and dental health factors were also collected, following statistical analysis. More than half of the individuals (54,9%) presented one or more problems of major to severe impact on health (COHI level 2); only 4,6% of the individuals do not need treatment or examination (COCNI level 0) and 85% of the study sample needs measures of educational or preventive action (COPI level 1). In 76,9% of the participants, oral health had impact on the quality of life. The most affected dimensions of life were physical pain with 61,9%, followed by psychological discomfort and psychological disability with 45,1% and 45%, respectively. With relation to oral health factors and sociodemographic variables it was verified that fewer teeth and higher self-perception of need for dental treatment had a negative impact on the quality of life. On the other hand, institutionalization and an increase in at least one category in the self-perception of the oral health status had a positive impact on the quality of life. Given the high burden of oral disease and the considerable impact on quality of life found in this study, the establishment of guidelines to improve the oral health and quality of life of these individuals should be regarded as imperative.

Access to dental services for children with intellectual and developmental disabilities - A scoping review

BACKGROUND

Children with Intellectual and Developmental Disabilities (IDD) face considerable challenges in participating in dental services. These challenges include resource constraints and inadequate skills of health service providers to work with this population.

AIM

The aim was to scope published studies that addressed access to dental services for children with IDD in order to determine the extent to which various barriers have been researched, using an access framework derived from the literature. Access was defined to include the six dimensions of accessibility, availability, affordability, accommodation, acceptability, and appropriateness.

METHOD

Arksey and O'Malley's scoping review framework was used. Relevant databases (e.g., Medline) were searched for all empirical studies conducted from January 2000 to February 2017 that met inclusion criteria. Data were extracted along the six dimensions of the access framework.

RESULTS

Sixteen international studies were identified which indicated common key barriers to dental service use: the difficulties of physical inaccessibility, lack of access to information among carers, lack of knowledge of disability issues, and low experience and skills in caring for children with IDD among dental practitioners.

CONCLUSIONS

Key recommendations made were exploring dental practitioners' understanding of disability legislation and developing training for practitioners to expand on issues specific to IDD.

Perspectives and experiences of Thai adults using wheelchairs regarding barriers of access to dental services: a mixed methods study

PURPOSE

To explore the perspectives and experiences of Thai wheelchair users regarding barriers of access to dental services and report potential solutions in terms of customer satisfaction.

PARTICIPANTS AND METHODS

We conducted a 2-phase cross-sectional study with quantitative and qualitative components at a community club for individuals with disabilities in Pathum Thani province, Thailand, in February 2018. In quantitative phase, participants were interviewed using a structured questionnaire that consisted of 1) questions on demographic characteristics and 2) adapted questions that were based on the modified Penchansky and Thomas dimensions of access. Enter method of binary logistic regression analysis was used. Regarding qualitative phase, focus group discussions were conducted using the themes of a semi-structured discussion guide. Thematic analysis was used.

RESULTS

A total of 156 wheelchair users participated in the quantitative phase. Most study participants had not attended dental care services in the previous year (78.2%). Multivariate analysis found a statistically significant association that indicated that participants who had education level ≤primary education were 3.5 times more likely to had not attended a dental appointment in the previous year (P=0.003). In the qualitative phase, 33 participants were included in 3 focus groups (each comprising 11 participants), they were wheelchair users with education >primary, who did not go to see a dentist in the previous 12 months. Findings of the 3 focus groups suggest generally negative views about Thai dental services for all dimensions of access.

CONCLUSION

This study reflects the unheard voices of wheelchair users and provides rigorous evidence in Thai context that difficulties of access to dental services persist. Policy makers and oral health professionals in oral health system should be alerted to the explicit barriers reported, such that equitable and equal dental services for disabled individuals can be developed.

Preventing perioperative bleeding in patients with inherited bleeding disorders

Data sourcesCochrane Cystic Fibrosis and Genetic Disorders Group's Coagulopathies Trials Register, a regularly updated database informed by trials identified within electronic databases including MEDLINE. Further defined searches were undertaken in PubMed, Embase, The Cochrane Library, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. Additional hand searching of relevant journals and books of conference proceedings was undertaken.Study selectionRandomised and quasi-randomised controlled trials in people of all ages with haemophilia or VWD undergoing oral or dental procedures using antifibrinolytic agents (tranexamic acid (TXA) or epsilon aminocaproic acid (EACA)) to prevent perioperative bleeding compared to no intervention with or without placebo.Data extraction and synthesisTwo authors independently assessed identified publications for inclusion based on defined selection criteria. The two authors performed data extraction and risk of bias assessments using standardised forms and the Cochrane risk of bias tools. A third author, deemed to have particular subject expertise, verified eligibility of inclusion.ResultsOne randomised, double-blinded placebo controlled trial and one quasi-randomised trial were included. A total of 59 participants with haemophilia undergoing dental extraction were involved. Both trials evidenced a notable reduction in post-operative bleeding following dental extraction when either TXA or EACA were used, in addition to routine preoperative factor replacement, when compared to placebo. The number of post-operative bleeds, amount of blood loss and the need for additional clotting factors were reduced in the groups receiving antifibrinolytic therapy. No eligible trials in people with VWD were identified.ConclusionsLow quality evidence exists to support the use of adjuvant antifibrinolytic therapy to reduce perioperative bleeding in patients with haemophilia undergoing dental extraction. The limited number of trials identified (N=2), minimal sample size (N=28, N=31) and historic nature of the studies, originating from the 1970s, in addition to study heterogeneity and subsequent selection bias results in a low quality evidence grade for recommending adjuvant antifibrinolytic therapy. There is no clear indication to alter current practice utilising antifibrinolytic therapy to manage patients with haemophilia undergoing dental surgery in accordance with internationally accepted guidelines. However, further research with standardised study deigns would be welcomed in order to enhance the evidence base in the management of people with haemophilia and VWD.

Access to oral health care services among adults with learning disabilities: a scoping review

BACKGROUND

The prevalence of oral diseases including dental caries and periodontal conditions is remarkably higher in people with disabilities. The provision of accessible oral health services for people with learning disabilities may be challenging.

OBJECTIVES

The objectives of the review were to identify barriers in accessing oral health care that persists within society, enabling or disabling people with learning disabilities.

METHODS

Using the Arksey O'Malley framework, a scoping review was conducted on PubMed/Medline, OVIDSP, and EMBASE. Studies were evaluated and short-listed based on the inclusion criteria, which consisted of: (1) study participants or population with learning disabilities, (2) aged 16 years or over, (3) reporting on access to oral health services, (4) published in the English language. Those that justified the inclusion criteria were carefully chosen after a blind peer-reviewed process when relevance and quality were debated.

RESULTS

Nine studies were eventually included from searches. Tabulation of data was done under the heading of study type, outcomes, the year of publication and patient selection. The majority of studies provided a biomedical overview of access for adults with learning disabilities.

CONCLUSIONS

The concept of access for people with disability is still ill-defined and obscure. Access to oral health care and needs of people with learning disabilities are complex and multi-facet.

Dental health and odontogenic infections among 6- to 16-year-old German students with special health care needs (SHCN)

OBJECTIVES

This cross-sectional study aimed to assess dental health and odontogenic infections in students with special health care needs (SHCN) in the Free State of Thuringia, Germany.

METHODS

From 1283 students with SHCN aged 6-16 years, 66.0 % (n = 848 of whom are 35.7 % females and 64.3 % males) with intellectual/learning disabilities (ID/LD), physical disabilities (PD), and sensory disorders (SD) participated after informed consent in oral examinations according to WHO standards. Dental caries was assessed by dmft/DMFT, odontogenic infections by pufa/PUFA. Fissure sealants (FS) were scored in permanent molars. Data were compared to regional and national reference data and analysed by t test and age-adjusted logistic regression models.

RESULTS

Students with SHCN revealed 41.2 % caries prevalence in permanent and 31.7 % in primary teeth. Highest prevalence/experience of caries and odontogenic infections in primary teeth was recorded in 6-11-year-olds with PD (65.1 %/2.3 dmft; 14.0 %/0.3 pufa). Most affected permanent teeth were observed in students with ID/LD (12-16-year-olds 59.6 %/2.4 DMFT; 6-11-year-olds 2.8 %/0.03 PUFA). All odontogenic infections in 12-16-year-olds occurred in males; n = 9 students revealed n = 9 teeth with pufa/PUFA. Students with ID/LD aged 6-11 years exhibited lowest prevalence of FS (29.0 %) and mean of 0.8 FS. Students with SHCN suffered more than twice as frequent from untreated dental caries and benefited up to 29.0 % less from FS than peers without disabilities.

CONCLUSION

This first study investigating odontogenic infections of German students with SHCN revealed highest prevalence in primary teeth and in males. Oral health among students with SHCN is reduced, and FS are underutilized compared to German students without disabilities.

CLINICAL RELEVANCE

Reinforcing the application of FS in students with SHCN might contribute to reducing disparities in oral health.

Dementia and Dentistry

Dementia is increasing in prevalence: by 2025 it is estimated that there will be over a million people in the UK with this diagnosis. The condition is likely to affect us all as healthcare providers, whether in our patients, our relatives or ourselves. This article gives an overview of dementia: causes, treatment, how it affects people and provides advice on how to manage patients with dementia who require dental care. CPD/CLINICAL RELEVANCE: By identifying the patient with dementia and being aware of the challenges in providing care the clinician can provide better treatment and reduce the chance of dental problems as the condition progresses.

Access to dental public services by disabled persons

Background

According to the World Health Organization, one in every 10 people has a disability, and more than two-thirds of them do not receive any type of oral dental care. The Brazilian Constitution of 1988 guarantees all civilians including disabled people the right to healthcare, shaping the guidelines of the Brazilian National Health Care System (Sistema Único de Saúde – SUS). However, there is limited information about the true accessibility of dental services. This study evaluated the accessibility of public dental services to persons with disabilities in Fortaleza, Ceará, which has the third highest disability rate in Brazil.

Methods

A cross-sectional quantitative study using structured questionnaires was administered to dentists (n = 89) and people with disabilities (n = 204) to evaluate the geographical, architectural, and organizational accessibility of health facilities, the communication between professionals and patients with disabilities, the demand for dental services, and factors influencing the use of dental services by people with motor, visual, and hearing impairments.

Results

43.1% of people with disabilities do not recognize their service as a priority of Basic Health Units (BHU), 52.5% do not usually seek dental care, and of those who do (n = 97), 76.3% find it difficult to receive care and 84.5% only seek care on an emergency basis. Forty-five percent are unaware of the services offered in the BHU. Of the dentists, 56.2% reported difficulty in communicating with deaf patients, and 97.8% desired interpreters stationed in the BHU. People with disabilities gave better accessibility ratings than dentists (p = 0.001). 37.3% of the patients and 43.8% of dentists reported inadequate physical access infrastructure (including doors, hallways, waiting rooms, and offices). Dentists (60%) reported unsafe environments and transportation difficulties as geographical barriers, while most people with disabilities did not report noticing these barriers.

Conclusions

While access to dental services has increased in Fortaleza, the lack of accessibility of health units and their surroundings does not promote the treatment of people with disabilities. Cultural, organizational, architectural, geographical, and communication barriers constrain the demand for and use of oral dental care services by this social segment.

Root canal treatment and special needs patients

AIM

To identify current trends of root canal treatment for patients with special needs.

METHODOLOGY

A postal questionnaire was sent to General Dentists in Victoria, Australia and Endodontists and Special Needs Dentists across Australia to determine the extent of root canal treatment performed on special needs patients.

RESULTS

Over a four-month period, 1120 questionnaires were distributed with an overall response rate of 63.9% (n = 716). Response rates were 63.2% (n = 655), 68.5% (n = 50) and 100.0% (n = 11) amongst General Dentists, Endodontists and Special Needs Dentists, respectively. Endodontists (95.7%) and Special Needs Dentists (100.0%) performed significantly more root canal treatment on adult patients with special needs compared with 51.2% of General Dentists, (P < 0.001 and P = 0.001 respectively; Fisher's exact test). The most common reasons for not undertaking root canal treatment included limited cooperation, poor oral hygiene and uncontrolled movement. Amongst General Dentists, 75.7% opted for extraction in preference to root canal treatment. Significantly, more specialist practitioners performed root canal treatment utilizing conscious sedation (P < 0.001) and general anaesthesia (P = 0.003). Most specialist practitioners (69.1%) had undertaken single-visit root canal treatment on special needs patients compared with only 29.7% of General Dentists (P < 0.001).

CONCLUSIONS

Root canal treatment in special needs patients was more likely to be carried out by specialist dental practitioners who were more likely to utilize a pharmacological approach for behaviour guidance and to perform single-visit root canal treatment compared with General Dentists. A multidisciplinary approach for special needs patients who require root canal treatment provides an opportunity for these patients to retain their dentition.

Oral health-care utilization in adults with disabilities in Belgium

Reports on oral health-service utilization among individuals with disabilities are very sparse. Nevertheless, such data are a prerequisite for the provision of proper care and for the development of optimal reimbursement schemes and may ultimately lead to better access to care. The objective of the present study was to provide data on oral health-care utilization in Belgian residents with disabilities and to compare these data with the utilization pattern of their peers without special needs. Data from the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents, were used. The database contained prospective data on oral and general health-care utilization and socio-demographic variables from 1,221 individuals with disabilities and from 131,877 individuals without disabilities, collected from 2002 to 2008. Overall, annual dental-attendance rates were very low and in those who attended, professional debridements, a cornerstone in preventive oral health care, were infrequently recorded. In adults with disabilities, significantly fewer radiographs, restorations, and endodontic treatments were recorded, whereas significantly more emergency visits were charged. Further research is indicated to evaluate whether this outcome points to high unmet oral-treatment needs.

Objective and subjective oral health care needs among adults with various disabilities

OBJECTIVES

The present study explored the objective and subjective oral health care needs and the association between both among Belgian adults with disabilities.

MATERIALS AND METHODS

A two-stage sampling methodology was used to select a sample of adults (22-65 years old) with disabilities, from various types of residential settings, day care centers, and sheltered workplaces and spread over the ten provinces. Oral screenings were performed by 28 trained dentists; subjective oral health care needs were collected through questionnaires.

RESULTS

Seven hundred seven adults with disabilities were recruited; from 656 (93 %), permission was obtained for an oral examination. In 467 (78 %) and 407 (68 %) participants, dental plaque and calculus, respectively, were observed. In 343 (56 %) participants, untreated caries lesions (into dentine) were recorded; 203 (33 %) participants had 20 or less teeth. The prosthetic replacement of missing teeth was poor. Exactly 228 (40 %) participants stated that they had a problem in the oral region, and 264 (48 %) indicated that they were in need of an appointment with a dentist. Barriers to consult a dentist were reported by 244 (42 %); fear (n = 87; 37 %), followed by financial and transportation problems (both, n = 68; 29 %), was the most frequently reported barrier.

CONCLUSIONS

The preventive as well as curative oral care needs in Belgian adults with various forms of disabilities are very high.

CLINICAL RELEVANCE

Efforts to tackle these vast oral health care needs should take into account the differences in needs and demands between subgroups and should comprise the improvement of access to proper care.

Guideline for oral healthcare of adults with Huntington’s disease

SUMMARY These guidelines present an overall strategy for oral healthcare based on the principles of achieving a disease-free, pain-free and safe mouth. The standards of care referred to in the document seek to provide guidelines for the care and treatment that is no less a standard provided for an individual that does not have this condition. Such care and treatment will take into account the health and safety of each individual within the context of their condition. Particular emphasis is placed on dental professionals working within a multidisciplinary team, focusing on prevention of oral disease and providing treatment appropriate to the various stages of the progression of this condition. It is intended that by providing and subsequently promoting these guidelines, it will focus the dental professions work on this condition and the implementation of good care for people with Huntington’s disease.

Factors that limit access to dental care for adults with spinal cord injury

This study investigated dental care service utilization among adults with spinal cord injury (SCI) and identified barriers and other factors affecting utilization among this population. There were 192 subjects with SCI who participated in the oral health survey assessing dental care service utilization and they were compared with subjects from the 2004 Behavioral Risk Factors Surveillance System (BRFSS). There was no significant difference in the proportion of subjects with SCI who visited the dentist for any reason in the past year compared to the general population (65.5% vs. 68.8%, p= .350). However, subjects with SCI were less likely to go to the dentist for a dental cleaning in the past year compared to the general population (54.6% vs. 69.4%, p < .001). The three most commonly reported barriers to accessing dental care were cost (40.1%), physical barriers (22.9%), and dental fear (15.1%). Multivariate modeling showed that physical barriers and fear of dental visits were the two significant factors deterring subjects from dental visits in the past year. Physical barriers preventing access to dental facilities and dental fear are prevalent and significantly impede the delivery of dental health care to adults with SCI. Dentists should undertake necessary physical remodeling of their facilities to accommodate wheelchair users and implement appropriate strategies for the management of dental fear among patients with SCI.

BDA special care case mix model

Routine dental care provided in special care dentistry is complicated by patient specific factors which increase the time taken and costs of treatment. The BDA have developed and conducted a field trial of a case mix tool to measure this complexity. For each episode of care the case mix tool assesses the following on a four point scale: 'ability to communicate', 'ability to cooperate', 'medical status', 'oral risk factors', 'access to oral care' and 'legal and ethical barriers to care'. The tool is reported to be easy to use and captures sufficient detail to discriminate between types of service and special care dentistry provided. It offers potential as a simple to use and clinically relevant source of performance management and commissioning data. This paper describes the model, demonstrates how it is currently being used, and considers future developments in its use.

Access to special care dentistry, part 9. Special care dentistry services for older people

This article looks at three common neurological conditions associated with later years: stroke, Parkinson's disease and dementia. All of them impact on oral health, access to dental services and delivery of dental care, and treatment goals need to be adapted to take into account patients' changing needs, medical status, pattern of recovery or the stage of dementia that they have reached. The article concludes by considering the topic of elder abuse. The dental team may have a role both in identifying abuse and ensuring appropriate action is taken.