To assess the knowledge, attitudes, and confidence of caregivers and administrators towards the oral health of nursing home residents in San Antonio, Texas.

OBJECTIVE: The primary objective of this research was to use qualitative methods to assess the knowledge, attitudes, and confidence of caregivers in their ability to provide oral hygiene assistance to residents. The secondary objective was to assess the knowledge and attitude of administrators on the provision of oral hygiene assistance for residents, and their confidence in caregivers' ability to provide oral hygiene assistance to nursing home residents in San Antonio, Texas. METHODS: A semi-structured interview guide was used to conduct face-to-face interviews with seven caregivers and twelve administrative staff from ten nursing homes in San Antonio, Texas. Employees in nursing homes who are caring for residents are referred to as caregivers and those whom they care for are referred to as nursing home residents. One survey instrument was developed for the caregiver's knowledge, attitude, and confidence toward providing oral health care, and another to assess the administrator's knowledge, attitude, and confidence in caregivers providing oral care for nursing home residents. The interviews were recorded, transcribed, and coded for thematic content. RESULTS: The findings revealed that caregivers and administrators had adequate knowledge of the connection between oral and systemic health. The administrators were confident that caregivers were adequately trained to provide oral hygiene care for residents. Caregivers had a positive attitude toward the importance of good oral health. They regularly assessed the residents' oral health, but due to time constraints, staffing shortages, and other competing tasks providing oral health care to the residents was challenging. Most caregivers were confident in their skills in providing oral care for the residents since 85.6% agreed. On the contrary, almost half of the administrators were confident that caregivers have the necessary skills to provide oral care for residents, while 41.7% were unsure. CONCLUSIONS: The study gave a broader insight into the provision of oral care in nursing home residents from the perspectives of caregivers and administrative staff. Administrators must provide caregivers with adequate training and time so they can provide adequate oral health care for the residents.

Dental care for pregnant patients: a survey to assess the current practices of Alabama dentists.

A commitment on the part of dentists to provide dental care to pregnant patients may contribute to alleviating the burden of oral disease experienced in this population. To assess barriers to providing dental care for pregnant patients, a survey instrument was developed and distributed to 472 Alabama Academy of General Dentistry members. Descriptive analyses were conducted to assess dental care practices, self-reported competence, and barriers to providing dental care. Bivariate analyses were conducted to determine whether dentists with and without residency training displayed differences in self-reported competence and dental care practice models. A total of 82 dentists completed the survey, yielding a response rate of 17.3%. Of the respondents, 93.9% reported providing dental care to pregnant patients in the past year. Lack of education and/or training was the most frequently identified barrier (41.5%) to the provision of care. Statistically significant associations were found between self-reported competence and residency training (χ2 = 4; P = 0.034; Φ = 0.235). Residency training may influence dentists' self-reported competence in providing care to pregnant patients. Dentists who did not receive residency training appeared more likely to report competence in their ability to provide such care. Most respondents reported providing dental care to pregnant patients, but only 40.6% of the respondents to the 2015 Alabama Pregnancy Risk Assessment Monitoring System (PRAMS) survey reported receiving a dental cleaning during pregnancy. Implementing systems to connect these patients with dentists may increase the receipt of care among this group.

Malpractice allegations among US dentists: association of malpractice allegation with the severity of the alleged malpractice injury.

The objective of this study was to explore associations between allegations of malpractice and the severity of the alleged malpractice injury. The public-use data file of the National Practitioner Data Bank was used to identify 34,042 dentist malpractice reports from January 1, 2010, through December 31, 2020. Univariate descriptive analysis was conducted to identify frequencies of malpractice allegations when classified by the severity of the alleged malpractice injury, practitioner graduation year, and year of original report processing. Ordinal logistic regression analyses were conducted to explore associations between the malpractice allegation type and the severity of the alleged malpractice injury. A total of 15,183 valid reports were used in the analysis. Compared with treatment-related allegations, a surgery related allegation proved 5.3 times more likely to result in minor permanent injury; a diagnosis-related allegation was 6.5 times more likely to result in significant permanent injury and 10.4 times more likely to result in major permanent injury; and an anesthesia-related allegation was 6.2 times more likely to result in major permanent injury. The confounding variable of graduation year proved significant with respect to major temporary and minor permanent injury. As the allegation group advanced from diagnosis-related to anesthesia-, treatment-, and surgery-related allegations, the odds of a higher severity of injury did not increase. Establishing a proper diagnosis and developing a treatment plan to manage the anticipated complications of the procedure to be performed are critical to a successful outcome.

Improving Healthcare in South Texas Rural Communities: An Interprofessional Initiative for Primary Care Dental and Medical Residents.

OBJECTIVE: To enhance primary care dentistry and medicine residents' didactic knowledge, communication skills to address patient's healthcare needs, and collaboration among healthcare professionals, while increasing confidence in integrating primary care skills into their clinical practice. METHODS: An Interprofessional Education workshop was organized to enhance didactic knowledge and learning of 42 primary care dentistry (PCD) and family and community medicine (FCM) residents on topics including addressing facial and dental trauma in adults, managing patients with alcohol use and abuse, pain control and prescription opioid use in dentistry, and opioid use disorder and treatment. An online survey was administered before and after the workshop to assess changes in knowledge, confidence, and future intentions to incorporate targeted primary care skills learned during the workshop into clinical practice and to elicit residents' perceptions of workshop quality. Overall scale means were assessed by chi-square tests for knowledge scales and analysis of variance for confidence and career intentions scales, significance levels were set at 0.05. RESULTS: Pre-workshop assessments were completed by all attendees while post assessments received a response rate of 83.3%. Both PCD and FCM residents reported an increase in their knowledge (p < 0.05) and confidence (p < 0.05) in providing care for patients with facial/dental trauma, identifying signs of opioid abuse, addressing alcohol abuse, and understanding the referral processes following the workshop. While an overall increase was noted regarding intentions to incorporate skills learned during the workshop into practice by the PCD (pre-course = 4.33, post-course = 4.42) and FCM (pre-course = 4.55, post-course = 4.73) residents, the differences were not statistically significant differences. CONCLUSIONS: The interprofessional education workshop for PCD and FCM residents enhanced their knowledge, confidence, and future intentions to incorporate primary care skills into clinical practice and improve patient outcomes.

Effectiveness of silver diamine fluoride in arresting dental caries in residents living in nursing homes: A randomized controlled trial.

OBJECTIVE: The primary objective of this randomized controlled trial was to determine the effectiveness of a single application of 38% silver diamine fluoride (SDF) solution in arresting and controlling active accessible caries compared to no treatment among adults aged 18 years and older residing in nursing homes or long-term care facilities. Many patients cannot receive standard-of-care dental treatment due to their medical conditions and inability to undergo anesthesia. All teeth in the control group will be treated with SDF at the conclusion of the study. METHODS: This study enrolled 39 adults aged 18 or older with 188 active lesions from nine San Antonio, Texas, nursing home facilities. Teeth were randomized and divided into two treatment and control groups. Each treatment tooth was paired with a control in the same oral cavity. Accessible carious lesions were treated with a single application of 38% SDF solution. Teeth were re-evaluated at 3 weeks where control groups also received SDF treatment. RESULTS: The treatment group demonstrated caries arrest in 77 (81.9%) teeth compared to 0 in the control group (0%). Notably, within the treatment group 14 of the 17 teeth with no caries arrest were posterior teeth (82.4%). CONCLUSIONS: Our results suggest that a single application of 38% SDF solution is an effective measure for arresting and controlling caries compared to standard oral hygiene maintenance. Our research team recommends the regular use of a single application of SDF solution in marginalized populations given the possible public health, oral health, social, and economic benefits.

Role of Patient's Ethnicity in Seeking Preventive Dental Services at the Community Health Centers of South-Central Texas: A Cross-Sectional Study.

BACKGROUND: This study was conducted to determine the impact of a patient's ethnicity on seeking preventive dental services at the Community Health Centers (CHCs) in South-Central Texas. METHODS: Primary electronic health records (EHR) data were collected regarding each patient's medical and dental history, and comprehensive treatment planning. The researchers retrieved EHR from January 2016 to 2022. Bivariate analysis was completed to test the outcome with the predictor variable and covariates using the appropriate statistical tests. A multiple linear regression model was used to understand the association between the predictor and outcome variable while controlling for confounders. RESULTS: The study findings revealed significantly higher dental visits (2.26 ± 2.88) for Hispanic patients. The results from the multiple regression model indicated that non-Hispanic patients had a smaller chance of visiting CHC for preventive dental services, by eight percent, compared to the Hispanic population (p-value < 0.001) when all other variables were held constant. However, the study results were not significant, as the effect size was too small to conclude the effect of ethnicity on the patients visiting the dental clinic at the CHC for preventive services. CONCLUSION: The study concluded that there is no difference in the preventive dental services completed by Hispanics and non-Hispanics when all other variables are controlled.

Impact of Prenatal Health Conditions and Health Behaviors in Pregnant Women on Infant Birth Defects in the United States Using CDC-PRAMS 2018 Survey.

OBJECTIVE: To assess both individual and interactive effects of prenatal medical conditions depression and diabetes, and health behaviors including smoking during pregnancy on infant birth defects. METHODS: The data for this research study were collected by the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2018. Birth certificate records were used in each participating jurisdiction to select a sample representative of all women who delivered a live-born infant. Complex sampling weights were used to analyze the data with a weighted sample size of 4,536,867. Descriptive statistics were performed to explore frequencies of the independent and dependent variables. Bivariate and multivariable analyses were conducted to examine associations among the independent and dependent variables. RESULTS: The results indicate significant interaction between the variables smoking and depression and depression and diabetes (OR = 3.17; p-value < 0.001 and OR = 3.13; p-value < 0.001, respectively). Depression during pregnancy was found to be strongly associated with delivering an infant with a birth defect (OR = 1.31, p-value < 0.001). CONCLUSION: Depression during pregnancy and its interaction with smoking and diabetes are vital in determining birth defects in infants. The results indicate that birth defects in the United States can be reduced by lowering depression in pregnant women.

An interprofessional education initiative: Introducing a local anesthesia dental course for nurse practitioner and physician assistant students.

PURPOSE/OBJECTIVE: To assess the impact of local anesthesia (LA) course for physician assistant (PA) and adult gerontology-acute care nurse practitioner (NP) program students on knowledge, attitudes, confidence, and intention to incorporate skills in clinical practice. METHODS: The course was conducted by dental faculty for forty-eight PA and seven NP students and consisted of two lecture hours on anatomy of the oral cavity, anesthesia and pain management, 2 hours of preclinic lab where participants practiced injection technique on mannikins, and a clinical practicum conducted by dental school faculty and residents where students observed dental treatment including administration of LA, and discussed symptom triage by NPs and PAs for patients with dental problems including orofacial pain, initial management including LA, and patient referral to dentists. An online survey was administered to all students before and after the course to assess changes in knowledge, attitudes, confidence, and intention to incorporate LA administration skills into clinical practice and elicit students' perception of program quality. Pre- to post-changes were analyzed by two-tailed t-tests and analysis of variance (ANOVA) with significance at 0.05. RESULTS: The response rate for pre- and post-course assessment was 96.4% and 87.3% respectively. Students' overall scale score for self-assessment of dental knowledge increased significantly from pre- (2.34) to post-assessment (4.19). An increase was seen in students' attitudes regarding management of dental emergencies (t = 2.181; p < 0.05). Furthermore, overall confidence of students related to managing patients with dental problems increased significantly (2.00 to 3.85) after taking the course. CONCLUSION: The LA course was well received by PA and NP students and resulted in increased knowledge and confidence in recognizing common oral health conditions, understanding dental pain management including administration of LA, and making referrals to dentists to optimize patient care.