Musculoskeletal disorders and risk indicators for pain chronification among German dentists: A cross-sectional questionnaire-based study.

OBJECTIVES: The aim of this study was to determine the prevalence of musculoskeletal (MS) disorders in practicing German dentists and identify risk factors for pain chronification. METHODS: This was a cross-sectional, quantitative, questionnaire-based study in which the validated German version of the Örebro Musculoskeletal Pain Questionnaire was sent out to practicing German dentists. RESULTS: Of the 8,072 questionnaires sent out, 576 dentists responded (60.2% men, 39.8% women; mean [SD] age, 50 [10.1] years; response rate, 7.1%). Overall, 344 dentists had current pain at 719 pain sites (point prevalence, 59.7%). The risk of chronic pain in dentists with current MS pain was high in 28.5% (n = 98), moderate in 30.5% (n = 105), and low in 41% (n = 141). The multivariate logistic regression analysis showed that specialization in restorative dentistry was associated with a significantly higher risk of experiencing pain chronification (odds ratio [OR], 3.94; P = .008), followed by specialization in pediatric dentistry (OR, 0.35; P = .048). A history of current pain, particularly current leg pain, was predictive of higher chronification risk (OR, 22.0; P < .001) and neck pain (OR, 4.51; P = .001). CONCLUSIONS: Almost two-thirds of practicing German dentists have MS pain, and one-third of these have a moderate through high risk of developing pain chronification. These health problems have an adverse impact on their ability to successfully perform dental services, with the potential for prolonged sick leave, disability, and early retirement. Accordingly, these problems deserve greater attention from the scientific community (identification of risk factors), universities (sensitization and education), and policy makers (development and implementation of appropriate countermeasures for MS disorders in the dental profession). PRACTICAL IMPLICATIONS: Knowing the risk factors associated with acute and chronic MS pain may help dentists take preventive measures and thereby improve their physical well-being and work-related quality of life.

Use of the modified Schirmer test to measure salivary gland hypofunction/hyposalivation: Systematic review and meta-analysis.

Although dry mouth is a relatively common condition, salivary flow is not routinely measured in dental clinical practice. Moreover, existing data regarding the use of the modified Schirmer test (MST) for the screening of dry mouth has not been summarized. This systematic review and meta-analysis, conducted in accordance with the PRISMA guidelines, aimed to determine whether the modified Schirmer test can be used to identify dry mouth. The databases of PubMed, Scopus, ScienceDirect, and CENTRAL (CRD42023393843) were systematically searched to retrieve articles published until 9th November 2023. Among the 343 original articles retrieved, six met the inclusion criteria. A total of 1150 patients, comprising 710 (61.7%) women and 440 (38.3%) men (mean age, 47.1 ± 7.3 years), were included. The meta-analysis revealed a weak correlation coefficient of r ¯ $\bar{r}$  = 0.42 (95% Cl: 0.29-0.55) between MST and the unstimulated salivary flow rate. Therefore, while the MST might offer a simple and accessible alternative for initial screening in the future, especially in non-specialized settings, its variability in sensitivity and specificity, along with an actual lack of standardization, necessitates cautious interpretation. Further studies are necessary before recommending the test in clinical routine.

Use of smartphone photos to document the oral care status of nursing home residents.

OBJECTIVE: Investigate whether clinically assessed oral care status by an external dentist can be replicated using smartphone photographs. BACKGROUND: Many people with care needs have poor oral hygiene. To help maintain oral health, caregivers require a simple way of communicating oral care status to the dental team. MATERIALS AND METHODS: Cross-sectional study in which smartphone photographs of the oral and prosthetic care situation of N = 50 nursing-home patients (mean age 85.6 [SD 6] years, 74% women) were assessed by two blinded, external examiners (D1/D2) and compared with clinical assessments made by the onsite dentist who also took the photographs (D0). Intraoral care status was clinically evaluated using the modified Plaque Index for Long-Term Care (PI-LTC) and Denture Hygiene Index (DHI). The intraclass correlation coefficient (ICC) determined correlations between clinical and photographic findings. RESULTS: The ICC was assessed for the PI-LTC (upper jaw, n = 41; lower jaw, n = 49) and DHI (upper jaw, n = 25; lower jaw, n = 18). The DHI showed excellent reliability between clinical assessment and smartphone evaluation for the determination of positive surfaces (ICC: upper 0.91 [95% confidence interval (CI) 0.83-0.96], P < 0.001; lower 0.95 [95% CI 0.89-0.98], P < 0.001). The PI-LTC showed good reliability between clinical assessment (D0) and D1/D2 for determination of vestibular plaque (ICC: upper 0.84 [95% CI 0.74-0.91], P < 0.001; lower 0.87 [95% CI 0.79-0.92], P < 0.001). CONCLUSIONS: Although limited, this pilot study demonstrated that standardised smartphone photographs can simply communicate the intraoral care status of patients who have difficulties accessing their dentist. This should be considered when planning improved communication between dentists, care recipients, and their support network.

Using the modified Schirmer test for dry mouth assessment: A cross-sectional study.

This study aimed to establish whether the modified Schirmer test could serve as a diagnostic tool for dry mouth, that is, whether it could reliably measure salivary film at selected locations within the oral cavity, and to identify levels of sensitivity/specificity and determine reference values. Therefore, a cross-sectional study (N = 120, mean age 63.5 [SD 13.9] years) was performed. The test was used at five locations (hard palate; buccal mucosa in molar region at 4 mm above occlusal plane; anterior tongue; lower lip; mouth floor), and results were recorded after 1, 2 and 3 min. A statistically significant discriminatory ability of the Schirmer test for the unstimulated salivary flow rates could be shown for the palate (at 3 min), buccal mucosa (at 1 min), mouth floor (at 1 min), and tongue (at 2 and 3 min) (areas under the curve 0.64-0.68), with individual sensitivity/specificity values depending on test location/time points. Thus, the modified Schirmer test has potential to become a simple and reproducible instrument for the detection of dry mouth based on low unstimulated salivary flow rates in dentistry and especially outreach care. Care must be taken concerning intraoral test location and measurement time.

Impact of an interdisciplinary curriculum for dental students (GeriDent-Cologne) on attitudes and awareness towards older people and geriatric conditions.

INTRODUCTION: Training of dental students in the treatment of older patients must also consider the multiple chronic medical conditions that may be present. We developed an interdisciplinary gerodontology training curriculum for dental students (GeriDent-Cologne) to investigate its influence on the attitudes and expectancies of dental students towards the treatment of older patients. MATERIALS AND METHODS: The curriculum (given to fourth-year students) comprised five clinical examination stations that simulated different medical conditions affecting older people. Students were able to experience related issues first hand, express their fears and problems concerning dental treatment in older people and, through discussion with the supervisor, develop strategies to overcome these difficulties and enhance treatment. An extended version of the Los Angeles Geriatric Attitudes Scale was given to fourth- and fifth-year students (who acted as controls) over one semester. RESULTS: Dental students had a positive attitude towards older people, and their attitude did not change after attending the curriculum. However, participating in GeriDent-Cologne had a significant beneficial impact on the feeling of being prepared to treat older people, led to a significantly greater understanding of the impact of medical issues and resulted in a considerably higher level of geriatric clinical knowledge over time. CONCLUSIONS: GeriDent-Cologne led to positive and semester-long changes in awareness and knowledge of specific geriatric problems that influence dental treatment. We recommend the curriculum as a blueprint for the module of senior dentistry implemented in the new German dental licencing regulations.

Evaluation of time and resources required for professional dental cleaning in nursing home residents.

AIM: We aimed to describe time requirements and costs associated with professional dental cleaning (PDC) performed by a dental nurse in one German nursing home, and to reveal potential differences in required time for demented versus nondemented and mobile versus immobile residents. METHODS AND RESULTS: We performed a retrospective, cross-sectional analysis of treatment time and costs, including a transparent, easily adaptable path of action that allows implementation of PDC in nursing homes. Total mean (±SD) treatment time for one session per resident was documented, including differences in demented and immobile residents, and projected treatment costs (€/$) per resident. We found no differences in required time for one PDC (37 ± 11 minutes) in residents with or without dementia (P = 0.803) or, immobile versus mobile residents (P = 0.396). Mean projected treatment costs of PDC were €14.98/$17.07 per resident per cleaning session, resulting in total costs of €13.5 million ($15.4 million). CONCLUSION: Cognitive status and mobility does not affect the mean time required to perform PDC by a dental nurse in nursing home residents. Main cost factor is working time of dental staff; consumable supplies have less impact. Our data may stimulate to include PDC as initial step toward implementation of long-term oral hygiene strategies.