Oral Health Complications Research Articles

Overcoming barriers to orthodontic treatment in the United States

Underserved patients are at the highest risk for oral and overall health complications due to the many obstacles that prevent the group from receiving the most basic forms of health care. Receiving orthodontic care is even scarcer since most dental insurances regard it as an elective treatment, and only a limited number of orthodontists will treat these patients. The situation only worsens, as it appears that orthodontists in training intend to see even less of these patients in the future. Considerable changes need to be made. One change that needs to occur is within the dental training and education orthodontists receive. There needs to be a transition that encourages and promotes the development of skills necessary for treating underserved patients. Another change needs to occur in the restrictions that prevent specialists from participating in programs designed to provide relief in underserved areas. The events that would follow this change demonstrate the necessity for revisions in prohibitive policies against specialists. Finally, an initiative is needed to decrease costs associated with orthodontic treatment to make treatment more accessible, especially for patients with U.S. federally funded healthcare - Medicaid. Encouraging limited orthodontic treatment in mixed dentition (Phase I treatment) could aid in resolving this issue. The worsening situation among the underserved is connected to an unsustainable status quo. These issues need to be addressed and resolved to prevent any further onset and begin recovery.

An Update on Dental Outlook for Autism

Autism or autistic disorder is lifetime neurodevelopment disorder described as major impairment in mutual social interactions, communication ability, and repetitive patterns of interests or behaviors. Since, globally large number of children affected by this devastating disorder, dental professionals should provide oral health care with family-centered approach comprising thorough understanding of parental concern, exceptional medical conditions, and vivid behaviours of each personality patient to improve the treatment planning. This article analyses oral health status, dental needs, complications and treatment of autistic children.

Oral health and stomatological complications in pediatric cancer patients

Oral health and stomatological complications in pediatric cancer patients

Evidence-based health promotion in nursing homes: A pilot intervention to improve oral health

ABSTRACTNursing home residents over the age of 65 years are at high risk for poor oral health and related complications such as pneumonia and adverse diabetes outcomes. A preliminary study found that Massachusetts’ nursing homes generally lack the training and resources needed to provide adequate oral health care to residents. In this study, an intervention targeting Certified Nurses’ Aides (CNAs) was developed and tested. We hypothesized that following the training, CNAs would have increased knowledge and self-efficacy toward providing oral health care to the residents in their charge.This pilot study used a one-group pretest-posttest design to test the effectiveness of a psycho-educational training intervention. Utilizing the constructs of knowledge and self-efficacy from the Theory of Planned Behavior and the Social Cognitive Theory, we framed the content of a training intervention and administered a 21-item instrument. The survey was distributed to the CNA staff of a single midsize nursing home immediately prior to and after the intervention. The 1-hour training intervention was empirically supported by formative data and delivered by dental faculty researchers.Findings indicate increases in two areas of oral health knowledge: toothbrush position and frequency of brushing. Self-efficacy, however, did not significantly change. Although the results marginally supported our hypothesis, this pilot study demonstrates the feasibility of delivering interventions to CNAs who have direct responsibility for promoting the oral health of long-term care facility residents.

Advances in Supportive Care for Late Effects of Head and Neck Cancer.

As the population of head and neck cancer survivors increases, it has become increasingly important for health care providers to understand and manage late complications of therapy. Functional deficits can be categorized as general health deficits resulting in frailty or debility, head and neck-specific functional deficits such as swallowing and speech, and musculoskeletal impairment as a result of tumor and treatment. Of critical importance is the growing data indicating that swallow therapy and physical therapy may prevent or ameliorate long-term functional deficits. Oral health complications of head and neck therapy may manifest months or years after the completion of treatment. Patients with hyposalivation are at high risk for dental caries and thus require aggressive oral hygiene regimens and routine dental surveillance. Swallowing abnormalities, xerostomia, and poor dentition may result in dietary adaptations that may cause nutritional deficiencies. Identification and management of maladaptive dietary strategies are important for long-term health. Follow-up with primary care physicians for management of comorbidities such as diabetes and hyperlipidemia may help to limit late vascular complications caused by radiation therapy. Herein, we review late effects of head and neck cancer therapy, highlighting recent advances.

PHS114 - Determinants Of Dental Care Utilization In Adult Diabetic Population

Diabetes is known to increase the risk for dental and periodontal diseases such as severe periodontitis, gingivitis, xerostomia, dental abscesses, cavities and subsequent tooth loss. In order to prevent the oral health complications associated with diabetes, guidelines recommend the use of dental care services and regular screening at least once every six months. The objective of this study is to investigate the relationship among socio-demographic factors related to the use of dental services in adult diabetic population the United States. We performed a cross sectional study using the 2010 Medical Expenditure Panel Survey (MEPS) database. All respondents above the age of 18 were used for the analyses. A two part linear regression model was built to analyze the self-reported use of any dental care services adjusting for various independent variables such as diagnosis of diabetes, age, race, sex, marital status, family income, years of education, and dental insurance status. All analyses incorporated person-level weights and variance adjustment weights (strata and primary sampling unit) provided by MEPS to produce nationally representative estimates. The level of statistical significance was P ≤.05 and all analyses were carried out using the statistical package, STATA IC version 10 (StataCorp, LP). Dental care service use was significantly lower in diabetic individuals (61%) compared to non-diabetic population (49%). Among those who visited a dentist, the annual number of visits was higher in diabetic population. Utilization was higher in whites, females, married individuals and in general increased with age. Low and middle income individuals were more likely to have no dental care visits compared to high income individuals. Having dental insurance also had a positive effect on the utilization. Dental care service utilization is higher among diabetics compared to the general population. However, there is lack of use of preventive services among this population.

Increased SGLT1 expression in salivary gland ductal cells correlates with hyposalivation in diabetic and hypertensive rats

BackgroundOral health complications in diabetes and hypertension include decreased salivary secretion. The sodium-glucose cotransporter 1 (SGLT1) protein, which transports 1 glucose/2 Na+/264 H2O molecules, is described in salivary glands. We hypothesized that changes in SGLT1 expression in the luminal membrane of ductal cell may be related to an altered salivary flow.FindingsBy immunohistochemistry, we investigated SGLT1 expression in ductal cells of parotid and submandibular glands from Wistar Kyoto rats (WKY), diabetic WKY (WKY-D), spontaneously hypertensive rats (SHR) and diabetic SHR (SHR-D), as well as in parotid glands from WKY subjected to sympathetic stimulation, with or without previous propranolol blockade. Diabetes and hypertension decreased the salivary secretion and increased SGLT1 expression in the luminal membrane of ductal cells, and their association exacerbated the regulations observed. After 30 min of sympathetic stimulation, SGLT1 increased in the luminal membrane of ductal cells, and that was blocked by previous injection of propranolol.ConclusionsSGLT1 expression increases in the luminal membrane of salivary gland ductal cells and the salivary flow decreases in diabetic and hypertensive rats, which may be related to sympathetic activity. This study highlights the water transporter role of SGLT1 in salivary glands, which, by increasing ductal water reabsorption, may explain the hyposalivation of diabetic and hypertensive subjects.

Interdental cleaning among persons with diabetes: relationships with individual characteristics

Given the existence of many potential oral health complications for adults with diabetes (especially for those who do not practise regular oral self-care), and the specific importance of regular interdental cleaning, the research determined the proportion of U.S. adults with diabetes who practise daily interdental cleaning and their socio-demographic, economic and oral health characteristics related to this practice. Analyses were conducted using data collected from 573 dentulous adults with diabetes≥30years who participated in the U.S. 2009-2010 National Health and Nutrition Examination survey. Using complex sample survey software, findings were extrapolated to >15million U.S. adults. Descriptive statistics were used to determine the frequency of interdental cleaning, and chi-square tests were used to identify salient individual characteristics related to this practice. 41.2% reported that they never used any interdental device, while 24.8% indicated that they practised interdental cleaning daily. Statistically significant relationships (P<0.05) with daily interdental cleaning included female sex, ever having had treatment for gum disease and using mouthwash daily for a dental problem. Because so many adults with diabetes do not practise regular interdental cleaning, and in view of the important role that dental hygienists fulfil as oral healthcare educators, there is a great need for dental hygienists to teach and motivate adults with diabetes to practise regular interdental cleaning. This need is especially great for subgroups of these adults who are men, have not been treated for periodontitis and do not regularly use a mouthwash for dental problems.

Expanding patient-reported outcomes to oral health complications from systemic cancer therapy.

60 Background: Cross-disciplinary patient reported outcomes (PROs) assess the full range of side effects from systemic cancer therapy. For oral health complications, however, the validity of oral-health specific and generic health-related quality-of-life (QoL) instruments is unknown for cancer patients. This study evaluates the performance, measurement, and prediction characteristics of the Oral Health Impact Profile (OHIP–14) and EQ–5D in cancer patients with bisphosphonate-associated Osteonecrosis of the Jaw (ONJ). Methods: 34 cancer patients assessed the QoL of their own ONJ with the OHIP–14 and evaluated the QoL of 4 standardized ONJ Health States with the EQ–5D, as previously published. For each instrument, the standard response mean (SRM), effect size (ES), and ability to distinguish minimally important differences (MID) were evaluated for ONJ compared to baseline (longitudinal responsiveness). Instrument MIDs (cross-sectional responsiveness) were also calculated. Performance of a published general dentistry algorithm to predict EQ–5D values from OHIP–14 results was tested. Results: The OHIP–14 and EQ-5D instruments demonstrated moderate to large longitudinal and cross-sectional responsiveness. Pain was one of the most responsive domains for both instruments. Ceiling/floor effects were most prominent for OHIP–14. A general dentistry algorithm did not adequately predict EQ–5D values for cancer patients. Conclusions: This study provides the first empirical evidence for the performance, measurement, and prediction characteristics of oral-health specific and generic QoL instruments for the oral health side effects of systemic cancer treatment. Instrument validity is supported for oral health complications in cancer patients. These results provide benchmarks for PROs at the intersection of oral medicine and surgery, dentistry, and oncology. [Table: see text]

Oral complications of cancer and cancer therapy

Answer questions and earn CME/CNE Oral complications resulting from cancer and cancer therapies cause acute and late toxicities that may be underreported, underrecognized, and undertreated. Recent advances in cancer treatment have led to changes in the incidence, nature, and severity of oral complications. As the number of survivors increases, it is becoming increasingly recognized that the aggressive management of oral toxicities is needed to ensure optimal long-term oral health and general well-being. Advances in care have had an impact on previously recognized oral complications and are leading to newly recognized adverse effects. Here, the authors briefly review advances in cancer therapy, including recent advances in surgery, oral care, radiation therapy, hematopoietic cell transplantation, and medical oncology; describe how these advances affect oral health; and discuss the frequent and/or severe oral health complications associated with cancer and cancer treatment and their effect upon long-term health. Although some of the acute oral toxicities of cancer therapies may be reduced, they remain essentially unavoidable. The significant impact of long-term complications requires increased awareness and recognition to promote prevention and appropriate intervention. It is therefore important for the primary oncologist to be aware of these complications so that appropriate measures can be implemented in a timely manner. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time.

Summary of: 'Oral health awareness in adult patients with diabetes: a questionnaire study'

Objective To investigate oral health awareness, oral hygiene and attitudes towards general dental practitioners' (GDP) involvement in diabetes screening in adults with diabetes. Design Self-completion questionnaire. Setting General medical practices in Warwickshire. Subjects and methods Adults with diabetes attending clinics run by practice or diabetes nurses in general medical practices. Results Two hundred and twenty-nine of 615 (37.2%) questionnaires were completed in 14 general medical practices. The majority of respondents (79.8%, 178/223) visited a dentist once or twice a year, but oral care varied; 67.2% (133/198) reported brushing at least twice a day, whereas only 15.3% (29/190) flossed daily. Awareness of oral health risks was limited: 69.1% (150/217) had never received any oral health advice related to their diabetes. Over half of respondents supported the idea of dentists offering screening for diabetes (121/226, 53.5%). Conclusions Many adults with diabetes have poor awareness of oral care and health complications associated with diabetes, and are receiving limited advice from healthcare professionals. Training and advice for both healthcare professionals and patients concerning the importance of good oral health in patients with diabetes is needed. The role of dentists in diabetes screening and support requires further investigation.

Oral health awareness in adult patients with diabetes: a questionnaire study

To investigate oral health awareness, oral hygiene and attitudes towards general dental practitioners' (GDP) involvement in diabetes screening in adults with diabetes. Self-completion questionnaire. General medical practices in Warwickshire. Adults with diabetes attending clinics run by practice or diabetes nurses in general medical practices. Two hundred and twenty-nine of 615 (37.2%) questionnaires were completed in 14 general medical practices. The majority of respondents (79.8%, 178/223) visited a dentist once or twice a year, but oral care varied; 67.2% (133/198) reported brushing at least twice a day, whereas only 15.3% (29/190) flossed daily. Awareness of oral health risks was limited: 69.1% (150/217) had never received any oral health advice related to their diabetes. Over half of respondents supported the idea of dentists offering screening for diabetes (121/226, 53.5%). Many adults with diabetes have poor awareness of oral care and health complications associated with diabetes, and are receiving limited advice from healthcare professionals. Training and advice for both healthcare professionals and patients concerning the importance of good oral health in patients with diabetes is needed. The role of dentists in diabetes screening and support requires further investigation.

Knowledge and awareness about diabetes and periodontal health among Jordanians

The aim of this study is to evaluate the awareness, perception, sources of information, and knowledge of diabetes mellitus and periodontal health among Jordanians, to examine the factors related to their knowledge, and organize effective education programs. A random sample of 500 diabetic patients was recruited from three hospitals and three comprehensive health centers that represent both urban and rural populations in Jordan between September 25, 2006, and February 20, 2007. Completed questionnaires with the answers were returned by 405 participants (response rate was 81%). Only 28% indicated that they followed up gum diseases with the dentist; 48% were aware that diabetic patients are more prone to gum diseases and oral health complications. About a third (38%) recognized that their periodontal health might affect their glycaemic level. Television and Internet were the main source of knowledge for dentists with the rate of 50%. Knowledge about diabetes and periodontal health among diabetic patients is low, and majority of patients were unaware of the oral health complications of their disease and the need for proper preventive care. Issues on education need to be addressed. Therefore, appropriate educational programs should be planned according to community needs, and the target of these programs should be patients with irregular visits to the dentist and physicians. The clinical implication of our findings is that dentists, physicians, and other health providers should inspect diabetic patients for gum diseases each time they come for care and recommend that diabetic patient see a dentist regularly.

Na+-Glucose Cotransporter SGLT1 Protein in Salivary Glands: Potential Involvement in the Diabetes-Induced Decrease in Salivary Flow

Oral health complications in diabetes include decreased salivary secretion. The SLC5A1 gene encodes the Na(+)-glucose cotransporter SGLT1 protein, which not only transports glucose, but also acts as a water channel. Since SLC5A1 expression is altered in kidneys of diabetic subjects, we hypothesize that it could also be altered in salivary glands, contributing to diabetic dysfunction. The present study shows a diabetes-induced decrease (p < 0.001) in salivary secretion, which was accompanied by enhanced (p < 0.05) SGLT1 mRNA expression in parotid (50%) and submandibular (30%) glands. Immunohistochemical analysis of parotid gland of diabetic rats revealed that SGLT1 protein expression increased in the luminal membrane of ductal cells, which can stimulate water reabsorption from primary saliva. Furthermore, SGLT1 protein was reduced in myoepithelial cells of the parotid from diabetic animals, and that, by reducing cellular contractile activity, might also be related to reduced salivary flux. Six-day insulin-treated diabetic rats reversed all alterations. In conclusion, diabetes increases SLC5A1 gene expression in salivary glands, increasing the SGLT1 protein content in the luminal membrane of ductal cells, which, by increasing water reabsorption, might explain the diabetes-induced decrease in salivary secretion.

Burning mouth syndrome and peripheral neuropathy in patients with type 1 diabetes mellitus

Objective Burning mouth syndrome (BMS) has been attributed secondarily to diabetes, poor glycemic control, and diabetic neuropathy. The prevalence and predictor factors of BMS were compared in type 1 diabetes mellitus (T1DM) and nondiabetic subjects. Study design An assessment of 371 adult T1DM subjects and 261 control subjects participating in a cross-sectional epidemiological study of oral health complications of diabetes was performed. Subjects were participants of the Pittsburgh Epidemiology of Diabetes Complications study. Prevalence of BMS was determined by response to the following questions: “Do you now or in the last month had any persistent uncomfortable sensations in your mouth or tongue? If yes, would you describe the feeling as tingling, burning, sore, numb, or other?” Results Burning mouth syndrome symptoms were reported by 28 T1DM and control subjects (4.6%). Eleven had oral pathologies that might explain the BMS, including atrophy of the tongue papillae, fissured tongue, denture stomatitis, and candidiasis. The prevalence of BMS within the two groups with no pathologies was similar; 12/371 (3.2%) vs. 5/233 (2.1%). Multivariate analyses of the 12 T1DM subjects with BMS found significant associations for female gender ( P=.042) and a diagnosis of diabetic peripheral neuropathy ( P=.024). Conclusions In this T1DM population, BMS or related discomforts occurred slightly more frequently than in the control group. Symptomatic T1DM subjects were more likely to be female who had also developed peripheral neuropathy. These findings and other similarities between BMS and diabetic peripheral neuropathy suggest that a neuropathic process may be an underlying source of BMS in some patients who have no apparent oral abnormality.

Nursing Staff Perspectives on Oral Care for Neuroscience Patients

Neuroscience patients frequently experience poor oral health and related complications because of motor and cognitive dysfunction and the side effects of treatments. Inadequate oral care increases plaque deposits, which can lead to inflammation, pain, and infection. These patients often depend on nurses for oral hygiene. In practice, nurses frequently delegate the delivery of oral care to unlicensed personnel, including nursing assistants, technicians, and student nurses. Few studies have addressed oral care interventions for neuroscience patients. This article identifies oral care interventions practiced by nurses and unlicensed personnel caring for neuroscience patients with self-care deficits. An investigator-designed survey instrument was used to obtain data from nurses and unlicensed personnel working with neuroscience patients in a large hospital. Participants responded to questions about products and agents used in care, frequency of care, documentation of care, patient risk factors, and system support issues such as availability of supplies. Data were analyzed using frequency distributions. Findings demonstrated that selection of products and agents used for oral care is not always evidence based, that provider preference leads to variations in type and frequency of care, and that system issues affect care. These findings suggest the need for increased attention to oral care for neuroscience patients. Research is needed to further examine the relationship between oral care interventions and patient outcomes.

Diabetes: A growing epidemic of all ages

The incidence and prevalence of diabetes mellitus are increasing, with more than 135 million people affected worldwide. Despite greater knowledge of the disease, one-third of people with the disease are undiagnosed. Recent estimates indicate that one in three U.S. children born in 2000 will develop diabetes. Diabetes is not equally distributed within the U.S. population. Type 1 diabetes occurs most frequently in white non-Hispanic children. A higher prevalence of type 2 diabetes is seen among those who are older, female and overweight. Non-Hispanic African-American and Hispanic populations in the United States also have been found to be at greater risk of developing type 2 disease. Among certain older patient populations, the prevalence of type 2 diabetes may be as high as 20 to 25 percent. As the percentage of older Americans increases and as the prevalence of obesity increases, a greater number of patients with diabetes will be seen and treated by dental practitioners. Oral health complications, including extensive periodontal disease, tooth loss, soft-tissue pathologies, xerostomia and burning mouth syndrome have been reported among patients with long-standing and poorly controlled diabetes. Dentists have an opportunity and responsibility to educate patients with diabetes about the oral complications of the disease, and to promote proper oral health behaviors that limit the risks of tooth loss, periodontal disease and soft-tissue pathologies.

Dental and other health care visits among U.S. adults with diabetes.

This study compared yearly dental visits of diabetic adults with those of nondiabetic adults. For adults with diabetes, we compared the frequency of past-year dental visits with past-year visits for diabetes care, dilated eye examinations, and foot examinations. We conducted a cross-sectional study using a sample of 105,718 dentate individuals aged > or =25 years, including 4,605 individuals with diabetes who participated in the 1995-1998 Behavioral Risk Factor Surveillance System in 38 states. Dentate adults (i.e., those with at least some natural teeth) with diabetes were less likely than those without diabetes to have seen a dentist within the preceding 12 months (65.8 vs. 73.1%, P = 0.0000). Adults with diabetes were less likely to have seen a dentist than to have seen a health care provider for diabetes care (86.3%); the percentage who saw a dentist was comparable with the percentage who had their feet examined (67.7%) or had a dilated eye examination (62.3%). The disparity in dental visits among racial or ethnic groups and among socioeconomic groups was greater than that for any other type of health care visit for subjects with diabetes. Promotion of oral health among diabetic patients may be necessary, particularly in Hispanic and African-American communities. Information on oral health complications should be included in clinical training programs. Oral and diabetes control programs in state health departments should collaborate to promote preventive dental services, and the oral examination should be listed as a component of continuous care in the American Diabetes Association's standards of medical care for diabetic patients.

DIABETES AND ORAL HEALTH PROMOTION: A SURVEY OF DISEASE PREVENTION BEHAVIORS

Diabetes is a chronic metabolic disease known to affect oral disease progression. The authors surveyed health behaviors essential for preventing dental and periodontal diseases and maintaining oral health is a population of adult patients with type 1 (insulin-dependent) diabetes. The goals of this study were to assess these patients' oral health behaviors, access to dental care and need for improved health education. As part of a dental and periodontal examination, 406 subjects with type 1 diabetes completed a questionnaire regarding their oral health attitudes, behaviors and knowledge. The authors also evaluated 203 age-matched nondiabetic control subjects. The authors found that diabetic subjects' tobacco use and oral hygiene behaviors were similar to those of the nondiabetic control subjects. Diabetic subjects, however, more frequently reported the cost of dental care as a reason for avoiding routine visits. Most of these subjects were unaware of the oral health complications of their disease and the need for proper preventive care. Patients with diabetes appear to lack important knowledge about the oral health complications of their disease. The results of this survey did not indicate improved prevention behaviors among the subjects with diabetes compared with nondiabetic control subjects. Dentists have an opportunity and the responsibility to promote good oral health behaviors such as regular dental examinations, proper oral hygiene and smoking cessation that may significantly affect the oral health of their diabetic patients.

The next decade of health spending: a new outlook. The National Health Expenditures Projection Team.

The next decade of health spending: a new outlook. The National Health Expenditures Projection Team.