Practical protocols for the prevention of dental disease in community settings for people with special needs: the protocols

Special Care Patients and Caries Prevalence in Permanent Dentition: A Systematic Review

Due to the increase in the population with special needs and the significant difficulty in their dental management, it is essential to analyze the caries prevalence in this group of patients. The systematic review was conducted following the PRISMA statement. A search was performed on 9 May 2022 and updated on 5 June 2022, in three databases: Pubmed, Scielo, and Cochrane library. Studies involving the analysis of caries in permanent teeth in patients with special needs were included. A total of 1277 studies were analyzed and 21 studies were selected. Quality assessments were performed using an adapted version of the STROBE guidelines. Among the analyzed groups (intellectual disabilities, human immunodeficiency virus infection, schizophrenia, down syndrome, drug addicts, adult heart transplant, kidney disease, diabetic, autism, psychiatric patients, cerebral palsy, and hemophilia), the highest prevalence of caries was observed in patients with intellectual disability, without differences between genders. However, there is a need for more studies with standardized methods for caries diagnosis to further investigate the prevalence of caries in permanent teeth in patients with special needs.

The perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders, Belgium

OBJECTIVES

To assess the perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders.

MATERIALS AND METHODS

Two questionnaires were developed, one for managers and one for caregivers. The questionnaires were distributed in all 570 organizations for people with disabilities in Flanders. The survey was carried out in February 2018.

RESULTS

Sixty-five managers completed the questionnaire and 63 of them could be linked to 57 unique organizations (10% of the contacted organizations). Managers perceived oral health to be better (P = 0.019) and mentioned less oral health needs (P = 0.049), when collaboration with a dentist was reported. When an oral health policy had been established in their organization, oral health was also perceived to be better (P = 0.048). The responses of 91 caregivers were included for analysis and 87 of them could be linked to 39 unique organizations (7% of contacted organizations). Seventy percent and 75% of the caregivers mentioned to have enough/comprehensive theoretical knowledge and practical skills, respectively, and 46% were interested in receiving oral health education. Most interest was shown in practical education and education customized to clients' needs. In organizations with an oral health project, more caregivers indicated that the organization was open to oral health questions than in organizations without such a project (97% compared with 81%; P = 0.045). When there was a collaboration with a dentist, the organization was more open to caregivers' questions (96% compared with 72%; P = 0.004) and a clear contact point was more readily available (81% compared with 48%; P = 0.004). Furthermore, caregivers were more interested to receive oral health education (P = 0.023) and mentioned to be more aware of the oral health of their clients (P = 0.015). About 23% and 30% of the caregivers indicated that guidelines were used in their organization for cleaning natural teeth and prostheses, respectively.

CONCLUSIONS

Despite the low response rate to the survey and reaching the management and caregivers of only 10% and 7% of the organizations respectively, this study indicates relevant issues to be incorporated when formulating recommendations for oral health promotion in people with disabilities in Flanders.

CLINICAL RELEVANCE

The results of this survey could affect the development of strategies and interventions to ameliorate the oral health of people with disabilities.

Knowledge, Attitude, and Practices of Dental Practitioners in Thiruvananthapuram on Oral Health Care for Children with Special Needs

The objective of this study was to investigate knowledge, attitude, and practices of dental practitioners in Thiruvananthapuram, India regarding dental management of children with special healthcare needs (CSHCN).

MATERIALS AND METHODS

A structured questionnaire was given to 400 dental practitioners. The data were analyzed using SPSS software (version 23.0) and Chi-square test was used.

RESULTS

The response rate was 94%. An estimated 73.8% treated children, 66.5% showed willingness to treat CSHCN, and 70.8% had attended CSHCN in their practice. A partial knowledge in dental management of CSHCN was reported by 67.5%. An estimated 36% had undergone training in special care dentistry (SCD) but 45% were not sure whether they can provide dental care with the graduate-level training. Knowledge regarding guidelines for CSHCN was known to 19.5% and that regarding timing of the first dental visit was known to 69% of participants. Tooth extraction (43.1%) and a subsequent caries treatment (39.1%) were the most frequently done procedures, and nonpharmacological management (46.5%) was the mostly used behavior management technique. Among the barriers faced by dentists in treating CSHCN, time consumption (55.6%) and lack of training (55.1%) were commonly enlisted. Further training and improved facilities would motivate the respondents in providing better care to CSHCN.

CONCLUSION

This study suggests that majority of the dentists participated had a partial knowledge on SCD and were willing to treat CSHCN. Insufficient training in the field of SCD was a major drawback, which prevented most general dentists from effectively managing CSHCN. Additional training and improving facilities can improve dental care to CSHCN.

HOW TO CITE THIS ARTICLE

Rajan S, Kuriakose S, et al. Knowledge, Attitude, and Practices of Dental Practitioners in Thiruvananthapuram on Oral Health Care for Children with Special Needs. Int J Clin Pediatr Dent 2019;12(4):251-254.

Interventions Focusing on Children with Special Health Care Needs

The term children with special health care needs encompasses a wide variety of conditions. When considering interventions, a broad definition of children with special needs is suggested in this article along with a focus on developing specific treatment recommendations based on a thorough data-gathering process and developing customized recommendations for children based on their unique circumstances. An area for future research is increasing the understanding of the relationship between customized recommendations and the underlying special health care needs.

Unmet oral health needs among persons with intellectual disability

The aim of this study was to examine the factors affecting oral health status among intellectually disabled individuals in Serbia. The sample population was categorized according to age, sex, living arrangements, general health and the level of intellectual disability (ID). The diagnosis of dental caries was performed using the DMFT/dmft criteria. The oral hygiene and gingival health were assessed with the plaque index (Silness&Löe) and gingival index (Löe&Silness), respectively. Descriptive analysis, step-wise and logistic regression were performed to analyze related influential factors for caries presence, number of extracted teeth, teeth restored, the oral hygiene level and the extent of gingival inflammation. Odds ratios for caries were significantly higher among adult persons with ID, in persons with co-occurring developmental disorders (DDS) and increased with the level of ID. Group with DDS was associated with a 1.6 times greater odds of untreated decay, while the institutionalization was associated with 2.4 times greater odds of untreated decay. Institutionalization and co-occurring disabilities have been found to be significantly associated with a higher probability of developing gingivitis. Targeting oral health services to individuals with ID are encouraged and may help to reduce overall negative effect on oral and general health associated with delayed treatments, chronic dental pain, emergency dental care, tooth loss and advanced periodontal disease.

Planning dental treatment for people with special needs

People with disabilities and other special needs present unique challenges for oral health professionals in planning and carrying out dental treatment. This article presents a schema for planning dental treatment that encourages the oral health provider to fully consider multiple medical, social, psychologic and dental findings when preparing treatment recommendations for a patient with special needs. If these factors are fully integrated, the resulting treatment recommendations provide the best chance of helping the individual achieve and maintain a lifetime of oral health.

Improving and maintaining oral health for people with special needs

The number of people in the United States population with disabilities and other special needs is growing dramatically. These individuals present unique challenges for oral health professionals in planning and carrying out dental treatment and for the oral health delivery system. Because it has been recognized that the current delivery system is not working well for these populations, new workforce, financing, and delivery models are beginning to emerge that may hold promise for creating and maintaining oral health for currently underserved populations, including people with disabilities and other special needs. This article discusses the implications of this for the oral health profession, describes the challenges of providing oral health services for this population, and discusses the implications of these challenges for the organization of the oral health delivery system.

Dental caries in older adults

Dental caries is one of the most significant health problems facing older adults. More than half of the elderly who are dentate are affected with either coronal or root caries, and caries is the primary cause of tooth loss in this population. New materials and techniques are emerging to help with geriatric preventive and restorative needs, but ongoing vigilance for caries will be required in this population, which is experiencing increased longevity and tooth retention.