Gamification and Oral Health in Children and Adolescents: Scoping Review

BACKGROUND

Oral health is a determinant of overall well-being and quality of life. Individual behaviors, such as oral hygiene and dietary habits, play a central role in oral health. Motivation is a crucial factor in promoting behavior change, and gamification offers a means to boost health-related knowledge and encourage positive health behaviors.

OBJECTIVE

This study aims to evaluate the impact of gamification and its mechanisms on oral health care of children and adolescents.

METHODS

A systematic search covered multiple databases: PubMed/MEDLINE, PsycINFO, the Cochrane Library, ScienceDirect, and LILACS. Gray literature, conference proceedings, and WHOQOL internet resources were considered. Studies from January 2013 to December 2022 were included, except for PubMed/MEDLINE, which was searched until January 2023. A total of 15 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The eligibility criteria were peer-reviewed, full-text, and empirical research related to gamification in oral health care, reports of impact, and oral health care outcomes. The exclusion criteria encompassed duplicate articles; unavailable full texts; nonoriginal articles; and non-digital game-related, non-oral health-related, and protocol studies. Selected studies were scrutinized for gamification mechanisms and outcomes. Two main questions were raised: "Does gamification in oral health care impact oral health?" and "Does oral health care gamification enhance health promotion and literacy?" The PICO (Patient, Intervention, Comparison, Outcome) framework guided the scoping review.

RESULTS

Initially, 617 records were obtained from 5 databases and gray literature sources. After applying exclusion criteria, 15 records were selected. Sample size in the selected studies ranged from 34 to 190 children and adolescents. A substantial portion (11/15, 73%) of the studies discussed oral self-care apps supported by evidence-based oral health. The most clearly defined data in the apps were "brushing time" (11/11, 100%) and "daily amount brushing" (10/11, 91%). Most studies (11/15, 73%) mentioned oral health care behavior change techniques and included "prompt intention formation" (11/26, 42%), "providing instructions" (11/26, 42%), "providing information on the behavior-health link" (10/26, 38%), "providing information on consequences" (9/26, 35%), "modeling or demonstrating behavior" (9/26, 35%), "providing feedback on performance" (8/26, 31%), and "providing contingent rewards" (8/26, 31%). Furthermore, 80% (12/15) of the studies identified game design elements incorporating gamification features in oral hygiene applications. The most prevalent gamification features were "ideological incentives" (10/12, 83%) and "goals" (9/16, 56%), which were found in user-specific and challenge categories, respectively.

CONCLUSIONS

Gamification in oral health care shows potential as an innovative approach to promote positive health behaviors. Most studies reported evidence-based oral health and incorporated oral health care behavior change techniques.

Social Media Impact on Self-Perceived Oral Health Practices Among Patients Visiting Tertiary Care Hospital in Lucknow: A Cross-Sectional Study

Background Social media is widely used in the medical field, and people often utilize it to learn about their symptoms prior to consulting with a healthcare professional. Hence, the study aims to investigate the influence of social media on self-perceived oral health practices among patients. Methodology A cross-sectional study design was adopted, with a questionnaire comprising 15 closed-ended questions. The sample size was estimated to be 451 participants based on the findings from the pilot study. The face validity of the questionnaire was assessed by a subject matter expert (0.83%), and the reliability was measured using Kappa statistics (0.86). The percentile was determined to assess the overall self-perceived oral health practices of the participants. The data was analyzed using descriptive analysis, chi-square test, and multivariate regression analysis at statistical significance (p ≤ 0.05). Results The majority of participants belonged to urban areas (66.5%), with an average age of 38.19 ± 6.70. The participants in urban 184 (61.3%) and rural 102 (67.5%) believed that social media provided better knowledge regarding oral health, which was statistically significant (p = 0.046). The majority of the participants, 267 (59.2%), spent more than 30 minutes to three hours per day on social media. It was found that participants who possessed professional occupations had increased odds of having good oral health practices on social media (p = 0.043). Conclusion The participants believed that social media provided better knowledge regarding oral health, and self-perceived practices among the participants were found to be poor. Social media platforms provide new educational possibilities in the dentistry sector, but their potential is neglected and unappreciated.

Development of the Antioxidant Property of Seagrass Extract-Based Hydrogel for Dental Application

Background Seagrass is rich in antioxidants, which can help neutralize harmful free radicals in the oral cavity. Free radicals can contribute to oxidative stress, inflammation, and various oral health issues. Incorporating seagrass extract into a hydrogel can enhance its antioxidant capacity, providing a protective effect for oral tissues. The hydrogel, composed of a biocompatible base, ensures that the material is well-tolerated by oral tissue. This is crucial for any dental application to avoid adverse reactions. Aim This work aimed to develop an antioxidant hydrogel that incorporates seagrass extract, with a specific emphasis on its possible use in dentistry. Methods A seagrass sample was collected, and its bioactive compounds were extracted through the utilization of methanol, and subsequent filtration was done. The resulting seagrass filtrate was then integrated into a hydrogel, which was synthesized using polyacrylamide and sodium alginate. Antioxidant hydrogel underwent testing for antioxidant activity through both the 2,2-diphenyl-1-picrylhydrazyl assay and the 2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid) assay. Besides, the hydrogel functional groups were investigated using Fourier transform infrared spectroscopy, while its crystalline structure was examined using X-ray diffraction analysis. Conclusion Seagrass extract provides inherent antioxidant properties, and incorporating this bioactive extract into the hydrogel imparts antioxidant features. The hydrogel's controlled-release property ensures both safety and efficiency. Antioxidant hydrogel for dental applications holds the potential to improve oral health.

Psychometric Properties of the Oral Health Values Scale and Cultural Adaptation in the Indian Population

AIM

The Oral Health Values Scale is a multidimensional instrument that identifies and measures a person's values related to oral health. This scale has been validated in American respondents. This study aims to evaluate the adaptability and validity of the Oral Health Values Scale in the Hindi language (H-OHVS).

METHODOLOGY

A total of 240 adults participated in the study that was carried out from July to November 2022. An offline one-to-one survey was carried out to collect data by an investigator blinded to the study protocol. The translation and testing of the OHVS were carried out based on the cross-cultural adaptation guidelines of the American Academy of Orthopedic Surgeons (AAOS) Evidence-Based Medicine Committee. The content validity was assessed by an expert panel. Construct validity was analyzed through Exploratory Factor Analysis (EFA), utilizing principal component analysis with varimax rotation. The internal consistency of the Hindi version of OHVS was evaluated using Cronbach's alpha.

RESULTS

 The results showed that H-OHVS had an Item-level Construct Validity Index (I-CVI) ranging from 0.82 to 1.00. Two components, compliance and hesitance, were formed on H-OHVS accounting for 63.91% of the cumulative variance. The resulting model fit indices on confirmatory factor analysis presented an adequate fit to the data. The overall Cronbach's alpha coefficient for H-OHVS (α = 0.868) presents excellent internal consistency.

CONCLUSIONS

The study findings provide a certain degree of evidence in favor of this scale and establish the Oral Health Values Scale (OHVS) as a psychometrically sound measure.

Assessment of Various Factors Contributing to Unfavourable Oral Health Care Seeking Behaviour: A Cross-Sectional Study

BACKGROUND

 Access to effective oral health care is crucial for a good quality of life. Unfortunately, many individuals face barriers in accessing the necessary oral health care services. By examining various factors, we can gain a better understanding of the challenges faced by the population and work towards improving oral health care outcomes. This study aims to assess the various factors contributing to unfavorable oral healthcare-seeking behavior in Chennai city.

MATERIALS AND METHODS

 A cross-sectional study was conducted in Chennai city involving six hundred and twenty-four individuals from the general population from 12 wards by lottery method. The data collection process involved interviews using a pre-designed questionnaire, through which demographic information was gathered. The Penchansky and Thomas model was employed to assess barriers in service utilization. All completed questionnaires were included in the data analysis, which was performed using SPSS version 20.

RESULTS

In the present study, among the various dimensions of access suggested by Penchansky and Thomas, the major reason for unfavorable oral healthcare-seeking behavior was accommodation (54.8%), followed by affordability (20.2%), accessibility (5.6%), acceptability (4.4%), and availability (1.1%). The other reasons that contributed were sociocultural factors (26.4%), lack of awareness (20.8%), and psychosocial factors (11.8%).

CONCLUSION

The present study highlights lack of time as the major factor contributing to unfavourable oral healthcare-seeking behaviour in an urban population. This finding contrasts with previous studies that have focussed on the lack of awareness about dental diseases and the high cost of dental treatment in rural areas.

Increased Expression of LIPC Is Associated With the Clinicopathological Features and Development of Head and Neck Squamous Cell Carcinoma

Introduction Lipase C hepatic type (LIPC) is a member of the lipase family and plays a role in tumor development. However, its specific role in head and neck squamous cell carcinoma (HNSCC) is not well understood. Objective This study aims to investigate LIPC gene expression in HNSCC and elucidate its potential role in the context of the disease. Methods LIPC expression was analyzed using the Cancer Genome Atlas-HNSCC (TCGA-HNSCC) dataset. Real-time polymerase chain reaction (qPCR) was used to validate LIPC expression in oral squamous cell carcinoma (OSCC) tissue samples, which is the most common type of HNSCC. The LIPC was assessed to find out if there is a link with HNSCC clinicopathological features, prognosis, and tumor infiltration. Functional pathways associated with the LIPC network were also examined. Results LIPC expression was found to be elevated in both HNSCC and OSCC tissues. The heightened expression of LIPC correlated with various clinicopathological features and influenced the prognosis of HNSCC patients. The LIPC gene demonstrated connections with several oncogenic genes and proteins, participating in lipid catabolic processes and other pathways. These findings suggest that LIPC expression may play a role in the pathogenesis of HNSCC. Conclusion Our study affirms that LIPC expression is linked to the development of HNSCC, suggesting its potential utility as a biomarker or therapeutic target for the disease. However, further functional studies are imperative to validate and expand upon these findings.

Popular Trend of Electronic Cigarettes and Their Adverse Effects on Oral Health

Electronic cigarettes were originally promoted as a possible tool to assist individuals in quitting smoking, particularly for those who had been tobacco users for an extended period. Compared with traditional tobacco use, these devices were promoted as a safer option. Over the years, it has been proven that conventional cigarettes adversely affect almost all body systems. Owing to the constantly evolving nature of the products and the difficulties in identifying potential e-cigarette effects in traditional tobacco users including combustible and noncombustible forms, studying the impact of e-cigarette usage on oral health is challenging. Although the existing scientific evidence is limited, it indicates that e-cigarette use may have negative effects on oral health. Moreover, the adoption of vaping among young people has increased globally. There is still a lack of awareness regarding the use of e-cigarettes and their associated health complications, especially in developing countries. We aim to sensitize the readers to the pertinent issue, which has clinical and public health significance.

Large-group simulation as a learning method to promote interprofessional collaboration and older adults' patient centered-care

AIMS

This study described the influence of a large-group simulation on social and health care students´ working life competence concerning interprofessional collaboration (IPC) and patient centered-care.

METHODS AND RESULTS

The target group (n = 319) was social and health care students from several different degree programs taking part in a large-group simulation concerning older people´s oral health as a part of his comprehensive well-being and health. Data were collected with a questionnaire containing background questions, statements about interprofessional practice and open-ended questions about learning experiences. The number of respondents was 257, including 51 oral health care students (OHCS). The data were analyzed using descriptive and statistical methods and content analysis. Working life competencies covers the overall social and collaborative skills which health-care professionals need in their work. They were reported to be improved in IPC and patient-centered care (PCC). The main described learning experiences in open responses included appreciating different professionals' competencies and the importance of interprofessional decision-making, interpersonal communication competence and patient-centered attitudes in care provision.

CONCLUSION

The large-group simulation is a good model for educating larger student groups simultaneously and it functioned well in improving understanding of IPC and PCC among older adults.

Literature review and prospect on oral cognition and disease diagnosis and treatment between Han and Tang dynasties

Chinese medicine entered a significant period from foundation to maturity between Han and Tang dynasties when the Chinese traditional stomatology was a key stage. Sorting and analysis of existing literature and research outcomes have showed that current research on stomatology between Han and Tang dynasties focuses on oral physiology, pathology, diagnosis and treatment, and health care. It also involves stomatology history and explanation of termino-logies related to mouth and teeth recorded in medical books, use of simple methods, and thinking with citation and analysis of literature simply listed and reasoning preliminarily deducted. From the macro perspective, current research has not unveiled the whole picture of stomatology between the two dynasties and left a series of key issues unresolved. Thus, new methods should be developed and employed to carry out medical research on stomatology between Han and Tang dynasties given that is has a prosperous future.

Impact of the COVID-19 pandemic on oral health care use in the United States through December 2021

BACKGROUND

The purpose of this study was to assess the effects of the COVID-19 pandemic on oral health care provided from July 2020 through December 2021 using national claims data.

METHODS

Deidentified quarterly claims from 2017 through 2021 were analyzed (2017-2019 provided prepandemic data). Data were sorted into multiple treatment categories. Analyses compared prepandemic with postpandemic procedure volumes and were stratified according to age groups (0-5 years, 6-18 years, 19-64 years, ≥ 65 years).

RESULTS

For children aged 0 through 5 years, use of sealants and topical fluorides other than varnish were considerably lower in 2021, as were direct operative and palliative procedures from 2020 through 2021. Only use of silver diamine fluoride, prefabricated crowns, and oral surgery increased significantly (P < .05) in some quarters. For children aged 6 through 18 years, diagnostic, direct operative, periodontic, oral surgery, and palliative procedures were significantly lower in most of 2020 through 2021, and only prefabricated crowns and indirect operative procedures increased significantly in more than 3 quarters. For adults aged 19 through 64 years, diagnostic and preventive procedures were significantly lower in 3 quarters, and direct operative, gingival surgery, endodontic, and palliative procedures were significantly lower in most of 2020 through 2021. Only occlusal guards and scaling and root planing increased significantly in more than 3 quarters. For adults 65 years and older, direct operative, gingival and osseous surgery, and palliative procedures were significantly lower in more than 3 quarters; all other procedures increased significantly in more than 3 quarters.

CONCLUSIONS

The pandemic was associated with changes in the provision of oral health care that persisted for more than 1 year.

PRACTICAL IMPLICATIONS

Reductions in preventive procedure volumes across age groups younger than 65 years may have implications for longer-term effects of the pandemic.

Assessment of knowledge, attitude, and behavior related to children's oral health in pediatricians and students in the pediatric field in Iran: a cross-sectional study

Background

Pediatricians have an important role to play in motivating and instructing parents on oral health in children. The aim of this study was to assess knowledge of, attitude to, and behavior regarding oral health care in children among pediatricians and students in the pediatric field in Iran.

Methods

This cross-sectional study included all students in the pediatric field (those who had started a residency or fellowship) and practicing pediatricians in provincial centers and universities (61 setting centers) throughout Iran in the course of 2021. Participants completed an online questionnaire assessing details of the parameters of knowledge of, attitude to, and behavior toward oral health for each individual. A convenience sampling technique was used to gather the study sample. All data were coded for each of the parameters. The data were analyzed by one-way ANOVA (Analysis of Variance)/Tukey and Pearson's correlation tests and path analysis.

Results

Out of 582 participants who visited the website, a total of 217 completed the entire questionnaire (participation rate of 37.2%). On the attitude parameter, 84.8% of participants scored above 75% of the possible attainable score, while only 37.9% and 48.1% of them had adequate knowledge and behavior for the possible score, respectively. Specialists had a higher mean score on behavior and knowledge than residents (P=0.001). There was a significant correlation between the scores on attitude and behavior (r=0.42, P<0.001), attitude and knowledge (r=0.19, P=0.005), and behavior and knowledge (r=0.25, P<0.001). Nearly all of the participants, 216 (99.5%), felt the need for the principles of dentistry to be included in the curriculum.

Conclusions

Pediatricians showed a favorable attitude to oral health, but their knowledge of and behavior in the field was inadequate. Improvement of pediatricians' interest and performance in oral health in children should be encouraged through the inclusion of these parameters in the curriculum for students of the pediatric field. Implementing training programs for practical pediatricians or incorporating independent theoretical and clinical courses offered by pediatric dentists in dental school departments into the field curriculum of the students in the pediatric field is recommended.

Dental anxiety in Switzerland: trends in prevalence and associations with socioeconomic factors in 2010 and 2017

Dental anxiety is a prevalent concern in Western societies, affecting a broad demographic from children to the elderly, and posing a challenge to the delivery of oral health care. The Swiss Dental Association (SSO) has been conducting national surveys since 1980, with additional questions since 2010, to better understand the Swiss population's perception of the dental profession. Their 2010 and 2017 surveys aimed to gain more insight into dental anxiety across Switzerland, and to relate their findings to various demographic and socio-economic factors. A total of 2240 participants (1129 in 2010 and 1111 in 2017), demographically representative of Switzerland's socioeconomic distribution, were surveyed, with an even gender distribution (49.7% male and 50.3% female, p=0.7656). The mean age of the cohort was 43.5 ±16.0 years. The prevalence of dental anxiety decreased from 2010 to 2017. In 2010, 21.3% (CI: 19.0-23.7) reported higher levels of dental anxiety, which decreased to 13.3% (CI: 11.4-15.4) in 2017. Women consistently reported higher levels of dental anxiety than men in both years (2010: p<0.0001, 2017: p=0.0003). Logistic regression analysis revealed that higher levels of education (p<0.0001), trust in the dentist (p=0.0005) and satisfaction with the dentist (p=0.0489) significantly predicted lower levels of dental anxiety. In conclusion, these results highlight an overall decrease in dental anxiety from 2010 to 2017, but particularly among highly educated individuals and participants expressing satisfaction and trust in their dentist. While women consistently reported higher levels of anxiety, the overall results suggest promising trends in perceptions of oral health in Switzerland.

Oral health care services for community-dwelling older people with dementia: A scoping review

OBJECTIVE

To assess whether, and if so, which oral health care services for community-dwelling older people with dementia are available.

BACKGROUND

Oral health in people with dementia is poor compared with people without dementia. Although multiple oral health care interventions have previously been studied for older people living in nursing homes, little is known about interventions or services for community-dwelling older people with dementia.

MATERIALS AND METHODS

A literature search was performed in the databases Pubmed, Embase and CINAHL. The following search terms were used: "Dementia", "Oral health", "Dental health services" and "Older person". The term "dental health services" was intended to be an as broad as possible construct because limited search results were expected.

RESULTS

The search generated 1624 unique references, of which seven studies were eligible for inclusion (four cohort studies, one cross-sectional study, and two qualitative studies). The included studies described two actual oral health care services: a telephone help line on oral health and dementia, and a mobile geriatric dental programme in adult day health centres. A need was found for services and strategies specific to community-dwelling older people with dementia. One identified solution was an intervention with individually tailored daily oral hygiene self-care supported by the informal caregiver. Furthermore, increasing accessibility of oral health care professionals with treatment at other locations than their own practices, better collaboration between health care professionals and preventive oral health care are highly necessary.

CONCLUSION

There is limited evidence on the availability of oral health care services for community-dwelling older people with dementia, while a need was found for oral health care services that focus on good accessibility, oral hygiene self-care, preventive strategies and collaboration among health care professionals.

Factors influencing home health care providers' performance of oral health care for older people: A qualitative study

AIM

To examine factors that affect the performance of oral health care (OHC) for older people receiving nursing care at home.

BACKGROUND

Oral health is often neglected by health care providers caring for older people. Research shows that health care providers' provision of OHC may be influenced by various factors (barriers and facilitators). When this research was conducted, health care providers from home healthcare services (HHCS) and nursing homes were grouped together despite setting differences; therefore, this study focuses on the performance of OHC by home health care providers (HHCPs) as a single group.

DESIGN

Explorative design with a qualitative approach.

METHODS

The managers of four HHCS units recruited 17 HHCPs to participate in focus group interviews. One interview was conducted per unit, and there were four to five participants in each interview. The analysis of interviews was based on theoretical thematic analysis and the PRECEDE constructs in the PRECEDE-PROCEED model. Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used in reporting this study.

FINDINGS

The analysis resulted in two themes with predisposing factors (HHCPs' professional responsibilities, older people's attitude), five themes with enabling factors (knowledge and skills, older people/carer trust, available time, available equipment and collaboration with public dental service (PDS)), and two themes with reinforcing factors (routines and OHC focus on the workplace) that affect the provision of OHC. The factors were categorised as individual, organisational and collaboration factors.

CONCLUSIONS

In addition to individual factors found in previous studies, factors related to the organisation of services and communication between HHCPs and PDS seem to affect HHCPs' provision of OHC for adults receiving HHCS.

IMPLICATIONS FOR PRACTICE

This study provides in-depth knowledge that can contribute to increasing HHCPs' provision of OHC and thereby prevent oral and dental disease among older people receiving HHCS.

The Impetus of Artificial Intelligence on Periodontal Diagnosis: A Brief Synopsis

The current advances in digitized data additions, machine learning and computing framework, lead to the swiftly emerging concept of "Artificial Intelligence" (AI), that are developing into areas that were formerly contemplated for human expertise. AI is a relatively rapid paced mechanics wherein the computer technology is tuned to perform human tasks. An auxiliary domain of AI is machine learning (ML), and Deep learning, a subclass of ML technique comprehends multi-layer mathematical operations. AI-based applications have tremendous potential to improve and systematize patient care thereby alleviating dentists from laborious regular tasks, and facilitate personalized, predictive and preventive dentistry. In the dental clinic, AI can execute a variety of easy tasks with greater accuracy, minimal manpower, and with fewer mistakes over human equivalents. These tasks range from appointment scheduling and coordination to helping with clinical evaluation and therapy. Besides, this could assist in the early diagnosis of dental and maxillofacial abnormalities like periodontal ailments, root caries, bony lesions, and facial malformations in addition to automatically identifying and classifying dental restorations on digital radiographs. This brusque narrative review describes the AI-based systems, their respective applications in periodontal diagnosis, the multifarious studies, possible limitations and the predictable future of AI-based dental diagnostics and treatment planning.

Methods of payment for oral health care in Yaoundé

Payment for dental services is one of the key determinants of treatment options, access to health care, and treatment decisions. The ability to pay for services directly affects the quality of life of an individual and also their accessibility to oral health services. The aim of the present study was to identify the different methods of payment used to obtain oral health care in Yaoundé, Cameroon This was a cross-sectional descriptive study carried out in selected dental clinics in Yaoundé using convenient sampling between January 2021 and June 2021. Data was collected using a structured questionnaire. A total of 377 patients aged 8 to 83 years made up of 194 (51.46%) females and 183 (48.54%) males participated in the study. There is no government-assisted package for oral health care in Cameroon and more than two-thirds (66.84%) made direct payments or paid out of pocket without a refund from any insurance company. More than half 147 (58.33%) of the study population did not complete the planned dental care due to insufficient funds. Direct payments covered treatments such as scaling, restorations, root canal therapy, and dental extractions while prostheses (dentures, crowns, bridges, and implants) were only afforded by very few patients. The reasons for the inability to pay for dental services included financial difficulties 107 (72.97%) and lack of time 36 (24.49%). Only half 36 (50%) of the participants employed in the formal sector had access to health insurance and treatments like scaling, dental prosthesis, orthodontics, and dental implants were rarely provided by an insurance company. These procedures were considered to be very expensive with fluctuating prices and were viewed as being for aesthetic purposes. The majority 67 (93.06%) of payments through insurance reported being reimbursed aftercare. Two-thirds of 48 (71.64%) of the insured participants said it was difficult to get reimbursed due to the administrative bottlenecks and as such some preferred to pay out of pocket despite being insured. Late consultations encountered led to caries complications with 105 (52.24%) pulpitis. In general, financial difficulty was reported by 97 (48.26%) as the main reason for not being able to afford dental care. Oral diseases present a huge burden for children and adults due to the high cost of treatment limiting their accessibility and treatment options. There is a need to create compulsory health insurance to enhance greater access to oral health services to encourage the population to seek dental care timeously.

Addressing Oral Health Disparities of a Tribal Population Through a Combined Implementation of Focus Group Discussion, Mobile Technology Networking, and Creating a Supportive Environment: A Prospective Study

BACKGROUND AND OBJECTIVE

 Oral health disparities generally exist among tribal populations, prompting creative solutions to tackle these challenges. By using a combined implementation strategy of including focus group discussion (FGD), mobile technology networking (MTN), and creating a supportive environment, this study aims to assess and bring positive changes in oral health in these populations.

METHODS

The current study employed a mixed-method approach on a sample of 100 tribal volunteers. Qualitative assessment included FGD conducted regularly for three months based on themes such as oral hygiene habits, access to oral health, technology in oral health, the relationship of oral health to general health, and the role of diet in oral health. Quantitative evaluation included recording of the oral hygiene index-simplified and gingival index to measure gingival status. Messages on oral health were routinely posted to mobile phones to reinforce oral health education. Appropriate use of indigenous oral hygiene aids (neem and datun) was also taught during the discussion session. Clinical examinations were compared before and after FGD. Data were analyzed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). A paired 't' test was used to find significant differences in gingival status at p<0.05.

RESULTS

The FGD sessions deduced observations such as limited access to dental care, inadequate oral hygiene practices such as usage of neem sticks and twigs, and lack of oral health awareness. The implementation of MTN facilitated the dissemination of oral health information and enhanced communication between community members and healthcare providers. The gingival index score significantly improved from pre-FGD to post-FGD with a mean difference of 0.41700 significant at p=0.000. Oral hygiene of the target population shifted from "Fair" oral hygiene status to "Good" oral hygiene status.

CONCLUSION

The combined implementation of FGD, MTN, and creation of a supportive environment demonstrated promising results in addressing oral health disparities among the tribal population. The interventions led to improved gingival status and better utilization of oral hygiene practices. These findings highlight the importance of tailored interventions, community engagement, and mobile technology in addressing oral health disparities in tribal populations. Ongoing support, sustainability, and further research are necessary to ensure the long-term impact and effectiveness of these interventions.

An Overview of Systemic Health Factors Related to Rapid Oral Health Deterioration among Older People

The oral health of older individuals can be negatively impacted by various systemic health factors, leading to rapid oral health deterioration. This paper aims to present an overview of the published evidence on systemic health factors that contribute to rapid oral health deterioration in older individuals, and to explore the implications of these factors for both general healthcare and oral healthcare provision. Older people are at risk of experiencing adverse reactions to medications due to multimorbidity, polypharmacy, and changes in pharmacokinetics and pharmacodynamics. Hyposalivation, a significant side effect of some medications, can be induced by both the type and number of medications used. Frailty, disability, sarcopenia, care dependency, and limited access to professional oral healthcare can also compromise the oral health of older people. To prevent rapid oral health deterioration, a comprehensive approach is required that involves effective communication between oral healthcare providers, other healthcare providers, and informal caregivers. Oral healthcare providers have a responsibility to advocate for the importance of maintaining adequate oral health and to raise awareness of the serious consequences of weakened oral health. By doing so, we can prevent weakened oral health from becoming a geriatric syndrome.

Improving Access to Oral Health Care: Integrating dental hygienists into federally qualified health center obstetrics and gynecology clinics in Michigan

Dental hygienists (DHs) are well positioned to be part of primary care teams to increase access to oral health care, particularly for those who encounter barriers to oral care, such as pregnant people. The Michigan Initiative for Maternal and Infant Oral Health (MIMIOH) integrates DHs into obstetrics and gynecology (OB/GYN) clinics in federally qualified health centers (FQHCs) to improve pregnant people's oral health. Evaluation of the MIMIOH program revealed that selecting DHs with personal characteristics desirable for integrated-care delivery was a major factor for successfully integrating DHs into OB/GYN clinics. Additionally, designing appropriate clinical workflows, gaining buy-in from prenatal health care professionals, presenting oral health care as part of prenatal care, having co-located OB/GYN and dental clinics, and maintaining adequate funding were all critical to program success. Analysis of Medicaid data showed that the MIMIOH model increased the percentage of pregnant people receiving oral health care at FQHC dental clinics. Innovative programs like MIMIOH add to the evidence that integrating DHs into primary care settings can increase access to oral health care, especially for those who face difficulties accessing the traditional oral health care system. There is great potential for DHs to leverage collaborative practice agreements and remote supervision to increase access to oral health care for the public. Providing DHs with autonomy to practice to the highest level of their scope of practice and permitting direct Medicaid reimbursement for DHs would make oral health care more accessible for underserved populations.

Determinants and barriers for visiting a dental clinic among (frail) older individuals

AIMS

With increasing age, the proportion of older individuals visiting a dental clinic decreases. The aim was to gain insight into a) whether frailty or dental status were associated with visiting a dental clinic and b) their perceived barriers to accessing oral health care.

METHODS

Individuals eligible for the yearly influenza vaccination in Winschoten, The Netherlands, were invited to participate in a questionnaire survey about dental visits and perceived barriers to such visits.

RESULTS

A total of 1027 individuals aged 60+ completed the questionnaire - 80% of the non-frail, 71% of the mildly frail and 60% of the moderately to severe frail individuals visited a dental clinic in the previous year. Dental status was the crucial determinant for not visiting a dental clinic. Edentate individuals were more likely to drop out of the dental care system than dentate individuals or individuals with partial prostheses. A higher proportion of moderately and severe frail people were edentate than non-frail or mildly frail people. Barriers to visiting a dentist were making an appointment, costs, and services available. Conclusions: Dental clinicians should pay attention to the barriers that they can influence. The influenza vaccination seems to be an interesting momentum for identifying people who have dropped out of the oral healthcare system.

Impact of COVID-19 on the Surrounding Environment of Nursing Home Residents and Attitudes towards Infection Control and Oral Health Care among Nursing Home Staff in Japan

The environments of nursing home staff and residents have dramatically changed since the onset of the COVID-19 pandemic, with greater demand for infection control. This study aimed to clarify the changes and regional differences in the surrounding environment of nursing home residents as well as the working environment of staff, including oral health care, after the spread of SARS-CoV-2. A self-administered questionnaire survey was sent to nursing staff at about 40 nursing homes in different areas of Japan in September and October 2021. The questionnaire consisted of items centered around: (1) the surrounding environment of nursing home residents, (2) awareness and attitudes towards daily work among staff, and (3) attitudes to and procedures for oral health care among staff. A total of 929 respondents included 618 (66.5%) nursing care workers and 134 (14.4%) nurses. Regarding changes in resident daily life, 60% of staff perceived decreases in psychosocial and physical function after the start of the pandemic due to limited family communication and recreational activities, especially in urban areas. Concerning infection control, most respondents adopted routines of disinfecting hands before and after their duties. Oral health care was part of the regular duties of over 80% of respondents. Many participants answered that the frequency and time of oral health care only slightly changed after the onset of COVID-19, but many also reported disinfecting hands both before and after oral health care, particularly in rural areas. Our findings suggested that the COVID-19 pandemic decreased the daily living activities of residents, leading to psychosocial and physical decline, especially in urban areas. The results also indicated that the spread of SARS-CoV-2 triggered improvements in the awareness and attitudes towards infection control in daily work, including oral health care, among nursing care staff, notably in rural areas. Such an effect may contribute to a more positive perception of oral health care infection measures after the pandemic.

Association between Dementia Severity and Oral Hygiene Management Issues in Older Adults with Alzheimer's Disease: A Cross-Sectional Study

Oral hygiene management issues vary across types and clinical stages of dementia. We aimed to clarify the issues related to oral hygiene management in older adults with Alzheimer's disease (AD) according to stages defined by the Functional Assessment Staging of Alzheimer's Disease (FAST). In all, 397 records (45 men and 352 women; average age, 86.8 years; age range, 65-106) from older adults with AD were used for the cross-sectional study. We used data from a cohort of older adults (≥65 years old) who required long-term care and lived in the Omorimachi area of Yokote City, Akita Prefecture, Japan. Multilevel logistic regression analysis was conducted to examine the associations of the FAST stage, set as the exposure variable, with oral hygiene management parameters set as outcome variables. Compared to the reference category (combined FAST stage 1-3), FAST stages 6 and 7 had significantly higher odds ratios for refusal of oral health care, dependence in performing oral health care, and rinsing and gargling disability. FAST stages 4 and 7 were associated with dental plaque accumulation. Oral health care for older adults with AD should be planned appropriately according to dementia severity.

Assessing inequities in unmet oral care needs among adults in Sweden: An intersectional approach

OBJECTIVES

The goal of the Swedish oral healthcare system is to achieve good oral health and equitable access to care for the entire population. However, considerable inequities in oral health and care are evident and occur across a range of social dimensions. This study uses an intersectional approach to examine complex inequities in unmet oral care needs among adults in Sweden over the period 2004-2021.

METHODS

Data were obtained from 14 Health on Equal Terms surveys conducted during 2004-2021. The final sample was 129 473 individuals aged 26-84 years. Applying intersectional analysis of individual heterogeneity and discriminatory accuracy, inequities in unmet oral care needs were estimated across 48 intersectional strata defined by gender, age, educational level, individual disposable income and immigrant status.

RESULTS

A high risk of unmet oral care needs was found among strata consisting of immigrants and those with low income. However, being an immigrant and/or having a low income did not universally entail a high risk but varied by the social position along other axes, particularly age and education. The discriminatory accuracy was moderate.

CONCLUSION

Groups with certain social disadvantages are highly heterogeneous themselves. An intersectionality approach is important to prevent the risk of stigmatizing large heterogenous groups while failing to identify the most vulnerable strata. The discriminatory accuracy analysis suggested that further policy and/or interventions may be the most effective if approaching the whole population, combined with selected targeted interventions directed at the most disadvantaged social strata.

Decision-Making concerning Involuntary Oral Care for Older Individuals with Dementia

Many older individuals with dementia (OIWD) show care-resistant behavior for oral care. Providing care despite resistance is considered to be involuntary care. Although involuntary care should be minimized, in some OIWD it may be necessary to avoid health risks. This study aims to assess the attitudes of healthcare providers with regard to involuntary oral care provision for OIWD who show care-resistant behavior. An online questionnaire consisting of general questions and case specific questions was administered via social media and networking to individuals involved in the oral care of OIWD. A total of 309 participants were included in this study. The outcomes of the questionnaires were categorized per case. In all cases, a discrepancy was seen between the assessment of oral health problems as potentially harmful (range: 73.1-93.5%) and the willingness to provide involuntary care (range: 31.1-63.4%). Hence, many healthcare providers are aware of the subsequent potential health risks related to not providing care, but are still reluctant to provide involuntary oral care. Therefore, many OIWD who show care-resistant behavior potentially do not receive the necessary oral care they require.

Status Quo and Advanced Progress in Oral Health Care and Treatment of Children with Autism Spectrum Disorder: A Literature Review

Autism spectrum disorder (ASD) has become one of the fastest growing diseases in the world, causing a great burden to ASD children's families and society. Children with ASD face more disadvantages relating to their oral health than those without ASD. There is a positive correlation between prevalence of caries lesions and severity of ASD. Poorer oral hygiene, higher detection rates of dental calculus and far more frequent cases of gingivitis occur in children with ASD. Traumatic injuries and various types of malocclusions are more frequent in children with ASD. Poorer oral health care and treatment status are caused by multiple adverse factors. Ways of promoting effective oral health care and treatment include pretreatment counselling; improvement of the individualised treatment environment; routine behaviour guidance techniques (BGTs) including tell-show-do, distraction, role model presentation, voice control, visual education and social stories, encouragement and reinforcement; targeted BGTs including visual education, behaviour modelling, applied behaviour analysis (ABA) and systematic desensitisation; passive BGTs including protective restraint, pharmaceutically administrated sedation and general anaesthesia; oral health education for guardians; and interdisciplinary collaboration and professional dental care/treatment. Dentists, families with children with ASD and schools should cooperate to improve family-centred oral health care and treatment for ASD children not only in China, but also the whole world.

Assessment of Binary Agarose-Carbopol Buccal Gels for Mucoadhesive Drug Delivery: Ex Vivo and In Vivo Characterization

Agarose (AG) is a naturally occurring biocompatible marine seaweed extract that is converted to hydrocolloid gel in hot water with notable gel strength. Currently, its mucoadhesion properties have not been fully explored. Therefore, the main aim of this study was to evaluate the mucoadhesive potential of AG binary dispersions in combination with Carbopol 934P (CP) as mucoadhesive gel preparations. The gels fabricated via homogenization were evaluated for ex vivo mucoadhesion, swelling index (SI), dissolution and stability studies. The mucoadhesive properties of AG were concentration dependent and it was improved by the addition of CP. Maximum mucoadhesive strength (MS) (27.03 g), mucoadhesive flow time (FT) (192.2 min), mucoadhesive time in volunteers (MT) (203.2 min) and SI (23.6% at 4 h) were observed with formulation F9. The mucoadhesive time investigated in volunteers (MT) was influenced by AG concentration and was greater than corresponding FT values. Formulations containing 0.3%, w/v AG (F3 and F9) were able to sustain the release (~99%) for both drugs till 3 h. The optimized formulation (F9) did not evoke any inflammation, irritation or pain in the buccal cavity of healthy volunteers and was also stable up to 6 months. Therefore, AG could be considered a natural and potential polymer with profound mucoadhesive properties to deliver drugs through the mucosal route.

Dental Service and Resource Needs during COVID-19 among Underserved Populations

Introduction:

In response to the coronavirus disease 2019 (COVID-19) outbreak, dental services in British Columbia, Canada, were restricted to urgent and emergency cases between March 16 and May 18, 2020. It is unclear how the curtailment of oral health services has affected underserved populations who already often have limited access to dental care due to cost, fear, stigma, and discrimination.

Objectives:

To explore the experiences of underserved populations and their community organizations when accessing oral health services and information in British Columbia and identify their coping mechanisms employed during the curtailment of oral health care services.

Methods:

Semistructured, remote interviews were conducted with 13 staff and 18 members from 6 community-based organizations. These organizations serve men and women with a history of incarceration and/or experiencing poverty and homelessness, persons living with human immunodeficiency virus/AIDS, adults living with mental illness, and older adults in long-term care facilities. The interviews were audio-recorded, transcribed verbatim, and coded for emerging themes using NVivo 12 software. Thematic analysis was performed.

Results:

The pandemic raised concerns and hesitancy among underserved populations and further reduced access to care. In turn, those with unmet dental needs resorted to coping mechanisms, including turning to community support or medical services, self-management of dental issues, and not dealing with dental issues altogether. Community organizers and members outlined needed resources such as assistance navigating the dental care system, having a contact for dental-related questions, and member preparation for dental service changes, while emphasizing the importance of positive relationships with dental providers.

Conclusion:

Underserved populations who already face barriers to oral health care services experienced increased difficulty in addressing their oral health needs and concerns during the beginning of the COVID-19 pandemic. Strategies aimed at reaching out to this population and those who support them are needed to help mitigate negative coping strategies and increased oral health disparities.

Knowledge Transfer Statement:

This study depicts ways of addressing unmet oral health–related issues during the COVID-19 pandemic for underserved populations and their community organizations with policy implications as well as practical strategies.

Association between periodontal care and hospitalization with acute myocardial infarction

BACKGROUND

Each year there are 800,000 myocardial infarctions in the United States. There is an increased risk of hospitalization for acute myocardial infarction (AMI) for those with periodontal disease. Yet, there is a paucity of knowledge about downstream care of AMI and how this varies with periodontal care status. The authors' aim was to examine the association between periodontal care and AMI hospitalization and 30 days after acute care.

METHODS

Using the MarketScan database, the authors conducted a retrospective cohort study among patients with both dental insurance and medical insurance in 2016 through 2018 who were hospitalized for AMI in 2017.

RESULTS

There were 2,370 patients who had dental and medical coverage for 2016 through 2018 and received oral health care in 2016 through 2017 and had an AMI hospitalization in 2017. Forty-seven percent received regular or other oral health care, 7% received active periodontal care, and 10% received controlled periodontal care. More than one-third of patients (36%) did not have oral health care before the AMI hospitalization. After adjusting for patient characteristics, we found that patients in the controlled periodontal care group were significantly more likely to have visits during the 30 days after AMI hospitalization (adjusted odds ratio, 1.63; 95% CI, 1.07 to 2.47; P = .02).

CONCLUSIONS

We found that periodontal care was associated with more after AMI visits. This suggests that there is a benefit to incorporating oral health care and medical care to improve AMI outcomes.

PRACTICAL IMPLICATIONS

Needing periodontal care is associated with more favorable outcomes related to AMI hospitalization. Early intervention to ensure stable periodontal health in patients with risk factors for AMI could reduce downstream hospital resource use.

A review of the effects of oral health media hype on clients' perception of treatment

OBJECTIVES

Research shows that approximately 75% of people worldwide access the internet for health information. Lower calibre websites often use inaccurate claims to attract internet browsers. The objective of this review is to alert oral health care professionals (OHCPs) to the impact of oral health media hype on client perceptions of oral care. It also aims to provide OHCPs with tools to educate clients on how to identify credible oral health information online so that they can make informed oral health treatment decisions.

METHODS

A literature search was conducted using PubMed and Google Scholar. The returns were screened using inclusion and exclusion criteria.

RESULTS

Thirteen studies met the inclusion criteria, of which 12 (92%) identified that clients browse the internet to research oral health conditions and treatments. Eleven studies (85%) concluded that media outlets influence client perceptions of oral health care and treatment. All 13 studies (100%) found that OHCPs and organizations should better guide clients with tools to discern between evidence-based (EB) and non-evidence-based (NEB) online health information.

DISCUSSION

According to the literature, viewing NEB oral health information on the internet affects clients' perceptions of oral health care, which may lead to potentially harmful treatment decisions. Chairside education is effective in reducing the impact of oral health misinformation.

CONCLUSION

OHCPs have the responsibility to address the impact of media hype on clients' perception of oral health care and to direct them to credible health information.

Relationships Between Oral Microecosystem and Respiratory Diseases

Oral microecosystem is a very complicated ecosystem that is located in the mouth and comprises oral microbiome, diverse anatomic structures of oral cavity, saliva and interactions between oral microbiota and between oral microbiota and the host. More and more evidence from studies of epidemiology, microbiology and molecular biology is establishing a significant link between oral microecosystem and respiratory diseases. Microbiota settling down in oral microecosystem is known as the main source of lung microbiome and has been associated with the occurrence and development of respiratory diseases like pneumonia, chronic obstructive pulmonary disease, lung cancer, cystic fibrosis lung disease and asthma. In fact, it is not only indigenous oral microbes promote or directly cause respiratory infection and inflammation when inhaled into the lower respiratory tract, but also internal environment of oral microecosystem serves as a reservoir for opportunistic respiratory pathogens. Moreover, poor oral health and oral diseases caused by oral microecological dysbiosis (especially periodontal disease) are related with risk of multiple respiratory diseases. Here, we review the research status on the respiratory diseases related with oral microecosystem. Potential mechanisms on how respiratory pathogens colonize oral microecosystem and the role of indigenous oral microbes in pathogenesis of respiratory diseases are also summarized and analyzed. Given the importance of oral plaque control and oral health interventions in controlling or preventing respiratory infection and diseases, we also summarize the oral health management measures and attentions, not only for populations susceptible to respiratory infection like the elderly and hospitalized patients, but also for dentist or oral hygienists who undertake oral health care. In conclusion, the relationship between respiratory diseases and oral microecosystem has been established and supported by growing body of literature. However, etiological evidence on the role of oral microecosystem in the development of respiratory diseases is still insufficient. Further detailed studies focusing on specific mechanisms on how oral microecosystem participate in the pathogenesis of respiratory diseases could be helpful to prevent and treat respiratory diseases.

Pandemics past, present, and future: Their impact on oral health care

BACKGROUND

Pandemics have significantly modified our societal behaviour over the millennia, and the COVID-19 pandemic is no exception.

TYPES OF ARTICLES REVIEWED

In this article, the authors review the history of pandemics, the probable reasons for their emergence, and the COVID-19 pandemic due to the severe acute respiratory syndrome virus 2 (SARS-CoV-2) and its variants, as well as its possible impact on dentistry during the postpandemic period.

RESULTS

There are multiple reasons why catastrophic pandemics occur due to new infectious organisms that cross the species barrier from animals to humans. These include, population explosion, mass migration, and prolonged survival of debilitated and susceptible cohorts on various immunosuppressants. Coupled with global warming and the resultant loss of habitats, such vicissitudes of humans and nature lead to microbes evolving and mutating at an exponential pace, paving the way for pandemics. The contemporary epidemics and pandemics beginning with the HIV pandemic have modulated dentistry beyond recognition, now with assiduous and robust infection control measures in place.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Because COVID-19 may become an endemic disease, particularly due to emerging SARS-CoV-2 variants the dental community should adopt modified infection control measures, teledentistry, and point-of-care diagnostics, among other measures. It is likely, that clinical ecosystems in future would be rendered even safer by predicting how pathogens evolve and priming the human immune system for the next wave of microbial combatants through vaccines produced using deep mutational scanning in which artificial intelligence and machine learning can predict the next variants even before their arrival.

Eritrean Refugees' and Asylum-Seekers' Attitude towards and Access to Oral Healthcare in Heidelberg, Germany: A Qualitative Study

Oral health concerns in Eritrean refugees have been an overlooked subject. This qualitative study explored the access of Eritrean refugees and asylum-seekers (ERNRAS) to oral health care services in Heidelberg, Germany, as well as their perceptions and attitudes towards oral health care. It involved 25 participants. We employed online semi-structured interviews (n = 15) and focus group discussions (n = 2). The data was recorded, transcribed, and analysed, using thematic analysis. The study found out that most of the participants have a relatively realistic perception and understanding of oral health. However, they have poor dental care practices, whilst a few have certain misconceptions of the conventional oral hygiene tools. Along with the majority's concerns regarding psychosocial attributes of poor oral health, some participants are routinely consuming Berbere (a traditional spice-blended pepper) to prevent bad breath. Structural or supply-side barriers to oral healthcare services included: communication hurdles; difficulty in identifying and navigating the German health system; gaps in transculturally, professionally, and communicationally competent oral health professionals; cost of dental treatment; entitlement issues (asylum-seekers); and appointment mechanisms. Individual or demand-side barriers comprised: lack of self-sufficiency; issue related to dental care beliefs, trust, and expectation from dentists; negligence and lack of adherence to dental treatment follow-up; and fear or apprehension of dental treatment. To address the oral health burdens of ERNRAS, it is advised to consider oral health education, language-specific, inclusive, and culturally and professionally appropriate healthcare services.

Community pharmacists' knowledge, attitude and practice of oral health care in Asir region, Kingdom of Saudi Arabia

OBJECTIVES

To assess community pharmacists' knowledge, attitude and practice towards oral health care in Asir region, Saudi Arabia.

METHODS

A prospective cross-sectional study was carried out using a self-administered structured questionnaire, targeting 254 community pharmacies across the Asir region. The questionnaire consisted of four domains: demographics, knowledge, attitudes and practice related to oral health care. Statistical analysis was performed using Social Sciences (SPSS) version 23.0.

RESULTS

Of the 254 pharmacists, 202 respondents completed the survey, yielding a response rate of 79.5%. Almost two-thirds (66%) of the community pharmacists exhibited good knowledge, 65% possessed a positive attitude, and 55% perceived a good practice towards oral health care. Pharmacists have shown a good understanding on dental care (p < 0.001) and oral conditions. Fifty-five per cent (n = 119) of pharmacists preferred to have dental-based subjects in Pharmacy curriculum.

CONCLUSION

Community Pharmacists possess overall good knowledge and attitude required for the provision of dental care counselling patients. They may participate in oral health development programmes to make a better practice.

Interprofessional Oral Health Collaboration: A Survey of Knowledge and Practice Behaviors of Hospital-Based Primary Care Medical Providers in New York City

BACKGROUND

The siloed delivery of oral and medical health care in the United States has contributed to a lack of awareness of the consequences of poor oral health and has hampered effective interprofessional education and collaboration. The aim of this study was to assess the knowledge and practice behaviors of primary care medical providers in an urban safety-net hospital regarding collaboration with dentists and integration of oral health into overall health-care delivery.

METHODS

A 36-item survey was designed in a web-based platform (Survey Monkey®) and electronically distributed in September 2020 to 181 primary care medical providers (physicians, nurses, physician assistants) within a municipal hospital in the Bronx, New York. The questionnaire included sections on demographics, current practices, oral health knowledge, and opinions regarding interprofessional collaboration. Descriptive statistics and bivariate analyses using the chi-square and Fisher's exact test were performed with a significance level of 0.05.

RESULTS

The response rate was 66% (119 respondents). The vast majority (80%) reported little or no training in oral health and 85% reported no team experience with oral health professionals. Medical providers' confidence in examining the oral cavity was positively associated with previous additional training (p = 0.001) and with team experience (p = 0.005). The two most commonly reported barriers to willingness to collaborate were lack of formal relationships with dental providers (74%) and competing priorities (69%).

CONCLUSION

Overall, there is very limited awareness and integration of oral health into the clinical practice of medical providers at this safety-net hospital. However, those providers with previous training and team experience had greater oral health confidence. Given the critical importance of oral health to overall health, increased efforts should be directed to further educate and train medical providers and address barriers to interprofessional care.

Knowledge, attitudes, and willingness of oral health professionals to treat transgender patients

Background

Lack of knowledge about transgender patients often correlates with increased stigma and an unwillingness to provide care to this population. This study examined the knowledge, attitudes, and willingness of oral health care providers with regard to treating transgender patients.

Methods

Dentists, mid-level providers, and dental hygienists in the United States and Canada accessed an online survey (N = 315) focused on assessing knowledge, attitudes, and willingness to provide care and/or seek additional education on treating transgender individuals. Descriptive statistical, correlational, and regression analyses were conducted.

Results

The survey completion rate was 85% (n = 268). Respondents correctly answered an average of 70% of the knowledge questions, with 56% of participants unable to define "gender" and 66% unable to define "sex identity". Almost 1 in 4 respondents incorrectly defined a trans male or trans female, or misidentified particular health disparities experienced by transgender individuals. A lack of willingness to seek additional information on providing culturally competent care, having lower levels of knowledge, and identifying with specific religions correlated with higher levels of stigma (p < 0.001). While US providers exhibited low stigma overall, Canadian providers, survey respondents with higher levels of knowledge, and those with transgender friends and/or family demonstrated lower levels of stigma (p < 0.001).

Discussion and conclusions

Transgender individuals face disparities in medical and oral health care. Based on the findings of this survey, it will be important to address factors associated with higher levels of stigma and educate oral health professionals on providing culturally competent care for transgender individuals.

Exploring barriers to oral health care experienced by individuals living with autism spectrum disorder

Background

Autism spectrum disorder (ASD) is a developmental disorder that affects behaviour and communication skills. ASD is estimated to affect approximately 1 in 66 Canadians, with symptoms typically arising within the first 3 years of life. Individuals with ASD present with an increased burden of disease and face heightened barriers to oral care.

Objective

This narrative literature review aims to raise awareness of the additional needs that individuals with ASD have when seeking oral care and to identify how barriers to such care may be reduced.

Methods

Twenty-one articles were included in this review, with a wide range of study designs and methodologies. Search terms in PubMed, Education Source, and CINAHL databases included autism spectrum disorder, barriers, dental, dental hygiene, developmental disability, oral health, and unmet needs.

Results and discussion

Key themes that emerged as barriers to care were behavioural challenges, inhibited social and communication skills, parental dependence, clinic environment, and abilities of oral health professionals to treat clients with special care needs.

Conclusion

Current literature reveals that individuals with ASD face numerous barriers when accessing oral care and attempting to achieve adequate oral health, thus contributing to an increased burden of disease. Oral health professionals should aim to improve their understanding of special care populations such as the ASD community and raise awareness among health care professionals to work towards diminishing the barriers to care these populations experience.

Alternatives to opioids for acute pain management after dental procedures: A Department of Veterans Affairs consensus paper

BACKGROUND

Opioid misuse is a widespread public health problem, and opioids are often prescribed in the dental environment. These recommendations provide alternatives to opioids to reduce or eliminate dental procedure-related acute pain.

METHODS

A multidisciplinary working group developed these clinical recommendations to specifically address procedure-related acute pain. These recommendations, which are based on published peer-reviewed research and guidelines, include therapies used before, during, and after dental procedures. When evidence is not definitive, the best practices, which are based on experts' consensus, are included. The recommendations are not intended to be exhaustive.

RESULTS

These recommendations are a summary of the evidence and best practices for opioid alternatives to treat acute pain related to dental procedures.

CONCLUSIONS

Dental providers should prioritize opioid stewardship when managing procedure-related pain with strategies such as thorough preprocedure pain assessment, minimally invasive techniques, preemptive analgesia, intraprocedure pain management, and appropriately selected postprocedure pharmacologic therapy.

PRACTICAL IMPLICATIONS

These recommendations are a concise resource for clinical providers. It is important to address patients' procedure-related pain, using nonopioids whenever possible. Alternatives are outlined, allowing providers to make informed decisions.

A research agenda on oral health care as a boundary object that unites the perspectives of patients and practitioners

Context

A research agenda for oral health care was established in the Netherlands using the Dialogue Model. This project served as a case study in which we applied boundary‐work theory as a framework to understand boundaries (ie demarcations) between and within groups, and how these boundaries can be overcome.

Objective

To gain insights into the boundaries encountered when setting a research agenda, we analysed how this agenda served as a boundary object (ie circumstances, situations or material that connect actor groups and allow boundary crossing) that facilitated crossing boundaries and uniting the perspectives of patients and practitioners.

Methods

We used a thematic approach to analyse researchers' observations, meeting materials, emails, interviews with patients (n = 11) and a survey among patients and practitioners (n = 18).

Results

Setting the research agenda helped to cross boundaries in oral health care, which demonstrates its role as a boundary object. First, this made it possible to integrate research topics representing the perspectives and priorities of all patients and also to unite those perspectives. It was essential to involve practitioners at an early stage of the project so that they could better accept the patients' perspectives. This resulted in support for an integrated research agenda, which facilitated the crossing of boundaries.

Conclusions

The research agenda‐setting project was found to serve as a boundary object in uniting the perspectives and priorities of patients and practitioners.

Patient contribution

Patient involvement in this case study was structured in the process of research agenda setting using the Dialogue Model.

Clinical Consequences of Dental Caries, Parents' Perception of Child's Oral Health and Attitudes towards Dental Visits in a Population of 7-Year-Old Children

This cross-sectional study aimed to assess the occurrence of the consequences of dental caries and factors affecting dental service utilization in a population of 7-year-old children. The research included oral examination of 7-year-old schoolchildren and socio-medical study of their parents/legal caregivers. It was carried out in five primary schools of two provinces, i.e., Greater Poland and Lubusz. Dental examination was performed in accordance with World Health Organization (WHO) recommendations. The socio-medical study consisted of questionnaires with close-ended questions concerning socioeconomic characteristics of the family, reasons and time of the last visit at the dental office, consequences of child’s oral health problems, parents’ attitude towards dental visits, and parental opinion about their child’s teeth. Factors affecting utilization of dental services were statistically analyzed using univariate logistic regression assuming p < 0.05. The pufa index of examined children ranged from 0 to 7 (mean 0.80 ± 1.49), while the dmf index ranged from 0 to 14 (3.86 ± 3.32). Low financial burden of oral health expenditures and university education of at least one of the parents significantly increased the chance of visiting a dentist despite lack of pain (OR = 3.0 and 2.5, respectively). In spite of the availability of free dental care for children, socioeconomic factors still determine the utilization of dental services in Poland. Poor oral health status of examined population and negligence of regular dental check-ups emphasize a need to strengthen oral health literacy of parents and children, promoting proper attitudes towards dental care.

Design and Progress of Oral Health Examinations in the Tohoku Medical Megabank Project

In order to assess the long-term impact of the Great East Japan Earthquake on the oral health of disaster victims and to evaluate gene-environmental interactions in the development of major oral diseases and oral-systemic associations, the oral part of two large-scale genome cohort studies by the Tohoku Medical Megabank Organization (ToMMo), including the Community-based cohort (CommCohort) study and the Birth and Three-Generation cohort (BirThree) study, have been conducted. The study population comprised 32,185 subjects, including 16,886 participants in the CommCohort study and 15,299 participants in the BirThree cohort study, recruited from 2013 to 2017. The oral studies consist of a questionnaire regarding oral hygiene behavior, clinical examinations by dentists, and oral plaque and saliva sampling for microbiome analyses, which were carried out at seven community support centers in Miyagi prefecture. The median age of all participants was 55.0 years, and 66.1% of participants were women. Almost all participants reported that they brushed their teeth more than once a day. The median number of present teeth was 27.0, and the decayed, missing and filled tooth number was 16.0, with a significant difference according to age and sex. The median periodontal pocket and clinical attachment level was 2.48 mm and 4.00 mm, respectively. Periodontal parameters increased significantly according to age, except for the accumulation of dental calculus. The oral part of these extensive cross-sectional studies provides a unique and important platform for future studies on oral health and diseases that elicit through interactions with systemic diseases, lifestyles, life events and genetic backgrounds, and contributes to researches clarifying the long-term effects of disasters on oral health.

Oral Health Care Delivery for Children During COVID-19 Pandemic-A Retrospective Study

Aim: COVID-19 outbreak and the lockdown period following was a very challenging time for pediatric dentistry. We aimed to find whether the characteristics of dental care provided to children at the Department of Pediatric Dentistry at Hadassah medical center, Jerusalem, Israel, differed between the periods, before COVID-19 outbreak, during the lockdown period and during the period that followed it.

Materials and Methods: We retrospectively reviewed computerized records of patients who visited the pediatric dental clinic at three different periods: pre-lockdown period, lockdown period, and post-lockdown period.

Results: Nine-hundred and forty-nine children were included in the study; most of them were healthy children between 3 and 6 years old. During lockdown, all scheduled appointments except for treatments under general anesthesia and deep sedation were canceled due to the government's restrictions; the frequency of treatments with non-pharmacological behavior management, general anesthesia or deep sedation was higher than in the previous or subsequent periods and the use of inhaled/conscious sedation was significantly lower. During lockdown most of the children were diagnosed with dentoalveolar abscess (32.3%), compared to 14 and 21% at the previous or subsequent periods, respectively (P < 0.001). Treatments combination during lockdown included more extractions, pulpectomies and pulp extirpation and less permanent restorations (P < 0.001). None of the staff members was infected with COVID-19 at the clinic during these periods. We concluded that dentists should be updated about Covid-19 modes of transmission and the recommended infection control measures in dental settings. Effective management protocols can help the dental staff to continue to provide efficient treatment and prevent Covid-19 contamination.

[Investigation and analysis of oral health status of the elderly in nursing homes in Taiyuan]

OBJECTIVES

This study aims to investigate awareness of oral health care and health status among elderly people in nursing homes in Taiyuan. Strategies for preventing and treating oral diseases and improving the quality of life of the elderly in nursing homes were formulated on the basis of analyzed data.

METHODS

A total of 359 participants from 48 nursing homes in six districts were selected randomly. Awareness, attitude, and behavior with regard to oral health care among the elderly were investigated through a survey using questionnaires and oral health examinations. Data were statistically analyzed with SPSS 20.0.

RESULTS

Among the elderly in the nursing homes in Taiyuan, awareness and behavior with regard to oral health care were deficient and inappropriate, and thus professional guidance was needed. In addition to method and time of brushing teeth and bad oral habits, the oral health status of the elderly was statistically affected by age and education. Compared with the data of the Fourth National Oral Epidemiological Investigation, the number of elderly people aged 55-64 or 65-74 years who brush their teeth every day and accept oral diagnosis and treatment was lower. However, the ratios of edentulous and missing teeth without treatment were higher than the national average level for the same age groups.

CONCLUSIONS

The awareness and attitude of the elderly in nursing homes with regard to oral health care are unsatisfactory, and their oral health status is poor. Education on oral health care, development of good oral care habits, and regular oral health examination are essential to the maintenance of oral health in elderly people.

Oral healthcare delivery in institutionalised older people: A health-economic evaluation

OBJECTIVES

This health-economic evaluation aimed to assess the cost-effectiveness of a number of alternatives for preventive and curative oral health care in institutionalised older people in Flanders.

METHODS

A six-state Markov model was used to compare expected costs and healthy oral years (HOYs) of four alternatives: (1) usual care; (2) on-site preventive care; (3) on-site preventive care + curative care in the community; and (4) on-site preventive care + on-site curative care. A healthcare payer perspective was adopted, and the time horizon was 10 years. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS

Incremental cost-effectiveness ratios (ICERs) of alternatives 2, 3 and 4 (all compared to alternative 1) were as follows: (2) 7944 €/HOY gained; (3) 1576 €/HOY gained; and (4) 1132 €/HOY gained. Hence, alternatives 2 and 3 were not cost-effective compared to alternative 4. The probability that oral care interventions are more effective and cost-saving than usual care was <3% for all three interventions.

CONCLUSIONS

For institutionalised older people, on-site solutions for preventive and curative oral health care might be the most cost-effective alternative. It should be kept in mind that on-site solutions require large initial investment and that the advanced age of the population and the high costs of oral health care make it unlikely that these interventions would become cost-saving, even in the long term.

Part 2 Functional Integration

OBJECTIVE

to synthesise a framework of barriers and facilitators in the functional integration of oral health care (OHC) into general health care for frail older adults at macro (system), meso (organisation and interprofessional integration) and micro (clinical practice) levels.

BACKGROUND

Identification of these barriers and facilitators is expected to promote better and more appropriate care.

METHODS

For this qualitative study, comprising 41 participants, representatives of 10 different groups of (professional) care providers, and OHC receivers (home-dwelling and nursing-home patients) were interviewed. Transcripts of the in-depth, topic-guided interviews were thematically analysed. In a subsequent workshop with 52 stakeholders, results and interpretations were discussed and refined.

RESULTS

Two themes were identified: (1) compartmentalised care systems and (2) poor interprofessional and communication infrastructure. Barriers related to (1) included lack of integrative policies and compartmentalised healthcare education (macro level); poor embedding of OHC in care procedures, instruments and guidelines (meso level); and poor interprofessional skills (micro level). Barriers related to (2) included poor financial incentives for collaborative practices (macro level) and badly connected ICT systems (meso level). Identified facilitators included integration of an OHC professional into care teams, and interdisciplinary consultations (meso level); and integration of OHC in individual care plans (micro level).

CONCLUSION

In The Netherlands, OHC for older people is at best poorly integrated into general care practices. Barriers and facilitators are interconnected across macro-, meso- and micro levels and between normative and functional domains and are mainly related to compartmentalisation at all levels and to poor interprofessional and communication infrastructure.

Part 1: Normative integration

OBJECTIVE

to synthesise a framework of barriers and facilitators in the normative integration of oral health care (OHC) into general health care for frail older adults at macro (system), meso (organisation and interprofessional integration) and micro (clinical practice) levels.

BACKGROUND

Identification of these barriers and facilitators is expected to promote better and more appropriate care.

METHODS

For this qualitative study, comprising 41 participants, representatives of 10 different groups of (professional) care providers, and OHC receivers (home-dwelling, and nursing home patients) in East Netherlands were interviewed. Transcripts of the in-depth, topic-guided interviews were thematically analysed. In a subsequent workshop with 52 stakeholders, results and interpretations were discussed and refined.

RESULTS

Two main themes were identified: (1) a compartmentalised care culture in which OHC and general health care are seen as two separate realms, and (2) prioritisation, awareness and attitude regarding OHC integration. Subthemes such as low political attention (macro level); unclear responsibilities, hierarchical relations and the lack of vision of organisations (meso level); and poor awareness and low prioritisation by care providers and patients (micro level) were identified as potential barriers. Subthemes such as leadership (meso level), and the supportive personality of individual caregivers and ownership of patients (micro level) were identified as facilitators.

CONCLUSION

Barriers and facilitators in normative OHC integration in The Netherlands are interrelated and apparent at macro-, meso- and micro levels. They are mainly related to (a) a compartmentalised care culture, and (b) related low prioritisation, and poor awareness of and attitude towards (integration of) oral health (care).

Failure on all fronts: Qualitative analysis of the oral health care experience in individuals with intellectual disability

AIM

To explore the oral health care experience of individuals with intellectual disability and their families.

METHODS

A qualitative approach utilising face-to-face semi-structured interviews with parents of individuals with intellectual disability. All interviews were audio recorded and transcribed verbatim, and Qualitative Framework Analysis was used to present the results.

RESULTS

Twenty-six parents of 26 individuals with intellectual disability were interviewed. The interviewees were 10 males and 16 females, and their average age was 46.4 ± 11.2 years (range 28-66). The average age of individuals with intellectual disability was 17.9 ± 9.2 years (range 6-48), and there were 11 (42.3%) males and 15 (57.7%) females. The interviewees reported that challenges to oral health care do occur on multiple levels: (a) home environment; (b) primary dental care; (c) secondary dental care facilities; (d) health and education policies and systems; and (e) societal views on individuals with intellectual disability.

CONCLUSION

Individuals with intellectual disability and their families are being failed at multiple levels of oral health care, leaving parents feeling frustrated, isolated, and sometimes helpless. Collaborative efforts are needed to train families to prevent oral health disease at home, establish better primary and secondary oral health care systems, and overcome wider cultural, social, and economic barriers.

Effects of perioperative oral care on postoperative inflammation following heart valve surgery

OBJECTIVE

Whether oral health care during the perioperative period can lead to a better outcome after heart valve surgery has not been adequately elucidated. We examined the effects of perioperative oral care on postoperative inflammation response in patients who underwent heart valve surgery.

MATERIALS AND METHODS

In this retrospective cohort study, 223 patients scheduled for single valve heart surgery were divided into the oral care, who underwent professional teeth cleaning or scaling within 3 days prior to surgery, and also following surgery at least twice a week (n = 111), and non-oral care (n = 112) groups. After propensity score matching, records of both groups (80:80) were examined after surgery to evaluate inflammation markers (white blood cell count [WBC], neutrophil/white blood cell ratio [NWR], C-reactive protein [CRP] level, body temperature [BT]).

RESULTS

WBC, NWR, CRP level, and BT were increased in both groups the day following surgery. Thereafter, CRP level, WBC, NWR, and BT on various days after surgery in the oral care group showed greater decreases as compared to the non-oral care group.

CONCLUSIONS

Perioperative oral health care can decrease postoperative inflammation in patients undergoing heart valve surgery and may be important to ensure a better outcome in those patients.

Barriers to the use of dental services by children in Lebanon and association with parental perception of oral health care

Background

Oral health is important to general health but use of dental services varies considerably, particularly for children.

Aims

We aimed to determine factors associated with parents' use of dental services for their children in Lebanon, and their perception of dental care relative to medical care.

Methods

A convenience sample of public and private schools in Beirut was selected between January and May 2013. Parents of children in grades 2-6 (aged 7-12 years) were invited to complete a questionnaire covering socioeconomic characteristics and use of dental services. Logistic regression analysis was used to assess the relationship between use of dental services, and parents' socioeconomic characteristics and awareness and perceptions of dental services.

Results

The parents of 316 children returned the questionnaire. Most children (72.8%) had been taken to the dentist in the past year, mainly for emergency care. Most parents (78.2%) considered dental care as important as or more important than medical care, and 89.9% were willing to contribute to dental insurance. Use of dental services was significantly associated with: older age of the parent (odds ratio, OR = 1.04; 95% confidence interval, CI: 1.02-1.06); awareness of dental care centres offering affordable treatment (OR = 3.18; 95% CI: 1.52-6.68); and children being in private schools (OR = 2.00, 95% CI: 1.08-3.95). It was negatively associated with > 4 children in the family compared with 1 child (OR = 0.18; 95% CI: 0.04-0.81).

Conclusion

Barriers to dental care for children were mostly related to economic factors.

Awareness among pediatricians regarding oral health care in children including those with special health care needs: A cross- sectional survey

Background:

Pediatricians are the custodians of the overall health of children and are the ideal healthcare personnel to impart information and instruction about oral health care. The aim of this survey was to evaluate awareness of pediatricians regarding oral health care and prevention of oral diseases in children.

Methodology:

The study participants consist of 102 young pediatricians working as Junior and Senior Residents. A questionnaire was formulated to evaluate their knowledge about oral diseases and their prevention. The questionnaire also tested the attitude and practices of pediatricians towards oral health of children with special health care needs.

Results:

Majority of the pediatricians had correct knowledge about dental caries (60%), bottle feeding (88.2%), tongue cleaning (83.3%) and medication causing gum enlargement (92.2%). Few had correct knowledge about recommended age to start tooth brushing (35.3%) and maximum recommended sugar exposures per day (35.3%). Although, majority (62.7%) had correct knowledge about fluoride and its role caries prevention, very few (2.9%) knew about recommended fluoride concentration in toothpaste for children.

Conclusion:

There was a lack of knowledge amongst pediatrician about oral health care, prevention, and appropriate referral. The study result necessitates the emphasis of improving oral health related knowledge among pediatrician.

The Effects of Gamification and Oral Self-Care on Oral Hygiene in Children: Systematic Search in App Stores and Evaluation of Apps

Background

Poor oral hygiene is a great public health problem worldwide. Oral health care education is a public health priority as the maintenance of oral hygiene is integral to overall health. Maintaining optimal oral hygiene among children is challenging and can be supported by using relevant motivational approaches.

Objective

The primary aim of this study was to identify mobile smartphone apps that include gamification features focused on motivating children to learn, perform, and maintain optimal oral hygiene.

Methods

We searched six online app stores using four search terms (“oral hygiene game,” “oral hygiene gamification,” “oral hygiene brush game,” and “oral hygiene brush gamification”). We identified gamification features, identified whether apps were consistent with evidence-based dentistry, performed a quality appraisal with the Mobile App Rating Scale user version (uMARS), and quantified behavior scores (Behavior Change score, uMARS score, and Coventry, Aberdeen, and London-Refined [CALO-RE] score) using three different instruments that measure behavior change.

Results

Of 612 potentially relevant apps included in the analysis, 17 met the inclusion criteria. On average, apps included 6.87 (SD 4.18) out of 31 possible gamification features. The most frequently used gamification features were time pressure (16/17, 94%), virtual characters (14/17, 82%), and fantasy (13/17, 76%). The most common oral hygiene evidence-based recommendation was brushing time (2-3 minutes), which was identified in 94% (16/17) of apps. The overall mean uMARS score for app quality was high (4.30, SD 0.36), with good mean subjective quality (3.79, SD 0.71) and perceived impact (3.58, SD 0.44). Sufficient behavior change techniques based on three taxonomies were detected in each app.

Conclusions

The majority of the analyzed oral hygiene apps included gamification features and behavior change techniques to perform and maintain oral hygiene in children. Overall, the apps contained some educational content consistent with evidence-based dentistry and high-quality background for oral self-care in children; however, there is scope for improvement.