1
|
Tan SHX, Lee GKY, Goh CE, Tong HJ, Chuang JCP, Ang KY, Lim DGX, Gao X. Impact of income and financial subsidies on oral health care utilization among persons with disabilities in Singapore. Community Dent Oral Epidemiol 2024. [PMID: 38644526 DOI: 10.1111/cdoe.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND/AIM(S) Globally, studies have shown that the dental disease burden among persons with intellectual and/or developmental disabilities (IDD) is high and can be attributed to lower utilization levels of dental services. The aim of the study was to assess the influence of income and financial subsidies on the utilization of dental care services among persons with IDD in Singapore. METHODS Between August 2020 and August 2021, a cross-sectional study was conducted via centres offering Early Intervention Programme for Infants and Children, special education schools and adult associations in Singapore serving persons with IDD. A sample of 591 caregivers of children and adults with IDD completed the survey. Data on sociodemographic information, oral health behaviours and dental utilization were collected. Financial subsidy status was assessed by the uptake of a government-funded, opt-in Community Health Assist Scheme (CHAS) for low-income families that provided a fixed subsidy amount for dental services in the primary care setting. Statistical analysis was carried out using univariable, multiple logistic regression and modified Poisson regression. Propensity score matching was carried out in R version 4.0.2 to assess the impact of financial subsidies on oral health care utilization among persons with IDD. RESULTS Compared to those with lower gross monthly household incomes, the adjusted prevalence ratios of having at least one dental visit in the past year, having at least one preventive dental visit in the past year, and visiting the dentist at least once a year for persons with IDD with gross monthly household incomes of above SGD$4000 were 1.28 (95% CI 1.08-1.52), 1.48 (95% CI 1.14-1.92) and 1.36 (95% CI 1.09-1.70), respectively. Among those who were eligible for CHAS Blue subsidies (247 participants), 160 (62.0%) took up the CHAS Blue scheme and 96 (35.4%) visited the dentist at least yearly. There was no statistically significant difference in the utilization of dental services among individuals enrolled in the CHAS Blue subsidy scheme among those eligible for CHAS Blue subsidies. CONCLUSION Higher household income was associated with a higher prevalence of dental visits in the past year, preventive dental visits in the past year, and at least yearly dental visits. CHAS Blue subsidies alone had limited impact on dental utilization among persons with IDD who were eligible for subsidies.
Collapse
Affiliation(s)
- Sharon Hui Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Charlene Enhui Goh
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Huei Jinn Tong
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | | | | | - David Guang Xu Lim
- Tzu Chi Singapore Free Clinic, Buddhist Compassion Relief Tzu Chi Foundation, Singapore, Singapore
- National Dental Centre Singapore, Singapore, Singapore
| | - Xiaoli Gao
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| |
Collapse
|
2
|
Tada S, Lee GKY, Koh SMY, Wong ML. Current situation, future vision and enablers of nursing home oral healthcare in Singapore: Dentists' perspectives. Gerodontology 2024; 41:169-181. [PMID: 36916766 DOI: 10.1111/ger.12686] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/15/2023]
Abstract
OBJECTIVES To address the following research questions: (i) What is the current situation and future vision on oral healthcare service in nursing homes (NHs) in Singapore? (ii) What are the enablers to achieve the future vision? (iii) How do views differ between dentists with and without clinical experiences in NHs? BACKGROUND Oral healthcare services in NHs need to reflect the perspectives of a diverse range of stakeholders and establish shared goals, however there is scarce evidence of in-depth dentists' insights. MATERIAL AND METHODS Dentists were purposively recruited. Focus group discussions with 4-5 participants each were conducted via teleconferencing. Data were analysed thematically. RESULTS The participants (n = 19, median 36.0 years) recognised the need of comprehensive reform of the oral healthcare paradigm in NHs: symptomatic care to preventive care, disease-oriented care to person-centred care and more active collaborative care. Overall, five domains of enabling factors emerged: (1) to improve general system of oral healthcare in NHs, (2) to increase the number of dentists engaging in NHs, (3) to improve the quality of dental practice, (4) to improve the quality of daily oral care and (5) to promote seniors' cooperative attitude to oral healthcare. There was a noticeable difference in the perception on how to encourage dentists to serve in NHs. CONCLUSION There is a need for a comprehensive reform of the oral healthcare paradigm for seniors in NHs in Singapore. A multi-tiered strategy using both top-down and bottom-up approaches is required.
Collapse
Affiliation(s)
- Sayaka Tada
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | | | - Sarah Mun Yee Koh
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Mun Loke Wong
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| |
Collapse
|
3
|
Lee GKY, Tan MN, Gao X, Wee HL, Lai BWP, Hong CHL, Hu S. Acceptance of silver diamine fluoride use in community dwelling older adults, nursing home residents, and caregivers. J Dent 2024; 141:104819. [PMID: 38128821 DOI: 10.1016/j.jdent.2023.104819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES To compare the level of acceptance of silver diamine fluoride (SDF) treatment between different functional groups of older adults aged 65-years-old and above. METHODS Three groups were recruited representing functionally-independent ("Community dwelling"), frail ("Nursing home"), and functionally-dependent older adults ("Caregiver": proxy respondent involved in caring for an older adult of all functional levels). Participants viewed a video on SDF and an interviewer-led questionnaire collected demographics, dental experience and perception on SDF use. RESULTS The study recruited 201 participants (100 "Community dwelling", 51 "Nursing home", 50 "Caregiver"). Overall, 73 % of participants were accepting of SDF treatment. Those in the "Community dwelling" group were most accepting (85 %), followed by the "Nursing home" group (61 %) and "Caregiver" group (60 %) (p<0.001). Participants were more accepting of SDF use on posterior (73 %) compared to anterior teeth (46 %). They were more accepting when SDF was presented as a treatment to avoid infection and pain (87 %), and general anesthesia (78 %). In a regression analysis, "Nursing home" and "Caregiver" participants were three times less likely to accept SDF (OR 0.27 [95 % CI: 0.13 to 0.60], and OR 0.27 [95 % CI: 0.12 to 0.58] respectively) compared to "Community dwelling" participants. After adjusting for other factors, only the "Caregiver" group remained significant (Adjusted OR 0.32 [95 % CI: 0.13 to 0.78]). CONCLUSIONS Older adults were accepting of SDF and this treatment modality has the potential to be a routine treatment option in dental caries management in this population. However, this was less certain among frail and functionally dependent older adults. CLINICAL SIGNIFICANCE An SDF program to manage caries is likely to be well-received by functionally-independent older adults. However, the acceptance among frail and functionally-dependent older adults were lower even though SDF is mostly likely to benefit these populations. There is a need to investigate this relatively lower levels of acceptance.
Collapse
Affiliation(s)
| | - Mei Na Tan
- National University Centre for Oral Health Singapore, National University Health System, Singapore
| | - Xiaoli Gao
- Faculty of Dentistry, National University of Singapore, Singapore; Saw Swee Hock School of Public Heath, National University of Singapore, Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Heath, National University of Singapore, Singapore
| | - Bien Wen Pui Lai
- Paediatric Dentistry Unit, National Dental Centre Singapore, Singapore
| | | | - Shijia Hu
- Faculty of Dentistry, National University of Singapore, Singapore.
| |
Collapse
|
4
|
Koh SMY, Tada S, Lee GKY, Wong ML. Dentists' perspectives on structural and system barriers hindering oral healthcare provision in residential care facilities. Community Dent Oral Epidemiol 2024. [PMID: 38251785 DOI: 10.1111/cdoe.12944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVES Oral healthcare service is not well integrated with existing healthcare policy in nursing homes (NHs) globally. This qualitative study aimed to identify dentists' perspectives on structural and system barriers that hinder oral healthcare (OHC) provision to seniors in NHs in Singapore and to understand the consequences of these barriers. METHODS Nineteen dentists (8 males and 11 females, 36.0 [IQR: 32.0-48.5] years old) were recruited through combination of purposive and snowball sampling. Four focus group discussions were conducted via teleconferencing, and each discussion had 4-5 anonymised participants. Sessions lasted 90-120 min and were audio-recorded and transcribed verbatim. Thematic analysis was conducted on data collected using NVivo software (Version12, QRS International). RESULTS Participants agreed that the current OHC system for seniors in NHs is not well developed. The challenges dentists faced were categorised in three themes: [1] general oral healthcare system level; [2] local nursing home setting level; and [3] geriatric oral healthcare education level. These challenges are complexly intertwined and have contributed to several consequences such as a shortage of dentists in NHs and their diminished motivation to serve. It has also limited the quality of dental service they are able to provide in NHs, contributing to the current poor access of dental services for seniors in NHs. CONCLUSIONS Dentists in Singapore face many structural and systemic barriers in providing OHC to seniors in NHs, some of which are unique to the local context. Newfound understanding of these barriers and its consequences will be helpful in developing strategic approaches to overcome these challenges.
Collapse
Affiliation(s)
- Sarah Mun Yee Koh
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - Sayaka Tada
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - Gabriel Keng Yan Lee
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | - Mun Loke Wong
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| |
Collapse
|
5
|
Lee GKY, Tada S, Wong ML. A customized table-top aging simulation exercise to augment gerodontology teaching. J Dent Educ 2024. [PMID: 38223982 DOI: 10.1002/jdd.13452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024]
Abstract
While aging simulation suits have been used in healthcare education to promote empathy for older adults, little has been published on learning outcomes specific to geriatric dental patients. We designed a seminar utilising a customised ageing simulation suit to help dental students empathise with several disabilties their older adult patients may face.
Collapse
Affiliation(s)
- Gabriel Keng Yan Lee
- Discipline of Primary Dental Care and Population Oral Health,Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Sayaka Tada
- Discipline of Primary Dental Care and Population Oral Health,Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Mun Loke Wong
- Discipline of Primary Dental Care and Population Oral Health,Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| |
Collapse
|
6
|
Goh CE, Zheng K, Chua WY, Nguyen T, Liu C, Koh CK, Lee GKY, Tay CM, Ooi BC, Wong ML. Development of a dental diet-tracking mobile app for improved caries-related dietary behaviours: Key features and pilot evaluation of quality. Digit Health 2024; 10:20552076241228433. [PMID: 38303969 PMCID: PMC10832442 DOI: 10.1177/20552076241228433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
Objective Diet significantly contributes to dental decay (caries) yet monitoring and modifying patients' diets is a challenge for many dental practitioners. While many oral health and diet-tracking mHealth apps are available, few focus on the dietary risk factors for caries. This study aims to present the development and key features of a dental-specific mobile app for diet monitoring and dietary behaviour change to prevent caries, and pilot data from initial user evaluation. Methods A mobile app incorporating a novel photo recognition algorithm and a localised database of 208,718 images for food item identification was developed. The design and development process were iterative and incorporated several behaviour change techniques commonly used in mHealth. Pilot evaluation of app quality was assessed using the end-user version of the Mobile Application Rating Scale (uMARS). Results User feedback from the beta-testing of the prototype app spurred the improvement of the photo recognition algorithm and addition of more user-centric features. Other key features of the final app include real-time prompts to drive actionable behaviour change, goal setting, comprehensive oral health education modules, and visual metrics for caries-related dietary factors (sugar intake, meal frequency, etc.). The final app scored an overall mean (standard deviation) of 3.6 (0.5) out of 5 on the uMARS scale. Conclusion We developed a novel diet-tracking mobile app tailored for oral health, addressing a gap in the mHealth landscape. Pilot user evaluations indicated good app quality, suggesting its potential as a useful clinical tool for dentists and empowering patients for self-monitoring and behavioural management.
Collapse
Affiliation(s)
| | - Kaiping Zheng
- School of Computing, National University of Singapore, Singapore
| | - Wen Yong Chua
- School of Computing, National University of Singapore, Singapore
| | - Thao Nguyen
- School of Computing, National University of Singapore, Singapore
| | - Changshuo Liu
- School of Computing, National University of Singapore, Singapore
| | - Chun Keat Koh
- Smart Systems Institute, National University of Singapore, Singapore
| | | | - Chong Meng Tay
- Division of Advanced General Dental Practice, National University Centre for Oral Health Singapore, Singapore
| | - Beng Chin Ooi
- School of Computing, National University of Singapore, Singapore
| | - Mun Loke Wong
- Faculty of Dentistry, National University of Singapore, Singapore
| |
Collapse
|
7
|
Lee GKY, Wong KY, Lee WZ, Chng CK. The oral health landscape in Singapore: A commentary on key features, challenges and future policies. Community Dent Oral Epidemiol 2023. [PMID: 37971154 DOI: 10.1111/cdoe.12927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
Over the last decade, Singapore has grappled with substantial healthcare challenges, chiefly a bourgeoning aging population and a mounting burden of chronic diseases. The oral health landscape has also changed, with the Ministry of Health placing a greater focus on a life-course approach supported by policies that facilitate Singaporeans to receive dental care appropriately and affordably. A pivotal oral health policy is the National Dental Strategy, a comprehensive framework governing dental services in the public sector. This strategy encompasses aspects such as financing, workforce management, and capacity considerations. To facilitate affordability and accessibility to dental services in the public sector, the government extends subsidies to reduce out-of-pocket costs. Those attending private dental clinics also benefit from the Community Health Assist Scheme, introduced in 2012, which alleviates treatment costs for enrolled Singaporeans. Furthermore, additional age-banded subsidies have been introduced for older Singaporeans born before 1960, enhancing financial support when accessing dental services in both private and public sectors. In 2019, a national adult oral health survey was commissioned to gauge the oral health status of Singaporeans aged 21 and above. The findings reported 34.8% having untreated dental caries, and 15.7% and 41.2% experiencing moderate and severe periodontitis, respectively. While over half (53.9%) of respondents visited the dentist at least annually, about 60% of eligible individuals did not utilize their government dental subsidies. In response, the Ministry of Health is committed to strengthening oral disease prevention, integrating oral health into general healthcare services, expanding dental financing schemes to enhance service utilization, improving the quality and transparency of dental care, and leveraging advancements in tele-dentistry and other modes of dental services. It is imperative to adapt Singapore's oral health policies and service delivery models to meet the evolving needs of the population and ensure a sustainable, equitable and resilient oral healthcare system.
Collapse
Affiliation(s)
- Gabriel Keng Yan Lee
- Discipline of Primary Dental Care and Population Oral Health, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
- Chief Dental Officer's Office, Office of the Director General of Health, Ministry of Health, Singapore, Singapore
| | - Kuan Yee Wong
- Chief Dental Officer's Office, Office of the Director General of Health, Ministry of Health, Singapore, Singapore
- National University Centre for Oral Health, Singapore, Singapore
| | - Wan Zhen Lee
- Chief Dental Officer's Office, Office of the Director General of Health, Ministry of Health, Singapore, Singapore
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore, Singapore
| | - Chai Kiat Chng
- Chief Dental Officer's Office, Office of the Director General of Health, Ministry of Health, Singapore, Singapore
- Cleft and Craniofacial Dentistry Unit, KK Women's and Children's Hospital, Singapore, Singapore
| |
Collapse
|
8
|
|
9
|
Lee GKY, Lee KH, Chu CY, Li HL, Khoo JLS. Non-traumatic Ischiorectal Epidermoid Cyst. Hong Kong J Radiol 2018. [DOI: 10.12809/hkjr1616403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
10
|
Lai TYY, Lee GKY, Chan WM, Lam DSC. Rapid development of severe toxic retinopathy associated with continuous intravenous deferoxamine infusion. Br J Ophthalmol 2006; 90:243-4. [PMID: 16424543 PMCID: PMC1860174 DOI: 10.1136/bjo.2005.080119] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
11
|
Abstract
AIM To compare the safety and effectiveness of trypan blue capsule staining under air vs under viscoelastic. METHODS A total of 52 consecutive patients planned for phacoemulsification of white mature cataract were randomly assigned to trypan blue staining under air or under viscoelastic. Perioperative changes in best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell density (ECD) were compared between the two groups. The differences in operating and phacoemulsification times, staining pattern, and complications between the two groups were also recorded. RESULTS Phacoemulsification of white mature cataract was performed in 50 (96%) eyes. The median preoperative BCVA was hand movement. No significant differences in the baseline characteristics were found between the two groups. At 3 months after phacoemulsification, the median BCVA improved to 0.8. The mean CCT returned to preoperative level by 1 month postoperatively and the mean ECD loss was 11.9% 3 months postoperatively. No significant differences in median BCVA, mean phacoemulsification and operation times, mean CCT, and mean ECD were found between the two groups. CONCLUSIONS Trypan blue staining of the anterior lens capsule under air or under viscoelastic were similarly effective and safe methods for the phacoemulsification of white mature cataract.
Collapse
Affiliation(s)
- V W Y Wong
- Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | | | | | | | | |
Collapse
|