Survey on the attitudes of dental hygiene students towards treating elderly patients.

OBJECTIVE: This questionnaire-based survey assessed the attitudes of dental hygiene students towards treating elderly patients. METHODS: The 14-item UCLA 14-item Geriatrics Attitudes Scale (GAS-14) questionnaire was used in this survey. A further set of nine questions evaluated the opinions of the students towards the existing geriatric curriculum in their respective institutions. Students from five dental hygiene schools from three countries (Switzerland, Belgium and Canada) participated in this survey. General demographic information from the participants was collected. Mean GAS-14 scores were calculated; ANOVA and Bonferroni's tests were used for statistical analyses (p < 0.05). RESULTS: Three hundred eighty-five students (Switzerland: n = 157, mean age = 25.38 ± 4.6 years; Belgium: n = 82, mean age = 27.58 ± 12.8 years; Canada: n = 146, mean age = 25.95 ± 12.3 years) completed the survey for a response rate of 86.3%. The overall GAS-14 scores for Switzerland, Belgium and Canada were 3.61 ± 0.42, 3.24 ± 0.37 and 3.32 ± 0.36, respectively. Switzerland scored significantly higher than Belgium and Canada (p < 0.0001). Overall scores revealed a significant effect of progressive training (p = 0.010). The GAS-14 score was influenced by the nationality of the participants (p < 0.0001), but not influenced by sex, age, origin, religion, or marital and accommodation statuses. Majority of the students (75.8%) agreed that geriatric dentistry was an important part of their education. 77.4% agreed that they would like hands on experience in treating the elderly patient during their education. 85.1% of the participants considered mobile dental clinics as a good solution for the provision of dental care to the institutionalized elders. CONCLUSIONS: The general attitudes of DH students towards treating the elderly patients are on an acceptable level and improved as they progressed through their dental hygiene academic programmes.

Effects of multisensory environment/stimulation therapy on adults with cognitive impairment and/or special needs: A systematic review and meta-analysis.

AIM: This review aimed to evaluate the effects of multisensory environments/stimulation (MSE/MSS) therapy, on the behavior and psychological symptoms in adults with cognitive impairment and/or special needs. METHODS: Online database searches were performed to identify studies reporting on the effects of MSS/MSE therapy in adults (>18 years). Data were extracted for the following investigated outcomes including anxiety, depression, mood, behavioral attributes, biomedical parameters, cognition, motor skills, quality of life (QoL), pain, and end of life quality. Two reciprocally blinded investigators extracted the data. Inter-investigator reliability (𝝹) was calculated. A meta-analysis and a qualitative analysis were performed on the information extracted. RESULTS: Thirty-six studies were included for data extraction and analysis. Meta-analysis of the included studies revealed a significant improvement with the MSE/MSS therapy, for agitation (p = .018), anxiety (p = .023), cognition (p < .001), and depression (p < .001). MSS/MSE therapy demonstrated a tendency for the improvement of the QoL in adults (p = .05). CONCLUSION: MSE/MSS therapies are beneficial in cognitively impaired adults and improve their anxiety, depression, cognitive and other behavioral attributes such as agitative behaviors. Promoting these therapies in geriatric care may help to improve/reduce the challenging/care-resistant behaviors in adults and facilitate effective provision of the necessary care.

Caries management using silver diamine fluoride and providing domiciliary dental care for dependent older adults: A qualitative study of Swiss dentists.

OBJECTIVES: Maintaining the oral health of dependent older adults is challenging, with limited access to dental care and limited focus on preventive oral health programmes. This study aimed to evaluate the attitudes of General Dental Practitioners (GDPs), working in Switzerland, to caring for dependent older adults with a focus on the use of silver diamine fluoride (SDF) as a caries preventive agent and more widely on the provision of domiciliary dental care (DDC). METHODS: Seventeen GDPs working in Switzerland were interviewed. Each interview was semi-structured by a topic guide, digitally recorded, and transcribed. The transcribed data were analysed using a thematic analysis. RESULTS: Three major themes to the widespread use of SDF in this population were identified: lack of basic knowledge including indications for use; aesthetic concerns and product availability. Those who had knowledge about the product believed that using it in the treatment of frail older adults had advantages, especially in the preservation and/or prolongation of the life of teeth without invasive treatments. The biggest barrier was its availability. The GDPs identified three major barriers related to DDC provision: lack of infrastructure, poor financial rewards and safety concerns (patient and operator safety). Those who provided this service stated that they were doing it because of self-motivation, kindness, or as a role in community service. CONCLUSIONS: The potential use of SDF was viewed positively by the majority of the GDPs interviewed but confusion exists over its availability in Switzerland, and other barriers were identified to more widespread use in this patient group. The GDPs interviewed in this study reported that a lack of infrastructure and a low level of remuneration continue to be barriers to more of them undertaking DDC for dependent older adults.

Silver Diamine Fluoride (SDF) in the management of root caries in elders: a systematic review and meta-analysis.

This systematic review was undertaken to address the PICO question: Is silver diamine fluoride (SDF) effective in preventing and arresting root caries lesions in (RCLs) elders? Systematic literature searches were conducted of electronic databases [PubMed, Embase, and CENTRAL (Cochrane Controlled Register of Trials)] and hand searches were performed to identify studies reporting on the use of SDF in elders to prevent and arrest root caries. Prospective clinical studies were included. Two independent investigators performed the literature search and data extraction. A total of 277 studies were identified; of those 3 randomized controlled clinical trials were included for data extraction and analysis. A meta-analysis, using a fixed-effects model, was performed on the mean active RCLs present after SDF intervention compared to controls at 24 months (3 studies), and 30-36 months (2 studies) post-intervention. The fixed-effects model revealed a significant decrease in the mean new active RCLs post intervention with SDF compared to controls at both 24 months (95%CI: 0.265 - 0.638; I2=0.0%; Overall: Z=4.749, p<0.001), and at 30-36 months (95%CI: 0.329 - 0.812; I2=0.0%; Overall: Z=4.629, p<0.001). A funnel plot ruled out any publication bias and the risk of bias was judged to be low. This systematic review and meta-analysis provides evidence that the application of silver diamine fluoride prevents and arrests root caries in elders.