Integration Of Oral Health Care Research Articles

Prevalence, correlates and treatment needs of dental caries in patients attending a diabetic clinic in rural southwestern Uganda: a cross-sectional study

BackgroundDiabetes mellitus is a complex heterogeneous metabolic disorder known to lead to several pathogenic disorders, and has a bidirectional relationship with oral health conditions. This study aimed at estimating the prevalence, treatment needs and correlates of dental caries among adult patients attending a diabetic clinic in Uganda.MethodsThis was a cross-sectional study that used questionnaires to collect data on socio-demographic factors, diabetes history, oral health status, dental health care, dietary factors, lifestyle factors, and dental examination guided by the modified World Health Organization oral health questionnaire for adults.ResultsWe enrolled 239 participants, prevalence of dental caries was 71.6%, treatment need was nearly 100%, and mean DMFT was 3.82 (SD = 5.46). Dental caries experience was associated with being widowed.ConclusionWe found a high prevalence of dental caries experience and large treatment need among our participants. We recommend integration of oral health care into routine diabetic services in rural sub Saharan Africa.

World Health Organization's global oral health status report: Paediatric dentistry in the spotlight.

World Health Organization's global oral health status report: Paediatric dentistry in the spotlight.

The proposed need for integrated maternal and child oral health policy: A case of South Africa.

The high oral disease burden among children in South Africa, specifically early childhood caries, has received scant attention despite the fact that it is a public health concern that negatively impacts the overall well-being and quality of life of the child. While South Africa has a number of well documented policies that focus on oral health in general and maternal and prenatal health, none specifically addresses the oral health of children under the age of six years. The integration of oral health in maternal and child health care in South Africa could lead to an improved oral health quality of life and better oral health outcomes for mothers and children to address the high prevalence of childhood caries and unmet treatment needs for this population. While the integration of oral health care into primary healthcare is recognised as crucial and affordable, it however continues to be neglected. In South Africa, oral health disparities are attributed to the unequal distribution of oral health services, and policies that govern oral, maternal and child health seem to work in parallel with one another. Integrating oral health into interventions for primary health care delivery is a cost-effective way to improve the health of disadvantaged groups. Considering that maternal oral health predicts children's oral health and primary health care teams regularly see under-6-year-olds, this primary care setting is ideal for integration of these services. Despite growing interest in an integrated oral health and primary care system, there is little literature on oral health integration models. Improving the oral health of vulnerable populations requires integrating oral health into primary care and implementing interdisciplinary public health programs. The development of an Integrated Maternal and Child Oral Health policy would play a critical role in advancing integration; however, such a policy should be designed with both implementation and translation in mind for it to be successfully followed through. Such a policy should be comprehensive and contextual, aimed at increasing access to oral health services for women and children and reduce the oral disease burden. This paper proposes and describes the possible content and objectives of such a policy that will enhance effective leadership and accountability and strengthen health system delivery platforms for quality maternal and child oral health services along the continuum of healthcare. Furthermore, it will illustrate the importance of a policy that aims to promote coordinated, relevant, trans-multi-disciplinary and inter-sectoral community engagement to improve pregnancy and oral health outcomes, and importantly, establish a sustainable and contextual surveillance system for maternal and child oral health.

Food Intake, Oral Hygiene Practices, Self-reported Oral Problems, and Knowledge of Oral Diseases among Pregnant and Non-pregnant Women Attending Community Health Center, Child Care Center, and Tertiary Care Hospital in Urban Ajmer

Aim: The aim of this study was to determine food intake, the level of knowledge of oral diseases, practices regarding oral hygiene, and self-reported oral problems among pregnant and non-pregnant women attending community health center, child care center, and tertiary care hospital in urban Ajmer. Materials and Methods: This was a quantitative, questionnaire-based, and cross-sectional study, in which 300 respondents of 20–35 years of age. Data were analyzed using the Statistical Package for the Social Sciences. Results: Participants in the knowledge of oral diseases were 26% gingivitis signs including gum swelling (5.7%) and bleeding (9.7%). Of all the participants, 21.3% practiced tooth brushing twice/day, 65.7% used toothpowder, and dental floss (17.7). Self-reported oral problems included reddish gums (8%), painful gums (10.7%), burning mouth (15.7%), dry mouth (28%), and bad breath (7%). Conclusion: Majority of women studied no basic knowledge of oral diseases and only few knew the causes. All respondents performed tooth cleaning however, majority did not know the appropriate practices, and only few had oral problems. Integration of oral health care to general health promotion and oral therapy given to pregnant women at high risk is recommended to prevent adverse pregnancy outcomes.

Barriers and Facilitators to integrate Oral Health care for Older Adults in General (Basic) Care in East Netherlands. Part 2 Functional Integration.

Objectiveto synthesise a framework of barriers and facilitators in the functional integration of oral health care (OHC) into general health care for frail older adults at macro (system), meso (organisation and interprofessional integration) and micro (clinical practice) levels.BackgroundIdentification of these barriers and facilitators is expected to promote better and more appropriate care.MethodsFor this qualitative study, comprising 41 participants, representatives of 10 different groups of (professional) care providers, and OHC receivers (home‐dwelling and nursing‐home patients) were interviewed. Transcripts of the in‐depth, topic‐guided interviews were thematically analysed. In a subsequent workshop with 52 stakeholders, results and interpretations were discussed and refined.ResultsTwo themes were identified: (1) compartmentalised care systems and (2) poor interprofessional and communication infrastructure. Barriers related to (1) included lack of integrative policies and compartmentalised healthcare education (macro level); poor embedding of OHC in care procedures, instruments and guidelines (meso level); and poor interprofessional skills (micro level). Barriers related to (2) included poor financial incentives for collaborative practices (macro level) and badly connected ICT systems (meso level). Identified facilitators included integration of an OHC professional into care teams, and interdisciplinary consultations (meso level); and integration of OHC in individual care plans (micro level).ConclusionIn The Netherlands, OHC for older people is at best poorly integrated into general care practices. Barriers and facilitators are interconnected across macro‐, meso‐ and micro levels and between normative and functional domains and are mainly related to compartmentalisation at all levels and to poor interprofessional and communication infrastructure.

Barriers and facilitators to integrate oral health care for older adults in general (basic) care in East Netherlands. Part 1: Normative integration.

to synthesise a framework of barriers and facilitators in the normative integration of oral health care (OHC) into general health care for frail older adults at macro (system), meso (organisation and interprofessional integration) and micro (clinical practice) levels. Identification of these barriers and facilitators is expected to promote better and more appropriate care. For this qualitative study, comprising 41 participants, representatives of 10 different groups of (professional) care providers, and OHC receivers (home-dwelling, and nursing home patients) in East Netherlands were interviewed. Transcripts of the in-depth, topic-guided interviews were thematically analysed. In a subsequent workshop with 52 stakeholders, results and interpretations were discussed and refined. Two main themes were identified: (1) a compartmentalised care culture in which OHC and general health care are seen as two separate realms, and (2) prioritisation, awareness and attitude regarding OHC integration. Subthemes such as low political attention (macro level); unclear responsibilities, hierarchical relations and the lack of vision of organisations (meso level); and poor awareness and low prioritisation by care providers and patients (micro level) were identified as potential barriers. Subthemes such as leadership (meso level), and the supportive personality of individual caregivers and ownership of patients (micro level) were identified as facilitators. Barriers and facilitators in normative OHC integration in The Netherlands are interrelated and apparent at macro-, meso- and micro levels. They are mainly related to (a) a compartmentalised care culture, and (b) related low prioritisation, and poor awareness of and attitude towards (integration of) oral health (care).

Two-eyed seeing of the integration of oral health in primary health care in Indigenous populations: a scoping review

BackgroundIndigenous people experience significant poor oral health outcomes and poorer access to oral health care in comparison to the general population. The integration of oral health care with primary health care has been highlighted to be effective in addressing these oral health disparities. Scoping studies are an increasingly popular approach to reviewing health research evidence. Two-eyed seeing is an approach for both Western and Indigenous knowledge to come together to aid understanding and solve problems. Thus, the two-eyed seeing theoretical framework advocates viewing the world with one eye focused on Indigenous knowledge and the other eye on Western knowledge. This scoping review was conducted to systematically map the available integrated primary oral health care programs and their outcomes in these communities using the two-eyed seeing concept.MethodsThis scoping review followed Arksey and O’Malley’s five-stage framework and its methodological advancement by Levac et al. A literature search with defined eligibility criteria was performed via several electronic databases, non-indexed Indigenous journals, Indigenous health organizational websites, and grey literature. The charted data was classified, analyzed, and reported using numeral summary and qualitative content analysis. The two-eyed seeing concept guided the interpretation and synthesis of the evidence on approaches and outcomes.ResultsA total of 29 publications describing 30 programs conducted in Australia and North America from 1972 to 2019 were included in the final analysis. The following four program categories emerged from the analysis: oral health promotion and prevention programs (n = 13), comprehensive dental services (n = 13), fly in, fly out dental services (n = 3), and teledentistry (n = 1). Biomedical approaches for integrated primary oral health care were leadership and governance, administration and funding, capacity building, infrastructure and technology, team work, and evidence-based practice. Indigenous approaches included the vision for holistic health, culturally appropriate services, community engagement, shared responsibility, and cultural safety. The program outcomes were identified for biological, mental, and emotional dimensions of oral health; however, measurement of the spiritual dimension was missing.ConclusionOur results suggest that a multiple integrated primary oral health care approach with a particular focus on Indigenous culture seems to be efficient and relevant in improving Indigenous oral health.

Anthropological perspectives on Miyupimaatisiiun and the integration of oral health in primary care in the Cree communities of Northern Quebec.

The integration of primary oral health care has a pivotal role in improving oral health outcomes and providing accessible and affordable health care. This article contributes to the deep understanding of the cultural aspects of the integration of oral health into primary health care at an Indigenous health organization. Proceeding from a collaborative and interdisciplinary research project evaluating the integration of oral health care within primary care in Eeyou Istchee, this research is based on group discussions (6) and individual interviews (36) with 74 participants (care providers, administrators, and patients) held in four Eastern James Bay Cree communities. This study anthropologically explored participants' perceptions about primary health care conceptualizations, culturally based approaches, and experiences of oral care services at this organization using a "two-eyed seeing" Indigenous framework. The study identified three key factors related to the integration of primary oral health care: Cree perception of primary health and oral health care, cultural safety, and health provider-patient communication and the role of silence. Study findings reflected a dichotomy of perception of primary health care and the relevant units of care between the Cree structural and cultural perspective and the non-Cree professional perspective. The Cree people perceived "household" as a unit of care in comparison to non-Cree who viewed "health care services" as units of care. Our results also underline the role of cultural safety agents to address the needs for cultural competence and the role of silence as implicit cultural protocol. Our anthropological analysis illustrates the potential for increasing the level of appreciation for both users and workers in oral care in the future by ameliorating communication skills and intercultural knowledge.

Primary oral health care in Nigeria; four decades after the Alma Ata declaration

It´s over 4 decades since the Alma-Ata declaration of comprehensive health care for all by a congregation of leaders from 67 nations across the world. Though this step was revolutionary, Primary Oral Health Care delivery is still lacking in many Primary Health Centres in Nigeria. The delivery of essential health services in the country has undergone many transitions. From a spread in just 52 local governments areas in the 80s to a ward system coverage in all the 774 local governments with over 30,000 facilities by the 90s. Despite this progress, only 20% of these facilities are functional and the delivery of primary oral health care in these centres is grossly limited. State governments have thus been encouraged to seize ownership and expand health care delivery. The burden of oral diseases remains high and has been linked with systemic conditions like diabetes, HIV and even delayed gravidity. The integration of oral health care with existing primary health care has been challenged by the limited number of human resources especially available at the rural communities. Poor funding has also hindered oral health care delivery because of the specialized nature of oral care. The National Oral Health Policy issued in 2012 stipulates the need for the integration of oral health services but lacked proper implementation guidelines and a revised edition is expected in 2020. Experts have advocated the need to have a higher proportion of dental auxiliaries to complement the demand for human resource for dental care delivery. Similarly, encouraging task-shifting at the grassroots will also provide an efficient route to expanding the coverage for oral health care in the Nigerian population. Finally, the goal of universal health coverage in Nigeria can be better served by prioritizing Primary oral health Care and full implementation of the National Oral Health Policy in Nigeria.

Integrating Oral health care as a part of a comprehensive risk reduction strategy for combating the burden of Non communicable diseases in developing countries

The prevention and control of non communicable disease is largelydependent upon the identification of the associated risk actors and theirmodification elimination. Only a few listed factors have been successfullyidentified and targeted as the focus to combat the disease burden. However,still there exists many unidentified lesser known factors which maycontribute to non communicable diseases by enhancing systemic state ofinflammation. A whole new concept of the status of the oral cavity and itsimpact on systemic health and disease has emerged in the recent past.Periodontal disease has been implicated as a risk factor for several systemicconditions like cardiovascular diseases, diabetes mellitus, adverse pregnancyoutcomes, obesity and stroke etc. This article intends to focus on this lesserknown associations of significant impact, in reference to non communicabledisease burden in developing countries and calls for integration of oralhealth care in overall health policy, a closer collaboration and cross-discipline education between oral health professionals and the medicalprofessionals.Key words: Non Communicable Disease, Risk Factor, , Periodontal Disease,Oral Health Care, Developing Countries

How primary health care teams perceive the integration of oral health care into their practice: A qualitative study.

Recently, new models for the integration of oral health into primary care have been proposed. However, these models may be adopted by a variety of health care systems, and will reach successful outcomes only if they can be adapted to suit the local context. To this end, the objective of this study was to explore the perceptions of Quebec primary health care teams on the integration of oral health into primary care. A qualitative approach and interpretive description methodology were used to conduct the study within a case-study design. Purposeful sampling with maximum variation and snowball technique were used for recruitment of study participants. Seventy-four in-depth, semi-structured interviews and five focus groups were conducted with primary health care teams including health care providers and managers working in a rural and an urban health care center. The interview guide and study conceptual framework were based on the Rainbow model. Data collection and data analyses were conducted concurrently and continued until saturation was achieved. To analyze the data, four phases of qualitative analysis were followed. The thematic analysis included interview debriefing, transcript coding, data display, and interpretation. Data analysis was conducted both manually and with the use of Atlas-ti software. A total of four themes emerged from the interviews and focus group discussions. These themes covered all domains of the study theoretical model and included: 1) drivers of integration; 2) importance of integration; 3) professionals’ role in integrated care; and 4) barriers and enablers of integration. In general, most of the barriers expressed by study participants were related to the organizational and system domains of integration. Primary health care teams who provide care in rural and urban areas in Quebec expressed their concerns on the absence of integrated oral health services. Implementation of governance policies, the prioritization of educational and management measures as well as inter-professional collaboration toward innovative care models could facilitate this integration.

Access to preventive services after the integration of oral health care into early childhood education and medical care

BackgroundThe effect of Early Head Start (EHS) on receipt of preventive oral health services (POHS) from both oral and medical health care providers is not known. MethodsThe authors compared children enrolled in North Carolina EHS programs with similar children enrolled in Medicaid but not EHS on the use of POHS. They analyzed 4 dependent variables (oral assessment by medical health care provider, oral assessment by oral health care provider, fluoride application by medical health care provider, fluoride application by oral health care provider) by using multivariate logistic regression that controlled for covariates. ResultsPrimary caregivers of children enrolled in EHS (n = 479) and Medicaid (n = 699) were interviewed when children were approximately 10 and 36 months of age. An average of 81% of EHS and non-EHS children received POHS from an oral or medical health care provider at follow-up. EHS children had greater odds of receiving an oral health assessment (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.74 to 3.13) and fluoride (OR, 1.53; 95% CI, 1.16 to 2.03) from an oral health care provider than children not enrolled. EHS children had decreased odds (OR, 0.73; 95% CI, 0.54 to 0.99) of receiving fluoride from a medical health care provider. ConclusionsBoth children enrolled in EHS and community control participants had high rates of POHS, but the source of services differed. EHS children had greater odds of receiving POHS from oral health care providers than non-EHS children. EHS and non-EHS children had equal rates for fluoride overall because of the greater percentage of non-EHS children with medical fluoride visits. Practical ImplicationsThe integration of POHS in early education and Medicaid medical benefits combined with existing dental resources in the community greatly improves access to POHS.

Gaps in oral health-care service provision systems for children in Nigeria: A case study of a tertiary health institution.

The study investigated the common dental conditions of children seen in a Nigerian tertiary hospital. The referral patterns were also determined to know how many of the patients had sought care at the lower levels of health before visiting a tertiary hospital. All the children aged 0-15 years seen at the Dental hospital, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria over a 4-year period were included in the study. Information retrieved from their case notes including patterns of referral, presenting complaints, diagnosis, and treatment were extracted from the case records of the patients. Treatment plans for patients seen at this tertiary hospital were categorized into primary, secondary, and tertiary health-care services. A total of 1,866 children sought treatment over a 4-year period at this tertiary hospital of which 1715 (91.9%) sought treatment without referral from lower levels of care. Only 102 (5.4%) children were referred from primary health care (PHC) centers. Six hundred and seventy-five (36.2%) children presented with pain while 502 (26.9%) attended for a "check-up." Furthermore, 779 (41.8%) children were diagnosed with periodontal disease (including gingivitis) and 539 (28.9%) with dental caries. Scaling and polishing with oral hygiene instruction was the most common treatment recommended. Only 5% of children seen at this tertiary health facility required specialized oral health-care services provided by tertiary health institutions. The range of oral health care needed and service provided by and for patients who visited this tertiary health-care institution can be effectively provided in a primary or secondary oral health-care delivery center. The poor integration of oral health care into PHC services in Osun State burdens the tertiary health-care institutions to provide nonspecialized oral health-care services.

"It was pain. That's it. It was pain." Lack of oral health care among otherwise healthy young adults living with HIV in South Africa: A qualitative study.

IntroductionThe purpose of this study is to understand engagement with and availability of dental services among people living with HIV in a low-income community of South Africa.MethodsIn depth qualitative interviewing was used to collect data, which was analyzed using an inductive content analytical approach. The study was conducted in Gugulethu, a township community located outside of Cape Town, South Africa. Local public sector health services provided free of charge are the main source of primary health and dental care for this population. Participants included South African adults (age 18–35) recently diagnosed with HIV who had a CD4 count >350 cells/mm3.ResultsMany participants had little to no experience with dental care, did not know which health care providers are appropriate to address oral health concerns, were not aware of available dental services, utilized home remedies to treat oral health problems, harbored many misperceptions of dental care, avoided dental services due to fear, and experienced poverty as a barrier to dental services.ConclusionsOur findings suggest that integration of oral healthcare into medical care may increase patient knowledge about oral health and access to care. Leveraging the relatively robust HIV infrastructure to address oral disease may also be an effective approach to reaching these participants and those living in resource poor communities generally.

Integration of oral health into primary care: a scoping review protocol

IntroductionIntegrated care has been introduced as a means of improving health outcomes and access to care, and reducing the cost of healthcare. Despite its importance, the integration of oral health...

Effectiveness of oral health education among primary health care workers at the primary health center in Nellore district, Andhra Pradesh

Background: Primary dental care can be a way of achieving good oral health for the community. This can be achieved by integration of oral health care with the existing primary health care activities through training of primary health care workers on aspects of oral health. Objective: To assess the effectiveness of oral health education among primary health care workers at the primary health center (PHC) in Nellore district, Andhra Pradesh. Materials and Methods: Descriptive longitudinal study was conducted from June 2010 to August 2010 at a PHC. Knowledge about oral health among primary health care workers was pretested using a self-administered questionnaire prepared in local language (Telugu). Later after a month health education was provided to the health workers, and pamphlets with information on oral health were distributed. Posttest assessment was done 1-month after providing health education using the same questionnaire. Statistical analysis was performed using the SPSS 12.0 software, Student's t-test was used to compare knowledge scores between pre and posttests. Results: A total of 118 Primary Health Care Workers with the majority in the 20-30 years age group participated in the study. Posttest assessment showed a change in knowledge level with an overall increase in knowledge level of primary health care workers with a mean difference of 12.56 ± 3.23, which was highly significant (P < 0.001). Conclusion: The knowledge about oral health was poor, and it improved after providing health education to primary health care workers. Change in knowledge was appreciable and may play a key role in oral health promotion of the vast majority of the rural population.

The integration of oral health care into day‐to‐day care in nursing homes: a qualitative study

This qualitative study explored barriers and enabling factors to the implementation of an oral hygiene protocol in nursing homes. Oral health care in nursing homes in Flanders (Belgium) is inadequate. Qualitative data were obtained from nurses employed in 13 nursing homes involved in two randomised controlled trials in Flanders-Belgium. Data were collected by focus group and face-to-face interviews during April 2005 and December 2009. All transcripts were analysed with support of NVivo 8 (Version 2008). Transcripts were intuitively analysed in a two-step method. Most revealed barriers were consistent with previous findings in the literature. Newly reported barriers were respect for residents' self-determination, experience based oral health care by nurses, residents' oral health status and nurses' inability to notice residents' oral health status. Demand-driven oral health care was found to be a strong enabling factor. The integration of oral health care into day-to-day care seems to be a major problem due to a multitude of barriers. In future implementation innovations in oral health care an a priori assessment of influencing factors is recommended.

Integration of oral health care into geriatric primary care: proposal for collaboration

Integration of oral health care into geriatric primary care: proposal for collaboration

Financing national policy on oral health in Brazil in the context of the Unified Health System

This article discusses the model of oral health care implemented in the Unified Health System of Brazil in the last decade. This model was conceived as a sub-sector policy that, over the years, has sought to improve the quality of life of the Brazilian population. Through a chronological line, the study presents the National Policy on Oral Health as a counter-hegemonic patient care model for the dentistry practices existing in the country before this policy was implemented. The reorganization of the levels of oral health care, the creation of reference facilities for secondary and tertiary care, through Centers of Dental Specialties and Regional Dental Prosthesis Laboratories, and the differential funding and decentralized management of financial resources were able to expand the actions of oral health for more than 90 million inhabitants. The evolution shown after the deployment of the National Oral Health Policy, as of 2004, demonstrates the greater integration of oral health care under the Unified Health System and provides feedback information to help this policy to continue to be prioritized by the Federal Government and receive more support from the state and local levels in the coming years.

Disaster medicine training survey results for dental health care providers in Illinois

Ongoing vigilance by governments, public health agencies and health care professionals monitoring potential epidemic and pandemic outbreaks, terrorist threats and ever-present natural disasters requires the continuous evolution of comprehensive disaster response plans and teams, which include the integration of oral health care professionals. The authors conducted a study in which oral health care professionals assessed their training in the American Medical Association's (AMA's) National Disaster Life Support (NDLS) courses. At the conclusion of each instructional session, the authors asked participants to complete an anonymous course evaluation form to report their impressions of the training activity. The authors included in the analysis those evaluations associated with sessions attended almost exclusively by dentists and hygienists. The authors derived descriptive statistics from the selected course evaluations. Overall, oral health care professionals believed that the Core Disaster Life Support (CDLS) and Basic Disaster Life Support (BDLS) courses were of great educational value, rating course impact at 9.50 and 9.29, respectively, on a scale from 1 to 10. Statistical evaluation instruments reveal satisfaction with the all-hazards awareness training received through the AMA's NDLS disaster medicine training curriculum. Licensed oral health care professionals in Illinois accepted the utility and merits of, and benefited from, the four-hour CDLS and eight-hour BDLS certification programs. Practice Implications. Dental professionals in Illinois require minimal additional training for dental emergency responder duties. The AMA's NDLS curriculum provides effective preparation for dental professionals.