Dental hygienists and dentists as providers of brush biopsies for oral mucosa screening.

BACKGROUND: Oral cancer is a severe and potentially fatal disease usually starting in the squamous epithelium lining the oral cavity. Together with oropharyngeal carcinoma, it is the fifth to sixth most common malignancy worldwide. To limit the increase in the global oral cancer incidence over the past two decades, the World Health Assembly adopted a resolution urging member states to integrate preventive measures such as engagement and training of dental personnel in screening, early diagnosis, and treatment into their national cancer control programs. AIM: The aim of this study was to investigate if dental hygienists (DHs) and dentists (Ds) in general dental practice care can be entrusted to perform brush sampling of oral potentially malignant disorders (OPMDs), and to evaluate their level of comfort in performing brush biopsies. METHODS: Participants were five DHs and five Ds who received one day of theoretical and clinical training in oral pathology to identify OPMDs (leukoplakia [LP], erythroplakia [EP], and oral lichen planus [OLP]), and perform brush sampling for PAP cytology and high-risk human papillomavirus (hrHPV) analysis. RESULTS: Out of 222 collected samples, 215 were adequate for morphological assessment and hrHPV analysis. All the participants agreed that sample collection can be incorporated in DHs and Ds routine clinical duties, and most of them reported that sample collection and processing was easy/quite easy. CONCLUSION: Dentists and DHs are capable of collecting satisfactory material for cytology and hrHPV analysis. All the participating DHs and Ds were of the opinion that brush sampling could be handled routinely by DHs and Ds in GDP.

Oral health care beliefs among care personnel working with older people - follow-up of oral care education provided by dental hygienists.

OBJECTIVES: The proportion of older people in the population is increasing rapidly. Along with this comes an increase in the number of people requiring assistance in daily living, including oral care. Swedish law stipulates that care personnel who work with older people should be offered oral health education every year. The aim of this study was to investigate oral health care beliefs among such personnel. METHODS: A questionnaire study was conducted among 2167 personnel providing care to older people at special accommodation sites and in home care. Data were collected using the Nursing Dental Coping Beliefs Scale. Descriptive statistics were calculated and logistic regression analysis was performed. RESULTS: Personnel working in home care had lower odds of having an internal locus of control than those working in special accommodation, and personnel with less than 10 years of working experience had lower odds than their more experienced counterparts. Men had higher odds of having an external locus of control than women. CONCLUSIONS: It seems important to ensure that home care personnel and less experienced personnel attend oral care educational sessions, and to encourage male staff to focus on oral care work.

'Caries disease among an elderly population-A 10-year longitudinal study'.

OBJECTIVES: To investigate the prevalence of dental caries and to identify risk factors for dental caries in an elderly population between 2008 and 2018. METHODS: This longitudinal study used data from a questionnaire survey and a clinical examination administered on two occasions 10 years apart to 273 individuals who were 65 and 75 years of age in 2008. The variables included were prevalence of dental caries as well as socioeconomic and socio-behavioural factors. RESULTS: The number of teeth decreased in both age groups by a mean of 2 over the 10-year study period, but the prevalence of dental caries remained stable. Approximately, a quarter of the participants had caries lesions. Toothbrushing once a day or less was the factor most strongly correlated with dental caries lesions (OR: 3.82, 95% CI: 1.68-8.66, p = 0.001), followed by need for homecare (OR: 3.50, 95% CI: 1.55-7.93, p = 0.003) and interproximal cleaning less than once a day (OR: 2.65, 95% CI: 1.36-5.19, p = 0.004). CONCLUSIONS: This longitudinal study revealed no increase in the prevalence of dental caries lesions, indicating that good oral health can be preserved among elderly people. The highest risk for dental caries lesions was among participants with inadequate oral hygiene routines (toothbrushing once a day or less and seldom using interproximal devices) and in need of help in daily living, emphasizing the importance of oral hygiene and collaboration between dental services and community-based health care.

Influence of smoking on periodontal healing one year after active treatment.

OBJECTIVE: To investigate the impact of smoking on the reduction of pockets >4 mm deep and a composite variable of residual pockets >4 mm and bleeding on probing (BoP) after treatment. METHODS: Eligible after exclusion due to missing records were 3,535 individuals, referred for periodontal treatment between 1980 and 2015. The number of teeth (NT), probing pocket depth (PPD), proportion of plaque (PLI) and BoP were registered before treatment and 1 year after treatment. To analyse the impact of smoking on PPD reduction, a mixed model adjusted for age, sex, type of therapy, baseline PPD, reduction of PLI, BoP and NT was used. Depending on residual PPD and BoP, two categories were created: good and poor responders. RESULTS: PLI was reduced by 20% in non-smokers and by 18% in smokers, and BoP by 46% and 37%, respectively. In the adjusted mixed model, the mean reduction of PPD > 4 mm among smokers undergoing surgery was 14.4 versus 9.7 in non-smokers (p < .001). The odds ratio for being a poor responder was 2.40 (95% CI 1.99-2.91, p < .001) for smokers. CONCLUSION: Although surgical treatment reduced PPD >4 mm in smokers more effectively than in non-smokers, significantly more non-smokers were good responders after periodontal therapy.

Prevalence of dental caries and influencing factors, time trends over a 30-year period in an adult population. Epidemiological studies between 1983 and 2013 in the county of Dalarna, Sweden.

OBJECTIVE: The aim of this study was to investigate the prevalence of dental caries in an adult population using four different cross-sectional studies over a 30-year period and to assess its possible associations with socio-economic and socio-behavioural factors. MATERIALS AND METHODS: Four cross-sectional epidemiological studies were performed in the county of Dalarna, Sweden, in 1983, 2003, 2008 and 2013. Random samples of 1012-2244 individuals, aged 20-85 years, who answered a questionnaire about socio-economic and socio-behavioural factors, were radiographically and clinically examined. RESULTS: The proportion of individuals with at least one decayed surface (DS) was 58% in 1983 and significantly lower, 34% in 2008 (p < 0.05) and 33% in 2013; the mean number of DS was 2.0 in 1983 and 1.1 in 2013 in the age group 35-75 (p < 0.05). In the age group 85, the mean number of DS was 1.2 in 2008 and 2.4 in 2013. Adjusted for age and number of teeth, irregular dental visits, limited financial resources for dental care, smoking, education below university, male gender, daily medication and single living were positively and statistically associated with manifest caries. CONCLUSION: The declining trend in the prevalence of manifest caries seems to be broken. In the oldest age group mean number of DS was higher in 2013 compared with 2008, indicating a possible beginning of an increase. This needs special attention as this group increases in the population, retaining natural teeth high up in age. Manifest caries was found to be associated with socio-economic and socio-behavioural factors.

Facilitating children's in-session involvement in child and family therapies: A dynamic framework of clinical practices.

Children's in-session involvement in child and family therapies correlates with both positive and negative treatment outcomes. Thus, it is important to gain a better understanding of the clinical practices that facilitate children's involvement in therapy sessions so that practitioners can employ them with greater precision. To address this need, we conducted a study to answer the following question: What clinical practices facilitate children's in-session involvement in child and family therapies? The data consisted of 16 extant audiovisual recordings of child and family therapy sessions and 24 stimulated-recall interviews with the participants in the recordings. Following constructivist grounded theory and incorporating storyline as an additional analytical technique, we have constructed a framework consisting of four involvement-enhancing practices: managing time, staying relevant, adjusting intensity, and facilitating inclusion. Furthermore, by detailing some of the complex processes that practitioners navigate when they facilitate children's involvement, our study adds a multilayered and dynamic dimension to the list of already established involvement facilitators. It may be used to moderate an overstandardized work culture that continues to characterize services that address children's needs. The results may be applied to other institutional encounters, providing resonance beyond the analyzed therapy sessions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effect of Domiciliary Professional Oral Care on Root Caries Progression in Care-Dependent Older Adults: A Systematic Review.

With care dependency, untreated root caries lesions (RCLs) and irregular dental visits are common. RCLs, if left untreated, could lead to pain, tooth loss, difficulties eating, and impact on general health. Therefore, there is a need for prevention and effective treatment for RCLs, and especially in those with care dependency. The aim of this systematic review was to investigate the effect of domiciliary professional oral care on root caries development and progression, in comparison with self-performed or nurse-assisted oral care. A literature search was conducted in four databases in November 2022. Two authors independently screened the literature throughout the review process. Five of the identified studies were found to be relevant. Four of these were assessed as having moderate risk of bias and were included in the review, while one study had high risk of bias and was excluded from further analyses. Due to heterogenicity of the included studies (and of the interventions and outcomes), no meta-analysis or synthesis without meta-analysis (SWiM) was performed. The participation of dental personnel performing mechanical plaque removal and fluoride, or chlorhexidine application seems beneficial for care-dependent older adults with risk of RCLs development and progression. However, future studies are needed.

Comparison of oral status in an adult population 35-75 year of age in the county of Dalarna, Sweden in 1983 and 2008.

UNLABELLED: The aim was to study the prevalence and distribution of number of teeth, number of intact and decayed teeth and prevalence and distribution of removable dentures and periodontal disease over 25 years 1983-2008. Two cross-sectional studies (EpiWux) were performed in the County of Dalarna, Sweden in 1983 and 2008. In the 1983 study a random sample of 1012 individuals were invited to participate in this epidemiological and clinical study and 1440 individuals in 2008. A total number of 1695 individuals, stratified into geographical areas (rural and urban areas), in the age groups 35, 50, 65 and 75 answered a questionnaire and were also clinically and radiographically examined.The number of edentulous individuals decreased from 15% in 1983 to 3% in 2008. Number of teeth increased from 22.7 in 1983 to 24.2 in 2008 and decayed surfaces per tooth showed a three-time reduction over this period of time. As a consequence of better oral status the prevalence of complete removable dentures in both jaws decreased from 15% in 1983 to 2% in 2008. Individuals with moderate periodontitis decreased from 45% in 1983 to 16% in 2008. CONCLUSION: Covering a period of 25 years the present study can report dramatic improvements in all aspects of dental status that were investigated.This is encouraging for dental care professionals, but will not necessarily lead to less demand for dental care in the future as the population is aging with a substantial increase in number of teeth.

'Periodontal health and disease in an older population: A 10-year longitudinal study'.

OBJECTIVES: To investigate alveolar bone loss (ABL), which is an indicator of periodontitis, and to identify risk factors for ABL in an older population between 2008 and 2018. METHODS: This longitudinal study used data from a questionnaire survey and a clinical examination administered on two occasions ten years apart to 273 individuals who were 65 years and 75 years in 2008. RESULTS: The mean number of teeth decreased significantly over the ten-year study period, while the proportion of individuals with calculus and moderate ABL visible on radiographs increased. For both ages, the number of teeth decreased by a mean of 2 teeth. The proportions of participants reporting poor general health, daily medication, xerostomia, living singly, visiting dental care irregularly and being in need of extra support in their homes all increased over the observation period. CONCLUSIONS: Despite an increased progression of moderate alveolar bone loss, a fairly good dentition and chewing capacity was retained in this older population. However, the individual's age and fragility are important indicators that need to be considered when planning oral health care and the availability of dental care.