Impact of Establishing Dental Access for Preventable Infectious Dental Diseases (PIDD) in Medical Settings: Case Study from Rural Wisconsin.

OBJECTIVE: The frequency of Preventable Infectious Dental Disease (PIDD) visits in medical centers was examined pre and post establishment of expanded dental access and adoption of an integrated medical-dental care delivery model. METHODS: A retrospective observational study of patient attributes and frequency of unscheduled PIDD visits between January 1, 1990 and February 29, 2020. Chi-squared tests compared (a) the number of PIDD visits (pre/post dental center establishment), (b) age at first diagnosis, (c) gender, (d) race, (e) primary insurance at the time of PIDD visits and (f) healthcare setting where visit occurred. RESULTS: System-wide, 21,957 unique patients were documented with a total of 34,892 PIDD visits as the primary diagnosis. Patients between 18-30 years and patients with Medicaid had the highest frequency of PIDD visits in medical settings. Following the establishment of dental centers, reduced relative risk of PIDD visits was observed for patients with no health insurance or self-pay/other coverage. PIDD visits in primary care settings was 0.87 times as likely as PIDD visits at ED/UCs after dental centers opened. CONCLUSIONS: The number of PIDD visits to medical centers increased before the dental infrastructure was established, followed by a decline afterwards, inclusive of disparity populations. Some residual persistence of PIDD visits to primary care settings was identified. This study reinforced importance of dental healthcare access for achieving appropriate PIDD management while reducing PIDD visits to medical settings.

Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years: US Preventive Services Task Force Recommendation Statement.

Importance: Oral health is fundamental to health and well-being across the lifespan. Oral health conditions affect the daily lives of school-age children and adolescents, leading to loss of more than 51 million school hours every year. Untreated oral health conditions in children can lead to serious infections and affect growth, development, and quality of life. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in children and adolescents aged 5 to 17 years. Population: Asymptomatic children and adolescents aged 5 to 17 years. Evidence Assessment: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years. Recommendations: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement).

[The impact of primary prevention programs of dental diseases on the main trends in the development of dental services]. / Vliyanie programm pervichnoi profilaktiki stomatologicheskikh zabolevanii na osnovnye tendentsii razvitiya stomatologicheskoi sluzhby.

The vision of the global strategy on oral health is universal health coverage for oral health for all individuals and communities by 2030, enabling them to enjoy the highest attainable state of oral health and contributing to healthy and productive lives (WHO, 2022). To achieve this goal, it is necessary to ensure the development of the dental care system in Russia on the basis of primary prevention of dental diseases. OBJECTIVE: Analysis of the methodology for the development, implementation and evaluation of programs for the primary prevention of dental diseases and their impact on the main trends in the development of dental services. MATERIAL AND METHODS: The main research methods were search for publications, analysis and systematization of information on the methodology for developing, implementing and evaluating programs for the primary prevention of dental diseases. RESULTS: Despite the single main goal of dental disease prevention programs, the analysis of the methodology of their construction and implementation must be carried out considering their impact on the main trends in the development of dental services. CONCLUSIONS: The main directions of development of the methodology for the development, implementation, and evaluation of primary prevention programs of dental diseases should include the use of indicators of oral health recognized by the international community, which allow us to trace the degree of their influence on the development of the system of dental care.

[Department of dental diseases prevention of the Central Research Institute of Dentistry and Maxillofacial Surgery]. / Otdelenie profilaktiki stomatologicheskikh zabolevanii FGBU NMITs «TsNIIS i ChLKh¼.

The article is devoted to the creation and development history of the Dental Diseases Prevention department in National Medical Research Center of Dentistry and Maxillofacial Surgery, Moscow, Russia. The main scientific and clinical achievements of the department's staff are presented in chronological order. The main directions of the scientific and clinical activities of the department are currently: the study of various factors affecting dental morbidity; the development of regionally-oriented programs for the prevention of dental diseases; organizational and methodological guidance and monitoring of primary prevention activities in organized groups of children and adolescents; the implementation of a set of measures for the primary prevention of dental diseases among adolescents and adult population applying to the polyclinic; introduction into practice of new methods and means of prevention and treatment of dental diseases; testing of new methods and means of prevention corresponding to the profile of the department, providing dental care to adolescents and adults; raising the level of theoretical knowledge and training practical skills in the prevention of dental diseases of medical personnel of healthcare institutions; promotion of sanitary and hygienic knowledge among the population.

Oral health training for general practitioners and general practice teams.

The role of oral health in promoting general health and wellbeing is recognised, but there is minimal oral health training for doctors, including GPs. The Directorate of Multi-Disciplinary Dental Education (DMDE) at Health Education England North East and North Cumbria has introduced oral health training for GPs, incorporating training recommended by NICE oral health guidance. DMDE oral health training for GPs and general practice teams covered the diagnosis, prevention and management of oral disease, relevant prescribing and accessing dental care. Training has been shown to be worthwhile, positively impacting upon the clinical practice of GPs and thereby improving patient care. General health benefits are anticipated. Interactive training, as outlined in the DMDE lesson plan, was deemed effective. 1-hour courses conveniently delivered within general practices were most popular with GPs. Online courses have been less popular. Barriers to training were overcome through producing a promotional brochure and gaining the support of NHS medical leaders, who assisted with its distribution. A shift to training the trainer will improve the cost-effectiveness and sustainability of training. It is recommended that all GPs receive oral health training.

Patient education in dental medicine: A review of the literature.

INTRODUCTION: In dental medicine, chronic diseases and chronic conditions (such as chronic periodontitis, temporomandibular disorders, chronic orofacial pain) justify patient education to self-care. This strategy of secondary or tertiary prevention, even if officially recognised, is still less known compared to health education, a form of primary prevention. The aim of the study was to make the point of recent studies devoted to patient education. Thus, the purpose of the study was to give an updated picture of patient education in odontology, describing, through an analysis of the international literature from 2006 to 2016, its characteristics and development. METHODS: The main databases selected were: PubMed, EMBASE, CINAHL, Web of Sciences, DOSS, 302 articles published between 2006 and 2016 on patient education among which four RCTs and a case study were analysed because of their rigorous scientific quality. RESULTS: Patient education concerns chronic diseases and conditions also in the field of orthodontics. This limited number of studies, showed that patient education in odontology can bring real bio-clinic, cognitive, psychological and economic benefits to patients. Overall, it allows patients to better understand their illness and treatment and, thus, to improve their health behaviours and self-care techniques, which would reduce the treatment costs. Educational interventions in odontology should constitute a component of patient education in several chronic systemic diseases such as diabetes. It would be necessary to train future practitioners in this field and to develop a scientific research on this practice.

Effect of long-term oral appliance therapy on obstruction pattern in patients with obstructive sleep apnea.

PURPOSE: Oral appliance therapy is an alternative treatment modality for obstructive sleep apnea (OSA). However, there have been no studies to determine whether changes in the obstructive pattern occur following long-term use of oral devices. Therefore, we examined whether the obstructive pattern changes in patients with OSA who undergo long-term oral appliance therapy using drug-induced sleep endoscopy (DISE). METHODS: We investigated 156 consecutive patients diagnosed with OSA. Seventy-nine of these patients were found to be eligible for inclusion in this study. All enrolled patients underwent two DISE examinations: before and after oral appliance use. We compared the DISE findings for each patient in terms of degree and configuration of airway obstruction at the levels of the velum, oropharynx, tongue base, and epiglottis. RESULTS: We found that dental problems, as assessed using the average values of overjet and overbite, were significantly decreased after 2 years of oral appliance use. Comparisons of the DISE findings revealed that there was significant widening of the upper airway structures following long-term oral appliance therapy, especially in the velum (P = 0.022) and epiglottis (P = 0.001). However, changes in the configuration of upper airway obstruction were not observed in any of the structures of the upper airway. CONCLUSIONS: We found evidence possibly indicating decreased obstruction at the levels of the velum and epiglottis after long-term use of oral appliances. We suggest further cohort studies to confirm these findings.

Behavior guidance: that was then but this is now.

Pediatric dentistry has evolved. Seasoned pediatric dentists believe that patients, parents, and behavior techniques have changed over their practice lifetimes. The purpose of this article is to provide dentists with a framework in which to adapt to the changes in society. Understanding cultural diversity, current societal values, technology and media influences, and contemporary parenting philosophies is essential to fostering communication with patients and their families. Building and honing behavior guidance skills are part of the process by which dentists help turn child patients into fearless adult patients with excellent oral health. This article reviews basic techniques and offers practical examples of implementing these in daily practice. The discussion also addresses changing parental and societal acceptance of various techniques and dentists' responsibility for informed consent regarding the risks and benefits of advanced behavior guidance techniques. Treating a patient from childhood to adulthood is the ultimate opportunity for the dentist to play a vital role in advancing the health and wellness of another human being.

Oral health of older residents in care and community dwellers: nursing implications.

BACKGROUND: Poor oral health is associated with a reduced quality of life and serious illnesses. Consequently, nurses need to be more aware of oral health to improve the general health of residents in care. AIM: To evaluate and compare oral health behaviours and levels of salivary haemoglobin and dental biofilm acidogenicity, which can be used to evaluate oral disease activity, between residents and community dwellers in South Korea. METHODS: This cross-sectional study included 133 participants: 64 residents and 69 community dwellers. All participants completed a questionnaire and tests to measure their salivary haemoglobin and dental biofilm acidogenicity. RESULTS: A higher percentage of community dwellers than of residents brushed their teeth three times a day, cleaned their tongue, used interdental cleaning devices and had visited a dental clinic within 1 year. The levels of salivary haemoglobin and dental biofilm acidogenicity tended to be higher in residents than in community dwellers. CONCLUSION: Residents showed poorer oral health behaviours and higher levels of gingival bleeding and acid production by oral bacteria than did community dwellers. IMPLICATIONS FOR NURSING PRACTICE: Nursing staff should enhance their monitoring of oral hygiene status and provide quality oral care to residents through cooperation with dental professionals. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Policymakers should be aware that oral health is an essential component of improving general health and well-being and therefore strive to develop policies to promote oral care services provided to residents. Nursing policies, such as mandating oral care and hands-on training in oral care for nursing staff, are important. We also suggest that factors related to oral care be added to the establishment or accreditation standards of care facilities.

The preexposure prophylaxis of stomatological diseases among the population of ukraine in the practice of the family doctor and the pediatrician.

INTRODUCTION: The dental health is one of the direct measures indicators of the population's health, integrated indicator of the nation's health, its invigoration and preservation are the most important medical, social and economic problems. The aim to investigate the position and the role of a family doctor and a pediatrician in the preexposure prophylaxis orthodontic pathology among the population of Ukraine. MATERIALS AND METHODS: The book-semantic analysis of the scientific literature; the content analysis - research of the regulatory and legal framework; the system analysis - analysis of the system of doctors' carrying preexposure prophylaxis of the stomatological diseases. CONCLUSIONS: The health system reforming will allow approaching the preexposure medical aid to the population, providing its quality, a doctor's responsibility for his patients. One of the direction of a pediatrician's and a family doctor's work will be the prevention and early diagnosis of the orthodontic pathology, the advocacy promotion of the health alimentation and the healthy lifestyle for adults and children, saving the dental health in general.

[Long-term results of dental health examinations of employees of industrial enterprises with hazardous working conditions]. / Otdalennye rezul'taty stomatologicheskoi dispanserizatsii rabotnikov promyshlennykh predpriyatii s opasnymi usloviyami truda.

The article analyzes the results of dental examination of employees with hazardous and normal working conditions in Atomenergomash enterprise with various dental care organization regimens and provides clear evidence of the effectiveness of serial attendances care in enterprise dental offices in terms of reduction in the dental treatment needs. Additional funding for departmental dental services was calculated by comparing the real cost of dental treatment and MHI tariffs allowing implementation of proposed dental care program.

[Specific age-related and gender related features in oral status]. / Stomatologicheskii status patsientov v zavisimosti ot ikh gendernykh i vozrastnykh kharakteristik.

The aim of the study was to assess age and gender related features of oral status and oral hygiene. The study included 234 patients (76 males and 158 females) aged 25 to 74 years. It is proved that females have more dental appointments than males mostly because of specific oral conditions associated with pregnancy and menopause as well as better compliance with prevention programs. Thus, females require more intense follow-up than males which should be taken into consideration in treatment and follow-up plans.

Dental disorders in brown howler monkeys (Alouatta guariba clamitans) maintained in captivity.

BACKGROUND: The aim of this study was to investigate dental disorders of brown howler monkeys maintained in captivity. The hypothesis is that the identification and diagnosis of the lesions may contribute to control and prevention. METHODS: Sixteen intact brown howler monkeys (Alouatta guariba clamitans), eight females and eight males, weighing from 3.9 to 6.8 kg, were studied. Under general anesthesia, the teeth were evaluated by visual inspection, probing, palpation, and intra-oral radiographic exam. The findings were registered on a dental chart specific for primates. RESULT: Of the 16 monkeys evaluated in the present study, 94% (n = 15) had some type of dental disorder. The lesions observed were dental calculus (88%), dental wear (81%), missing teeth (38%), gingivitis (19%), gingival recession (6%), dental fracture (19%), pulp exposure (19%), and dental staining (25%). CONCLUSIONS: Alouatta guariba clamitans maintained in captivity have a high rate of dental problems.

Effect of Free Dental Services on Individuals with Sickle Cell Disease.

OBJECTIVES: Poor oral health can have a negative impact on overall health. This is especially concerning for individuals with sickle cell disease (SCD), an inherited blood disorder that affects hemoglobin and can lead to an increased risk of infection and hyperalgesia. Because the majority of individuals with SCD have Medicaid insurance and no dental coverage, we provided free basic dental care to individuals with SCD to determine whether it decreased overall healthcare utilization. METHODS: Through a contract with a private dental office, we provided free basic dental care (eg, cleanings, fillings, x-rays) to individuals with SCD. We reviewed medical records for the 12 months before and after their initial dental visit to determine whether there were any changes in acute care visits (defined as a visit to the emergency department, sickle cell infusion center, or visits to both in the same day), hospitalizations, and total days hospitalized. We conducted a negative binomial regression to determine any differences in the pre-post periods. RESULTS: In our multivariable analysis, there was a statistically significant decrease in hospital admissions. In addition, there was a significant decrease in total days hospitalized if dental work was completed, but an increase in days hospitalized in men. CONCLUSIONS: Providing dental care to individuals with SCD who did not have dental insurance did not greatly alter acute care visits. A larger sample size may be necessary to observe an effect.

[The Common Risk Factor Approach - An Integrated Population- and Evidence-Based Approach for Reducing Social Inequalities in Oral Health]. / Common Risk Factor Approach ­ Ein integrierter bevölkerungsbezogener und evidenzbasierter Ansatz zum Ausgleich sozialer Ungleichheiten in der Mundgesundheit.

Worldwide, non-communicable diseases including dental caries and periodontal diseases, remain a major public health problem. Moreover, there is a social gradient in health across society that runs from the top to the bottom in a linear, stepwise fashion. Health promoting behaviours become more difficult to sustain further down the social ladder. Oral health inequalities also exist in Germany. Earlier explanations of social inequalities have mainly focused on individual lifestyle factors, ignoring the broader social determinants of health and disease. Until recently, the dominant approaches to general health promotion focused on actions to reduce specific diseases, separating oral health from general health. An alternative approach is the common risk factor approach (CRFA) where risk factors common to a number of major chronic diseases, including diseases of the mouth and teeth, are tackled. The CRFA focuses on the common underlying determinants of health to improve the overall health of populations, thereby reducing social inequalities. The main implication of the CRFA for oral health policies is to work in partnership with a range of other sectors and disciplines. Oral health issues need to be integrated with recommendations to promote general health. Improvements in oral health and a reduction in oral health inequalities are more likely by working in partnership across sectors and disciplines using strategies that focus upstream on the underlying determinants of oral diseases.

Oral health care-related beliefs among Finnish geriatric home care nurses.

OBJECTIVES: The aim was to investigate beliefs about oral health care tasks among nursing staff caring for home-dwelling older people using the Nursing Dental Coping Beliefs (nursing DCBS) index. METHODS: The study population comprised nursing staff working at the homes and sheltered accommodations of older people in Ylivieska, Finland (N = 141). The data were collected using the nursing DCBS index (five-point Likert scale). RESULTS: On average, the nurses held moderate to high Oral health care beliefs, Internal locus of control beliefs and External locus of control beliefs, but low beliefs about Self-efficacy. The nurses with an earlier adjunct education scored lower for Oral health care beliefs on the factor Knowledge about preventing gum diseases (OR = 0.3, 95% CI: 0.1-0.9) than did the others. Regarding beliefs about External locus of control, the age group 31-49 years scored lower on the factor Retaining teeth as one ages (OR = 0.2, 95% CI: 0.1-0.7), but scored higher on the factor How to prevent dental diseases (OR = 5.6, 95% CI: 1.1-29.3) than did younger nurses (≤30 years). The nurses with only a nursing education showed significantly higher mean scores on the Self-efficacy factor Confidence of the need for dental knowledge than did those with an earlier adjunct education (P = 0.034). CONCLUSIONS: The nursing staff mostly believed that oral diseases are preventable and teeth can be retained in advanced age, but failed to recognize the value of dental knowledge and had little confidence in their ability to manage oral diseases. Improving the oral health-related knowledge and self-efficacy beliefs of nursing staff will require additional oral health education.

Dental health of children with cerebral palsy.

Cerebral palsy (CP) is a common chronic motor disorder with associated cognitive, communicative, and seizure disorders. Children with CP have a higher risk of dental problems creating significant morbidity that can further affect their wellbeing and negatively impact their quality of life. Screening for dental disease should be part of the initial assessment of any child with CP. The objective of this article is to present an updated overview of dental health issues in children with CP and outline important preventative and practical strategies to the management of this common comorbidity. Providing adequate oral care requires adaptation of special dental skills to help families manage the ongoing health issues that may arise. As oral health is increasingly recognized as a foundation for general wellbeing, caregivers for CP patients should be considered an important component of the oral health team and must become knowledgeable and competent in home oral health practices.

Older people and oral health: setting a patient-centred research agenda.

OBJECTIVE: The aim of this pilot study was to provide the opportunity to enable older people to prioritise the research agenda to improve their own oral health. BACKGROUND: Little is known about the ageing population's views about their oral health from their perspective. Priority Setting Partnerships (PSPs) incorporate users' perspectives to prioritise research agendas and are based on a series of sequential steps to build consensus. This structured approach ensures their narrative and thoughts are heard and helps counter the 'top-down' medical model that can dominate healthcare services. MATERIALS AND METHODS: A PSP was undertaken with four key stakeholder groups: service users, carers, third sector and specialists. Six initial questions were posed to each group prior to a facilitated discussion led by one of the research team. Collective responses where then considered by a final consensus group. The views of the different groups were recorded, transcribed verbatim and underwent thematic analysis. RESULTS: The top three research priorities identified by the final group were to: (i) identify 'best practice' in the prevention and treatment of oral diseases for older people, (ii) identify the training needs for the dental profession and (iii) understand the key issues for older people from their perspective. Improving access to services, the importance of client appropriate information and the need for effective primary and secondary prevention were also articulated. CONCLUSION: Asking older people to prioritise the research agenda proved to be a positive experience. Key issues related to improving communication and the availability of appropriate evidence-based information on primary, secondary and tertiary prevention.

Clinical leadership and prevention in practice: is a needs led preventive approach to the delivery of care to improve quality, outcomes and value in primary dental care practice a realistic concept?

BACKGROUND: There is a need to improve access to, and the quality of, service delivery in NHS primary dental care. Building public health thinking and leadership capacity in clinicians from primary care teams was seen as an underpinning component to achieving this goal. Clinical teams contributed to service redesign concepts and were contractually supported to embrace a preventive approach. METHODS: Improvement in quality and preventive focus of dental practice care delivery was explored through determining the impact of several projects, to share how evidence, skill mix and clinical leadership could be utilised in design, implementation and measurement of care outcomes in general dental practice in order to champion and advocate change, during a period of substantial change within the NHS system. The projects were: 1. A needs-led, evidence informed preventive care pathway approach to primary dental care delivery with a focus on quality and outcomes. 2. Building clinical leadership to influence and advocate for improved quality of care; and spread of learning through local professional networks. This comprised two separate projects: improved access for very young children called "Baby Teeth DO Matter" and the production of a clinically led, evidence-based guidance for periodontyal treatment in primary care called "Healthy Gums DO Matter". RESULTS: What worked and what hindered progress, is described. The projects developed understanding of how working with 'local majorities' of clinicians influenced, adoption and spread of learning, and the impact in prompting wider policy and contract reform in England. CONCLUSIONS: The projects identified issues that required change to meet population need. Clinicians were allowed to innovate in an environment working together with commissioners, patients and public health colleagues. Communication and the development of clinical leadership led to the development of an infrastructure to define care pathways and decision points in the patient's journey.