Laser fluorescence assessment of dental caries arrest with two silver fluoride agents in patients with special needs- a preliminary report.

PURPOSE: While silver diamine fluoride has been used extensively for caries arrest and desensitising, silver fluoride (AgF) at neutral pH may also have value as a minimally invasive dental caries treatment. This study explored the effectiveness of two AgF products (AgF/KI and AgF/SnF2) when used in adult patients with special needs (SN) who had high caries risk and salivary gland hypofunction. METHODS: This split-mouth clinical study, over two appointments 3-months apart, compared the impact of a single application of AgF/KI (Riva Star Aqua, SDI) and AgF/SnF2 (Creighton Dental CSDS, Whiteley) on matched carious lesions in the same arch, by clinical visual-tactile (cVT) assessment of caries status and laser fluorescence (LF, DIAGNOdent) evaluation of bacterial load in the lesions, using repeated measures analysis. RESULTS: Twelve participants were recruited in the study. A total of 56 teeth (28 pairs) were included. Both AgF products gave a significant decrease in caries activity as measured by cVT (P < 0.0001) and LF (P = 0.0027). There were no statistically significant differences between the two AgF treatments, with response rates for improvements in active lesions of 92% in the AgF/KI arm, and 96% in the AgF/SnF2 arm. There was no effect of tooth type, lesion type, arch type, plaque metabolism and plaque area at the site level on outcomes, nor was there a clustering effect of sites in a patient level analysis. Overall, LF was superior to cVT for detecting lesions that still progressed despite treatment (P = 0.0027). CONCLUSION: A single application of AgF/KI or AgF/SnF2 has high predictability (over 90%) for achieving arrest in active caries lesions in adult patients with SN and high caries risk. Clinical assessment should use visual-tactile examination combined with LF readings to detect lesions that are still progressing and that require additional treatments. Future studies should compare these AgF modalities with SDF and explore factors such as time between applications and the need for repeated applications. TRIAL REGISTRATION: The study was registered with the Australian Clinical Trials Registry (ACTRN12621001139864p) on 23/08/2021.

Singapore dentists' attitudes toward dental care provision for older adults with disabilities.

OBJECTIVES: This study aimed to assess dentists' attitudes toward providing dental care for older adults with disabilities in Singapore and the factors influencing their willingness to provide care. BACKGROUND: Dentists face a rapidly ageing patient demographic. Practitioner unwillingness to circumvent the attending challenges of care provision prevents older adults from accessing the dental care necessary for better oral and systemic health. Previous studies have reported on dentists' attitudes toward caring for older adults with disabilities; however, these are mostly limited to dependent older adults and exclude frail, community-dwelling older persons. METHODS: A cross-sectional study was conducted in 2020 using a self-administered questionnaire. Quantitative data analysis was presented in the form of descriptive statistics, followed by bivariate analyses. RESULTS: There were 193 respondents, a response rate of under 9%. Dentists were less willing, confident and involved in the care of older adults with disabilities as the individual's severity of impairments increased. Less than half of respondents were willing to treat individuals with severe disabilities in cooperation (23.3%), swallowing (30.6%), mobility (33.7%) and communication (45.1%). Dentists with training in geriatric dentistry were more willing to provide care. However, younger dentists, general dental practitioners, private practitioners and public sector dentists had specific restraining and driving forces, which further modulated their willingness to provide care. CONCLUSIONS: The current areas of training needs among Singapore dentists are in severe impairments of swallowing, communication, cooperation and mobility. Further geriatric dentistry training may effectively increase dentists' willingness to provide care; however, additional specific targeted interventions are also needed.

Association between lack of dental service utilisation and caregiver-reported caries in Australian Indigenous children: A national survey.

AIM: To investigate the association between the lack of dental service utilisation and dental caries in Australian Indigenous children. METHODS: Data from the Longitudinal Study of Indigenous Children, which is a longitudinal population-based cross-sectional study in Australia were analysed. A total of 1258 children were included, consisting of the baby cohort and the child cohort at Wave 7. Logistic regression analysis was conducted to examine the association between caregiver-reported child dental caries and dental service utilisation. Multiple imputation using the fully conditional specifications approach was used to account for missing data. RESULTS: Around one tenth (12.3%) of Indigenous children did not see a dentist when required. Lack of dental service utilisation was associated with an increased likelihood of caregiver-reported dental caries (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.5-3.8) and teeth removed due to dental caries (OR 2.3; 95% CI 1.1-4.7). These associations remained after adjusting for confounders (caregiver-reported dental caries OR 2.3; 95% CI 1.3-3.8; teeth removed due to dental caries OR 2.1; 95% CI 1.0-4.4). The reasons reported for not utilising dental services when required were the lack of an available dentist (31.4%), difficulties with physical access (19.8%), long waiting times (13.9%), financial issues with cost (5.8%) and feeling that 'they could cope' (4.6%). CONCLUSIONS: Lack of dental service utilisation was associated with dental caries and extraction due to caries in Australian Indigenous children.

Perspectives of oral health therapists on the barriers to oral care provision in nursing homes in Singapore: A qualitative analysis.

INTRODUCTION: Oral health therapists (OHTs) are a valuable resource for increasing access to dental care for the frail elderly in nursing homes (NHs). However, OHTs face several barriers and their skill-set continues to be under-utilized. AIMS: To evaluate the perceptions of OHTs regarding the barriers towards oral care provision for the elderly residents in NHs. METHODOLOGY: Semi-structured interviews were conducted with 11 OHTs to discuss the factors that may hinder them from providing oral health services in NHs. An inductive thematic analysis directed by the grounded theory approach was performed. RESULTS: Four major themes emerged: (i) lack of opportunity, (ii) lack of adequate education and training, (iii) limited work scope and registration status, and (iv) lack of adequate financial remuneration and adequate equipment. OHTs also raised the lack of awareness among OHTs and the various stakeholders, of how the skill-set of OHTs may be relevant for oral care provision in NHs. CONCLUSION: Findings revealed underlying educational and regulatory barriers which need to be addressed in tandem. Addressing these barriers can be impactful in informing future strategies for the greater utilization of the skill-set of OHTs in Singapore.

Modified Oral Health Assessment Tool (M-OHAT) for Residential Aged Care: A Co-Design Protocol.

Background: Older adults in residential aged care facilities (RACFs) experience disproportionate levels of poor oral health relative to other groups in the general population, affecting their physical and mental wellbeing. The Oral Health Assessment Tool (OHAT) is a validated and widely used dental assessment tool; however, recent systematic reviews have identified shortcomings with respect to its measurement properties. Objective: The objective of this protocol is to provide a detailed overview of a multidisciplinary qualitative study that aims to (a) co-design and develop a modified OHAT for RACFs and (b) inform the development of an OHAT training package and implementation strategies. Methods: This study will utilize a co-design methodology with aged care residents, caregivers, staff members, and health professionals. The co-design workshops will: (1) investigate the barriers to and enablers of optimal oral healthcare in RACFs; and (2) co-design a modified version of the Oral Health Assessment Tool and a referral to treatment pathway that is appropriate for use in RACFs. The co-design workshops will facilitate group discussion and involve interactive activities using, for example, mind mapping and Sticky Notes. Qualitative data (transcripts and artefacts from co-design activities) will be analyzed in NVivo using an inductive codebook thematic analysis, specifically a template analysis. Conclusion: The findings of this study will inform a modified OHAT (M-OHAT), as well as future study phases regarding training and implementation strategies. It is expected that the M-OHAT will have enhanced usability and relevance to RACFs, facilitating the identification of poor oral health and timely referral to dental treatment.

Association between disability status and dental attendance patterns in Australian children: A national survey.

OBJECTIVES: This study investigated the dental attendance patterns of Australian children with and without disabilities using data from Growing up in Australia: The Longitudinal Study of Australian Children. METHODS: Data on 6470 participants within two groups (B cohort [aged 12-13]: n = 3381; K cohort [aged 16-17]: n = 3089) were used for the study. Binomial regression models were fitted to examine the association between disability status and dental attendance. The models were adjusted for gender, parent's country of birth, region of residence, highest parental education and household weekly income, and multiple imputations was used for handling missing data. RESULTS: Children with disabilities constituted 2.4% and 3.8% of the study sample in the B and K cohort, respectively. The unadjusted risk ratio of irregular (vs. regular) dental attendance between children with and without disabilities was 1.07 (95% CI 0.78-1.46) in the B cohort and 1.15 (95% CI 0.93-1.42) in the K cohort. After adjustment and imputation, the risk ratios were 1.03 (95% CI 0.76-1.41) and 1.10 (95% CI 0.89-1.36) in the B and K cohort, respectively. CONCLUSIONS: Dental attendance pattern was positively, but minimally, associated with disabilities in older children, and factors including region of residence, parental education and household income were related to disability status and dental attendance. Further studies are required to clarify the association and ascertain key factors that affect the health and wellbeing of children with disabilities.

Interprofessional collaboration utilizing oral health therapists in nursing homes: Perceptions of oral health therapists and nursing home staff in Singapore.

INTRODUCTION: Oral health therapists (OHTs) have the potential to increase the access to oral care for elderly residents in nursing homes (NHs). AIMS: To evaluate the perceptions of NH staff and OHTs regarding the barriers and enablers toward oral care provision for elderly NH residents, and their perceptions toward interprofessional collaboration through the utilization of OHTs in NHs. METHODOLOGY: Electronic surveys were completed by 231 direct care and 15 managerial staff from 15 NHs, and 103 OHTs. Factors influencing oral care provision, and aspects of awareness, capabilities, and willingness/interest toward collaboration were evaluated. RESULTS: The OHTs and NH staff reported mutually positive responses toward interprofessional collaboration. The most frequently reported barriers by the NH staff were the lack of regular support from dental health professionals and inadequate knowledge and skills. The OHTs expressed willingness and competence in assisting the NH staff, but lacked regulatory and educational support. CONCLUSION: OHTs have the potential to address the barriers faced by the NH staff, if adequately supported through policy and education. Oral health promotion in intermediate and long-term care sectors should take into account this potential for interprofessional collaboration through greater utilization of the skill-set of OHTs.

Association between disability status and dental attendance in Australia-A population-based study.

AIMS: Disability is a key social determinant of health. The objective of this study was to test the association between disability status and irregular dental attendance among the Australian population, and to examine whether the observed association varied among adolescents. METHODS: Data on 17 501 participants from The Household, Income and Labour Dynamics in Australia (HILDA) were analysed. The main outcome examined was irregular dental attendance (two or more years since last dental visit) with disability as the primary exposure. Multivariable logistic regression models were fitted to test the associations between disability and dental attendance pattern. Models were adjusted for age, gender, country of birth, region of residence, education and income. Analysis was repeated among adolescents (15- to 24-year-old) to examine for variations in observed association. RESULTS: One in four participants reported having a disability. Unadjusted model showed that the odds for irregular dental attendance were 1.40 times greater (95%; CI, 1.30-1.51) in those with disability than those without disability. After adjusting for all covariates, participants with disability had 1.20 times higher odds (95%; CI 1.10-1.30) of irregular dental attendance than those without disability. Irregular dental attendance was 1.41 times greater (95%; CI 1.10-1.80) in those with disability aged 15-24 years than those without disability. CONCLUSIONS: Australian individuals with disability are more likely to have irregular dental attendance than those without.

Oral management of patients with cancer / Manejo oral de pacientes con cáncer

Abstract The oral management of individuals affected by medical conditions, including those with a current cancer diagnosis, is often complex and as such should be provided by either experienced dentists or dental specialists (e.g. Special Needs Dentists) with adequate training and experience. Patients with cancer need early dental intervention as the cancer itself or its therapy may place them at increased risk of systemic and oral complications. In Colombia, Special Needs Dentistry (SND) has not been formally recognized as a specialty and does not form part of the current dental curricula suggesting a paucity of suitably qualified dentists to provide complex oral care for oncology patients. While it is accepted that general dentists will provide the bulk of care to these individuals, their knowledge base is unclear. This paper aims to improve the knowledge base around complex SND by addressing the oral complications faced by this patient cohort and how to prioritize treatment, together with proposing a simple protocol to streamline coordination of care between the dental, allied health and medical teams, that is, through a multidisciplinary approach. It is important to acknowledge that dentists have a role at all three levels of the multidisciplinary management of cancer patients: pre- treatment evaluation and preparation, oral care during treatment and post-treatment care.

Resumen El manejo oral de las personas afectadas por condiciones médicas, como el cáncer, a menudo es complejo y como tal debe ser proporcionado por dentistas experimentados o especialistas en áreas dentales (por ejemplo, dentistas que atienden necesidades especiales) que cuenten con la formación y la experiencia adecuadas. Los pacientes con cáncer necesitan una intervención dental temprana, ya que el cáncer en sí o su terapia pueden ponerlos en mayor riesgo de complicaciones sistémicas y orales. En Colombia, la Odontología de Necesidades Especiales (ONE) no ha sido reconocida formalmente como una especialidad y no forma parte de los planes de estudios de las escuelas de odontología, lo que indica que hay una escasez de dentistas adecuadamente calificados para proporcionar atención oral compleja para pacientes oncológicos. Si bien se considera que los dentistas generales pueden proporcionar la mayor parte de la atención a estas personas, su base de conocimiento no es clara. Este documento tiene como objetivo mejorar la base de conocimientos en torno a la ONE abordando las complicaciones orales a las que se enfrenta este grupo de pacientes y cómo priorizar el tratamiento, junto con la propuesta de un protocol simple para agilizar la coordinación de la atención entre los equipos médicos, dentales y personal de apoyo, es decir, a través de un enfoque multidisciplinario. Es importante anotar que los dentistas cumplen un papel en los tres niveles del manejo multidisciplinario de los pacientes con cáncer: evaluación y preparación previa al tratamiento, cuidado oral durante el tratamiento y atención postratamiento.