Access to special care dentistry, part 7. Special care dentistry services: seamless care for people in their middle years – part 1

Barriers and Facilitators to Dental Care Services Utilization Among Children With Disabilities: A Systematic Review and Thematic Synthesis

BACKGROUND

This systematic review investigates barriers and enablers to dental care utilization by disabled children. Given the high global prevalence of disabilities in children, coupled with poor oral hygiene and a 45% rate of dental caries in this group, developing inclusive oral health strategies is critical. The review aims to synthesize literature on factors affecting oral healthcare improvement for disabled children, identifying barriers, facilitators and knowledge gaps.

METHODS

The review was conducted following the Joanna Briggs Institute's methods and reported according to PRISMA guidelines. A comprehensive search spanned multiple databases, considering perspectives from carers, parents, dentists and health professionals. The focus was on studies involving children up to age 17 with disabilities, as defined by WHO, using dental care services. Exclusions included non-qualitative studies, populations over 18 and nondisabled children. There were no restrictions on publication date or language. Thematic synthesis of the studies extracted themes related to barriers and enablers in oral healthcare for disabled children.

RESULTS

Thematic synthesis identified five overarching themes: stigma, communication issues, professional development, oral health education and medical-dental collaboration. Facilitators included enhancing accessibility and availability of dental care through a holistic approach, improving dental care facility environments and ensuring skilled dental care providers.

DISCUSSION

The review underscores the importance of interprofessional collaboration, improved parent/caregiver education and specialized dental facilities to support children with disabilities. It identifies key barriers and facilitators in dental care, including challenging stereotypes, improving communication between providers and parents, enhancing holistic training and addressing gaps in oral health education and integrated healthcare systems.

CONCLUSION

Addressing the complex dynamics of dental care for disabled children is essential for developing inclusive and effective preventive and therapeutic strategies. This review highlights the need for tailored approaches and enhanced support systems to improve oral health outcomes in this vulnerable population.

PATIENT AND PUBLIC CONTRIBUTION

The members of the family support department, Middle East and North Africa (MENA) Organization for Rare Disease and Disability who provided the disability voice and contributed to providing input to the review protocol.

Diabetes Mellitus and Its Influence on Oral Health: Review

Diabetes mellitus (DM) is one of the most common diseases all over the world. The effect of this endocrine disease on body systems cannot be ignored, where its oral side effects are well distinguished. As this disease incident is increasing dramatically, it is essential for the health care providers to be fully aware of the disease diagnosis, management and to deal with it in a full confident. This review discusses the disease itself, its complications, methods of diagnosis as well as its management. Furthermore, oral manifestations and dental considerations that should be followed when treating patients with diabetes mellitus have been discussed in this review.

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.

Multiple sclerosis and its impact on dental care

Multiple sclerosis affects approximately 130,000 people in the UK. Due to the wide variation in the symptoms associated with this condition and their variable severity, the provision of dental care for affected patients must be determined by an individual's specific needs. This will often vary significantly over time. This paper reviews the aetiology, presentation and current management of multiple sclerosis, and explores the impact of these on oral health and the provision of dental care.

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.

Oral health needs of athletes with intellectual disability in Southern Europe: Greece, Italy and Spain

AIMS

The population with intellectual disabilities (ID) has been reported to be a vulnerable population in terms of oral health. The aims of this study were to evaluate the oral condition and treatment needs of Special Olympics (SO) athletes from Greece, Italy and Spain.

METHODS AND RESULTS

A cross-sectional study was performed with data collected in annual SO events held in Greece, Italy and Spain, between 2010 and 2012. The recorded parameters were the presence/absence of edentulism, untreated decay, filled or missing teeth, sealants, tooth injury and signs of gingival disease. Among the main findings, the prevalence of untreated decay was 57.0% in Greece, 48.8% in Italy and 41.7% of the Spanish athletes. The prevalence of signs of gingival disease was 61.1% in Greece, 60.6% in Italy and 66.1% in Spain. While the majority of the athletes were in need of dental treatment.

CONCLUSIONS

Oral disease is an unresolved problem among athletes with ID in these Mediterranean countries. Therefore efforts should be directed to meet their treatment needs and to prevent oral disease.

Effect of daily manual toothbrushing with 0.2% chlorhexidine gel on pneumonia-associated pathogens in adults living with profound neuro-disability

Purpose

To investigate the effect of daily toothbrushing with 0.2 % chlorhexidine digluconate (CHX) on the colonization of dental plaque by pathogens associated with pneumonia amongst non-ventilated adults with a neuro-disability.

Methodology

Forty-nine patients living in long-term care were recruited. Daily toothbrushing with 0.2 % CHX gel was conducted for 48 weeks. Plaque accumulation was assessed and microbiological sampling was undertaken every 6 weeks.

Results

At any one time point at least 65 % (n=32) of subjects were found to harbour respiratory pathogens. Although there were significant changes in the proportion of individuals colonized over time with Gram-negative bacilli and Pseudomonas aeruginosa, the changes were not sustained. By week 48 there was no significant difference from the levels that had been recorded at baseline.

Conclusions

Bacteria known to be causal in pneumonia are present and colonize the dental plaque of non-ventilated adults with a neuro-disability. Daily toothbrushing with 0.2 % CHX gel did not produce a sustained reduction in intra-oral respiratory pathogen counts after 48 weeks.

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.

The impact of 0.2% chlorhexidine gel on oral health and the incidence of pneumonia amongst adults with profound complex neurodisability

AIMS

Investigate the effect of toothbrushing with 0.2% chlorhexidine gel on oral health and pneumonia amongst patients with a neurodisability who are fed via percutaneous endoscopic gastrostomy.

METHOD

Forty-nine patients at the Royal Hospital for Neuro-disability were recruited to an observational study. Daily toothbrushing with 0.2% chlorhexidine gel was undertaken for 12 months by trained nursing staff. Plaque and gingival health were assessed every six weeks using the Simplified Debris Index and the Basic Periodontal Examination. The annual incidence and prevalence of episodes of pneumonia experienced by patients whilst using the chlorhexidine gel were compared to rates from the previous year.

RESULTS

Plaque levels and the proportion of patients with periodontal pocketing > 3.5 mm significantly reduced, P < .001, with chlorhexidine toothbrushing. Total number of pneumonia episodes (75-67), antibiotics administered (73-64), and radiographs taken (19 to 16) were lower in the year wherein chlorhexidine was employed, and hospitalisations dropped by 31% (16-11), but these reductions were not statistically significant. No adverse events were reported.

CONCLUSION

Daily toothbrushing with 0.2% chlorhexidine undertaken by a trained and supported nursing staff was effective in improving oral health but did not significantly affect annual rates of pneumonia amongst patients.

International Guidelines for the Treatment of Huntington's Disease

The European Huntington's Disease Network (EHDN) commissioned an international task force to provide global evidence-based recommendations for everyday clinical practice for treatment of Huntington's disease (HD). The objectives of such guidelines are to standardize pharmacological, surgical and non-pharmacological treatment regimen and improve care and quality of life of patients. A formalized consensus method, adapted from the French Health Authority recommendations was used. First, national committees (French and English Experts) reviewed all studies published between 1965 and 2015 included dealing with HD symptoms classified in motor, cognitive, psychiatric, and somatic categories. Quality grades were attributed to these studies based on levels of scientific evidence. Provisional recommendations were formulated based on the strength and the accumulation of scientific evidence available. When evidence was not available, recommendations were framed based on professional agreement. A European Steering committee supervised the writing of the final recommendations through a consensus process involving two rounds of online questionnaire completion with international multidisciplinary HD health professionals. Patients' associations were invited to review the guidelines including the HD symptoms. Two hundred and nineteen statements were retained in the final guidelines. We suggest to use this adapted method associating evidence base-medicine and expert consensus to other rare diseases.

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.

Oral health of patients with intellectual disabilities

DATA SOURCES

Medline, PubMed, Clinical Queries and PsychLIT.

STUDY SELECTION

The studies were evaluated independently by two reviewers and only included studies that had been published in English since 1975. The studies included had to meet three criteria; adult humans with mental retardation or a similar ID, had at least one quantitative measure of oral health status and the study compared the subjects to a control or comparison group without ID. Studies were assessed on the strength of evidence in three domains: quality, quantity and consistency.

DATA EXTRACTION AND SYNTHESIS

Owing to the heterogeneity of the data, meta-analyses were not attempted. The results were descriptive with no odds ratios or confidence intervals mentioned and gave an overview of oral health and ID.

RESULTS

27 studies were included in the review. Studies were of variable quality with many being of a small sample size. People with ID were found to have poor oral hygiene and higher prevalence and greater severity of periodontal disease. Caries rates in people with ID are the same as or lower than the general population. The rates of untreated caries are consistently higher in people with ID.

CONCLUSIONS

This review supports the need to develop strategies to increase patient acceptance for routine care, for additional training for dentists to provide care and for the development of more effective preventive strategies to minimise the need for this care.

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.