PRENATAL DENTAL CARE: EVALUATION OF PROFESSIONAL KNOWLEDGE OF OBSTETRICIANS AND DENTISTS IN THE CITIES OF LONDRINA/PR AND BAURU/SP,BRAZIL, 2004

The purpose of this study was to assess the current knowledge and recommendations of obstetricians and dentists as to the dental care to pregnant patients in the cities of Londrina/PR and Bauru/SP, Brazil. Questionnaires were distributed to professionals of both cities, arguing on the following issues: oral health during pregnancy; contact between prenatal care and dental care providers; prenatal fluoride supplementation; selection of therapeutic agents for local anesthesia, pain control and treatment of infection; and dental procedures that can be performed during each trimester. Data were analyzed by frequency of responses and statistical analyses were carried out using X² (type of workplace/service) and t test (time since graduation), significant if p<0.05. Seventy-nine obstetricians and 37 dentists responded the questionnaires. Most physicians referred the patient to dental care only when a source of dental problem was mentioned, limiting the adoption of a preventive approach. Forty-three percent of dentists and 34% of obstetricians did not know the potential contribution of periodontal infection as a risk factor for preterm low birth-weight babies. There was divergence from scientific literature as to the recommendation of local anesthetics (dentists and obstetricians), prenatal fluoride supplementation (obstetricians) and dental radiographs (dentists). The findings of this survey with dentists and obstetricians showed that dental management during pregnancy still presents some deviations from scientific literature recommendations, indicating the need to update these health care professionals in order to establish guidelines for prenatal dental care.     

Evaluation of preventive treatment by risk of caries among 13-year-olds

Abstract Implementation of caries preventive treatment in relation to the risk of caries was studied among 13-year-olds (n=132) in two groups treated in the same public dental clinics in Helsinki: caries patients (n=100) had the greatest numbers of decayed teeth (DT+dt), 5.5 on average, whereas cavity-free patients (n=32) had intact teeth. Data taken from patients' personal oral health records served for evaluation of individual need for caries prevention, risk of caries, and preventive treatment given to each patient. Patients with any caries lesions or erupting teeth or poor oral hygiene were considered to be at risk of caries and in need of preventive treatment. The more caries lesions a patient had, the more prevention was expected to have been given. Preventive treatment of caries was weakly or only moderately in accordance with patients' individual needs and risk of developing caries, although patients with more caries lesions tended to have been given more preventive treatment than did those with none or only a few lesions. The majority of preventive measures given were applications of fluoride varnish, whereas motivation of and instruction in oral health care habits remained weak. However, patients whom their dentists had judged to be at high risk of caries received more intensified preventive treatment than did other caries patients. As a conclusion, intensification of caries prevention among high-risk patients is still needed. Dentists should always consider each patient's risk of developing caries to improve quality of preventive treatment.     

Oral health status and dental care for individuals with visual impairment. A narrative review

Visual impairment is a highly prevalent condition worldwide. Oral health care in this group of patients is not always adequate. This is due to the low awareness of the importance of oral health in this population group and the fact that these patients prioritize their general health over oral health. Therefore, caries and periodontal disease are frequent in this population group. Especially, periodontal status is worse in patients with acquired visual impairment compared to patients with congenital visual impairment. On the other hand, the proportion of treated caries in this group is very low. This may be due to the poorer access of this population to dental care, which is limited by physical, social, and information barriers. Dental phobia and the lack of dental professionals capable of treating this population group have been identified as one of the most important factors. Therefore, establishing oral hygiene routines that are adapted to individuals’ skills and needs is essential to achieve good oral health and improve patient's quality of life. This narrative review also updates those dental treatment considerations, depending on each dental specialty, that can help improve patient satisfaction when they come to the dental office.     

Oral health of young children in Mississippi Delta child care centers: a second look at early childhood caries risk assessment

Objectives: To identify the predictors of early childhood caries and urgent dental treatment need among primarily African‐American children in child care centers in the Delta region of Mississippi. The purpose of this study was to replicate predictors of caries and urgent dental treatment needs that were identified in an earlier study conducted in Delta child care centers and to assess additional caries risk factors not collected in the original study. Methods: Children in 19 child care centers were examined by the dentists, and the parents provided data on oral health practices, oral health history, and on children's oral health‐related quality of life (QOL). The dentists also assessed visible plaque and tested levels of mutans streptococci. Predictors of caries and treatment need among children 24 to 71 months of age were examined using logistic regression. Results: Two parent predictors of caries identified in the earlier study (parent flossing and soft/sugary drink consumption) were not predictive in the current study. Parent history of abscess continued to predict their child's urgent need for treatment. Young children's level of salivary mutans streptococci, maxillary incisor visible plaque, and parents' reports of child oral health‐related QOL measures predicted the presence of both caries and urgent treatment need. Some expected predictors, such as frequency of child's toothbrushing, were not predictive of caries. Conclusions: Parental abscess and parent's report of the child's oral health‐related QOL are risk indicators for poor oral health outcomes that could be used by nondental personnel to identify young children in need of early preventive intervention and dental referral.     

Pretreatment for the cardiovascularly compromised geriatric dental patient: Geriatric Dentistry

As more elderly patients seek dental care, dentists will increasingly be confronted with growing numbers of ill patients on multiple medication regimes. Because cardiovascular disease is the largest disease entity in this age group and the greatest cause of morbidity and mortality, this paper has focused on the major types of cardiovascular disease, and the cardiac medications routinely prescribed. Possible interactions with dental procedures or medications and alternative dental treatments and medications are discussed. The need for the dentist to continually assess the stability of the patient's health and compliance with his or her prescribed treatment regimen is stressed, because through an awareness of the patient's medical status and level of compliance the dentist can determine a course of dental treatment that will not jeopardize the geriatric patient's already compromised cardiovascular health.     

Dietary and nutritional needs of patients after therapy for head and neck cancer

BackgroundThe number of cancer survivors in the general population is increasing. Oral and dental status affects patients' quality of life and oral function, which, in turn, may affect nutritional intake and general health. The authors review the importance of oral health and the role of the oral health care provider in supporting dietary intake and providing nutritional guidance.MethodsThe authors provide a brief review of oral complications of therapy and nutritional guidelines for patients with head and neck cancer.ResultsOral adverse effects of head and neck cancer treatment include salivary gland dysfunction, taste change, orofacial pain and mucosal sensitivity, oral infection, tissue defects and necrosis, trismus and fibrosis, progressive dental and periodontal disease, and problems with prosthesis function.ConclusionsManaging oral adverse effects of treatment may have an impact on dietary and nutritional intake, as well as on quality of life. Dietary modifications may be needed because of the patient's oral function and may include modification of food texture and flavor, as well as the use of dietary supplements.Clinical ImplicationsAs part of the patient's health care team, dental care professionals should be aware of the oral adverse effects of cancer therapy, as well as their role in recognizing and treating the resulting oral conditions. In addition, they should provide guidance to patients to support their oral dietary and nutritional intake.     

Oral health attitudes, knowledge, and behavior among school children in North Jordan

The aim of this study was to assess the knowledge, attitude, and behavior of school children towards oral health and dental care as well as to evaluate the factors that determine these variables. School children (n=557) of an average age of 13.5 years attending public schools in North Jordan were recruited into this study. The subjects completed a questionnaire that aimed to evaluate young school children's behavior, knowledge, and perception of their oral health and dental treatment. The participants' oral hygiene habits (such as tooth brushing) were found to be irregular, and parents' role in the oral hygiene habits of their children was limited. The study population showed higher awareness of caries than periodontal conditions. Irregular visits to the dentist were found to be common, and toothache was the major driving factor for dental visits. Children had positive attitudes toward their dentists; nevertheless, they indicated that they feared dental treatment. The children in this study also recognized the importance of oral health to the well-being of the rest of the body. Parents were not proactive in making sure that their children received regular dental care. Parents' knowledge and attitudes about the importance of oral health care and their fears about dental treatment influenced their children's dental care. The results of this study indicate that children's and parents' attitudes toward oral health and dental care need to be improved. Comprehensive oral health educational programs for both children and their parents are required to achieve this goal.     

Dentists' selection of measures for assessment of oral health risk factors for Finnish young adults.

Dentists' selection of measures for assessing oral health risk factors for young adults, in relation to their oral health status and to those dentists' characteristics, was studied in one administrative unit of the Finnish public oral health service. A random selection (n = 239) was made of all young adults born in the period 1966-71 and clinically examined during 1994. On the original oral health records of those selected, all notes were scrutinized concerning the most recent clinical examination and treatment course; in total 208 (87%) records. We found that assessment of risk factors to oral health was rare. The patient's diet had been recorded as assessed in 7% of all cases, use of fluoride in 8%, and oral hygiene habits in 14%. No salivary tests were performed; nor was patients' use of tobacco assessed. No correlation was detected between measures used by these dentists and their patients' oral health status (DMFT and DT scores, number of approximal incipient lesions, and number of healthy sextants by CPITN). The oral health status impelled only slightly assessments by bite-wing radiographs. Fewer than half (44%) of the dentists performed and recorded any kind of assessment measure; 4% assessed diet, hygiene, and use of fluoride for all their patients in our sample. A dentist's gender showed no correlation with number of measures used; younger dentists tended to perform and record assessments slightly more often than did older dentists, but in all age groups there were those who had not done this. The practice of risk-factor assessment should be more widespread and standardized, contributing to needs-based treatment and allocation of resources.     

Secular trends in dental services provided by dental therapists and dentists in Southwest Alaska

BackgroundThe goal of the study was to identify secular trends in dental service delivery between dental therapists and dentists in the Yukon-Kuskokwim Delta region of Southwest Alaska, the first area of the United States to authorize dental therapy practice.MethodsElectronic health record transactions from the Yukon-Kuskokwim Health Corporation from 2006 through 2015 (n = 27,459) were analyzed. Five types of dental services were identified using Current Dental Terminology procedure codes: diagnostic, preventive, restorative, endodontic, and oral surgery. Main outcomes were percentages of services provided by dental therapists compared with dentists and population-level preventive oral health care.ResultsThe overall number of diagnostic, preventive, and restorative services in the Yukon-Kuskokwim Delta increased. For diagnostic services, there was a 3.5% annual decrease observed for dentists and a 4.1% annual increase for dental therapists (P < .001). Similar trends were observed for restorative services. For preventive services, there was no change for dentists (P = .89) and a 4.8% annual increase for dental therapists (P < .001). Dental therapists were more likely than dentists to provide preventive care at the population level.ConclusionsDental therapists have made substantial contributions to the delivery of dental services in Alaska Native communities, particularly for population-based preventive care.Practical ImplicationsThe study’s findings indicate that there is a role for dental therapy practice in addressing poor access to oral health care in underserved communities.     

Clinical record keeping by general dental practitioners piloting the Denplan 'Excel' accreditation programme

BACKGROUND: Denplan is a private capitation-based system of providing primary dental care in the UK. An additional programme called Denplan Excel has been developed which requires General Dental Practitioners to instigate various quality processes within their practices in order to become accredited. Clinical record keeping is one area where standards are monitored. This study reports changes in record keeping at patient recall appointments following the implementation of the Denplan Excel programme. METHOD: Fifty dentists participating in the Denplan Excel pilot programme from different areas of the UK were sampled by means of cluster sampling. Twenty records for each dentist were sampled and items recorded for patients recalled both pre- and post-pilot were compared. RESULTS: The majority of dentists recorded presenting complaint, diagnosis and treatment plan both pre- and post-pilot. However, post-pilot there were a number of improvements in record keeping. Caries recorded on a grid increased from 7% of records to 46%, basic periodontal examination increased from 48% to 85% of records and the updating of medical history increased from 51% to 65% of records. These findings were all significant at the p<0.01 level. CONCLUSION: Changes can be achieved by voluntary participation in a system of structured record keeping.     

Concordance between patient satisfaction and the dentist's view: Findings from The National Dental Practice-Based Research Network

ObjectivesIn this study, the authors examined the dentist's view of the patient's experience and concordance with the patient's rating of satisfaction.MethodsPractitioners from 197 practices in The National Dental Practice-Based Research Network recruited consecutively seen patients who had defective restorations that were replaced or repaired. At the end of the dental visit, the treating dentist and 5,315 patients completed and returned a survey that asked about the patient's satisfaction.ResultsMost dentists viewed their patients as having been satisfied with the treatment experience (n = 4,719 [89 percent]) and as having perceived them as friendly (n = 5,136 [97 percent]). Dentists had less strong feelings about whether patients had a preference for the restorative material (n = 2,271 [43 percent]) or an interest in obtaining information about the procedure (n = 1,757 [33 percent]). Overall, patients were satisfied, and most of the time dentists correctly predicted this outcome. Among patients who were less than satisfied, there was a substantial subset of cases in which dentists were not aware of this dissatisfaction.ConclusionFor improved patient-centered care, dentists should assess patients' desires, expectations and perceptions of the dental care experience and then manage or correct the expectations and perceptions as needed.Practical ImplicationsBy taking a patient-centered approach, dentists should seek to understand how patients evaluate and rate the services provided, thereby enabling them to focus on what each patient values most.     

Study on oral health status and health behavior of workers at government office]

The purpose of this study was to investigate the oral health status and health behavior of the adult population in the workplace. In 1998, oral health examination of 388 workers (male: 287, female: 101) at a government office was performed. A questionnaire was administered to obtain data regarding oral symptoms and health behavior. The results were as follows: Overall, 48% needed treatment for dental caries, 44% needed calculus removal, and 23% needed treatment for periodontal disease. Although there were no oral health complaints, 20% had early caries, 40% had dental calculus, and 19% had periodontitis. Compared to males, more females brushed their teeth, had home dentists (44%) and received more regular dental health check-ups at least once a year (48%). For males, those with home dentists had higher FT and DMFT in the twenties and thirties. There was no relationship between oral health status and regular check-ups in both males and females. The results revealed that receiving regular dental check-ups from home dentists was not popular in Japan. Further, the role of home dentists is not preventive oriented. It was concluded that it is necessary to provide regular oral health examination and health promotion programs for adult population at the workplace in Japan.     

LOCAL ANESTHETICS AND PREGNANCY. A REVIEW OF THE EVIDENCE AND WHY DENTISTS SHOULD FEEL SAFE TO TREAT PREGNANT PEOPLE

Oral health and dental treatment are essential during pregnancy. Despite dental treatment being safe during pregnancy for mother and baby, many dentists are reluctant to treat pregnant people. Previously published FDA and ADA recommendations for the treatment of pregnant people exist. Consensus statements and injectable local anesthetic manufacturers' information exist as well. Yet many dentists continue to demonstrate reluctance and hesitancy to treat pregnant people during all stages of pregnancy and for all routine comprehensive care such as exams, diagnostic radiographs, scaling and root planning, restorative, endodontic, and oral surgical procedures. Local anesthetics are most widely used in dental treatment, and many dental procedures necessitate their use when treating pregnant people. To facilitate dentists... comfort and clinical decision-making in the use of local anesthetics in improving the pregnant population's receipt of dental treatment and care outcomes and to calibrate practices to the current standard of practice aligning with contemporary evidence, this paper will review essential published evidence-based studies, guidelines, resources, and information from national organizations responsible for protecting the public's health.     

Oral health and personnel needs in the Pacific

A regional review of oral health in the Pacific showed the major problems to be dental caries, periodontal diseases, poor dental health service management and lack of appropriate dental personnel. A strategy for training appropriate dentists to manage oral health services in the Pacific was suggested. Such a strategy must include training of ancillary and auxiliary dental health workers guided by dentists with clinical and managerial competencies. The training programme for dentists must be career-ladder, problem-based, and community-oriented with competency-based learning of a spiral of tasks with increasing sophistication. The curriculum content must contain about 50 per cent on public health and clinical aspects, respectively.     

Nitrous oxide-oxygen sedation in dental care

Abstract The aim of this study was to evaluate the dental treatments under nitrous oxide-oxygen sedation carried out during 1 yr by the first 45 Swedish dentists trained at probationary courses in the use of the technique. Special emphasis was placed on evaluating the risk and incidence of side effects. Data from 1719 treatment sessions in 823 patients, mainly children, were analyzed. Standardized sedation technique was used and the maximum level of nitrous oxide administered was set at 60%. About 90% of the patients showed excellent or fair acceptance. Factors influencing the acceptance were the patient's age, history of psychiatric disorders, mental retardation and occurrence of side effects. In 4.5% of the treatment sessions the patient experienced side effects, e.g. restlessness, vomiting or nausea, during treatment and in 0.9% after the treatment session. The side effects were mainly mild. No correlation was found between side effects and the nitrous oxide concentration used, length of treatment, patient's age or health classification. It is concluded that nitrous oxide-oxygen sedation is an excellent and safe aid to dental care.     

Opinions on the provision of dental care in Iowa nursing homes

Using a stratified random sample, a questionnaire was mailed to 400 practicing dentists and 200 directors of nursing (DONs). Response rates were 58.3% for dentists and 50% for DONs. Dentists were representative of Iowa dentists, with 85% male, mean age 49.1 years, and 22.4 years in practice. All DONs were female, with mean age of 44.9 years. Of the participating dentists, 86% had provided dental care for nursing home residents, but the majority of care was completed in dental offices. Three‐quarters of dentists were somewhat/not interested in nursing home dentistry. Dentists and DONs held common perceptions of the most frequent problems related to care provision at nursing homes: low financial reimbursement, especially for Medicaid patients; no portable dental equipment; no suitable area for dentistry; dentist's preference to treat patients at their dental practice; and transportation of residents to a dental practice. Dentists and DONs had some differing perceptions about oral health care (p < .01). Minimal dental care was provided on‐site at Iowa nursing homes.     

Knowledge of oral and physical manifestations of anorexia and bulimia nervosa among dentists and dental hygienists

Despite the crucial role oral health care providers can have in the early identification of eating disorders and the referral and case management of patients with these disorders, little is known concerning their knowledge of oral complications of these disorders. The purpose of this study was to determine the knowledge among dentists and dental hygienists concerning the oral and physical manifestations of eating disorders. Employing a randomized cross-sectional study, data were collected from 576 dentists and dental hygienists randomly selected from the American Dental Association and the American Dental Hygienists' Association. Results indicated low scores concerning knowledge of oral cues, physical cues of anorexia, and physical cues of bulimia among study participants. More dental hygienists than dentists correctly identified oral manifestations of eating disorders (p=.001) and physical cues of anorexia (p=.010) and bulimia (p=.002). As the first health professional to identify oral symptoms of eating disorders, the most important task of the dental care provider when identifying oro-dental signs of eating disorders is to ensure that the patient receives treatment. Implications for education include the addition of conceptual, procedural, and skill-based curricula objectives addressing etiologic assessment and patient communication--thus increasing behavioral capacity for delivery of restorative care and patient referral.     

A clinical minimum data set for primary dental care.

OBJECTIVE: To achieve consensus within primary dental care on the contents of a clinical minimum data set to measure oral health status. DESIGN: Using the Delphi process a simple random sample of 30 LDCs and 10 CDS services in England were asked to rank a list of existing clinical indicators in order of their perceived importance as a means of measuring oral health. A nominated panel representing the stakeholder organisations of primary dental care reviewed this ranking and identified a core group of clinical indicators to be included in a clinical minimum data set. RESULTS: An 80 percent response rate to the Delphi process was achieved. Consensus was reached on a core group of 10 indicators, which can provide information on patient's perceptions of pain, function and appearance, and professional measurements of caries, teeth present, periodontal disease, oral sepsis, presence of mucosal pathology and tooth wear. CONCLUSIONS: A representative sample of primary care dentists in England and the key representative organisations of primary dental care achieved consensus on the contents of a clinical minimum data set to record oral health status in primary dental care. This is a first step in standardising the measurement of oral health status across primary care.     

Dental management of patients receiving oral bisphosphonate therapy: expert panel recommendations

BackgroundIn light of the uncertainty surrounding the incidence of bisphosphonate-associated osteonecrosis of the jaw (BON) and concomitant risk factors, dentists have questioned how to manage the care of patients receiving oral bisphosphonate therapy. Expert panelists were selected by the American Dental Association Council on Scientific Affairs on the basis of their expertise in the relevant subject matter and on their respective dental or medical specialties, and the panel was tasked with developing guidance for dentists treating these patients.MethodsThere are no data from clinical trials evaluating dental management of the care of patients receiving oral bisphosphonate therapy and, therefore, these recommendations are based on a thorough review of the available literature relating to bisphosphonate use and osteonecrosis of the jaw. After reviewing the literature, the panel developed these recommendations based on their expert opinion.ResultsThese panel recommendations focus on conservative surgical procedures, proper sterile technique, appropriate use of oral disinfectants and the principles of effective antibiotic therapy.ConclusionsThe recommendations are a resource for dentists to use in their practice, in addition to the dentist's own professional judgment, the information available in the dental and medical literature, and information from the patient's treating physician. The recommendations must be balanced with the practitioner's professional judgment and the individual patient's preferences and needs.