An Expert Opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European Policy Recommendations on Oral Health in Older Adults.

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care-dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture-related conditions, hyposalivation, and oral pre- and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person-related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non-dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured.

The Bleeding on Brushing Index: a novel index in preventive dentistry.

BACKGROUND: The aim of this study was to evaluate the suitability of a dichotomous index, based on a special interdental brushing tool, to detect initial pathological processes in interproximal areas. Furthermore, different techniques of interdental hygiene were compared. METHODS: Participants (n = 108) were instructed to clean their teeth using the Bass technique and were randomly assigned to three groups according to the type of interdental cleaning used: group A, use of interdental brushes; group B, no interdental hygiene (the control group); and group C, use of dental floss. Approximal Plaque Index (API), Plaque Index (PI), modified Sulcus Bleeding Index (mSBI) and the Bleeding on Brushing Index (BOB) were measured at baseline, and after 2 (t1) and 4 (t2) weeks. Statistical analysis was performed using the Wilcoxon test and the Mann-Whitney U-test. RESULTS: One-hundred and six participants completed the study. The BOB decreased significantly in all groups (P < 0.001) with the most pronounced reduction being recorded for group A (baseline: 49.3 ± 23.0%; 4 weeks: 5.1 ± 6.9%). Also, the mSBI (P < 0.001) decreased significantly in all groups during the study. The API appeared to be less affected by the oral hygiene than other indices. The highest correlation was observed between BOB and mSBI (r = 0.785, P < 0.001). CONCLUSION: The BOB is a valuable complement for the existing array of indices in preventive dentistry, and is able to detect potential pathological processes in interproximal spaces. Additionally, this study suggests that interdental hygiene with individually selected brushes is superior to flossing. CLINICAL RELEVANCE: With the BOB, gingival inflammation can be demonstrated to patients, which could increase compliance.

Perceived competency towards preventive dentistry among dental graduates: the need for curriculum change.

BACKGROUND: A previous study has shown that dental practitioners in Benghazi believed that the less prevention-oriented education system is one of the barriers to applying preventive dentistry. OBJECTIVE: To assess attitudes and perceived competence of the dental graduates in Benghazi towards prevention and early management of dental caries. METHODS: A cross-sectional, questionnaire-based survey was conducted among internship students attending the Department of Community and Preventive Dentistry in Faculty of Dentistry, Benghazi, Libya. The participants were asked to provide demographic information, to respond to statements about their attitudes towards preventive dentistry, and to answer questions regarding their perceived competence in applying preventive dentistry procedures. RESULTS: Data from 108 Libyan dental graduates were analysed for this study, of which 64% of them were females and 42.1% of them passed their final year with grade: acceptable. The most acknowledged aspects of preventive dentistry were being useful and essential to the community (95.4 and 90.8%, respectively). The percentage of participants expressing a proficiency in providing oral hygiene instructions was the highest (95.4%). There were differences between study subgroups in their perceived competence of preventive dental practices by gender and academic performance (p≤0.05). CONCLUSION: This study highlighted that the currently implemented undergraduate education programme in Benghazi dental school does not provide dentists with the required attitude and skills to fulfil their role in providing preventive-oriented health services.

A review of a child population dental preventive programme in Halton and St Helens.

INTRODUCTION: An evaluation was undertaken to measure the dental health of five cohorts of 5-year-old children living in Halton and St Helens, each cohort having had a different length of time they were exposed to a population dental prevention programme before their fifth birthday. METHOD: The dental health of each of five consecutive cohorts of 5-year-old children was measured epidemiologically using standardised methods. RESULTS: The mean level of active decay (dt) in the cohort that had the greatest exposure to the preventive intervention (cohort 5, 2011/12) was 0.83, whereas the mean level of active decay in the cohort with no exposure to the preventive programme (cohort 1, 2007/8) was 1.07. This represents a reduction of 22% in the mean level of active decay in 5-year-olds. There was also a 5.9% absolute increase in the number of 5-year-old children free from decay experience between cohorts 5 and 1. Children living in Halton and St Helens with postcodes in the more socially deprived index of multiple deprivation (IMD) tertiles gained the most from the programme. Comparing cohort 5 and cohort 1, the increase in the proportion of children free from decay was greatest in IMD tertiles 1 and 2 and least in IMD tertile 3 (least socially disadvantaged). CONCLUSION: Following a four-year population dental preventive programme the dental health of 5-year-old children living in Halton and St Helens has improved and dental health inequalities have reduced. As there was no control group, the effects seen are associative and cannot be assumed to be causative.

Are general dental practitioners providing best practice in prevention in everyday general practice?

AIMS: To discover whether general dental practitioners are providing best practice in prevention, as defined by the 'Delivering Better Oral Health' toolkit, in everyday general practice. METHOD: A questionnaire was created with five scenarios describing the key findings of the examination of five hypothetical patients. Dentists attending a postgraduate meeting were asked to list all the preventive treatment and advice they would give each patient. The content of their answers was compared with the toolkit by two researchers. RESULTS: Twenty four dentists completed the questionnaire. In general terms, they did not mention much of the specific advice or recommend the treatment listed in the toolkit except that a significant proportion would apply fluoride varnish to children's teeth and all would give smoking cessation advice where appropriate. Suitable recall intervals, defined by the National Institute for Clinical Excellence, were suggested for three of the scenarios but the advice was inconsistent for the other two scenarios. CONCLUSION: This small investigation suggests that dentists' implementation of prevention, as advised by the toolkit, is not thorough or consistent. Comprehensive adoption of prevention in dentistry will require intensive multifaceted education and organisational change such as might be provided by the new contracts being piloted at present.

Economic evaluation of preventive dental programs: what can they tell us?

The role of public health program planners is to determine the effectiveness of public health programs, what recommendations should be made, what future initiatives should be taken, and what policies should be developed. At a basic level, to choose between competing alternatives, two characteristics of an intervention must be considered; these are its outcome and its cost. Based on cost and outcome, planners must select the option that offers the most advantages. Economic evaluation is commonly adopted by decision makers in the health sector to investigate the effectiveness of public health programs and to help plan future initiatives. Economic evaluation assists decision makers who must weigh the information it provides in the context of many and often competing options. In this way, an economic evaluation is an aid to decision making rather than the decision itself. Economic evaluation is becoming essential for informed decision making, with potential implications for public health policy and practice and for clinical practice too. While economic evaluations are commonly used in decision-making processes about health programs, few examples exist in the oral health literature. In the case of preventive oral health programs, economic analysis is often difficult, largely because it makes demands on epidemiological and demographic data that are hard to meet. This study will address the concepts and tools required to conduct economic evaluations of prevention programs. The emphasis will be on oral health and preventive dental programs, although the concepts presented could be useful for other public health programs by practitioners and managers with the aim of producing effective and efficient oral health programs.

Child dental neglect: is it a neglected area in the UK?

This commentary focuses on the condition of dental neglect (DN) in children in the UK. It is divided into three sections: the first section defines DN in children and its consequences, the second section discusses who may be responsible for dental diseases in children as a result of neglect and the third section proposes a holistic approach to address DN in children in the UK.

Geo-mapping of time trends in childhood caries risk--a method for assessment of preventive care.

BACKGROUND: Dental caries is unevenly distributed within populations with a higher burden in low socio-economy groups. Several attempts have been made to allocate resources to those that need them the most; there is a need for convenient approaches to population-based monitoring of caries risk over time. The aim of this study was to develop the geo-map concept, addressing time trends in caries risk, and demonstrate the novel approach by analyzing epidemiological data from preschool residents in the region of Halland, Sweden. METHODS: The study population consisted of 9,973 (2006) and 10,927 (2010) children between 3 to 6 years of age (~77% of the eligible population) from whom caries data were obtained. Reported dmfs>0 for a child was considered as the primary caries outcome. Each study individual was geo-coded with respect to his/her residence parish (66 parishes in the region). Smoothed caries risk geo-maps, along with corresponding statistical certainty geo-maps, were produced by using the free software Rapid Inquiry Facility and the ESRI® ArcGIS system. Parish-level socioeconomic data were available. RESULTS: The overall proportion of caries-free (dmfs=0) children improved from 84.0% in 2006 to 88.6% in 2010. The ratio of maximum and minimum (parish-level) smoothed relative risks (SmRRs) increased from 1.76/0.44=4.0 in 2006 to 2.37/0.33=7.2 in 2010, which indicated an increased geographical polarization of early childhood caries in the population. Eight parishes showed evidential, positional changes in caries risk between 2006 and 2010; their corresponding SmRRs and statistical certainty ranks changed markedly. No considerable parallel changes in parish-level socioeconomic characteristics were seen during the same time period. CONCLUSION: Geo-maps based on caries risk can be used to monitor changes in caries risk over time. Thus, geo-mapping offers a convenient tool for evaluating the effectiveness of tailored health promotion and preventive care in child populations.