Oral Care Interventions Research Articles

Salivary Antimicrobial Peptide in Patients With Dementia Before and After Clinical Oral Rehabilitation Programme: A Randomised Controlled Trial.

Emerging evidence suggests a link between salivary metabolite changes and neurodegenerative dementia, with antimicrobial peptides (AMPs) implicated in its pathogenesis. We investigated the effects of a clinical oral rehabilitation programme tailored for dementia patients on salivary flow rate, AMP levels and oral health-related quality of life (OHRQoL). Eligible patients were randomly assigned to either the experimental group (EG; n = 28) or the control group (CG; n = 27). Both groups received a leaflet on oral health. In addition, the EG received an oral care intervention that included individual lessons on oral muscle exercises and oral self-care practices. Saliva samples and OHRQoL data were collected at baseline and follow-up visits. Generalised estimating equation models were used to analyse the changes over time. At the 3-month follow-up, EG showed significantly lower histatin 5 (HTN-5) levels (β = -0.08; effect size [ES] = 0.72) than CG. At 6 months, EG exhibited improved salivary flow rate (β = 0.89; ES = 0.89) and OHRQoL (β = 6.99; ES = 1.31) compared to CG. Changes in salivary flow rate (β = 4.03), HTN-5 level (β = -0.78) and beta-defensin 2 level (BD-2) (β = -0.91) at 3 months predicted improved OHRQoL at 6 months (all p < 0.05). Our clinical oral rehabilitation programme reduced the level of salivary HTN-5, increased salivary flow rate and enhanced OHRQoL in dementia patients. Furthermore, changes in salivary flow rate, HTN-5 level and BD-2 level were associated with improvements in patients' OHRQoL.

A preventive care approach for oral health in nursing homes: a qualitative study of healthcare workers’ experiences

BackgroundOral health problems are common among care-dependent older adults living in nursing homes. Developing strategies to prevent the deterioration of oral health is therefore crucial to avoid pain and tooth loss. A standardized work widely used in nursing homes in Sweden is the quality register Senior Alert (SA), which assesses age-related risks concerning e.g. pressure sores, falls, malnutrition and oral health. The oral health assessment is performed with the Revised Oral Assessment Guide-Jönköping (ROAG-J), which also includes planning and implementation of preventive oral care interventions with the goal of achieving good quality care. However, what facilitates and hinders healthcare workers in working with oral health in SA remains unexplored. The aim of this study was to describe healthcare workers’ experiences of assessing oral health with the ROAG-J, planning and performing preventive oral health care actions in accordance with SA in nursing homes.MethodsHealthcare workers (n = 28) in nursing homes in two Swedish municipalities participated and data was collected through six focus group interviews. Reflexive thematic analysis was used to identify patterns of meaning in the data.ResultsThemes generated in the analysis were:A structured process promotes communication and awareness and stresses the importance of oral health;Oral care for frail older adults is challenging and triggers ethical dilemmas;Unclear responsibilities, roles and routines in the organization put oral health at risk;Differences in experience and competence among healthcare staff call for educational efforts.ConclusionsThe structured way of working increases staff awareness and prioritization of oral health in nursing homes. The main challenges for the healthcare workers were residents’ reluctance to participate in oral care activities and oral care being more complicated since most older adults today are dentate. Organizational challenges lay in creating good routines and clarifying staff roles and responsibilities, which will require continuous staff training and increased management involvement.

ORAL CARE AND DENTAL INTERVENTIONS SHOW MIXED AND UNCLEAR EFFECTS ON COGNITIVE FUNCTION

ORAL CARE AND DENTAL INTERVENTIONS SHOW MIXED AND UNCLEAR EFFECTS ON COGNITIVE FUNCTION

Enhancing patient-provider encounters when proposing SDF therapy by utilizing a qualitative analysis of parental feedback.

Silver Diamine Fluoride (SDF) is a minimally invasive option for caries arrest, part of a paradigm shift in the management of pediatric dental caries. The perspective of parents regarding the long-term pros and cons of this therapy should be understood in order to achieve optimal patient-centered care. This study used Constant comparative analysis as an analytic approach, applying the Precaution-Adoption Process Model (PAPM) as the Grounded Theory framework in the qualitative analysis of 30 parental unformatted, spontaneous comments collected at the end of a questionnaire to evaluate their satisfaction with treatment provided at a University Clinic. Our analysis provided important insights about the factors that influenced the parents' decision to act and have their child receive SDF therapy, their perception of the outcomes, the necessary follow-ups after the therapy, and what impacted on their overall satisfaction with the completed procedure. Both positive and negative themes were identified. The positive themes point to SDF treatment's ease of application and addressing the immediate treatment needs on children with limited cooperation. The negative themes identified the adverse consequences of SDF treatment, specifically, the duration and appearance of the cosmetic consequences, as well as the parents' misunderstandings and incorrect expectations of the long-term sustainability of the treatment, which in many instances requires further interventions. It was also evident from the parents' comments that they needed additional educational guidance on other aspects of the treatment, such as the necessity for clinical follow-ups, information that impacted parents' overall satisfaction with the treatment their child received. Our results highlight the need to discuss the short and long term benefits of the treatment, as well as, its short and long-term limitations. Specifically, while it is important to discuss immediate outcomes and consequences, such as the ease of treatment and the resultant staining, to ensure that parental consent for the treatment is truly well-informed, it is also important to prepare parents, when this procedure is initially proposed, of the likely need for additional oral care interventions in the future.

The Effect of Oral Care Intervention in Mucositis Management Among Pediatric Cancer Patients: An Updated Systematic Review [Letter

The Effect of Oral Care Intervention in Mucositis Management Among Pediatric Cancer Patients: An Updated Systematic Review [Letter

Oral care interventions for autistic individuals: A systematic review.

Oral care-related challenges are well documented in the autistic community; dental care remains one of the most prevalent unmet health needs among autistic individuals. This review examined interventions designed to improve oral health in autistic individuals from children and adult populations. Through a systematic process, 36 studies were identified. These studies focused on improving home-based oral care skills and routines and reducing fear, anxiety, and/or negative behaviors in the dental clinic. Studies incorporated different types of techniques for facilitating oral care practice, including preparatory interventions to support home-based hygiene activities or improve an approaching dental encounter (n = 29), most often using visual aids, and/or strategies to manage behavioral difficulties exhibited in the dental office (n = 17). Some studies used both approaches (n = 10), combining visual aids prior to a visit with behavior management. Using an evidence-based rubric, we reviewed the methodological quality of the studies and found that most were only "adequate" (n = 8) or "weak" (n = 23) in reporting their evidence. This review has two key findings: (1) there is support for preparatory home-based visual interventions to improve toothbrushing and/or ready patients for dental visits; and (2) distraction or sensory-reducing interventions may also improve experiences in the dental clinic. Only one study purposefully recruited autistic adults, and no studies included intervention elements tailored to race/ethnicity, culture, and/or socioeconomic status. This review highlights the need for more studies investigating the impact of oral care-related interventions for autistic individuals of all ages and identifies a gap in interventions for autistic adults and those from minoritized populations.

Association of leukopenia in the development of cancer chemotherapy‐induced oral mucositis and its severity

AbstractAimTo prevent oral mucositis, it is important to understand its associated risk factors, such as highly cytotoxic chemotherapeutic agents, sex, and low body weight. However, to the best of our knowledge, no study has investigated the association between chemotherapy‐induced myelosuppression and oral mucositis in Japan. In this study, we examined the relationship between chemotherapy‐induced leukopenia and the severity of oral mucositis.MethodsWe conducted a retrospective cohort study of patients who received oral care interventions during cancer chemotherapy. Hematological values were obtained at the initiation of chemotherapy and on the proximal day of changes in the grade (Gr) of oral mucositis. The Gr of oral mucositis was assessed by dentists and dental hygienists using the Common Terminology Criteria for Adverse Events (version 5.0).ResultsThe data of 79 patients were analyzed during the study period. The incidence of oral mucositis was 7/79 (8.9%). The incidences of grades 1–4 were 4/79 (5.1%), 2/79 (2.5%), 0/79 (0%), and 1/79 (1.3%), respectively. Notably, the incidence of oral mucositis was significantly higher in patients with lower white blood cell and neutrophil counts (p &lt; 0.01). Logistic regression analysis further revealed that patients with Gr 2 or higher leukopenia had a significantly higher risk of developing Grade 2 or higher oral mucositis (adjusted odds ratio: 5.2; 95% confidence interval: 1.60–17.0; p = 0.0062).ConclusionCancer chemotherapy induced‐oral mucositis may be at great risk in patients with Gr 2 or higher leukopenia.

Impact of oral care intervention on quality of life of patients with oral cancer undergoing radiotherapy in Sri Lanka: A quasi-experimental study.

Radiotherapy is used to treat oral cancer, yet it negatively affects patients' health-related quality of life (HRQOL). The aim was to evaluate the impact of an oral healthcare intervention on HRQOL of patients with oral cancer who receive radiotherapy with or without chemotherapy. An oral healthcare intervention was provided to 41 patients with oral cancer before radiotherapy (fluoride varnish application, scaling, permanent restorations, adjustment of sharp teeth, and extraction of teeth with questionable prognosis, oral hygiene instructions), during, and 3 months after radiotherapy (baking soda mouthwash, artificial saliva spray). EORTC QLQ-H&N35 was used to compare the HRQOL of the intervention and control groups, with the latter having received routine oral healthcare. The intervention group showed lesser values for HRQOL domains and items indicating fewer side effects during the last week of radiotherapy and 3 months after, compared to the control group. Most of the changes in HRQOL were significantly less in the intervention group compared to the control group (p < 0.01). The oral healthcare intervention effectively reduced the effect of radiotherapy and positively impacted on HRQOL of patients with oral cancer.

The Effect of Oral Care Intervention in Mucositis Management Among Pediatric Cancer Patients: An Updated Systematic Review.

Chemotherapy-induced mucositis is inflammation that develops in the oral mucosal due to anticancer treatment. Mucositis has negative consequences that may lead to distress in pediatric patients, resulting in escalated expenses, diminished quality of life, hindrance in cancer therapy, and decreased survival rates. However, despite the numerous methods, oral care protocols are suggested for implementation in the pediatric population despite a lack of high-level evidence studies, particularly regarding which appropriate oral care agents should be administered. This systematic review aimed to identify the effect of oral care intervention in mucositis management among pediatric cancer patients. Studies were published between 2014 and 2023 from five databases: PubMed, Embase, Medline, ScienceDirect, and Scopus. They were identified using a search strategy to identify relevant studies that identify oral care interventions for managing mucositis in children with cancer. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies and followed the recommended reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Eight studies met the inclusion criteria, including seven RCTs and one quasi-experimental study. Oral care interventions involving tooth brushing, mouthwash, and lip care are performed entirely or partially. The frequency of oral care ranges from two to six times daily, and the duration of intervention is from 5 days to six weeks. Oral care interventions using honey, olive oil, Aloe Vera, Andiroba, and salivary enzyme toothpaste are beneficial to lower the severity of mucositis, reduce pain, minimize mucositis duration, and reduce the use of analgesics, but not significantly improve the child's quality of life. However, Caphosol mouthwash did not significantly reduce mucositis. Our study highlights that oral care intervention using effective agents integratively, including honey, olive oil, Aloe vera, Andiroba, and salivary enzyme toothpaste, is essential to manage chemotherapy-induced mucositis among children. PROSPERO registration number was CRD42023456278.

Efficacy of Lemon Mouthwash in Improving Dry Mouth Symptoms and Salivary Flow in Hemodialysis Patients

Background/AimsGargling mouthwash is a safe and convenient oral care intervention; it rinses the mouth and increases salivary flow rate. The effectiveness of lemon mouthwash in relieving xerostomia and increasing the salivary flow rate among hemodialysis patients has not been studied. Our study sought to analyze the effectiveness of varying concentrations of lemon in mouthwash solutions on xerostomia and salivary flow rate. MethodsA multi-concentration test was used to assess lemon mouthwash at 20%, 15%, 10%, 5%, and 2.5% concentrations to determine the optimal concentration for relieving dry mouth and increasing salivary flow rate. Generalized estimating equations were used to analyze the differences between various concentrations of lemon mouthwash and bassline values. ResultsIn total, 44 patients were recruited. The 10% lemon concentration mouthwash was the most effective for increasing salivary flow rate, but the 5% and 2.5% were better accepted by the participants. Our findings can help establish intervention guidelines to relieve xerostomia among hemodialysis patients. ConclusionsOur findings can help establish intervention guidelines to relieve xerostomia among hemodialysis patients.

Campuran Produk Berbasis Alami dan Perawatan Mulut Dasar untuk Pengelolaan Mukositis Mulut dan Xerostamia bagi Pasien Kanker

This study aims to describe the effectiveness of oral care using mouthwash or using herbal solutions to reduce the severity, value of pain, incidence of mucositis and xerostomia and other oral symptoms such as dysphagia for cancer sufferers. This research method uses a literature review by searching articles in 6 trusted databased such as PubMed, ScienDirect, Scopus, Springer, ProQuest and EBSCHost. The results of this study showed that eleven articles out of thirteen showed the effectiveness of herbal solutiona as mouthwash in reducing mucositis and xerostomia. Two of them are the use of herbal solutions which can reduce xerostomia, bad breath and increase the rate of saliva for those undergoing hemodialysis. In conclusion, oral care interventions using mouthwash and herbal solutions as mouthwash and herbal solutions as mouthwash are effective, safe and can be used to reduce mucositis and xerostamia for cancer patients. Keywords : Mucositis, Cancer Patients, Oral Care, Xerostomia

The Effect of Oral Care Intervention in Mucositis Management Among Pediatric Cancer Patients: An Updated Systematic Review [Response to Letter

The Effect of Oral Care Intervention in Mucositis Management Among Pediatric Cancer Patients: An Updated Systematic Review [Response to Letter

Impact of allergic rhinitis on stomatitis in Korean adolescents

Objectives: This study aimed to determine whether adolescents with allergic rhinitis are at an increased risk of stomatitis and to ascertain possible sex-specific differences. Methods: The data for this cross-sectional study was obtained from the 18th Korea Youth Risk Behavior Web-based Survey (2022). Of the 56,213 students surveyed, 51,850 (boys 26,397 and girls 25,453) were included in the final analyses. Multivariate logistic regression was performed to identify the impact of allergic rhinitis on the risk of stomatitis among Korean adolescents. Results: In Model II, which was adjusted for allergic disease, boys with allergic rhinitis had a 1.53-fold (adjusted odds ratio [aOR]=1.53, 95% confidence interval [CI]=1.40–1.67), and girls had a 1.35-fold (aOR=1.35, CI=1.25–1.46) elevated risk of stomatitis than in those without. In Model III, after adjusting for all covariates, boys with allergic rhinitis had a 1.48-fold (aOR=1.48, CI=1.36–1.62) elevated risk of stomatitis than in those without, and girls had a 1.32-fold (aOR=1.32, CI=1.22–1.43) elevated risk, which remained statistically significant after adjusting for covariates. Therefore, allergic rhinitis in adolescents exerts a detrimental effect on the risk of experiencing stomatitis symptoms; the risk was higher in boys than in girls. Conclusions: These findings suggest that oral health care attention and intervention are needed for adolescents with allergic rhinitis.

Effectiveness of Swallowing and Oral Care Interventions on Oral Intake and Salivary Flow of Patients Following Endotracheal Extubation at a Tertiary Care Center: A Randomized Controlled Trial.

Endotracheal intubation and mechanical ventilation are the most frequently used life-sustaining interventions in critical care. Prolonged intubation can lead to post-extubation dysphagia, affecting the individual's nutritional level and communication ability. Thereupon, this study aims to assess the effectiveness of swallowing and oral care interventions in resuming oral intake and increasing salivary flow in post-extubation patients. A randomized controlled trial was conducted in critical care units of a tertiary care setting, where 92 post-extubation patients who had undergone intubation for≥48 hours were enrolled. The intervention group received swallowing and oral interventions, including safe swallowing education (SSE), toothbrushing, salivary gland massage, oral cavity, and swallowing exercises. In contrast, the control group received standard oral care every 8th hour. Oral intake was assessed daily with the Functional Oral Intake Scale, and the salivary flow measurement was assessed with oral Schirmer's test on the 1st, 3rd, and 7th day after extubation. The baseline demographic and clinical characteristics showed that the groups were homogenous. The intervention group achieved total oral intake two days earlier than the control group. Findings also showed that the participants in the intervention group had a significant increase in salivary flow than in the control group on the 3rd and 7th days of the intervention. Swallowing and oral care interventions help post-extubation patients resume early oral intake and increase salivary flow after prolonged intubation. Hence, it improves the patient's outcome toward a healthy life.

Oral health care intervention protocol for older adults at home in dental hygienists: a narrative literature review

Objectives: This study aims to propose a standard protocol for oral health care intervention activities by dental hygienists. Methods: A narrative literature review of home visit oral health care intervention activities reported in Cheonan, South Korea was conducted to enable the proposal of a standard home visit protocol for dental hygienists in the context of community care. Results: Oral health management intervention activities contributed to improving the quality of life, as well as the oral health, of older adults living at home. This was a result of applying a protocol consisting of oral observation, oral massage, expert oral hygiene management, oral muscle function training, and final stages. Conclusions: The visiting oral health intervention protocol was effective in resolving oral health problems of older adults. In the future, customized programs and reimbursement systems should be developed to promote oral health care for older adults that can be provided at home.

Awareness and attitudes regarding oral care intervention program based on community care for older adults at home: focusing on the grounded theory

Objectives: This study is based on a visiting oral health care intervention program in the community care. This qualitative study was conducted through in-depth interviews to identify awareness and attitudes regarding intervention program among older adults. Methods: The research team visited the homes of the target older adults and conducted in-depth interviews for approximately an hour using a semi-structured questionnaire. The collected voice recordings were transcribed using Clova Note, and AI program by Naver. Using the ‘Word Cloud Generator 3.7’ program, words of high importance and interest from interview answers were extracted, visualized, and analyzed. Results: Participating older adults acknowledged that their quality of life related to oral health could be improved by increasing the level of oral health awareness and oral health knowledge through the intervention program. In addition, the older adults indicated that their oral hygiene management ability improved compared to before the intervention through expert oral hygiene management and oral health education. Further, as the level of oral health knowledge increased, so too did satisfaction with the intervention program increase. Conclusions: The intervention program for visiting oral health care showed a positive effect on the awareness and attitude of older adults. Thus, it is suggested that education for continuous competency enhancement of dental hygienists and multidisciplinary education for the improvement of general health and quality of life of older adults should be promoted.

Study on Relieving Symptoms of Oral Pain in the Elderly with Oral Care

Objective: The objective is to investigate the relationship between oral care and dietary nutrition in elderly patients with oral ulcerative pain. Methods: From January 2021 to January 2022, 116 elderly patients with oral ulcer were selected. The two groups of patients were divided into experimental group and control group by random numbering method. The control group received the usual treatment. The control group was given dietary intervention support. The SF-36 questionnaire was used to evaluate the quality of life of the two groups of patients by comparing their satisfaction after nursing intervention, the healing time of oral ulcer, the time when pain disappeared and the normal feeding time. Results: The pain grade of both groups was evaluated by digital pain score. The health knowledge of patients with oral ulcer was compared between the two groups, and the good rate of oral ulcer was compared between the two groups. Results: Compared with the control group, the oral ulcer of the control group healed, the pain disappeared, and the time of normal eating was significantly shortened (P&lt;0.05). After treatment, the scores of general health, mental health, social function, energy and knowledge of the experimental group were higher than those of the control group, but the scores of NRS were lower than those of the control group (P&lt;0.05). The oral healing rate of the experimental group was higher than that of the reference group (P &lt; 0.05). Conclusion: The combination of oral care and dietary intervention in elderly patients with oral ulcer has a significant effect. This can relieve the pain of the patient and speed up the healing of the wound.

Advancing dentistry: fractal assessment of bone health in pediatric patients with celiac disease using dental images.

To assess the effects of a gluten-free diet on bone structure in children with celiac disease using fractal analysis on panoramic radiographs. A total of 49 patients with celiac disease aged 6-13 years, separated into 2 groups as previously and newly diagnosed, and a control group of 32 healthy individuals were evaluated. In previously and newly diagnosed patients with celiac disease, body mass index (BMI) Z-scores were calculated, calcium, alkaline phosphatase, vitamin D3, and parathormone levels were measured and bone mineral density (BMD) Z-scores obtained from dual energy X-ray absorptiometry. In all patients, the fractal dimensions (FD) of the right and left temporomandibular condyles were evaluated with the fractal analysis method on panoramic radiographs. The mean values of serum biomarker levels and the BMI and BMD Z-scores for both celiac groups were within the normal reference range. No statistically significant difference was determined between right and left condyle FD values in the 3 groups examined. In terms of both right and left condyle FD values, there was a statistically significant difference between groups. The highest FD values were determined in the previously diagnosed group. Differences in FD values were observed among patients with celiac disease following the gluten-free diet. Utilizing fractal analysis on panoramic radiographs can prove valuable for dentists in evaluating BMD due to its cost-effectiveness, easy accessibility, and reduced radiation exposure for patients, enabling them to provide comprehensive oral health care and potential early interventions for patients with celiac disease.

Oral care reduces incidence of pneumonia after esophagectomy: systematic review and meta-analysis.

Post-operative pneumonia after esophagectomy is a major contributor to morbidity and mortality. Prior studies have demonstrated a link between the presence of pathologic oral flora and the development of aspiration pneumonia. The objective of this systematic review and meta-analysis was to evaluate the effect of pre-operative oral care on the incidence of post-operative pneumonia after esophagectomy. A systematic search of the literature was performed on September 2, 2022. Screening of titles and abstracts, full-text articles, and evaluation of methodological quality was performed by two authors. Case reports, conference proceedings, and animal studies were excluded. A meta-analysis of peri-operative oral care on the odds of post-operative pneumonia after esophagectomy was performed using Revman 5.4.1 with a Mantel-Haenszel, random-effects model. A total of 736 records underwent title and abstract screening, leading to 28 full-text studies evaluated for eligibility. A total of nine studies met the inclusion criteria and underwent meta-analysis. Meta-analysis revealed a significant reduction in post-operative pneumonia among patients undergoing pre-operative oral care intervention compared to those without an oral care intervention (OR 0.57, 95% CI 0.43-0.74, p < 0.0001; I2 = 49%). Pre-operative oral care interventions have significant potential in the reduction of post-operative pneumonia after esophagectomy. North American prospective studies, as well as studies on the cost-benefit analysis, are required.

Swallowing and Oral Care Intervention on Dysphagia among Post- Extubation Patients

Introduction: One of the most common causes of admission to the intensive care unit is the need for mechanical ventilation. Orotracheal intubation for life support can cause dysphagia and delay oral feeding after extubation. Hence, the current study was conducted to determine the effectiveness of swallowing and oral care intervention on dysphagia among post-extubation patients. Methods: Quasi-experimental research design was adopted to conduct the study with 60 samples that met the inclusion criteria at saveetha Medical College and Hospital. Samples were selected by convenience sampling and assigned to the experimental group (n=30) and the control group (n=30). Demographic and clinical variables were collected using multiple choice questionnaires followed by a pre-test assessment using the Gugging swallowing screen for both the experimental and control groups. The experimental group received the swallowing and oral care intervention twice daily for five consecutive days. The control group received routine care at the hospital. The post-test assessment was done using the Gugging swallowing screen at the end of the 5th day of intervention for both the experimental and control group. Results: Out of 30 participants, more than 50% had slight dysphagia to moderate levels of dysphagia samples in both the experimental and control group. The pre-intervention mean score was compared with a post-intervention score in the experimental group by paired t-test, showing statistical significance (p