The oral health impact of dental hygiene and dental therapy populations: a systematic review.

OBJECTIVES: Oral health-related quality of life (OHRQoL) is pivotal in patient care, reflecting oral health through dental patient-reported outcomes (dPROs). This systematic review aims to outline the 4-dimensional (4-D) impact of OHRQoL within patient populations routinely treated by dental hygiene and/or dental therapy providers, as there is limited literature present for these oral health care professionals. METHODS: The study extracted and analyzed characteristics and multidimensional impact of OHRQoL, using the Oral Health Impact Profile (OHIP) as the primary dental patient-reported outcome measure (dPROM). The search strategy spanned 7 databases: Medline via the Ovid interface (Ovid MEDLINE(R) ALL), Embase via Ovid, Cinahl, APA PsycINFO via Ovid, Dentistry and Oral Sciences Search, Scopus, and Web of Science (Core Collection). It commenced September 2, 2022, with a refinement search on July 5, 2023. English language criteria yielded 645 articles postduplication removal. A screening procedure involving 3 reviewers encompassed title, abstract, and full-text review. RESULTS: After application of inclusion and exclusion criteria, 5 articles were subjected to data extraction, capturing domain-specific information including baseline and follow-up OHRQoL data. An additional set of 13 articles containing summarized OHRQoL data underwent separate analysis. The Joanna Briggs Institute (JBI) critical appraisal tools were utilized for risk bias assessment of the included articles. The 4-D impact scores reported for baseline OHRQoL data, ranged from 3.10 to 4.20 for Oral Function, 0.84-2.70 for Orofacial Pain, 1.70-4.50 for Orofacial Appearance, and 0.44-2.50 for Psychosocial Impact. In follow-up OHRQoL data, the range for Oral Function was 1.52-3.60, Orofacial Pain 0.60-2.10, Orofacial Appearance 0.91-2.25, and Psychosocial Impact 0.10-0.60. CONCLUSIONS: This review highlights a critical call for standardization in OHRQoL data collection for dental hygiene and dental therapy patient populations as only 26% of the predetermined distinct populations were found to have studies completed with 4-D impact of OHRQoL. Moreover, the presence of limited research in describing the multi-dimensional impact in patients routinely treated by these providers shows the urgency of substantive research in this area.

Health topics emerged from brief-motivational interviewing: A randomized clinical trial.

OBJECTIVE: The goal of this study was to analyse transcription of audio recordings to determine health topics that emerged from brief-motivational interviewing (MI) compared to traditional oral hygiene instructions (OHI). METHODS: Fifty-eight periodontal maintenance patients were randomized to a brief-MI or traditional OHI group for a longitudinal 1-year clinical trial. Both groups received four patient education sessions per their assigned group. Audio recordings were transcribed and coded. The overarching themes and subthemes emerged were quantified and reported as the number of instances per participant. Global scores and behavioural counts were compared across baseline, 4, 8, and 12-month research visits using mixed-effect models. RESULTS: Of the six overarching themes, the brief-MI group evoked more topics toward total health. Oral home care behaviours (15 vs. 10.2) and oral diseases/conditions (3.3 vs. 1.9) were discussed more in the brief-MI group compared to the traditional OHI group. This positive outcome for the average number of times a health topic was discussed in the brief-MI group compared to the traditional OHI group continued for the remaining major themes: lifestyle behaviours (1.0 vs. 0.4), nutrition (2.6 vs. 0.8), emotional/mental health (1.8 vs. 0.8) and general health (1.2 vs. 0.4). CONCLUSION: This study identified that brief-MI was a more successful communication approach to increase discussions of oral home care behaviours, oral diseases/conditions, lifestyle behaviours, nutrition, emotional/mental health and general health compared to traditional OHI in individuals with periodontitis.

EXISTING EVIDENCE FOR DENTAL HYGIENE AND DENTAL THERAPY INTERVENTIONS: A DETERMINATION OF DISTINCT PATIENT POPULATIONS.

BACKGROUND: Dental patients seeking care expect to receive treatment options that are supported by evidence-based dental research based on dental patient-reported outcomes (dPROs). In dental hygiene and dental therapy, there is little usage of dPROs and dental patient-reported outcome measures (dPROMs) to assess the four-dimensions of oral health-related quality of life (OHRQoL). In order to assess the current evidence for dental hygiene and dental therapy interventions, the determination of distinct patient populations is essential. AIMS: To determine patient populations that are clinically distinct groups of dental hygiene and dental therapy patients. To provide a preliminary literature search for a systematic review to identify interventions that provide four-dimensional oral health impact information for these patient populations. METHODS: This narrative and methodological manuscript utilizes an allied dental expert panel consisting of two dental hygienists, two dental therapists, and a moderator to generate a list of clinically distinct patient populations within the scopes of dental hygiene and dental therapy. Additionally, a preliminary literature search utilizing PubMed was completed to assess the current research within the scopes of practice of dental hygiene and dental therapy that uses dPROs and dPROMs to assess the four-dimensions of OHRQoL. The patient population list generated by the allied dental expert panel and the patient populations from the articles identified in the preliminary literature search were compared to determine the needed and available evidence for dental hygiene and dental therapy interventions. RESULTS: There were 19 distinct patient populations derived from the allied dental expert panel. Nine of the distinct patient populations were shared in the dental hygiene and dental therapy scopes of practice, six were specific to the dental hygiene scope of practice, and four were specific to the dental therapy scope of practice. From the preliminary literature search, five distinct patient populations had corresponding research. Of those, three distinct populations were shared between dental hygiene and dental therapy, and two were dental hygiene specific. There  : were no distinct patient populations found from the preliminary search specific to dental therapy. CONCLUSION: There is a lack of research in the dental hygiene and dental therapy scopes of practice regarding utilization of dPROs and dPROMs to assess the four-dimensions of OHRQoL. In order to standardize the assessment of OHRQoL, the development of a list of distinct patient populations for dental hygiene and dental therapy interventions is essential. This initiative identifies which populations are lacking evidence and provides a pragmatic approach to conducting a systematic review to assess the four-dimensions of OHRQoL in the field of dental hygiene and dental therapy.

Including the patient's oral health perspective in evidence-based decision-making.

BACKGROUND: How to approach the assessment of patient-perceived oral health is of fundamental importance for the evaluation of clinical and public health interventions because the patient's assessment should be used as an adjunct to objective dental findings in order to decide which interventions work. AIM: This review article aims to provide an overview of the principles, current status, and future outlook for how a patient's oral health perception can and should be assessed. REVIEW FINDINGS: The hierarchical position of dental patient-reported outcomes, oral health-related quality of life (OHRQoL), and dental patient-reported outcome measures within the hierarchical concepts of quality of life and its component, health-related quality of life, is presented. The Mapping Oral Disease Impact with a Common Metric project is outlined as an international effort to describe current approaches to standardize the measurement of oral impact using the four OHRQoL dimensions of oral function, orofacial pain, orofacial appearance, and psychosocial impact. CONCLUSION: Ultimately, these four dimensions of OHRQoL provide a practical and psychometrically solid way to collect and analyze OHRQoL data for all oral diseases in all settings, and eventually for all treatments through the use of a standardized, universal measurement tool. This universal impact metric capturing the patient's oral health perspective is the key to moving evidence-based dentistry and value-based oral health care forward.

Linking patient-reported oral and general health-related quality of life.

Background: The relationship between oral and overall health is of interest to health care professionals and patients alike. This study investigated the correlation between oral health-related quality of life (OHRQoL) and health-related quality of life (HRQoL) in a general adult population. Methods: This cross-sectional study used a convenience sample of adult participants (N = 607) attending the 2022 Minnesota County and State fairs in USA, the 5-item Oral Health Impact Profile (OHIP-5) assessed OHRQoL, and the 10-item PROMIS v.1.2 Global Health Instrument assessed HRQoL. Spearman and Pearson correlations were used to summarize the bivariable relationship between OHRQoL and HRQoL (both physical and mental health dimensions). A structural equation model determined OHRQoL-HRQoL correlations (r). Correlations' magnitude was interpreted according to Cohen's guidelines (r = 0.10, 0.30, and 0.50 to demarcate "small," "medium," and "large" effects, respectively). Results: OHRQoL and HRQoL correlated with r = 0.52 (95% confidence interval, CI: [0.50-0.55]), indicating that the two constructs shared 27% of their information. According to Cohen, this was a "large" effect. OHRQoL, and the physical and mental HRQoL dimensions correlated with r = 0.55 (95% CI: [0.50-0.59]) and r = 0.43 (95% CI: [0.40-0.46]), respectively, indicating a "large" and a "medium" effect. OHRQoL and HRQoL were substantially correlated in an adult population. Conclusion: Using OHIP-5 to assess their dental patients' oral health impact allows dental professionals to gain insights into patients' overall health-related wellbeing.

Efficacy of a Revised Prototype Solution to Facilitate the Removal of Dental Calculus: A follow-up proof-of-concept study.

Purpose The purpose of this follow-up proof-of-concept study was to determine the efficacy of a revised calculus disruption solution in facilitating the removal of both supragingival and subgingival calculus in-vivo, as measured by time, difficulty, and pressure required to remove supragingival and subgingival calculus.Methods Patients from a dental school in Minnesota were recruited to participate in a randomized, split-mouth, cross sectional proof-of-concept study comparing time, difficulty and pressure used with hand instrumentation alone compared to the use of a calculus disruption solution and hand instrumentation. Quadrants were randomized to either treatment or control group. Descriptive and inferential statistics were used to analyze the amount of time used. A paired Student's t-test was used to analyze the primary outcome (α = 0.05). Post-treatment questionnaires were completed by the investigator and participants to score the perceived difficulty and pressure required to remove calculus.Results Thirty participants completed the study. An average of 3.1 minutes less time was needed to remove supra and subgingival calculus in the treatment quadrants although this was not statistically significant (p=0.5757). The secondary outcomes, the investigator and participants' perceived difficulty and pressure used for calculus removal showed either no difference, or slight improvements in the treatment quadrants. Overall, the product was well tolerated by participants.Conclusion Quadrants treated with a calculus disruption solution, required slightly less time than control quadrants for calculus removal with hand instruments although the difference was not statistically significant. Reformulation to increase the viscosity of the solution may improve efficacy. Future studies should include a larger sample size, using multiple operators, and a double-blind study design.

Effect of scaling and root planing with and without minocycline HCl microspheres on periodontal pathogens and clinical outcomes: A randomized clinical trial.

BACKGROUND: This study tests the effects of scaling and root planing (SRP) versus SRP plus minocycline hydrochloride microspheres (SRP+MM) on 11 periodontal pathogens and clinical outcomes in Stage II-IV Grade B periodontitis participants. METHODS: Seventy participants were randomized to receive SRP (n = 35) or SRP+MM (n = 35). Saliva and clinical outcomes were collected for both groups at baseline before SRP, 1-month reevaluation, and at 3- and 6-month periodontal recall. MM were delivered to pockets ≥5 mm immediately after SRP and immediately after the 3-month periodontal maintenance in the SRP+MM group. A proprietary saliva test* was utilized to quantitate 11 putative periodontal pathogens. Microorganisms and clinical outcomes were compared between groups using generalized linear mixed-effects models with fixed effects and random effects terms. Mean changes from baseline were compared between groups via group-by-visit interaction tests. RESULTS: Significant reduction in Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, Prevotella intermedia, Parvimonas micra, and Eikenella corrodens were identified at the 1-month reevaluation after SRP+MM. Six months after SRP with a re-application of MM 3 months after SRP, Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens were significantly reduced. SRP+MM participants had significant clinical outcome reductions in pockets ≥5 mm at the reevaluation, 3- and 6-month periodontal maintenance, and clinical attachment loss gains at the 6-month periodontal maintenance. CONCLUSION: MM delivered immediately after SRP and reapplication at 3 months appeared to contribute to improved clinical outcomes and sustained decreased numbers of Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens at 6 months.

Health Topics Emerged From Brief Motivational Interviewing: A randomized clinical trial.

Purpose The goal of this study was to analyze transcription of audio recordings to determine health topics that emerged from brief-motivational interviewing (MI) compared to traditional oral hygiene instructions (OHI).Methods Fifty-eight periodontal maintenance patients were randomized to a brief-MI or traditional OHI group for a longitudinal 1-year clinical trial. Both groups received four patient education sessions per their assigned group. Audio recordings were transcribed and coded. The overarching themes and subthemes emerged were quantified and reported as the number of instances per participant. Global scores and behavioral counts were compared across baseline, 4, 8, and 12-month research visits using mixed-effect models.Results Of the six overarching themes, the brief-MI group evoked more topics toward total health. Oral home care behaviors (15 vs 10.2) and oral diseases/conditions (3.3 vs 1.9) were discussed more in the brief-MI group compared to the traditional OHI group. This positive outcome for the average number of times a health topic was discussed in the brief-MI group compared to the traditional OHI group continued for the remaining major themes: lifestyle behaviors (1.0 vs 0.4), nutrition (2.6 vs 0.8), emotional/mental health (1.8 vs 0.8) and general health (1.2 vs 0.4).Conclusion This study identified that brief-MI was a more successful communication approach to increase discussions of oral home care behaviors, oral diseases/conditions, lifestyle behaviors, nutrition, emotional/mental health and general health compared to traditional OHI in individuals with periodontitis.