Oral healthcare systems for an ageing population: concepts and challenges

A Descriptive Review of the Healthcare System and the Provision of Oral Healthcare in the Republic of Sudan

Oral health constitutes a significant public health concern in Sub-Saharan Africa. The precise burden of oral diseases and the adequacy of oral healthcare provision remain often unknown. The present study aims to evaluate key components of the healthcare system in Sudan and the delivery of oral healthcare across eight dimensions: Healthcare System Framework, Financing, Service Delivery, Epidemiology, Prevention, Personnel, Dental Education and Training System, and Health Benefit Package. The evaluation of Sudan's healthcare system and oral healthcare provision utilizing the extended World Health Organization building blocks healthcare systems analysis framework. The evolving healthcare landscape in Sudan is characterized by a transition towards a Bismarckian model, a shift facilitated by the implementation of a National Health Insurance Fund. In 2018, Sudan's total healthcare expenditure surged to 2.4 billion US dollars and dental care accounted for less than 1% of this financial allocation. During the period spanning from 2016 to 2019, there was an expansion in the healthcare infrastructure and utilization rates. The number of healthcare facilities and hospital admissions respectively increased from 2,083 to 3,578 and from 14,967,113 to 22,455,772, while the registered number of dentists in 2019 reached 8,964. Within the framework of the national healthcare system, medical consultations and emergency treatments are encompassed in the oral health benefit package. Sudan's healthcare system grapples with endemic vulnerabilities compounded by recurrent political and economic challenges. Nevertheless, strides towards an insurance-based healthcare system and the upward trend observed in oral healthcare provision and infrastructure assets offer promising prospects for future generations.

Preventive dental service use and oral health-related quality of life in Brazilian older adults

BACKGROUND

Information on the use of preventive dental services and associated variables is needed to guide policy for the old adult population and consequently promote better oral health-related quality of life (OHRQoL).

OBJECTIVE

To investigate the association between preventive dental service use and OHRQoL by older Brazilians.

MATERIALS AND METHODS

This cross-sectional study was carried out using the baseline data of participants of the Brazilian Longitudinal Stud of Aging (ELSEI-Brazil) who were aged 60 years or more. Associations with the use of preventive dental services were carried out using Poisson regression models with robust variance, adjusting for confounders.

RESULTS

The final sample consisted of 5432 older adults. Almost all (90.7%) participants reported not having sought preventive dental services in the last year. Individuals who used dental services for prevention had fewer impacts on their OHRQoL (RR: 0.74; [95% CI: 0.57-0.97]).

CONCLUSION

Preventive dental service use is associated with a better OHRQoL in older Brazilians. Policies to improve access to preventive dental services may result in improved OHRQoL in this age group.

The Presence of Women in the Dental Profession: A Global Survey

OBJECTIVES

The aim of this research was to acquire knowledge about the female dental workforce, identifying factors to pursue specialty training and career choices and working in dental institutions/associations.

METHODS

An original online questionnaire was developed, validated (n = 22), and sent to 189 member associations in 133 countries of the Women Dentists Worldwide section of the FDI World Dental Federation.

RESULTS

In all, 3232 female dentists from 81 countries participated. Results were divided into 5 geographic areas by continent. Difference in proportion amongst questionnaire items was evaluated with χ2 test or Fisher exact test. Ordinal multinomial linear regression analysis was performed to evaluate the association of questionnaire items with total work experience in dentistry (in years), motivation to study dentistry, type of specialisation, working hours per week, perception of female dentists about working hours, sex-based inequalities, job security after maternity leaves, as well as involvement in political organisations within their country of residence and their role in dental associations. A majority of participating female dentists are self-employed (57.7%), and 60.0% have 10 to 30 years of experience. The most popular form of practice is the single private practice (29.7%), followed by the group private practice (28.8%). Further, 44.8% work 31 to 40 h/wk, 29.1% part-time up to 30 h/wk, and 26.0% more than 40 h/wk.

CONCLUSIONS

Women are still poorly represented in professional organisations, and few are officers in representative assemblies, members of the board, or president. Family life with children influences perceptions and has an impact on professional life, especially in academia and political/professional associations, so that taking on leadership positions poses additional challenges.

Linking current dental education to gerontological education to meet the oral health needs of growing aging populations

Objective

This study aimed to recognize the gaps in dental education by studying the current level of geriatric oral health training of recent graduated dentists who have been admitted into an Advanced Education in General Dentistry (AEGD) program.

Methods

The AEGD program was developed along with the Age-Friendly 4Ms model to enhance current dental education. We adopted the Rapid Cycle Quality Improvement model to test the effectiveness of the training for AEGD residents from 2019 to 2022. A total of 18 residents participated (6 residents each year). A 5-question survey was administered before and after the rotation and Wilcoxon signed-rank with Fisher Exact tests were conducted to compare pre- and post- rotation results.

Results

All 18 residents have completed pre- and post-program surveys. They self-reported minimal to no training in preparation to provide care to older adults with multiple chronic conditions. After the rotation, residents' confidence in treating older adults was significantly increased (p = 0.011). Meanwhile, residents gained knowledge to apply the 4Ms framework (what matters, medication, mentation, and mobility) to their practices (p = 0.015) and provide age-friendly care for older adults.

Conclusion

The study identified and addressed the missing link in dental education to gerontological and geriatrics education. More clinical rotations and didactic training to equip residents with competences of providing geriatric oral health are strongly recommended.

Dental care utilization among home care recipients, nursing home residents, and older adults not in need of long-term care: An observational study based on German insurance claims data

OBJECTIVES

To describe and compare dental care utilization (DCU) among home care recipients, nursing home residents, and older adults not in need of long-term care (LTC).

METHODS

Using nationwide claims data of 8 German statutory health and LTC insurance funds, proportions of home care recipients (n = 68,137), nursing home residents (n = 21,167), and non-LTC dependents (n = 632,205) aged 65+ years with DCU in 2017 were determined and compared. Associations between DCU and individual characteristics and setting were investigated via multivariable logistic regression. The proportions of individuals with DCU one year before and after transition to (a) home care (n = 23,590) and (b) nursing home care (n = 6,583) were compared.

RESULTS

Proportions of home care recipients and nursing home residents with DCU were lower compared to non-LTC dependents (51.9, 53.1, and 73.2%, respectively). Adjusted odds ratios for DCU for home care recipients vs. non-LTC dependents ranged from 0.55 (LTC grades 1/2; 95% confidence interval 0.54-0.56) to 0.38 (LTC grades 4/5; 0.36-0.40). For nursing home residents vs. non-LTC dependents they ranged from 0.69 (3; 0.65-0.72) to 0.67 (4/5; 0.63-0.71). Women, older individuals, those with 0-1 diseases of the Elixhauser comorbidity index, dementia, and those from West Germany were also less likely to utilize dental care than their counterparts. Utilization decreased after transition to home care (60.0 vs. 55.6%) and increased after transition to nursing homes (46.1 vs. 53.5%).

CONCLUSIONS

Nursing home residents and especially home care recipients utilized dental care less frequently than older non-LTC dependents. Organizational barriers for dental care utilization and ways to remove them should be investigated.

CLINICAL SIGNIFICANCE

Dental care utilization among LTC dependents is low and should be improved in both the home care and nursing home setting.

Global prevalence of edentulism and dental caries in middle-aged and elderly persons: A systematic review and meta-analysis

OBJECTIVE

The aim of the study was to analyze data collected from studies worldwide on the prevalence of edentulism and dental caries, in community-dwellers aged ≥ 45 years.

DATA

Inclusion criteria; participants aged ≥ 45 years, community-dwellers. Exclusion criteria; participants aged < 45 years, in nursing homes, data obtained from dental clinics or pre-2005. The quality assessment tool by The National Heart, Lung and Blood Institute for Observational Cohort and Cross-sectional studies was used. Meta-analysis using the random-effects model (95% confidence interval) was done with data on participants who were edentulous and/or had active dental caries and stratified by regions of the world, age and Gross National Income per capita. Limitations in the data arose from several factors such as design of the studies included differences in socioeconomic status and access to health care among different countries.

SOURCES

Embase, MEDLINE via Pubmed and Scopus, manual searches, from January 2016, restricted to English. Experts from different countries were contacted to identify National oral health surveys (NOHS) conducted from 2010 onwards.

STUDY SELECTION

Eighty-six papers and seventeen NOHS were selected for data extraction. Majority of the studies (n = 69) were cross-sectional and of fair quality. 1.1%-70%, 4.9% - 98% prevalence of edentulism and dental caries, respectively. 22%, 45% estimated random-effects pooled prevalence of edentulism and dental caries, respectively.

CONCLUSIONS

Within the limitations of this study, the findings indicate that untreated dental caries and tooth loss are prevalent on a global level with wide variations among different countries, age groups and socioeconomic status.

CLINICAL SIGNIFICANCE

The findings demonstrate the reality of the new cohort of older adults, with higher tooth retention implying more dental caries incidence and the need for different care strategies to ensure better oral health. Large variations and difficulty in making comparisons among different countries highlight the need for more standardized, regular research.

Advancing pharmacy and healthcare with virtual digital technologies

Digitalisation of the healthcare sector promises to revolutionise patient healthcare globally. From the different technologies, virtual tools including artificial intelligence, blockchain, virtual, and augmented reality, to name but a few, are providing significant benefits to patients and the pharmaceutical sector alike, ranging from improving access to clinicians and medicines, as well as improving real-time diagnoses and treatments. Indeed, it is envisioned that such technologies will communicate together in real-time, as well as with their physical counterparts, to create a large-scale, cyber healthcare system. Despite the significant benefits that virtual-based digital health technologies can bring to patient care, a number of challenges still remain, ranging from data security to acceptance within the healthcare sector. This review provides a timely account of the benefits and challenges of virtual health interventions, as well an outlook on how such technologies can be transitioned from research-focused towards real-world healthcare and pharmaceutical applications to transform treatment pathways for patients worldwide.

Disparities in Healthcare Services and Spatial Assessments of Mobile Health Clinics in the Border Regions of Thailand

Reducing the disparities in healthcare access is one of the important goals in healthcare services and is significant for national health. However, measuring the complexity of access in truly underserved areas is the critical step in designing and implementing healthcare policy to improve those services and to provide additional support. Even though there are methods and tools for modeling healthcare accessibility, the context of data is challenging to interpret at the local level for targeted program implementation due to its complexity. Therefore, the purpose of this study is to develop a concise and context-specific methodology for assessing disparities for a remote province in Thailand to assist in the development and expansion of the efficient use of additional mobile health clinics. We applied the geographic information system (GIS) methodology with the travel time-based approach to visualize and analyze the concealed information of spatial data in the finer analysis resolution of the study area, which was located in the border region of the country, Ubon Ratchathani, to identify the regional differences in healthcare allocation. Our results highlight the significantly inadequate level of accessibility to healthcare services in the regions. We found that over 253,000 of the population lived more than half an hour away from a hospital. Moreover, the relationships of the vulnerable residents and underserved regions across the province are underlined in the study and substantially discussed in terms of expansion of mobile health delivery to embrace the barrier of travel duration to reach healthcare facilities. Accordingly, this research study addresses regional disparities and provides valuable references for governmental authorities and health planners in healthcare strategy design and intervention to minimize the inequalities in healthcare services.

Domiciliary dentistry clinics: a multiple case study in the province of Quebec, Canada

BACKGROUND

The demand for more flexible and person-centered models of oral healthcare delivery is increasing and while mobile and domiciliary dental services have the potential to increase access to oral healthcare among dependent elderly and people with disabilities; the uptake of this service model by dentists remains low. Therefore, the aim of this study was to understand how existing domiciliary dental services operate within a particular context.

METHODS

We used a qualitative descriptive multiple case study design. We studied three independent domiciliary dentistry clinics in the province of Quebec, Canada. We completed observations of 27 domiciliary visits, four of which were in private homes and the remaining 23 in LTCFs. We also conducted semi-structured interviews with dental professionals, patients, and caregivers. We performed a qualitative content analysis using a deductive/inductive coding framework.

RESULTS

We presented a detailed description of the physical and service features of the studied cases. Physical features included the set-up of the mobile clinics, the portable equipment used, and the domiciliary locations of visits. For service features, we described the roles, attitudes, and interactions among those involved on both the providers' and recipients' sides, as well as, the logistical and financial aspect of the domiciliary dental services.

CONCLUSIONS

Despite variations in setup and years of practice, the three mobile clinics had similar physical and service features. They also faced common logistic challenges but were able to provide services and respond to the high demand for domiciliary dental services. Additional research in different contexts would further contribute to building evidence-based models to help increase the uptake of this type of practice by current and future dental professionals.

The use of teledentistry in facilitating oral health for older adults: A scoping review

BACKGROUND

Teledentistry is used in many countries to provide oral health care services. However, using teledentistry to provide oral health care services for older adults is not well documented. This knowledge gap needs to be addressed, especially when accessing a dental clinic is not possible and teledentistry might be the only way for many older adults to receive oral health care services.

TYPES OF STUDIES REVIEWED

Nine databases were searched and 3,396 studies were screened using established eligibility criteria. Included studies were original research or review articles in which the intervention of interest was delivered to an older adult population (≥ 60 years) via teledentistry. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review criteria.

RESULTS

Nineteen studies were identified that met the criteria for inclusion. Only 1 study was from the United States. Seven studies had results focusing on older adult participants only, with most of those conducted in elder care facilities. The remainder consisted of studies with mixed-age populations reporting distinct results or information for older adults. The included studies used teledentistry, in both synchronous and asynchronous modes, to provide services such as diagnosis, oral hygiene promotion, assessment and referral of oral emergencies, and postintervention follow-up.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Teledentistry comprises a variety of promising apps. The authors identified and described uses, promising possibilities, and limitations of teledentistry to improve the oral health of older adults.

The development and psychometric properties of oral health assessment instruments used by non-dental professionals for nursing home residents: a systematic review

BACKGROUND

Globally, oral health status of the geriatric population residing in nursing homes is poor. The integration of non-dental professionals is vital to monitor oral health, early identification and triaging of oral health problems, and timely referral to dental professionals. The aims of this systematic review were to provide a summary on the development and characteristics of oral health assessment instruments currently used by non-dental professionals for nursing home residents, and to perform a critical appraisal of their psychometric properties.

METHODS

This review was conducted as per the PRISMA guidelines. CINHAL (EBSCO), Medline (Ovid), and EMBASE (Ovid) were searched systematically. Two reviewers independently screened the title, abstract, and full text of the studies as per the eligibility criteria. Studies describing oral health assessment instruments used to assess oral health of nursing home residents by non-dental professionals were included. Using a methodological framework, each instrument was evaluated for purpose, content, and psychometric properties related to validity, reliability, feasibility, generalisability, and responsiveness. Additionally, the reporting quality assessment of each included study was performed according to the SURGE guidelines.

RESULTS

Out of the 819 screened articles, 10 studies were included in this review. The 10 identified instruments integrated 2 to 12 categories to assess oral health, which was scored on a 2 to 5-point scale. However, the measurement content varied widely, and none were able to comprehensively measure all aspects of oral health. Three measurement approaches were identified: performance- based assessment, direct inspection of the oral health status, and interview measures. Only eight instruments provided quality assessment on the basis of validity, reliability, feasibility and generalisability, whereas three instruments- Brief Oral Health Status Examination, Dental Hygiene Registration, and Oral Health Assessment Tool reported good methodological quality on at least one assessment criteria.

CONCLUSIONS

None of the instruments identified in this review provided a comprehensive assessment of oral health, while three instruments appeared to be valid and reliable. Nonetheless, continuous development of instruments is essential to embrace the complete spectrum of oral health and address the psychometric gaps.

Geriatric Health Experts Validate Oral Neglect Timelines for the Institutionalized Elderly

The purpose of this follow-up Delphi survey was to have an expert panel of 31 academic geriatric physicians, geriatric nurses, and medical directors of nursing homes evaluate the original timeline set to avoid oral neglect of nursing home residents. The Oral Neglect in Institutionalized Elderly (ONiIE) timelines defined oral neglect as having occurred when >7 days for acute oral diseases/conditions or >34 days for chronic oral disease/conditions had passed between initial diagnosis and offering access to dental care to the long-term care (LTC) nursing home resident. The results of this follow-up Delphi survey validated those originally defined ONiIE timelines as 90% of this panel agreed with the original timelines. This ONiIE definition adds a broad-based validation for the ONiIE timelines for setting an oral health standard of care for institutionalized elderly residents of nursing homes and should now be used to protect the vulnerable elderly residing in LTC nursing homes.