Clinical Oral Health Outcomes Research Articles

Utilization of Dental Care and Oral Health Outcomes in the United States: Results from the National Health and Nutrition Examination Survey (2017-2020).

This analysis aims to evaluate the association between the time since and reason for a patient's last dental appointment across clinical oral health outcomes. We used data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES), a cross-sectional, nationally-representative survey of noninstitutionalized US adults. The predictors were the time since and the reason for the last dental appointment (routine vs. urgent). We examined the presence and number of missing teeth and teeth with untreated coronal and root caries. Multivariable regression models with interaction were used to assess the association between the time since the last dental appointment and clinical oral health outcomes among routine and urgent users separately. Two-thirds of the US population had a dental appointment within a year, while nearly 44 million individuals did not visit a dentist for the last three years. The odds of having teeth with untreated coronal or root caries increased with the length of time since the last appointment, and urgent users had worse dental outcomes compared to routine users. Compared to those who had a dental appointment within a year, individuals who had their last dental appointment more than 3 years ago had 2.94 times the average number of teeth with untreated caries among routine users (95%CI=2.39, 3.62) and 1.60 times the average among urgent users (95%CI=1.05, 2.43). Recent, routine dental appointments are associated with improved oral health outcomes. The outcomes reiterate how social determinants of health impact access to oral health care and oral health outcomes.

A systematic review of medicinal plants and herbal products' effectiveness in oral health and dental cure with health promotion approach.

Medicinal plants and herbal drugs are being used increasingly as part of primary health care in most parts of the world. As important adjunctive and alternative treatments for oral health care, herbal products' use may continue to increase and become more widespread. The objective of this study is to present a comprehensive systematic review of the current published literature on the effectiveness of medicinal plants and herbal products employed to improve oral health in adolescents with a health promotion approach. The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The keywords "herbal medicine," "herbal extract," "herbal supplements," "plant extract," "natural drug," "pulpitis," "dental caries," "oral viral diseases," and "abscess" were used in combination with the Boolean operators OR and AND. PubMed, Embase, Scopus, and Web of Science were searched. Quality assessment of the included studies was performed using the Cochrane Handbook for Systematic Reviews of Interventions. The search yielded 49 original research studies. A total of 22 studies had low or unclear risk bias. The geographical distribution of included studies was primarily concentrated on western countries. Overall, studies reported herbal product users' age, ranging from young adults aged 18 years to elderly people aged 75 years or older. Most studies reported multiple compounds, including herbal drugs and herbal extracts. Chamomile and Aloe vera were the most frequently reported herbal compounds. The most commonly described herbal products to treat oral diseases were gels, mouth rinses, and pastes. The studies included a range of people with oral diseases, including periodontal and gingival diseases, recurrent aphthous stomatitis, oral lichen planus, and oral candidiasis. Herbal product interventions were found to be effective and safe alternatives for oral health care. One of the most important goals of the World Health Organization (until 2015) is the oral health index, so it is important that dental services be followed up more seriously. Considering the problems in reaching this goal of the World Health Organization in our country, herbal products have the ability to improve clinical oral health outcomes in adolescents. Limited adverse side effects indicate the overall safety of these treatments for a wide range of oral diseases. Therefore, the use of medicinal plants as well as alternative medicine is one of the useful methods in achieving this important goal of public health.

Health promotion interventions to improve oral health of adolescents: A systematic review and meta-analysis.

To evaluate the effectiveness of health promotion interventions on oral health knowledge, behaviour and status of healthy adolescents. This review included randomized controlled trials (RCTs) of oral health promotion interventions targeting adolescents. Primary clinical outcomes (gingival health, plaque scores, caries) and secondary proxy outcomes were evaluated. Meta-analysis of primary outcomes was conducted where possible, with subgroup analysis based on intervention (comprehensive health promotion and education-only). Thirty-seven eligible publications reporting on 28 unique RCTs of oral health promotion interventions were included. Quality appraisal of studies ranged from 48% to 96%. Interventions reported ranged from single-session interventions to community-wide programmes, including clinical preventive procedures and take-home products. Half used a health behaviour change theory to inform their intervention. The meta-analysis pooling of results favoured the intervention over control for all clinical outcomes, except DMFS in the education-only subgroup. Stronger intervention effects were seen in the comprehensive intervention subgroup than the education-only subgroup for DMFS (P=.02). This effect was slight, but not as clear in all other clinical categories. The majority of studies reported improvements in oral health knowledge, attitudes and behaviours. More positive outcomes were found with longer programmes, especially for dental caries outcomes. Oral health promotion programmes targeting adolescents have the ability to improve clinical oral health outcomes in the short and long term. Programmes should use more behavioural theory-based interactive and strategic methods, including self-awareness and the use of the wider community and peers for oral health promotion activities over a longer intervention duration.

Oral Health of Children With Attention Deficit Hyperactivity Disorder: Systematic Review and Meta-Analysis

Objective: This systematic review investigated the oral health of children with ADHD. Method: A structured search strategy was performed on five electronic databases: SCOPUS, Web of Science, COCHRANE, PubMed, and PsychInfo. Studies were included in the review if they reported clinical oral health outcomes on a population diagnosed with ADHD under the age of 18 years old. Qualitative and quantitative analysis was performed on pooled prevalence and mean/median values for caries, trauma, periodontal problems, and tooth wear. Results: Twenty-seven effective articles were reviewed by two calibrated assessors. Meta-analysis of the results found higher mean number of decayed surfaces, plaque index, and trauma prevalence among children with ADHD. Conclusion: Children with ADHD show increased risk for caries and traumatic dental injuries, and may have poorer oral hygiene compared with children without ADHD. More awareness among clinicians would promote better caries- and trauma-preventive advice and management.

A randomized clinical trial of oral hygiene care programmes during stroke rehabilitation

ObjectivesThe objectives of this study were to evaluate and compare the effectiveness of an advanced oral hygiene care programme (AOHCP) and a conventional oral hygiene care programme (COHCP) in improving oral hygiene, and reducing gingival bleeding among patients with stroke during outpatient rehabilitation. MethodsSubjects were randomized to receive (i) the COHCP comprising a manual toothbrush, toothpaste, and oral hygiene instruction, or (ii) the AOHCP comprising a powered toothbrush, 0.2% chlorhexidine mouthrinse, toothpaste, and oral hygiene instruction. Dental plaque, gingival bleeding, and other clinical oral health outcomes were assessed at baseline, the end of the clinical trial, and the end of observation period. Development of infectious complications was also monitored. ResultsParticipants of both programmes had a significant reduction in the percentages of sites with moderate to abundant dental plaque (p<0.001) and with gingival bleeding (p<0.05). Those in the AOHCP had significantly less plaque and gingival bleeding than those in the COHCP controlling for other factors at the end of the clinical trial period (both p<0.001) and the observational period (plaque: p<0.05, gingival bleeding: p<0.01). ConclusionsAlthough both oral hygiene care programmes were effective in terms of plaque and gingival bleeding control, the AOHCP was more effective than the COHCP in reducing dental plaque and gingival bleeding. Clinical significanceThis study highlighted the value of oral hygiene programmes within stroke outpatient rehabilitation and provides evidence to advocate for the inclusion of oral hygiene care programmes within stroke outpatient rehabilitation for patients with normal cognitive abilities.

Interventions to Improve the Oral Health of People with Dementia or Cognitive Impairment: A Review of the Literature.

Oral diseases and conditions are prevalent among older people with dementia and cognitive impairment. While many interventions have been advocated for use in this population, evidence for their effectiveness is unclear. Our objective was to review systematically the content and effectiveness of interventions and implementation strategies used to improve or maintain the oral health of people with dementia or cognitive impairment. Original studies published in English at any time until January 2015 were identified through electronic searches of the Medline, Embase, CINAHL, Scopus and Cochrane databases and hand searches of eligible studies and relevant reviews. Two investigators independently abstracted study characteristics and assessed the methodological quality of eligible studies. Results were presented as a narrative review because significant heterogeneity among included studies precluded a meta-analysis. The 18 included studies varied considerably in terms of size, scope and focus. Only two studies were identified that had been designed specifically for and examined exclusively in people with dementia or cognitive impairment. All studies were in residential care; none was population-based. While several studies reported positive effects, a number of methodological weaknesses were identified and the overall quality of included studies was poor. The specific outcomes targeted varied across studies but most studies focused almost exclusively on proximal clinical oral health outcomes such as levels of dental or denture plaque. Attempts to measure intervention integrity were limited and there was usually little or no effort to evaluate intervention effects over a sustained period. There is a lack of high quality evidence to support the effectiveness of oral health interventions and implementation strategies for older people with dementia or cognitive impairment. More rigorous, large scale research is needed in this area. Recommendations are provided to improve the overall quality of evaluation in this area. Emphasis must be placed on developing evidence-based, achievable and sustainable oral health strategies if the needs of people with dementia and cognitive impairment are to be met into the future.

Is clinical oral health poorer in regional areas compared with major city areas?

To determine if clinical oral health outcomes differ between people who reside in major city, inner regional and outer regional areas of Australia. Data from the National Survey of Adult Oral Health 2004-06 that used a clustered stratified random sampling design with telephone interviews, standardised oral epidemiological examinations and self-complete questionnaires were used to compare the clinical oral health. Decayed, missing and filled permanent teeth. Australians aged 15 years or more. Data were weighted by age, sex and regional location to the Estimated Resident Population, bivariate analysis undertaken to determine confounders and multivariate analysis completed with dental caries clinical measures as dependent variables. Inner regional people had a significantly higher decayed, missing and filled teeth than people from major cities (Estimate = 1.15, P < 0.01), but there was no difference between inner and regional areas. Older people had higher outcomes for decayed, missing and filled teeth (15.42, P < 0.01) and missing teeth (9.66, P < 0.01), but less decayed teeth (-0.37, P < 0.01), and people with the highest incomes had lower dental caries experience (-1.34, P < 0.01) and missing teeth (-1.42, P < 0.01). Dental caries experience was greater in inner regional areas than in major city areas, but not outer regional areas. Dental caries experience was similar in outer regional and major city areas.

Differences in Self-Reported Oral Health Among Community-Dwelling Black, Hispanic, and White Elders

To compare differences in self-rated oral health among community-dwelling Black, Hispanic, and White adults aged 60 and older. A total of 4,859 participants in the National Health and Nutrition Examination Survey (1999-2004) provided self-report information on oral health. Blacks and Hispanics reported poorer self-rated oral health than Whites. In separate dentate and edentulous groups, socioeconomic status, social support, physical health, clinical oral health outcomes, and dental checkups accounted for much of the difference in self-rated oral health in Blacks, but significant differences remained for Hispanics. The study findings may have important implications for health policy and program development. Programs and services designed for minority populations should target treatments for dental diseases and include components that take into account subjective evaluations of oral health conditions and perceived dental needs of the individuals.

Relative oral health outcome trends between people inside and outside capital city areas of Australia

The aim of this study was to evaluate relative change over 17 years in clinical oral health outcomes inside and outside capital city areas of Australia. Using data from the National Oral Health Survey of Australia 1987-88 and the National Survey of Adult Oral Health 2004-06, relative trends in clinical oral health outcomes inside and outside capital city areas were measured by age and gender standardized changes in the percentage of edentate people and dentate adults with less than 21 teeth, in mean numbers of decayed, missing and filled teeth, and mean DMFT index. There were similar reductions inside and outside capital city areas in the percentage of edentate people (capital city 63.7%, outside capital city 60.7%) and dentate people with less than 21 teeth (52.5%, 50.1%), in the mean number of missing teeth (34.3%, 34.5%), filled teeth (0.0%, increase of 5.5%), and mean DMFT index (21.2%, 19.2%). The reduction in mean number of decayed teeth was greater in capital city areas (78.0%) than outside capital city areas (50.0%). Trends in four of the five clinical oral health outcomes demonstrated improvements in oral health that were of a similar magnitude inside and outside capital city areas of Australia.

Clinical oral health outcomes in young Australian Aboriginal adults compared with national‐level counterparts

To compare clinical oral health outcomes between a birth cohort of young Australian Aboriginal adults and age-matched, national-level counterparts. Comparison of outcomes between the dental component of Wave-3 of the Aboriginal Birth Cohort (ABC) study--a cross-sectional study conducted between January 2006 and December 2007, nested within a prospective longitudinal investigation in the Northern Territory's Top End--and the 2004-06 National Survey of Adult Oral Health (NSAOH), a representative survey of the Australian population. Data were analysed for 442 ABC study participants and 202 NSAOH participants aged 16-20 years. Severity and prevalence of clinical oral health outcomes. The mean number of decayed teeth was 8.0 times higher among ABC study participants than NSAOH participants, while the prevalence of untreated decayed teeth was 3.1 times higher. ABC study participants experienced 10.8 times the prevalence of moderate or severe periodontal disease of NSAOH participants, and 1.9, 4.1 and 4.5 times the prevalence of calculus, plaque and gingivitis, respectively. Adverse clinical oral health outcomes were 2-11 times higher in a cohort of young Australian Aboriginal adults than their age-matched, nationally representative counterparts.