Navigating Barriers to Oral Health Challenges Faced by Children With Autism Spectrum Disorder: A Scoping Review.

This article identifies the multifaceted challenges that hinder optimal oral health among children diagnosed with autism spectrum disorder (ASD). While dental care is a fundamental aspect of overall well-being, children with ASD encounter unique obstacles that often go unnoticed. Drawing from a comprehensive review of existing literature and insights from healthcare professionals, this article explores the sensory sensitivities, communication difficulties, and behavioral issues that contribute to suboptimal oral hygiene in this demographic. We also discuss the critical role of caregivers, dentists, and educators in addressing these challenges, emphasizing the importance of early intervention and tailored strategies to improve the oral health of children with ASD. By shedding light on these obstacles, this article aims to foster a more inclusive and holistic approach to oral healthcare for children with ASD, ultimately enhancing their overall quality of life.

[Improvement of oral health of older people in hospitals: a scoping review]. / Verbesserung der Mundgesundheit älterer Menschen in Krankenhäusern: ein Scoping-Review.

BACKGROUND: The current evidence regarding interventions to improve oral health in older hospital patients is unclear. OBJECTIVE: This scoping review assesses the scope and nature of research activities and identifies gaps in the existing literature. METHODS: The inclusion criteria for this study included adults over the age of 65 years who were treated as inpatient outside of intensive care units and covered all interventions aimed at promoting oral health or hygiene. RESULTS: The systematic search yielded 12 final studies, focusing on oral healthcare interventions in various settings, primarily in high-income countries. The studies employed diverse designs including randomized controlled trials and prospective studies, with interventions mainly provided by multidisciplinary teams. The interventions aimed to improve oral health or prevent pneumonia. Overall, the studies highlighted a potential effectiveness of multidisciplinary approaches in improving oral health and preventing pneumonia in geriatric populations. CONCLUSION: This scoping review shows a limited and heterogeneous evidence base for oral health interventions for older patients in hospitals. The need for patient involvement is evident; however, there is often a lack of high-quality studies to draw robust conclusions.

The oral health care system in Libya: a case study.

BACKGROUND: This study aims to describe the Libyan oral health care system in terms of its structure, function, workforce, funding, reimbursement and target groups. METHODS: A single descriptive case study approach and multiple sources of data collection were used to provide an in-depth understanding of the Libyan oral health care system. A purposeful sample of the key informants (Managers of oral health centers, dentists of various specialties with experience in the field, dentists, nurses, dental technicians, and officials in the affairs of medical insurance) was recruited. The case and its boundaries were guided by the study's aim. Both qualitative and quantitative analyses were conducted. Descriptive statistics were used for quantitative data. Framework analysis, informed by the study objectives, was used to analyze interviews and documents. RESULTS: The analysis showed that oral health services are integrated into medical services. The provision of dental care is mainly treatment-based, in the private sector. The oral health services in the public sector are mainly emergency care and exodontia. The dental workforce included in the study were mostly dentists (89% General Dental Practitioners (GDPs), 11% specialists), with a marked deficiency in dental technicians and nurses. Around 40% of dentists work in both the private and public sectors. The government provides the funding for the public sector, but the private sector is self-funded. No specific target group(s) nor clear policies were reported. However, the system is built around primary health care as an overarching policy. Dental caries is the most common oral problem among Libyan preschool children affecting around 70% and is the most common cause of tooth loss among adults. CONCLUSION: The oral health care system in Libya is mainly privatized. The public health services are poorly organized and malfunctioning. There is an urgent need to develop policies and plans to improve the oral health care system in Libya.

Access to oral health care services for children with disabilities: a mixed methods systematic review.

BACKGROUND: Children with disabilities experience poorer oral health and frequently have complex needs. The accessibility of oral health care services for children with disabilities is crucial for promoting oral health and overall well-being. This study aimed to systematically review the literature to identify the barriers and facilitators to oral health care services for children with disabilities, and to propose priority research areas for the planning and provision of dental services to meet their needs. METHODS: This was a mixed methods systematic review. Multiple databases searched included MEDLINE, Scopus, PsycINFO, EMBASE, and CINAHL. The search strategy included Medical Subject Heading (MeSH) terms related to children, disabilities, and access to oral health. Eligibility criteria focused on studies about children with disabilities, discussing the accessibility of oral health care. RESULTS: Using Levesque's framework for access identified barriers such as professional unwillingness, fear of the dentist, cost of treatment, and inadequate dental facilities. Facilitators of access offered insight into strategies for improving access to oral health care for children with disabilities. CONCLUSION: There is a positive benefit to using Levesque's framework of access or other established frameworks to carry out research on oral healthcare access, or implementations of dental public health interventions in order to identify gaps, enhance awareness and promote better oral health practices. The evidence suggests that including people with disabilities in co-developing service provision improves accessibility, alongside using tailored approaches and interventions which promote understanding of the importance of dental care and increases awareness for professionals, caregivers and children with disabilities. TRIAL REGISTRATION: Protocol has been registered online on the PROSPERO database with an ID CRD42023433172 on June 9, 2023.

Nationwide exploration: assessing oral microbiome knowledge among dental professionals in Saudi Arabia and its implications for oral health care.

BACKGROUND: The relationship between the microbiome and oral health is intricate, yet there is a lack of comprehensive knowledge regarding the microbiome's impact on oral health. Integrating knowledge regarding the oral microbiome and its significance in oral and systemic diseases holds profound implications for dental professionals in patient care and professional development. This study assessed dental professionals' oral microbiome comprehension and knowledge levels in Saudi Arabia and its implications for oral healthcare. METHODS: Data were gathered using a cross-sectional design by administering a comprehensive online questionnaire to 253 dental professionals from diverse demographic backgrounds. The questionnaire, administered in English, was divided into four sections: (1) Microbiome awareness and understanding, (2) Diet, nutrition, and microbiome relationship, (3) Microbiome and oral and systemic diseases, and (4) Counselling, education, and implications. Statistical analyses were used to identify and understand underlying patterns, including descriptive statistics, chi-squared tests, ANOVA, and post hoc tests. The Spearman rank correlation coefficient was applied to assess self-rated knowledge. RESULTS: Of the 253 participants, 94.6% were familiar with the term "microbiome." Merely 13% of participants considered the oral microbiome to be the second most diverse, following the gut microbiome. About 39.9% of participants knew the connection between oral mucosal diseases and the oral microbiome. Furthermore, only 6.7% thought there was a connection between systemic diseases and the oral microbiome. Participant comprehension of oral microbiome questions averaged 9.19 out of 13, with 83.7% scoring "good". There were significant differences in knowledge scores among dental specializations (F = 7.082, P < 0.001) and years of professional experience (F = 4.755, P = 0.003). Significantly, 53.8% of participants had uncertain self-perceptions of their knowledge of the oral microbiome, while only 0.8% rated their understanding as 'very good'. CONCLUSION: Our findings reveal that dental professionals have varying levels of awareness and comprehension of the oral microbiome. Despite widespread awareness, understanding its diversity and implications for oral and systemic health remains limited. It is essential to address these gaps in knowledge through future research and educational interventions, considering the vital part that dental professionals play in promoting oral health through personalised dietary recommendations, lifestyle changes, and hygiene practices. These initiatives may promote a robust oral microbial community, enhance patient outcomes, and advance oral healthcare locally and globally.

Herbal Dentifrices for Prevention of Dental Caries in Children and Adolescents: A Systematic Review.

Despite a large number of trials conducted on the use of herbal oral care products to reduce dental plaque or gingivitis, the results are conflicting and inconclusive. This systematic review aimed to evaluate the effectiveness of herbal dentifrices in caries prevention in children and adolescents and to ascertain the potential of herbal dentifrices to remineralize white spot lesions, reduce halitosis, and improve gingival and periodontal health in children with special healthcare needs (SCHN) and among orthodontic patients. A comprehensive search was designed and conducted using several databases. The articles were independently screened for eligibility by two reviewers. Seven of the 6,940 studies were found to meet the eligibility criteria. A meta-analysis showed that for bacterial scores, the standard mean difference was estimated to be 0.6 [95% confidence interval (CI): -0.78, 1.99] and was statistically insignificant (p = 0.39). Herbal dentifrice is evidenced as equally effective in reducing bacterial count and altering bacterial plaque when compared to nonherbal dentifrices within the confines of the included studies. To verify the definitive use of herbal dentifrices for daily use, further research, including randomized controlled trials (RCT) of sufficient quality, would be recommended. How to cite this article: Saikia A, Sivasubramanian A, Muthu MS, et al. Herbal Dentifrices for Prevention of Dental Caries in Children and Adolescents: A Systematic Review. Int J Clin Pediatr Dent 2024;17(2):229-236.

Impact of various solutions on the oral health status of critically ill patients.

Oral care is a crucial challenge of nursing care in orally intubated patients. Oropharyngeal colonization with microorganisms is probably the first step in the pathogenesis of most bacterial pulmonary infections. This study aimed to investigate the effect of different oral care solutions on the oral health status of critically ill patients. We conducted a quasi-experimental study involving a convenience sample of 60 adult orally intubated patients, distributed equally into three groups: 20 patients received 0.12% chlorhexidine gluconate (CHX) solution as an oral rinse; 20 patients received 0.1% hexetidine (HEX) solution as an oral rinse; and a control group of 20 patients received routine hospital oral care with 0.9% normal saline (NS) solution. Oropharyngeal and tracheal cultures were obtained from patients within 24-48 h of admission, before the administration of topical oral antimicrobial solutions and then repeated on day 4 and day 7 after the oral solutions. The study revealed that CHX has a more powerful effect than HEX and NS in improving the oral mucosa and decreasing colonization of both the oropharynx and trachea. On day 7, the improvements were statistically significant in the CHX group and the HEX group (P = 0.02 and P = 0.03, respectively), but not in the NS group. This research confirms the effect of CHX and HEX in lowering the risk of tracheal and oropharyngeal colonization, and recommends the use of a CHX solution as oral mouth care in critically ill patients.

Effects of personalized oral hygiene management on oral health status of pregnant women.

BACKGROUND: The Cariostat caries activity test (CAT) was used to evaluate the effectiveness of personalized oral hygiene management combining oral health education and professional mechanical tooth cleaning on the oral health status of pregnant women. AIM: To investigate whether personalized oral hygiene management enhances the oral health status of pregnant women. METHODS: A total of 114 pregnant women who were examined at Dalian Women's and Children's Medical Center were divided into four groups: High-risk experimental group (n = 29; CAT score ≥ 2; received personalized oral hygiene management training), low-risk experimental group (n = 29; CAT score ≤ 1; received oral health education), high-risk control group (n = 28; CAT score ≥ 2), and low-risk control group (n = 28; CAT score ≤ 1). No hygiene intervention was provided to control groups. CAT scores at different times were compared using independent samples t-test and least significant difference t-test. RESULTS: No significant difference in baseline CAT scores was observed between the experimental and control groups, either in the high-risk or low-risk groups. CAT scores were reduced significantly after 3 (1.74 ± 0.47 vs 2.50 ± 0.38, P < 0.0001) and 6 months (0.53 ± 0.50 vs 2.45 ± 0.42, P < 0.0001) of personalized oral hygiene management intervention but not after oral health education alone (0.43 ± 0.39 vs 0.46 ± 0.33, P > 0.05 and 0.45 ± 0.36 vs 0.57 ± 0.32, P > 0.05, respectively). Within groups, the decrease in CAT scores was significant (2.43 ± 0.44 vs 1.74 ± 0.47 vs 0.53 ± 0.50, P < 0.0001) for only the high-risk experimental group. CONCLUSION: Personalized oral hygiene management is effective in improving the oral health of pregnant women and can improve pregnancy outcomes and the oral health of the general population.

Can oral health care be a gateway to improve cardiovascular disease? A scoping review.

Background: Cardiovascular diseases (CVDs) are a significant cause of morbidity and mortality worldwide, resulting in a high socioeconomic burden. Growing evidence has shown a link between oral diseases and several chronic conditions including CVDs. The focus of this review is to investigate and summaries the evidence surrounding oral health interventions and their potential impact on reducing both the risk and/or severity of CVDs. Methods: A scoping review was conducted to examine oral health interventions for managing CVD outcomes and risks. The review adhered to the Joanna Briggs Institute (JBI) framework for evidence synthesis and followed the reporting standards outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analysis- extension to Scoping Review (PRISMA-ScR). A systematic search across EBSCOhost, PubMed, and Scopus databases from 2012 to 2024 was utilized to identify relevant studies. Inclusion criteria focused on English language articles with a sample size of at least 50, evaluating the impact of oral health interventions on CVD outcomes. Results: Out of the initial 2,154 studies identified in the search, 12 studies met the inclusion and exclusion criteria and were included in the final analysis. Overall, the studies revealed that along with surgical and non-surgical periodontal therapy, regular oral hygiene care practices, including toothbrushing, tongue brushing, and flossing, significantly reduced the risk of cardiovascular events and mortality. These interventions in patients with or without CVD baseline have shown a decrease in CVD risk markers as well as a reduction in bacterial colonization. Similarly, consistent oral hygiene routines, combined with regular dental visits, were associated with a lower risk of heart failure and CVD risk mortality. Conclusion: The evidence extracted from this review suggests that periodontal therapy, regular dental cleaning, and re-enforcing of oral health regimes can stabilize oral health conditions and subsequently improve CVD progression/risks. However, limited to no evidence exists regarding the therapeutic effects of oral health promotion in managing CVD markers and its direct impact on disease outcomes, warranting further investigation.

A qualitative exploration of patients' perception regarding the comprehensive dental services availed at a primary health center.

Introduction: Comprehensive oral care is a service centered around the patient, and individuals who need it the most often face limited access. Patient perception acts as a guide for enhancing quality, ensuring patients' future intent to utilize the services and facilitating recommendations to others. The present study aimed to assess the patients' perception of comprehensive dental services availed at a Primary Health Center (PHC). Methods: This qualitative study was based on a phenomenological interpretive approach, and judgment sampling method was employed. A validated interview guide, developed from relevant literature was employed in the local language to conduct interviews among adults visiting the PHC, gathering their views regarding the services provided. The interviews were audio recorded on a digital voice recorder, and files were password protected. Content saturation guided the determination of the final number of participants interviewed. After translating and transcribing the interviews, thematic analysis and coding were performed using ATLAS. ti 23 for Windows. Results: A total of 12 participants were included in the study, following data saturation. Among them, there were 8(66.7%) female and 4(33.3%) male participants. Ten overarching main themes were discerned through the assigned codes, including positive views, neutral views, negative views, previous dental clinics visited, previous experience with dental treatment, treatments sought at the center, referrals, source of information about the dental center, subsequent visits and suggestions for improvement. Conclusions: The findings of this study revealed a positive patient perception of the comprehensive dental services offered at the PHC. Through insightful interviews, various strengths, and areas for improvement regarding the center and care provision were identified. These insights provide valuable suggestions that can be applied to elevate the utilization of dental services, ensuring continuous improvement in patient care.

Education for Integration: Dental hygiene student and family medicine residents.

Purpose The integration of oral health and primary care offers promising solutions to overcome barriers hindering patient access to oral health care. However, primary care providers require training in basic preventive oral health care and information regarding interprofessional practice opportunities. The purpose of this feasibility study was to examine the perspective of families, learners, faculty, and administrators who engaged in an interprofessional training experience for family medicine residents and dental hygiene students.Methods Family medicine residents and dental hygiene students participated in an interprofessional oral health integration training experience, which included didactic, preclinical, and clinical components. The clinical experience was conducted during a Medicaid Managed Care clinic session, which included the participation of children who had not undergone a well-child visit within the past year. The care teams were comprised of a family medicine resident and dental hygiene student, who collaborated on the provision of preventive oral health care services, including oral examinations, preventive interventions, patient education, and care coordination. Qualitative data gathered using field notes, focus groups, and key informant interviews were analyzed to identify themes from care team, patient/family, and administrative perspectives.Results The care teams provided preventive health oral health care services to 10 pediatric patients during their well child visit. Patients and family members reported appreciating the convenience and value of the care provided. The experience was well received by family medicine residents, dental hygiene students, and clinical faculty members, who highlighted the value of the experience in expanding access to care. The family medicine residents reported the training and interprofessional practice opportunity to be highly valuable, reporting better preparation for the identification, evaluation, and treatment of oral conditions that they may have otherwise overlooked or misdiagnosed.Conclusions This interprofessional educational experience demonstrates the potential value of integrating preventive oral health in primary care visits for children. This care integration may be especially helpful for populations that experience barriers to oral health care. Results of this study suggest that expanding interprofessional education between dental hygiene programs and family medicine residencies may be beneficial for preparing the future workforce for integrated care. Additional research is needed to formalize training models that support integration and promote interprofessional collaboration and practice.

Community Oral Health Initiative: Driving value-based transformation in North Carolina.

CareQuest Institute for Oral Health's mission is to improve the oral health of all. One way to achieve this is through programmatic initiatives, which train dental clinics to provide equitable, integrated and accessible care for their communities. The Community Oral Health Transformation (COrHT) Initiative, allowed CareQuest Institute to collaborate with the North Carolina Oral Health Collaboration (NCOHC) and Blue Cross Blue Shield (BCBS) of North Carolina Foundation to implement and support the initiative in North Carolina. This mixed methods study was designed to collect quantitative and qualitative data while 11 dental clinics and a control clinic participated in the program through the end of the program. Quantitative data included patient demographics, claims data, and financial and data measures. Descriptive statistics of participating clinics and the control clinic were analyzed, and aggregated clinic data showed improvements in patient care delivery measures. Qualitative interviews were also conducted at midpoint and conclusion, and an outcome evaluation was completed. This short report will provide readers with results from the COrHT Initiative, with an emphasis on medical-dental integration (MDI) as an integral component of comprehensive, person-centered care. The evaluation of programmatic strengths and weaknesses has been included to identify the potential for future implementation, sustainability, and policy making.

To assess the knowledge, attitudes, and confidence of caregivers and administrators towards the oral health of nursing home residents in San Antonio, Texas.

OBJECTIVE: The primary objective of this research was to use qualitative methods to assess the knowledge, attitudes, and confidence of caregivers in their ability to provide oral hygiene assistance to residents. The secondary objective was to assess the knowledge and attitude of administrators on the provision of oral hygiene assistance for residents, and their confidence in caregivers' ability to provide oral hygiene assistance to nursing home residents in San Antonio, Texas. METHODS: A semi-structured interview guide was used to conduct face-to-face interviews with seven caregivers and twelve administrative staff from ten nursing homes in San Antonio, Texas. Employees in nursing homes who are caring for residents are referred to as caregivers and those whom they care for are referred to as nursing home residents. One survey instrument was developed for the caregiver's knowledge, attitude, and confidence toward providing oral health care, and another to assess the administrator's knowledge, attitude, and confidence in caregivers providing oral care for nursing home residents. The interviews were recorded, transcribed, and coded for thematic content. RESULTS: The findings revealed that caregivers and administrators had adequate knowledge of the connection between oral and systemic health. The administrators were confident that caregivers were adequately trained to provide oral hygiene care for residents. Caregivers had a positive attitude toward the importance of good oral health. They regularly assessed the residents' oral health, but due to time constraints, staffing shortages, and other competing tasks providing oral health care to the residents was challenging. Most caregivers were confident in their skills in providing oral care for the residents since 85.6% agreed. On the contrary, almost half of the administrators were confident that caregivers have the necessary skills to provide oral care for residents, while 41.7% were unsure. CONCLUSIONS: The study gave a broader insight into the provision of oral care in nursing home residents from the perspectives of caregivers and administrative staff. Administrators must provide caregivers with adequate training and time so they can provide adequate oral health care for the residents.

Assessing oral health-related quality of life among older people in home-based care - survey results of the InSEMaP study in Germany.

BACKGROUND: Older people receiving home-based care (HBC) often face barriers to access preventive oral health care (OHC) and dental treatments. Leading to deterioration of their oral healthcare. It is further deteriorated by factors such as increasing burden of systemic diseases, medicinal side effects, limited mobility, financial constraints and lack of professional OHC at home. Older people also struggle to maintain necessary daily oral hygiene, leading to malnutrition, weight loss, and a risk of a further health degradation. This cross-sectional survey aimed to investigate the oral health-related quality of life (OHRQoL) and their associated factors in HBC recipients. METHODS: 5,280 older people (≥ 60 years) living in Hamburg, who were in need of care and insured with statutory health insurance DAK-Gesundheit received the questionnaire, which included the German version of the Oral Health Impact Profile (OHIP G-14) and, the EQ-5D health-related quality of life (HRQoL) measure as well as further questions regarding the extent of informal social support, subjective oral health status, oral health behaviour, subjective cognitive status, and socio-demographic variables. RESULTS: The participants (n = 1,622) had a median age of 83.2 years, with 72.0% of the sample being female. Nearly two thirds of the sample reported that their independence or abilities were significantly impaired (care level 2). Regarding oral health impacts, 40.0% of the participants reported experiencing at least one of the fourteen possible prevalent impacts of the OHIP-G14 fairly often or very often. A multivariate regression model on the severity of oral health impacts revealed, that a better HRQoL, a positive perception of one's own dental status, fewer visits to dental practices, and no need for support in OHC were associated with better OHRQoL. Conversely, respondents with a negative perception of their oral health status, more frequent visits to a dental practice, a need for support in OHC, and subjective memory impairment showed poorer OHRQoL. CONCLUSIONS: The results highlight the risk for poor oral health among older people in HBC. We conclude that there is an urgent need to prioritise oral health, especially as poor oral health can further compromise the systemic wellbeing of these already care dependent population.

Factors associated with the use of oral health care services among seniors in Canada.

Background: This study explores the link between dental insurance, income, and oral health care access among seniors (aged 65 and over) in Canada. It contributes to the understanding of oral health care among seniors before the implementation of the Canadian Dental Care Plan. Data and methods: This study uses data from the 2019/2020 Canadian Health Survey on Seniors (n=41,635) to report descriptive statistics and logistic regression model results and examine factors associated with seniors living in the community and access to oral health care services. Results: At the time of the survey (2019/2020), 72.5% of seniors in Canada reported having had a dental visit in the past 12 months, with 83.0% of insured and 65.3% of uninsured seniors reporting visits. Seniors reporting excellent or very good oral health had a higher prevalence of visits (79.2%) compared with those with good, fair, or poor oral health (62.3%). Among seniors who had not visited a dental professional in three years, 56.3% deemed it unnecessary, and 30.8% identified cost as the major barrier. After sociodemographic characteristics were controlled for, insured seniors were more likely to have had a dental visit in the past 12 months (adjusted odds ratio [OR]: 2.27; 95% confidence interval [CI]: 2.03 to 2.54) and were less likely to avoid dental visits because of cost (OR: 0.18; 95% CI: 0.12 to 0.28) compared with their uninsured counterparts. Interpretation: This study underscores the role of dental insurance in seniors' oral health care access. While insurance is associated with seniors' access to oral health care services, the study also emphasizes the need to consider social determinants of oral health such as income, gender, age, level of education, and place of residence when assessing oral health care access for seniors.

Cross-cultural validity of the Dutch sleep-related breathing disorder scale of the Pediatric Sleep Questionnaire in a general population.

BACKGROUND: Pediatric sleep-disordered breathing is associated with multiple health problems. Polysomnography is the reference standard for identifying this disorder, but availability is limited. Therefore, an alternative screening tool is needed. Globally, the Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire (PSQ) has proven to be a feasible tool. Consequently, this study aimed to translate and culturally adapt the PSQ into Dutch and then to examine the cultural validity, internal consistency, and test-retest reliability of the Dutch version among a general population visiting oral healthcare centers. METHODS: The translation, review, adaptation, pretest, and documentation approach was used to ensure cross-cultural adaptation of the PSQ. Then, 220 children (2.4-18 years) were sampled for clinimetric evaluation. We estimated the cross-cultural validity by comparing the factor analyses of the original PSQ and the Dutch version. Reliability was assessed using Cronbach's alpha, Spearman's correlation, the intraclass correlation coefficient, the standard error of measurement, and a Bland-Altman plot. RESULTS: The factor loading patterns of the Dutch version matched with the original study around the four predetermined factors: breathing, sleepiness, behavior, and other. The internal consistency, with a Cronbach's α of 0.77, was acceptable. The test-retest reliability with an intraclass correlation coefficient and Spearman's correlation of 0.89 and 0.93, respectively, was good to excellent. CONCLUSIONS: Cultural adaptation was ensured and the results support cross-cultural validity, internal consistency, and test-retest reliability of the Dutch Sleep-Related Breathing Disorder scale of the PSQ. This questionnaire could therefore be a valuable tool for screening disordered breathing in Dutch children.

A Protocol for Treating Patients with Post-Covid Conditions in Dental Settings.

Purpose The relative newness of Post-COVID Conditions (PCC) has revealed a void in assessment protocols and treatment guidelines for dental settings. Providing oral health care practitioners with an assessment and treatment protocol could facilitate the delivery of comprehensive oral health care. The purpose of this study was to test a protocol for assessing and treating patients with PCC in dental practice settings.Methods A qualitative exploratory research design was used to conduct the study. A PCC assessment and treatment protocol (ATP) was developed and was used by dental hygienists in clinical practice in California for a period of 6 weeks. Following the use of the PCC ATP practitioners were invited to participate in individual interviews. Online individual interviews were comprised of 20 dental hygienists recruited via purposive sampling. Participant anonymity was preserved using pseudonyms. A qualitative analysis software program was used to identify codes and themes. Investigator triangulation, member checks, and saturation were used to validate responses.Results Fifty-six participants completed the six-week PCC ATP and twenty participants took part in the interview session. Four themes were identified: awareness, accessibility, resources, and complications. Within the accessibility theme, subthemes of ease of use and guidance emerged. The complications theme yielded three subthemes: time, clinician hesitation, and patient lack of cooperation.Conclusion This study demonstrated that a PCC ATP created awareness of the varied symptoms of PCC and is a useful resource for clinical practitioners. Providing dental hygienists with a treatment protocol supports efforts to provide person-centered evidence-based care.

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.