Oral Health Care For People Research Articles

INTEGRALIDADE NA ATENÇÃO EM SAÚDE BUCAL PARA PESSOAS COM DEFICIÊNCIA

Introduction: Comprehensiveness in oral health care for people with disabilities. These are principles that seek to ensure comprehensive care in the social and family context. The objective of the present study was to discuss aspects related to comprehensive care in dental services offered by the Unified Health System (SUS) for patients with disabilities. Material and Method: This is a narrative review of the literature with research in the Scholar Google, SciELO, PubMed and Virtual Health Library databases, using the descriptors "Integrality", "People with Disabilities" and "Collective Health". Results: Articles that met the selected inclusion criteria were selected. Conclusion: Special care for people with disabilities is a skill that should be developed by dentists, strengthening the principles of the SUS and the consolidation of curricular guidelines and humanizing care.

Readiness of dentists in providing oral health care for HIV/AIDS patients: Insights from Ho Chi Minh City, Vietnam

Limited research has been conducted to identify barriers to dentists’readiness in providing oral health care for people living with HIV/AIDS (PLWH) in Southeast Asia and Viet Nam. This study aimed to evaluate the readiness of dentists in providing oral health care for PLWH in Ho Chi Minh City, Vietnam. A total of 414 dentists participated in this cross sectional study, with an average age of 39.17 ± 11.52 years and an average professional experience of 14.10 ± 11.37 years. The online fill-in-the-blank questionnaire with 10 items related to dentists’readiness in providing oral health care services for PLWH was sent to the study participants. Results revealed that 35.75% of dentists were willing to treat HIV/AIDS patients, 41.30% held neutral opinions, and 22.95% were unwilling. The majority of dentists (77.29%) were aware of ART therapy, but only 4.83% perceived themselves as having adequate knowledge of each treatment protocol for HIV/AIDS patients. Additionally, 22.71% had no knowledge of ART therapy. Concerningly, 77.05% believed in the risk of transmission during ART treatment, with varying perceptions of risk: 18.60% high, 16.18% moderate, and 42.27% low. Furthermore, 10.14% perceived almost no risk, and 12.80% were unsure or lacked knowledge. Dentists’opinions about providing oral health care for people living with HIV/AIDS will offer valuable insights for developing strategies tailored to this special community.

Providing better access to oral health care for people receiving substance use treatment: A timely discussion.

Substance use disorders are a risk factor for poor oral health which in turn impacts quality of life. Resultant oral problems contribute to chronic illness, premature mortality, social stigma, embarrassment and reduced opportunities for employment and social interaction. Providing dental services to people with substance use disorders is often difficult due to high rates of oral disease, anxiety, behavioural and drug use changes, and lifestyle factors. Previous studies have demonstrated that alcohol and other drug service clients find accessing and navigating oral health services complex and suggest a multidisciplinary care approach to improve outcomes. In this commentary, we describe individual and structural barriers that limit the use of oral health care among people with substance use disorders, alcohol and other drug clinicians' challenges to integrating oral health into their practice and identify key issues for oral health services in delivering care. We draw on our experience to recommend a multidisciplinary approach be used to develop strategies in order to increase access to oral health services at a standard similar to the general population for clients of alcohol and other drug services.

Trauma-informed care: An approach to improve oral health care for people with HIV.

Trauma-informed care: An approach to improve oral health care for people with HIV.

Interventions supporting community nurses in the provision of Oral healthcare to people living at home: a scoping review

BackgroundOral health is a critical issue for public health and poor oral health is associated with significant chronic health conditions and lower quality of life. There has been little focus on providing oral health care to people who receive care in their own homes, despite the high risk of poor oral health in older people. Nurses practicing in the community are well placed to deliver this care, but little is known about how to build this capability through education or training interventions.MethodsA scoping review methodology was employed to find and review studies of oral health interventions involving populations of people receiving care in their own home or those nurses who deliver this care. The research question asked what previous research tells us about oral health interventions delivered by nurses in the community. Data was extracted for four areas: setting and type of intervention, patient outcomes, changes to nursing practice and implementation and process evaluations of interventions.ResultsTwo thousand eighty papers were found from the searches, and only nine were ultimately deemed eligible for inclusion in the review. Included studies spanned community nursing for older people (n = 3) and health visiting or community nursing for children and infants (n = 6). Patient outcomes were generally positive, but this is based on a low level of evidence. Changes to practice including increased oral health care administered by nurses were found, but this required professional support to be sustainable.ConclusionsThis review has found that there is a clear gap in the research around interventions designed to be used by community nurses to improve oral health care for people receiving care in their own homes. The results also suggest that any future intervention must make use of a participatory, co-design approach and consider the complex setting of nursing practice in the community and the barriers to delivering this care, such as time pressure and lack of prior experience.

Oral Health Care of People with Disabilities - A Challenge in Dental Education in Georgia

Introduction: The dental caries and periodontal disease are the most prevalent diseases in people with disabilities. In 2014 The Association for Dental Education in Europe set up a special interest group to develop the field “Special Care dentistry”, which provides oral care services for people who are unable to accept routine dental care. Aim: This article aims to substantiate the role of implementation “Special Care Dentistry” in the dental curriculum and describes the importance of continuing medical education for the dentists, to provide equal and adequate dental services to the people with disabilities in Georgia. Methods: The first part of research was based on the analysis of the secondary data for identification the structure of the dental education programs of Georgian higher education institutions; A quantitative and qualitative data was analyzed among 160 people with disability through a specially designed questionnaire, deep interviews were conducted with participants, dentists, and managers of dental clinics. Results: 25% of Dental Clinic Managers reported, that their clinics are adapted for people with disabilities. Dental caries 18%, missed tooth due to caries 24% and gingival bleeding was detected in 47.8% of study participants, among them 10.6% outlined the lack of doctor qualifications and experience. Discussion: Provision comprehensive dental services to people with disabilities remain a significant challenge for dental clinics. A small number of dentists in Georgia have completed a continuing medical education course in special care dentistry. Conclusions: The oral health of people with disabilities in Georgia is unsatisfactory. More affords should be performed to implement “Special Care Dentistry” in dental education in Georgia.

Oral Health Care of People with Down Syndrome in Germany.

Background: Due to a dearth of information on preventive and supportive oral care for people with Down Syndrome (PDS) in Germany, caregivers of PDS were surveyed on the topic. Methods: An anonymized questionnaire was sent to the 610 members of the German Down Syndrome Association. The study was approved by the ethics committee of Witten/Herdecke University (# 165/2017). Results: The parents/caregivers of 207 PDS responded. These PDS were between 1 and 55 years old (mean age 24.4 years) and included 111 males and 96 females. At their first dental appointment, 40.7% (n = 82) had been younger than three years. Although 78.3% (n = 162) tooth brushed twice daily, only 30.9% (n = 64) brushed for 2–3 min; 84.0% (n = 135) did not use other dental hygiene products apart from toothbrushes. Age-specific differences were found: Although only 30.8% (n = 12) of PDS < 18 years (n = 39) independently performed dental self-care; this was 67.3% (n = 113) for PDS ≥ 18 years (n = 168). A statistically significant (p < 0.001; Chi-Square-Test) difference in toothbrush preferences emerged: While PDS < 18 years mainly used manual toothbrushes, PDS ≥ 18 years preferred electric toothbrushes. In contrast to 72.6% of PDS ≥ 18 years, only 51.3% of PDS < 18 years accepted most types of toothpaste. Conclusions: Age-dependent differences in tooth brushing behaviour became evident within the group of PDS in Germany. Hence, better age-specific, inter-professional dental prophylaxis concepts need to be developed and offered for all age groups of PDS. These concepts should include personalized check-up intervals and hands-on instruction in dental hygiene procedures by dental practitioners.

Oral Health Care for People With Special Health Care Needs: A Call to Action

Oral Health Care for People With Special Health Care Needs: A Call to Action

Oral health care for people with disabilities in Brazil: Transition from the specialized dental services between 2014 and 2018

To identify changes in the dental service provision to people with disabilities (PD) in the Dental Specialties Centers (acronym CEO in Portuguese-Centro de Especialidades Odontológicas) between the first and second cycles of the Program for the Improvement of Access and Quality of CEO and analyse factors associated with any changes. This nationwide ecological time series study adopted the CEO as the analysis unit. The 827 CEO who participated in the two program's cycles (2014 and 2018) were included. Data on the structure and the work process were considered to identify features of providing services to PD in both cycles. Latent transition analysis (LTA) was performed to identify latent status (LS) with similar features and model the transition between LS over time. Models with five variables and with two to five LS were tested, considered best conceptual interpretability and best model fit parameters: human resources structure (dentist working exclusively with PD) and work process that identified guarantee of PD treatment at the CEO, the CEO's interface with primary care, and the interface with tertiary care. Spatial analysis was performed to identify spatial patterns of LS in the Brazilian territory with choropleth maps. A multinomial logistic regression model was performed to identify factors associated with changes in the provision of CEO (improved, remained or worsened). The best-fit model identified four LS: 'Better', 'Medium better', 'Medium worse' and 'Worse'. CEO remained in the LS 'Better' (94%), LS 'Medium' (5.3%) and LS 'Worse' (78.4%). It is noteworthy that the highest proportion of CEO, in both cycles, was in the LS 'Better', featured by the CEO, characterized by all the CEO guaranteeing treatment to users with PD, high proportions of professionals working exclusively with PD, and most CEO articulated with primary care and with tertiary care. However, there is a decrease in the number of postgraduate professionals specializing in this service profile (1.3%). The higher the population growth, the greater the likelihood of the CEO achieving 'improved' in the LS. Moreover, the higher the number of goals, the lower the likelihood of the CEO getting 'worse' in the LS. Advances in dental service provision were observed, with more significant transitions to the 'Better' class, with improvements mainly in the interface with primary and tertiary care. Disability will be an even more significant concern as the population ages. Initiatives that can remove barriers and empower PD are potent in the provision of oral health services.

Oral health and supporting people with intellectual disabilities to get access to dental treatment

Oral health is an important aspect of a person’s overall health and well-being. People with intellectual disabilities have poorer oral health than the general population, so it is essential that service users and their carers are supported to address this. This article provides information for nurses and other healthcare professionals on how to provide evidence-based practice that supports people with intellectual disabilities with their oral healthcare and assists them to access dental services. The authors examine the latest evidence about optimal practice in oral healthcare for people with intellectual disabilities, emphasising the importance of a person-centred approach. The article also discusses the barriers that people with intellectual disabilities experience when accessing dental services and how these barriers can be addressed.

Barriers to the provision of oral health care for people with disabilities

Both in dental care and wider healthcare services, people with disabilities face a particular range of barriers that can prevent them accessing appropriate care. These initially occur at the societal level but filter down to the clinical environment.1 The Equality Act 2010 defines a disability as 'having physical or mental impairment that has a 'substantial' and 'long-term' negative effect on your ability to do normal daily activities'.2 An estimated 16% of people in the UK are living with some form of disability be it physical, intellectual, mental, or sensory in nature.3 In 1971, Hart's 'Inverse Care Law' stated that 'the availability of good medical care tends to vary inversely with the need for it in the population served'.4 The barriers that lead to this situation are still relevant today, meaning that people with disabilities report poorer access to healthcare, which exacerbates their poorer general2 and oral health.4 Historically, language referred to peoples' disabilities instead of people, attributing problems faced to the disability rather than wider society. The social model of disability is seen as a more appropriate way of understanding the problems people with disabilities may face in receiving appropriate healthcare.5 This model describes how it is society that erects barriers - by action, or inaction - that prevent people with disabilities living a life comparable to non-disabled people. In this model, to break down barriers to care, society must adjust by making far-reaching changes from legislation through to design of cities, transport, healthcare services and beyond to ensure people living with disabilities are not disadvantaged. The Equality Act 2010 places a legal duty on organisations, including dental services, to make reasonable adjustments to reduce the barriers that may affect people accessing care.2 Through increased waiting times, restrictions of certain services, patient shielding and additional PPE, the COVID-19 pandemic has introduced additional barriers which may disproportionately affect those with disabilities.6 It is therefore more important now than ever that both general and specialist dental services consider how they can make adjustments to support people living with different disabilities. 'Reasonable adjustments' made in general dental practices can ensure that a substantial proportion of people with disabilities can be treated in primary care without need for referral to specialist services. A general practitioner may be geographically closer, and the 'normalisation' of attending with family members, in a manner as 'close as possible to the norms and patterns of the mainstream of society'7 is highly important to many. This aligns with the Commissioning Standards for Special Care Dentistry, where 'level 1' care, suitable for the majority of patients, can be provided by a general dentist, as per Table 1. 8 Table 1 Levels of care for Special Care Dentistry. Taken from NHS England8

Perceptions and practices of general practitioners on providing oral health care to people with diabetes - a qualitative study

BackgroundPoorly controlled diabetes leads to multiple complications including oral health problems. General practitioners (GPs) are at the forefront of management of chronic diseases in primary health care. Diabetes guidelines encourage a proactive role for GPs in oral health complications management in people with diabetes, yet little is known about this area of care. This study aimed to explore current practices, perceptions and barriers of GPs towards oral health care for people with diabetes.MethodsWe employed a qualitative research method utilising telephone interviews. Purposive and snowball sampling were used to recruit 12 GPs from Greater Sydney region. A thematic analysis involving an inductive approach was used to identify and analyse contextual patterns and themes.ResultsA majority of participants were males (n = 10), working in group practices (n = 11) with a mean ± SD age of 55 ± 11.4 years and 25 ± 13.6 years work experience. Three major themes emerged: oral health care practices in general practice settings; barriers and enablers to oral health care; and role of diabetes care providers in promoting oral health.Most GPs acknowledged the importance of oral health care for people with diabetes, identifying their compromised immune capacity and greater risks of infections as risk factors. GPs reported 20–30% of their patients having oral health problems, however their current oral health care practices relating to education, risk assessment and referrals were reported as very limited.GPs identified several barriers including time constraints, absence of referral pathways, and limited knowledge and training in promoting oral health care. They also reported patient barriers including oral health care costs and lower oral health awareness. GPs perceived that resources such as education/training, a standardised assessment tool and patient education materials could support them in promoting oral health care. GPs also perceived that other diabetes care providers such as diabetes educators could play an important role in promoting oral health.ConclusionsDespite current recommendations, GPs’ current oral health care practices among people with diabetes are limited. Further strategies including capacity building GPs by developing appropriate oral health training programs and simple risk assessment tools along with accessible referral pathways are needed to address the current barriers.

Accessibility to oral health care for people on social assistance: a survey of social service providers from Public Welfare Centers in Flanders

The goals of the present study were as follows: (i) to explore the characteristics of the Flemish Public Centers for Social Welfare (PCSW) concerning oral health care; (ii) to explore possible barriers experienced by people on social assistance and oral health-care providers; and (iii) to explore the accessibility of general and oral health care for people on social assistance. The data of this cross-sectional study were obtained by a survey of social service providers working in a PCSW. For this purpose, a new questionnaire was developed. The survey was validated by means of a pilot study. All 306 PCSWs in Flanders were invited to participate in this survey, of which 192 (62.7%) responded. The findings demonstrate that for people on social assistance, financial limitations and low prioritisation of oral health are the main barriers to good oral health care. The study reveals that such individuals experience greater financial barriers and poorer access to a dentist than to a general medical practitioner. The study also reveals that dentists report financial concerns and administrative burdens as the main barriers in treating this subgroup. The responses of PCSWs demonstrate that local dentists are reluctant to treat this subgroup. Additional efforts are needed to improve the accessibility of oral health care for people on social assistance. Recommended improvements at the organisational level could improve increased education to target the population on the importance of oral health care. Administrative burden and financial concerns of the providers also need to be addressed to decrease their reluctance to work with those on social assistance.

Acessibilidade à saúde bucal de pessoas com Deficiência Intelectual na perspectiva do cuidador: uma avaliação qualitativa

Objetivo: acessar e identificar barreiras à atenção à saúde bucal de pessoas com deficiência intelectual (DI), na perspectiva dos cuidadores. Material e métodos: a amostra aleatória foi composta por 55 cuidadores de pessoas com DI e um roteiro de entrevista com abordagem qualitativa foi aplicado para aprofundar o entendimento deste grupo sobre acessibilidade aos serviços de saúde bucal. A análise qualitativa foi realizada por meio do Discurso do Método do Sujeito Coletivo. Resultados: nós observaram algumas barreiras ao acesso e cuidados à saúde bucal de pacientes com deficiência, tais como: falta de estrutura e organização do serviço, formação deficiente de profissionais para atendimento, entre outros. Além disso, os cuidados de saúde dentro de uma prática pouco remunerada e fracamente baseada na promoção da saúde foram outros fatores que comprometeu o acesso de pessoas com ID. Conclusão: a avaliação de acesso é extremamente importante, pois permite o reordenamento de ações e serviços de acordo com as necessidades dos usuários. Entretanto, apesar dos avanços, o paciente com DI ainda enfrenta barreiras, basicamente à acessibilidade ao tratamento realizado por profissionais, a recepção e baixa gestão.

Monitoring oral health of people in Early Intervention for Psychosis (EIP) teams: The extended Three Shires randomised trial

BackgroundThe British Society for Disability and Oral Health guidelines made recommendations for oral health care for people with mental health problems, including providing oral health advice, support, promotion and education. The effectiveness of interventions based on these guidelines on oral health-related outcomes in mental health service users is untested. Objective: To acquire basic data on the oral health of people with or at risk of serious mental illness.To determine the effects of an oral health checklist in routine clinical practice. DesignClinician and service user-designed cluster randomised trial. Settings and participantsThe trial compared a simple form for monitoring oral health care with standard care (no form) for outcomes relevant to service use and dental health behaviour for people with suspected psychosis in Mid and North England. Thirty-five teams were divided into two groups and recruited across 2012-3 with one year follow up. Results18 intervention teams returned 882 baseline intervention forms and 274 outcome sheets one year later (31%). Control teams (n=17) returned 366 baseline forms. For the proportion for which data were available at one year we found no significant differences for any outcomes between those allocated to the initial monitoring checklist and people in the control group (Registered with dentist (p=0.44), routine check-up within last year (p=0.18), owning a toothbrush (p=0.99), cleaning teeth twice a day (p=0.68), requiring urgent dental treatment (p=0.11). ConclusionThis trial provides no clear evidence that Care Co-ordinators (largely nursing staff) using an oral health checklist improves oral health behaviour or oral health state in those thought to be at risk of psychosis or with early psychosis.

Relationships between dental personnel and non-dental primary health care providers in rural and remote Queensland, Australia: dental perspectives

BackgroundCollaboration between dental practitioners and non-dental primary care providers has the potential to improve oral health care for people in rural and remote communities, where access to oral health services is limited. However, there is limited research on collaboration between these professional disciplines. The purpose of this paper was to explore the relationships between dental practitioners and non-dental primary care providers from rural and remote areas of Queensland and to identify strategies that could improve collaboration between these disciplines from the perspective of dental participants.MethodsSemi-structured interviews were conducted between 2013 and 2015 with visiting, local and regional dental practitioners (n = 12) who had provided dental services to patients from eight rural and remote Queensland communities that did not have a resident dentist. Participants were purposely recruited through a snow ball sampling technique. Interview data were analysed using thematic analysis with the assistance of QSR Nvivo v.10.ResultsFour major themes emerged from the data: (1) Communication between dental practitioners and rural primary care providers; (2) Relationships between dental and primary care providers; (3) Maintenance of professional dualism; (4) Strategies to improve interprofessional relationships (with subthemes: face to face meetings; utilisation of technology; oral health training for primary care providers; and having a community based oral health contact person). Participants observed that there was a lack of communication between the dental providers who saw patients from these rural communities and the primary care providers who worked in each community. This was attributed to poor communication, the high turnover of staff and the siloed behaviours of some practitioners. Visiting dental practitioners were likely to have stronger professional relationships with hospital nursing, administrative and allied health care staff who were often long term residents of the community.ConclusionsThe findings suggest that there was little relationship between the dental personnel and primary care providers. Interprofessional collaboration between dental care providers and non-dental rural primary care providers in the rural and remote communities sampled could be improved by having regular face to face meetings between practitioners from across the health disciplines, providing oral health education to primary care providers, establishing and maintaining effective communication and referral pathways, and exploring a greater role for tele-dentistry.

Enhancing oral health for better mental health: Exploring the views of mental health professionals.

The association between oral health, self-esteem and quality of life is well established yet there is limited research on the impact of addressing the poor oral health of people living with mental health disorders. Greater consideration is warranted on how enhancing oral health in the course of mental healthcare might reduce the burden of a person's ill health. The role of mental health professionals is important in this regard yet uncertainty persists about the role these providers can and should play in promoting oral health care for people with mental health disorders. This qualitative study explored the issue of oral health and mental health with community based mental health professionals in Perth, Western Australia. It examined their views on the oral health status and experiences of their clients, and the different and alternative ways to improve access to care, knowledge and preventative regimens. Findings indicated participants' ambivalence, reluctance and lack of training in raising oral health issues, despite its acknowledged importance, indicating a siloed approach to care. Findings offer an opportunity to reflect on whether a more integrated approach to oral health care for people with mental health disorders would improve health outcomes.

Barriers and enablers for oral health care for people affected by mental health disorders.

People with mental health disorders are reported to have poorer access to dental services and poorer oral health outcomes. The aim of this paper is to analyze current published work regarding barriers and enablers for oral health outcomes and access to dental care for adults with mental health disorders which will be addressed from individual, organizational and systemic perspectives METHODS: A narrative review based on a search of the relevant published work regarding oral health for people with mental health disorders was undertaken using Medline, Web of Science, ERIC and Psychlit. Any relevant systematic reviews were highlighted in this process along with primary studies. The published work repeatedly verified poorer oral health and inadequate access to dental services in people with mental health disorders. The published work identified barriers at individual, organizational and systemic levels. Much of the published work focused on barriers with less focus on enablers and interventions. Considerable investigation of barriers had not elucidated options to improve care or outcomes.

Active steps towards a healthier life for people with severe mental illness: a qualitative approach to understanding the potential for implementing change

Our health systems are failing to provide optimal physical care for people with severe mental illness. To address this gap, Queensland Health and General Practice Queensland in partnership developed a comprehensive package of guidelines and health messages. However, guidelines alone are likely to be inadequate motivators of change. The objective of this research was to qualitatively explore key stakeholders' expectations about the implementation of guidelines, with the purpose of identifying interventions to support practice change. Participants wer recruited from the partnership governance committee. A semistructured interview guide was used to gather data. Using grounded-theory techniques, the data were analysed to identify key themes. All stakeholders agreed that the purpose of developing comprehensive guidelines and health messages was to achieve change through innovation and the promotion of early intervention, reduction of avoidable admissions and sectoral integration. However, existing structures within the system were considered to be insurmountable barriers. Key stakeholders sought broader change than just guidelines and health messages developed by the partnership focussed specifically on awareness-raising about the physical care of people with severe mental illness. However, there was no clear consensus as to what that change should be. This mismatch between the goals and actions of such a large-scale initiative is problematic. Suggestions are made about how to address change.

Oral Health Care for Patients with Epidermolysis Bullosa ‐ Best Clinical Practice Guidelines

To provide the users with information on the current best practices for managing the oral health care of people living with EB. A systematic literature search, in which the main topic is dental care in patients with Epidermolysis Bullosa, was performed. Consulted sources, ranging from 1970 to 2010, included MEDLINE, EMBASE, CINAHL, The Cochrane Library, DARE, and the Cochrane controlled trials register (CENTRAL). In order to formulate the recommendations of the selected studies the SIGN system was used. The first draft was analysed and discussed by clinical experts, methodologists and patients representatives on a two days consensus meeting. The resulting document went through an external review process by a panel of experts, other health care professionals, patient representatives and lay reviewers. The final document was piloted in three different centres in United Kingdom, Czech Republic and Argentina. The guideline is composed of 93 recommendations divided into 3 main areas: 1) Oral Care--access issues, early referral, preventative strategies, management of microstomia, prescriptions and review appointments 2) Dental treatment: general treatment modifications, radiographs, restorations, endodontics, oral rehabilitation, periodontal treatment, oral surgery and orthodontics, and 3) Anaesthetic management of dental treatment. A preventive protocol is today's dental management approach of choice.