Oral health promotion and labour market prospects of socially disadvantaged and unemployed people - a randomised controlled trial.

BACKGROUND: Previous studies indicate that poor oral health may constitute a barrier for labour market success. This study examines whether an oral health promotion intervention has an effect on economic self-support, and proximity to the labour market, among socially disadvantaged unemployed people. METHODS: From April-June 2018, we enrolled 273 vulnerable people on welfare benefits into a randomised controlled trial. Participants were allocated to either control (n=159), or intervention (n=114). Intervention consisted of individual support to improve individuals' oral health by reducing significant barriers to dental care. Ten participants were excluded, leaving 263 participants (intervention n=110, control n=153) for analyses. A national register was used to assess economic self-support and proximity to the labour market within 1.5 years post-intervention. Items of information on health and socio-demographics were obtained from a questionnaire and from national registers. Logistic and multiple linear regression modelling was performed. RESULTS: Overall, higher frequencies of economic self-support and proximity to the labour market were found in the intervention group, although no significant results were seen for economic self-support alone. Adjusted models revealed significantly higher odds (odds ratio=1.85, 95% confidence interval 1.08-3.17) among the intervention group of achieving proximity to the labour market after 12 months. After 18 months, the intervention group had on average obtained 5 more weeks (95% confidence interval 0.02-9.99) with proximity to the labour market. CONCLUSIONS: Overall, the oral health promotion intervention had a positive effect on proximity to the labour market in the intervention group, especially within the first year of the study. Our findings suggest that interventions promoting oral health among socially disadvantaged and unemployed groups may contribute to social rehabilitation.

Improving oral health in nursing home residents: A cluster randomized trial of a shared oral care intervention.

OBJECTIVES: To compare a designated shared oral care intervention in a group of public nursing home residents with a standard oral care programme, focusing on levels of oral plaque and oral inflammation. METHODS: A cluster randomized field trial was undertaken in 14 Danish public nursing homes. There were 145 participants included in the intervention group and 98 in the control group. We undertook a six-month intervention based on the principle of situated interprofessional learning. The primary outcomes were plaque and inflammation levels measured with the mucosal plaque index (MPS); this was assessed at baseline, after three and six months (end of intervention), and at follow-up (six months postintervention). The odds ratios (OR) and 95% confidence intervals (CI) were estimated with ordinal regression. RESULTS: Socio-demographic characteristics and oral health status at baseline were comparable between the two groups, with the exception of age: the intervention group were significantly younger than controls (median 82 vs 87 years). After three and six months, those receiving the shared oral care intervention had significantly lower plaque and inflammation than the control group. The adjusted ORs for a reduction in MPS were 11.8 (CI: 6.5-21.3) and 11.0 (CI: 5.8-20.9), respectively. At follow-up, plaque levels and oral inflammation had approached the pre-intervention level, with no remaining statistically significant group differences. CONCLUSIONS: The shared oral care intervention based on a situated learning perspective was effective in improving oral health among care home residents. However, after termination of the intervention, the effect quickly decreased. This confirms the challenges of achieving long-term improvement in oral health in nursing home residents. An implementation strategy focusing on achieving changes at both organizational and individual levels with persistent attention to oral health care seem required for long-term improvement.

Toothbrushing compliance tracking in a nursing home setting using telemonitoring-enabled powered toothbrushes.

Introduction Nursing home residents with cognitive and physical disabilities often depend on assistance from caregivers to perform personal hygiene tasks including toothbrushing. Only a minority receives the care needed and toothbrushing compliance levels are not registered.Aims To describe toothbrushing compliance levels in a nursing home setting and investigate the relevance and practicality of using telemonitoring-enabled powered toothbrushes for automated compliance tracking. Furthermore, to investigate changes in plaque and bleeding scores.Materials and methods Nursing home residents were provided with powered toothbrushes and telemonitoring gateways. Toothbrushing frequency and duration were automatically recorded by the telemonitoring gateways, and an email report was sent once a week to the nursing home manager. Plaque index and bleeding index were assessed by dentists at baseline, at the end of the intervention and at three months post-intervention.Results Data from 20 participants for 100 days (3,920 measurements) were collected and used to evaluate toothbrushing compliance. A minority of toothbrushings (5%) were in compliance with the two-minute toothbrushing duration recommendation, while around 30% achieved the one-minute toothbrushing minimum duration recommendation. Around 25% of participants would get only one toothbrushing per day, while 40% would get none. Both plaque and bleeding scores improved significantly during the project, but all progress was lost three months after the project's end.Conclusions It is relevant and practical to monitor toothbrushing compliance in the nursing home setting using telemonitoring-enabled powered toothbrushes. Despite finding limited compliance levels, a significant improvement in the plaque and bleeding index was found after the intervention, which was lost again three months after the telemonitoring gateways had been removed.

Patterns of dental services and factors that influence dental services among 64-65-year-old regular users of dental care in Denmark.

OBJECTIVES: To describe the pattern of dental services provided to 64-65-year-old Danes who are regular users of dental care over a 5-year period, to analyse whether this pattern is associated with socio-demographic and/or socioeconomic factors, and if different uses of dental services are related to dental status and caries experience. Finally, to discuss the future planning of dental services aimed at the increasing population of elderly citizens. [Correction made on 21 March 2014, after first online publication: The sentence 'Data on elderly's dental service are scarce, although increased use is seen and more teeth are present in this age group.' was removed.] METHODS: A cross-sectional study of all aged 64-65 (n = 37 234) who received a dental examination in 2009 was conducted. Clinical data comprised dental services received under the National Health Insurance reimbursement scheme, dental status and DMFT. Geographical, socio-demographic and socioeconomic data derived from public registers. RESULTS: Almost all received restorations, while periodontal treatment was received by <50% during 5 years. Heavy use of dental services was dominated by periodontal services. Periodontal services were most prevalent in the capital and the most affluent areas. Relatively more extractions were related to low income and persons in least affluent areas. Total number of services was highest among women, persons with ≥20 teeth, persons living in the capital, and where the ratio user per dentist was low. CONCLUSION: For future planning of dental care for elderly, dental status, geographical and social area-based factors and to some degree gender, income, and education must be taken into consideration as all these factors seem to influence the future demand for dental services.

A register-based study of variations in services received among dental care attenders.

OBJECTIVES: To investigate whether receipt of dental services, among attenders, reflects variations in dental health or whether and to what degree it is associated with socioeconomic status, with irregular or regular dental attendance and with the availability of dentists in residential areas. MATERIALS AND METHODS: This retrospective register-based study followed two Danish cohorts, aged 25 and 40, with a dental examination in 2009 (n = 32,351). The dental service data were registered during 2005-2009. The number of dental examinations, individual preventive services (IPS), tooth extractions, root fillings and composite fillings were analyzed in relation to socioeconomic status, irregular/regular dental attendance, inhabitant/dentist ratio and to DMFT at age 15 (DMFT15) and change in DMFT (ΔDMFT) from age 15 to age 25 and age 40, respectively. Poisson regression and negative binomial regression analyses were used. RESULTS: The variations in number of services received in the study population were small (SD = 0.2-2.7). However, with a few exceptions, high levels of DMFT15 and ΔDMFT were associated with receipt of more dental services. Socioeconomically-privileged individuals received more dental examinations but fewer tooth extractions, root fillings and composite fillings compared to disadvantaged persons, when controlled for dental health levels. Irregular attenders received fewer IPS and composite fillings but had more extractions compared to regular attenders. CONCLUSIONS: Variations in dental care services were found to reflect variations in dental health, but the variations were also related to individual socioeconomic status, residential area and dental attendance patterns.

A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark.

AIM: To describe the oral health and the oral-health-related quality of life (OHRQoL) of citizens in Copenhagen City on admission to a specific oral health-care programme for disabled elderly persons. Further, to analyse how various factors influence the oral health and the OHRQoL among these patients. METHODS: A cross-sectional study of 189 persons (average 85 years) consecutively admitted to a special oral health-care programme. Clinical data and data from interviews comprising social factors, life-style, dental visit habits, oral hygiene practices and self-perceived oral health were collected. A modified index on perceived dysfunction, discomfort and disability due to oral disorders was used. RESULTS: Sixty-eight per cent had natural teeth, among those 57% had decayed teeth and two out of three wore dentures. Smoking habits influence the number of teeth present and the OHRQoL (p < 0.05) of the patients. Edentulousness, decayed teeth, and presence of dentures did not seem to cause OHRQoL problems, while higher OHRQoL scores (more problems) were reported by those with 1-9 teeth and tooth mobility. CONCLUSION: OHRQoL of these patients can be increased by removal of loose teeth and provision of dentures to those with very few teeth rather than focus on traditional caries treatment.

Clustering of obesity and dental caries with lifestyle factors among Danish adolescents.

PURPOSE: To assess any clustering between obesity, dental health, and lifestyle factors (dietary patterns, physical activity, smoking, and alcohol consumption) among adolescents. MATERIAL AND METHODS: A cluster sample of 15-year-old Danish adolescents (DA) from eight municipalities was selected. Self-reported questionnaires for adolescents and their mothers to assess body-mass index (BMI), socioeconomic and lifestyle factors, and clinical examinations to examine adolescents' dental status (DMFT) were used. Descriptive statistics, chi-square tests, and factor analysis were applied. RESULTS: The mean DMFT was 2.03 and mean BMI was 21.30 among DA.Of the whole sample, 62% experienced caries (DMFT > 0) and 16% were classified as obese. No association appeared between obesity and DMFT (p > 0.05). Most adolescents were likely to have breakfast every day (76%), but their daily consumption of fruit was lower (38%). More than half of adolescents reported having physical exercise (66%) and no alcohol consumption (57%). Smokers were more likely to consume alcohol (80%) but less likely to exercise (44%) than nonsmokers (alcohol consumption, 55%; exercise, 68%), (P < 0.05). Principal component analysis revealed that DMFT and obesity were interrelated in DA. CONCLUSION: In line with earlier studies, obesity and dental caries share common lifestyle factors among adolescents, regardless of nationality and different health-care systems. Thus, it seems that dental health is a global health concern. There is a need for collaboration between dental and general health-care providers to manage both obesity and dental caries in adolescents by using a holistic approach.

Professional and patient-based evaluation of oral rehabilitation in patients with tooth agenesis.

OBJECTIVES: The outcome of oral rehabilitation is usually monitored with clinical tests rather than by patient's perception of change. The aim of this study was to describe the objective measure and subjective perception of oral rehabilitation in patients with tooth agenesis. MATERIAL AND METHODS: The study included 129 patients with tooth agenesis rehabilitated with implant- or tooth-supported reconstructions, and a control group of 58 patients. Professional assessments included biological, technical and aesthetic variables. An aesthetic index score included mucosal discoloration, crown morphology, crown color match, occlusal harmony, and papilla level. The Oral Health Impact Profile (OHIP) questionnaire was used to evaluate the patient-based outcomes. Six OHIP questions were subtracted to evaluate the patient-based aesthetic outcomes. RESULTS: Severe root resorption was observed in 36% of the patients in whom orthodontic treatment had been performed. Twelve percent of patients had implants with 5-7 mm peri-implant bone defects. Mucosal discoloration was recorded in 57% of the patients. Twelve percent of the patients had metal visible on the buccal side. The median scores for all five aesthetic variables were acceptable in 92% of the implant reconstructions and for 83% of the tooth-supported fixed dental prostheses (FDPs). The total OHIP score was inferior in rehabilitated patients with tooth agenesis to that of the control group without tooth agenesis. The total OHIP score after rehabilitation was <50 for 95% of the patients with tooth agenesis. The six OHIP questions concerning aesthetics demonstrated patient-based aesthetic problems in 41% of patients treated with implant-supported reconstructions and 47% of patients treated with tooth-supported FDPs. Ninety-eight percent of the group treated with implant-supported reconstructions and 84% of the patients in the tooth-supported FDP group were very satisfied or satisfied with the treatment outcome. CONCLUSIONS: Patients with tooth agenesis had a high risk of severe root resorption after orthodontic treatment. A better aesthetic outcome was obtained with implant-supported reconstructions than with tooth-supported reconstructions. A positive but not significant correlation was observed between the professional and patient-based evaluations of aesthetic outcomes.

Public dental health care program for persons with disability.

The objectives of the study were (1) to describe the organization and content of the Danish public oral health care program for persons with disability, and (2) to analyse possible variations in relation to the goals and requirements set by the health authorities. Data were collected by means of self-administered questionnaires completed by the person responsible locally for the program in each municipality. The response rate was 84%. The following topics were included: (1) Number of persons attending the program, (2) procedure for identification of persons eligible for the program, (3) payment of service, (4) providers of oral health care, (5) special training of staff, 6) dental services delivered, (7) ethical issues, and (8) patient rights. Less than one-third of persons estimated by the health authorities were enrolled in the program. On average, 0.4% of the municipal population attended the program, ranging from 0.03% to 1.53%. In large municipalities, and where internal providers delivered oral health care, relatively more persons were enrolled in the program (p < 0.001). Overall, more than 20 categories of personnel were involved in the selection procedure; attitude and lack of knowledge of oral health and oral health care for persons with disability were barriers to equal access to the program. Preventive dental services were the most frequent services delivered, although relatively few oral hygienists were involved in the program. Special training was most frequent in large municipalities. To secure equal access for persons with disability, it is recommended that joint collaboration between smaller municipalities should be made regarding procedures of such programs. Special training of dental personnel and of the staff responsible for selecting persons for the program should be systematically organized at a higher administrative level. The pattern of dental services delivered justifies further involvement of oral hygienists in the program.