Testing the effect of including oral health in general health checks for elderly patients in medical practice--a randomized controlled trial

AIM: To test the feasibility and effectiveness of an oral health referral process for elderly patients (aged 75 years or over) attending a preventive health check (PHC) with their general medical practitioner. OBJECTIVES: To evaluate the effectiveness of the process in increasing dental attendance at baseline and 6 months after the intervention. To identify key characteristics of those who accepted an oral health visit (OHV). To determine the proportion of people attending the OHV who required treatment and subsequently attended a dentist. Setting: Three general medical practices in east Cheshire, UK. DESIGN: A randomized controlled trial. METHOD: Elderly patients attending their general medical practice for PHCs were randomly assigned to a test group, who were invited to attend for an OHV, and to a control group, who received no intervention. Six months after the PHC the effectiveness of the process was measured. RESULTS: Some 50% of those invited for an OHV accepted. Those accepting were more likely to be edentulous, wear dentures or have a current oral health problem, than those declining. Regression analysis showed the best predictors of acceptance to be having a current dental problem or pain and not having a regular dentist. The mean time since their last dental visit was 8.1 years which was significantly longer than those declining the OHV. 63% of individuals attending the OHV were assessed as having a realistic treatment need and 70% of those referred went on to complete the course of treatment. In the test group a highly significant increase in reported dental visiting was found at sixth month evaluation. The primary care staff were happy to include the dental checklist and felt it was a valuable addition to the PHC. CONCLUSIONS: The offer of an OHV was taken up most readily by those with current oral problems, or pain and those with no regular dentist. The inclusion of a dental checklist within the PHC for elderly patients together with help with arranging a dental appointment shows promise as a way of ensuring the dental needs of this group are met.     

Oral and maxillofacial dental care professionals in critical care during the COVID-19 pandemic

At the peak of the COVID-19 pandemic there was a ‘call to arms’ across the oral and maxillofacial staff. This article reports on the extended role of the department's dental care professionals (DCPs) and the tremendous opportunity and value that temporary redeployment presented.     

Differences in dimensions of satisfaction with private and public dental care among children

Measures of patient satisfaction have application in understanding patient behaviour, and in evaluating dental providers, services, and facilities. Further, differences in delivery systems may be reflected in variation between the component dimensions of satisfaction. AIM: The aim of this study was to compare perceptions of satisfaction with care provided by the School Dental Service (SDS) and private dentists. DESIGN: A three-stage cross-sectional survey was conducted during 1993-94. This analysis is based on Stage 2 of the study (n=2,792 participants, response rate=78.0%). SETTING: Schools in metropolitan Adelaide, South Australia. PARTICIPANTS: Parents and schoolchildren. INTERVENTIONS/METHODS: Mailed self-complete questionnaires. MAIN OUTCOME MEASURES: The Dental Satisfaction Index (DSI) and component subscales. RESULTS: Overall satisfaction using the DSI showed no significant difference between SDS users and users of private dental care. Parents of children using the SDS had lower satisfaction scores for 'general satisfaction', 'quality', 'access', and 'continuity', but had higher satisfaction scores for the dimensions of 'cost' and 'availability' (OLS regression; P<0.01). These patterns of satisfaction with dental care by provider group persisted after controlling for time since last visit, parental education level, insurance status, occupation and language spoken (OLS regression; P<0.05). This may reflect a counter-balancing of dimensions of satisfaction across provider groups resulting in no significant difference in the DSI. CONCLUSIONS: Overall satisfaction was high and did not vary by provider group, but there was variation in the component dimensions of satisfaction.     

The delivery of oral care services to elderly people living in a noninstitutionalized setting

Advances in medical science are enabling people to survive more illness and disability. As people live longer, their mobility and/or ability for self-care often are reduced by physical or mental disability and other chronic diseases. It may become unreasonable or impractical for them to access mainstream dental services. Increasing numbers of dentate elderly people with expectations of oral health higher than earlier cohorts of elderly people are likely to bring increasing demands to the dental profession for their continuing care. Thus, the oral care for disabled elderly people in noninstitutionalized settings may pose a challenge. The oral care options available to this group of people include the dental surgery/operatory, a mobile dental service, home-based or domiciliary dental care, a mix-and-match combination of surgery-based and domiciliary care, and cyberspace. Noninstitutionalized, disabled elderly people may have to rely on domiciliary care services for their oral health care. This paper explores the training implications, the necessary knowledge and skills base, the benefits and limitations to both the service provider and user, the equipment available, and the cost/funding of domiciliary dentistry. Domiciliary dental care services need to be developed by improving pre- and postdoctoral training programs and by establishing realistic remuneration for dental teams providing this care so that noninstitutionalized, disabled elderly people can access oral health care.     

Oral health‐care utilization in adults with disabilities in Belgium

Leroy R, Declerck D. Oral health‐care utilization in adults with disabilities in Belgium.
Eur J Oral Sci 2013; 121: 36–42. © 2012 Eur J Oral Sci Reports on oral health‐service utilization among individuals with disabilities are very sparse. Nevertheless, such data are a prerequisite for the provision of proper care and for the development of optimal reimbursement schemes and may ultimately lead to better access to care. The objective of the present study was to provide data on oral health‐care utilization in Belgian residents with disabilities and to compare these data with the utilization pattern of their peers without special needs. Data from the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents, were used. The database contained prospective data on oral and general health‐care utilization and socio‐demographic variables from 1,221 individuals with disabilities and from 131,877 individuals without disabilities, collected from 2002 to 2008. Overall, annual dental‐attendance rates were very low and in those who attended, professional debridements, a cornerstone in preventive oral health care, were infrequently recorded. In adults with disabilities, significantly fewer radiographs, restorations, and endodontic treatments were recorded, whereas significantly more emergency visits were charged. Further research is indicated to evaluate whether this outcome points to high unmet oral‐treatment needs.     

Oral health in pregnancy: educational needs of dental professionals and office staff

Objective: Dental care during pregnancy is important for pregnant women and their children. Comprehensive guidelines for the provision of dental services for pregnant patients were published in 2006, but there is relatively little information about their use in actual practice. The aim of this study was to examine differences in knowledge and attitudes regarding dental care in pregnancy among dentists, dental hygienists, dental assistants, and nonclinical office staff. A secondary aim was to identify sources of influence on attitudes and knowledge regarding the guidelines. Methods: A survey was used to collect information from 766 employees of a Dental Care Organization based in Oregon; responses from 546 were included in the analyses reported here. Results: Statistically significant differences in knowledge were found among the professional‐role groups. Dentists and hygienists consistently answered more items correctly than did other respondents. Within all professional‐role groups, knowledge gaps existed and were most pronounced regarding provision of routine and emergency services. Positive perceptions of providing dental care during pregnancy were associated with higher knowledge scores (z = 4.16, P < 0.001). Conclusions: Updated dental education and continuing education for all dental office personnel are needed to promote the diffusion of current evidence‐based guidelines for dental care during pregnancy.     

Dental care practices and socio-economic status in Denmark

abstract A sociologic survey of dental care practices and related attitudes and knowledge was conducted on 2071 16- to 45-year-old Danes in three selected areas. The complete findings were published in 1971 in a Danish thesis; only the findings on the frequency of dental visits (in childhood and at present), toothbrushing habits, and the selfreported number of teeth are presented here in detail. Particular emphasis is placed on the marked relationship of these factors to socio-economic status, the latter being determined by the respondents' education and occupation. Among the 35- to 45-year-olds, 84 % of the “high” SES group made regular dental visits, as opposed to 55% of the “middle” and 37 % of the “low” SES group. Similar trends were demonstrated in all age groups and for all the parameters investigated.     

北京市城乡居民口腔卫生服务利用与费用影响因素分析

目的：通过对北京市居民口腔卫生利用和费用的定量研究及影响因素分析，为控制口腔费用的增长和建立口腔医疗保险制度提供依据。方法：分层、整群、随机抽取城乡居民3395人进行调查，利用单变量Logistic 回归、方差分析和三部模型方法进行口腔卫生服务利用和费用的因素分析。结果：城区0－14岁儿童，享有保障制度和患病者的人群利用概率高，OR值分别为5．834、2．721、1．793，低收入者利用概率低，高收入者就诊费用高，儿童的就诊费用低较，保障制度对农村居民口腔卫生服务利用几乎没有影响。影响居民就诊的主要因素是年龄、职业，患病状况和收入的高低，一旦利用口腔卫生服务，影响就诊费用的主要是不同的病种。结论：年龄是影响居民需求的主要因素。收入对个人是否就诊的决定有显著作用，保障制度对城乡居民的服务利用呈现相反的趋势，无论城乡居民，一旦利用口腔卫生服务，口腔健康状况是影响利用频率和费用的重要因素。     

Public dental service utilization among adults in South Australia

Background:  Longitudinal patterns of public dental service use may reflect access issues to public dental care services. Therefore, patterns of dental service use among South Australian adult public dental patients over a 3½-year period were examined.
Methods:  Public dental patients (n = 898) initially receiving a course of emergency dental care (EDC) or general dental care (GDC) at baseline were followed for up to 3½ years. Patient clinical records were accessed electronically to obtain information on dental visits and treatment received at those visits.
Results:  Some 70.7 per cent of EDC and 51.3 per cent of GDC patients returned for dental treatment post-baseline. EDC patients returned within a significantly shorter time period post-baseline, received significantly more courses of care and were visiting more frequently than GDC patients. A greater proportion of EDC patients received oral surgery, restorative, endodontic and prosthodontic services, but fewer received periodontic services. EDC patients received significantly more oral surgery and fewer preventive services per follow-up year, on average, than GDC patients. Large proportions of EDC (52.4 per cent) and GDC (63.8 per cent) patients who returned sought emergency care post-baseline.
Conclusions:  Patients appeared to be cycling through emergency dental care because of lack of access to general care services, highlighting access problems to public dental care.     

Oral health in the context of primary care in Brazil

This article presents an integrative literature review that analyses the advances and challenges in oral health care of the Brazilian primary health care system, based on a political agenda that envisages re‐organising the unified health system (SistemaÚnico de Saúde – SUS). It is presumed that the actions suggested by the Alma‐Ata Conference of 1978 are still up‐to‐date and relevant when adapted to the situation in Brazil. Several studies and policies are reviewed, including works demonstrating the importance of primary care as an organising platform in an integrated health‐care network, Brazil's strategy for reorganising the primary care network known as the Family Health Strategy, and the National Oral Health Policy. This review discusses results obtained over the last twenty years, with special attention paid to changes in oral health‐care practices, as well as the funding of action programmes and assistance cover. The conclusion is that oral healthcare in the Brazilian primary health care system has advanced over the past decades; however, serious obstacles have been experienced, especially with regard to the guarantee of universal access to services and funding. The continuous efforts of public managers and society should focus on the goal of achieving universal coverage for all Brazilians.     

Chronicling the dental therapist movement in the United States

There have been three attempts to introduce dental therapists (DTs) to the US dental workforce. This account will review early failed attempts to develop DTs, the recent successful Alaska initiative, the Minnesota legislature's authorization of DTs, state dental associations' deliberations on therapists in the workforce, and the efforts of national advocacy groups, foundations, and state legislatures to promote workforce innovation. It concludes with a discussion of the opposition to therapists from elements of organized dentistry.     

Patient safety with orthognathic surgery in an outpatient setting

Orthognathic surgery is traditionally performed in inpatient care. The question is whether patient safety is maintained when orthognathic surgery is performed in outpatient care. This retrospective cohort study was conducted to investigate patient safety in selected single-jaw orthognathic surgeries performed in outpatient care compared to inpatient care. Postoperative infection, postoperative bleeding, postoperative pain, plate removal, and re-operation, as well as emergency visits/phone calls and postoperative admission during the first 12 months after surgery were recorded. Predictor variables were sex, age, smoking, general disease, antibiotics, operation type, and operation time. Of the 165 patients included, 58 were treated in inpatient care and 107 in outpatient care. No significant difference was found between the groups regarding postoperative bleeding, pain, plate removal, re-operation, or emergency visits/phone calls. Ninety-four percent of outpatients (n = 101) were able to leave the hospital on the day of surgery as planned. There was an increased risk of postoperative infection in the outpatient care group (odds ratio 2.46, P = 0.049). Selected single-jaw orthognathic surgery can be performed in the outpatient setting, with maintained patient safety. The reason for the increased risk of postoperative infection among patients operated in outpatient care should be investigated in further studies.     

Access to dental care in two long-term refugee camps in western Tanzania; programme development and assessment

Objective: To analyse the demographics surrounding and the sustainability of a course in Emergency Dental Care and Health Promotion developed and taught by a team of dentists from the United States to refugee camp health‐care workers in two long‐term refugee camps in Western Tanzania. Methods: Refugee camp dental patient log books from Mtabila and Nyarugusu camps Kigoma, Tanzania were analysed and demographic data collected on each patient visit from the programme inception in November 2007 until August 2009. Data collection included information relevant to 1961 patient visits. Data were entered into SPSS Statistics 17.0 using the Freq application. Outcomes: Patient visit data included demographics involving both the resident camp populations and the surrounding communities. The distribution of patients treated by nationality was: 58% Burundian (Mtabila), 14% Congolese (Nyarugusu), and 28% Tanzanian citizens residing near both camps. Extractions accounted for 95.5% of procedures performed. Recorded incidences of post‐operative complications were 1 > % of patient visits. Patient visits were steady over time and a referral system was implemented for complex cases. Health promotion sessions were held in both camps. Conclusion: This dental programme has been self‐sustaining and is providing some access to care where none existed previously. Programmes such as this may be one solution to the access to dental care problem in long‐term refugee camps.     

Reasons for seeking dental care in a Malaysian urban adult population: an analysis by sex and ethnic group

Different groups of people will view and use modern dental services differently. This is determined by their traditional beliefs and cultural background. The aim of this study is to identify variations in utilization among adults in the three major ethnic groups in Malaysia. Dental records of 500 adults attending the University dental center were randomly selected and analyzed by sex and ethnic group. Results from this pilot study clearly indicate that different ethnic groups tend to use certain types of services more than others. Similarly, there is evidence of variation in the type of dental service preferred between males and females. The implications of these findings for dental health educators, program planners and further research is emphasized in order to promote a more positive pattern of utilization among the various ethnic groups.     

Oral health needs and access to dental care of homeless adults in the United States: a review

The homeless population in the United States is one of great diversity that continues to increase in number. Although data on the oral health status of individuals who are homeless is limited, studies consistently report both the perception and clinical evidence of dental needs among this population as well as a low utilization rate for dental services. This article reviews the oral health needs of people who are homeless as reported in literature, barriers to receiving dental care, and methods used to deliver dental care to this population. Many rehabilitation centers for adults who are homeless consider the establishment and maintenance of a state of good general and oral health as a priority and a key factor in helping homeless adults to return to the workforce and mainstream society.     

A register-based study of variations in services received among dental care attenders

Objectives. To investigate whether receipt of dental services, among attenders, reflects variations in dental health or whether and to what degree it is associated with socioeconomic status, with irregular or regular dental attendance and with the availability of dentists in residential areas. Materials and methods. This retrospective register-based study followed two Danish cohorts, aged 25 and 40, with a dental examination in 2009 (n = 32,351). The dental service data were registered during 2005–2009. The number of dental examinations, individual preventive services (IPS), tooth extractions, root fillings and composite fillings were analyzed in relation to socioeconomic status, irregular/regular dental attendance, inhabitant/dentist ratio and to DMFT at age 15 (DMFT15) and change in DMFT (ΔDMFT) from age 15 to age 25 and age 40, respectively. Poisson regression and negative binomial regression analyses were used. Results. The variations in number of services received in the study population were small (SD = 0.2–2.7). However, with a few exceptions, high levels of DMFT15 and ΔDMFT were associated with receipt of more dental services. Socioeconomically-privileged individuals received more dental examinations but fewer tooth extractions, root fillings and composite fillings compared to disadvantaged persons, when controlled for dental health levels. Irregular attenders received fewer IPS and composite fillings but had more extractions compared to regular attenders. Conclusions. Variations in dental care services were found to reflect variations in dental health, but the variations were also related to individual socioeconomic status, residential area and dental attendance patterns.