Oral Care Delivery Research Articles

Teledentistry in the Time of Conflict in Sudan

Background: The War in Sudan between the Sudanese armed forces and rapid support forces has left undeniable impacts on the healthcare system which is already compromised by decades of neglect. Hospitals were bombed or occupied by conflict parties. Healthcare providers were killed or assaulted, citizens were forced to displace, and access to healthcare was impaired in many cities. Teledentistry is a modern and promising way to provide dental consultations. It is an easy, safe, and affordable solution for both patients and dental personnel in times like war. This short communication aims to urge the need to implement teledentistry to facilitate access to dental services during the current conflict in Sudan. Methods: This article discusses teledentistry, which according to the American Teledentistry Association (ADA) is the use of electronic information, imaging, and communication technologies, such as audio, video, and data communications for oral care delivery, diagnosis, consultation, treatment, and education. The healthcare system in Sudan is currently facing many challenges such as a lack of healthcare providers, economic crisis, inability to access dental health centers, and political instability. The application of teledentistry will facilitate access to oral healthcare and provide optimum solutions during the current conflict in Sudan. Conclusion: Implementation of teledentistry during military conflicts is a golden solution for both patients and dental care providers as it is a time-saving, cost-effective, safe, and quick way to access oral healthcare services.

Could the minimum intervention oral care framework help improve the quality of oral health delivery and access to NHS primary dental care?

Access to NHS primary dental care services is a perennial issue in the UK. Two aspects must be considered when measuring access to dental care: ‘entry access', which relates to service availability resulting in realised initial or continued access; and ‘effective access', the delivery of effective, equitable and efficient care, which manifests as equitable and optimal outcomes of care. It is proposed that the minimum intervention oral care (MIOC) delivery framework provides a person-focused, prevention-based, susceptibility/needs-related, team-delivered approach to ensuring effective access to primary oral and dental care. A theory of change model could identify the key barriers to overcome the implementation of the MIOC approach, involving all key stakeholders in primary oral and dental care delivery.

The role of telehealth in the delivery of oral and maxillofacial surgery services at a level 6 hospital in New South Wales Australia during COVID-19 - the John Hunter Hospital experience: a commentary, review and cautionary tale for the future.

The objective of this article is to understand the uptake in use of Telehealth services during the COVID-19 pandemic as a way to provide compelling impetus for further research and promotion of Telehealth in general. A data review of Outpatient Department data from 2020 to 2023, as compiled by the Surgical Outcomes improvement Unit. Telehealth was widely adopted during the COVID-19 pandemic for clinicians to provide healthcare to patients whilst adhering to strict lockdown guidelines aimed at limiting exposure and spread of the respiratory virus. There has been minimal analysis, however, of the ethical and legal implications of telemedicine. Whilst it seems that access to care is improved via telehealth, there are subtle, inherent barriers intrinsic to it. There was a significant increase in the use of audio and audiovisual aids in the delivery of Oral and Maxillofacial Outpatient care during the COVID-19 period. Further analysis and improvements need to be made to the system before it can be considered as sufficient and adequate. Where there is rapid adoption of Telehealth in the delivery of Oral and Maxillofacial Surgery Services, there must be concurrent rigorous review and update of systems in order to address the key areas of patient safety and accuracy of treatment.

Implementation of peer-to-peer oral care objective structured clinical examination-based learning for nursing students.

Nurses' skills and confidence in providing oral care to patients play important roles in healthcare. Studies have proved that peer-to-peer learning and assessment can help improve nurses' skills and confidence. However, no study has investigated it using an objective assessment checklist. This study investigated an oral hygiene practice training program for nursing students. It focused on their oral healthcare skills, confidence, and perspectives regarding implementing an objective structured clinical examination (OSCE). A pre- and post-survey of 97 nursing students from a nursing school in Japan was conducted as a peer-to-peer oral health education training program that included an assessment and performance checklist. Confidence in performing and assessing oral care significantly improved after attending the program. Furthermore, the changes were significantly greater in the developed program than in the training program without the checklist. The mean total assessment scores (0-25) of the first, second, third, and fourth participants in the four-student groups were 22.1, 23.4, 23.9, and 24.1, respectively. The mean scores of the second, third, and fourth participant groups were significantly higher than that of the first participant group (p < .01). Fifty-two positive and 58 negative comments were received regarding the implementation of the program with professional assessments and the checklist. The most common positive comment mentioned that the evaluation by professionals improved oral care learning and skills. This study developed a program to improve nursing students' confidence and oral care delivery skill building in an OSCE-style delivery.

More than a mouth to clean: Case studies of oral health care in an Australian hospital.

This study aimed to explore older patients' oral health status, their opinions about oral health care and their experiences with oral health care while in hospital. Improving older adults' oral health is considered an urgent priority at both the national and international levels, especially for hospitalised older patients who have been found to have poor oral health. However, a one-size-fits-all standardised approach to oral care delivery may not be the answer. This study was an embedded, multiple-case study, integrating qualitative and quantitative data. Seven patients were recruited from a geriatric ward of an acute hospital in Australia and participated in semi-structured interviews and oral health assessments using the Oral Health Assessment Tool (OHAT) in June-July 2022. Data were analysed descriptively and presented in case summaries. OHAT assessments identified oral health problems in all patients, but not all patients self-reported problems with their mouths. Each patient valued oral health care, but the reasons given varied. Patients had established, individualised oral health care routines, which they brought to hospital. Clinical observations of patient's oral health status might not match the patient's own judgement of their oral health and, if not explicitly addressed, may mask the need for oral health and hygiene intervention. Assessment and care planning needs to incorporate patients' own perceptions of their oral health and existing oral health care routines. Oral health histories may provide a means of facilitating this person-centred oral health care for older patients in hospital.

Geroscience: Aging and Oral Health Research.

Research in aging has significantly advanced; scientists are now able to identify interventions that slow the biologic aging processes (i.e., the "hallmarks of aging"), thus delaying the onset and progression of multiple diseases, including oral conditions. Presentations given during the 3-part session "Geroscience: Aging and Oral Health Research," held during the 2023 American Association for Dental, Oral, and Craniofacial Research meeting, are summarized in this publication. Speakers' topics spanned the translational research spectrum. Session 1 provided an overview of the geroscience and health span (disease-free and functional health throughout life) concepts. The common molecular mechanisms between oral cancer and aging were discussed, and research was presented that showed periodontal microflora as a potential factor in Alzheimer's disease progression. Session 2 focused on behavioral and social science aspects of aging and their oral health significance. The keynote provided evidence that loneliness and isolation can have major health effects. These social conditions, along with poor oral health, tooth loss, and cognitive decline, could potentially affect healthy eating ability and systemic health in older adults. Research could help elucidate the directions and pathways connecting these seemingly disparate conditions. Session 3 focused on the delivery of oral care in different settings and the many barriers to access care faced by older adults. Research is needed to identify and implement effective technology and strategies to improve access to dental care, including new delivery and financing mechanisms, workforce models, interprofessional provider education and practice, and use of big data from medical-dental integration of electronic health records. Research to improve the "oral health span," reduce oral health disparities, and increase health equity must be tackled at all levels from biologic pathways to social determinants of health and health policies.

Implementing a Screen-Clean-Hydrate bundle of care for improving swallow screening, oral health, and hydration in acute stroke: Protocol for a Type 2 hybrid-effectiveness pre-post study.

Stroke clinical guidelines recommend care processes that optimize patient outcomes and minimize hospital-acquired complications. However, audits and surveys illustrate that recommended care is not always consistently or thoroughly implemented. This paper outlines the methods for implementing and evaluating a new bundle of care. Screen-Clean-Hydrate bundles together recommendations from the Australian Clinical Guidelines for Stroke Management and supplements these with evidence-informed best practice from the literature for: swallow screening within 4 h of presentation to hospital (Screen); oral health assessment and delivery of oral care (Clean); and hydration assessment and management (Hydrate). The study is a pre-post Type 2 hybrid effectiveness/implementation design with an embedded process evaluation, which will be conducted in two acute stroke units in a capital city of Australia. The integrated-Promoting Action on Research Implementation in Health Services (iPARIHS) framework will be used to guide study design, conduct, and evaluation. Clinical effectiveness will be measured by rates of hospital-acquired complications and proxy measures of cost (length of stay, procedure costs) for 60 patient participants pre- and postimplementation. Implementation outcomes will focus on acceptability, feasibility, uptake and fidelity, and identification of barriers and enablers to implementation through staff interviews, medical record audits, and researcher field notes. Due to its design as a hybrid effectiveness/implementation study, once completed, the study will provide information on both intervention and implementation effectiveness, including details of successful and unsuccessful multidisciplinary implementation strategies. This will inform a larger multisite effectiveness/implementation trial for future upscale, leading to improved compliance with stroke guidelines and therefore stroke outcomes.

Colour-blind racial attitudes in entry-level dental hygiene students in Virginia.

Subscribing to colour-blind racial attitudes may contribute to inequities in the delivery of oral care and affect treatment of diverse patients. The purpose of this study was to survey all entry-level dental hygiene students in one state to determine colour-blind racial attitudes. After IRB approval, a convenience sample of 220 dental hygiene students in all entry-level programmes in Virginia were invited to participate in this cross-sectional study. The Colour-Blind Racial Attitudes Scale (CoBRAS), an effective, validated measuring instrument, was used to quantify unawareness of contemporary racist ideals. Three subscales (Racial Privilege, Institutional Discrimination and Blatant Racial Issues) were also measured by the survey. Descriptive statistics, separate one-way between-subjects ANOVA and independent samples t-tests were used to analyse the data. One-hundred and sixty (n = 160) dental hygiene students completed the survey. Independent samples t-tests revealed statistically significant differences when comparing year in programme and programme type. Participants in their second year of dental hygiene education had significantly lower overall CoBRAS scores compared to those in their first year of education (M = 50.76, M = 59.13, respectively; p = 0.004). Participants enrolled in a baccalaureate dental hygiene (B.S.) programme had significantly lower overall CoBRAS scores compared to those enrolled in an associate (A.S.) programme (M = 50.53, M = 59.54, respectively; p = 0.002). Participants possessed moderate levels of colour-blindness, suggesting a need for more awareness and training early in dental hygiene education to increase delivery of culturally competent oral healthcare.

Exploring facilitators and barriers associated with oral care for inpatients with dysphagia post-stroke.

To explore the attitudes, facilitators and barriers in providing oral care for inpatients with dysphagia post-stroke as perceived by healthcare professionals. Dysphagia is a common complication of stroke and is associated with a higher incidence of aspiration pneumonia, malnutrition and dehydration. In the acute phase of stroke recovery, a dental professional is not usually part of the multidisciplinary team caring for the patient and oral care is the responsibility of the healthcare professionals in the stroke unit. There is a lack of high-quality evidence to demonstrate the most effective method of providing oral care for patients with dysphagia post-stroke. This was a single-site study conducted with healthcare professionals working in the Stroke Unit of Cork University Hospital in Ireland, using focus groups and a qualitative thematic analysis approach. A total of three focus groups were conducted in the Stroke Unit with 17 healthcare professionals. The focus groups included representation from all healthcare professional groups providing direct clinical care to patients on the Stroke Unit including geriatric medicine, dietetics, speech and language therapy, healthcare assistance, nursing, occupational therapy and physiotherapy. A qualitative thematic analysis was carried out and seven overarching themes emerged from the data. Three themes related to facilitators to providing oral care for this patient group: (i) a focus on oral care in both policy and practice, (ii) expanding professional roles in the provision of oral care, (iii) perceived importance of oral care in recovery and rehabilitation. Four themes related to barriers to the provision of oral care for this patient group: (i) lack of confidence and concerns related to the perceived risk for patients with dysphagia, (ii) unique challenges of patient and stroke-related factors, (iii) lack of resources and time and (iv) perceived importance of oral care in recovery and its relative importance with competing demands. Members of the stroke multidisciplinary team believe that they all have a part to play in the delivery of oral care for patients with dysphagia post-stroke. Opportunities exist for the development of multidisciplinary interventions to improve the oral cavity assessment and oral care provided in the Stroke Unit.

Are we well? A post-pandemic snapshot of dental educator wellness, well-being, and fulfillment.

The COVID-19 pandemic brought unprecedented changes to oral care and dental education delivery. To date, the vast majority of studies focus on the impact COVID-19 had on the well-being and wellness of patients, practitioners, and students; however, limited literature addresses the pandemic's impact on dental educators. The aim of this study was to investigate the wellness, well-being, and fulfillment of dental educators in the years following the onset of the COVID-19 pandemic. Following Institutional Review Board approval, an anonymous electronic Qualtrics survey was emailed to full-time and adjunct faculty across five (5) dental education institutions in the US. Faculty self-reported on their wellness, general well-being, physical well-being, mental well-being, fulfillment, and work-life balance. Group differences were examined using analysis of variance and the Tukey-Kramer test for multiple comparisons at the p<0.05 level. The results revealed females and younger dental faculty members reported statistically significantly lower levels of wellness (F2, 123 =11.16, p<0.001, F3, 121 =8.53, p<0.001), physical (F2, 123 =11.53, p<0.001, F3, 121 =5.54, p=0.001) and mental well-being (F2, 123 =12.49, p<0.001, F3, 121 =8.63, p<0.001), fulfillment (F3, 121 =5.01, p<0.003), and higher levels of burnout (F2, 123 =5.53, p=0.005, F3, 121 =4.85, p<0.003). Those who expressed higher levels of burnout also had statistically lower mean well-being scores (F4, 119 =10.54, p<0.001). Females also reported a significantly lower work-life balance score compared to male respondents (F2, 121 =10.37, p<0.002). Despite the social and environmental challenges faced over the last couple of years post-pandemic, dental educators demonstrate a quick ability to adapt, however, disproportional differences in gender and age groups were identified as being significantly correlated to dental educators' self-reports on wellness, well-being, and fulfillment. Insight into these variables can help inform strategies in the academic setting to help support and strengthen the academic workforce.

Tele dentistry - A modern day boon to dental practice

Telemedicine is the use of electronic information to communicate technologies to provide and support healthcare when distance separates the participants. Brown N. A brief history of telemedicine. Teledentistry is a field that combines telecommunications and dentistry to provide newer opportunities of dental education and delivery of oral care. It involves delivering data in the form of clinical information and images from one point (spoke point) to another point (hub site) for dental treatment using telecommunications technology. It can potentially improve the accessibility and delivery of oral healthcare, extending to underserved patient populations, such as those in rural areas, at a reasonable cost. Teledentistry can thus eliminate the disparities in oral health care between urban and rural communities. This article reviews the role of teledentistry in different fields of dentistry.

Mineralizing agents to manage early carious lesions. Part II: clinical application

The successful commercialization of mineralization technologies used for the primary and secondary prevention of early carious lesions provides several clinical options for the oral healthcare team using the minimum intervention oral care (MIOC) delivery framework. These new technologies are available in many different forms, with different properties, and can be used in a variety of clinical scenarios. This article is the second in a series providing a review on the clinical efficacy of new technologies and the products available, as well as clinical guidance for their use. CPD/Clinical Relevance: Clinicians should have an appreciation of the different mineralizing agents available, and their related guidelines.

Partnering for Integrated Care: A Learning Collaborative for Primary Care and Oral Health Teams.

The Teaming and Integrating for Smiles and Health (TISH) Learning Collaborative was developed to help health care organizations accelerate progress in integrating delivery of oral and primary care. By providing expert support and a structure for testing change, the project aimed to improve the early detection of hypertension in the dental setting and of gingivitis in the primary care setting, and to increase the rate of bidirectional referrals between oral and primary care partners. We report its outcomes. A total of 17 primary and oral health care teams were recruited to participate in biweekly virtual calls over 3 months. Participants tested changes to their models of care through Plan-Do-Study-Act cycles between calls. Sites tracked the percentages of patients screened and referred, completed the TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) and Interprofessional Assessment questionnaires, and provided qualitative feedback and updates in storyboard presentations. On average, with implementation of the TISH Learning Collaborative, sites displayed a nonrandom improvement in the percentages of patients screened for hypertension, referred for hypertension, referred to primary care, and referred for gingivitis. Gingivitis screening and referral to oral health care were not markedly improved. Qualitative responses indicated that teams made progress in screening and referral workflows, improved communication between medical and dental partners, and furthered understanding of the connection between primary care and oral care among staff and patients. The TISH project is evidence that a virtual Learning Collaborative is an accessible and productive avenue to improve interprofessional education, further primary care and oral partnerships, and achieve practical progress in integrated care.

Oral Care Delivery to Patients with Multiple Sclerosis

Oral Care Delivery to Patients with Multiple Sclerosis

Oral Care for Children with Special Healthcare Needs in Dentistry: A Literature Review.

Oral health is a very important aspect of general health, especially for vulnerable groups such as children with special healthcare needs. It is important to provide appropriate oral care in order to promote quality of life and good health for everyone, especially for children with special healthcare needs. Method: We reviewed the recent literature to collect knowledge regarding the delivery of quality oral care to children with special healthcare needs. We also explored some of the treatment management options that could address the needs of these children when attending dental clinics. Result: Unfortunately, we noted significant inequalities with issues related to oral health among those children. This situation often results in limitations to the activities of daily living for these children. There is therefore a need for much-needed advancements and refinements in oral healthcare to address the needs of children who have special healthcare needs. Conclusions: Providing children with special healthcare needs with high-quality dental care may necessitate active liaisons with healthcare facilitators and will require work across professions to make certain that these children’s oral health is also prioritized. Coordinated efforts by dental professionals are needed to provide dental health education and preventive interventions for these children.

Going electronic: an Epic move.

Medicine and dentistry have historically existed as separate entities, resulting in the creation of separate patient health records, which may limit patient care and safety. The General Dental Council emphasise the need to 'make and keep contemporaneous, complete and accurate patient records' as part of the expected standards of the dental team, with no suggested preference on paper or electronic notes. Despite offering clear advantages in primary care dental practice for efficiency, patient accessibility and financial benefit, the comparatively limited uptake of electronic records in dentistry in the secondary care setting has created barriers for patients and clinicians in delivery of evidence-based oral care. In this paper, we report on the challenges and benefits presented by the national drive to integrate technology into the NHS, including the enhancement this can provide to patient care. In primary care dentistry, electronic record keeping is well established in the UK. There is sparse literature or reported outcomes on the use of electronic record keeping in dental departments in secondary care. The Royal National Ear, Nose and Throat and Eastman Dental Hospitals is now a fully digitised hospital through the introduction of Epic, a fully integrated electronic health record. We explore the role of electronic record keeping in primary and secondary care dental practice, the benefits to patient care and the challenges presented when implementing an electronic health record. We consider the benefits and challenges in digitising a centrally-based specialist teaching dental hospital, including specific features of Epic, which provide enhanced user accessibility and applications for general use and specialised services, including research and public health surveillance.

Integrating oral care into nursing practice in care homes.

This article details a narrative review that explored the barriers to and facilitators of integration of oral care into nursing practice in care homes to enhance nurses' delivery of oral care. Three themes were identified: gaps in oral care protocols and the complexity of nursing oral care; how interprofessional collaboration and education can improve oral care; and limitations and unresolved issues in nurses' oral care training. The review found that interprofessional collaboration and education were important in normalising oral care practice and nurse leadership in care homes. Nurse-led interprofessional oral care could enhance the quality of care in care homes by advancing interprofessional collaboration and education, coordinating care and improving organisational support.

Minimum intervention oral care delivery for children: developing the oral healthcare team

This article discusses the potential use of the oral healthcare team in the delivery of minimum intervention oral care (MIOC) for caries management in children. It summarizes opportunities and difficulties, both evidenced and anticipated, in the context of general dental practice in the UK. Given the push to provide safe and effective care using wider members of the oral healthcare team, this article offers insight into potential barriers and facilitators that may present in general dental practice. CPD/Clinical Relevance: There is a belief that the wider team within general dental practice will have an increasingly important role to play in the provision of oral and dental care.

Is Teledentistry a Feasible Alternative for People Who Need Special Care?

The aim of this study is to explore the feasibility and acceptability of teledentistry as a vehicle that provides enhanced delivery of oral care for the people who need special care (PNSC). Between January 2018 and September 2020, PNSC who were admitted in the study were either waiting for a follow-up (F) appointment or on a waiting list. An examination via video call was carried out for initial examination (IE) and F purposes. The virtual examination was scored by the clinician who performed the examinations. The experience of the participants was evaluated with a satisfaction questionnaire. Forty PNSC (26 females, 14 males) between ages 7 and 48 years (21.17 ± 10.62) participated in the study. According to the clinician ratings, the accuracy of the examination was rated as the lowest. The F group had higher scores when compared to the IE group regarding clinician rating. No significant differences were found in terms of the scoring of the clinician and patient/parent satisfaction regarding cooperation status and type of examination (P ≥ 0.05). Through adequate adaptation of the technology into clinical practice and overcoming the barriers for wider implementation, the teledentistry approach could be a reliable and feasible alternative in triaging, treatment planning, and F purposes for PNSC.

Exploring oral care practices, barriers, and facilitators in an inpatient stroke unit: a thematic analysis

Purpose Oral care is essential to support the health and rehabilitation of stroke survivors but is often performed poorly in the inpatient setting. This article examines the current practices, barriers and facilitators to oral care on an Australian stroke unit to inform future knowledge translation interventions within this setting. Methods Qualitative semi-structured interviews were conducted with nursing staff members and speech-language pathologists with experience delivering oral care to stroke survivors. Reflexive thematic analysis was used to analyse the data. Results Three themes were developed from the data. In the first theme, participants described current oral care practices within their stroke unit and acknowledged that there is room for improvement. In the second theme, participants identified the multiple overlapping barriers to oral care delivery on the ward. Finally, the third theme explored participants’ suggestions for improving oral care, including both local and organisational change. Conclusions This study illustrates the complexities of oral care in the inpatient stroke setting and gives voice to the perspectives of nursing and speech-language pathology staff. It is clear that future oral health interventions in this setting require a comprehensive approach to addressing barriers and should prioritise the concerns of staff delivering the care. IMPLICATIONS FOR REHABILITATION The delivery of good oral care post-stroke is essential, but in practice is difficult due to limited time and supplies, inadequate education, fear of harm to patient and self, and perceived low priority of the care. Speech-language pathologists are often involved in oral care, but their role is not clearly delineated, and they are not provided with formal training in oral care provision. Oral care interventions should be comprehensive, including organisational policies, clear practice guidelines, structured multi-disciplinary education, and appropriate supplies.