An investigation of the nature of research into dental health in prisons: a systematic review

Adjusting the british triage system for dental care in South Korean correctional institutions: a cross-sectional study

BACKGROUND

The oral health status of inmates in South Korean correctional institutions is poor, mainly due to limited resources and an unestablished triage system. Hence, this study aimed to develop a newly structured dental triage system for South Korean correctional institutions, using the British triage system as a reference.

METHODS

This study included 32 public health dentists working at correctional institutions in South Korea in 2020, accounting for the entire population of public health dentists that year. Data on the dentists' evaluation of resources and perceptions of dental service items were collected using a self-administered online survey including 19 dental service items from the British triage system to assess the level of agreement on dental triage items. All responses were recorded within 1 week of request, and a hierarchical cluster analysis was performed to develop a new dental triage system.

RESULTS

The survey included 31 respondents working at 47 correctional institutions; 16, 14, and one respondent provided dental services at one, two, and three institutions, respectively. Among the correctional institutions, 2%, 74%, and 23% were the National Forensic Hospital, prisons, and detention centres, respectively. The hierarchical cluster analysis identified four adjusted dental triage categories: emergency, urgent, routine, and checkups, mainly in accordance with those in the British system, but a few items were reallocated. The new dental triage system was compared to the existing system and found to have higher specificity and sensitivity, indicating that it may be more effective at meeting the oral health needs of inmates in South Korean correctional institutions.

CONCLUSIONS

This study developed a newly structured dental triage system by adjusting the British system and evaluated its efficacy compared to the existing system. The new system may help improve the oral health status of inmates in South Korean correctional institutions by providing a more organized approach to dental care provision.

A survey of dental services in England providing targeted care for people experiencing social exclusion: mapping and dimensions of access

Introduction Poor oral health and barriers to accessing dental services are common among people experiencing social exclusion. This population experience a disproportionate and inequitable burden of oral disease. A small number of dental services have published models of care that target this population, but no national surveys have been conducted.Aims This study aims to identify what types of services are providing dental and oral healthcare for people experiencing social exclusion in England and the models of delivery adopted by these services.Methods A snowballing sampling strategy was used to identify services that provide targeted for adults experiencing social exclusion. The study used a survey to collect data about the location, service models and barriers and enablers of these services.Results In total, 74 responses from different services met the inclusion criteria for the study. Seventy one were included in the mapping exercise and 53 provided free-text comments that contributed to an understanding of barriers and enablers of services.Discussion Most services operated to meet the needs of the mainstream population and described inflexibilities in their service design models as barriers to providing care for socially excluded groups.Conclusion Limitations of current models of service delivery create frustrations for providers and people experiencing social exclusion. Creative commissioning and organisational flexibility are key to facilitating adaptable services.

Dental education and prison health: A scoping review

INTRODUCTION

There is a huge oral disease burden among imprisoned people. Comprehensive guidelines are available on prison dentistry. Prison dental education is important to increase the quality and quantity of the dental workforce in prisons. It improves student perceptions about imprisoned people and gives students a sense of social responsibility and accountability.

OBJECTIVES

The aim of the scoping review was to determine what is known in the literature about teaching pre-doctoral dental students about prison health.

METHODS

A literature search was conducted on seven databases accessed through the Public Health England knowledge and library services. These databases were AMED, Embase, Emcare, Medline, Social Care Institute for Excellence, Web of Science, and Social Care Online. Appraisal of quality was done for included studies.

RESULTS

Eleven papers were included in the review, all of which are based in the USA. Two articles looked at dental students as one group engaged in prison health education while five considered imprisoned people as one of the vulnerable populations focused on dental education. Only four articles solely looked at prison dental education. Program design with a collaborative approach between prisons and teaching institutions, and the positive impact of prison health education on dental students emerged as important.

CONCLUSION

The evidence suggests prison dental education to be important in reducing the high burden of oral diseases among the incarcerated by influencing the present and future prison dental workforce. It also improves students' understanding of social determinants of health. Further studies are needed to determine the most effective teaching methods and models.

A health promotion intervention to improve oral health of prisoners: results from a pilot study

PURPOSE

Prisoners have poorer oral health than the general population. Good oral health is essential for both social and physical well-being. For prisoners, poor oral health is also related to drug use after release, whereas good oral health is related to successful reintegration into society. The purpose of this study was twofold: to examine the effect of an intervention based on motivational interviewing (MI) on prisoners' oral health-related behavior and to assess if the intervention is a good fit for this population.

DESIGN/METHODOLOGY/APPROACH

In total, 16 prisoners in a Norwegian prison were offered a brief MI-based intervention focusing on changing their oral health-related behavior. An oral examination was also performed and the prisoners received a small package containing oral hygiene aids. Two weeks later, a second oral examination and a semi-structured interview were conducted to explore the effect of the intervention and examine the prisoners' responses to the intervention. Qualitative data analyzes were guided by thematic analysis.

FINDINGS

The findings indicate that the intervention had positive effects on both the prisoners' motivation to use oral health-related behavior and their performance of oral health-related behavior. The findings also indicate that the intervention was well adapted to the target population.

ORIGINALITY/VALUE

This is one of the first studies that explore the effect of an intervention in improving prisoners' oral health and bridges a knowledge gap in the literature. The findings may increase the understanding of how dental services should be organized and offered to provide dental health care to this vulnerable group.

Impact of incarceration on nutritional status and oral health among male inmates of central jail of Jaipur city, India

AIM

Prison is an especially difficult environment for promoting oral health and leads to the exacerbation of unhealthy behaviors. This study set out to assess the impact of incarceration on nutritional status and oral health among the male prison inmates of Central Jail of Jaipur city, Rajasthan, India.

MATERIAL AND METHOD

A cross sectional study was conducted among 181 male inmates. Dental caries and periodontal status were assessed by using modified the Decayed Missing Filled Teeth (DMFT) index and Community Periodontal Index (CPI) and Loss of Attachment (LOA) index as per the WHO methodology 1997. Nutritional status was assessed by Body Mass Index (BMI) and weight (kg)/height (m2).

RESULTS

Out of 181 inmates, 141 (77.90%) had normal BMI. The majority (n=128, 70.70%) of inmates were incarcerated for less than 6 years. A significant difference (P<0.05) was found between age and periodontal status. A significant difference was observed (P<0.05) in the CPI score 3 and LOA 0 and 1 score. However, no significant difference (P>0.05) was observed in DMFT and period of incarceration. Age was the significant (P<0.001) risk factor for CPI and LOA.

DISCUSSION

Dental caries and periodontal health deteriorates with age and period of incarceration. Oral hygiene maintenance along with comprehensive oral care can be accomplished by establishing dental care facilities in prisons.

Understanding the association between self-reported poor oral health and exposure to adverse childhood experiences: a retrospective study

Background

Adverse childhood experiences, including physical, sexual or emotional abuse, can have detrimental impacts on child and adult health. However, little research has explored the impact that such early life experiences have on oral health. This study examines whether experiencing adverse childhood experiences before the age of 18 years is associated with self-reported poor dental health in later life.

Methods

Using stratified random probability sampling, a household survey (N = 5307; age range 18–69 years) was conducted in the South of England (Hertfordshire, Luton and Northamptonshire). Data were collected at participants’ homes using face-to-face interviews. Measures included exposure to nine adverse childhood experiences, and two dental outcomes: tooth loss (> 8 teeth lost due to dental caries or damage) and missing or filled teeth (direct or indirect restorations; > 12 missing or filled teeth).

Results

Strong associations were found between exposure to childhood adversity and poor dental health. The prevalence of tooth loss was significantly higher (8.3%) in those with 4+ adverse childhood experiences compared to those who had experienced none (5.0%; p < 0.05). A similar relationship was found for levels of missing or filled teeth (13.4%, 4+ adverse childhood experiences; 8.1%, none; p < 0.001). Exposure to 4+ adverse childhood experiences was associated with a higher level of tooth loss and restorations at any age, compared to individuals who had not experienced adversity. Demographically adjusted means for tooth loss increased with adverse childhood experience count in all age groups, rising from 1.0% (18–29 years) and 13.0% (60–69 years) in those with none, to 3.0% and 26.0%, respectively in those reporting 4+.

Conclusions

Exposure to childhood adversity could be an important predictive factor for poor dental health. As oral health is an important part of a child’s overall health status, approaches that seek to improve dental health across the life-course should start with safe and nurturing childhoods free from abuse and neglect. Given the growing role that dental professionals have in identifying violence and abuse, it seems appropriate to raise awareness in the field of dentistry of the potential for individuals to have suffered adverse childhood experiences, and the mechanisms linking childhood adversity to poor dental health.

Oral diseases: a global public health challenge

Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact. Although oral diseases are largely preventable, they persist with high prevalence, reflecting widespread social and economic inequalities and inadequate funding for prevention and treatment, particularly in low-income and middle-income countries (LMICs). As with most non-communicable diseases (NCDs), oral conditions are chronic and strongly socially patterned. Children living in poverty, socially marginalised groups, and older people are the most affected by oral diseases, and have poor access to dental care. In many LMICs, oral diseases remain largely untreated because the treatment costs exceed available resources. The personal consequences of chronic untreated oral diseases are often severe and can include unremitting pain, sepsis, reduced quality of life, lost school days, disruption to family life, and decreased work productivity. The costs of treating oral diseases impose large economic burdens to families and health-care systems. Oral diseases are undoubtedly a global public health problem, with particular concern over their rising prevalence in many LMICs linked to wider social, economic, and commercial changes. By describing the extent and consequences of oral diseases, their social and commercial determinants, and their ongoing neglect in global health policy, we aim to highlight the urgent need to address oral diseases among other NCDs as a global health priority.

Ending the neglect of global oral health: time for radical action

Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.

Dental caries status of inmates in central prison, Chennai, Tamil Nadu, India

Aim:

To understand the dental health among prison inmates, we assessed the dental caries status of central prison inmates in Chennai, India.

Materials and Methods:

A total of 1060 inmates from three divisions of the central prison in Chennai were assessed by a single investigator for dental caries status based on World Health Organization specifications.

Results:

Among the inmates, 58.2% of males and 54.2% of females had decayed teeth. About 4.1% of males and 2.9% of females had filled teeth. The mean decayed, missing, filled teeth index was 5.1 and 3.9 for female and male prisoners, respectively. The prevalence of dental caries was highest among inmates younger than 24 years age.

Conclusion:

Our study suggests that a high proportion of prison inmates was affected by dental caries, which necessitates the need for initiating oral health promotion activities among prison inmates.

Oral health and risk factors for dental disease of Australian young people in custody

AIM

To describe the prevalence and risk factors for markers of poor oral health in Aboriginal and non-Aboriginal young people in custody in Australia.

METHODS

All incarcerated youth, aged 13-21 years, in New South Wales Juvenile Custodial Centres between August and October 2009 were invited to participate and undertake a dental exam. The main outcome measures were an assessment of moderate/abundant plaque, periodontal disease, dental caries experience, mean decayed and/or filled and/or missing teeth (DMFT) index and untreated decay.

RESULTS

Two hundred ninety-four participants (91% male, 46% Aboriginal) underwent a dental exam. Markers of poor oral health were common - 49.4% with moderate/abundant plaque, 34.4% with periodontal disease, mean DMFT 3.56 and 54% having untreated decay. Risk factors independently associated with poor oral health were geographical remoteness and non-fluoridation of the water supply of the usual residence, a shorter incarceration time and dental treatment outside of custody.

CONCLUSIONS

Young people entering custody have poor oral health, with those from geographically remote areas without water fluoridation at highest risk. The incarceration period is an opportunity for oral health improvements in these young people through access to dental treatment services. Better triaging systems are needed to identify those of greatest priority, and prevention services are needed.

Dental caries experience and use of dental services among Brazilian prisoners

This ross-sectional study involving 127 male prisoners evaluates the use of dental services and dental caries among Brazilian inmates. Data were collected by interview and clinical examination. Sociodemographic and sentencing information as well as use of dental services, self-reported dental morbidity, self-perception, and oral health impacts were investigated. The mean DMFT index value was 19.72. Of the components, the decayed component showed the highest mean value (11.06 ± 5.37). Statistically significant association was found between DMFTs with values from 22 to 32 and oral health satisfaction (p = 0.002), difficulty speaking (p = 0.024), shame of talking (p = 0.004) and smiling (p < 0.001). Regarding the use of dental services, 80% had their last dental appointment less than one year ago, with most visits occurring in prison (80%), with restorative treatment (32%), followed by dental pain (26.4%), being the main reasons for such appointments. Most prisoners used dental services provided by the prison. Although restorative treatment has been the main reason for the use of dental services, “decayed” and “missing” components contributed to the high mean DMFT index.

Assessment of oral mucosal lesions among psychiatric inmates residing in central jail, Bhopal, Madhya Pradesh, India: A cross-sectional survey

AIM

The aim of the current cross-sectional study was to assess oral mucosal lesions among psychiatric jail patients residing in central jail, Bhopal, Madhya Pradesh, India.

MATERIALS AND METHODS

The study subjects consisted of prediagnosed psychiatric patients residing in central jail, Bhopal. A matched control consisting of cross section of the population, that is, jail inmates residing in the same central jail locality was also examined to compare the psychiatric subjects. The WHO oral health assessment proforma, 1997 along with 18-item questionnaire was used for the oral health examination.

RESULTS

A total number of subjects examined were 244, which comprised of 122 psychiatric inmates and 122 nonpsychiatric inmates. Among all psychiatric inmates, about 57.4% of inmates had a diagnosis of depression, 14.8% had psychotic disorders (like schizophrenia), and 12.3% had anxiety disorder. A total of 77% study inmates, which comprised of 87.7% psychiatrics and 66.4% nonpsychiatrics had a habit of tobacco consumption (smokeless or smoking). Overall prevalence of oral mucosal lesions among the inmates was 85 (34.8%), which comprised of 39.3% psychiatric inmates and 30.3% nonpsychiatric inmates.

CONCLUSION

The information presented in this study adds to our understanding of the common oral mucosal lesions occurring in a psychiatric inmate population. Leukoplakia and oral submucous fibrosis were the most common types of oral mucosal lesions found. Efforts to increase patient awareness of the oral effects of tobacco use and to eliminate the habit are needed to improve oral and general health of the prison population.

Assessment of prevalence of tobacco consumption among psychiatric inmates residing in Central Jail, Bhopal, Madhya Pradesh, India: A cross-sectional survey

AIM

The aim of the current cross-sectional study was to assess the prevalence of tobacco consumption among psychiatric jail patients residing in Central Jail, Bhopal, Madhya Pradesh, India.

MATERIALS AND METHODS

The study subjects consisted of prediagnosed psychiatric patients residing in Central Jail, Bhopal, Madhya Pradesh, India. A matched control consisting of cross-section of the population, that is, jail inmates residing in the same Central Jail locality was also assessed to compare the psychiatric subjects. An 18 item questionnaire was used to assess the prevalence of tobacco consumption among study subjects.

RESULTS

The total number of subjects examined was 244, which comprised of 122 psychiatric inmates and 122 nonpsychiatric inmates. Among all psychiatric inmates, about 57.4% of inmates had a diagnosis of depression, 14.8% had psychotic disorders (such as schizophrenia), and 12.3% had anxiety disorder. A total of 77% study inmates, which comprised of 87.7% psychiatrics and 66.4% nonpsychiatrics had a habit of tobacco consumption (smokeless or smoking).

CONCLUSION

The information presented in this study adds to our understanding of the common tobacco related practices among psychiatric inmate population. Efforts to increase patient awareness of the hazards of tobacco consumption and to eliminate the habit are needed to improve oral and general health of the prison population.

What motivates dentists to work in prisons? A qualitative exploration

OBJECTIVE

To explore what motivates dentists to work in prisons using Vroom's theoretical model of motivation as an explanatory framework.

METHOD

In-depth interviews were conducted with ten of the 15 dentists working in Scottish prisons. The focus was to explore their motivations to work in Scottish prisons. The data were analysed using a thematic framework based on the three motivational dimensions of expectancy, instrumentality and valence.

RESULTS

The dentists had the skills to help improve their prisoner-patients' oral health but their efforts were often hindered by institutional rationing and the requirement to fit in with prison routines and procedures (expectancy). Despite these institutional difficulties the dentists experienced work rewards associated with the improvement in the prisoners' oral health (instrumentality). Finally, the dentists experienced a feeling of personal worth and a sense of commitment to providing care to Scottish prisoners (valence).

CONCLUSIONS

The dentists' motivation to work in Scottish prisons may be explained by Vroom's Expectancy Theory. The dentists' motivation is characterised by their beliefs that their work will improve clinical outcomes which will be rewarded by the satisfaction experienced when they overcome environmental obstacles and provide oral health care for their prisoner-patients.

Oral health of substance-dependent individuals: impact of specific substances

Little is known about how different types of substances affect oral health. Our objective was to examine the respective effects of alcohol, stimulants, opioids, and marijuana on oral health in substance-dependent persons. Using self-reported data from 563 substance-dependent individuals, we found that most reported unsatisfactory oral health, with their most recent dental visit more than 1 year ago. In multivariable logistic regressions, none of the substance types were significantly associated with oral health status. However, opioid use was significantly related to a worse overall oral health rating compared to 1 year ago. These findings highlight the poor oral health of individuals with substance dependence and the need to address declining oral health among opioid users. General health and specialty addiction care providers should be aware of oral health problems among these patients. In addition, engagement into addiction and medical care may be facilitated by addressing oral health concerns.

Conducting research in corrections: challenges and solutions

Research in correctional settings has progressed from the exploitation of a vulnerable population in the years prior to 1978 to its current overly protective and restrictive state. With the considerable growth in the numbers of inmates with medical and mental health care needs, developing effective interventions to serve this population is paramount. There now appear to be signs of interest in and support for research with inmates by correctional agencies, academia, and health care organizations. Innes (2003) has articulated the following strategies for implementing research in prison: (1) gather stakeholders; (2) include one or more experienced research collaborators; (3) consider obtaining technical assistance from a university or the National Institute of Corrections (NIC); (4) define potential opportunities/interests that support the institution's mission; (5) develop a relationship with an IRB; (6) pilot a small proposal that is of interest and potential value to the organization. The authors illustrate the implementation of a study in a correctional system that uses these strategies.

The performance of a screening test for urgent dental treatment need in a prison population

OBJECTIVE

To compare the performance of a questionnaire-based assessment of dental pain delivered by non-dental prison nursing staff against a clinical examination performed by an experienced prison dentist (gold standard).

SETTING

The research fieldwork took place in the healthcare department at HMP Brixton located in South London.

METHODS

The cohort were those who had complained of dental/facial pain to the prison authorities and were therefore placed on the waiting list for emergency dental care. Subjects were asked to complete the screening test and were then clinically examined by trained and calibrated dentists. The screening test was in the form of a 12-item questionnaire designed to categorise a population reporting dental pain into one of three groups. The screening test results were compared with the diagnosis of a clinical examination.

RESULTS

Ninety-six subjects were recruited during the 16-week study period. Of the 96 prisoners recruited, 27 of those failed to complete the screening test and/or the diagnostic examination even though they had reported pain previously. When sensitivity and specificity values were calculated for the 96 prisoners recruited, the sensitivity was fairly high (81%) and the specificity was poor (33%). However, when these values were calculated for the sub-population, those that completed both the screening test and diagnostic examination (n = 69), the sensitivity did not improve particularly (83%) but the specificity value fell substantially to 13%.

CONCLUSIONS

This study highlighted the problems of conducting research in the prison environment, for example increased security preventing researchers from gaining access into the prison and general pressures on prison staff. Additionally, the study demonstrated that screening is not effective in local prisons with a high turnover of prisoners.