Nursing home residents' perspectives on oral health: An in-depth interview study.

Background: Oral health is associated with general health and care dependency, but is often neglected in nursing homes. Integration of oral care into general care is necessary, but is hampered by multiple barriers at different levels. This study is part of research into the implementation of the new Oral Health Section for use within the interRAI Long-Term Care Facilities instrument, which is used to assess care needs of nursing home residents. This new Oral Health Section evaluates nine aspects of oral health and results in two Collaborative Action Points. Objective: To identify residents' perspectives on oral health, oral care, and on the assessment of their oral health using the new Oral Health Section. Design: Qualitative design using in-depth interviews. Settings: Three nursing homes. Participants: Residents were selected using purposeful sampling in nursing homes participating in research evaluating the use of the new Oral Health Section. The selection was based on their oral status for maximum variation and on their cognitive performance score. Twenty-two residents from three Flemish nursing homes agreed to participate. Methods: Residents' oral health was assessed using the new Oral Health Section and dental indices. In-depth interviews were conducted, including the validated short-form Oral Health Impact Profile to evaluate the impact of oral conditions on residents' well-being. The interviews were coded and analysed by three researchers and mapped into a model to understand participants' oral health behaviours. Results: Low Oral Health Impact Profile scores indicated a low impact of oral health issues on participants' lives. However, despite 77.3 % of the participants reporting satisfaction with their oral health, 86.4 % had poor oral hygiene and 68.2 % required referral to a dentist, suggesting a tendency to overestimate their oral health. Their oral health behaviour was determined by a lack of oral health knowledge (Capability), positive attitudes towards oral health and autonomy (Motivation), upbringing and social support (Opportunity). Participants considered assessments with the new Oral Health Section acceptable. Conclusions: This study shows how older people perceive their oral health and oral healthcare. Understanding their wishes and needs will not only facilitate their involvement in their oral care, but is also likely to enable the improvement of their oral hygiene and the development of effective oral care strategies for the future. Policy makers and managers of care organisations may use these results to foster integration of oral care guidelines into care protocols within nursing homes, including collaboration with dentists and dental hygienists. Tweetable abstract: Oral health assessments with the new Oral Health Section for use within interRAI were positively perceived by nursing home residents.

Implementing an oral health policy in long-term care facilities for older adults in Flanders, Belgium: The Oral Health Care Track.

BACKGROUND: The oral health of care-dependent older people living in residential care facilities is generally suboptimal. To facilitate adequate daily oral care and timely referral to a dental professional, studies emphasise the need for sustainable, structured oral healthcare policies in aged care organisations. The effect of such interventions is often limited or uncertain owing to a lack of understanding of how effective the integration and implementation of the policy has been within the facilities. This study reports on the development of a method to adequately implement an oral healthcare policy in long-term care organisations for older adults. MATERIALS AND METHODS: An intervention mapping protocol was used to develop a theory- and practise-based methodology. This step-by-step approach combined findings from a literature review, experiences from earlier projects and behaviour change theories in a multilevel programme. RESULTS: Intervention mapping yielded a systematic programme for implementing an oral healthcare policy in aged care organisations. The Oral Health Care Track or "De Mondzorglijn" comprises seven phases, each subdivided into several tasks. The programme's implementation is guided by oral healthcare coaches. CONCLUSION: By using intervention mapping, it was possible to combine behaviour change theories, information derived from needs assessment and earlier experiences into a comprehensive programme to improve the oral health and quality of life of older residents in residential care facilities. Further research is needed to evaluate the use of coaches in the implementation of the Oral Health Care Track.

Long-term Outcome of Endodontically Treated Traumatized Immature Upper Incisors.

INTRODUCTION: In a growing child, preservation of traumatized immature permanent upper incisors is challenging. This study aimed to evaluate the long-term outcome of endodontically treated traumatized immature upper incisors and associated variables. METHODS: A total of 183 traumatized immature upper incisors treated with pulpotomy, apexification, or regenerative endodontic procedure (REP), with follow-up between 4 and 15 years, were assessed for presence of pulpal responses or periodontal/bone responses using standardized clinical and radiologic criteria. Logistic regression, including stage of root development, type and complexity of traumatic event, type of endodontic intervention, and history of orthodontic management, were used to estimate impact on tooth survival and occurrence of tissue responses. Study approved by Ethics Committee Research UZ/KU Leuven (S60597). RESULTS: After a median follow-up of 7.3 years (interquartile range, 6.1-9.2), 159 teeth (86.9%) were still functional. From these teeth, 58 (36.5%) developed tissue responses. This was significantly associated with stage of root development at moment of trauma (root length <¾) and type of endodontic intervention (REP presenting worst outcome). Tooth loss (24 teeth, 13.1%) occurred after a mean time span of 3.2 years (±1.5) and was significantly associated with type and complexity of the traumatic event and type of endodontic intervention, with apexification showing better results than REP (odds ratio, 0.30; 95% confidence interval, 0.11-0.79). CONCLUSIONS: A large number of endodontically treated traumatized immature teeth could be kept functional. Very immature teeth, teeth with periodontal tissue damage, and teeth treated with REP were at highest risk for an unfavorable outcome.

Is use of CBCT without proper training justified in paediatric dental traumatology? An exploratory study.

BACKGROUND: Proper skills in radiographic diagnosis are essential for optimal management of dental trauma. AIM: To assess diagnostic accuracy obtained by paediatric dentists using Cone Beam Computed Tomography (CBCT) without specific training and to compare this with their performance using intraoral radiographs. METHODS: Intraoral and CBCT images of 89 teeth, spread over twenty dental trauma cases were presented in random order to nine paediatric dentists. Diagnostic findings were compared with those of a benchmark reference. Sensitivity and specificity were calculated and compared using paired t-tests. RESULTS: Overall, observers' diagnostic performance was rather poor with significantly higher sensitivity when using 2D images (P = 0.017). Performance differed considerably according to the type of pathology. Using either imaging modality, sensitivity for diagnosing apical pathology and root fractures was high while the opposite was seen for inflammatory root resorption, root cracks and subluxations. Statistically significant differences between imaging modalities were seen for root fractures (P = 0.013) and apical pathology (P = 0.001), in favor of 3D, and for crown fractures (P = 0.009) in favor of 2D. CONCLUSION: Overall poor performance of paediatric dentists indicates that additional training in radiographic diagnosis is required. In order to justify the use of CBCT to increase diagnostic performance, proper training of the paediatric dentist is mandatory.

Oral health status in patients with inherited epidermolysis bullosa: a comparative multicenter study.

OBJECTIVE: Epidermolysis bullosa (EB) is a rare genetic mucocutaneous disorder characterized by epithelial fragility leading to blister formation on skin and mucous membranes with even minor mechanical trauma. Most EB oral health publications give fragmented information, focusing on only one oral health aspect or one EB type. The aim of this study was to expand the knowledge of the overall oral health status of individuals with dystrophic, junctional, and simplex EB. METHOD AND MATERIALS: A comparative multicenter study, including a control group, and based on questionnaires and clinical examinations, was undertaken in three EB expert centers. RESULTS: Most EB (90.2%) participants brushed their teeth at least once a day despite the pain. The prevalence of enamel defects and caries experience did not differ between the 42 EB participants and the 42 age-/sex-matched healthy controls. Gingival inflammation unrelated to dental plaque accumulation was found in EB participants. Blisters, erythema, and erosion/ulceration mainly involved gingiva, buccal mucosa, lips, and palate, with different topographic patterns according to EB type. EB patients whatever the age showed a similar lesion distribution. Simplex and dystrophic EB patients under 12 years old displayed higher lesion severity than junctional EB ones. Only dystrophic type exhibited microstomia and ankyloglossia. CONCLUSION: Oral health status seemed to benefit from a close collaboration between dental practitioner and dermatologist, and from regular dental examination, starting at a young age and with a focus on prevention. The new appreciation of oral health involvement highlighted by this study is essential for EB patients care, regarding comorbidities and quality of life.

Impact of case complexity on paediatric dentists' ability to radiographically diagnose traumatic dental injuries.

BACKGROUND/AIMS: Being able to correctly interpret radiographs after a traumatic dental injury is an essential skill for providing appropriate and timely treatment. The aim of this study was to assess the impact of case complexity on paediatric dentists' performance when radiographically diagnosing traumatic dental injuries (TDI) and to investigate a possible added value of cone-beam computed tomography (CBCT) when compared with digital intra-oral radiography (2D vs 3D). MATERIALS AND METHODS: A test panel of paediatric dentists was instructed to detect, identify and interpret radiographic findings using either 2D or 3D images. Intra-oral radiographs and CBCT images of 20 trauma cases were presented in random order, and the findings were recorded using structured scoring sheets. Case complexity was determined by two experienced benchmark scorers. Results were analysed using generalized linear mixed modelling. RESULTS: In general, performance for detection, identification and interpretation of findings was low, both with 2D and 3D images, with significantly lower values for difficult cases (p < 0.05). For easy as well as for difficult cases, 3D imaging resulted in a significantly better performance for detection and identification of findings (P < 0.001). This was not the case for correct interpretation, where significantly poorer performance was seen when using 3D images for difficult cases (p < 0.05). CONCLUSION: This study provides evidence that case complexity of traumatic dental injuries influences diagnostic performance. The use of CBCT enhanced detection and identification of findings but when case complexity increased, 3D imaging adversely affected correct interpretation.

Perceptions on Oral Care Needs, Barriers, and Practices Among Managers and Staff in Long-Term Care Settings for Older People in Flanders, Belgium: A Cross-sectional Survey.

Background and Objectives: This study aimed to explore oral health perception and oral care needs, barriers, and current practices as perceived by managers and staff in long-term care organizations for older people in Flanders. Research Design and Methods: This is a cross-sectional study where 2 questionnaires were developed, one for managers and one for caregivers, and were validated in Flemish long-term care organizations. Descriptive analyses and multivariable generalized linear models evaluated the main outcomes and their associations with determinants such as the size of the organization, the presence of an oral health policy, collaboration with a dentist, among others. Results: A total of 145 managers and 197 caregivers completed the questionnaire. More than 50% of caregivers and managers perceived their residents' oral health as mediocre to good. Collaboration with a dentist (B = 0.84) and oral health care involvement (B = 0.08) within the organization showed a strong association with a positive perception of oral health. Lack of time (57%) and care resistance (70%) were the most important barriers perceived by caregivers. Guidelines concerning oral care were not available or were unknown to 52% of the caregivers. Having an oral health policy within the organization was strongly associated with the correct use of guidelines for daily care of natural teeth (B = 1.25) and of dental prosthesis (B = 1.15). Discussion and Implications: The results emphasize that collaborating with a dentist and the presence of an oral health policy in care organizations are important for a positive perception of the oral health of the residents and for the adoption of guidelines by caregivers and managers. In addition, training on handling care refusal should be included in the overall training. These results are crucial input for the development of a methodology for implementing a structured oral care policy in long-term care facilities.

Evolution of root length throughout orthodontic treatment in maxillary incisors with previous history of dental trauma: a longitudinal controlled trial.

OBJECTIVES: To compare changes in root length of maxillary incisors with and without dental trauma throughout orthodontic treatment. MATERIALS AND METHOD: Patients younger than 18 years, with trauma on at least one maxillary incisor, undergoing orthodontic treatment between 2017 and 2021 were included, using the contralateral side as control without trauma when available. Periapical radiographs were taken pre-treatment and at 6 months intervals, and root/crown ratio was calculated. Linear mixed models were used to describe the evolution of root length at the different time points and to compare trauma and control values. Differences between central and lateral incisors and between treatment modalities were additionally explored. RESULTS: A total of 1768 measurements were performed on 499 teeth (201 with trauma) in 135 patients. Incisor root length significantly decreased during orthodontic treatment in teeth with and without trauma. Lateral incisors with trauma were more susceptible to root resorption than those without trauma and central incisors. No significant decrease in root length was observed with removable appliances, which never exceeded 15 months of treatment. Treatment with fixed appliances led to gradually increasing, significant root length shortening in teeth with and without trauma. CONCLUSION: Treatment duration directly correlated with root length shortening both in teeth with and without trauma history. Teeth with trauma showed significantly more root resorption after treatment with fixed appliances while removable appliances had no significant influence on root length. CLINICAL RELEVANCE: Previous history of dental trauma is no absolute contra-indication to start orthodontic treatment, as long as treatment duration is kept as short as possible.

Prevalence of Orthodontic Malocclusions in Healthy Children and Adolescents: A Systematic Review.

The purpose of this study was to systematically review the literature regarding the prevalence of malocclusion and different orthodontic features in children and adolescents. METHODS: The digital databases PubMed, Cochrane, Embase, Open Grey, and Web of Science were searched from inception to November 2021. Epidemiological studies, randomized controlled trials, clinical trials, and comparative studies involving subjects ≤ 18 years old and focusing on the prevalence of malocclusion and different orthodontic features were selected. Articles written in English, Dutch, French, German, Spanish, and Portuguese were included. Three authors independently assessed the eligibility, extracted the data from, and ascertained the quality of the studies. Since all of the included articles were non-randomized, the MINORS tool was used to score the risk of bias. RESULTS: The initial electronic database search identified a total of 6775 articles. After the removal of duplicates, 4646 articles were screened using the title and abstract. A total of 415 full-text articles were assessed, and 123 articles were finally included for qualitative analysis. The range of prevalence of Angle Class I, Class II, and Class III malocclusion was very large, with a mean prevalence of 51.9% (SD 20.7), 23.8% (SD 14.6), and 6.5% (SD 6.5), respectively. As for the prevalence of overjet, reversed overjet, overbite, and open bite, no means were calculated due to the large variation in the definitions, measurements, methodologies, and cut-off points among the studies. The prevalence of anterior crossbite, posterior crossbite, and crossbite with functional shift were 7.8% (SD 6.5), 9.0% (SD 7.34), and 12.2% (SD 7.8), respectively. The prevalence of hypodontia and hyperdontia were reported to be 6.8% (SD 4.2) and 1.8% (SD 1.3), respectively. For impacted teeth, ectopic eruption, and transposition, means of 4.9% (SD 3.7), 5.4% (SD 3.8), and 0.5% (SD 0.5) were found, respectively. CONCLUSIONS: There is an urgent need to clearly define orthodontic features and malocclusion traits as well as to reach consensus on the protocols used to quantify them. The large variety in methodological approaches found in the literature makes the data regarding prevalence of malocclusion unreliable.

Antibiotics at replantation of avulsed permanent teeth? A systematic review.

OBJECTIVES: At present there is no clear consensus whether systemic antibiotics should be administered at replantation of an avulsed permanent tooth. This systematic review and meta-analysis assessed the evidence on effectiveness and harms of the administration of systemic antibiotics at replantation of avulsed permanent teeth. METHODS: In August 2020 a systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, for systematic reviews, randomized controlled trials (RCT) and observational controlled studies in MEDLINE, PreMedline, Embase, and the Cochrane databases. The population of interest were medically fit patients with a replanted avulsed tooth. Main outcomes were tooth survival, periodontal healing, pulpal revascularization as well as (severe) adverse events. These outcomes were compared in patients who did and who did not receive systemic antibiotics. The GRADE methodology was used to assess the quality of evidence. RESULTS: The search yielded no RCTs, and none of the 7 included observational studies had the prime intent to investigate the effectiveness or harms of antibiotics. According to GRADE, the overall level of evidence was very low. The meta-analyses showed non-significant associations between the administration of systemic antibiotics on the one hand and tooth survival (1 study, RR = 3.70, 95% CI: 0.63-21.69), periodontal healing (meta-analysis of 6 studies RR: 1.07; 95% CI: 0.80-1.45), and pulpal revascularization (meta-analysis of 2 studies, RR: 0.36; 95% CI: 0.05-2.41) on the other hand. CONCLUSION: Currently there is no high-quality evidence to support the use of systemic antibiotics at replantation of avulsed permanent teeth. Hence, their routine use cannot be recommended in medically fit patients. Well-designed RCTs should be a priority on the research agenda.

Does clinical experience with dental traumatology impact 2D and 3D radiodiagnostic performance in paediatric dentists? An exploratory study.

BACKGROUND: The aim of this study is to evaluate the impact of experience with traumatic dental injuries (TDI) on paediatric dentists' performance and self-assessed confidence when radiodiagnosing traumatic dental injuries (TDI) and to explore whether this is influenced by the imaging technique used (2D versus 3D). MATERIALS AND METHODS: Both 2D and 3D radiological images of young anterior permanent teeth having experienced dental trauma were assessed randomly by a panel of paediatric dentists using structured scoring sheets. The impact of level of experience with dental traumatology on radiological detection, identification and interpretation of lesions and on observer's self-assessed confidence was evaluated. Findings were compared to benchmark data deriving from expert consensus of an experienced paediatric endodontologist and dentomaxillofacial radiologist. Results were analysed using generalized linear mixed modelling. RESULTS: Overall, observers performed moderately to poor, irrespective of their level of TDI experience and imaging modality used. No proof could be yielded that paediatric dentists with high TDI experience performed better than those with low experience, for any of the outcomes and irrespective of the imaging modality used. When comparing the use of 3D images with 2D images, significantly higher sensitivities for the detection and correct identification of anomalies were observed in the low experienced group (P < 0.05). This was not the case regarding interpretation of the findings. Self-assessed confidence was significantly higher in more experienced dentists, both when using 2D and 3D images (P < 0.05). CONCLUSION: There was no proof that paediatric dentist's higher experience with TDI is associated with better radiodiagnostic performance. Neither could it be proven that the use of Cone Beam Computed Tomography (CBCT) contributes to an improved interpretation of findings, for any experience level. More experienced dentists feel more confident, irrespective of the imaging modality used, but this does not correlate with improved performance. The overall poor performance in image interpretation highlights the importance of teaching and training in both dental radiology and dental traumatology.

Determination of craniofacial and dental characteristics of individuals with Williams-Beuren syndrome by using 3D facial scans and radiographs.

BACKGROUND: Williams-Beuren syndrome (WBS) is caused by a microdeletion on chromosome 7q11-23 and clusters a variety of systemic affectations. AIM: To investigate whether 3D facial scans can detect WBS by objectively addressing their craniofacial, skeletal and dental characteristics, compared with those of a non-affected control group. MATERIALS AND METHODS: 3D facial surface scans of 17 WBS individuals and 33 normal developing patients were analysed. Additionally, cephalometric and panoramic radiographs of subjects with WBS were compared with those of non-affected individuals. RESULTS: The 3D surface scans showed significant facial differences around the nose and mouth area. The cephalometric aspects of individuals with WBS differed mainly at the lower incisor region. Additionally, hypoplastic tooth morphology seems to be more often present in WBS. CONCLUSION: 3D images are a non-invasive, efficient method to observe facial anomalies and facilitate an early diagnosis of WBS. Additionally, the analysis of the cephalometric and panoramic images revealed significant differences in dental characteristics. Together with early diagnosis through 3D images, these can help in the establishment of adequate medical, dental and orthodontic treatment planning.

Dentist Related Factors Associated with Implementation of COVID-19 Protective Measures: A National Survey.

Little is known about the extent to which dentists have implemented COVID-19 infection control guidelines and the factors influencing this process in daily practice. This national online survey assessed the implementation of enhanced infection control guidelines in daily practice, and explored dentist related factors influencing their application, more specifically dentist infection status and their perceived risk of cross-infection in the dental setting. The survey was validated, pretested and carried out in 2020. A total of 1436 dentists participated, of whom 9.1% presumably had COVID-19 infection experience. At least 75% of dentists complied with the core part of the recommended protective measures protocol. For each patient treated during the pandemic, an additional cost of 10-30 EUR (86.7%) and an extra time of 10-30 min (70.7%) was estimated. A stepwise binary logistic regression analysis revealed that dentists assumed to have experienced COVID-19 reported a higher self-perceived risk of virus acquisition (ß = 2.090; p = 0.011), lower concern of getting infected (ß = 0.576; p = 0.027), and lower confidence in being able to prevent disease transmission in the dental setting (ß = 0.535; p = 0.022). Some parts of the protective measures were more difficult to apply than others; however, there was no indication of increased disease acquisition in the dental setting.

Are systemic antibiotics indicated in children presenting with an odontogenic abscess in the primary dentition? A systematic review of the literature.

OBJECTIVES: This systematic review aimed to assess (1) whether systemic antibiotics are beneficial or harmful in healthy children who present with an odontogenic abscess in the primary dentition with or without systemic involvement and (2) if antibiotics are beneficial, which type, dosage and duration are the most effective. MATERIALS AND METHODS: Electronic databases (Medline, Embase, and the Cochrane Library) were screened from 1948 up to August 2020. No filters with respect to study design were applied. Outcomes of interest included pain, swelling, pain relief, adverse effects, signs of infection, quality-of-life measurements and medication required for pain relief. RESULTS: Altogether, 352 titles and abstracts were screened for eligibility; of these, 19 were selected for full text assessment. All were excluded because none of them fulfilled the inclusion criteria and addressed the (adjunctive) use of antibiotics in children who present with an odontogenic abscess in the primary dentition. CONCLUSIONS: At present, there is no single randomised or non-randomised clinical study evaluating the effectiveness and harms of systemic antibiotics administered in children who present with an odontogenic abscess in the primary dentition. CLINICAL RELEVANCE: There is no clinical evidence to support nor to refute the use of antibiotics in children who present with an odontogenic abscess in the primary dentition without signs of local spread or systemic involvement. Given this lack of scientific evidence, the use of antibiotics cannot be recommended in these children. Well-designed clinical trials are indicated to fully understand the impact and necessity of antibiotics in these situations.

Development of practice guidelines for daily oral care in care-dependent older adults to complement the InterRAI suite of instruments using a modified Delphi approach.

AIM: To develop practice guidelines for nursing assistants who provide daily oral care to older adults. BACKGROUND: The interRAI suite of instruments is internationally used in professional health care to assess the needs of care-dependent older persons. An optimised oral health section was developed recently to identify care clients with poor oral health and hygiene. Internationally shared guidelines for daily oral care are needed to complement the optimised oral health section of the interRAI suite of instruments. MATERIAL AND METHODS: The modified Delphi approach started with the preparation of an initial draft. Subsequently, an online survey and a face-to-face discussion were conducted with international experts. Their feedback was used to revise the draft. Two additional online surveys were conducted with the experts to reach consensus agreement for each item of the revised version. The same group of experts was invited to the different study phases. RESULTS: The three surveys were completed by 26, 27 and 23 international experts, respectively. A group of 18 experts completed each survey, whereof a subgroup of 11 experts also took part in the face-to-face discussion. Experts were dental hygienists, dentists, nursing scientists, physicians and psychologists from 14 different countries. After the final survey, consensus agreement was reached for 54 of the 57 (94.7%) items, representing the final version of the guidelines. CONCLUSION: Available evidence was combined with practical feedback from international experts to develop clear and concise practice guidelines for daily oral care in older adults. IMPLICATIONS FOR PRACTICE: The guidelines will help to improve knowledge and reduce barriers of nursing assistants to provide daily oral care.

Assessment of oral health in older adults by non-dental professional caregivers-development and validation of a photograph-supported oral health-related section for the interRAI suite of instruments.

OBJECTIVES: An optimized oral health-related section and a video training were developed and validated for the interRAI suite of instruments. The latter is completed by professional non-dental caregivers and used in more than 40 countries to assess care needs of older adults. METHODS: The optimized oral health-related section (ohr-interRAI) consists of nine items and a video training that were developed in consecutive phases. To evaluate psychometric properties, a study was conducted in 260 long-term care residents. Each resident was assessed by a dentist and by four caregivers (two who received the video training, two who did not). RESULTS: Mean kappa values and percent agreement between caregivers and dentist ranged between κ = 0.60 (80.2%) for dry mouth and κ = 0.13 (54.0%) for oral hygiene. The highest inter-caregiver agreement was found for dry mouth with κ = 0.63 [95% CI: 0.56-0.70] (81.6%), while for the item palate/lips/cheeks only κ = 0.27 [95% CI: 0.18-0.36] (76.7%) was achieved. Intra-caregiver agreement ranged between κ = 0.93 [95% CI: 0.79-1.00] (96.4%) for dry mouth and κ = 0.45 [95% CI: 0.06-0.84] (82.8%) for gums. Logistic regression analysis showed only small differences between caregivers who watched the video training and those who did not. CONCLUSIONS: Psychometric properties of the optimized ohr-interRAI section were improved compared to previous versions. Nevertheless, particularly the items based on inspection of the mouth require further refinement and caregiver training needs to be improved. CLINICAL RELEVANCE: Valid assessment of oral health by professional caregivers is essential due to the impaired accessibility of regular dental care for care-dependent older adults.

Assessment of oral health conditions presented in photographs - is there a difference between dentists and non-dental professional caregivers?

BACKGROUND: Photographs can help non-dental professional caregivers to identify problems when inspecting the mouth of care-dependent older individuals. This study evaluated whether the assessment of oral health-related conditions presented in photographs differed between dentists and non-dental professional caregivers. MATERIALS AND METHODS: One-hundred-and-seventy-nine photographs were taken from long-term care facility residents and from patients at the Department of Dentistry of a University Hospital. The following oral health aspects were depicted: denture hygiene, oral hygiene, teeth, gums, tongue and palate/lips/cheeks. Collection continued until for each oral health aspect a pool of photographs was available that showed conditions from perfect health and hygiene to severe problems. A segmented Visual Analogue Scale was applied to assess the conditions presented in the photographs. Each photograph was assessed by each participant of this study. The benchmark was established by three dentists with academic-clinical expertise in gerodontology, special needs dentistry and periodontology. For each photograph, they provided a collective score after reaching consensus. Photographs were assessed individually by 32 general dentists and by 164 non-dental professional caregivers. Linear mixed effects models and generalized linear mixed effects models were fitted and mean squared errors were computed to quantify differences between both groups. RESULTS: For the different oral health aspects, absolute distances from the benchmark scores were 1.13 (95%CI:1.03-1.23) to 1.51 (95%CI:1.39-1.65) times higher for the caregivers than for the dentists. The odds to overestimate the condition were higher for the caregivers than the dentists for oral hygiene (OR = 0.72, 95%CI = 0.62-0.84) and teeth (OR = 0.74; 95%CI = 0.61-0.88). The odds to underestimate the condition were higher for the caregivers than the dentists for gums (OR = 1.39; 95%CI:1.22-1.59) and palate/lips/cheeks (OR = 1.22; 95%CI = 1.07-1.40). Over all assessments, the variance in caregiver scores was 1.9 (95%CI:1.62-2.23) times higher than that for the dentists. CONCLUSION: Small but significant differences were found between dentists and non-dental professional caregivers assessing oral health-related conditions presented in photographs. When photographs are used to aid non-dental professional caregivers with the oral health assessment, these visualizations should be complemented with comments to facilitate accurate interpretation.

The perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders, Belgium.

OBJECTIVES: To assess the perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders. MATERIALS AND METHODS: Two questionnaires were developed, one for managers and one for caregivers. The questionnaires were distributed in all 570 organizations for people with disabilities in Flanders. The survey was carried out in February 2018. RESULTS: Sixty-five managers completed the questionnaire and 63 of them could be linked to 57 unique organizations (10% of the contacted organizations). Managers perceived oral health to be better (P = 0.019) and mentioned less oral health needs (P = 0.049), when collaboration with a dentist was reported. When an oral health policy had been established in their organization, oral health was also perceived to be better (P = 0.048). The responses of 91 caregivers were included for analysis and 87 of them could be linked to 39 unique organizations (7% of contacted organizations). Seventy percent and 75% of the caregivers mentioned to have enough/comprehensive theoretical knowledge and practical skills, respectively, and 46% were interested in receiving oral health education. Most interest was shown in practical education and education customized to clients' needs. In organizations with an oral health project, more caregivers indicated that the organization was open to oral health questions than in organizations without such a project (97% compared with 81%; P = 0.045). When there was a collaboration with a dentist, the organization was more open to caregivers' questions (96% compared with 72%; P = 0.004) and a clear contact point was more readily available (81% compared with 48%; P = 0.004). Furthermore, caregivers were more interested to receive oral health education (P = 0.023) and mentioned to be more aware of the oral health of their clients (P = 0.015). About 23% and 30% of the caregivers indicated that guidelines were used in their organization for cleaning natural teeth and prostheses, respectively. CONCLUSIONS: Despite the low response rate to the survey and reaching the management and caregivers of only 10% and 7% of the organizations respectively, this study indicates relevant issues to be incorporated when formulating recommendations for oral health promotion in people with disabilities in Flanders. CLINICAL RELEVANCE: The results of this survey could affect the development of strategies and interventions to ameliorate the oral health of people with disabilities.