Qualitative inquiry from multiple perspectives of barriers and facilitators of oral health care for adults with disabilities.

AIMS: Adults with special health care needs (ASHCN) face significant disparities in access to oral health care and subsequent health outcomes, resulting from several etiologies. This study investigated perspectives of patients, caregivers, and providers to better understand care barriers and facilitators for ASHCN. METHODS: We conducted 26 semi-structured interviews with a purposive sample from an academic clinic specializing in oral health care for ASHCN with disabilities [patients (N = 4), caregivers (N = 8), and providers (N = 14)], and thematically analyzed transcripts for care barriers and facilitators. RESULTS: Three overarching themes that encompassed overlapping barriers and facilitators of oral health care for ASHCN emerged: relational aspects, provider training/experience, and infrastructure aspects. Themes include intersecting perceptions of factors that hinder or help oral health care and management of ASHCN. CONCLUSIONS: Building relationships with patients, inherent empathetic provider characteristics, and accommodating clinical infrastructure are imperative to facilitate oral health care for ASHCN. The primary themes revealed in this study are facilitators to care when they are present, and barriers to care when they are absent. No individual theme stands alone as a single contributor to quality care, and the provision of care for ASHCN relies on coordination of providers, patients, caregivers, and the overarching infrastructure.

Impact of disability diagnosis on dental care use for adults in the United States: Status matters.

BACKGROUND: Approximately 25% of adults in the United States have a disability that limits function and independence. Oral health care represents the most unmet health care need. This population has been found to have decreased oral health outcomes compared with the general population. METHODS: The authors used the 2018 adult National Health Interview Survey to assess the association between disability status and dental care use (dental visit within or > 2 years). Disability status was categorized as adults with an intellectual, acquired, or developmental disability (IADD) that limits function, other disability that limits function, or no disability, on the basis of diagnoses of birth defect, developmental diagnosis, intellectual disability, stroke, senility, depression, anxiety, or emotional problem, all causing problems with function. RESULTS: Adults with an IADD with functional and independence-limiting disabilities experienced higher crude odds of going 2 years or more without a dental visit than adults without disabilities (odds ratio [OR], 2.29; 95% CI, 1.96 to 2.67). This association was part of a significant interaction and was stronger among those with IADDs who could afford oral health care (OR, 1.73; 95% CI, 1.47 to 2.14) than among those who could not afford oral health care (OR, 1.21; 95% CI, 0.88 to 1.67; P value of interaction <.01). CONCLUSIONS: Adults with IADDs have decreased access to oral health care compared with adults with other disabilities or without disabilities. The inability to afford oral health care lessens the impact of disability status. PRACTICAL IMPLICATIONS: Dentists can use this study to understand the implications of IADD diagnoses on dental care use and make efforts to facilitate care for these patients.

Considerations for Protective Stabilization in Community General Dental Practice for Adult Patients with Special Healthcare Needs.

Protective stabilization (PS) is a method of medical restraint used for behavior management for children and adults with special needs for dental care. With the increase in availability and options for behavior management techniques, PS has become less popular and more controversial. This scoping review analyzes the use of PS for dental care for adults with special needs within the literature. METHODS: A review of publications between 1990 and 2020 was conducted in Ovid Medline, Embase, and Dentistry and Oral Sciences Source using the search terms as follows: "protective stabilization," "dentistry," "restraint," "patient positioning," and "immobilization," with Boolean operators "AND" and "OR." Articles were screened by title and abstract and included by full read review with consensus from the research team. RESULTS: A total of 298 articles were reviewed and 29 were included as part of the scoping review. The articles include original research, policy guidelines, and clinical commentary reviews. CONCLUSION: There is variable evidence regarding the use of PS as a method of behavioral management for adults with special needs. It is less popular for use due to improvements in alternative methods such as pharmacologic intervention and general anesthesia. PS still has applicable use among this population and is dependent on patient and parental consent, patient selection and safety, and clinician training.

Can extraoral suction units minimize droplet spatter during a simulated dental procedure?

BACKGROUND: Aerosol and droplet production is inherent to dentistry. Potential for COVID-19 spread through aerosols and droplets characterizes dentistry as having a high risk of experiencing viral transmission, with necessity for aerosol and droplet mitigation. METHODS: Simulations of restorative treatment were completed on a dental manikin with a high-speed handpiece and high-volume evacuation suction. Variable experimental conditions with use of an extraoral vacuum suction at different distances from the simulated patient's mouth and different vacuum settings were tested to evaluate extraoral suction ability for droplet reduction. RESULTS: Using the extraoral suction unit during dental procedure simulations reduced droplet spatter at the dentist's eye level, as well as the level of the simulated patient's mouth. When the extraoral suction unit was used at level 10 and 4 inches from the simulated patient's mouth, less spatter was detected. CONCLUSIONS: Extraoral suction units are an effective method of reducing droplet spatter during operative dental procedures and can be useful in helping reduce risk of experiencing COVID-19 spread during dental procedures. PRACTICAL IMPLICATIONS: During the pandemic, dentistry and its aerosol-generating procedures were placed on hold. The process to getting back to patient care is multifactorial, including personal protective equipment, patient screening, and mitigating aerosol spread.

Coordinated pediatric reconstruction and rehabilitation of maxillary central giant cell granuloma: A case report.

BACKGROUND AND OVERVIEW: A 9-year-old girl underwent comprehensive resection and rehabilitation of a central giant cell granuloma that required phased interprofessional collaborative care to optimize treatment decisions and outcome. CASE DESCRIPTION: The interprofessional treatment team included an oral and maxillofacial surgeon, maxillofacial prosthodontist, dentist, orthodontist, and speech-language pathologist, and treatment spanned 9 years. Treatment included surgical resection of a central giant cell granuloma and obturation with a removable interim prosthesis. After adequate growth and development, the patient then underwent a surgical free-tissue transfer reconstruction by using virtual surgical planning, followed by dental implant placement and a transitional restoration, subsequent orthodontic therapy, and eventual definitive rehabilitation with an implant-retained fixed hybrid prosthesis. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The interprofessional phased and collaborative treatment facilitated an optimal functional and esthetic process in a young patient with transitional and definitive treatments that considered long-term quality-of-life implications.

Variability between credit units dedicated to dental and clinical sciences in dental schools across the USA.

PURPOSE: The Commission of Dental Accreditation (CODA) does not set minimum standards for clock hours of training in Dental and Clinical sciences. The purpose of this evaluation was to compare United States (US) dental schools for variability in clock hours. The current paper utilizes the American Dental Association's survey of clock hours of all US dental schools which is publicly available data. Clock hours survey from 2010 to 2011 was utilized and the analysis tool, JMP, was utilized to visualize and report variability. PERSPECTIVE: The current paper highlights the large variation in clock hours of training among core clinical subjects in accredited dental schools around the United States. For example, teaching Physical Evaluations; Oral and Maxillofacial; and Oral Diagnosis and Treatment Planning were 97.0; 126.6; and 74.4 h. Moreover, upper limit for hours of Operative Dentistry teaching was 1410 h and lower limit was 129 h. Various other fields of education do enforce strict requirements on educational clock hours. For instance, Massachusetts' General Law states that both private and public schools must have 900 and 990 h in a school year for elementary and secondary schools, respectively. However, no such stipulation exists in the field of Dental Education. CODA's mission is "to serve the oral health care needs of the public" and CODA must consider if the average dental patient would consider a dentist who attended the school delivering 1410 h of Operative Dentistry to be the same standard as a graduate of the school delivering 129 h.

Measuring working memory is all fun and games: a four-dimensional spatial game predicts cognitive task performance.

We developed a novel four-dimensional spatial task called Shapebuilder and used it to predict performance on a wide variety of cognitive tasks. In six experiments, we illustrate that Shapebuilder: (1) Loads on a common factor with complex working memory (WM) span tasks and that it predicts performance on quantitative reasoning tasks and Ravens Progressive Matrices (Experiment 1), (2) Correlates well with traditional complex WM span tasks (Experiment 2), predicts performance on the conditional go/no go task (Experiment 3) and N-back (Experiment 4), and showed weak or nonsignificant correlations with the Attention Networks Task (Experiment 5), and task switching (Experiment 6). Shapebuilder shows that it exhibits minimal skew and kurtosis, and shows good reliability. We argue that Shapebuilder has many advantages over existing measures of WM, including the fact that it is largely language independent, is not prone to ceiling effects, and take less than 6 min to complete on average.