Risk factors associated with the development of osteoradionecrosis (ORN) in Head and Neck cancer patients in Ireland: A 10-year retrospective review.

BACKGROUND AND PURPOSES: To assess osteoradionecrosis (ORN) incidence in a population of Irish Head and Neck cancer (HNC) patients, and assess precipitating factors that may contribute to ORN development to aid prevention. MATERIALS AND METHODS: Review of 1050 HNC patients attending the Dental Oncology Clinic, CUDSH between 2010 and 2021 identified 47 cases of ORN. Medical, dental and radiotherapy records of these forty-seven patients were retrospectively reviewed. Patient-, tumour-, and treatment-related variables were investigated in association with osteoradionecrosis development. Analysis conducted using SPSS, Pearson's Chi-square test (p < 0.05), and ordinal regression model. RESULTS: ORN incidence was 4.4 %. Median time from radiotherapy (RT) to ORN development was 9.5 months (range 1-98.5 months). ORN development within the mandibular surgical site was significant (p <.001), presenting at a higher Notani grade (p =.002), in mid-mandibular body region (p =.028), at radiation doses ≥ 60 Gy (p =.035), due to induced causes (p =.029), and without resolution (p =.019). CONCLUSION: This is the first retrospective study of ORN in HNC patients in Ireland over 10-year period. ORN incidence was extremely low (4.4%). As patients reported high smoking/alcohol use and poor dental attendance pre-diagnosis, this suggests intensive dental intervention pre/post-diagnosis contributed to low ORN rates. Mandibular surgery pre-RT increased risk of developing ORN at the surgical site. Therefore, we recommend future treatment planning should contour the surgical site, designating it an organ at risk (OAR), assigning a dose constraint, where oncologically possible, with emphasis on reducing the hot-spot to this region; findings reinforce importance of life-long expert dental care to reduce ORN incidence.

Home care aides' attitudes to training on oral health care.

This study investigated home care aides' (HCAs) oral health care experience, knowledge, and their intention to receive professional training, to explain and predict factors of their intention to receive such training. This cross-sectional study collected data through a structured questionnaire. HCAs affiliated with home care agencies in Taichung, Taiwan were recruited through purposive sampling. A total of 487 questionnaires were distributed from September to December 2015 with 280 valid responses collected (57.4%).This study predicted the factors of HCAs' intention to receive oral health care training through a decision tree analysis. The decision tree model classified the respondents with an accuracy of 77.5%. The optimal predictor variable was oral health care knowledge (χ2 = 66.662, p < 0.0001). Among the low-scoring respondents on oral health care knowledge, 76.4% were classified in the "uninterested" group, whereas 84.8% of the high scorers were classified in the "interested" group. The second best predictor variable was whether oral health care is part of the job responsibility (χ2 = 7.979, p = 0.007). Among those who answered Yes, 92.9% were in the interested group, as were 76.5% of those who answered No. It is recommended to add "disease and oral care-related content" and "safety protection, assessment, and usage of oral care tools during practical oral care process" to the oral healthcare training course content for HCAs in order to improve HCAs' oral healthcare knowledge and oral care skills. These research findings are valuable and may be taken into account in the future development of the in-service educational training of oral healthcare for HCAs.

The Effect of Regime Oral-Hygiene Intervention on the Incidence of New White Spot Lesions in Teenagers Treated with Fixed Orthodontic Appliances.

The present study aimed to evaluate the effect of the oral-hygiene regime on the incidence of enamel demineralization in young patients treated with fixed appliances. Research was conducted in a group of 144 patients aged 12-18 years, divided into 2 groups: orthodontically treated and control. The study was divided into three stages: before treatment (I), at 1 month (II), and at 6 months (III) for their follow-up. The International Caries Detection and Assessment System (ICDAS) was used for the visual assessment of white spot lesions (WSL). After 1 month, no new white spot lesions were observed. After 6 months of the treatment, new lesions were observed in 5% of the orthodontically treated patients and in 6% of the patients in the control group. New decalcifications were located on the proximal surfaces of the central incisors, first premolars, and first molars in the orthodontically treated group; and on the lateral incisors, first premolars, and first molars in the control group. We also observed new enamel demineralization on the vestibular surfaces of the canine and first premolar in the study group. The placement of a fixed appliance did not significantly affect teeth with the presence of new white spot lesions compared to the control group during 6 months of observation.

Oral hygiene practices and utilization of oral healthcare services among in-school adolescents in Calabar, Cross River State, Nigeria.

INTRODUCTION: oral health mirrors an individual´s general health, hence, proper care should be taken to prevent oral diseases and conditions. An estimated 3.9 billion people worldwide are affected by oral conditions, and adolescents are at increased risk due to diet choices and hormonal changes. This study aimed at determining the oral hygiene practices, awareness and utilization of oral healthcare services among in-school adolescents in Calabar Municipality. METHODS: a descriptive cross-sectional study design was employed in studying these variables among in-school adolescents (10-19 years) in secondary schools (JSS1-SSS2) using a self-administered, semi-structured questionnaire. Data were entered and analyzed with EPI-Info. Cross tabulations of variables were conducted using Chi-square test with significance level of 5%. RESULTS: a total of 335 students participated in the study with 228 (68.1%) and 136 (40.6%) reporting that they are aware of and have utilized oral healthcare services (OHS), respectively. There was no statistically significant association between age (p=0.923), gender (p=0.351) and type of school (p=0.497) respectively with awareness and utilization of OHS. Toothache/pain and presumed good dental health respectively were the main reasons for the usage and non-utilization of these services. Time-to-use of oral health services after the onset of toothache/pain was within five days (75.7%). CONCLUSION: the utilization rate of OHS did not match up to the level of awareness of these services with pain being the main driver for utilization. Increased awareness of oral healthcare through health education and oral healthcare demonstrations among adolescents is highly recommended as part of school health programs.

Saúde Bucal em tempos de pandemia

O Debate Virtual do Conass desta sexta-feira (02/10), às 16h30, irá apresentar experiências exitosas de municípios brasileiros na estruturação dos serviços de Saúde Bucal e discutir desafios e caminhos na organização dos serviços odontológicos em rede. O objetivo é apoiar profissionais e gestores na estruturação das ações e dos serviços de Saúde Bucal, buscando responder de forma efetiva à pandemia de Covid-19, o que tem sido um grande desafio. A organização do cuidado em Saúde Bucal, em todos os níveis de atenção, também é profundamente afetada nesse cenário, uma vez que uma das principais via de transmissão do vírus é a saliva e os procedimentos odontológicos, por sua natureza, apresentam elevado potencial de contaminação cruzada entre usuários e profissionais. É necessário cuidar e proteger a população e também os profissionais de saúde. O Guia Orientador para Enfrentamento da Covid-19 na Rede de Atenção à Saúde, elaborado conjuntamente pelo Conass e o Conasems, apresenta orientações para apoiar profissionais e gestores de saúde bucal da Atenção Primária à Saúde (APS) na organização do cuidado aos usuários. Este encontro virtual contará com a participação do coordenador de Saúde Bucal de Caxias, Maranhão, Thiago Henrique Gonçalves Moreira; da coordenadora de Saúde Bucal de Mairi, Bahia, Caroline Santos Figueiredo; e do facilitador da Planificação da Atenção à Saúde do Conass, Wagner Fulgêncio Elias. Os debatedores serão o assessor técnico do Conasems, Rodrigo Lacerda; e a coordenadora geral de saúde bucal do Ministério da Saúde, Caroline Martins José dos Santos. A mediação do debate será feita pela assessora técnica do Conass, Maria José Evangelista.

Prevalence of dental caries and associated risk factors in children living with disabilities in Rwanda: a cross-sectional study.

INTRODUCTION: several studies have been done on children with disabilities, and the results have shown that these particular individuals are more prone to developing various abnormal oral conditions. However, little is known about the oral health conditions among children with disabilities in Rwanda. This study aims to determine the prevalence of dental caries and associated risk factors among children with disabilities. METHODS: a cross-sectional study conducted among 226 randomly selected children living with physical disabilities; learning, intellectual and developmental disabilities; deafness, blindness and hearing impairment disabilities aged between 7 and 20 years old, who live and/or are under the care of NYANZA Home de la Vierge des Pauvres (HVP) GATAGARA. Bivariate and logistic regression analyses were done using SPPS version 20 at 95% confidence interval. The significance level was set at p<0.05. RESULTS: the prevalence of dental caries found in children with disabilities is 42.4%. In bivariate analysis age (p=0.003), frequency of sugary food consumption (p=0.001) and oral hygiene status (p=0.000) are respectively significantly associated with dental caries. In logistic regression model, children who take once or more times per day sugary food like biscuits, cake, chocolates and sweets are almost 6 times higher at risk of developing dental caries [OR: 5.945, CI: 1.187; 29.774, P=0.03) while a good oral hygiene status was protective against dental caries [OR: 0.296, CI: 0.159; 0.550, P=0.000]. CONCLUSION: dental caries is a reality among children living with disabilities. Appropriate measures should be taken to protect these children and these measures should mainly focus on identified factors.

Teamwork and Oral Health in Diabetes Care.

BACKGROUND: The integration of oral health into primary care is often limited, despite its significant connection with many diseases, including diabetes mellitus (DM). OBJECTIVE: This project aimed to develop, implement, and evaluate an oral health education program for medical assistants (MAs) to increase oral health knowledge and enhance practice using standardized oral health screening questions for patients with DM. METHODS: A nurse practitioner-led oral health program was implemented. Medical assistants completed a pre-test and post-test to assess oral health knowledge, a pre-survey and post-survey to assess likelihood of performing screening questions, and a post-implementation survey to assess barriers. RESULTS: Analyses of pre-test and post-test results using the Wilcoxon matched pairs signed rank test (two-tailed) showed a significant increase in correct answers on the post-test (W = 0, N = 8, p ≤ 0.05), with the mean score increasing from 81% to 95%. In addition, the MAs' likelihood of asking screening questions increased and 62.5% reported no barriers to implementation after 1 week. CONCLUSIONS: All participants demonstrated an increase in knowledge and likelihood of using screening questions. IMPLICATIONS FOR NURSING: An oral health program using a team approach to equip MAs with training offers a practical method to incorporate evidence-based recommendations into primary care.

Covid-19: a survey on knowledge, awareness and hygiene practices among dental health professionals in an Indian scenario.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) continues to spread globally. It has become a major cause of concern for health care professionals all over the world. Objective: The aim of this study was to assess knowledge, awareness and hygiene practices regarding COVID-19 among private dental practitioners practicing in Tricity (Chandigarh, Panchkula and Mohali) in India during these critical times. Materials and Methods: A total of 245 private dentists participated in this cross-sectional survey and finally 215 constituted the final sample size. A self-administered, multiple choice type questionnaire (verified by a specialist) was administered to obtain information from the subjects. The questionnaire was divided into two parts and included 15 questions on knowledge and awareness regarding COVID-19. Statistical analysis was done using ANOVA and Student's t-test. Results: Percentage of subjects who answered correctly regarding main symptoms of COVID-19 and primary mode of transmission was 87% and 82.5% respectively. One-third of the subjects were not aware regarding Personal Protective Equipment (PPE) to be used while rendering dental treatment. 75% of subjects were of the opinion that supportive care is the current treatment regime for COVID-19. Less than one-third of subjects (30.2%) reported high scores. Education level (p=0.018) and health sector profile (p=0.024) of the subjects were significantly associated with mean knowledge scores. Conclusion: The findings of the present study showed that some notable deficiencies in knowledge existed among dental professionals regarding some vital aspects of COVID-19. Therefore, there is an urgent need for improving dentists'knowledge via health education and training programs. Further studies on the subject are also warranted once the situation normalizes.

Impact of interdental brush shape on interpapillary cleaning efficacy - a clinical trial.

This study aimed to investigate whether interdental brush shape influences cleaning efficacy, by comparing a waist-shaped interdental brush (W-IDB) with a cylindrical IDB (C-IDB); both provided with the same bristle texture. Cleaning efficacy of differently shaped IDBs was measured in proximal surfaces of teeth in a split-mouth cross-over design. Twenty-eight patients abolished oral hygiene for 4 d. Line angle plaque area was scanned with an intraoral camera after use of disclosing dye in baseline and after IDB application and analyzed planimetrically. Additionally, bacterial load in the IDBs was analyzed after usage by colony forming units (cfu). A Wilcoxon signed-rank test with continuity correction was used to compare the results of the waist-shaped and the cylindrically-shaped IDBs. The waist-shaped IDBs cleaned significantly better than their cylindrically-shaped counterparts (area cleaned: 23.1% vs. 18.3%), when applied at same interdental spaces (p < 0.001). However, no significant differences were found in comparison of bacterial load on the IDBs (median cfu counts: 2.3E9 vs. 2.7E9, p = 0.93). Irrespective of bristle texture or size, IDB shape have impact on cleaning efficacy. Waist-shaped IDBs are more effective in cleaning of the line angle area than cylindrically-shaped IDBs.

A special needs dentistry study of institutionalized individuals with intellectual disability in West Sumatra Indonesia.

People with intellectual disability have a higher risk of oral health problems. This study assessed the clinical oral health status and behaviors and treatment needs of people living in an institution in Padang, West Sumatra, Indonesia. We quantified oral health status of 65 individuals with intellectual disability using Oral Hygiene Index Simplified (OHIs), Angle's classification of malocclusion, Community Periodontal Index and Treatment Need (CPITN), and decay index and also recorded their brushing behavior. We found that males had significantly lower OHIs (p < 0.001), more malocclusion (p < 0.001), greater caries number (p < 0.001), greater CPITN (p = 0.001) and higher need of dental treatment (p < 0.01) than females. Additionally, we found that high caries number was associated with poor OHIS, malocclusion, periodontal disease, and dependent brushing behavior (p < 0.001). The findings of this study imply that there is a gap in appropriate oral health care in individuals with intellectual disability. There should be a greater focus on providing appropriate oral health education to people with intellectual disability, improving the health literacy and quality of care of caregivers, and providing more dentists with specialized training in special needs dentistry.

Development of a periodontitis risk assessment model for primary care providers in an interdisciplinary setting.

BACKGROUND: Periodontitis (PD), a form of gum disease, is a major public health concern as it is globally prevalent and harms both individual quality of life and economic productivity. Global cost in lost productivity is estimated at US$54 billion annually. Moreover, current PD assessment applies only after the damage has already occurred. OBJECTIVE: This study proposes and tests a new PD risk assessment model applicable at point-of-care, using supervised machine learning methods. METHODS: We compare the performance of five algorithms using retrospective clinical data: Naïve Bayes (NB), Logistic Regression (LR), Support Vector Machine (SVM), Artificial Neural Network (ANN), and Decision Tree (DT). RESULTS: DT and ANN demonstrated higher accuracy in classifying the patients with high or low PD risk as compared to NB, LR and SVM. The resultant model with DT showed a sensitivity of 87.08% (95% CI 84.12% to 89.76%) and specificity of 93.5% (95% CI 91% to 95.49%). CONCLUSIONS: A predictive model with high sensitivity and specificity to stratify individuals into low and high PD risk tiers was developed. Validation in other populations will inform translational value of this approach and its potential applicability as clinical decision support tool.

Factors influencing oral care in intubated intensive care patients.

BACKGROUND: The practice of oral care in intensive care settings remains inconsistent among intubated patients, yet these patients are at high risk of developing ventilator-associated pneumonia. Therefore, it is important to adopt safe professional behaviour based on clinical practice guidelines. This study was based on Ajzen's (1985) theory of planned behavior, a conceptual framework that allows a better understanding of how internal and external factors influence behaviour adoption. AIMS AND OBJECTIVES: To study influential factors in how nurses practice oral care with intubated clients in intensive care settings, referring to the theory of planned behavior (TPB) constructs. DESIGN: A cross-sectional descriptive correlational design was conducted through a provincial postal survey in Quebec, Canada. METHODS: A questionnaire was completed by 375 nurses working in intensive care units (ICUs). RESULTS: Perceived behavioural control and attitude were the most important determinants in the level of intention to engage in oral care. Knowledge, available human and material resources, and number of years of experience in critical care nursing also seemed to be significant influencing factors. CONCLUSIONS: This study improved our understanding of the factors influencing the practice of oral care in intubated patients in the ICU, relying on TPB as an explanatory framework. It would be important to continue to study this professional behaviour and to work in collaboration with health care facilities to promote the importance of oral care as an imperative for the safety and quality of health care. RELEVANCE TO CLINICAL PRACTICE: The results of this study represent a solid foundation for advancing continuing education programmes and intensive care orientation programmes tailored to the needs of nurses.

Implementing and Evaluating the Impact of a Nurse-Led Oral Care Initiative.

BACKGROUND: Nursing interventions in oral hygiene have been shown to be important for health promotion and illness prevention. This medical center advanced a registered nurse (RN)-led oral health initiative to introduce and standardize oral care practices. PROBLEM: To examine the impact of the oral health initiative, we conducted an evaluation of documentation trends among RNs and the effect of the initiative on patients' oral health during hospitalization. APPROACH: We used a single-group pretest-posttest design and drew a sample of all inpatients who were admitted to the medical center from October 1 through December 31, 2017. OUTCOMES: Of the 13 303 patients admitted, the empirical evidence demonstrates 99.5% compliance in documentation at admission and discharge. Among 13 237 patients, there was improvement in patients' oral health during hospitalization (-0.03, P < .001), especially those initially assessed with moderate or severe dysfunction. CONCLUSIONS: The oral health initiative standardized assessment and care practices that have improved outcomes in patients' oral hygiene.

Necesidad de tratamiento estomatológico en niños de la Escuela Especial Jardín de La Alegría, 2016 / Need for stomatological treatment in children of the Special School Jardín de La Alegría, 2016

RESUMEN Introducción: La salud bucal del paciente discapacitado intelectual ha sido una gran preocupación a nivel mundial. Cuba no se escapa de ello, por lo que ha implementado programas que priorizan a este tipo de individuos. Objetivo: Determinar la necesidad de tratamiento estomatológico de los pacientes con discapacidad intelectual según la categoría diagnóstica de la Escuela Especial Jardín de la Alegría. Métodos: Estudio descriptivo transversal realizado en el período comprendido entre 2016-2017. El universo de estudio estuvo constituido por 105 niños que representa la matrícula total de la escuela. El examen clínico de los escolares se realizó en el sillón dental. Para la recolección de la información se confeccionó una planilla encuesta teniendo en cuenta las características del grupo objeto de estudio: edad, sexo, categoría diagnóstica, índice COP-D y ceo-d, índice de necesidad de tratamiento periodontal comunitario, y la higiene bucal mediante el índice de higiene bucal simplificado de Greene y Vermillon. Resultados: La categoría diagnóstica que prevaleció fue el discapacitado intelectual leve con 82,8 por ciento. El 68,6 por ciento de la población estudiada presentó higiene bucal regular. El 67,6 por ciento de los niños presentó enfermedad periodontal, el 59,0 por ciento maloclusión y el 54,2 por ciento caries dental. Según necesidad de tratamiento, el 67,0 por ciento requiere tratamiento periodontal, el 59,0 por ciento tratamiento ortodóncico y el 45,7 por ciento tratamiento conservador. Conclusiones: Existió una alta necesidad de tratamiento periodontal en los individuos con discapacidad intelectual leve(AU)

ABSTRACT Introduction: The oral health of the intellectually disabled patient has been a great concern worldwide. Cuba does not escape this concern by implementing programs that prioritize this type of individuals. Objective: To determine the need for stomatological treatment of patients with intellectual disability according to the diagnostic category of the Jardín de la Alegría Special School. Methods: a cross-sectional descriptive study conducted in the period 2016-2017. The clinical examination of the students was carried out in the dental chair. For the collection of the information a survey form was made taking into account the characteristics of the group under study: age, sex, diagnostic category, COP-D index and ceo-d, index of need for community periodontal treatment, and oral hygiene using the simplified oral hygiene index of Greene and Vermillon. The universe of study was constituted by 105 children that represents the total enrollment of the school. Results: the diagnostic category that prevailed was the mild intellectual disability with 82.8. 68.6 percent of the studied population presented regular oral hygiene. 67.6 percent of the children presented periodontal disease, 59.0 percent malocclusion and 54.2 percent dental caries. According to need of treatment, 67 percent need periodontal treatment, 59.0 percent orthodontic treatment and 45.7 percent need conservative treatment. Conclusions: there was a high need for periodontal treatment in individuals with mild intellectual disability(AU)

Quasi-Randomized Trial of Effects of Perioperative Oral Hygiene Instruction on Inpatients with Heart Diseases Using a Behavioral Six-Step Method.

The assessor-blinded, parallel-design, quasi-randomized study (alternating allocation) aimed to determine the effects of the six-step method on postoperative numbers of oral bacteria, periodontal status, and atrial fibrillation (AF) among inpatients with heart diseases and periodontitis. Seventy inpatients who received preoperative periodontal treatment were quasi-randomly assigned to intervention and control groups at University Hospital. The intervention group received intensive oral hygiene instruction using a six-step method for 15 minutes per week and the control group received routine oral hygiene instruction. Significantly fewer oral bacteria were identified on the tongue at discharge compared with baseline in the intervention than the control group (ANCOVA) (large effect size, p = 0.02). Changes in scores for self-efficacy, plaque scores, probed pocket depth, and bleeding on probing between baseline and discharge were significantly greater in the intervention, than in the control group (p < 0.05). The period of postoperative AF (days) was significantly shorter in the intervention, than in the control group (p = 0.019). In conclusion, oral hygiene instruction using the six-step method decreased the numbers of oral bacteria on the tongue and improved self-efficacy, oral health behaviors, oral hygiene status, periodontal status, and period of postoperative AF among inpatients with periodontitis and heart diseases.

Aging and Oral Care: An Observational Study of Characteristics and Prevalence of Oral Diseases in an Italian Cohort.

Background: Poor oral health is a common condition in patients suffering from dementia. Several aspects of this systemic pathology contribute to causing oral problems: cognitive impairment, behavior disorders, communication and, motor skills deterioration, low levels of cooperation and medical-nursing staff incompetency in the dental field. Objectives: The objectives of this study were to evaluate the prevalence and the characteristics of oral pathology in a demented elderly population, as well as to check the association between the different degree of dementia and the oral health condition of each patient. Materials and Methods: In this observational study (with cross-sectional design) two groups of elderly patients suffering from dementia, living in two different residential care institutions were recruited. The diagnosis of dementia of each included patient was performed using the Clinical Dementia Rating Scale. In order to evaluate the oral health condition of the included subjects, each patient underwent a physical examination of the oral cavity, during which different clinical parameters were analyzed (number of remaining teeth, oral mucosa, periodontal tissues, bone crests). To each parameter, a score was assigned. Spearman's Rho test was used. Results: Regarding the prevalence of oral pathology in elderly suffering from dementia, it emerged that 20.58% of the included patients had mucosal lesions and/or new mucosal formations (in most cases undiagnosed and therefore untreated). The prevalence of periodontal disease was equal to 82.35% and a marked clinically detectable reabsorption of bone crests was found in almost all patients (88.23%). 24.13% of patients, who underwent the oral examination, had totally edentulous maxillae and/or with retained roots, without prosthetic rehabilitations. The correlation index r showed the presence of a linear correlation (inverse relationship) between the degree of dementia and the state of health of the oral cavity of each patient. Conclusions: Several factors contribute to poor oral health in the elderly suffering from dementia: cognitive functions deterioration, behavioral disorders and inadequate medical-staff nursing training on oral hygiene. This study also demonstrated that the lower the dementia degree is, the lower tends to be the oral health status. In order to guarantee a complete assistance to these patients, residential care institutions should include in their healthcare program specific dental protocols.

Knowledge and Practices of Pregnant Women regarding Oral Health in a Tertiary Care Hospital in Nepal.

INTRODUCTION: Poor dental hygiene has been associated with various perinatal complications in studies done worldwide but few studies in Nepal have explored the knowledge of pregnant ladies regarding dental hygiene. The aim of the study was to know the knowledge and practices of pregnant women regarding oral health in a tertiary care center in Nepal. METHODS: A qualitative study was carried out in Nobel Medical College and Teaching Hospital from January 15, 2018 to June 15, 2018 after approval from the Institutional Review Committee of Nobel Medical College. Convenience sampling was done. Fifty pregnant women admitted in antenatal ward were interviewed regarding their knowledge of dental care in pregnancy, the common dental problems they faced and the treatment taken. A predesigned proforma was used and results were analyzed using SPSS version 17. RESULTS: Twenty two (44%) patients reported dental problems during pregnancy. Bleeding gums was seen in 7 (14%) and toothache in 7 (14%) were commonly reported dental problems. Forty seven (94%) patients acknowledged that routine dental care was needed for health, only 6 (12%) were aware that poor dental health could affect baby weight. Oral health not seen as priority in 24 (48%) was the main barrier to seeking dental care in pregnancy followed by costs of treatment in 18 (36%) and safety concerns in pregnancy in 8 (16%) cases. CONCLUSIONS: Though dental problems were a common occurrence in pregnancy, utilization of services was low for the same. The participants reported significant barriers to obtaining dental care including lack of knowledge about the importance of maternal oral health and the treatment costs.

Preoperative oral hygiene recommendation before open-heart surgery: patients' adherence and reduction of infections: a quality improvement study.

Aim: To implement recommendations for oral hygiene before elective open-heart surgery in a thoracic surgery ward and to evaluate whether the number of patients who needed to be treated with antibiotics postoperatively was reduced. Background: Healthcare systems are challenged to implement initiatives that reduce the development of nosocomial infections, to offer patients a safe and cost-efficient treatment and to reduce the use of antibiotics. Previous interventions have focused on staff behaviour in reducing postoperative infections. In this study, patients were recommended to carry out oral hygiene as recommended in a clinical guideline. Methods: A quasiexperimental design with a control and an intervention group was used. Information on adherence to the recommendation was collected at admission. All medical information and prescriptions of antibiotics were obtained from patients' medical records. Data were reported as intention to treat. Results: Altogether 972 patients (506 controls and 466 interventions) were included in the study. Of the intervention patients, 405 (86.9%, 95% CI 83.3 to 89.8) reported that they had adhered to the oral hygiene recommendation. 64 (12.6%) control patients and 36 (7.7%) in the intervention group (p=0.015) were treated with antibiotics postoperatively. Conclusions: It was feasible to involve patients in a programme for oral hygiene and thereby reduce the number of patients needing antibiotics after open-heart surgery and this might contribute to reducing costs.

Back to Basics: CLABSI Reduction Through Implementation of an Oral Care and Hygiene Bundle.

Children with cancer often undergo treatments that render them severely immunocompromised. Side effects of treatment place them at risk for developing oral mucositis (OM), which can potentially lead to infection and bacteremia. Staff nurses on an inpatient pediatric oncology unit noted inconsistent daily oral hygiene practices despite assessing OM consistently. Basic oral hygiene can reduce the severity of OM, and evidence-based bundled care has shown to increase consistency of practice. Based on findings and recommendations from the literature, an oral care and hygiene bundle was developed. The oral care bundle included a soft bristled toothbrush, fluoride toothpaste, twice-daily brushing and sodium bicarbonate rinses, lip balm, and oral moisturizer. The hygiene component consisted of a daily bath or shower and daily linen changes. Education on the rationale and purpose for the use of an oral care and hygiene bundle was provided to the inpatient direct care staff prior to implementation on two inpatient oncology units. Audits were performed to measure the adherence of the oral care and hygiene bundle. Central line-associated bloodstream infections were measured in collaboration with the quality and infection prevention departments. Since the oral care and hygiene bundle was implemented, laboratory-confirmed bloodstream infection rates decreased from 1.05 to 0.54 per 1,000 catheter days, while mucosal barrier injury rates decreased from 2.98 to 1.27 per 1,000 catheter days.

Strategies for preventing ventilator-associated pneumonia: an integrative review.

OBJECTIVE: to identify studies about strategies for prevention of ventilator-associated pneumonia deployed in health services and classify their level of evidence. METHOD: integrative review of the literature, in 7 databases, which included the following descriptors: Prevention and Control AND Pneumonia Ventilator-Associated AND Intensive Care Units AND Bundle AND Patient Care. RESULTS: twenty-three scientific productions were included. Of the preventive measures identified, 9 (39.1%) correspond from three to five strategies. The most frequent were: 22 (95.6%) lying with head elevated, 19 (82.6%) oral hygiene with chlorhexidine and 14 (60.8%) reduction of sedation whenever possible. FINAL CONSIDERATION: the application of measures based on scientific evidence is proven to be effective when carried out in conjunction, impacting the reduction of the incidence of ventilator-associated pneumonia.