Measuring oral health-How can the International Classification of Functioning help?

Oral hygiene self-care: Concept analysis for the development of a new nursing diagnosis

OBJECTIVE

This study aims to analyze the concept of oral hygiene self-care and develop a new problem-focused nursing diagnosis (ND) based on the NANDA-I terminology.

METHOD

A concept analysis was performed based on the Walker and Avant framework, including a scoping review phase according to the Joanna Briggs Institute guidelines. Searches were performed in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Web of Science, Virtual Health Library, and specific gray literature databases. The development of the diagnostic structure followed the NANDA-I guidelines with a focus on Orem's self-care theory.

RESULTS

Including 51 studies, the analysis facilitated the formulation of attributes, antecedents, and consequences of oral hygiene self-care. The ND "Oral hygiene self-care deficit" was created and included 17 defining characteristics, 9 related factors, 5 associated conditions, and 5 high-risk populations. Two cases were constructed to illustrate the use of key terms.

CONCLUSIONS

The conceptual analysis provided insight into the concept of oral hygiene self-care and supported the structure of a new ND.

IMPLICATIONS FOR NURSING PRACTICE

This study contributes to the implementation of the nursing process by focusing on the identification of individuals with oral hygiene self-care deficit. It will facilitate the promotion of oral health, thereby impacting the individual's quality of life. In addition, it will aid in the development of public policy for the prevention of oral diseases.

Oral health care for individuals with intellectual and developmental disabilities: A statewide model

BACKGROUND AND AIM

Effective strategies and practices can assist in forming future initiatives and policies to improve oral health for individuals with intellectual and developmental disabilities (IDD). This manuscript aims to describe the Tufts Dental Facilities (TDF), a university-state collaboration providing sustained statewide access to comprehensive oral health care for individuals with IDD.

PROGRAM DESCRIPTION

The TDF program was established in 1976 as the result of a class action lawsuit to improve medical and dental care for individuals with IDD residing at state institutions in Massachusetts. TDF, A partnership, between Tufts University School of Dental Medicine (TUSDM) and the Commonwealth of Massachusetts, is a network of seven dental clinics strategically positioned across the state. These clinics are specifically designed to meet the oral health needs of individuals with IDD. TUSDM's oral health providers with expertise in special care dentistry deliver comprehensive oral health care for over 6500 individuals with IDD, incorporating supportive care services and access to general anesthesia. Additionally, the program provides training in special care dentistry for dental residents and pre-doctoral dental students.

CONCLUSIONS

Leveraging state and university resources, TDF provides a model of a sustainable, long-term system for statewide access to oral health care for individuals with IDD.

Association between shortened dental configurations and health outcomes: a scoping review

This study mapped definitions of shortened dental configurations and health outcomes employed in association studies. A scoping review was conducted using the PubMed/Medline, Scopus, Web of Science, SciELO and Cochrane databases. Two trained researchers selected studies and extracted data. Studies that investigated the association between shortened dental configurations (exposure) and person-centered outcomes (general and oral health) related to health behavior (dietary patterns). Clinical outcomes were classified according to the International Classification of Functioning, Disability and Health and the International Classification of Diseases of the World Health Organization (WHO). Shortened dental configurations were defined as at least 20/21 teeth or the position of the teeth, including esthetics, dental occlusion and periodontal status (Eichner Index, Shortened Dental Arches, Functional Dentition Classification System, Posterior Occluding Pairs, Functional Tooth Units). The initial search resulted in 12,525 records in English, Portuguese and Spanish, 432 of which addressed the association of interest. General health (n = 203) and oral health (n = 201) were addressed in a similar number of studies. Most outcomes were related to general health (n = 184), the most frequent of which were endocrine, nutritional or metabolic diseases (n = 57) and mental functions (n = 26). Person-centered measures were addressed in 153 studies, most of which were about oral health and oral health-related quality of life (n = 62). Oral health outcomes were predominantly related to intake functions (n = 44) and diseases or disorders of the orofacial complex (n = 24). Dietary patterns (n = 43) and mortality (n = 38) were also studied. The cross-sectional design (n = 257) and non-probabilistic sampling (n = 218) were more frequent. The shortened dental configurations defined by the WHO were the most frequent in the studies (n = 206). The effects of shortened dental configurations have been investigated mainly in relation to endocrine, nutritional or metabolic diseases and measures of oral health-related quality of life. The findings point to a diversity of health outcomes assessed and substantial methodological variability.

Advancing Universal Oral Health Coverage via Person-Centred Outcomes

The World Health Organization member states proposed a comprehensive "Global Strategy on Oral Health," which includes achieving universal oral health coverage by 2030. Challenges and barriers, including persistent inequalities, will hamper the achievement of universal oral health coverage. In low- and middle-income countries, the oral health of a large proportion of the population has been neglected, increasing oral health inequalities. In high-income countries, some receive excessive dental treatment, whilst particularly those with higher needs receive too little dental care. Therefore, an analysis of individual countries' needs, encompassing the training of oral health professionals in a new philosophy of care and attention and the optimisation of the existing resources, is necessary. Distancing from a person-centred focus has prompted individual and societal issues, including under-/overdiagnosis and under-/overtreatment. The person-centred approach considers the perceptions, needs, preferences, and circumstances of individuals and populations. Patient-reported outcome measures, such as self-rated and -reported health, reflect an individual's overall perception of health and are designed to mediate human biology (ie, the disease) and psychology. The usage of patient-reported outcome measures in dentistry to place the individual at the centre of treatment is delayed compared to other areas. This paper discusses some challenges and potential solutions of patient-reported outcome measures in dentistry for achieving universal oral health coverage.

Implant-supported prostheses in patients with special needs: A systematic literature review of protocols and outcomes

STATEMENT OF PROBLEM

Implant-supported prostheses for individuals with special needs have been considered high-risk because of the prevalence of poor oral hygiene and parafunction in this population; however, systematic evidence on protocols and outcomes is scarce.

PURPOSE

The purpose of this systematic review was to summarize implant procedures and outcomes for the special needs population.

MATERIAL AND METHODS

A systematic literature review was conducted using PubMed, Embase, and Scopus databases in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodological framework. Data collected included patient information, location and number of implants, surgical and prosthetic procedures, behavior support techniques, postoperative follow-up, complications, and criteria for outcome assessment. Survival rates were pooled for quantitative analysis, and a separate analysis pooling data from groups of special needs patients that present similar risks was undertaken.

RESULTS

The qualitative analysis included 79 studies involving 759 patients and 2269 implants. The quantitative analysis included 65 studies concerning 666 patients with special needs and 1886 implants. The overall weighted implant survival rate was 95.4%, with a mean follow-up duration of 40.7 ±29.5 months.

CONCLUSIONS

In individuals with special needs considered suitable for implant-supported prostheses by their clinician, implant survival rates were similar to those reported in the general population. (J Prosthet Dent xxxx;xxx:xxx-xxx).

Oral health inequalities and disability: Closing the gap

The social determinants of health impact disproportionately on disabled people creating a cumulative risk of unequal oral health outcomes, compounded by impairment. Problems in early life, education and employment, poor social status and support, social exclusion, poverty and stress characterize the life course of many disabled people. Ableism and exclusion combine to ensure that disabled voices are rarely heard, ignorance and indifference lead to prejudice in policy-making and enforcement and negative media attitudes fuelled by political austerity lead to stigmatization. Yet, the health disparities experienced by disabled people are still perceived as being uniquely caused by a medical condition or impaired body function, excluding disabled people from the inequalities discourse. In parallel, the influence of medical conditions within other marginalized groups are minimized (e.g. mental health), leading to the underestimation of the impact of disability on oral health generally. The common ground between all groups subject to oral health inequalities can be conceptualized using the WHO International Classification of Functioning. Outcomes for all might be improved by emphasizing this common ground; by considering disability as a primary variable, such as gender or age; by identifying disabled people within existing inequalities research; and by explicitly including disabled people in future research.