Dental Care Setting Research Articles

A Case-Finding Protocol for High Cardiovascular Risk in a Primary Care Dental School—Model with Integrated Care

National Health Service (NHS) strategies in the United Kingdom (UK) have highlighted the need to maximise case-finding opportunities by improving coverage in non-traditional settings with the aim of reducing delayed diagnosis of non-communicable diseases. Primary care dental settings may also help to identify patients. Case-finding appointments took place in a primary care dental school. Measurements of blood pressure, body mass index (BMI), cholesterol, glucose and QRisk were taken along with a social/medical history. Participants with high cardiometabolic risk were referred to their primary care medical general practitioner (GP) and/or to local community health self-referral services, and followed up afterwards to record diagnosis outcome. A total of 182 patients agreed to participate in the study over a 14-month period. Of these, 123 (67.5%) attended their appointment and two participants were excluded for age. High blood pressure (hypertension) was detected in 33 participants, 22 of whom had not been previous diagnosed, and 11 of whom had uncontrolled hypertension. Of the hypertensive individuals with no previous history, four were confirmed by their GP. Regarding cholesterol, 16 participants were referred to their GP for hypercholesterolaemia: 15 for untreated hypercholesterolaemia and one for uncontrolled hypercholesterolaemia. Case-finding for hypertension and identifying cardiovascular risk factors has high acceptability in a primary dental care setting and supported by confirmational diagnoses by the GP.

Relations between Dentistry and COVID-19 Infections

As a result of the virus's global dissemination, novel COVID-19 infections have emerged as a significant obstacle for all healthcare professionals to overcome. Dental specialist plays an effective role in the prevention of coronavirus. Dental care units and settings face various problems relating to the transmission of disease during treatment and dental operations. Blood, saliva, and mixed water droplets possessing the virus cause contamination of equipment used for dental treatment. Both patients and workers may become transmitters and infectors of COVID-19 through direct contact during dental operations. Both dental workers and patients are likely to become infectors and transmitters of COVID-19. The dental care routine is very effective as we discussed below the prevention steps are very effective. All healthcare workers at the dentistry clinics, including nurses, should collaborate to prevent the spread of the COVID-19 virus among patients.

Clinical Practice Guidelines for Oral Frailty

The associations between lowered oral health status and frailty in elderly have been previously reported in many studies. Despite the increasing number of elderly populations in Korean society, there have been no attempt to develop clinical practice guideline and diagnostic criteria for oral frailty. Hence, this study reviewed the previous cohort studies and systematic reviews about oral frailty and proposed 15 recommendations as an oral frailty guideline for Korean elderly on the basis of the evidence-based methodology. This clinical practice guideline will provide overall guidance on the identification, diagnosis, and management of oral frailty in pri-mary dental care setting and finally help to achieve healthy aging in elderly.

Quality of zirconia crowns, following prep-guide, and dentist-technician communication

Background/Aim: Dentist-technician communication is crucial for a successful working relationship in the healthcare setting that contributes to positive health outcomes. However, the interruption of the dentist and the technician communication can harm the dental care procedure. Besides, mistakes in dental laboratories can be both expensive and time-consuming. Materials and Methods: This research project focused on paper-based communication in the dental laboratory setting and its impact on the quality of prosthesis of zirconium crowns. The study's findings suggested that ineffective communication between technicians and dentists resulted in poor quality of zirconium crowns. The study adopted quantitative analysis, which entails a purposive non-probabilistic sampling of dentists targeted located in Texas. Statistical measurements such as Pearson's correlation employed in determining the association between the independent and dependent variables. Results: The research results suggest a significant positive correlation between inter-professional communication in the dental care setting and prosthetic treatment quality. The results also underscore the effectiveness of prep guides in improving the communication between the technicians and the dentist. Conclusions: The researchers conclude that adherence to prep guides contributes to the quality of zirconium crowns and productive communication among dentists and technicians.

Effect of Virtual Reality and Artificial Intelligence on Anxiety and Behavior Among Individuals with Mental Disabilities in a Dental Setting

Over one million individuals suffer from mental disabilities in Saudi Arabia. These individuals are unable to express their dental treatment needs. This study focuses on assessing the impact of interventions based on virtual reality (VR) and artificial intelligence (AI) on the anxiety levels and behavioral responses of individuals with mental disabilities when undergoing dental treatments. Our findings indicate that VR and AI interventions have great potential in reducing anxiety and behavioral responses of individuals with mental disabilities. The reduction in anxiety levels was determined using a galvanic skin response sensor, whereas the improvement in behavior was evaluated using the Venham and Frankl behavior rating scales. Descriptive statistics were used to calculate the means, standard deviations, and ranges of the scores on various scales. The mean scores of pretreatment and posttreatment were analyzed. Our results from the above-mentioned tests revealed lowered anxiety and positive behavior when VR and AI interventions were used in dental care settings. In conclusion, our research indicates that distraction using VR and AI interventions is an effective method for lowering anxiety and improving behavior among individuals with mental disabilities during dental treatments. Moreover, a positive correlation between anxiety and behavior was observed.

Factors affecting infection control measures performed by dental workers

Background/purposeAn understanding of self-protection related factors is important for dental infection control. This study aimed to investigate factors associated with personal self-protection in infection control among dental care workers. Materials and methodsA cross-sectional survey with self-report questionnaire was conducted between Jan and Dec, 2018.275 dentists and 298 dental assistants were enrolled from randomly selected dental care settings. ResultsCompliance with wearing hair caps, facial masks, and hand washing is not as high as oral masks and gloves (over 90%). For dentists, the level of clinical setting (aOR = 3.1, P < 0.001) and the correct use of disinfectants for impression materials (aOR = 2.0, P < 0.05) were associated with hair cap wearing. Gender (aOR = 0.15, P < 0.05) and correct use of indicator during sterilization (aOR = 2.9, P < 0.05) were associated with facial mask wearing. The correct use of indicator during sterilization (aOR = 2.4, P < 0.05) and disinfection for impression materials (aOR = 2.2, P < 0.05) were associated with hand washing. For dental assistants, longer work experience (aOR = 1.05, P < 0.05), working days (aOR = 1.82, P < 0.05), the correct use of disinfectants for impression materials (aOR = 2.4, P < 0.001), and the frequent use of gloves (aOR = 8.0, P < 0.05) were associated with facial mask wearing. The surface disinfection of working tables (aOR = 2.8, P < 0.001) and the frequent changing of gloves (aOR = 5.96, P < 0.05) were associated with hand washing. ConclusionGender, the length of work practice, and correct techniques for sterilization use were identified as major factors associated with compliance with self-protection in infection control among dental care workers.

Effects of COVID-19 pandemic on orthodontic practice

The COVID-19 is a respiratory illness which was declared as pandemic in 2020 by WHO. The pandemic has not only affected daily lives of people but greatly influenced the healthcare system across the globe especially dental care setup which was affected due to lockdown preventive measures taken by various countries. Orthodontic treatment involves regular consultations and visits to the dental clinic which unfortunately got negatively affected by the pandemic situation resulting in delayed appointments and prolonged treatment. The aim of this research was to review the available information regarding the effects of COVID-19 pandemic on orthodontic practice. Most of the orthodontic services were suspended and dental care settings were closed during the time of pandemic, only emergency patients were treated. Due to the delay in orthodontic services and treatment most orthodontic problems such as loosening brackets and arch wires could not be treated timely which affected patients. Many orthodontics utilized the digital technology for the provision of services and held virtual-based sessions with their patients. Findings from the literature exhibit that corona virus disease pandemic has posed a significant impact on the field of orthodontics however, in future more research is needed on designing management strategies in times of pandemic, so the dental care and orthodontic services are not affected.

Behavioural intervention to promote the uptake of planned care in urgent dental care attenders: study protocol for the RETURN randomised controlled trial

BackgroundPeople with disadvantaged backgrounds are less likely to visit the dentist for planned care, even though they have disproportionately poorer oral health. They are correspondingly more likely to experience dental problems and use urgent dental care, general practices and Accident and Emergency departments, which not only makes meeting their needs expensive, but, since these services often rely on prescriptions rather than addressing the clinical cause, can contribute to antimicrobial resistance.MethodsThe RETURN intervention has been developed with substantial community co-production, to be delivered opportunistically in urgent dental care settings. This brief intervention is delivered by dental nurses and involves material relevant to the ‘in-group’ targeted. The material includes booklets relating to barriers to planned dental visiting with corresponding short video clips featuring local people and including a modelling element. Dental nurses are trained to have supportive and non-judgemental conversations, assisting patients to set personal goals and action plans, which are reinforced in a follow-up text within a few weeks. A randomised controlled trial will be undertaken in 3 types of sites: dental practices delivering urgent care (a) within working hours, (b) out of hours, and (c) in a Dental Hospital. The trial will recruit 1180 adult urgent dental care users over 12 months, who have not visited a dentist for a planned care appointment for 2 years or more and do not have a dentist who they visit for routine care. It aims to investigate the effectiveness and cost-effectiveness of the intervention and to explore whether the intervention has different effects across the socio-economic gradient. Participants will be followed up at 6, 12 and 18 months after randomisation. Co-primary outcomes are attendance at a dental practice for planned care within 12 months and self-reported oral health-related quality of life at 12 months.DiscussionThis is a pragmatic trial, evaluating the effectiveness of the intervention under the usual condition in which it might be applied. Since dental practices work as independent contractors to the NHS, this brings implementation and fidelity challenges which will be explored and described in embedded qualitative work.Trial registrationISRCTN registry identifier ISRCTN84666712. Registered 12/04/2021.

Patient acceptance of HIV rapid testing in the dental care setting

ABSTRACT Dental settings are untapped venues to identify patients with undiagnosed HIV who may otherwise lack testing opportunities. Perceived lack of patient acceptance has been a significant barrier limiting dentists’ willingness to offer HIV testing. This study implemented rapid HIV testing in dental settings located in an HIV prevalent region to evaluate patient acceptance. Two South Florida community health centers implemented routine oral rapid HIV testing as part of clinical practice, followed by exit interviews with patients immediately after to determine patient acceptance. The binary primary outcome was patient’s acceptance of the rapid HIV test. Multivariable logistic regression assessed associations between patient characteristics and acceptance. Overall acceptance by dental patients (N = 600) was 84.5%. Patients who were more likely to participate in other medical screenings in dental settings were more than twice as likely to accept the test compared to those who were neutral/less likely (OR: 2.373; 95% CI: 1.406–4.004). Study findings highlight the high patient acceptance of HIV testing in dental settings. Widespread implementation of such testing will require an expanded societal view of the traditional role of the dentist that will embrace the potentially valuable role of dentistry in preventive health screenings and population health.

The role of preprocedural mouth rinse application in decreasing COVID-19 transmission in Dental Care Settings: A mini-review

The COVID-19 virus present in saliva and respiratory droplets is a possible high-risk source of viral transmission in health care settings. Dental practitioners and dentists in particular are highly susceptible to virus acquisition from their source patients. Mouthwashes before dental examination and procedures may be one possible solution to decrease the viral burden in the mouth, hence reducing transmission probability. Application of hydrogen peroxide, cetylpyridinium chloride, povidone-iodine, and chlorhexidine have been proposed to achieve this target. This paper aims to investigate for evidence in the literature for a decrease in the viral burden following preprocedural application of different mouthwashes.

PROBLEMS AND PROSPECTS OF THE EDUCATIONAL PROCESS FOR DENTAL STUDENTS (STATUTORY TERM OF TRAINING)

Applicants for higher medical education usually demonstrate a highly developed logical and abstract thinking and the ability to control their own mental processes effectively. However, some of them, due to not fully formed certain personality traits (willingness to learn, ability to learn independently, the ability to control themselves and their emotions and properly distribute learning and free time) do not always successfully master new knowledge and skills. The training course of students who have got a diploma of a junior specialist and then enter medical universities in the specialty "Dentistry", lasts four years, a shorter term compared with applicants applying after high schools because a range of disciplines delivered at medical colleges should no be retaken. Students with statutory term of training demonstrate better and faster adaptation to university routine compared with freshmen who enter universities after the school graduation. Students who have graduated from medical colleges have a background including basic professional knowledge, which facilitates the process of their adaptation to learning. At each department of the university, educational materials essential for the hight quality training are available on the websites of the departments and are used for classroom activities, students’ independent and individual work. Depending on the direction of specialization of the departments, students are provided with relevant knowledge, skills and abilities. At the departments of morphological profile, the students learn different levels of living organization, biological phenomena and processes, the structure and functions of individual organs, systems and the human body in health and in the development of pathological processes; they are trained to apply acquired knowledge in further learning and future practice. Much attention is paid to the study of the fundamentals of histology and embryology of the head, neck, and oral cavity, the emergence of possible disorders, macroand microscopic structure of tooth structures, functions, timing of eruption, disease prevention and treatment. The purpose of training at clinical departments is to apply theoretical knowledge for mastering practical skills of diagnosis, treatment and prevention of dental diseases and preparation of students for independent professional activity. The organization of the educational process for students at the Faculty of Dentistry with a statutory term of training in medical universities is aimed at implementing the principles of the competency approach and focuses on the ultimate goals of the educational process, consisting in the preparation for professional activities in dental care settings.

COVID-19 transmission in dental and oral/maxillofacial surgical practice during pandemic: questionnaire survey in 51 university hospitals in Japan

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has become a major public health problem. Dental procedures that generate aerosols are considered to impose a high risk of infection; therefore, dental professionals, such as dentists and dental hygienists, may be at high risk of viral transmission. However, few studies have reported COVID-19 clusters in dental care settings.AimTo investigate whether dental and oral/maxillofacial procedures are associated with the occurrence of COVID-19 clusters and measures taken to prevent nosocomial infection in dental clinics.MethodsAn online questionnaire survey on clinical activities (administrative control), infection control measures (environmental/engineering control, personal protective equipment, etc.), and confirmed or probable COVID-19 cases among patients and clinical staff was administered to the faculties of the dental and oral/maxillofacial surgical departments of university hospitals.FindingsFifty-one faculty members completed the questionnaire. All members were engaged in the treatment of dental and oral surgical outpatients and actively implemented standard precautions. Fourteen faculty members treated patients with COVID-19, but no infections transmitted from the patients to the medical staff were observed. In seven facilities, patients were found to have the infection after treatment (medical staff came in close contact), but there was no transmission from patients to medical staff. Four facilities had medical staff with infections, but none of them exhibited disease transmission from staff to patients.ConclusionCOVID-19 clusters are unlikely to occur in dental and oral surgical care settings if appropriate protective measures are implemented.

Dental health care for children with Down syndrome: Parents' description of their children's needs in dental health care settings.

A visit to the dental clinic may be challenging for a child with Down syndrome due to medical and oral health problems as well as communication problems. The aim of the present study was to explore how parents of children with Down syndrome describe their child's needs in the dental health care setting. In a survey concerning parental experiences with dental health care in Sweden, free comments were analysed with content analysis and resulted in five categories: “Need for continuity of care in dental health care”; “Need for dental health care professionals to have knowledge and expertise in caring for children with Down syndrome and other disabilities”; “Need for dental health care professionals to use a caring approach with children with Down syndrome”; “Need for the child with Down syndrome to be prepared to participate in their dental health care visit” and “Need for the child with Down syndrome to be given the same rights as typically developing children”. To support children with Down syndrome in an optimal way, dental health care needs to be tailored to meet the child's unique needs. In addition, dental health care professionals need knowledge of and expertise in the care of children with Down syndrome.

Impact of DHCWs' Safety Perception on Vaccine Acceptance and Adoption of Risk Mitigation Strategies.

To estimate the association between safety perception on vaccine acceptance and adoptions of risk mitigation strategies among dental health care workers (DHCWs). A survey was emailed to DHCWs in the New Jersey area from December 2020 to January 2021. Perceived safety from regular SARS-CoV-2 testing of self, coworkers, and patients and its association with vaccine hesitancy and risk mitigation were ascertained. Risk Mitigation Strategy (RiMS) scores were computed from groupings of office measures: 1) physical distancing (reduced occupancy, traffic flow, donning of masks, minimal room crowding), 2) personal protective equipment (fitted for N95; donning N95 masks; use of face shields; coverings for head, body, and feet), and 3) environmental disinfection (suction, air filtration, ultraviolet, surface wiping). SARS-CoV-2 testing of dental professionals, coworkers, and patients were perceived to provide safety at 49%, 55%, and 68%, respectively. While dentists were least likely to feel safe with regular self-testing for SARS-CoV-2 (P < 0.001) as compared with hygienists and assistants, they were more willing than hygienists (P = 0.004; odds ratio, 1.79 [95% CI, 1.21 to 2.66]) and assistants (P < 0.001; odds ratio, 3.32 [95% CI, 1.93 to 5.71]) to receive the vaccine. RiMS scores ranged from 0 to 19 for 467 participants (mean [SD], 10.9 [2.9]). RiMS scores did not significantly differ among groups of DHCWs; however, mean RiMS scores were higher among those who received or planned to receive the COVID-19 vaccine than those with who did not (P = 0.004). DHCWs who felt safer with regular testing had greater RiMS scores than those who did not (11.0 vs. 10.3, P = 0.01). Understanding DHCWs' perception of risk and safety is crucial, as it likely influences attitudes toward testing and implementation of office risk mitigation policies. Clinical studies that correlate risk perception and RiMS with SARS-CoV-2 testing are needed to demonstrate the effectiveness of RiMS in dental care settings. Educators, clinicians, and policy makers can use the results of this study when improving attitudes toward testing and implementation of risk mitigation policies within dental offices, for current and future pandemics.

Review of Professionally Applied Fluorides for Preventing Dental Caries in Children and Adolescents

This review aims to evaluate the effectiveness of professional topical fluoride application on the prevention of dental caries in primary and permanent dentition. A web search was conducted for English papers published from 2000 to 2020, using various digital resources (Pubmed, Google Scholar, Cochrane Library, and ResearchGate). The keywords were “professionally applied fluoride”, “fluoride gel”, “fluoride varnish”, “fluoride foam”, “fluoride mouthrinses”, and “non-cavitated caries lesions”. Inclusion criteria: (a) participants: children and adolescents, treated in a dental care setting; (b) intervention: professionally applied fluorides (gel, varnish, foam, mouthrinse); (c) comparator: no professional treatment or other preventive treatments; (d) outcomes: clinical effectiveness (e.g., caries reduction, tooth remineralization); (e) study design: randomized controlled trials, systematic reviews, meta-analyses; (f) publication period: 1 January 2000–31 December 2021. Clinical studies about home-use fluoride products, discussion papers, in-vitro studies, case reports, non-English articles, and studies with unclear methodology were excluded. Topical fluoride applications are indicated for patients with active smooth surface caries and for patients in high caries risk groups. Both APF gel and fluoride varnish are effective and can be recommended for caries prevention in primary and permanent teeth. For children under the age of 6, only 2.26% fluoride varnish is recommended.

COVID-19 outbreak: Knowledge, attitude, and practice among dental students in a tertiary care hospital: A cross-sectional study

Background: Dental care settings have the risk of COVID-19 infection due to the aerosols generated during procedures, handling of sharps, and proximity of the dentist to the patient's oropharyngeal region. Materials and Methods: This descriptive cross-sectional online survey among undergraduate and postgraduate dental students studying in a tertiary care hospital employed a convenient snowball sampling technique. The survey instrument consisted of pretested and prevalidated questionnaire comprising demographic characteristics, 14 items on knowledge domain, 6 items on attitude domain, and 4 items on practice domain modified from a previously published questionnaire on COVID-19. Statistical Analysis: Statistical analysis was done using SPSS version 20.0 to perform the Chi-square test, MannWhitney, KruskalWallis, Spearman's correlation, and linear regression analysis. Results: The study population comprised 79 (28.9%) males and 194 (71.1%) females, with approximately 53% belonging to the age group of <20 years. Based on our results, the majority of the general population had inadequate (42.1%) knowledge about the disease with a mean knowledge score was 22.82 ± 1.98. Conclusion: This study showed that the dental students had an inadequate level of knowledge and negative attitude in their outlook on overcoming the COVID-19 pandemic. Various health education programs are necessary, particularly targeting students with lower knowledge regarding COVID-19 are essential for encouraging adequate knowledge, positive attitude, and maintain safe dental practices.

Oral potentially malignant disorders: advice on management in primary care

Introduction: The diagnosis of and risks associated with oral potentially malignant disorders (OPMD) have been widely reported, but little has been published on the management of OPMDs in a primary dental care setting. Hospital services face ongoing pressures due to long-term follow-up, with a need for surveillance to be jointly undertaken with primary dental care clinicians. In a primary care setting, identification and surveillance of OPMDs can be challenging as no universal guidance exists on recommended recall intervals. Corpus: In this article, an update on OPMDs is provided and, based on the practices of six Oral Medicine units in Europe (London (United Kingdom), Milan (Italy), Bordeaux (France), Porto (Portugal), Zagreb (Croatia) and Santiago de Compostela (Spain)), aiming to provide guidance on monitoring in a primary care setting in Europe. Conclusion: Oral medicine clinicians can provide guidance to general dental practitioners (GDPs) on recommended recall intervals. It is important that they feel confident in monitoring these conditions and, when concerned, to arrange referral to a hospital or appropriate specialist. GDPs should document descriptions of lesions and, if possible, take clinical photographs. Patients should be counselled on modifiable lifestyle factors and directed to oral medicine society websites to access patient information leaflets.

Hospitalization for Oral Health-Related Conditions of the Australian Ageing Population: Two Decades of Analysis.

The burden of oral health care increases among older people, with a profound challenge in utilising dental services in primary dental care settings. This study aimed to analyse two decades of nationwide hospital separation patterns due to oral health-related conditions among older people. Ageing population data were obtained from the Australian Bureau of Statistics, including people aged 65 years and older. All principal diagnoses of oral health conditions (ICD-10-AM) were analysed in this study. The hospitalisation data included all separations of older people for the financial years 1998–1999 to 2018–2019. A total of 205,461 hospital separations were recorded for older people over a period of twenty-one years. More than 60% of these separations were collectively attributed to dental caries, disorders of teeth and supporting structures, diseases of the jaws, diseases of the pulp and periapical tissues. However, the average rate of separations per 10,000 people due to dental caries was the highest among the dental conditions (8.68). Furthermore, the remaining oral health-related conditions predict an annual percentage increase in the rate that would compromise their oral health quality of life. Dental caries and its sequela seem to be the leading cause for oral health-related hospital admissions in Australia for people aged 65 and older. This could be an indicator of the inadequacy of disease management in the primary dental care setting.

Perceptions of general dental practitioners in Northern Ireland on the clinical management of patients taking direct oral anticoagulants

##Statement of the problem Despite guidance advocating the management of patients taking direct oral anticoagulants (DOACs) in primary dental care settings, evidence from clinical audit in Northern Ireland suggested that a high proportion of patients were being referred to secondary and tertiary care settings for dental procedures with a bleeding risk. ##Purpose of the study The aim of this study was to evaluate the perceptions of general dental practitioners (GDPs) working in the health service in Northern Ireland on the clinical management of patients taking DOACs in primary dental care. ##Materials and methods: A questionnaire was distributed to the 1,167 registered GDPs in Northern Ireland, assessing perceptions of the clinical management of DOAC patients in primary dental care. The data obtained was analysed using SPSS statistical software. Qualitative data underwent thematic analysis. ##Results A total of 344 questionnaires were analysed. Some 83% (285) of responding GDPs were aware of the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance. Some 98% (337) believed that patients taking DOAC medication could potentially be managed in primary care but that additional training was required. Some 80% (275) of GDPs had referred patients to secondary care. Procedures presenting a low risk of postoperative bleeding complications accounted for 12% (41) of referrals. ##Conclusions A lack of GDP confidence and experience in the management of DOAC patients are motivating factors in referral to secondary care settings for treatment. Some 12% of the referrals analysed were potentially inappropriate, given the low risk of associated postoperative bleeding complications. Additional training and support for GDPs, as well as enhanced awareness of the SDCEP guidance, is essential.

The impact of COVID-19 on paediatric dental services and tips for patient management.

Managing paediatric patients in primary dental care while awaiting treatment by the specialist paediatric dental services can be tricky. COVID-19 has had a significant impact on dental services meaning wait times to be seen by a paediatric dental service may have been delayed. This article will discuss the management of paediatric patients in primary dental care and provide an update on some of the latest techniques in paediatric dentistry. It also covers tips that can be employed in the primary dental care setting such as the use of tooth mousse and silver diamine fluoride.