Changes In Oral Health Status Research Articles

Changes in oral health status and function among older adults through professional oral care and rehabilitation exercises

Objectives: To develop a program that combines the oral health promotion program for the elderly and to investigate the effect of improving oral function by applying the oral health promotion program to elderly people using welfare facilities. Methods: From June to October 2022, a total of 29 elderly individuals utilizing welfare facilities in the Gyeongnam region were recruited. The control group underwent surveys and objective oral health assessments. The experimental group participated in an oral health promotion program, consisting of oral functional rehabilitation exercises and expert oral health management, conducted once a week for 8 weeks at the facilities. Objective oral health assessments were conducted before, during (at 4 weeks), and after (at 8 weeks) the intervention period for both groups. Results: As a result of the oral health promotion program, it was confirmed that there was an improvement effect in bad breath (p<0.001), saliva secretion amount (p<0.001), orbicularis oculi muscle (p<0.001), and plaque index (p<0.001). Conclusions: A revitalization plan is needed so that the efficient oral health promotion program for the elderly can be reflected as a systematic and professional community care oral health management program.

SOCIAL STRUCTURAL DISPARITIES IN DENTAL CARE UTILIZATION AMONG ADULTS IN CHINA’S MEGACITIES

Abstract This study utilized data from the “2019 New Era and Living Conditions in Megacities Survey” to investigate social structural disparities in dental care utilization among adults aged 18-65 from 10 megacities in China. Logistic regressions were conducted to examine the relationships between social structural factors, such as hukou status, occupational status, migrant status, and city of residence, and dental care utilization. Margins post estimation was used to explore whether the social structural disparities in dental care utilization were associated with changes in oral health status. Results showed that only 22.36% of participants had at least one dental visit per year. Having urban hukou as compared with rural hukou (OR, 1.76; 95% CI, 1.47-2.12), working in state-owned enterprise as compared with in other enterprises (OR, 1.34; 95% CI, 1.14-1.57), and living in more developed cities as compared with in less developed cities (OR, 1.48; 95% CI, 1.27-1.72) were associated with a higher likelihood of regular dental visits. Additionally, participants with urban hukou and those living in more developed cities were more likely to have regular dental visits when their oral health was good, such as when they had full natural teeth. This study highlights social structural disparities in oral health behaviors among adults in China’s megacities. The findings suggest that efforts should be made to improve dental care utilization by promoting public messaging about oral health knowledge, expanding dental care coverage, and improving access to dental care services in China.

Changes in oral health status with dental intervention during the acute to subacute stages of stroke.

To investigate the changes in oral health status with dental intervention during the acute and subacute stages of stroke and their associations with oral intake status. Oral health may deteriorate easily in patients following a stroke. However, data are scarce on the changes in oral health with dental intervention throughout the acute and subacute stages of stroke recovery. We prospectively recruited 98 stroke patients who were admitted to an acute hospital and referred to a dental team and then could be followed at a subacute rehabilitation unit in the same hospital. Provided dental intervention, including oral health care and other general dental treatments, was recorded. Oral health was assessed with Oral Health Assessment Tool (OHAT), and the changes in OHAT score during the acute and subacute stages were statistically tested. Oral feeding status was examined using Functional Oral Intake Scale (FOIS). The cohort was divided into the non-oral feeding, dysphagia and regular diet groups based on FOIS score. Differences in OHAT among the oral intake groups were statistically tested. Gross OHAT score did not differ among the oral intake groups at the time of admission (mean ± standard deviation score: 6.5 ± 2.8 for non-oral diet, 5.6 ± 2.4 for dysphagia diet and 5.3 ± 2.1 for regular diet), but improved more in the regular diet group (2.4 ± 1.5) than in the other groups (5.8 ± 3.0 for non-oral diet and 4.0 ± 2.1 for dysphagia diet) at the last evaluation. Oral hygiene scores improved significantly in the acute stage, while scores for dentures and natural teeth ameliorated significantly in the subacute stage. Our findings suggest that appropriate dental intervention in the acute and subacute stages of stroke may contribute to improved oral health and oral food intake.

Outreach dental care program for older adults using residential care or day care services in Hong Kong: A cohort study.

To evaluate the effects of an outreach dental care program (ODCP) on the oral health status and oral health-related quality of life (OHRQoL) of older adults who used residential or day care services in Hong Kong. Older adults who had received dental treatments provided in the ODCP were recruited. Clinical examinations were performed by one calibrated examiner (SXY) at baseline and 1-year follow-up in the residential homes or day care centres. Face-to-face interviews were conducted using the transition scale of the Oral Health Impacts on Daily Living (OHIDL) questionnaire to investigate the perceived change in OHRQoL at baseline, 2-month and 1-year follow-ups. The Wilcoxon matched-pair signed-rank test or McNemar/McNemar-Bowker test was used to explore the change in oral health status after dental treatments. Factors associated with the perceived change in OHRQoL were explored with binary logistic regression. Four hundred and thirteen older adults (mean age=83.8 years) participated in the study at baseline, and 377 (91.3%) and 359 (86.9%) were successfully followed 2 months and 1 year after receiving the outreach dental service, respectively. At the 1-year follow-up, the number of decayed teeth and functional tooth units, and the prevalence of poor denture hygiene decreased while there was more dental plaque deposition and a higher proportion of participants with gingival bleeding upon probing. More than 50% of the participants perceived no change or an improvement in OHRQoL in all domains at both follow-ups. Older adults who perceived their oral health status as 'healthy or fair' and those who suffered from toothache at baseline had a higher chance to perceive having a better or at least the same OHRQoL at the 2-month and 1-year follow-ups, respectively. The ODCP in Hong Kong can solve some of the dental problems of older adults using long-term care services and keep most of them from deterioration in OHRQoL, especially those suffering from toothache.

Changes in oral health status of the elderly with visiting oral hygiene care intervention based on community health care: Case reports

Changes in oral health status of the elderly with visiting oral hygiene care intervention based on community health care: Case reports

Age, period and cohort trends in oral health status in South Korean adults.

The purpose of this study was to identify the age, period and cohort effects on the changes in oral health status in South Koreans. The age, period and cohort analysis (APC analysis) of the oral health status was conducted using an aggregated age-by-time period table. The age-by-time period table was formulated using data from the Korea National Oral Health Survey (KNOHS) 2000 and 2006, and the Korea National Health and Nutrition Examination Survey (KNHANES) 2010 and 2015. Two oral health outcomes were measured: the number of teeth and Decayed-Missing-Filled Teeth (DMFT) index. Descriptive analysis by graphical representation and partial least square (PLS) regression was used for APC analysis. Both graphical description and PLS regression showed age and cohort effects in oral health status with the number of teeth decreasing and the DMFT index increasing with age. No period effects were found in either index. The number of teeth increased in the recent birth cohorts. However, the DMFT index showed a reverse J-shaped trend, which worsened in recent birth cohorts. The DMFT index increase in the recent cohort was mainly attributed by an increase in the FT index. The effects of age on the number of teeth and caries highlight the importance of oral health in adulthood. The increased caries experience in recent cohorts may indicate the limitations of the current oral health policy. It would be relevant to explore what determinants cause the changes in oral health status. Future oral health policies should address the new directions to reduce the burden of oral diseases.

A Multi-Level Approach to Understanding Oral Health Beliefs and Practices in Rural Ethiopia - A Qualitative Study

Introduction: Oral conditions are multifactorial in their causes: they are influenced by socioeconomic inequalities, access to care, as well as cultural beliefs and practices. Most available literature about dental public health in Ethiopia only reports on the prevalence of dental caries, other oral conditions are largely ignored. There is also a paucity of data exploring the links between systemic and individual factors that affect the oral health status in Ethiopia. Study purpose: We conducted a study exploring the oral health beliefs and practices of a community in rural Ethiopia. We situated these proximal factors affecting oral health within the larger health system and socioeconomic context in order to highlight the fundamental causes of oral health conditions. So far, these dynamics are largely overlooked, yet examining them is imperative for developing and implementing effective programs that address oral health inequalities that exist in rural disadvantaged populations in Ethiopia. Materials and methods: We conducted twelve focus group discussions in Koraro Millennium Village located in Tigray Region of North-Eastern Ethiopia. Ninety-six community members participated in our focus groups. Each focus group was attended by 8 members of the community that represented different stakeholders such as teachers, community health workers, midwives and nurses, farmers, men and women development group members, students and regional and local heads of schools, youth organizations, and parents-teacher associations. The discussions were conducted in the local language (Tigrania) using a discussion guide that was developed based on existing literature and informal conversations with key stakeholders of the community. Data were audio recorded, transcribed and translated into English and later checked for consistency by two translators fluent in both languages. We used grounded theory methodology for open coding of the data and identifying emergent themes. Thematic analysis led to development of three main categories of factors affecting oral health in the village: individual, health system-related and structural. Results: Individual-level factors included lack of awareness regarding the causes of oral diseases and effectiveness of oral hygiene tools. For example, several participants believed that “worms cause dental caries”. We also found that younger adults, even though better informed, did not diligently follow oral hygiene regimens. Health system factors included geographical access to dental services, shortage of skilled dental professionals, and lack of infrastructure as well as supplies needed for dental procedures. Structural factors included socioeconomic and cultural factors. Participants emphasized the lack of diversity in diet as a cause of dental diseases that they attributed to their low income. Although government programs supply grains, community members believed that they were infested with insects that ultimately caused their teeth to decay. Cultural beliefs influenced their treatment-seeking behavior. Summary and conclusions: There is a need for interventions that address risk factors on multiple levels in order to bring about change in oral health status in Ethiopia. Such interventions should be a collaborative effort between the government, developmental organizations, academia, dental professionals and the local community. Mere educational interventions targeting individual behaviors will not be effective. Funding: GlaskoSmithK. Declaration of Interest: The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article. Ethical Approval: The study was conducted under the ethical oversight of Columbia University Medical Center Institutional Review Board and local ethical approval was sought from the Health Research Ethics Review Committee at Mekele University College of Health Sciences, Ethiopia. Written informed consent was obtained in Tigrinya (the local language) from all study participants.

Estado de salud oral antes, durante y después del tratamiento antineoplásico en un instituto de cáncer en Barranquilla, Colombia.

Chemotherapy and radiotherapy are aggressive treatments for cancer management. Both therapies make the stomatogatic system vulnerable to adverse effects on the oral mucosa and hard tissues. This may result in severe oral complications that can affect the quality of life of the oncologic patient. Consequently, oral diagnosis and interdisciplinary management by the stomatologist are critical for cancer treatment, regardless of its location. Objective. To determine the oral health status of cancer patients before, during and after antineoplastic treatment at a cancer institute in the city of Barranquilla, Colombia. Materials and Methods. A descriptive, longitudinal and prospective study of 131 cancer patients, was conducted. The study consisted of initial stomatological assessment of the antineoplastic therapy; classification according to the antineoplastic therapy given by the oncologist; a second stomatological assessment during treatment; and a final stomatological assessment or evaluation forty days after the end of therapy. Descriptive statistics, chi-square and MacNemar test were used to compare and identify variances at the different stages. Results. Female patients accounted for 69%, and breast cancer had 24% prevalence among the included subjects. At the initial stomatological assessment, high frequency lesions were identified, such as generalized biofilm-associated gingivitis in 69% of the cases, followed by oral candidiasis in 61%. The specific prevalence of lesions was 10.65%. In the second stomatological assessment, a greater frequency of periodontal abscesses was observed in 31%, and oral mucositis type II in 18%. The third clinical assessment showed significant changes in oral health status; an increase in the frequency of gingivitis was found in 9.9% (p<0.001); unlike before and during, there was an increment in dental caries of 26.73% (p<0.00000) at this last stage, root remains increased by 39.53% (p<0.00000), and finally, xerostomia increased by 45%. Oral candidiasis was the only lesion that showed improvement. Conclusion. An increase in the number of lesions was observed during and after antineoplastic treatment. The oral cavity is susceptible to antineoplastic treatments; gingivitis, candidiasis, xerostomia, and mucositis were observed, among others conditions.

Changes in Adolescents’ Oral Health Status: Responsiveness of the Child Perception Questionnaire11–14

Changes in oral health status following treatment should be assessed clinically as well as by patients’ reported outcomes. This study investigated changes on oral-health-related quality of life (OHRQoL) of adolescents enrolled in a comprehensive oral health care program for caries and gingival conditions. The sensitivity of the Child Perception Questionnaire_11–14 (CPQ_11–14) to detect clinical changes, that is, its responsiveness, was assessed. A total of 618 10–15-year adolescents answered the questionnaire before treatment and 560 at follow-up after 1 year. In the follow-up, 2 additional global transition judgment questions were asked. The adolescents were clinically and radiographically examined. At the baseline, 374 adolescents needed only nonoperative treatment, whereas 274 needed non- and operative treatments. After 1 year, the adolescents were regrouped according to the fulfillment of their treatment needs in Group 1 (n = 363) needing/receiving nonoperative treatment only; Group 2 (n = 98) needing/receiving both non- and operative treatments; Group 3 (n = 99) receiving nonoperative treatment only, while needing also operative treatment. The CPQ_11–14 total mean change scores by the global transition judgment on self-perceived oral health status indicated significant differences (p < 0.001, ANOVA; internal responsiveness). The effect of the program for the treatment groups was significant (p = 0.014, ANCOVA; external responsiveness). The effect size for the change scores was of moderate magnitude. In conclusion, an overall improvement of adolescents’ OHRQoL was observed following 1-year oral health care program for caries and gingival conditions. The CPQ_11–14 was internally and externally sensitive to detect substantial clinical changes. The CPQ_11–14 seems appropriate for measuring long-term changes on adolescents’ OHRQoL.

Preoperative periodontal treatment and its effects on postoperative infection in cardiac valve surgery.

ObjectivesOral infection control is important for patients undergoing cardiac valve replacement (CVR) as prophylaxis for postoperative complications. This study examined the changes in oral health status by preoperative periodontal treatment and its effects on postsurgical complications in CVR patients.Material and methodsWe recruited 64 patients undergoing CVR who received preoperative periodontal treatment at our hospital as the intervention group and retrospectively reviewed the medical records of 38 patients who had undergone CVR surgery without dental intervention as the control group. Oral health status was assessed at the first visit to our dental office, 1 day before surgery, and >7 days after surgery. Days of high fever, antibiotics use, and postoperative hospitalization were recorded for the intervention and control groups for statistical comparisons.ResultsIn the intervention group, oral health status significantly improved from the initial visit to >7 days after surgery. There were significantly fewer days of high fever (>37.5°C) in the intervention group than in the control group, with comparable results for other events.ConclusionsThis study's findings suggest that preoperative periodontal treatment can improve oral health status surrounding CVR surgery and could be the contributor of the reduction in the risk of postoperative infection.

The influence of oral conditions on quality of life of adolescents: an integrative review

INTRODUCTION: During adolescence, changes in oral health status can influence even more the quality of life since in this phase there is greater physical, psychological and social vulnerability, being a moment in which the individual is shaping his identity. OBJECTIVE: to evaluate the level of evidence and scientific knowledge currently available in the literature on the association between the status of the oral condition of adolescents and the quality of life reported by them. METHODOLY: This integrative review followed the steps idealized by Cooper (1982). After the problem was formulated, data were collected from the studies found in Pubmed and Lilacs databases. The studies that attended the inclusion and exclusion criteria previously established were selected and completely read. During the analysis of collected data, each article was classified according to their level of evidence. Afterwards, it was realized the analysis and interpretation of data and finally the public presentation. RESULTS: From the adopted criteria, 13 articles were selected, most of them were cross-sectional studies. Systematic reviews or randomized controlled trials were not found. The Oral Health Impact Profile (OHIP-14) was the most used instrument. CONCLUSION: There were few studies with a high level of scientific evidence that evaluated the association between the status of adolescents' oral condition and the quality of life reported by them. The literature is still inconclusive regarding the association of oral health and quality of life of adolescents.

Randomized Trial Based on the Common-Sense Model of Self-regulation to Increase Child Dental Visits.

School screening and the note home (pinned to a backpack) informing parents/caregivers that their child needs to see a dentist have not been effective. The Family Access to a Dentist Study (FADS) evaluated the effectiveness of school interventions based on the common-sense model of self-regulation (CSM) among K-4 children needing restorative treatment. FADS was a multisite double-blind randomized controlled trial with 5 arms. FADS tested a CSM-driven referral letter and dental information guide (DIG) to move caregivers from inaccurate to accurate perceptions of dental caries. Six school districts from Ohio and Washington (14 schools) participated in school years 2015 to 2016 and 2016 to 2017. A total of 611 caregivers were randomized, and 86% (n = 597 children) completed the exit examination. The primary outcome was receipt of care based on a change in oral health status determined clinically within 1 school year. In accordance with our primary aims, 5 arms were collapsed into 3: CSM letter and reduced CSM letter (combined), CSM letter + DIG and reduced CSM letter + reduced DIG (combined), and standard letter. Among all sites, 39.7% received restorative care (237 of 597). Combined analysis of sites revealed that the CSM referral letter (with and without the DIG) did not increase dental visits when compared with the standard letter. However, for combined sites (East Cleveland, Ohio; Washington), the CSM + DIG increased dental visits when compared with standard letter in univariate analysis (51.3% vs. 40.9%), indicating 1.6-times increased odds of a dental visit (95% CI, 0.97 to 2.58) after imputation and adjustment for covariates. The CSM + DIG group had 1.9-times increased odds (95% CI, 1.21 to 3.08) of care when compared the CSM letter alone. A CSM-driven approach to informing caregivers of the chronic nature of caries with resources in an illustrative manner can increase the benefit of school oral health screening (ClinicalTrials.gov NCT02395120). A school dental referral (note home) that tells a parent that the child has cavities has not been effective. In this trial, a referral based on the common-sense model of self-regulation increased follow-up care for children with restorative needs.

Impact of primary endodontic treatment provided by undergraduate students and endodontic specialists on patients’ quality of life

Everyday life of individuals can be significantly influenced by positive and negative changes in oral health status, by symptoms and severity of oral disorders and diseases. The World Health Organization (WHO) proclaims a necessity to measure health and the effects of health care not only on the basis of changes in the frequency and severity of diseases but also by estimation of patients’ well-being assessed with the improvement in their quality of life. The aim of our study was to investigate the impact of primary root canal treatment on the perceived quality of life amongst patients treated by providers with different qualification and experience. Two hundred systemically healthy, mentally fit and legally capable of signing an informed consent patients needing an endodontic care were randomly selected and participated voluntarily in the study conducted in the Department of Conservative Dentistry, Faculty of Dental Medicine, Medical University, Sofia, Bulgaria. The treatment was provided by fourth-year and fifth-year students in the course of their clinical exercises and by five endodontic specialists. The study instrument was the modified Oral Health Impact Profile comprising 17 items which was filled in anonymously by all participants. The interview was carried out before the root canal treatment and two weeks after it was completed by one and the same examiner. The impact of endodontic disease and its treatment was recognized by seven conceptual dimensions: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap. The responses of the OHIP items were made on a five-point scale ranging from 0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often to 4 = very often. The analyses of the results revealed that patients perceived their quality of life impaired because of the irreversible inflammation of the dental pulp. The negative impact of the endodontic disease was similar for the patients treated by students and specialists as the difference between the registered mean impact values at the first appointment was insignificant. Experience and training level influenced the degree of improvement as registered mean impact values were significantly greater in the group treated by endodontic specialists when compared to the one treated by undergraduate students.

Improving overall health of children living with HIV through an oral health intervention in Cambodia: study protocol for a randomized controlled trial

BackgroundCurrently, the number of children living with HIV is the highest ever. This has led to an increased focus on a healthy life expectancy in this population. Improving oral health status may contribute to improved immunity, which could in turn lead to greater overall health in this population. This study aims to evaluate the effectiveness of an oral health intervention in improving oral health and immune status among children living with HIV in Cambodia.MethodsA randomized controlled trial will be conducted in Phnom Penh from May 2018 to April 2020. Among 520 dyads of children living with their respective caregivers, half will be randomly allocated to the intervention group and the other half to the control group. Children aged 3–15 years who are currently receiving antiretroviral therapy at the National Pediatric Hospital will be recruited. In addition, 260 HIV-uninfected children (age-matched to the intervention group) will be recruited from the communities. They, together with their caregivers, will comprise the second control group. The main components of the intervention will include oral health education sessions for the children, as well as daily oral self-care under the supervision of their caregivers. The primary study outcome will be the change in oral health status including the number of decayed, missing, or filled permanent teeth, and the secondary outcome will be CD4 count. The effects of the intervention will be assessed by comparing outcome indicators between the children in the intervention and those in the control groups.DiscussionThis trial will investigate the effects of an oral health intervention on the improvement of oral health and immune status among children living with HIV and determine the differences compared with the control groups. This intervention would encourage the promotion of oral health interventions among children living with HIV and thus contribute to delaying the onset of AIDS.Trial registrationCurrent Controlled Trials, International Standard Randomized Controlled Trial Number Register, ISRCTN15177479. Registered on 17 January 2018.

Bias in retrospective assessment of perceived dental treatment effects when using the Oral Health Impact Profile.

Aim of this exploratory study was to investigate whether a retrospective assessment of oral health-related quality of life (OHRQoL) using the Oral Health Impact Profile (OHIP) is susceptible to bias such as implicit theory of change and cognitive dissonance. In this prospective clinical study, a sample of 126 adult patients (age 17-83years, 49% women) requiring prosthodontic treatment was consecutively recruited. The OHRQoL was assessed using the 49-item OHIP at baseline and at follow-up. Additionally, patients were asked at follow-up to retrospectively rate their oral health status at baseline (retrospective pretest or then-test) and the change in oral health status using a global transition question. Furthermore, patients' ratings of overall oral health and general health were used as validity criteria for the OHRQoL assessments. Response shift was calculated as the difference between the initial and retrospective baseline assessments. Baseline and retrospective pretest did not differ substantially in terms of internal consistency and convergent validity. Response shift was more pronounced when patients perceived a large change in OHRQoL during treatment. Retrospective pretests were more highly correlated with the baseline than with the follow-up assessment. Findings suggest that retrospective assessments of OHRQoL using the OHIP-49 are susceptible to bias. Cognitive dissonance is more likely to appear as a source of bias than implicit theory of change.

Change in oral health status associated with menopause in Japanese dental hygienists

Oral symptoms such as xerostomia and burning mouth syndrome have been recognized to increase associated with menopause. The purpose of this study was to clarify the changes in oral health as well as systemic health due to menopause and their relations with hormonal change and mental status. Ninety-seven female dental hygienists aged 40-59years were assigned to premenopausal, menopausal and post-menopausal groups based on self-reported menstrual condition. Subjective health statuses were evaluated by questionnaire, and objective holistic and oral statuses were evaluated by measuring serum 17β-estradiol (E2), salivary flow rate, α-amylase and secretory IgA (SIgA) and taste sensitivity. A significant difference among the three groups was observed in the self-rating questionnaire of depression (SRQ-D) score and serum E2 level as well as unstimulated salivary flow rate, whereas no significant difference was observed in Simplified menopausal index, Short-Form 36-Item Health Survey, General Oral Health Assessment Index, salivary α-amylase activity, salivary SIgA concentration and taste threshold. Serum E2 levels positively correlated with unstimulated salivary flow rates and negatively correlated with SRQ-D scores and α-amylase activities. The results demonstrated a negative correlation between E2 levels and SRQ-D scores as well as salivary α-amylase activities, suggesting an influence of E2 on mental condition. Furthermore, E2 decrease may result in reduction of salivary flow which in turn causes various problems of oral health. Since the participants were graduates from several dental hygienist schools and working at various places, these results can be generalized to Japanese dental hygienists to some extent.

Change in Quality of Life and Its Association with Oral Health and Other Factors in Community-Dwelling Elderly Adults-A Prospective Cohort Study.

To determine whether changes in oral health status were associated with decline in quality of life (QoL). Prospective cohort study. Carlos Barbosa, southern Brazil. A random sample of 872 community-dwelling individuals aged 60 and older was evaluated in 2004. The current study population consisted of 389 participants available for follow-up in 2012. Change in QoL was assessed through the use of the short version of the World Health Organization QoL Assessment tool (WHOQOL-BREF) at baseline and follow-up. Each WHOQOL domain generates a score, with changes being calculated for each domain. Individuals with the same or higher scores at follow-up were categorized as having improved QoL, and those with lower scores were categorized as having a decline in QoL. Sociodemographic and health variables were assessed in an interview, and tooth loss, use of dental prostheses, and satisfaction with chewing ability and oral appearance were verified through oral examinations. Interviews and examinations were repeated. Risk ratios (RRs) relative to the outcome and independent variables were estimated using Poisson regression with a robust variance estimator. Tooth loss was a risk factor for decline in the psychological domain of QoL (RR = 1.04, 95% confidence interval (CI) = 1.02-1.06). Improvement in satisfaction with chewing ability was a protective factor for decline in this same domain (RR = 0.69, 95% CI = 0.50-0.97). Greater satisfaction with oral appearance was a protective factor against decline in social (RR = 0.84, 95% CI = 0.72-0.98) and environmental (RR = 0.77, 95% CI = 0.61-0.97) domain scores. Preventing tooth loss and recognizing and properly addressing concerns about chewing and dental appearance can affect the general well-being of community-dwelling elderly adults.

Family Access to a Dentist Study (FADS): A multi-center randomized controlled trial

Many low-income parent/caregivers do not understand the importance of cavity-free primary (baby) teeth and the chronic nature of dental caries (tooth decay). As a consequence, dental preventive and treatment utilization is low even when children are screened in schools and referred for care. This study aims to test a referral letter and Dental Information Guide (DIG) designed using the Common-Sense Model of Self-Regulation (CSM) framework to improve caregivers' illness perception of dental caries and increase utilization of care by children with restorative dental needs. A multi-site randomized controlled trial with caregivers of Kindergarten to 4th grade children in urban Ohio and rural Washington State will compare five arms: (1) CSM referral letter alone; (2) CSM referral letter+DIG; (3) reduced CSM referral letter alone; (4) reduced CSM referral letter+DIG; and (5) standard (control) referral. At baseline, children will be screened at school to determine restorative dental needs. If in need of treatment, caregivers will be randomized to study arms and an intervention packet will be sent home. The primary outcome will be dental care based on a change in oral health status by clinical examination 7 months post-screening (ICDAS sealant codes 1 and 2; restoration codes 3-8; extraction). Enrollment commenced summer 2015 with results in summer 2016. This study uses the CSM framework to develop and test behavioral interventions to increase dental utilization among low-income caregivers. If effective this simple intervention has broad applicability in clinical and community-based settings.

Effectiveness of an Alternative Dental Workforce Model on the Oral Health of Low-Income Children in a School-Based Setting.

We evaluated the effect of an alternative dental workforce program-Kansas's Extended Care Permit (ECP) program--as a function of changes in oral health. We examined data from the 2008 to 2012 electronic medical records of children (n = 295) in a Midwestern US suburb who participated in a school-based oral health program in which preventive oral health care was delivered by ECP dental hygienists. We examined changes in oral health status as a function of sealants, caries, restorations, and treatment urgency with descriptive statistics, multivariate analysis of variance, Kruskal-Wallis test, and Pearson correlations. The number of encounters with the ECP dental hygienist had a statistically significant effect on changes in decay (P = .014), restorations (P = .002), and treatment urgency (P = .038). Based on Pearson correlations, as encounters increased, there was a significant decrease in decay (-0.12), increase in restorations (0.21), and decrease in treatment urgency (-0.15). Increasing numbers of encounters with alternative providers (ECP dental hygienists), such as with school-based oral health programs, can improve the oral health status of low-income children who would not otherwise have received oral health services.

Improving the oral health of residents with intellectual and developmental disabilities: An oral health strategy and pilot study

This article presents an oral health (OH) strategy and pilot study focusing on individuals with intellectual and/or developmental disabilities (IDD) living in group homes. The strategy consists of four components: (1) planned action in the form of the behavioral contract and caregiver OH action planning; (2) capacity building through didactic and observation learning training; (3) environmental adaptations consisting of additional oral heath devices and strategies to create a calm atmosphere; and (4) reinforcement by post-training coaching. A pilot study was conducted consisting of pre- and post-assessment data collected 1 week before and 1 week after implementing a 1-month OH strategy. The study sample comprised 11 group homes with 21 caregivers and 25 residents with IDD from one service organization in a Midwestern city. A process evaluation found high-quality implementation of the OH strategy as measured by dosage, fidelity, and caregiver reactions to implementing the strategy. Using repeated cross-sectional and repeated measures analyses, we found statistically significant positive changes in OH status and oral hygiene practices of residents. Caregiver self-efficacy as a mechanism of change was not adequately evaluated; however, positive change was found in some but not all types of caregiver OH support that were assessed. Lessons learned from implementing the pilot study intervention and evaluation are discussed, as are the next steps in conducting an efficacy study of the OH strategy.