Oral hygiene in stroke survivors undergoing rehabilitation: does upper extremity motor function matters?

Background: Traditionally, stroke rehabilitation outcomes are based on indicators of physical function, such measures may underrate the all-inclusive impact of stroke such as oral health.Objectives: To investigate the relationship between upper extremity motor function and oral hygiene status as well as the impact of stroke on Oral Health-Related Quality of Life (OHRQoL).Methods: Sixty stroke survivors were included in this cross-sectional survey. Spasticity and motor function/mobility of the affected upper extremity were assessed using the Modified Ashworth Scale and Action Research Arm Test, respectively. Oral hygiene was assessed using the Simplified Oral Hygiene Index and oral health impact was assessed using the 14-item Oral Health Impact Profile. Pearson's moment correlation coefficient was used to determine the relationship between oral hygiene and upper extremity motor function variables.Results: There were significant relationships between the oral hygiene index and Shoulder muscles spasticity (r = 0.374, p = .01), wrist muscles spasticity (r = 0.352, p = .01), as well as basic mobility (r = 0.423, p = .01). An estimated 8% (n = 5) of study participants have their QoL strongly impacted by their oral health.Conclusions: Upper extremity motor function variables such as spasticity and basic mobility matters in determining oral hygiene status after stroke. Stroke has little impact on oral health-related quality of life.

Endodontic treatment-related antibiotic prescribing patterns of South African oral health professionals.

AIM: To assess the antibiotic prescribing patterns of South African dentists for patients undergoing endodontic treatment. METHODOLOGY: This study used data from 2013 health insurance claims submitted by South African oral health professionals to determine the antibiotic prescribing patterns related to endodontic treatment. A logistic regression model was used to test the fully adjusted statistical significance of the association between the exploratory variables (gender, age group, event type, abscess treatment, chronic health) and the dependent variable (antibiotic prescription). Odds ratios with 95% confidence intervals (CI) are reported, and a 95% CI excluding 1 was considered statistically significant. RESULTS: Almost 10% of endodontic treatments were prescribed an antibiotic. There were no significant differences in prescribing patterns by gender, age and chronic health status. Prescriptions were more common at the preparatory stage (9.4%) of root canal treatment compared to the therapy (4.7%) and canal filling (2%) stages. Patients who received apical surgery (OR = 2.28; 95% CI 1.38-3.76) and treatment of an abscess (OR = 2.57; 95% 1.82-3.63) had a significantly increased odds of being prescribed an antibiotic. Almost three-quarters of prescriptions were for narrow spectrum antibiotics. CONCLUSION: The frequency of antibiotic prescribing by South African dental practitioners for patients undergoing endodontic treatment is relatively low and predominantly involved narrow spectrum antibiotics. It, however, remains important that antibiotics are only prescribed when clinically essential, such as when there are obvious systemic effects. These include fever above 37 degrees, malaise, lymphadenopathy, trismus, increase swelling, cellulitis, osteomyelitis and persistent infection. The wider dissemination and adherence to clear evidence-based prescribing guidelines for antibiotics in this clinical area are important.

Knowledge, attitudes and practices of oral health care workers in Lesotho regarding the management of patients with oral manifestations of HIV/AIDS.

Lesotho has the third highest prevalence of HIV in the world with an estimated 23% of the adult population infected. At least 70% of people living with HIV/AIDS (PLWHA) have presented with oral manifestation of HIV as the first sign of the disease. Oral health workers regularly encounter patients presenting with oral lesions associated with HIV disease and therefore need to have adequate knowledge of these conditions for diagnosis and management. The aim of the present study was to determine the knowledge, attitudes and practices of oral health care workers (OHCW) of Lesotho regarding the management of oral manifestations of HIV/AIDS. A descriptive cross-sectional survey was conducted on all 46 OHCW in 26 public and private care facilities in all ten districts of Lesotho. A self-administered questionnaire was used to gather information. The response rate was 100%. Nearly all (94.7%) agreed that oral lesions are common in people living with HIV and/or AIDS. The majority (91.3%) named oral candidiasis (OC) as the most common lesion found in PLWHA while Kaposi's Sarcoma (KS) (34.7%) and Oral Hairy Leukoplakia (OHL) (32.6%) were mentioned as the least common oral lesions of HIV. Most correctly identified the images of oral candidiasis (97.8%), angular cheilitis (86.9%) and herpes zoster (80.4%). Only 16.7% felt they had comprehensive knowledge of oral HIV lesions, although 84.8% reported having previously received training. Almost three quarters (71%) reported that there was no need to treat HIV positive patients differently from HIV negative patients. OHCW in Lesotho demonstrated high confidence levels in their competence in managing dental patients with oral lesions associated with HIV, however, they lacked an in-depth knowledge in this regard. Amongst this group there is a need for comprehensive training with regards to diagnosis and management of oral lesions of HIV including the training of other cadres of health care workers together with nurses and community health workers.