The use of vacuum-molded polyvinyl acetate-polyethylene copolymer (PVAC.PE) for a handicapped patient

This paper provides a survey of recent literature on the use of mouth sticks for patients who have little or no use of their limbs. Criteria for mouth stick design, types of appliances, and the fabrication of such devices are described. Details are given of a case of a young child with arthrogryposis multiplex congenita, in whom a novel approach was used to allow the safe intra-oral retention of writing implements     

A retrospective review of a service to provide comprehensive dental care under general anesthesia

Day-stay general anesthesia is indicated for a number of dental reasons, not least for those patients who are unable to accept routine dental care. Since 1979, the Dental Hospital of the University of Newcastle upon Tyne, UK, has provided a weekly day-stay service for the dental care of such patients. Reviews of this service were undertaken in 1983 and again in 1993. The latter study Investigated the provision of care for 265 patients and compared this with that for the 96 patients reviewed in the earlier study. This paper presents the results of the review and underlines the need for a very aggressive approach to preventive dental care for patients treated by this modality.     

Oral hygiene, gingivitis, and periodontitis in persons with Down syndrome

This study was conducted to determine and compare the prevalence, severity, and extent of gingivitis and periodontitis in patients with Down syndrome and patients who did not have Down syndrome. The authors also assessed the relationship of these conditions and compared them to the age, gender, and oral hygiene profiles in both groups. Using a case-control study design, the authors examined 32 individuals with Down syndrome (DS) and matched each with a participant from the control group (CG) according to age and gender. Researchers determined the Simplified Oral Hygiene Index, Gingival Index, and measured the level of gingival attachment for each participant. The authors found that the relationship between the presence of dental plaque and the severity of gingivitis was moderate among participants with DS. While the overall characteristics of the periodontal and gingival health status were not markedly different between the two groups, the extent and severity of gingivitis and the extent of periodontitis were greater in the group with DS than in the CG.     

Dental Fluorosis Following Downward Adjustment of Fluoride in Drinking Water

The drinking water fluoride concentration in Hong Kong was reduced by about 0.2 ppm in June 1978. This study was undertaken to determine whether the prevailing level of dental fluorosis was affected by such a minor change. Cohorts of children (N = 1,062) aged seven to 12 years, who were born both before and after the fluoride reduction, were examined clinically using Dean's fluorosis index. Based on upper right central incisors, dental fluorosis prevalence decreased from 64 to 47 percent and the community fluorosis index decreased from 1.01 to 0.75 (P less than .01). Thus, dental fluorosis was reduced, although the reduction in water fluoride concentration was not sufficient to achieve the minimal fluorosis level that Dean associated with a fluoride concentration optimal for caries prevention. Variation in dental fluorosis has been reported previously to result from marked sudden changes, during tooth formative years, to drinking water fluoride concentration. This study confirms preliminary findings that variation in dental fluorosis arising from minor changes to the fluoride level in drinking water is also measurable.     

An Index of Chewing Ability

This study was carried out to develop and test an index of chewing ability suitable for epidemiologic surveys. Existing data on older adults living independently in East York, Ontario, were reanalyzed and the index was developed using techniques of scalogram analysis. Individuals were scored from 0 to 5 based on their self-reported ability to chew the most difficult of five foods. In this representative sample, 77 percent scored 5. The index has high predictive values when compared to two other questions on chewing ability in the survey. Among those with chewing disability (scoring 0 to 4), the odds ratio (OR) for being edentulous was 4.1 (95%) Cl = 2.1-8.3). No factor influenced chewing ability among the edentulous. Among the dentate, several clinical dental health status measures appeared to influence chewing ability. Logistic analysis identified the absence of functioning opposing pairs of natural posterior teeth, OR 5.6 (95% Cl = 2.21-14.39), and the need for urgent care, OR 23.7 (95% Cl = 1.05-6.95), as the most important.     

Building consensus in defining and conceptualizing acceptability of healthcare: A Delphi study

Background

The concept of healthcare acceptability is important for nursing staff spending most of their time with patients. Nevertheless, acceptability remains confusing without a collective definition in existing literature.

Objective

This study aimed to create a consensus among experts on definition and conceptual framework of healthcare acceptability.

Methods

We conducted two rounds of Delphi surveys to collect opinions from experts on definition and conceptual framework of healthcare acceptability proposed following thematic content analysis. We calculated the consensus among experts using the modified Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument and followed the guidance on conducting and reporting Delphi studies (CREDES) best practices.

Results

A total of 34 experts completed two rounds of Delphi survey. The definition was validated through consensus as: “a multi-construct concept describing the nonlinear cumulative combination in parts or in whole of experienced or anticipated specific healthcare from the relevant patients/participants, communities, providers/researchers or healthcare systems' managers and policy makers' perspectives in a given context.” The overall quality rating was 92.6% and 95.1% for the proposed definition and conceptual framework respectively.

Conclusion

Opinions collected from experts provided significant insights to build a consensus on healthcare acceptability advancing public health nursing.     

Oral disorders and chronic systemic diseases in very old adults living in institutions

This study evaluated whether oral disorders were associated with chronic systemic diseases in 532 Canadian adults who are old and very old and living in institutions. A brief oral examination documented tooth retention, caries, and periodontal and gingival health. Medical records provided information about chronic systemic conditions. A history of stroke was associated with a higher experience of caries, a higher ratio of decayed-to-present teeth, and more gingival and periodontal problems. Participants with high blood pressure, osteoporosis, or diabetes were more likely to be edentulous or to have fewer teeth than participants who did not have these conditions. Participants who had arthritis retained more teeth with age. Participants who had more diseases also tended to have poorer gingival or periodontal conditions, fewer teeth, and higher risk of edentulousness. The associations between systemic diseases and more severe oral disorders may be direct or may be mediated by underlying factors such as health behaviors.     

The Influence of Dental Insurance on Institutionalized Older Adults in Ranking Their Oral Health Status

To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel‐Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as “good,”“very good” or “excellent” by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting “good,”“very good” or “excellent” oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.