Oral Health Care Delivery System Research Articles

Oral health situation analysis and integration of Massive Open Online Course Modules on Oral Health Promotion in WHO SEAR Countries: A Comprehensive Report

Background: Massive Open Online Course (MOOC) modules are deemed to be novel educational models to optimize learning. They can be useful in delivering oral health education to primary health care workers to strengthen the oral health care delivery system. Therefore, the aim of this study is to analyze the current oral health situation analysis of the South East Asia region countries and to assess areas where the MOOC modules can be integrated as oral health training material. Methodology: A focus group discussion was held virtually with 70 participants from SEAR. The MOOC modules were developed as learning activities to facilitate the application of the material learned, in public settings. The themes for the situation analysis were based on oral health policy, barriers to dental treatment needs and action plan for implementation of the MOOC modules in each SEAR country. Results: Results highlighted the importance of formulating and implementing oral health policy at the national level among the participating countries. Nepal, Maldives, Timor–Leste reported on existing gaps regarding the unmet dental treatment needs. The inclusion of helath care workers in conducting dental procedures was observed in Bhutan. Global school health promoting initiatives were recorded in Maldives. The participating SEAR countries reported on the sensitization of primary healthcare workers through the developed MOOC modules. Conclusion: The developed massive open online course module was acknowledged to be an improved and interactive tool for primary health care workers by the country's oral health officers for oral health promotion and networking.

Introduction to this special issue.

Introduction to this special issue.

Advantages and Types of Bioceramics in Endodontics

The exponential rise of endodontics is aided by advancements in endodontic material sciences. Bioceramics are one of the most recently developed materials in endodontics, and they have completely transformed the field. Bioceramics are biocompatible ceramic materials or metal oxides with improved sealing properties, as well as antibacterial and antifungal activity, that are used in medicine and dentistry. The response to bioceramic technology in endodontics has been overwhelmingly positive. As more dentists think about the procedure, they are seeing not just the obvious advantages in endodontics, but they are also wondering how this technology may be used to other elements of dentistry. The purpose of this research is to review the available information about the advantages and types of bioceramics used in field of endodontics. Within the living environment, bioceramics are safe and compatible, non-toxic, non-shrinking, and chemically stable. Another benefit of such materials is their capacity to generate hydroxyapatite and, as a result, form a connection with dentin. Because of their interaction with periapical tissues, bioceramics contain bioactivity that aids bone healing and neoformation. Bioceramics have evolved into an important component of today's oral health care delivery systems. The entire extent of the possibilities is only now becoming apparent. Bioceramics are advantageous because of their biological compatibility and antibacterial capabilities however, in future more clinical studies need to be conducted and published to signify the importance of use of bioceramic materials in endodontics.

Integrating dentistry into palliative medicine - Novel insights and opportunities

Palliative care is a global human right, to be provided in a systematic way. The dentist can help the patient right from the initial diagnosis of the condition up to the relief of pain in the terminal stages of the diseases. This inquiry into the oral physician‘s role on elderly care and special needs would be of benefit to researchers of Palliative Dentistry; particularly in multidisciplinary contexts. This text proposes to discussintegrated oral care, oral health care delivery system, and a flow of educational actions, resources, research, conceptual framework, guidelines and dissemination of newer trends in oral palliative care.

Dental caries experience of schoolchildren of two different oral health care delivery systems

To report on the dental caries experience in schoolchildren from a region with a needs-based dental service compared with a region with a demand-led dental service. Cross-sectional study with clustered sampling. Urban primary schools in Dublin (Ireland) and Freiburg (Germany). 12-year-old schoolchildren. A trained and calibrated dentist examined a representative, random sample of schoolchildren under the same standardised conditions. Social class was recorded using the 'Goldthorpe-Social-Class-Schema'. Dental caries was recorded using WHO criteria. Atotal of 567 schoolchildren were examined, 332 in Ireland and 249 in Germany. For Ireland the mean DMFT in SC-1 (highest social class) was 0.28, in SC-2 (middle social class) it was 1.1 and in SC-3 (lowest social class) it was 0.94. For Germany the mean DMFT in SC-1 was 0.31, in SC-2 it was 0.61 and in SC-3 it was 1.33. This study demonstrated the existence of social gradients in dental caries levels in both samples but the magnitude of the difference varied across the two populations and appeared to be smaller in the needs-based dental service.

Assessment of Oral Health Care Delivery System in Greater Noida Using Five A’s Model

BACKGROUND: Access to dental health services refers not only to utilization but also to the extent by which the utilization is judged as per the professional norms using five independent dimensions of accessibility, availability, accommodation, affordability and acceptability. AIM: The aim of the study is to assess the dental services utilization among population of Greater Noida using Five A’s model. MATERIALS AND METHOD: The study was conducted in Dental College in Greater Noida. This cross-sectional study was carried out on the 200 subjects using convenient sampling on the patients visiting dental OPD.A self-administered structured questionnaire in English and Hindi language was used. Data was entered in the Microsoft excel sheet and analysed using SPSS (version 20.0).RESULTS: Mean level of access to dental services in the study population was 60.3.Corresponding figures for affordability, availability, accessibility, accommodation and acceptability were 55.2 ± 12.1,57.1± 12.8,60.75 ± 14.7,61.75 ± 8.7,58.65± 11.4 respectively.CONCLUSION: According to the results of our study , the level of access to dental care services is not very good with family income, location and level of education being the determinants of this access.

A Reflection Curriculum for Longitudinal Community-Based Clinical Experiences: Impact on Student Perceptions of the Safety Net.

Community-based dental education (CBDE) allows dental students to be immersed in community settings and provide care to populations that are underserved. Exposure to those groups during training may impact provider attitudes, which may be strengthened by supporting students' reflection and exploration of their own attitudes. The aim of this study was to describe the implementation and preliminary results of a pilot longitudinal reflection curriculum integrated into a community-based clinical experience (CBCE) for senior dental students at one U.S. dental school and to report the impact of the reflection curriculum and CBCE on student experiences with populations that are underserved. In academic year 2015-16, all 35 senior dental students at one U.S. dental school were invited to complete an 11-item survey before and after completing a 12-week CBCE with integrated, longitudinal online reflections. Students received feedback from a faculty member after each reflection. All 35 students completed the survey, for a 100% response rate. After the CBCE, the students reported improved clinical efficiency and increased confidence in treatment planning and in treating dental emergencies and dentally anxious patients. They also reported improved understanding of the structure and relevance of community health centers, the role of different health care team members, and the impact of health policy. There was no significant difference in future plans to work with groups that are underserved. These results suggest that the CBCE and reflection curriculum had a positive impact on the students' clinical confidence as well as expanding their understanding of the broader oral health care delivery system. To address persistent oral health disparities, dental schools should continue to adopt CBDE programming that will prepare providers to effectively care for populations that are underserved.

The Oral Health Care Delivery System in 2040: Executive Summary.

This executive summary for Section 4 of the "Advancing Dental Education in the 21st Century" project examines the projected oral health care delivery system in 2040 and the likely impact of system changes on dental education. Dental care is at an early stage of major changes with the decline in solo practice and increase in large group practices. These groups are not consolidated at the state level, but further consolidation is expected as they try to increase their negotiating leverage with dental insurers. At this time, there is limited integration of medical and dental care in terms of financing, regulation, education, and delivery. This pattern may change as health maintenance organizations and integrated medical systems begin to offer dental care to their members. By 2040, it is expected that many dentists will be employed in large group practices and working with allied dental staff with expanded duties and other health professionals, and more dental graduates will seek formal postdoctoral training to obtain better positions in group practices.

Feasibility Study for a Satellite Program of an Established School of Dentistry

Creative thinking is required to solve the many challenges the oral health care delivery system faces in meeting the needs of the U.S. Access to oral health care services varies widely across the country based on a host of factors including individual patient characteristics, demographic variables, and distribution of professionals by locale. There is also significant variability of need, so that many new solutions have been proposed to meet the needs of specific areas. In late 2012, the University of Missouri-Kansas City School of Dentistry embarked on a feasibility study to determine whether its existing DDS program could be extended closer to underserved areas of Missouri and surrounding regions by utilizing distance education and a clinical training facility in conjunction with another public university. This article describes the study and its outcomes. Other institutions may find this process useful as they assess factors that could impact the success of future programming and seek new solutions to long-standing problems.

Preventing Advanced Carious Lesions with Caries Atraumatic Restorative Technique

An alternative approach to controlling dental caries and preventing the associated pain, called atraumatic restorative technique (ART), is described for populations in need, where dental hygienists restore decayed teeth with glass ionomer restorations without prior removal of all decayed tooth structure. Background and purposeThere are populations whose decay needs are not adequately being met within the current oral health care delivery system. These include those in poverty conditions, vulnerable children, and the elderly who are often in long-term care facilities without adequate resources or opportunities for traditional dentistry. ART provides a viable option for controlling caries and relieving the pain of untreated decay. The purpose of this article is to suggest that the evidence surrounding ART be viewed objectively and that dental hygienists, with additional education in this approach, can contribute to relieving the pain of untreated dental decay. ConclusionEvidence suggests that teeth can be effectively restored with ART. Dental hygienists represent an appropriate workforce to provide ART with their current background and education combined plus a brief training program; it is suggested that dental hygiene educational programs include ART within the curriculum. Along with dental sealants and fluoride varnish application, ART can be an important component of a comprehensive preventive program to address the unmet needs of vulnerable populations.

Status of governmental oral health care delivery system in Haryana, India.

Background:Health system should be organized to meet the needs of entire population of the nation. This means that the state has the direct responsibility for the health of its population and improving the quality of life through research, education, and provision of health services. The present study was conducted to evaluate the government oral health care delivery system in Haryana, India.Materials and Methods:The present cross-sectional study was conducted among 135 dental care units (DCUs) of various primary health centers (PHCs), community health centers (CHCs), and general hospitals (GHs) existing in the state by employing a cluster random sampling technique. Data regarding the provision of water and electricity supply, dental man power and their qualification, number and type of instruments in the dental operatory unit, etc., were collected on a structured format. Statistical analysis was done using number and percentages (SPSS package version 16).Results:Alternative source of electricity (generator) existed in only a few of health centers. About 93.4% (155) of the staff were graduates (BDS) and 6.6% (11) were postgraduates (MDS). Ultrasonic scaler was available at dental units of 83.1% (64) of PHCs, 73.1% (19) of CHCs, and 93.8% (30) of GHs. Patient drapes were provided in 48.1% (65) of the DCUs, doctor's aprons were provided in 74.1% (100) of the places.Conclusion:There is a shortfall in infrastructure and significant problem with the adequacy of working facilities. A great deal of effort is required to harmonize the oral health care delivery system.

Evaluation of governmental oral health-care infrastructure in the state of Haryana.

Health system should be organized to meet the needs of entire population of the nation. Oral diseases are the most common of the chronic diseases, but there are few efficient dental care systems to cope with these problems. The present cross-sectional study was conducted among 135 dental care units of various primary health centers, community health centers, and general hospitals existing in the state to evaluate the government oral health-care infrastructure in Haryana. Data regarding provision of water and electricity supply, dental workforce and their qualification, number and type of instruments in the dental operatory unit, etc., were collected on a structured format. There is a shortfall in infrastructure and significant problem with the adequacy of working facilities. This can prove to be a big hurdle in the provision of adequate oral health care to people with greatest health-care needs. A great deal of effort is required to harmonize the oral health-care delivery system.

Comparative Study of Oral Health Promotion Activities between Malaysia and Thailand- An Outbound Programme

The Comparative Study of Oral Health Care Delivery Systems (between Malaysia and other countries) is a compulsory course in the Master of Community Oral Health (MCOH) degree. In 2015, the Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya formed a partnership with Chiang Mai University to organise an outbound programme which took place from 3-7 August 2015. Three MCOH postgraduate students from UM and one accompanying lecturer participated in this outbound programme. The aim of the programme was to compare and evaluate the oral health care delivery systems between Malaysia and Thailand. The objectives of the outbound programme were 1) To observe the public health care services in Chiang Mai. 2) To observe the implementation of the central policy through a field visit at different levels, i.e. central (federal), intermediate (state & district level) and primary health care delivery system between Malaysia and Chiang Mai. During the outbound program, the places visited were Faculty of Dentistry, Chiang Mai University. Intercountry Centre for Oral Health (ICOH), a community-based defluoridation programme, hospital and district level oral healthcare facilities in Sansai district and Rajanagarindra Institute of Child Development. This report is aimed to describe the oral health promotion activities in Thailand in comparison to those activities in Malaysia. In Thailand, various programmes are being implemented to promote the health (including oral health) of the population. These activities are organized by the Thai Health Promotion Foundation (Thai Health). Many of the activities place emphasis on individualised oral health promotion activities. Thailand is also known for its community-based on oral health promotion programme which was developed and delivered by the ICOH.

Job satisfaction and perceived future roles of Malaysian dental therapists: findings from a national survey

To assess Malaysian dental therapists' perceptions of their job satisfaction and future roles. A nationwide postal survey involving all Malaysian dental therapists who met the inclusion criteria (n = 1726). The response rate was 76.8%. All respondents were females; mean age 35.4 years (SD = 8.4). Majority were married (85.5%) and more than one-half had a working experience of <10 years (56.1%). Majority worked in community dental service (94.3%) and in urban areas (61.7%). Overall, they were highly satisfied with most aspects of their career. However, they were least satisfied with administrative workload (58.1%), career advancement opportunities (51.9%) and remuneration package; specifically income (45.2%), allowances (45.2%) and non-commensurate between pay and performance (44.0%). Majority perceived their role as very important in routine clinical tasks such as examination and diagnosis, preventive treatment, extraction of deciduous teeth and oral health promotion. However, fewer than one-half consider complex treatment such as placement of preformed crowns on deciduous teeth (37.1%) and extraction of permanent teeth (37.2%) as very important tasks. Majority expressed high career satisfaction with most aspects of their employment but expressed low satisfaction in remuneration, lack of career advancement opportunities and administrative tasks. We conclude that most Malaysian dental therapists have positive perceptions of their current roles but do not favour wider expansion of their roles. These findings imply that there was a need to develop a more attractive career pathway for therapists to ensure sustainability of effective primary oral healthcare delivery system for Malaysia's children.

Guest Editorial on the Festschrift “Challenges in population oral health for the 21st Century”

This Festschrift provides important and valuable guidance on population oral health. It is unfortunate that it coincides with the retirement of one of population oral health's pioneers, Professor John (AJ) Spencer, who has made significant contributions to the subject over the last 35 years. Oral diseases and disorders remain prevalent and have detrimental effects on individuals, and society-at-large. Many of our attempts to improve population oral health through existing oral health services have met with limited success, owing to the focus on 'care' rather than 'cure'. It has long been recognised that oral diseases are largely behavioural in origin; but this approach at the individual level has not been entirely successful. There is a need to consider 'mid- and up-stream' approaches to changing oral health and health care delivery systems. However social inequalities are a major determinant of oral health, and their influence in oral health are omnipresent, which emphasises the important role of population oral health in future health care strategies. The Festschrift provides theoretical and empirical evidence of the need for further epidemiological investigations (particularly life course studies), innovative approaches to oral health surveillance and oral health outcome evaluation, plus a realisation that multidisciplinary approaches are the way forward. In an information and globalization era, we must put the 'population' into oral health and this is our challenge for the 21st Century.

Envisioning an oral healthcare workforce for the future

Health is critical to human well-being. Oral health is an integral component of health. One is not healthy without oral health. As health is essential to human flourishing, it is important that an oral healthcare delivery system and workforce be developed and deployed which can help ensure all citizens have the potential to access oral health care. As such access does not generally exist today, it is imperative to advance the realization of this goal and to develop a vision of an oral healthcare workforce to functionally support access. Public funding of basic oral health care is an important element to improving access. However, funding is only economically feasible if a workforce exists that is structured in a manner such that duties are assigned to individuals who have been uniquely trained to fulfill specific clinical responsibilities. An essential element of any cost-effective organizational system must be the shared responsibility of duties. Delegation must occur in the oral health workforce if competent, cost-effective care is to be provided. Desirable members of the oral health team in an efficient and effective system are as follows: generalist dentists who are educated as physicians of the stomatognathic system (oral physicians), specialist dentists, dental therapists, dental hygienists, dually trained hygienists/therapists (oral health therapists), oral prosthetists (denturists), and expanded function dental assistants (dental nurses).

Beginning the Socialization to a New Workforce Model: Dental Students’ Preliminary Knowledge of and Attitudes About the Role of the Dental Therapist

The purpose of the study reported here was to assess first- and second-year dental students' knowledge of and attitudes about the role of the dental therapist in the oral health care delivery system. The results of this study are informing the continued development and implementation of a new dental workforce training model at the University of Minnesota. Dental students at the university (Classes of 2012 and 2013) were surveyed in 2009, with follow-up surveys planned for the subsequent five years. Multiple-choice questions and statements to be ranked using a Likert scale were used to determine what the students knew and thought about dental therapists' scope of practice, care delivery, work quality, cost-effectiveness, and role in reducing disparities in oral health care access. The results suggest that the students had generally neutral or uncertain attitudes about dental therapy, based on minimal knowledge about the role of dental therapists. In addition, we found little difference in attitudes between the two classes, the only exception being that the first-year students less often perceived the therapists as a solution to access problems. These baseline data are guiding the intraprofessional training of dental, dental hygiene, and dental therapy students toward the goal of positive socialization to a new workforce model and affirmation of the dental therapist as a member of the oral health care team.

Improving oral healthcare delivery systems through workforce innovations: an introduction

The objective of this paper is to describe the purpose, rationale and key elements of the special issue, Improving Oral Healthcare Delivery Systems through Workforce Innovations. The purpose of the special issue is to further develop ideas presented at the 2009 Institute of Medicine (IOM) workshop, Sufficiency of the U.S. Oral Health Workforce in the Coming Decade. Using the IOM discussions as their starting point, the authors evaluate oral health care delivery system performance for specific populations' needs and explore the roles that the workforce can play in improving the care delivery model. The contributing articles provide a broad framework for stimulating and evaluating innovation and change in the oral health care delivery system. The articles in this special issue point to many deficits in the current oral health care delivery system and provide compelling arguments and proposals for improvements. The issues presented and solutions recommended are not entirely new, but add to a growing body of work that is of critical importance given the context of wider health care reform.

Attributes of an ideal oral health care system

The sense of urgency concerning the inadequacies of the current U.S. oral health care system in better preventing oral diseases, eliminating oral health disparities, and ensuring access to basic oral health services has increased in recent years. This paper sought to articulate the attributes that an ideal oral health care system would possess, which would be consistent with the principles of the leading authorities on the public's health. The authors reviewed policy statements and position papers of the World Health Organization, The Institute of Medicine, The American Public Health Association, Healthy People 2010 Objectives for the Nation, and the American Association of Public Health Dentistry. Consistent with leading public health authorities, an ideal oral health care system would be have the following attributes: integration with the rest of the health care system; emphasis on health promotion and disease prevention; monitoring of population oral health status and needs; evidence-based; effective; cost-effective; sustainable; equitable; universal; comprehensive; ethical; includes continuous quality assessment and assurance; culturally competent; and empowers communities and individuals to create conditions conducive to health. Although there are some attributes of an ideal oral health care system on which the United States has made initial strides, it falls far short in many areas. The development of an oral health care delivery system that meets the characteristics described above is possible but would require tremendous commitment and political will on the part of the American public and its elected officials to bring it to fruition.

Envisioning success: the future of the oral health care delivery system in the United States

AbstractThe elimination of oral health disparities in the US will require enhancing access to oral health care services. The workshop convened in 2009 by the Institute of Medicine on the “US Oral Health Workforce in the Coming Decade” highlighted both the current workforce's failure to meet the nation's needs as well as the promising opportunities presented by various workforce strategies to significantly enhance access and improve oral health outcomes. In this article, we have briefly reviewed and expanded on the contributions in this special issue of the Journal of Public Health Dentistry, with the goal of identifying common themes and providing a framework for evaluation. There are several key areas where change is critically needed in order to ensure successful implementation of any new workforce models. These areas include a) the public and private financing of dental care, b) the dental educational system, and c) state and federal policies.