Dental patients as partners in promoting quality and safety: a qualitative exploratory study.

OBJECTIVE: Active patient involvement in promoting quality and safety is a priority for healthcare. We investigated how dental patients perceive their role as partners in promoting quality and safety across various dental care settings. METHODS: Focus group sessions were conducted at three dental practice settings: an academic dental center, a community dental clinic, and a large group private practice, from October 2018-July 2019. Patients were recruited through flyers or word-of-mouth invitations. Each session lasted 2.5 h and patients completed a demographic and informational survey at the beginning. Audio recordings were transcribed, and a hybrid thematic analysis was performed by two independent reviewers using Dedoose. RESULTS: Forty-seven participants took part in eight focus group sessions; 70.2% were females and 38.3% were aged 45-64 years. Results were organized into three major themes: patients' overall perception of dental quality and safety; patients' reaction to an adverse dental event; and patients' role in promoting quality and safety. Dental patients were willing to participate in promoting quality and safety by careful provider selection, shared decision-making, self-advocacy, and providing post-treatment provider evaluations. Their reactions towards adverse dental events varied based on the type of dental practice setting. Some factors that influenced a patient's overall perception of dental quality and safety included provider credentials, communication skills, cleanliness, and durability of dental treatment. CONCLUSION: The type of dental practice setting affected patients' desire to work as partners in promoting dental quality and safety. Although patients acknowledged having an important role to play in their care, their willingness to participate depended on their relationship with their provider and their perception of provider receptivity to patient feedback.

Pre-emptive analgesia efficacy of piroxicam versus tramadol in oral surgery.

Background: This double-blind randomized controlled trial (RCT) was conducted to evaluate the pre-emptive analgesia and anti-inflammatory efficacy of piroxicam compared with tramadol in patients undergoing oral surgery. Methods: Seventy-eight patients who required extraction of impacted mandibular third molars were randomized into three treatment groups of 26 patients each: group I received 100 mg of tramadol, group II received 20 mg of piroxicam, and group III received a placebo. Drugs were administered intramuscularly 30 min prior to the extraction procedure. Results: Pain intensity, time to first analgesic administration, total analgesic consumption, facial edema, and trismus were the outcomes of interest. The group receiving 20 mg of piroxicam showed significantly lower pain intensity, increased time to first analgesic, and reduced edema from preoperative to postoperative day seven than those in the tramadol and placebo groups. Conclusion: The findings of this study showed that piroxicam had significant pain relief efficacy after third molar surgery compared with that in tramadol.

Diabetes and prediabetes prevalence among young and middle-aged adults in India, with an analysis of geographic differences: findings from the National Family Health Survey.

OBJECTIVES: This study aimed to approximate the prevalence of hyperglycemia in India. METHODS: The study was conducted using the Demographic and Health Survey 2015-16 (also known as the National Family Health Survey-4), which surveyed 811,808 individuals using a stratified, multistage, cluster sampling design. This cross-sectional survey recorded socio-demographic and anthropometric data, including blood glucose levels, of adults aged 18 years to 54 years. RESULTS: The final analysis included 718,597 individuals, of whom 49.90% (weighted) were males. The overall prevalence of diabetes was 6.65% and that of prediabetes was 5.57%. A positive association was seen with urban residence, geographic region, sex, age, body mass index, socioeconomic status, and hypertension. Approximately two-thirds of individuals with diabetes lived in urban areas, and about half of the urban population was considered overweight/obese. South India showed a higher prevalence of diabetes (prevalence ratio, 2.01; p<0.001) than northern India. CONCLUSIONS: Hyperglycemia (diabetes and prediabetes) has a high prevalence in India and is a major public health issue. Diabetes is unevenly distributed based on geographic location and urbanization. Prevention, early detection, and treatment strategies should consider this uneven distribution of diabetes.

Oral HPV prevalence and HPV vaccination among special needs population in the US.

INTRODUCTION: Special needs population have barriers accessing healthcare, higher incidence of sexual assaults and lower sexual education. Due to the above this study was conducted- 1) To assess the current prevalence of oral HPV infection among individuals with SHCN (special health care needs) as compared to the general population and 2) To compare the prevalence of HPV vaccination in SHCN individuals (within the recommended age groups) to general population. METHODS: This data was obtained from NHANES 2013-14 and included 665 individuals with special needs. Weighted prevalence estimates and prevalence ratios (PR) were calculated for oral HPV infection by gender, age (18-59 years), race, smoking history, economic status, and sexual behavior. Prevalence rates were calculated for HPV vaccination. RESULTS: Oral HPV was detected in 9% (7.1-11.5; p = 0.05) of special needs adults. High-risk HPV genotypes prevalence was also higher among adults with special needs [5.56% (3.9-7.9) vs 3.87% (2.7-5.4)]. The HPV vaccination rates among 9-26 years special needs females (33.5% vs 37%) and males aged 9-21 years (16.7% vs 21.2%) with special needs was lower than non-special needs individuals. CONCLUSION: There is higher burden of oral HPV infection among adults with special needs compared to general population. Contrastingly, lower vaccination rates were observed among them within the recommended age groups. Further studies are required to determine the barriers to HPV vaccination among individuals with special needs.

Dental Sealant Prevalence Among Children with Special Health Care Needs: National Health and Nutrition Examination Survey (NHANES) 2013 to 2014.

Purpose: The purpose of this study was to evaluate dental care access and sealants prevalence among children with special health care needs. Methods: The authors utilized the publicly available National Health and Nutrition Examination Survey (NHANES) 2013 to 2014 datasets collected by trained dental examiners for the Centers for Disease Control and Prevention. This study included 2,651 six- to 19-year-olds who provided demographic, dental visit, disability, and sealants information. Weighted prevalence estimates and odds ratios (OR) were calculated for sealant use by disability, gender, age, race, and economic status. Results: Approximately 68 percent of participants had a dental visit in the past six months, with 84 percent of them being routine dental visits; each had approximately two sealed teeth (mean equals 2.37). Children with a physical disability have lower odds of having a sealant (OR equals 0.5; P=0.04) compared to nondisabled children. Six- to 11-year-olds have lower odds of having a sealant versus older age groups. Sealant use prevalence was lowest among African American children (39 percent) versus Hispanic (47 percent) and Caucasian (54 percent; P=0.01) children. Conclusions: The findings indicate disparities in dental sealants use among those with physical disabilities and younger age groups. Further studies and strategies are needed to intervene at an early age and increase utilization of sealants among children with special health care needs. (Pediatr Dent 2019;41(3):186-90) Received September 15, 2018 | Last Revision February 24, 2019 | Accepted March 4, 2019.

Importance and Potential of Dentists in Identifying Patients at High Risk of Diabetes.

OBJECTIVES: The study was conducted to assess the utilization of medical and dental services by dental patients at two dental school hospitals and to approximate the number of patients having no known previous diagnosis of type 2 diabetes but are at high risk of acquiring it. METHODS: A cross-sectional study was conducted at two dental school hospitals in India. A 20-item questionnaire was administered as interviews among the dental patients aged 35 to 55 years. Data was collected on past dental and medical visits, medical history, family history relevant to diabetes, cardiovascular health, BMI and waist circumference (measured). RESULTS: A total of 413 adult patients (males 61.26%, females 38.74%) participated in the surveys. The mean age was 43.06 years. Results revealed that nearly 50% did not have a medical or a dental visit in the last 1 year, 33% had Cardiovascular Diseases (CVD). Among those who did not have medical visit in last one year 45% had BMI >25 kg, 55% had waist circumference above the normal range and 38% were at high risk of diabetes. CONCLUSION: The high number of patients without a medical visit in the past year or more, as well as the high levels of diabetes risk indicators, affirms the need for dentists to perform chair-side screenings for diabetes. These results suggest the need for additional training among dental students to improve early detection and identification of high-risk patients to minimize potential morbidity due to diabetes.

Tobacco Use and Effects of Professional Advice on Smoking Cessation among Youth in India

Objective: Healthcare professionals and addiction programs play important roles in tobacco use prevention and cessation activities. In this study, we analyzed the prevalence of tobacco use and the impact of smoking cessation advice through programs/professionals among a nationally representative sample of youth in India. Methods: The data were obtained from the Global Youth Tobacco Survey (GYTS) 2009 dataset from a nationally representative school based survey of 8th to 10th grade students in India (n=14,543). Professional or provider advice for smoking cessation was analyzed with reference to quitting smoking. Descriptive analysis was performed for tobacco and smoking prevalence and the types of tobacco products used. Logistic regression was employed to assess any associations between professional or program advice and quitting smoking. Results: The overall prevalence of current tobacco use was 13.5%. About 76% were never tobacco users and 9.3% were former tobacco users. The prevalences of smoking, smokeless tobacco and poly tobacco use among current tobacco users were 35.1%, 43.3% and 21.5% respectively. Among the never smokers, 80% were weakly and 20% were strongly susceptible. Recipients of advice from a program or professional showed higher odds (OR=5.3) of quitting smoking. Conclusion: Professional and program advice to quit smoking is very effective for youth in India. More programs and healthcare professionals must be employed to prevent and encourage youth to abstain from the use of tobacco.