Development of Routine Dental Care for Liver Transplant Outpatients.

BACKGROUND: Liver transplantation has become commonplace for patients with end-stage liver disease. The liver is a bodily organ of great importance, and its dysfunction can cause significant complications throughout the body. Patients with hepatic disease should be able to acquire knowledge of the physiology of the liver via the dental profession, and it is also necessary to modify some aspects of dental treatment even in healthy patients. Problems such as excessive bleeding and hepatotoxicity caused by some of the drugs used in dental treatment can lead to a decrease in systemic health. Otherwise, patients with liver disease will have poorer oral health than the general population. Thus, it is important to have well-established routine dental care in this patient group and offer management of oral health in view of the effects of liver disease. METHODS: The objective of this work was to undertake a bibliographic review of the dental approaches to patients with liver disease and liver transplant recipients and to propose a dental care routine for such patients in an outpatient setting. RESULTS: A search was carried out on the main scientific databases (PubMed, Medline, and SciELO) for publications related to this subject and, particularly those published after 2010. The articles selected describe poor oral hygiene among patients, independent of the etiology of their liver disease. These patients also had a high index of xerostomia, caries, periodontal disease, apical lesions, and fungical infections. To control bleeding during and after surgery, hemostatic measures must be understood and adopted. CONCLUSION: There are no data about routine dental care among liver disease/transplantation patients. Thus, our findings will hopefully encourage other services to structure their approaches and consider enhancing their dental care protocols for patients with liver-related complications.

The virtual dental home: a critique.

The Virtual Dental Home is a concept of the Pacific Center for Special Care of the Arthur A. Dugoni School of Dentistry in San Francisco. It is designed to improve access to dental care for underserved populations, specifically children and institutionalized adults. This article describes the development and implementation of the Virtual Dental Home, subsequently critiquing the concept. The criteria for a dental home are not met by the program. It is the equivalent of a traditional public oral health prevention and screening program, with the additional dimension of allowing dental hygienists and assistants to place interim glass ionomer restorations in dental cavities. The critique questions the need to insert a "cloud" dentist into the process. The routine utilization of radiographs is also challenged. The VDH not only lacks the attributes of a dental home, it has not been shown to be as efficient and effective as traditional programs staffed by dental hygienists and dental therapists. The article concludes by describing how programs utilizing dental therapists could address the deficiencies of the Virtual Dental Home, effectively improving access to oral health care for underserved populations.

Dental care in Texas: An opportunity for implementing a comprehensive and patient-centric approach with special emphasis on cancer patients and survivors.

OBJECTIVE: To examine practices of dentists in Texas providing dental/oral care to cancer patients. METHOD: Dental providers in Texas were invited via email to participate in an exploratory cross-sectional study. A non-probability voluntary convenience sampling procedure was used to recruit the sample. The online, anonymous, self-reported survey included questions to capture demographics, type of dental practice, services provided, and number of cancer patients. The study was approved by the Institutional Review Board of The university of Texas MD Anderson Cancer Center. RESULT: A total of 655 dentists completed the questionnaire items. Results revealed that 62% of the respondents were 51-65 years old, predominantly (68%) male, Caucasian (81%) with their dental degrees awarded in the state of Texas (77%). 91% of the dentists provide dental care to patients who are currently undergoing cancer treatment or have a history of cancer. However, 80% of the dental providers do not teach oral self-exam to their patients, which may include cancer survivors or those undergoing cancer treatment, while 32% dentists do not deliver brief interventions for effectively motivating and assisting tobacco users to quit. CONCLUSION: Because Texas, especially Houston, is known for world-class cancer care, dentists in the state are more likely to provide dental care to oncologic patients, especially emergency dental procedures in cancer patients facing some of the side effects of cancer treatment. Careful monitoring of oral health and reducing tobacco use are especially important during and after cancer therapy to prevent, detect, and treat complications as soon as possible. A further step in oral care for cancer patients and survivors is to train patients how to perform regular oral self-examination and to provide tobacco users with cessation counseling as part of their dental/oral treatment. These simple but comprehensive approaches, along with regular dental visits, will positively impact the health-related outcomes for cancer patients, enhancing both survival and quality of life.

Managing Bariatric Patients in Dentistry.

Obesity is a growing issue across the world, presenting a range of challenges to society. Management of obese or bariatric patients in the dental environment has become more commonplace. This article considers an overview of obesity, reviews its dental impact and offers some solutions to minimising those challenges in the dental setting.

Collaboration, focus drive transplant success rate at Northwest Kidney Centers.

The first step toward creating a successful transplant culture like we have in Seattle is having leaders who understand that transplant truly is the best option for certain patients. A dialysis organization must create infrastructure that addresses patients' needs before, during and after transplant. Patient education and IDT involvement are essential. And working in collaboration with local transplant programs, other health care providers and community partners can propel such an initiative to success.

Oral health status of individuals with cerebral palsy at a nationally recognized rehabilitation center.

Cerebral palsy (CP) is a set of nonprogressive neuromuscular disorders caused by defects in the developing fetal brain. The aim of this study is to investigate the prevalence and distribution of various dental conditions including dental caries and periodontitis among individuals with CP who receive care at the Rancho Los Amigos National Rehabilitation Center dental clinic. Medical records of 478 patients between the ages of 3 and 78 years were reviewed. Patients were divided into four age groups: 3-20, 21-35, 36-55, and 56 and above year old. Data related to their dental conditions including caries, periodontitis, and other oral diseases were assessed. Statistical analyses were conducted to evaluate the correlations between these oral diseases and age, gender, ethnicity as well as their living conditions (home or group home). The 36-55-year-old age group displayed significantly more caries and periodontitis than any other age groups. Individuals aged 3-20 years showed a significantly lower rate of periodontitis and caries. There was no significant association between gender and race with these outcome variables but there was a correlation between these variables and living conditions. Differences in oral health exist among people with CP from different age groups and living conditions. These findings suggest that there is a dire need for more oral hygiene training and education for the care givers. Dental schools should better prepare their graduates to meet the treatment demands of individuals with special healthcare needs.

Gingival evaluation of the pediatric cardiac patient.

PURPOSE: Children with congenital cardiovascular diseases (CCDs) who suffer from dental diseases have an increased risk of infective endocarditis. In the light of recent evidence, oral inflammatory diseases may also increase the severity of their cardiovascular condition. The purpose of this study was to evaluate the gingival status of children with congenital cardiovascular diseases in comparison to healthy children. METHODS: Fifty 7- to 13-year-old children were included. The test group comprised 25 CCD children subdivided into three groups: (1) unrepaired ventricular septal defect; (2) aortic valve stenosis; and (3) coarctation of the aorta. The control group consisted of 25 healthy age- and gender-matched children. Gingivitis, plaque, calculus, and recession were measured on six sites per tooth on 12 teeth. RESULTS: CCD children had significantly more gingivitis (P<.001), plaque (P<.001), recession (P>.02), and calculus (P<.001) than controls. Among the CCDs groups, no statistically significant differences were found for gingivitis, plaque, or recession. CONCLUSIONS: Children with congenital cardiovascular diseases had a higher prevalence of periodontal disease, evidenced by gingivitis, plaque, calculus, and recession. These children should be evaluated periodontally and their oral health monitored on a 3-month basis to prevent disease development, benefit cardiovascular condition, prevent endocarditis, and improve quality and longevity of life.

Oral health resources for cancer patients in Texas.

Over 1.4 million new cases of cancer are diagnosed each year, and many of these patients will, by necessity, be treated in private practice, including dental practice. Dental professionals play a key role in helping patients understand that good oral care can prevent or reduce oral complications. Treatment of oral cancers and other malignancies cause oral sequelae that can compromise patients' quality of life and dictate reduction or discontinuation of optimal therapeutic regimens, which in turn reduces the odds of long-term survival. This can be prevented or better managed if dental and medical health care providers work together. The purpose of this article is to identify the cancer centers associated with dental clinics and the dental practitioners in the state of Texas, including maxillofacial prosthodontists, with training and/or a special interest in providing oral care to cancer patients. To be included on the list, which will be available on the Dental Oncology Education Program (DOEP) Web site (doep.org), please contact Grady Basler at the DOEP office (grady@doep.org), or the Department of Public Health Sciences (214-828-8350).

Increasing access to oral health care for people living with HIV/AIDS in rural Oregon.

Access to oral health care for people living with HIV/AIDS is a severe problem. This article describes the design and impact of an Innovations in Oral Health Care Initiative program, funded through the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance (SPNS) program, that expanded oral health-care services for these individuals in rural Oregon. From April 2007 to August 2010, 473 patients received dental care (exceeding the target goal of 410 patients) and 153 dental hygiene students were trained to deliver oral health care to HIV-positive patients. The proportion of patients receiving oral health care increased from 10% to 65%, while the no-show rate declined from 40% to 10%. Key implementation components were leveraging SPNS funding and services to create an integrated delivery system, collaborations that resulted in improved service delivery systems, using dental hygiene students to deliver oral health care, enhanced care coordination through the services of a dental case manager, and program capacity to adjust to unanticipated needs.

Tooth agenesis in patients referred to an Irish tertiary care clinic for the developmental dental disorders.

PURPOSE: This study was carried out to determine the prevalence, severity and pattern of hypodontia in Irish patients referred to a tertiary care clinic for developmental dental disorders. MATERIALS AND METHODS: Details of 168 patients with hypodontia referred during the period 2002-2006 were entered in a database designed as a national record. Tooth charting was completed using clinical and radiographic examinations. The age of patients ranged from 7-50 years, with a median age of 20 years (Mean: 21.79; SD: 8.005). RESULTS: Hypodontia referrals constituted 65.5% of the total referrals. Females were more commonly affected than males with a ratio of 1.3:1. The number of referrals reflected the population density in this area; the majority were referrals from the public dental service. Mandibular second premolars were the most commonly missing teeth, followed by maxillary second premolars and maxillary lateral incisors; maxillary central incisors were the least affected. Symmetry of tooth agenesis between the right and left sides was an evident feature. Slightly more teeth were missing on the left side (n = 725) than on the right side (n = 706) and in the maxillary arch (n = 768) as compared to the mandibular arch (n = 663). Some 54% of patients had severe hypodontia with more than six teeth missing; 32% had moderate hypodontia, with four to six teeth missing. The most common pattern of tooth agenesis was four missing teeth. CONCLUSION: Hypodontia was a common presentation in a population referred to this tertiary care clinic. The pattern and distribution of tooth agenesis in Irish patients appears to follow the patterns reported in the literature.

Satisfaction with dental case management among people living with HIV/AIDS.

We evaluated access to and satisfaction with dental services for people living with HIV/AIDS receiving services from a dental case manager (DCM). People living with HIV/AIDS who had received dental services at two Community Dental Centers on Cape Cod, Massachusetts were eligible to participate in a mailed, anonymous return, Dental Satisfaction Survey (N = 160). Overall, respondents were satisfied with the dental care they had received. Most patients (58%) were new to the practice and were more likely to report that they had not been seen by a dental provider for more than 12 months (OR 3.0, P = 0.044). The majority of respondents reported that they heard about the clinic from local agencies. Of respondents recognizing they had a DCM, almost all answered that their DCM had helped them receive the care they needed. Respondents who agreed that they sometimes avoided going to the dentist due to pain were significantly more likely to report that they had a dental case manager than patients who disagreed (OR 3.42, P = 0.027). When patients were asked how their DCM had helped them, themes identified included: assisting with access to dental care, conducting a needs assessment, and providing comfort. People living with HIV/AIDS often have unmet needs regarding dental care. The addition of the DCM to the dental facility appears to facilitate access to dental care for those connected to medical care through community outreach/partnerships and provides some respondents with an identified dental advocate.

Oral health and HIV infection: a chronic disease model.

HIV disease is now considered a chronic illness requiring continued management and monitoring. However, for those with poor access to anti-retroviral medications, the disease continues to be associated with higher morbidity and mortality. With the expansion of the HIV pandemic into vulnerable subpopulations, HIV care requires coordinated and integrated care for a complex mix of psychosocial and clinical services that must include oral health care.

Community-based dental partnerships: improving access to dental care for persons living with HIV/AIDS.

Access to oral health care for persons living with HIV/AIDS is limited. Academic dental institutions can play a significant role in addressing the problem. The purpose of this article is to describe the design and impact of the Community-Based Dental Partnership Program (CBDPP), a federal program created to reduce dental care access disparities for persons living with HIV/AIDS through education and training of students and residents in underserved communities. CBDPP forms collaborations between participating dental education programs and community health organizations. Data for this report were drawn and analyzed from site visits, site visit reports, focus groups, and program data reports. In 2007, 4,745 individuals received oral health services through this program, an increase of 47 percent from 2004, the first year of full program operations. The number of dental providers who delivered oral health services grew from 766 in 2004 to 1,474 in 2007. Providers acquired skills, developed self-confidence, and overcame stereotypes in managing the oral health needs of persons living with HIV/AIDS. Community partners reported expanded dental care capacity to meet the unmet oral health needs of their service populations. CBDPP has had a positive impact on access to dental care and training of providers in HIV and oral health.

[Oral hygiene in haemodialyzed patients with chronic renal failure]. / Higiena jamy ustnej u hemodializowanych chorych na przewlekla niewydolnosc nerek.

UNLABELLED: The present study aimed to assess the oral hygiene in haemodialyzed patients with chronic renal failure (CRF). MATERIAL AND METHODS: 44 haemodialyzed patients with CRF were analyzed (18 F and 26 M, mean age 47.4 +/- 1.6). In all patients a stomatological examination and dental panoramic x-ray were performed. The presence of chronic periodontal disease (CP) and an approximal plaque index (API) were assessed. RESULTS: Chronic periodontitis was found in 17 patients (39%), whereas in 27 (61%) patients periodontal disease was not present. Oral hygiene assessed by API was not satisfactory in 50%, while very good only in 11% haemodialyzed patients. Patients with periodontal disease were characterized by worse API than patients without periodontitis. CONCLUSION: Oral hygiene status is unsatisfactory in most of haemodialyzed uremic patients.

Policy for prevention of oral manifestations in HIV/AIDS: the approach of the WHO Global Oral Health Program.

The HIV/AIDS pandemic has become a human and social disaster, particularly affecting the developing countries of Africa, Southeast Asia, and Latin America. By the end of 2004, about 40 million people were estimated to be infected by HIV globally. The health sectors in many affected countries are facing severe shortages of human and financial resources, and are struggling to cope with the growing impact of HIV/AIDS. In most developed countries, the availability of antiretroviral treatment has resulted in a dramatic reduction in HIV/AIDS-related mortality and morbidity. In contrast, in the developing countries, there is little access to treatment, and access to HIV-prevention services is poor. The '3 by 5' initiative was launched by the WHO and UNAIDS in 2003 with the aim of providing antiretrovirals to three million people in developing countries by the year 2005. HIV infection has a significant negative impact on oral health, with approximately 40-50% of HIV-positive persons developing oral fungal, bacterial, or viral infections early in the course of the disease. Oral health services and professionals can contribute effectively to the control of HIV/AIDS through health education and health promotion, patient care, effective infection control, and surveillance. The WHO Global Oral Health Program has strengthened its work for prevention of HIV/AIDS-related oral disease. The WHO co-sponsored conference, Oral Health and Disease in AIDS, held in Phuket, Thailand (2004), issued a declaration calling for action by national and international health authorities. The aim is to strengthen oral health promotion and the care of HIV-infected persons, and to encourage research on the impact that HIV/AIDS, public health initiatives, and surveillance have on oral health.

Implications of HIV disease for oral health services.

This paper, by means of a quality framework, reviews health services research in relation to people with HIV infection. The relevance of oral health care services to people's needs is considered in terms of the goal of health services to reduce the burden of disease on the everyday life of the population. Dental services may therefore have a role in primary prevention in the HIV epidemic, passing on information about HIV and promoting health through the early diagnosis and treatment of oral disease. Effectiveness research of oral health care in HIV assesses the usefulness of oral diagnosis, whether care is safe, and whether treatment is clinically effective. Few data are available on the efficiency of services. People with HIV still have problems accessing dental care, due to the volume of care available in relation to their need and acceptability of care. Access problems in the US are compounded by social inequality. Health services research data are particularly sparse in resource-poor countries, and there is a need to translate the available information into treatment guidelines appropriate to these settings. The research community and funding agencies should place greater emphasis on the quality of oral health services for people with HIV.