Dental care for older adults in home health care services - practices, perceived knowledge and challenges among Norwegian dentists and dental hygienists.

BACKGROUND: Providing dental services to dependent older adults might be challenging because of physical and cognitive decline. The present study aimed to explore current practices, knowledge, and experienced challenges related to the treatment of older adults in home health care services (HHCS) among dentists and dental hygienists in Norway. METHODS: An electronic questionnaire survey was distributed to Norwegian dentists and dental hygienists, inquiring about background characteristics, current practices, self-perceived knowledge, and challenges when providing oral health care for older HHCS patients. RESULTS: Four hundred and sixty-six dentists and 244 dental hygienists treating older HHCS patients responded to the survey. The majority were female (n=620; 87.3%) and worked in the public dental service (PDS) (n=639; 90%). When older HHCS adults attended the dental practice, the treatments provided were most frequently aimed at relieving acute oral problems, although dental hygienists reported to focus on improving oral health more often than dentists. Dentists reported to have more self-perceived knowledge than dental hygienists regarding patients with complex treatment needs, cognitive or physical impairment. Exploratory Factor Analysis (EFA) was carried out on the 16 items related to challenges, three factors were extracted and Structural Equation Models (SEMs) were performed. Challenges related to dental care for older HHCS adults were related to time, practical organization and communication. Variation within these categories was associated with sex, graduation year and country, as well as time used per patient and work sector, but not with professional status. CONCLUSIONS: The results indicate that dental care for older HHCS patients is time-demanding and more often aimed at relieving symptoms than improving oral health. A substantial proportion of dentists and dental hygienists in Norway lack confidence when providing dental care for frail elderly.

Dental Health Services Response to COVID-19 in Norway.

We aimed to investigate the management of urgent dental care, the perception of risk and workplace preparedness among dental staff in Norway during the COVID-19 pandemic. An electronic questionnaire regarding the strictest confinement period in Norway (13 March-17 April 2020) was distributed to dental staff. Among the 1237 respondents, 727 (59%) treated patients, of whom 170 (14%) worked in clinics designated to treat patients suspected or confirmed to have COVID-19. Out of them 88% (143) received training and 64% (103) simulation in additional infection prevention procedures, while 27 (24%) respondents reported deviation. In total, 1051 (85%) respondents perceived that dental staff had a high risk of being infected, 1039 (84%) that their workplace handled the current situation well, 767 (62%) that their workplace had adequate infection control equipment and 507 (41%) agreed that their workplace is well equipped to handle an escalation. Before an appointment, 1182 (96%) respondents always/often inquired per phone information if a patient experienced symptoms of COVID-19, and 1104 (89%) asked about a history of travel to affected areas. Twice as many patients on average per week were treated by phone than in a clinic. A lower proportion of dental staff in high incidence counties applied additional infection prevention measures compared to low and medium incidence counties. To conclude, urgent dental health care was managed relatively well in Norway. Additional training of the dental staff in adequate infection prevention and step-by-step procedures may be needed. These results may be used to improve the dental health service's response to future outbreaks.