Non-dental Health Professionals Research Articles

The Effectiveness of Oral Health Education Among Non-dental Healthcare Professionals in Jeddah, Saudi Arabia: A Quasi-experimental Study.

The purpose of the study was to evaluate the level of oral health knowledge and practices among non-dental health professionals and to evaluate the effectiveness of oral health education provided to them. A convenience sample was recruited from non-dental healthcare professionals in Jeddah, Saudi Arabia. A self-administered questionnaire was distributed to participants to evaluate their oral health knowledge and behavior. Then, oral health educational material (a video) that was specifically developed for the study was sent to all participants to educate them about some oral health information related to adult oral health, oral signs of some systemic diseases, and the oral side effects of some medications. Two weeks later, the same questionnaire was sent to these participants to assess the effectiveness of the oral health education provided to them. The pre-intervention questionnaire results revealed a lack of oral health knowledge and inadequate oral health practices among the participants. After the intervention, the level of knowledge improved significantly from 6.4±2.2 to 10.4±3.8 out of 16 (p <0.001). The oral health education intervention used in the current study was effective in improving oral health knowledge among non-dental healthcare professionals.

Oral health and individuals with a lived experience of an eating disorder: a qualitative study

BackgroundLimited evidence exists describing the impact to oral health when living with an eating disorder and the availability of information or access to oral health services. This study investigated the perceptions of individuals with a lived experience of an eating disorder specifically to understand their needs and recommendations for improving access to early intervention and oral health promotion.MethodsUsing purposive sampling a total of 12 semi-structured interviews were conducted with participants across Australia who had a lived experience of an eating disorder. A hybrid inductive and deductive approach to thematic analysis was used to construct salient themes and subthemes.ResultsMost participants had experienced some oral health manifestation as part of their eating disorder hence, many felt quite knowledgeable on the topic. Following their eating disorder many participants felt confident in engaging with dental services, although, barriers including embarrassment, shame, and cost compromised access at times. Participants felt strongly that greater emphasis on oral health promotion during an eating disorder was important and this may be achieved by increasing the availability of resources and using trusted non-dental health professionals like dietitians.ConclusionsThe need for oral health promotion while experiencing an eating disorder was evident, however, dentists can often be a costly option. Non-dental health professionals like dietitians working with clients with an eating disorder may be an acceptable alternative for closing this gap.

Health professionals delivering oral health interventions in early childhood: A scoping review of Australian and New Zealand literature.

Dental caries is highly prevalent in very young Australian and New Zealand children. Health professionals other than registered dental professionals can help prevent early childhood caries, promoting oral health to assist families establish preventative oral health habits at a child's early age. This review identifies oral health promotion (OHP) delivered by nondental health professionals in Australia and New Zealand involving very young children. Databases (MEDLINE, CINAHL, Embase, Emcare, Web of Science, Scopus, ProQuest, Google Scholar, TROVE) and digital libraries were searched between 2001 and 2021 for eligible studies and grey literature. Studies with a focus on preventative oral health strategies in a primary health care context were included. The review identified 76 studies. Seven met the inclusion criteria, and were conducted in Australia across metropolitan, rural, and remote settings. Studies that successfully engaged nondental health professionals to promote oral health to families reported a positive change in oral health practices among very young children. Delivering OHP during a child's early life stage positively influenced their oral health outcomes. Integration of dental and primary health care increased access to oral health care and advanced positive oral health outcomes for children. With adequate training, resources, and support mechanisms, nondental health professionals can deliver oral health strategies that facilitate behaviour change in parents to improve children's oral health. So What? Health promotion generates enabling conditions that support and empower families to improve and maintain their oral health. Nondental health professionals can play a crucial role promoting oral health for very young children and improving equitable access to preventative oral health care.

Education/Training Interventions to Improve Oral Health of Adults with Intellectual Disability.

People with intellectual disability have poorer oral health outcomes and experience greater difficulties accessing dental services than the rest of the community. Interdisciplinary educational programs for those involved in oral health decision making for people with intellectual disability aim to improve their oral health. This scoping review explored education/training interventions related to the oral health of adults with intellectual disability. Interventions targeted dental health and non-dental health professionals, adults with intellectual disability, and their paid and unpaid supporters. Six electronic databases were searched using PRISMA guidelines and the Crowes critical appraisal tool. The search strategy, plus the application of the inclusion and exclusion criteria, presented in the body of the manuscript, led to the selection of 20 papers for inclusion into this review. The quality of undergraduate tuition relating to disability was reported to be poor, but students and dental health professionals expressed interest in expanding their knowledge in this area. Disability-support workers and primary carers of people with intellectual disability reported improved knowledge and attitude, but the oral health status of the people they supported was not impacted. No research was found that explored the perspectives of non-dental health professionals. Oral health training/education contributes to systemic barriers in general health, wellbeing, and social inclusion of people with intellectual disability. Revision of disability-related programs in general dentistry courses and longitudinal impact research is needed.

Methods for prevention of early childhood caries: Overview of systematic reviews.

Early childhood caries (ECC) is a global problem, disproportionately affecting disadvantaged populations. The aim of this study was to evaluate systematically the available scientific evidence on the effectiveness of methods for ECC prevention. Six electronic databases were searched. Two independent reviewers selected the publications and analysed the quality of the included systematic reviews. Thirteen studies were included. Overall, eight reviews were classified with methodological quality critically low using the AMSTAR 2, whereas five reviews achieved a high risk of bias using the ROBIS tool. The methods identified that were positively related to the prevention of ECC were as follows: preventive dental programmes for pregnant women; advice on diet and feeding; prenatal oral health care; integration of maternal and children's oral health promotion into nursing practice; maternal oral health programmes undertaken by non-dental health professionals; dental health education in combination with the use of fluoride for children; early preventive dental visits; and the use of fluoride varnish and toothpastes with more than 1000ppm of fluoride. The currently available evidence supporting the effectiveness of methods for prevention of ECC, although suggesting some methods of greater potential, is still lacking due to the methodological quality of the systematic reviews and the included primary studies.

Early childhood caries prevention: non-dental health professionals' viewpoint.

Dental caries can develop early in life and have harmful consequences. Objective: To examine non-dental practitioners' knowledge of early childhood caries (ECC). A questionnaire on oral health and caries knowledge was emailed to five types of health professional who work with young children: paediatricians, GPs, midwives, paediatric nurses and paediatric healthcare assistants. Questions concerned: when a child should first visit a dentist; at what age toothbrushing should start; aetiopathogenic factors; early diagnosis; and the effect of breastfeeding. 494 health professionals (79 paediatricians, 59 physicians, 217 midwives, 92 paediatric nurses and 47 paediatric healthcare assistants) participated. Although most (89.86%) discussed oral health with parents, responses on when a child should first see a dentist and when toothbrushing should start varied. Almost half of respondents said they could diagnose caries but not all were confident in this. Aetiological factors in ECC mentioned included oral hygiene, bottle feeding, sugar intake, genetics and a lack of fluoride. Non-dental practitioners lack knowledge about ECC, so cannot help prevent it. Initiatives including interprofessional training would improve their knowledge of oral health in early childhood.

Effectiveness of preventive dental programs offered to mothers by non-dental professionals to control early childhood dental caries: a review

BackgroundEarly childhood caries is a common chronic childhood disease and maternal oral health is a risk factor. Improving the oral health behaviours of pregnant women/young mothers can positively influence the oral health of children and reduce their caries risk. Such preventative strategies have been undertaken by non-dental professionals producing mixed results encompassing various interventions across the perinatal period. However, no comprehensive review of these studies has been undertaken. The aim of this review was to assess the effectiveness of maternal oral health programs undertaken during the antenatal and/or postnatal period by non-dental health professionals to reduce early childhood caries.MethodsA systematic search of five databases was undertaken using key search terms. Studies were included if they (a) involved quantitative study designs with a control; (b) were published in English; (c) reported on interventions delivered by non-dental professionals (d) delivered the intervention to expectant mothers or mothers with young infants up to 24 months; (e) measured outcomes when the child was under 5 years; (f) measured changes in oral health outcomes of children clinically and oral health behaviours of mothers or children. No restrictions were placed on the study quality and setting.ResultsNine studies met the inclusion criteria and involved interventions delivered by diverse non-dental professionals across the antenatal (n = 1), postnatal (n = 6) and perinatal period (n = 2). Most studies were of low methodological quality (n = 6). The interventions focussed on oral health education (n = 8), dental referrals (n = 3) and oral health assessments (n = 1). Interventions conducted in either the postnatal or antenatal periods showed meaningful improvements in children’s clinical and mother’s behavioural oral health outcomes. The outcomes appear to be sustained when a suite of interventions were used along with referral reminders. There were mixed results from interventions across the perinatal period.ConclusionsNon-dental professionals can promote maternal oral health by providing oral health education, risk assessment and referrals. Combining these interventions could provide a sustained improvement in oral health outcomes for children although current evidence is weak. More high-quality studies are needed to confirm these findings and determine whether the antenatal and/or postnatal period is best suited to deliver these interventions.

Screening for periodontal diseases by non-dental health professionals: a protocol for a systematic review and overview of reviews

BackgroundPeriodontal diseases are responsible for a vast burden of disease globally and are associated with other severe illnesses such as cardiovascular diseases or diabetes. Tests for early diagnosis of periodontal diseases and effective treatments are available. The effectiveness of screening for periodontal diseases to detect periodontal diseases at an early stage during periodic health examinations at primary care facilities, however, is unclear. The objective of this systematic review is to assess the benefits and risks of screening for periodontal diseases in adults during the periodic health examinations.MethodsWe will use two methodological approaches: (1) a systematic review to assess the effectiveness and risk of harms of screening for periodontal diseases during periodic health examinations and (2) an overview of systematic reviews to determine the effectiveness of treatment approaches for early periodontal disease. We will search electronic databases (Ovid MEDLINE, Embase.com, the Cochrane Library, Epistemonikos, Centre for Reviews and Dissemination databases, PubMed (non-MEDLINE content)) for published studies as well as sources for grey literature to detect unpublished studies. Two authors will independently screen abstracts and full texts using pre-defined eligibility criteria, select studies, extract data, and assess the risk of bias of included studies or reviews. In general, we will conduct a systematic narrative synthesis. Criteria for conducting meta-analyses were defined a priori. Our primary outcomes of interest are tooth loss, loosening of teeth, and depletion of bone tissue. Secondary outcomes are gingivitis/gum inflammation, pocket depths, dental hygiene, lifestyle modifications (e.g., smoking, alcohol, nutrition), and toothache. We consulted a panel of experts and patient representatives to prioritize these outcomes. Two investigators will assess independently the certainty of the evidence for each outcome using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.DiscussionWe anticipate that our review will highlight the gaps in the available evidence about the effectiveness of screening for periodontal diseases during periodic health examinations. Implications for screening programs may be based on linked evidence about the validity of available screening tools and the effectiveness of early treatment.Systematic review registrationPROSPERO CRD42017081150

Oral hygiene status and dental awareness of non – dental health professionals in Aminu Kano Teaching Hospital, Kano State, Nigeria

Background and Aims: The oral hygiene status of individuals may be a strong indication of the extent of their dental awareness. The level of awareness can make a great difference in the quality of oral health care that can be rendered to patients. The aim of this study is to evaluate the oral hygiene status and dental awareness of non-dental health professionals in Aminu Kano Teaching Hospital, Kano State, Nigeria. Methodology: A total of 425 participants selected by multistage sampling technique fulfilled the inclusion criteria for this study. They included 238 males and 187 females. Each respondent completed an informed consent sheet and a modified questionnaire on dental awareness. They were examined immediately after to assess oral hygiene status using the Simplified Oral Hygiene index by Greene and Vermillion (1964). Results: Majority of study participants displayed moderate dental awareness. Dental awareness was categorized as poor, low, moderate, high and excellent using a researcher's analysis index. 56.5% displayed moderate awareness. Using the simplified oral hygiene index by Greene and Vermillion (1964), 60.94% were found to have fair oral hygiene. A strong statistically significant difference was observed in dental awareness among the professional specialties and ethnic groups. A very strong statistically significant difference was seen in the oral hygiene status. Conclusion: The dental awareness of the cadre of health professionals included in this research is considered unsatisfactory while the oral hygiene status of majority of the respondents needs improvement. These findings will therefore necessitate interventions to upgrade their awareness level and oral hygiene.

The role of indigenous health workers in promoting oral health during pregnancy: a scoping review

BackgroundEarly childhood caries is the most common chronic childhood disease worldwide. Australian Aboriginal and Torres Strait Islander children are twice more likely to develop dental decay, and contributing factors include poor maternal oral health and underutilisation of dental services. Globally, Indigenous health workers are in a unique position to deliver culturally competent oral healthcare because they have a contextual understanding of the needs of the community.MethodsThis scoping review aimed to identify the role of Indigenous health workers in promoting maternal oral health globally. A systematic search was undertaken of six electronic databases for relevant published literature and grey literature, and expanded to include non-dental health professionals and other Indigenous populations across the lifespan when limited studies were identified.ResultsTwenty-two papers met the inclusion criteria, focussing on the role of Indigenous health workers in maternal oral healthcare, types of oral health training programs and screening tools to evaluate program effectiveness. There was a paucity of peer-reviewed evidence on the role of Indigenous health workers in promoting maternal oral health, with most studies focusing on other non-dental health professionals. Nevertheless, there were reports of Indigenous health workers supporting oral health in early childhood. Although some oral health screening tools and training programs were identified for non-dental health professionals during the antenatal period, no specific screening tool has been developed for use by Indigenous health workers.ConclusionsWhile the role of health workers from Indigenous communities in promoting maternal oral health is yet to be clearly defined, they have the potential to play a crucial role in ‘driving’ screening and education of maternal oral health especially when there is adequate organisational support, warranting further research.

Knowledge and Opinions Regarding the Interface between Oral and Overall Health among California Physicians, Dentists, Pharmacists and Advanced Practice Registered Nurse Practitioners

Background and Purpose: Oral health is often related to other medical conditions. This study investigated the knowledge and opinions of California physicians, dentists, pharmacists, and advanced practice registered nurses (APRNs) regarding the interface between oral and overall health and their suggestions for strengthening this interface. Methods: A survey packet was mailed to randomly-selected California healthcare providers in Winter 2015. Twenty five-point Likert-type questions were used to measure the providers’ knowledge and opinions of the oral and overall health interface. Results: Sixtytwo physicians, 117 dentists, 136 pharmacists, and 289 Advanced Practice Registered Nurses (APRNs) responded (total N= 604). A majority of all health professionals agreed/strongly agreed that oral health topics received little attention in the education of non-dental health professionals (n=499, 82.6%), and that the dental discipline remains relatively segregated from other healthcare disciplines (n=500, 82.8%). Dentists and APRNs were more likely to agree/agree strongly that the inadvertent prescribing of medications that can have xerostomic effects without considering their oral health implications is a major problem. Conclusion: There is a need for more inter-professional collaboration by all primary care providers in managing the patients’ oral and overall health, as well as more oral health education and training for all non-dental health professionals.

Knowledge and practices of diabetes care providers in oral health care and their potential role in oral health promotion: A scoping review.

Oral health complications are common in people with diabetes yet very little is reported about the oral health care provided in diabetes care setting. This study reviewed global evidence on the oral health care knowledge and practices of diabetes care providers and the role of non-dental health professionals in oral health promotion. A systematic search of five databases was undertaken with key search terms using a scoping review framework. Relevant studies published till October 2016 in the English language were included (n=30) and no restrictions were placed on the study design, quality or setting. Most diabetes care providers are not addressing oral health care with the main barriers being time constraints and limited oral health knowledge. Diabetes educators (DEs) could engage in oral health promotion with few studies showing this model of care can translate into improved patient outcomes. However, no appropriate oral health training programs and assessment tools exist for DEs. With proper training, non-dental professionals like nurses have successfully incorporated oral healthcare in other settings. DEs are well placed to promote oral health in diabetes care setting. Further research is needed to identify barriers and oral health resources to support DEs in this role.

The Aetna-NDA Partnership for Achieving Racial and Ethnic Health Equity.

The author discusses the Racial and Ethnic Health Care Equity Project, a partnership between Aetna insurance company and the National Dental Association (NDA) to educate non-dental health professionals about the importance of oral health and to create opportunities for medical and dental clinicians to interact with one another in an effort to address oral health disparities in the U.S.

'Oral health has become a priority for dietitians'

What do non-dental health professionals advise patients when it comes to the oral cavity? Laura Pacey spoke to dietitian Aisling Pigott.

Breaking down the barriers: a qualitative study to understand child oral health in refugee and migrant communities in Australia

Objective. Australia is an increasingly multicultural nation. Never before has the dental workforce been exposed to such language, cultural, religious and ethnic diversity. There is evidence that refugee and migrant children experience significantly poorer oral health than the nonmigrant population. However, little is known about the oral health knowledge, practices and beliefs of parents with young children from refugee and migrant backgrounds. The aim of this study was to identify the sociocultural influences on child oral health in these communities.Design. Participatory and qualitative research methods were utilised. Partnerships were established with community agencies representing migrants from Iraq, Lebanon and Pakistan. Focus group discussions and semi-structured interviews were conducted with community members. Qualitative data were analysed thematically, combining focus group and interview data.Results. Over 100 women participated in focus groups (n = 11) and semi-structured interviews (n = 7). Key findings included the knowledge, beliefs and practices concerning: caries risk factors, oral health practices and oral health literacy. Despite mothers' knowledge of the major causes of poor oral health – dietary changes, confusion about child oral hygiene practices and limited oral health literacy all influenced child oral health outcomes.Conclusion. This culturally competent qualitative study explores the sociocultural factors influencing child oral health in refugee and migrant communities. Understanding and acknowledging these factors are a prerequisite to determining where and how to intervene to improve oral health. Furthermore, it has implications for both dental and non-dental health professionals working to reduce health inequalities within such communities.

Turning Australia into a ‘flat-land’: What are the implications for workforce supply of addressing the disparity in rural–city dentist distribution?

Dentistry in Australia has faced, and continues to face, significant workforce issues, in particular, a grossly distorted workforce distribution. In this study, an analysis of the consequences for the workforce that would occur under a series of reduced maldistribution scenarios is examined and reported. Three different scenarios were tested based on existing dental practice to population data at a national level. This study clearly highlights the very significant maldistribution of practices in Australia. However, more importantly, it highlights that to address this maldistribution requires something in the order of a tenfold increase in dental practice numbers (and the commensurate increase in workforce), which is not possible (or reasonable). As a nation, Australia has to look to other methods of achieving equity in access to good oral health. The application of modes of care delivery including, but not limited to visiting services needs to be examined and extended. Clearly, these new methodologies are going to rely on non-dental health professionals taking a far more significant role in leading oral health-care models as well as the expanded application of technology to bring unique skill bases to areas where these skilled individuals do not (and will not) reside.

'We're still seeing children have a full clearance'

What do non-dental health professionals advise patients when it comes to the oral cavity? Laura Pacey spoke to school nurse Jacqueline Ombler.

Oral health referral trigger tools for people living with HIV

This study validated and compared two different Oral Health Referral Trigger Tools in the form of brief (3-item and 5-item) questionnaires designed to identify people living with HIV (PLHIV) with symptoms of oral disease requiring a dental referral from other health professionals. It was composed of a self-completed questionnaire and oral screen by a dentist of a convenience sample selected from PLHIV attending two outpatient clinics for routine nondental care for HIV infection. The dental exam was completed by a single dentist at a third location. The one hundred participants were HIV positive, predominantly male and of Caucasian origin with a mean age of 45.6 years. Both referral tools were found to be valid and had adequate sensitivity to identify HIV positive subjects at risk of oral disease and facilitate appropriate referral by nondental health professionals to dental health service. When both tools were compared the 3-item tool proved to be a more valid and sensitive indicator which could be easily applied by nondental staff to facilitate a dental referral.

OPENWIDE: An Innovative Oral Health Program for Non‐Dental Health and Human Services Providers

Emerging awareness of the nature and severity of oral diseases and disorders and their serious impact on overall health and well-being, combined with a nationwide crisis in access to oral health care for populations with the most and worst disease, makes it imperative that non-dental health and childcare professionals engage more fully in oral health promotion and disease prevention. OPENWIDE is a comprehensive training program designed to help achieve this goal. The Connecticut Department of Public Health has trained more than 2,000 individuals during the first year of the OPENWIDE program. This article reports on successes and impediments to training and implementation encountered in the early stages of OPENWIDE and makes recommendations to improve the curriculum and its delivery to families and children.

The 20 Item Oral Mucositis Index: Reliability and Validity in Bone Marrow and Stem Cell Transplant Patients

Precise quantification of oral complications in cancer patients receiving bone marrow and stem cell transplantation is essential when testing new treatment strategies for mucositis. Using 133 adult transplant patients, the authors evaluated the 20 item oral mucositis index (OMI), adapted from the 34 item OMI, to facilitate use by nondental health professionals. The OMI-20 consists of nine items measuring erythema, nine measuring ulceration, one measuring atrophy, and one measuring edema; all are scored from 0=none to 3=severe and summed for a total possible score of 0–60. The two sets of nine items measuring erythema and ulceration can also be summed separately to produce subscale scores ranging from 0 to 27. Results demonstrated internal consistency, test–retest, and inter-rater reliability, and strong evidence of construct validity. Provided that clinical examiners have appropriate training and experience, the OMI-20 can be used as a reliable, valid, and quantifiable measure of mucositis in clinical research.