Evidence-based Oral Health Care Research Articles

Wake Smiles Prizes Dignity and Empathy Alongside Evidence-based Oral Health Care.

Wake Smiles Prizes Dignity and Empathy Alongside Evidence-based Oral Health Care.

Assessment of the quality of guidelines on oral health care during pregnancy: a systematic review.

Importance of oral health during pregnancy has been well reported. To prevent the occurrence of oral diseases and maintenance of oral health, a number of guidelines have been developed by different organizations. However, despite numerous efforts in development of these guidelines, a critical evaluation of the quality of guidelines has not been carried out. Thus, we aimed to perform a systematic review to assess the quality of guidelines on oral health care during pregnancy. PubMed, Embase, Scopus and Cochrane Databases were electronically searched in March 2024. We included guidelines that were carried out within last 10 years and focused on oral health during pregnancy were included in this review. Guidelines focused for both oral health professionals and non-oral health professionals were included in this review. The assessment of the guidelines in this review was carried out using the AGREE II instrument. The four appraisers who carried out the assessment comprised of a gynecologists, a dental practioners, a public health expert and a dental public health professional. The instrument comprises of 23 key items within six domains and two additional global rating items. We included eight guidelines in this review. The AGREE II showed two domains with mean score of more than 70% scores across the guidelines. A comparative evaluation of all the guidelines revealed consistently higher scores in scope and purpose (81.71 + 6.3) and clarity of presentation (71.61 + 11.7). Lowest mean scores were reported for editorial independence (47.87 + 7.21) followed by rigour of development (56.19 + 16.97), applicability (57.50 + 13.7) and stakeholder involvement domain (63.17 + 14.31). Although many guidelines have demonstrated adherence to systematic methodologies, there still exists a scope of improvement in domains such as editorial independence, rigour of development, applicability and stakeholder involvement. Addressing these shortcomings is essential for promoting evidence-based oral health care practices and improving maternal and neonatal health outcomes.

Educating long-term care staff on older adult oral health: Maine's oral team-based initiative vital access to education (MOTIVATE) program.

The oral health status of older adults in the United States is a public health crisis and a silent epidemic. Maine's Oral Team-Based Initiative Vital Access to Education (MOTIVATE) Program is an innovative interprofessional oral health program aimed at enhancing oral health education and practice of interprofessional health care teams in nursing homes. Using a blended learning model, a combination of in-person and online learning, this program provides a foundation from which to implement evidenced based oral care in nursing homes. Learning outcomes were assessed via a three-part timed series survey. A set of self-report assessment items measured skills implemented at baseline and post-training. Learning domain scores increased over time from baseline to post-training. Confidence in providing oral healthcare and role clarity in providing oral health care improved over time. Staff identified using new skills in daily oral care and communication across the interprofessional team. The MOTIVATE program is an effective collaborative-based model for developing oral health competencies and promoting evidence-based oral health care in nursing homes.

Australian nursing students’ perception, knowledge, and attitude towards oral healthcare of older people and associated factors: a national cross-sectional survey

BackgroundThe oral health of many older Australians is poor and associated with many systemic health problems. However, nurses often have a limited understanding of the importance of oral healthcare for older people. This study aimed to investigate Australian nursing students’ perception, knowledge, and attitude toward providing oral healthcare for older people and associated factors.MethodsA cross-sectional study was conducted among final year nursing students studying at accredited nursing programs using an online self-reported 49-item survey. The data were analysed using univariate and bivariate analysis (t-test, ANOVA, Spearman’s correlation test).ResultsA total of 416 final-year nursing students from 16 accredited programs in Australia completed the survey. Mean scores showed that more than half of the participants felt they lacked confidence (55%, n = 229) and had limited knowledge about oral healthcare for older people (73%, n = 304); however, their attitude towards providing such care was favourable (89%, n = 369). A positive correlation was found between students’ confidence in delivering oral healthcare to older people and their perceived knowledge (r = 0.13, p < 0.01). Results revealed a statistically significant positive association between students’ experience in providing oral healthcare to older people and students’ perception (t = 4.52, p < 0.001), knowledge (t = 2.87, p < 0.01), and attitude (t = 2.65, p < 0.01) mean scores in such care. Nearly 60% (n = 242) of participants received education/training in oral healthcare for older people at university, but this was often for less than one hour. Around 56% (n = 233) believed that the current nursing curriculum did not prepare them to provide effective oral healthcare to older people.ConclusionFindings suggested a need for nursing curricula to be revised to include oral health education and clinical experience. Knowledge of evidence-based oral healthcare by nursing students may improve the quality of oral healthcare for older people.

Academic detailing in oral healthcare – results of the ADVOCATE Field Studies

Background: Academic detailing (AD) is a defined form of educational outreach that can be used to influence decision making and reduce unwarranted variation in healthcare delivery. This paper describes the results of the proof of concept phase of the ADVOCATE Field Studies. This study evaluated the feasibility, acceptability and usefulness of AD reinforced with feedback data, to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs).Methods: In the Field Studies, six groups of GDPs (n = 39) were recruited in The Netherlands, Germany and Denmark. Each group had four meetings reinforced with feedback data for open discussions on dental practice and healthcare delivery. Conventional and directed content analysis was used to analyze the qualitative data collected from focus group interviews, debriefing interviews, field notes and evaluation forms.Results: A total of nine themes were identified. Seven themes related to the process of the Field Studies and covered experiences, barriers and facilitators to AD group meetings, data collection and the use of an electronic dashboard for data presentation and storage. Two themes related to the outcomes of the study, describing how GDPs perceived they made changes to their clinical practice as a result of the Field Studies.Conclusions: The ADVOCATE Field Studies approach offers a novel way of collecting and providing feedback to care providers which has the potential to reduce variation oral healthcare delivery. AD plus feedback data is a useful, feasible approach which creates awareness and gives insight into care delivery processes. Some logistic and technical barriers to adoption were identified, which if resolved would further improve the approach and likely increase the acceptability amongst GDPs.

Using big data to promote precision oral health in the context of a learning healthcare system.

SummaryThere has been a call for evidence‐based oral healthcare guidelines, to improve precision dentistry and oral healthcare delivery. The main challenges to this goal are the current lack of up‐to‐date evidence, the limited integrative analytical data sets, and the slow translations to routine care delivery. Overcoming these issues requires knowledge discovery pipelines based on big data and health analytics, intelligent integrative informatics approaches, and learning health systems. This article examines how this can be accomplished by utilizing big data. These data can be gathered from four major streams: patients, clinical data, biological data, and normative data sets. All these must then be uniformly combined for analysis and modelling and the meaningful findings can be implemented clinically. By executing data capture cycles and integrating the subsequent findings, practitioners are able to improve public oral health and care delivery.

Posttreatment endodontic disease among patients seeking treatment at a referral dental hospital in Kenya

Background: The incidence of postendodontic treatment disease has equally increased in prevalence among patients with previous root-treated teeth. Objective: This study aimed at determining the characteristics of post-treatment disease following endodontic treatment. Materials and Methods: This was a descriptive cross-sectional study. Convenience sampling was used to select periapical radiographs of patients who needed treatment of teeth with previous root canal treatment. Data were analysed using SPSS. Study Benefits: This research will aid in the development of realistic, evidence-based oral health care policies that could be integrated into general health care within the region. Results: A total of 42 patients participated in the study with 54 teeth presenting with posttreatment endodontic disease (PTEDx). The ages of most patients were distributed in the range of 31–40 years with maxillary molars (25.9%) being the most commonly affected teeth. Thirty-nine (72.2%) teeth were asymptomatic, whereas 15 (27.8%) were associated with pain of varying severity. Well-defined radiolucent lesions were present in 59.3% of the cases, whereas 74.1% of the teeth presented with voids. Inadequate root-filling length (79.6%) appeared to be the most common characteristic of PTEDx. Conclusion: Posttreatment disease in this sample presented with the comparatively high substandard technical quality of root fillings and restorations. Recommendations: Academic institutions teaching dentistry and related authorities should collaborate managing this problem of posttreatment disease judiciously. Technical skills, technology, and performance of root canal filling procedures should be emphasized, and suitable methods should be developed in order to achieve better treatment outcomes. Further studies should be done to establish the challenges that lead to substandard root canal treatment.

Perspectives of general dental practitioners on preventive, patient-centred, and evidence-based oral healthcare—A Q-methodology study

ObjectiveIn the last 30 years, innovations in oral healthcare (OHC), such as advanced restorative techniques, shifts towards preventive and evidence-based care and changes in patients’ expectations, have increased the complexity of clinical decision-making in OHC. Little is known about the perspectives of general dental practitioners (GDPs) on the value of providing preventive, patient-centred and evidence-based OHC. This study aimed to explore the range of perspectives present amongst GDPs on OHC.MethodQ-methodology was used to explore perspectives among 78 GDPs working in the Netherlands. Participants were asked to sort 50 statements representing three central domains in OHC: i.) restorative versus preventative OHC, ii.) disease-centred versus patient-centred OHC and iii.) expertise-based versus evidence-based OHC. Opinion statements about delivering OHC were formulated on the basis of published literature and input from OHC professionals. By-person factor analysis was used to reveal clusters of communality in statement rankings, which were interpreted and formed perspectives on OHC.ResultsFour perspectives, explaining 47% of variance, on OHC were identified amongst GDPs: ‘the patient-focused dentist who values prevention’, ‘the outcome-oriented dentist who values learning from colleagues’, ‘the team player with ultimate care responsibility’ and ‘the dentist who considers oral health the responsibility of the patient.’ConclusionQ-methodology can be effectively used to describe the different perspectives that GDPs have on the challenges of preventive, patient-centred and evidence-based OHC. GDPs should not be seen as a homogenous group; rather they have different views and approaches to the care they provide. This has implications for health systems; awareness of the heterogeneity of practitioners’ perspectives can potentially be used to develop bespoke quality of care improvement strategies that constructively engage with each of these different groups.

Improving oral healthcare using academic detailing – design of the ADVOCATE Field Studies

Background: Academic detailing (AD) is a defined form of educational outreach that can be deployed to intrinsically motivate practitioners towards improving quality of care. This paper describes the design of the ADVOCATE Field Studies. This proof of concept study aims to evaluate the feasibility, acceptability and usefulness of AD, reinforced with feedback information to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs).Methods: Six groups of GDPs will be recruited; two groups of six to eight GDPs in each of three countries – the Netherlands, Germany and Denmark. GDPs will meet for four Academic Detailing Group (ADG) meetings for open discussions using comparative feedback data to stimulate debate about their dental practice performance and care delivery. Group meetings will be moderated using the AD methodology. Qualitative data will be collected through focus group interviews, an online discussion forum, field notes and debriefs of ADG meetings and analysed by conventional content analysis using MaxQDA software.Discussion: The results of the study will provide novel information on the feasibility, perceived acceptability and usefulness of AD and feedback data for GDPs to improve oral healthcare delivery.

Advocacy for the Provision of Dental Hygiene Services Within the Hospital Setting: Development of a Dental Hygiene Student Rotation

Educational preparation of dental hygiene students for hospital-based practice, and advocacy efforts promote inclusion of dental hygienists within hospital-based interdisciplinary health care teams. Background and purposeAlthough the value of attending to the oral care needs of patients in critical care units has been recognized, the potential impact of optimal oral health care for the general hospital population is now gaining attention. This article describes a hospital-based educational experience for dental hygiene students and provides advocacy strategies for inclusion of dental hygienists within the hospital interdisciplinary team. MethodsThe dental hygienist authors, both educators committed to evidence-based oral health care and the profession of dental hygiene, studied hospital health care and recognized a critical void in oral health care provision within that setting. They collaboratively developed and implemented a hospital-based rotation within the curriculum of a dental hygiene educational program and used advocacy skills to encourage hospital administrators to include a dental hygiene presence within hospital-based care teams. ConclusionsHospital-based dental hygiene practice, as part of interprofessional health care delivery, has the potential to improve patient well-being, shorten hospital stays, and provide fiscal savings for patients, institutions, and third party payers. Advocacy efforts can promote dental hygienists as members of hospital-based health care teams. Further research is needed to document: (1) patient outcomes resulting from optimal oral care provision in hospitals; (2) best ways to prepare dental hygienists for career opportunities within hospitals and other similar health care settings; and (3) most effective advocacy strategies to promote inclusion of dental hygienists within care teams.

Drivers Advancing Oral Health in a Large Group Dental Practice Organization

Three change drivers are being implemented to high standards of patient centric and evidence-based oral health care within the context of a large multispecialty dental group practice organization based on the commitment of the dental hygienist chief operating officer and her team. Background and purposeA recent environmental scan elucidated 6 change drivers that can impact the provision of oral health care. Practitioners who can embrace and maximize aspects of these change drivers will move dentistry forward and create future opportunities. This article explains how 3 of these change drivers are being applied in a privately held, accountable risk-bearing entity that provides individualized treatment programs for more than 417,000 members. To facilitate integration of the conceptual changes related to the drivers, a multi-institutional, multidisciplinary, highly functioning collaborative work group was formed. Methods and approachThe document Dental Hygiene at a Crossroads for Change1 inspired the first author, a dental hygienist in a unique position as chief operating officer of a large group practice, to pursue evidence-based organizational change and to impact the quality of patient care. This was accomplished by implementing technological advances including dental diagnosis terminology in the electronic health record, clinical decision support, standardized treatment guidelines, quality metrics, and patient engagement to improve oral health outcomes at the patient and population levels. The systems and processes used to implement 3 change drivers into a large multi-practice dental setting is presented to inform and inspire others to implement change drivers with the potential for advancing oral health. ConclusionsTechnology implementing best practices and improving patient engagement are excellent drivers to advance oral health and are an effective use of oral health care dollars. Improved oral health can be leveraged through technological advances to improve clinical practice.

요양시설노인을 위한 구강간호 임상실무지침 수용개작

Purpose: This study attempted to adapt evidence-based oral health care guidelines for nursing home residents in South Korea. Methods: The manual for guideline adaptation, version 2.0, developed by the Korean National Evidence-based Healthcare Collaborating Agency was applied. On the basis of a comprehensive literature review of current research and multidisciplinary panel discussion on adapting such guidelines, we developed evidence- based guidelines for oral health at nursing homes. Results: The guidelines have three domains: oral assessment, oral hygiene care, and support and facilities. Oral assessment includes recommendations on the frequency of and tools for conducting oral health assessment. Oral hygiene care involves recommendations for care of natural teeth, denture care, xerostomia, and behavioral problems. Support and facilities refer to six components of the support system provided by facilities to encourage oral hygiene care among nursing home residents. Conclusion: These adapted guidelines could be an effective method to improve oral hygiene among nursing home residents.

The effectiveness of an oral health care program for preventing ventilator-associated pneumonia.

To determine the effectiveness of an oral health care program for preventing ventilator-associated pneumonia (VAP). Research has shown a significant correlation between oral bacteria and VAP, indicating that an oral health care program plays a very important role in VAP prevention. A quasi-experimental study was used and conducted in the intensive care unit in a medical centre. A total of 199 mechanically ventilated patients were enrolled and divided into two groups: the experimental group (n=99) and control group (n=100). The experimental group was cared for using an evidence-based oral health care program, and the control group was cared for using routine nursing care procedures. Each group received the assigned treatment for four consecutive days. The incidence of VAP in the experimental group (4%, 4/95) was significantly lower than that in the control group (21%, 18/82). The oral assessment guide (OAG) mean score (9.16 ± 2.07) of the experimental group was significantly different (P<0.05) from that of the control group (10.07 ± 1.79). The general estimated equation further showed that there was a significant difference between groups (P<0.01) for the third post-test data and no significant difference for the pre-test or the first and second post-test data between groups, indicating that an increased duration of intervention resulted in significant decreases in the OAG scores in the experimental group compared with the control group. The evidence-based oral health care program effectively improved oral mucosal health and statistically reduced the incidence of VAP in this study. The study findings may be useful as an empirical reference for health care professionals performing an oral health care program in the future. Additionally, it may serve as a reference for long-term care policies aimed at reducing the ventilation duration, days of hospitalization and mortality rate to enhance patient safety and the quality of medical care.

Faculty Positions

Virginia Commonwealth University, School of Dentistry is seeking full-time faculty members in the Department of General Practice. Ideal candidates will have experience in the areas of dental materials, dental practice management, or preclinical and clinical skills development. Responsibilities will include course director, teaching and mentoring undergraduate and graduate dental students in preparation for private practice, service, and scholarship. Methods will include clinical and didactic teaching, course directorship, curriculum development, scholarly activity, mentoring and patient care. Participation in faculty practice and demonstrated ability to build a practice is required. Experience in research or desire to engage in research is preferred. Teaching in an integrated curriculum system that includes baccalaureate, graduate, and professional education and across traditional departmental lines and in multidisciplinary teams is required. Faculty members are expected to foster transformative learning that is informed by interdisciplinary and translational research, teaching, scholarship, and creative expression. Candidates must demonstrate ability to teach (dentistry and/or dental hygiene), or to acquire and develop such ability that incorporates adult learning theory, evidence-based oral health care, innovation in student learning, and critical thinking. Candidates must demonstrate the ability to contribute to and participate in a humanistic environment of learning and discover and demonstrate the ability to adapt to change and embrace modern technologies. Applicants must have a D.D.S. or D.M.D. degree and eligible for licensure in Virginia. Required are strong leadership skills, expansive clinic experience, and expertise in practice management. Salary and rank will be commensurate with experience and qualifications.Send curriculum vitae and a list of at least three references to Dr. Peter Antinopoulos, Chair of Search Committee, Department of General Practice, School of Dentistry, Virginia Commonwealth University, P.O. Box 980566, Richmond, VA 23298.Virginia Commonwealth University is an equal opportunity, affirmative action university, providing access to education and employment without regard to age, race, color, national origin, gender, religion, sexual orientation, veteran's status, political affiliation or disability.A full-time, tenure-track, Assistant/Associate Professor position in the Department of Adult Restorative Dentistry at the University of Nebraska Medical Center College of Dentistry will be available July 1, 2014. The position's responsibilities include teaching and directing undergraduate preclinical and clinic courses in restorative dentistry and related courses. Candidates must have a DDS/DMD from an ADA accredited dental school or a foreign equivalent degree and successful completion of Part I and Part II of the National Dental Board Examination. Master's degree or certificate in Operative Dentistry from an ADA accredited dental school preferred. Experience in dental education is preferable and eligibility for Nebraska dental licensure is required. Participation in the College of Dentistry's University Dental Associates practice is available. Salary and rank will be commensurate with qualifications and experience. Applications will be reviewed as received. Individuals from diverse backgrounds are encouraged to apply.Application for this position must be made through: http://jobs.unmc.edu, position #2013-222.

Faculty Positions

Faculty Positions

Oral Health Nursing Education and Practice Program

Millions of Americans have unmet oral healthcare needs and profound oral health disparities persist in vulnerable and underserved populations, especially poor children, older adults, and racial and ethnic minorities. Nurses can play a significant role in improving the quality of oral health including access to care with appropriate education and training. The purpose of this paper is to describe New York University College of Nursing's response to this challenge. The Oral Health Nursing Education and Practice (OHNEP) program is a national initiative aimed at preparing a nursing workforce with the competencies to prioritize oral disease prevention and health promotion, provide evidence-based oral healthcare in a variety of practice settings, and collaborate in interprofessional teams across the healthcare system. The overarching goal of this national initiative is to create an educational infrastructure for the nursing profession that advances nursing's contribution to reducing oral health disparities across the lifespan.

An oral health care guideline for institutionalised older people

Institutionalized older people are prone to oral health problems and their negative impact due to frailty, disabilities, multi-morbidity, and multiple medication use. Until recently, no evidence-based oral health care guideline for institutionalized older people has been available. For that reason, the Dutch Association of Nursing Home Physicians developed the Oral health care Guideline for Older people in Long-term care Institutions (OGOLI), meeting the requirements of the AGREE instrument for assessing a guideline's quality. This short report presents the keynotes and the content of the Oral health care Guideline. Most recommendations are based on expert opinions. Only 4 recommendations (education, pneumonia, use of an electric toothbrush, and fluoride rinsing in case of a sudden increase of oral plaque amount) are based on evidence level A2 conclusions. This emphasizes the need for further research on oral health of institutionalized older people.

Oral Health Care for Patients After Stroke

Oral health care (OHC) is a deceptively simple task. For many people with stroke-related limitations, the routine practice of OHC becomes a challenge and they become partially or totally reliant on others for their OHC. Poor oral health contributes to discomfort, pain, infection, and systematic health problems. Evidence-based OHC interventions are essential for this vulnerable patient group. Our recent Cochrane review update1 synthesized the randomized control trial evidence relating to the effectiveness of staff-led OHC interventions for individuals after a stroke. ### Search Strategy In this update, we searched a range of sources, including the trial registers of the Cochrane Stroke Group (last searched April 2010) and Cochrane Oral Health Group (last searched May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library May 2010), MEDLINE (1966 to …

Evidence‐based care and the curriculum

An evidence-based (EB) approach has been a significant driver in reforming healthcare over the past two decades. This change has extended across a broad range of health professions, including oral healthcare. A key element in achieving an EB approach to oral healthcare is educating our practitioners, both current and future. This involves providing opportunities integrated within simulated and actual clinical settings for practitioners to learn and apply the principles and processes of evidence-based oral healthcare (EBOHC). Therefore, the focus of this discussion will be on ways in which EBOHC and associated research activities can be implemented into curricula, with the aim of improving patient care. This paper will initially define the scope of EBOHC and research, what these involve, why they are important, and issues that we need to manage when implementing EBOHC. This will be followed by a discussion of factors that enable successful implementation of EBOHC and research into curricula. The paper concludes with suggestions on the future of EBOHC and research in curricula. Key recommendations related to curricula include strengthening of the culture of a scientific approach to education and oral healthcare provision; complete integration of EBOHC into the curriculum at all levels; and faculty development to implement EBOHC based on their needs and evidence of effective approaches. Key recommendations to support implementation and maintenance of EBOHC include recognition and funding for high-quality systematic reviews and development of associated methodologies relevant for global environments; building global capacity of EBOHC researchers; research into improving translation of effective interventions into education and healthcare practice, including patient-reported outcomes, safety and harms, understanding and incorporation of patient values into EB decision-making, economic evaluation research specific to oral healthcare and effective methods for changing practitioner (faculty) behaviours; and extend access to synthesized research in 'user friendly' formats and languages tailored to meet users' needs. Realizing these recommendations may help to improve access to effective healthcare as a basic human right.

The Dental Education Environment

The second in a series of perspectives from the ADEA Commission on Change and Innovation in Dental Education (CCI), this article presents the CCI's view of the dental education environment necessary for effective change. The article states that the CCI's purpose is related to leading and building consensus in the dental community to foster a continuous process of innovative change in the education of general dentists. Principles proposed by CCI to shape the dental education environment are described; these are critical thinking, lifelong learning, humanistic environment, scientific discovery and integration of knowledge, evidence-based oral health care, assessment, faculty development, and the health care team. The article also describes influences external to the academic dental institutions that are important for change and argues that meaningful and long-lasting change must be systemic in nature. The CCI is ADEA's primary means to engage all stakeholders for the purpose of educating lifelong learners to provide evidence-based care to meet the needs of society.