Oral Health Care For Patients Research Articles

A critical synthesis of the role of the pharmacist in oral healthcare and management of medication-related osteonecrosis of the jaw

ObjectiveTo consolidate extant published evidence in relation to the potential of integrating oral healthcare for patients at risk of developing medication-related osteonecrosis of the jaw (MRONJ).MethodsA critical synthesis and consolidation of five publications was undertaken. As a mechanism of situating the extant work within the context of primary healthcare provision, the Rainbow Model of Integrated Care was applied as a theoretical lens through which the conceptual findings could be collectively applied to practice.ResultsThe critical synthesis revealed a thematic emergence relating to both formative and normative integration. The most salient of these were the identification of limited shared clinical records, and disconnection of oral healthcare provision from patients’ general medical care. The three levels of the Rainbow Model of Integrated Care reflected a series of issues for address.ConclusionIn the context of collaborative, multi-disciplinary working for patients at risk of development of MRONJ, pharmacists are a professional group which this research reveals to be an underutilised resource. Reduction of oral health inequality at all levels of patient care is a key priority and this research highlights areas for address in relation to requirements for interprofessional education, optimal communication and policies reflective and facilitative of these.

Proposal of Dental Hygiene Diagnosis for Cancer Patients Based on Dental Hygiene Process of Care in Acute Care Hospitals: A Narrative Review.

A narrative review was conducted to propose dental hygiene diagnoses for cancer patients based on dental hygiene process of care in acute care hospitals. Six researchers, including three dental hygienists, all with expertise in oral healthcare for patients with cancer, decided the review outline. All researchers reviewed the literature and developed terminology for dental hygiene diagnoses. The team then modified the terminology and discussed its clarity and acceptability to develop an initial list of dental hygiene diagnosis names according to the dental hygiene human needs conceptual model subscales. In wholesome facial image, one new diagnosis was developed. In protection from health risks, 15 new diagnoses were developed. In biologically sound and functional dentition, 10 new diagnoses were developed. In skin and mucous membrane integrity of the head and neck, 10 new diagnoses were developed. In freedom from head and neck pain, two new diagnoses were developed. In freedom from anxiety and stress, eight new diagnoses were developed. In responsibility for oral health, five new diagnoses were developed. In conceptualization and understanding, three new diagnoses were developed. Based on this study, it is necessary for the academic community to develop a better taxonomy of dental hygiene diagnoses pertaining to dental hygienist clinical practice.

Systemic sclerosis: Update for oral health care providers.

Systemic sclerosis (SSc), also known as scleroderma, is an autoimmune disease of unknown origin characterized by an uncontrolled inflammatory process resulting in fibrosis of the skin, internal organs and vasculopathy. Manifestations of SSc are heterogenous and can include pulmonary, cardiac, neural, renal, muscular, cutaneous and orofacial complications. Recent scientific advances have led to a better understanding of disease etiopathogenesis and the development of a new classification system. Therapeutic management is often multidisciplinary and targeted toward the affected organs. Oral health care providers (OHCPs) should be familiar with SSc, particularly as it relates to its impact on the orofacial region and modifications to delivery of oral health care for patients with this condition.

Mammalian Target of Rapamycin (mTOR) Inhibitors Induce Stomatitis in Patients with Metastatic Breast Cancer (Review)

Metastatic breast cancer patients may acquire oral morbidity from therapeutic procedures. A common adverse event (AE) of the Mammalian target of rapamycin (mTOR) inhibitor is associated stomatitis (mIAS) secondary to mTOR inhibitor therapy, which have a negative impact on the quality of life, therapy adherence and health care expenses. A multidisciplinary team strategy is essential for reducing mIAS and capitalize on therapy advantages for breast cancer patients. We discuss the pathophysiology, diagnosis, and natural history of mIAS in this review. In the context of promoting a coordinated team care approach to optimizing patient care, current and new management policies are outlined for the prevention and treatment of mIAS. Types of Studies Reviewed: We piloted different research from 2007 through 2019 using the terms “stomatitis,” “mIAS,” “mTOR,” “everolimus,” “oral care.” and “metastatic breast cancer,” We have chosen papers from peer-reviewed journals reporting controlled trials and evidence-based guidance. Results: Cytototoxic chemical or radiation therapy causes, clinical presentation, and paradigms of therapy can distinguish mIAS from mucositis. The continuum of patient oral health care may include specific preventive and therapeutic leadership approaches. Practical consequences: Oral health providers are at the forefront of oral health care for patients who have metastatic breast cancer and are uniquely positioned to deliver patient education, to advocate precise reporting of mIAS, and to encourage early identification, monitoring and rapid intervention to reduce the serious and time-limiting dose of this manageable AE.

Using the web to increase access to oral health care for patients with special health care needs in South Carolina: A replicable model.

To create an accessible web-based resource of providers willing to provide dental services for patients with special health care needs (SCHNs). With a grant from The Duke Endowment, surveys were sent to dentists in South Carolina RESULTS: Data showed that the majority of providers expressed willingness to treat patients with one or more mild SHCN, but fewer expressed willingness to treat those with one or more moderate or severe SHCN. Additionally, the data showed that among general practitioners specifically, only one-third were willing to treat mild and moderate/severe manifestations of all categories listed. The number of practitioners willing to treat moderate to severe manifestations of SHCN and accept Medicaid and willing to take new Medicaid patients dropped even further. These results demonstrated a need to increase the number of providers in South Carolina who are willing to treat patients with SHCN, and a need to provide an accessible resource for patients with SHCN to be able to find these providers. Data collected populated the web-based resource for the Special Adult Network of Dentists url:www.sandsc.org1 CONCLUSION: This resource may be used by patients, caregivers, and health care providers and could be replicated in other states or designed as a national resource.

Ventilator-associated pneumonia and SARS-CoV-2 (COVID-19): An invisible risk for patients

The present note aims to alert the importance of oral healthcare in patients under mechanical ventilation by COVID-19. Patients hospitalized for long periods and needing the support of mechanical ventilators are susceptible to secondary infections. Thereby, many patients may have already died from infections, secondary to pneumonia caused by COVID-19.

Oral health care provided by nurses for hospitalized patients in Korea.

To investigate registered nurses' awareness and implementation of oral health care in patients who are hospitalized in general wards or intensive care units (ICUs) in South Korea. This research was performed as a descriptive survey of 149 nurses working in nine general hospitals with at least 100 beds in major Korean cities. Approximately half (40.9%) of the survey respondents reported providing oral health care for hospitalized patients but that relevant protocols were not available at most hospitals or wards (89.5%). Nurses working in an ICU were significantly more likely to provide oral health care than those working in general wards (83.9% vs 15.1%; P<.001). Most respondents (83.2%) were aware of the importance of providing oral health care for hospitalized patients; however, the proportion considering that such care should be provided by dental hygienists was greater than that considering it should be provided by nurses (36.4% vs 26.0%; P<.001). Agreement that oral health care should be provided for hospitalized patients by dental hygienists was highest in nurses working in ICUs (53.3%; P<.001). According to this survey, oral healthcare provision is generally low in hospitalized patients and differs between ICUs and general wards. Most respondents considered that dental hygienists should provide oral health care for hospitalized patients. There is an opportunity for nurses and dental hygienists to work collaboratively towards development of an evidence-based protocol for oral health care in hospitalized patients.

Comprehensive oral care improves treatment outcomes in male and female patients with high-severity and chronic substance use disorders

BackgroundUsing data from a workforce training program funded by the Health Resources and Services Administration, the authors de-identified pre- and posttreatment assessments of high-severity and chronic substance use disorders (SUDs) to test the effect of integrated comprehensive oral health care for patients with SUDs on SUD therapeutic outcomes. MethodsAfter 1 through 2 months of treatment at a SUD treatment facility, 158 male self-selected (First Step House) or 128 randomly selected sex-mixed (Odyssey House) patients aged 20 through 50 years with major dental needs received integrated comprehensive dental treatment. The SUD treatment outcomes for these groups were compared with those of matched 862 male or 142 sex-mixed patients, respectively, similarly treated for SUDs, but with no comprehensive oral health care (dental controls). Effects of age, primary drug of abuse, sex, and SUD treatment facility–influenced outcomes were determined with multivariate analyses. ResultsThe dental treatment versus dental control significant outcomes were hazard ratio (95% confidence interval [CI]) 3.24 (2.35 to 4.46) increase for completion of SUD treatment, and odds ratios (95% CI) at discharge were 2.44 (1.66 to 3.59) increase for employment, 2.19 (1.44 to 3.33) increase in drug abstinence, and 0.27 (0.11 to 0.68) reduction in homelessness. Identified variables did not contribute to the outcomes. Conclusions and Practical ImplicationsImprovement in SUD treatment outcomes at discharge suggests that complementary comprehensive oral health care improves SUD therapeutic results in patients with SUDs. Integrated comprehensive oral health care of major dental problems significantly improves treatment outcomes in patients whose disorders are particularly difficult to manage, such as patients with SUDs.

Oral health care for patients with Alzheimer's disease: An update.

Alzheimer's disease and related disorders (ADRD) are among the age-associated chronic conditions that are most challenging to health care systems around the globe, as patients with dementia require full-time, intensive care for multiple years. Oral health care is negatively impacted by cognitive decline, and consequently poor oral health is common among people with ADRD. Poor oral health status is linked with many undesirable consequences for the well-being of people with ADRD, from excruciating local pain to life-threatening conditions, as aspiration pneumonia. In this paper, the authors provide an update on the most current concepts about Alzheimer's disease epidemiology, etiology, and management, current oral health care for patients with Alzheimer's disease, oral health promotion strategies for this population, as well as current research and future direction for improving oral health care for patients with Alzheimer's disease. It concludes that oral health care should be included in the patient's routine health care as early as possible in the progression of Alzheimer's disease for preventing rapid oral health deterioration. Establishing oral hygiene routines and providing dental treatment that is customized to the patients' individual needs and disease stage are important to achieve good oral health outcomes and prevent quality of life decline.

Awareness and approaches in treating patients with special needs among dental practitioners of Chennai City: A pilot study

Background: Special children are among the underserved dental patient groups around the globe, and their oral health care still remains an unmet challenge among the dental practitioners. One out of two persons with a disability cannot find an oral health professional resource to provide appropriate dental care. The identification of barriers can be the first step in addressing the deficiencies in dental care for such patients. Aim: The aim of the study is to assess the knowledge, attitude, and practices toward treating patients with special care need among private dental practitioners employed at a private dental teaching institution. Materials and Methods: A cross-sectional pilot study was conducted among a conveniently sampled 45 dental professionals from the same institution who were both private dental practitioners as well as academicians. The study was conducted between November 2017 and December 2017. Participants were interviewed through a validated questionnaire, which consisted of 14 items. The questionnaire comprised demographic details of the participants, their years of dental experience, disabled patients they had encountered so far in their practice, and questions related to their attitude, perception, and practice to provide oral health care for patients with special needs. Informed consent was obtained from the participants prior to the study. The data obtained were entered into Microsoft Excel 2010 and descriptive statistics was computed using the SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results: A response of 71% was obtained. Majority of the dentists (65%) were unaware of the Right to Disability Act. Half of the dentists (50%) felt teledentistry would do more good to people with special needs. About (31.8%) of them felt inadequate training to handle patients with special needs as major barrier faced while treating them. Conclusion: Majority of the study participants felt inadequate training among the dental practitioners as barrier to treat special needs patients and hence suggested incorporation of special care dentistry into the dental curriculum.

Oral health care for patients with developmental disabilities: A survey of Michigan general dentists.

The aim of this study to examine the level of access to dental care in Michigan for individuals with DD and explore the dentists' practices, attitudes, and perceived barriers to providing care to this vulnerable population. A survey was mailed to a random sample of 1250 general dental practitioners with an active license in the State of Michigan. The survey included questions related to dentists' demographic information, opinion about willingness, barriers, and training needs associated with delivering care to children and adults with developmental disabilities. Descriptive statistics were computed and chi-squared tests and logistic regression models analyzed the association between predictor and key outcome variables. Results show that most dentists treated individuals with developmental disabilities (80.3%). Respondents who indicated that they currently do not treat these patients identified behavior management of patient (67.9%), inadequate training and experiences (52.4%) and severity of patient's condition (41.7%) as the most common reasons for not providing care to individuals with developmental disabilities. A majority of Michigan general dentists treat patients with developmental disabilities. Addressing barriers like training and improved reimbursements might help in increasing the number of dentists willing to treat patients with developmental disabilities.

Stomatitis associated with mammalian target of rapamycin inhibition: A review of pathogenesis, prevention, treatment, and clinical implications for oral practice in metastatic breast cancer

BackgroundPatients with metastatic breast cancer may develop oral morbidities that result from therapeutic interventions. Mammalian target of rapamycin (mTOR) inhibitor–associated stomatitis (mIAS) is a common adverse event (AE), secondary to mTOR inhibitor therapy, that can have a negative impact on treatment adherence, quality of life, and health care costs. A multidisciplinary team approach is important to minimize mIAS and to maximize treatment benefits to patients with breast cancer. In this review, we discuss the pathophysiology, diagnosis, and natural history of mIAS. Current and new management strategies for the prevention and treatment of mIAS are described in the context of fostering a coordinated team care approach to optimizing patient care. Types of Studies ReviewedThe authors conducted a PubMed search from 2007 through 2017 using the terms “stomatitis,” “mIAS,” “everolimus,” “mTOR,” “metastatic breast cancer,” and “oral care.” They selected articles published in peer-reviewed journals that reported controlled trials and evidence-based guidelines. ResultsmIAS can be distinguished from mucositis caused by cytotoxic chemotherapy or radiotherapy on the basis of cause, clinical presentation, and treatment paradigms. Specific preventive and therapeutic management strategies can be implemented across the continuum of patient oral health care. Practical ImplicationsOral health care providers are on the frontline of oral health care for patients with metastatic breast cancer and are uniquely positioned to provide patient education, advocate accurate reporting of mIAS, and support early identification, monitoring, and prompt intervention to mitigate the severity and duration of this manageable, potentially dose-limiting AE.

Development of a managed clinical network in oral medicine.

Oral medicine is concerned with the oral health care of patients with chronic, recurrent and medically related disorders of the oral and maxillofacial region, and with their diagnosis and non-surgical management. For historical reasons care for conditions falling within the scope of oral medicine practice has been inconsistent with limited planning of clinical services. Managed Clinical Networks (MCNs) bring advantages to all stakeholders with a positive impact on patient pathways and access to equitable and quality care across a network of providers working in a coordinated way to make best use of NHS resources. MCNs provide a framework to address the limitations of legacy arrangements and are very relevant to dentistry. Here we describe oral medicine MCN development in Yorkshire and the Humber within the framework of the Five year forward view NHS policy. A step-wise approach is being taken across the region to introduce an MCN model that reflects cooperative working between oral medicine, oral surgery, oral & maxillofacial surgery and other stakeholders. Preliminary data are already informing how a regional oral medicine MCN can be further developed with the potential for translation of the lessons learned to other regions.

Prospective cohort study of dental implant success rate in patients with AIDS.

BackgroundOral health care of patients with acquired immune deficiency syndrome (AIDS) due to human immunodeficiency virus (HIV) is a growing area of concern, taking into consideration the increased life expectancy of patients resulting from antiretroviral therapy. There is insufficient literature regarding the impact of dental implants in AIDS patients. This study investigated the long-term clinical outcome of implant placement in patients diagnosed with AIDS.MethodsThis monocentric study included AIDS patients with CD4 <200 cells/μL, age 18 years or older, and a minimum of one edentulous space requiring implant. All patients in the study were undergoing highly active antiretroviral therapy (HAART). HAART includes nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs). Typical treatment includes two different NTRIs, along with a third drug, either an INSTI, a PI, or an NNRTI. Bicon dental implants were placed in the patients after medical clearance and were followed up for 5 years. Bicon system implants were chosen because of availability and previous experience with this brand. Implant success criteria are defined as implants that had no clinical mobility at uncovering, no radiographic radiolucency, and allowed for loading and abutment placement. Implant success in AIDS patients was measured over a period of 5 years. Descriptive statistics were used.ResultsSixteen adults met the inclusion criteria (12 males and 4 females) with mean CD4 count as 141.25 (sd 35.5). Thirty-three implants were placed in selected patients. Average time to uncovering was 151 days (sd 25 days). Two of the three failures were maxillary implants in the anterior arch, and the third was in the mandibular posterior arch.ConclusionsThe study found a slightly higher failure rate of 10 % in patients with AIDS, compared to widely accepted failure rates in healthy patients at 5–7 %. With the advent of new medical therapies, even AIDS patients should be offered the option of root-formed implants as a viable alternative to fixed and removable prosthetics.

Promoção de saúde bucal e extensão universitária: novas perspectivas para pacientes com necessidades especiais

Este relato de experiência faz uma reflexão acerca da importância da extensão universitária para consolidação das mudanças nos conceitos de atenção à saúde dos pacientes com necessidades especiais. O projeto de extensão “Promoção de Saúde Bucal para Pacientes Especiais- PROSBE” ocorre no Centro Integrado de Educação Especial (CIES – Teresina/Piauí), promovendo capacitação para professores e responsáveis sobre a importância da promoção de saúde bucal, através de práticas de uma equipe multidisciplinar. Ações educativas podem desenvolver competência e estímulo aos responsáveis pelos pacientes e propiciar aos estudantes segurança e familiaridade no atendimento aos pacientes especiais. O PROSBE favorece o convívio entre os profissionais e o binômio aluno/professor universitário, propiciando pesquisas e uma relação social de impacto entre a Universidade e a sociedade. Além disso, este trabalho enaltece a indissociabilidade ensino-pesquisa-extensão que reafirma a extensão como processo acadêmico de formação e de geração de conhecimentos.

Knowledge and attitude of Indian clinical dental students towards the dental treatment of patients with human immunodeficiency virus (HIV)/acquired immune-deficiency syndrome (AIDS)

Oral health care of patients with human immunodeficiency virus (HIV)/acquired immune-deficiency syndrome (AIDS) is a growing area of concern. Information on HIV- and AIDS-related knowledge among dental students provides a crucial foundation for efforts aimed at developing an appropriate dental curriculum on HIV and AIDS. The purpose of this study was to assess the knowledge and attitude of Indian clinical dental students towards the treatment of patients with HIV/AIDS and perceived sources of information regarding HIV-related issues. Data were collected from clinical dental students (third year, fourth year and internship) from three dental institutions in Delhi National Capital Region (NCR). The questions assessed the knowledge and attitude towards treatment of patients with HIV and the perceived source of information related to HIV. The willingness to treat HIV-positive patients among dental students was 67.0%, and 74.20% were confident of treating a patient with HIV/AIDS. The potential problems in rendering treatment to these patients were effect on the attitude of other patients (49.90%) and staff fears (52.50%). The correct knowledge regarding the infection-control practice (barrier technique) was found among only 15.50% of respondents. The respondents had sufficient knowledge regarding the oral manifestations of HIV/AIDS. There was no correlation between the knowledge and attitude score, demonstrating a gap between knowledge and attitude among dental students regarding treatment of HIV-infected patients. Appropriate knowledge has to be delivered through the dental education curriculum, which can instil confidence in students about their ability to manage HIV-positive patients.

Oral surgery in patients undergoing chemoradiation therapy.

Oral health care in patients undergoing chemotherapy and/or radiation therapy can be complex. Care delivered by a multidisciplinary approach is timely and streamlines the allocation of resources to provide prompt care and to attain favorable outcomes. A hospital dentist, oral and maxillofacial surgeon, and a maxillofacial prosthodontist must be involved early to prevent avoidable oral complications. Prevention and thorough preparation are vital before the start of chemotherapy and radiation therapy. Oral complications must be addressed immediately and, even with the best management, can cause delays and interruption in treatment, with serious consequences for the outcome and prognosis.

A review of continuing professional development for dentists in Europe*

To summarise findings from a literature review of dentists' engagement in continuing professional development (CPD) and its effects on improving oral health care for patients. The search strategy used key terms in a range of databases and an academic literature search engine, complemented by hand searching and citation follow-up. One hundred and fourteen papers were reviewed. The majority of dentists engaged in CPD. Factors affecting participation included time since graduation, costs, work and home commitments, postgraduate qualification, interest and convenience. Learning needs identification and reflection on practice were rarely evidenced. Common modes of CPD were courses and journal reading; no one delivery method proved more effective. Few papers directly explored recommendations for topics although suggestions related to common areas of error and gaps in knowledge or skill. Studies of CPD effectiveness and impact-on-practice suggested that courses can result in widespread new learning and considerable self-reported change in practice. However, significant barriers to implementing change in workplace practice were noted and included availability of materials, resources and support from colleagues. To ensure high standards of care, alongside recommending core or mandatory topics, more attention should be given to reflection on learning needs, the learner's readiness to engage with education and training and the influence of the workplace environment.

Coordinated Oral Health Care in Patients With Cancer

Abstract Introduction Cancer therapy, either with ionizing radiation or chemotherapeutic agents, is based on the principle of destruction of rapidly replicating cancer cells. Although effective in ...

Knowledge of oral cancer and screening practice of B.Sc. nursing students in Davangere City, India

Background: Oral cancer mainly affects individuals in the 6 th and 7 th decades of life with a history of risk factors like, smoking, tobacco chewing and alcohol consump­tion. Early recognition and referral is essential for higher cure rates and better quality of life. Nursing staff provides the oral health care for patients in hospital. Admission to hospital provides a ''window of opportunity'' for oral cancer screening via an oral health checkup during nursing care. Objective: To measure awareness of risk factors, clinical signs and screening service for oral cancer among nursing students. Materials and Methods: A cross-sectional questionnaire survey was conducted in two Nursing Colleges of Davangere city. The questionnaire consisted of 17 closed ended questions. The questionnaire was pre-tested and validated before administering. Results: Among 300 nursing students, 231 were females and 69 were males. Over 90% thought oral health checkups were important although only 69% performed oral examination regularly; approximately 90% identified smoking and use of tobacco products as a risk factor but very few identified other associated factors like alcohol. Only 55% of the respondents were aware about the most common site of occurrence of oral cancer. Only 49% recognized a non healing ulcer as a sign of oral cancer. Over 90% of the students felt that a nursing student needs more education about screening for oral cancer and were willing to participate in a network to promote early screening for oral cancer. Conclusion: This study revealed that nurses' awareness of oral cancer risk factors and clinical signs, in the group under study was, however, poor. This study highlights a need for improved education of nurses on oral cancer to make the oral health checkup on admission viable for oral cancer screening.