Effect of malocclusion on adults seeking orthodontic treatment.

INTRODUCTION: Our objective was to examine the Teen Oral Health-related Quality of Life (TOQOL) questionnaire for use in adults receiving orthodontic treatment and assess validity and reliability by age group. METHODS: Teenagers from 10 to 18 years and adults 18 and over completed surveys at the orthodontic clinic at Boston University. The survey consisted of sociodemographic information, dental behavior questions, and the TOQOL instrument. Malocclusion severity was assessed using the Index of Orthodontic Treatment Need. RESULTS: Overall, 161 teens and 146 adults participated. The mean ages were 13 years for the teens and 32 years for the adults. Subjects were represented by both sexes and diverse racial and ethnic backgrounds. In general, scores overall and by domains were higher for adults than for teens, signifying a greater effect of the malocclusion on the quality of life. Mean TOQOL scores as well as emotional and social domain scores (P <0.001) were worse (17.6) in adults than in teens (11.9; P <0.01). Construct validity was supported by strong a association of TOQOL scores with self-reported oral health. The Cronbach alpha was higher in adults overall and for all domains (0.75 in adults compared with 0.68 in teens). CONCLUSIONS: Adults who come for orthodontic treatment appear to be more affected by their malocclusion than are teens. The total TOQOL score and the emotional and social domains were significantly higher for adults. The total TOQOL score and the emotional and social domains were significantly higher (worse) for adults than teens. This project suggested that TOQOL may be a useful way to measure the impact of malocclusion on the quality of life in both adults and teens.

Knowledge Gaps Exist Among Dentists Regarding Curing Lights and Personal Protection.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Light curing procedures - performance, knowledge level and safety awareness among dentists. Kopperud SE, Rukke HV, Kopperud HM, Bruzell EM. J Dent 2017;58:67-73. SOURCE OF FUNDING: Information not available TYPE OF STUDY/DESIGN: Cross-sectional study.

The most common types of nontraumatic dental conditions among emergency department visits in North Carolina before and during the COVID-19 pandemic.

BACKGROUND: This study aimed to identify the most common types of nontraumatic dental conditions (NTDCs) before and during the COVID-19 pandemic and assess the variations in the most common NTDCs by patient age groups and rural or urban locations and the impact of COVID-19 on emergency department (ED) visits for NTDCs in North Carolina. METHODS: The authors conducted a retrospective data analysis of ED data from the North Carolina Disease Event Tracking and Epidemiology Collection Tool. The authors estimated the proportions of NTDCs of all ED visits in 2019 and 2021 and ranked the proportions of the major categories of NTDCs by age groups and rural or urban locations. They used a multiple logistic regression model to assess the impact of COVID-19 on NTDCs. RESULTS: By the first diagnosis, the proportion of NTDCs dropped from 1.1% in 2019 to 0.99% in 2021 (P < .001). Caries was specified as the third most common NTDC. Oral infection was the top NTDC among young (≤ 17 years) and older patients (≥ 65 years). No significant differences were found in NTDCs between rural and urban areas (P = .68). Children younger than 2 years (adjusted odds ratio, 4.36) and adults aged 18 through 44 years (adjusted odds ratio, 4.54) were more likely to visit the ED for NTDCs than those 75 years and older. CONCLUSIONS: The proportion of NTDCs seen at the ED was lower during the COVID-19 pandemic in 2021 than in 2019. The common NTDCs varied by age group but were similar in rural and urban areas. The most common NTDCs were related to toothache, oral infection, and caries. PRACTICAL IMPLICATIONS: More efforts are needed to reduce ED visits for NTDCs.

Geofencing: Mobile Technology as a Health Promotion Tool to Raise Awareness of a Dental Clinic in Rural North Carolina.

PURPOSE: The purpose of the study was to assess the use of geofence technology to raise awareness of a dental clinic in rural North Carolina. METHODS: The catchment area of the dental clinic was defined by ZIP Codes. A geofence was identified, and cell phones within the perimeter were targeted for oral health message drops to occur over 3 months from April to June 2017. Surveys conducted twice, pre- and postintervention (message drop), evaluated change in community awareness of services available at the dental clinic. A cross-sectional analysis was used to measure the effect of the exposure to the geofence technology in survey respondents. FINDINGS: The survey included 200 participants (100 pre- and 100 postintervention). There were no significant differences in race or age for pre- and postintervention survey groups. The majority of respondents were American Indians (47.0% pre, 58.6% post) or black (28.8% pre, 25.5% post). There was a statistically significant improvement in awareness of the dental clinic (P = .045) from pre- to postintervention. A significant increase was also observed in the question related to dental visits by the respondent or family member of the respondent (from 6.5% to 15.0%, P = .04). A more modest improvement was found in questions related to the cost of dental care, type of insurance accepted, and services provided. CONCLUSION: Geofencing has the potential to increase awareness of health care services and ultimately increase the number of patients receiving care.

Barriers to and Facilitators of Oral Health Among Persons Living With Mental Illness: A Qualitative Study.

OBJECTIVE: Persons with mental illness have poorer oral health and are less likely to receive oral health care than those in the general population. A comprehensive understanding of barriers to and facilitators of accessing oral health care from a multidisciplinary perspective is lacking. The authors of this qualitative study sought to explore barriers and facilitators in addressing the oral health needs of individuals with mental illness from the perspectives of patients, psychiatrists, and dentists. METHODS: A thematic content analysis approach was used to triangulate the perspectives of the three groups. Face-to-face semistructured interviews were conducted in 2018-2019 with patients with mental illness (N=20), psychiatrists (N=20), and dentists (N=25) at an academic medical campus in rural eastern North Carolina. Participants were recruited until thematic saturation for each group was reached. RESULTS: Reported barriers to oral health care were categorized under emerging themes: access to dental care, fear of dental care, characteristics of mental illness, lack of oral health screening by psychiatrists, lack of education and training, stigma of mental illness, and lack of communication. Facilitators of oral health care were linked to the reported need for education and training, financial support, dentists' chairside manner, community support, and interprofessional communication. CONCLUSIONS: The findings highlight health system gaps between oral health and mental health. The barriers and facilitators identified can help inform the development of interventions to improve oral health of patients with mental illness. Interventions should include interdisciplinary education and training, improved communication, and strategies to reduce financial barriers and anxiety in dental practice.

Trends in use of dental care provider types and services in the United States in 2000-2016: Rural-urban comparisons.

BACKGROUND: The authors conducted a study to assess recent trends in dental care provider mix (type of dental professionals visited) and service mix (types of dental procedures) use in the United States and to assess rural-urban disparities. METHODS: Data were from the 2000 through 2016 Medical Expenditure Panel Survey. The sample was limited to respondents who reported at least 1 dental visit to a dental professional in the survey year (N = 138,734 adults ≥ 18 years). The authors estimated rates of visiting 3 dental professionals and undergoing 5 dental procedures and assessed the time trends by rural-urban residence and variation within rural areas. Multiple logistic regression was used to assess the association between rural and urban residence and service and provider mix. RESULTS: A decreasing trend was observed in visiting a general dentist, and an increasing trend was observed in visiting a dental hygienist for both urban and rural residents (trend P values < .001). An increasing trend in having preventive procedures and a decreasing trend in having restorative and oral surgery procedures were observed only for urban residents (trend P values < .001). The combined data for 2000 through 2016 showed that rural residents were less likely to receive diagnostic services (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.72 to 0.93) and preventive services (AOR, 0.87; 95% CI, 0.78 to 0.96), and more likely to receive restorative (AOR, 1.11; 95% CI, 1.02 to 1.21) and oral surgery services (AOR, 1.23; 95% CI, 1.11 to 1.37). CONCLUSIONS: Although preventive dental services increased while surgical procedures decreased from 2000 through 2016 in the United States, significant oral health care disparities were found between rural and urban residents. PRACTICAL IMPLICATIONS: These results of this study may help inform future initiatives to improve oral health in underserved communities. By understanding the types of providers visited and dental services received, US dentists will be better positioned to meet their patients' oral health needs.

Use of patient self-report oral health outcome measures in assessment of dental treatment outcomes.

OBJECTIVE: To assess the sensitivity of a newly developed brief measure of oral health-related quality of life (OQOL). METHODS: Self-assessed oral health and OQOL were measured in three groups of patients who had presented for either prophylaxis (n = 32), endodontic care (n = 15), or for a denture (n = 16) in a dental school setting before and after treatment. Main outcome measures included the single-item self-report of oral health (OH-1) and the 6- and 12-item versions of a new OQOL instrument. General linear modeling was used to compute means of self-reported oral health by treatment group. RESULTS: Of the 63 patients who completed the baseline questionnaire, 44 (70 percent) returned questionnaires after treatment. The sample averaged 43 +/- 15 years, 48 percent male and 55 percent with some college education. Ethnic representation included 35 percent White, 33 percent Black, and 32 percent other - mostly Latino. The mean self-reported number of teeth was 20.6. In terms of sensitivity, significant differences were observed between the treatment groups on the items assessing being upset (P < 0.05), feeling depressed (P < 0.05), and uncomfortable about the appearance of teeth or dentures (P < 0.05). However, magnitude of change, as measured by an effect size, was characterized as minimal to small in the recall and endodontic groups and borderline moderate in the denture group. CONCLUSION: The measure was sensitive to differences within groups, with a small to borderline magnitude of change.

Influence of Community-Based Dental Education on Practice Choice: Preliminary Data from East Carolina University.

Maldistribution of the dental workforce contributes to poor access to oral health care. Community-based dental education (CBDE) may help to address this problem by using experiential learning to encourage new dentists to practice in underserved areas. The East Carolina University School of Dental Medicine (East Carolina University SoDM) employs a multifaceted strategy, including CBDE, to increase the number of dentists practicing in underserved areas of North Carolina. The aim of this study was to assess the influence of CBDE and other factors on practice choice among East Carolina University SoDM graduates. This cross-sectional study assessed practice intentions before and after a senior-year CBDE experience. Data were obtained for students in three graduating years from written student reflections and self-reported practice plans solicited at graduation. Of the total 156 students between 2015 and 2017 (52 each year), all students participated in at least one component of this evaluation: all students (100%) completed required student reflections, and 148 (95%) provided pre-graduation practice plans. Data were also obtained on alumni practice characteristics via a survey of recent graduates; 72 alumni (46% response rate) participated in the alumni survey. The assessments found positive attitudes towards the CBDE program before and after participation, although areas for improvement relating to business management and financial viability were reported. The majority of alumni respondents (67%) remained in the state to practice after graduation, with half reporting practicing in rural areas. For most alumni respondents (>75%), debt, salary, benefits, type of patient population, and desire to own/run a business were important factors other than the CBDE program influencing their practice choice. Nearly half of them (45.8%) rated desire to work in a public health setting as an important factor. This study provides preliminary evidence of the effectiveness of this educational model in retaining new dentists within the state to address the critical shortage of dentists in North Carolina.

Implementation of Recommended Tobacco Cessation Systems in Dental Practices: A Qualitative Exploration in Northeastern North Carolina.

Every year, cigarettes and other tobacco products cause nearly one in five deaths in the U.S., but many smokers report not being advised to quit by their health care providers. Dentists have an important role to play in tobacco cessation, but more research is needed about the extent of and barriers to implementation in dental practices. The aims of this study were to assess the extent to which dental practices in northeastern North Carolina were implementing the recommended U.S. Public Health Service (PHS) Clinical Practice Guideline, to understand policies about smoking in dental practice settings, and to identify barriers to implementation of recommended systems. In the 252 telephone area code, which covers northeastern North Carolina, 75 general dentists were identified from the American Dental Association website and purposely selected for geographic, gender, race, and practice size diversity from the sampling frame. The 11 dentists who agreed to participate (seven male, four female) took part in 15-minute semi-structured interviews by phone in January-March 2017. The interview transcripts were thematically coded for adherence to the PHS guideline. The results showed that full implementation of the guideline and the 5As was limited, although asking, advising, and assessing about tobacco use was consistently present in these dental practices. Other recommendations, particularly designation of a staff member as coordinator, were not implemented. In terms of barriers, interviewees reported very limited past or present training for themselves or their staff members. This study found meaningful levels of adherence to the tobacco cessation guideline in this area with high smoking prevalence; but the results suggest room for improvement in training through both dental curricula and continuing education.

Development of the Teen Oral Health-Related Quality of Life Instrument.

OBJECTIVE: The aim of this study was to develop the Teen Oral Health-Related Quality of Life instrument (TOQOL) and demonstrate its validity and reliability in a diverse sample of 13-18-year-old adolescents. METHODS: A total of 363 adolescents aged 13-18 years participated in this cross sectional study. Oral screening examinations were conducted to collect oral health status data. Adolescents completed the TOQOL and a generic measure of health-related quality of life, the PedsQL. The psychometric properties of the TOQOL were evaluated in terms of face, content, convergent, concurrent and discriminant validity in addition to internal reliability. RESULTS: The 16-item TOQOL covers five domains: Physical functioning, Role functioning, Social functioning, Oral problems, and Emotional functioning. The total scale and subscales showed satisfactory reliability with Cronbach alpha ranging from 0.75 to 0.92. TOQOL scores showed significant associations with perceived oral health status and the PedsQL (convergent validity) and discriminated well between adolescents with caries and adolescents who were caries free (discriminate validity). CONCLUSION: The TOQOL is a valid and reliable oral health-related quality of life measurement that can be recommended for self-report in adolescents aged 13-18 years.

Saudi and U.S. dental student attitudes toward treating individuals with developmental disabilities.

This study was conducted to compare the attitudes of senior dental students at the Faculty of Dentistry at King Abdulaziz University (KAU) in Jeddah, Saudi Arabia, and at Tufts University School of Dental Medicine (TUSDM) in Boston, Massachusetts, about providing dental care to individuals with developmental disabilities (DD). Two subsequent classes of senior dental students at both universities were surveyed using a pretested, validated, online questionnaire. The students' demographic and educational data were collected, along with information about their experience, training, and attitudes toward this population. Two hundred and fourteen students responded to the online survey, for a response rate of 35 percent (51 percent for KAU students and 21 percent for TUSDM students). Students at TUSDM had more training, more experience, and more positive attitudes toward individuals with DD compared to KAU students (p<0.05). Students who reported having previous experience with individuals with DD had more positive attitudes than students who reported no experience with these individuals (p<0.05). Students who reported being prepared to treat individuals with DD had more positive attitudes than students who reported not being prepared (p<0.05). These findings suggest an association between predoctoral education in the treatment of individuals with special needs and having positive attitudes toward providing oral health care to individuals with DD.