Oral Health Risk Assessment Research Articles

Integrative and collaborative care models between pediatric oral health and primary care providers: a scoping review of the literature.

Collaborative and/or integrative care between oral health and primary care providers can increase access to care to a more expansive population, helping to mitigate oral health related disease. The objective of this review was to present and evaluate different types of care models that exist between oral health and primary care providers in pediatric settings. A literature search was conducted using five databases: MEDLINE/PubMed, ISI Web of Science, Dentistry and Oral Sciences Source, Cochrane Database, and EMBASE, to identify literature from January 1990 to January 2016. Combinations of controlled terms were utilized. Eligible sources targeted pediatric populations ages 1-17 and provided descriptions of existing collaborative and/or integrative models. Data related to the practice model, oral care provided, level of integration/collaboration and workflow were extracted. Sixteen articles were included that discussed 24 models of collaboration. These models provided ranges of services, but each offered a minimum of oral health risk assessment, oral health instruction, topical fluoride application and assessment for further treatment. These models included different levels of collaboration based off a ranking system created by the authors with 16.6 percent (4) classified as low, 54.2 percent (13) as medium and 29.2 percent (7) as high. Existing care models offered varying services and levels of integration and/or collaboration, but each offered a baseline of oral care. Most of these collaborations were based within Federally Qualified Health Centers and aimed to ease access to care issues.

Knowledge, attitudes, and practices among gynecologists regarding oral health of expectant mothers and infants in Bhubaneswar City, Odisha.

Early intervention is aimed at preventing or mitigating common pediatric oral diseases and conditions while initiating a relationship between the mother, the child, and the dental caregiver. Every expectant mother should receive oral health education and risk assessment. There are a number of reports that showed the association between oral diseases and preterm, low birth weight, and gestational diabetes. The purpose of this study is to understand the attitude and knowledge regarding prenatal as well as infant oral health care among gynecologists in the medical colleges in Bhubaneswar, Odisha, India. The study involved a survey involving gynecologists in medical colleges in Bhubaneswar, Odisha. A pretested questionnaire was provided to all the gynecologists (21) working in the medical colleges in Bhubaneswar regarding prenatal and perinatal oral health care. The study gave an idea that most gynecologists working in a medical college in Bhubaneswar, Odisha, India, had adequate knowledge regarding oral health of expectant mothers, but lack in knowledge when it comes to imparting knowledge on infants' health care. There is an adequate knowledge among the gynecologists about oral health of expectant mothers and infants, but still, there is a need of a multidisciplinary collaboration among gynecologists, pediatricians, and pediatric dentists to prevent the dental diseases rather than treating them.

Knowledge, attitude and practice among Health Visitors in the United Kingdom toward children's oral health.

The purpose of this study was to determine knowledge, attitude, and practical behavior of health visitors regarding children's oral health in the United Kingdom (UK). A web-based self-administered survey with 18 closed and 2 open ended questions was distributed to a convenience sample of approximately 9,000 health visitors who were currently employed in the United Kingdom and a member of the Institute of Health Visiting. A total of 1,088 health visitors completed the survey, resulting in a response rate of 12%. One-third of the health visitors reported that they had not received oral health training previously. Almost all agreed that oral health advice/promotion should be included in their routine health visiting contacts. Previous oral health training/education was associated with an increase in oral health knowledge; confidence in entering a discussion with parents/caregivers and willingness to be involved in dental referral process. The results of our study support the need for health visitors to receive oral health training in oral health promotion including oral health risk assessment, guidance on evidence based up-to-date prevention measures, increasing the dental attendance prevalence at early stages and awareness of including specific oral health guidelines/fact sheets into their regular practice.

Paediatricians’ Knowledge, Attitude and Practice towards Children’s Oral Health in North Cyprus

The frequent one-to-one contact offers an ideal opportunity for paediatricians to perform oral health risk assessment and educate families on preventive oral health care at early stages. The aim of this research is to assess paediatricians’ knowledge, attitude and practice regarding children’s oral health. A cross-sectional survey was sent to all paediatricians currently practicing in the North Cyprus. Data was analysed using statistical package for social sciences for descriptive and univariate analysis. Response rate was 92%. Almost all of the paediatricians stated that oral health advice should be included in their routine health supervision. However, many of them reported not feeling confident enough to take active role in preventive oral health care. Less than quarter of the total paediatricians reported that they had received oral health education previously. Previous oral health education/training was associated with improved oral health knowledge, confidence in entering oral health discussions with caregivers and identifying oral health pathologies. The results of our study support the need for paediatricians to receive further oral health training/education.

Conocimientos, creencias y percepción de universitarios mexicanos sobre caries temprana de la infancia

The promotion of oral health in the early years of life is important to promote well-being and prevent early childhood cavities. The aim of this work was to determine the level of knowledge, beliefs, and perceptions of a group of Mexican university students in the area of health on early childhood cavities. A questionnaire was applied to students ( N = 515) of the tenth semester of the degrees of Nursing, Medicine, and Dentistry based on the Health professional’s guide to pediatric oral health management, Guide for oral health risk assessment training and Dental Beliefs Scale N. The x 2 test was used to analyze the association of variables among students. Of the total respondents, 80.7% scored regular knowledge, 13.3% good, and 6% poor. Association was observed in the belief of knowing how to treat problems of tooth decay (x 2 = 0.003, p < 0.05), how to perform oral hygiene on children (x 2 = 0.025, p < 0.05) and in perception between the information and bachelor’s degree (x 2 = 0.012, p < 0.05). Educ ational programs in the area of health must find ways to introduce topics on best practices in child oral health, particularly those related to dental cavities and early childhood cavities.

Practices and awareness of the paediatricians regarding syrups and sugar free medicines in Chennai City

IntroductionPaediatricians and paediatric health care professionals should develop the knowledge base to perform oral health risk assessments on all patients beginning at 6 months of age Dentist are not the only health professionals to see children at high risk for tooth decay. Paediatricians have a key role in helping young patients before tooth decay becomes a reality. Aim1. To assess Practices of the paediatricians regarding syrups and sugar free medicines in Chennai City. 2. To assess Awareness of the paediatricians regarding syrups and sugar free medicines in Chennai City. Materials and MethodsThe study consisted of 65 males and 45 females which totally comprised of 110 study subjects. The subjects were of age ranging between 28 and above 57 years old. The source of data was primary and was obtained through a questionnaire survey. The resulting data was coded and statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 17.0 software, Chi-square test was applied to compare the percentages and the level of significance was set at 0.05. ResultsThough there was a difference in responses given by Paediatricians regarding their practices and awareness on syrups and sugar free medicines according to year of practices there was no marked difference noted between them. ConclusionIn the present study, most paediatricians recognize that paediatric medicines can cause teeth problems, a high percentage are able to establish a relationship with the dental caries. Paediatric formulations without added sugar should be available to those responsible, and professionals could provide better and more intensive teaching on the proper oral hygiene care after use of these medicines.

Red fluorescence of dental plaque in children —A cross-sectional study

ObjectivesThe relation between the presence of red fluorescent plaque and the caries status in children was studied. In addition, the microbial composition of dental plaque from sites with red fluorescent plaque (RFP) and from sites with no red fluorescent plaque (NFP) was assessed. MethodsFluorescence photographs were taken from fifty children (6–14 years old) with overnight plaque. Full-mouth caries scores (ICDAS II) were obtained. The composition of a saliva sample and two plaque samples (RFP and NFP) was assessed using 16S rDNA sequencing. ResultsAt the site level, no clinically relevant correlations were found between the presence of RFP and the caries status. At the subject level, a weak correlation was found between RFP and the caries status when non-cavitated lesions were included (rs=0.37, p=0.007). The microbial composition of RFP differed significantly from NFP. RFP had more anaerobes and more Gram-negative bacterial taxa. The most discriminative operational taxonomic units (OTUs) for RFP were Corynebacterium, Leptotrichia, Porphyromonas and Selenomonas, while the most discriminative OTUs for NFP were Neisseria, Actinomyces, Streptococcus and Rothia. ConclusionsThere were no clinical relevant correlations in this cross-sectional study between the presence of RFP and (early) caries lesions. There were differences in the composition of these phenotypically different plaque samples: RFP contained more Gram-negative, anaerobic taxa and was more diverse than NFP.Clinical significance: The study outcomes provide more insight in the possibilities to use plaque fluorescence in oral health risk assessments.

Senior Smiles: preliminary results for a new model of oral health care utilizing the dental hygienist in residential aged care facilities.

The aim of this study was to determine whether a qualified dental hygienist could improve oral health outcomes for residents living in residential aged care facilities on the Central Coast of New South Wales, Australia. A qualified dental hygienist undertook a 24-week oral hygiene intervention in five residential aged care facilities to test the Senior Smiles, oral health model of care. The facilities were invited to take part in the research, which was funded by a grant from NSW Medicare Local, Erina. Residents were asked to consent to having oral health risk assessments, oral healthcare plans and to receiving referrals for treatment where needed. Pre- and post-intervention plaque scores were recorded for residents and P values calculated using a paired t-test. In addition, the number of residents examined, treated and referred for more complex dental care was recorded. The statistical analysis program, SPSS, was used to conduct a paired t-test to compare pre- and post-intervention plaque scores on residents from the 5 RACFs. A statistically significant result of P < 0.0001 showed the intervention of the dental hygienist was effective in reducing plaque scores in residents across the 5 RACFs. The Senior Smiles model of care provided residents with preventive oral hygiene care, referral pathways for complex dental treatment needs and established a formal management programme for ongoing oral health care within the RACFs. The Senior Smiles model of care is successful and transportable.

Pediatric Residents' Knowledge and Comfort With Oral Health Bright Futures Concepts: A CORNET Study

ObjectiveTraining residents in oral health helps eliminate disparities and improves access. The American Academy of Pediatrics Bright Futures Guidelines curriculum is used as a training guide. We assessed knowledge, confidence, and perceived barriers to incorporating Bright Futures oral health concepts into well-child care for children below 3 years in a national sample of pediatric residents. MethodsA sample of postgraduate year 1 and 2 residents from CORNET sites completed demographic, Bright Futures oral health concepts confidence and knowledge cross-sectional surveys before any intervention. Measures were tested for reliability using Cronbach's alpha coefficient. ResultsOne hundred sixty-three residents from 28 CORNET sites completed the surveys. One third reported no prior training in oral health. Time (42%) and knowledge (33%) led the perceived barriers to addressing these concepts in well visits. Although 63% rated their confidence as excellent in identifying tooth decay risk factors, a significant percentage rated their oral health risk assessment skills as poor or neutral (64%) and identifying caries at examination (53%). Only 49% conveyed oral health messages during encounters and 80% correctly scored 75% or higher on knowledge questions. ConclusionsThis cross-sectional study shows that residents from a wide geographic range have high self-reported oral health knowledge but low perceived skills and competency in clinical implementation. Lack of time and knowledge in identifying caries led the perceived barriers. Barriers are addressed by implementing oral health curricula that promote competence and skill-development. This study helps programs effectively implement Bright Futures concepts to train graduates to incorporate oral health in well visits.

Oral Health Services Update

New codes for oral health risk assessment as part of the universal preventative services recommendations.

Oral Health Considerations in HIV-Infected Children

Children with the human immunodeficiency virus (HIV) have a higher probability of hard and soft oral tissue diseases because of their compromised immune systems and socioeconomic factors such as poor access to medical and dental care and limited availability of fluoridated water or toothpaste. To improve health outcomes and help monitor the progression of HIV, a preventive, child-specific oral health protocol for children with HIV that is easy to use and appropriate for all different resource settings should be established. Further, both medical and dental health practitioners should incorporate such a protocol into their care routine for HIV-infected children. Using proactive oral health risk assessments complemented by scheduled follow-up visits based on individual risk determination can prevent opportunistic infection, track the HIV disease trajectory, and monitor the effectiveness of highly active antiretroviral therapy (HAART) while improving the quality of life and longevity of children living with HIV.

Pediatricians' assessments of caries risk and need for a dental evaluation in preschool aged children.

BackgroundRisk-based prioritization of dental referrals during well-child visits might improve dental access for infants and toddlers. This study identifies pediatrician-assessed risk factors for early childhood caries (ECC) and their association with the need for a dentist’s evaluation.MethodsA priority oral health risk assessment and referral tool (PORRT) for children < 36 months was developed collaboratively by physicians and dentists and used by 10 pediatricians during well-child visits. PORRT documented behavioral, clinical, and child health risks for ECC. Pediatricians also assessed overall ECC risk on an 11-point scale and determined the need for a dental evaluation. Logistic regression models calculated the odds for evaluation need for each risk factor and according to a 3-level risk classification.ResultsIn total 1,288 PORRT forms were completed; 6.8% of children were identified as needing a dentist evaluation. Behavioral risk factors were prevalent but not strong predictors of the need for an evaluation. The child’s overall caries risk was the strongest predictor of the need for an evaluation. Cavitated (OR = 17.5; 95% CI = 8.08, 37.97) and non-cavitated (OR = 6.9; 95% CI = 4.47, 10.82) lesions were the strongest predictors when the caries risk scale was excluded from the analysis. Few patients (6.3%) were classified as high risk, but their probability of needing an evaluation was only 0.36.ConclusionsLow referral rates for children with disease and prior to disease onset but at elevated risk, indicate interventions are needed to help improve the dental referral rates of physicians.

Oral health of Alzheimer's patients in São José dos Campos, Brazil

Neglecting oral health can negatively affect the quality of life of Alzheimer's patients. This work evaluates the oral health of Alzheimer's patients in São José dos Campos, Brazil. Brazilian versions of the Oral Health Risk Assessment and Index to dental management of patients with Alzheimer's disease questionnaires were given to 50 patients (14 men, 36 women) diagnosed with Alzheimer's disease, with an average age of 79.7 years (SD = 9.2 years). Alternatively, the questionnaire was given to patients' caregivers. Cronbach's alpha test was applied to validate the Brazilian versions of these tests. Non-parametric tests were applied to test for possible associations. Cronbach's alpha was 0.677. Nearly half of the patients (42%) presented with mild Alzheimer's disease, 38% moderate, and 20% severe. Most of the patients did not have their natural teeth (74%), had no oral health problems (64%), were on medication (92%), had not visited the dentist in the last year (70%), and had no need for urgent dental treatment (92%). Of the 42% of patients who used dentures, 76.2% had been wearing the same dentures for over 5 years. There was no association between severity of disease and the presence of natural teeth (P = 0.346), use of removable dentures (P = 0.233), and the presence of oral health problems (P = 0.066). Patients with Alzheimer's disease have unmet oral health needs, but there was no association between severity of their disease and the presence of oral health problems.

Sharing Early Preventive Oral Health with Medical Colleagues: A Dental Pain Prevention Strategy

An alarming number of children suffer from preventable dental pain and infections. Untreated caries may cause severe discomfort and grave systemic problems. Using this article as a curriculum of fundamentals, all dental professionals are encouraged to share current best practice oral health prevention strategies with their local community medical providers. Subject matter includes rudimentary pathophysiology, very early oral health risk assessment, anticipatory guidance, fluoride varnish, and establishing a dental home by age 1.

Pediatrician’s Role in Children’s Oral Health: An Indiana Survey

To evaluate Indiana pediatricians' current practices related to oral health, knowledge of oral health prevention, and opinions on anticipatory guidance integration into their practices. The American Academy of Pediatrics (AAP) May 2003 policy statement on oral health risk assessment timing and establishment of a dental home has provided pediatricians with guidelines to assess patients' oral health and caries risk status. A survey of 31 questions was distributed via mail to all active Indiana pediatricians (300) registered in the Indiana State Medical Association to evaluate current practices relating to oral health prevention and guidance. Of the 300 distributed surveys, 138 were returned (46%). The authors found that 15% of pediatricians recognize the AAP-recommended age for a dental home as 12 months and practice this recommendation. Among the respondents, 7% believe application of fluoride should be part of a well-child visit. The majority (89%) of respondents reported interest in obtaining further knowledge on oral health.

Perceptions of Oral Health Training and Attitudes Toward Performing Oral Health Screenings Among Graduating Pediatric Residents

There is a lack of access to oral health services for American children. Some propose that pediatricians be trained to deliver preventive screening and education to families until they access a dental home. However, little is known about the current oral health training provided during pediatric residency. OBJECTIVE. The purpose of this work was to evaluate the oral health training that pediatricians receive during residency and their attitudes toward performing basic oral health screenings. The American Academy of Pediatrics Survey of Graduating Residents is an annual, randomly sampled national survey of graduating pediatric residents. The 2006 Survey of Graduating Residents surveyed 611 residents and examined their perception of their oral health training and their attitudes about performing oral health screenings. Thirty-five percent of residents received no oral health training during residency. Of those who did, 73% had <3 hours of training, and only 14% had clinical observation time with a dentist. Seventy-one percent felt that they had too little oral health training, and only 21% felt that their residency was very good or excellent in preparing them to perform oral health-risk assessments. Residents felt confident in their ability to offer anticipatory guidance but not to do the more technical oral health screenings. The majority of residents believed that pediatricians should conduct basic oral health screenings. Multiple regression analysis indicated that residents who received >or=3 hours of oral health training, who applied for jobs in the inner city, and whose career goal was to work in primary practice are those most likely to support this idea. Pediatric residents currently receive little training in oral health, and the majority wish for more. This study shows that oral health training during residency can increase pediatrician confidence in participating in important oral health promotion tasks, including anticipatory guidance, oral screenings, and oral health-risk assessment.

Oral health of people with dementia

Oral health of people with dementia

Interprofessional Educational Partnerships in School Health for Children with Special Oral Health Needs

Dental caries is an infectious yet preventable disease that is rampant in some subpopulations in the United States, in particular among individuals with neurodevelopmental/intellectual disabilities (ND/ID). This article reports on the implementation and evaluation of the Louisiana State University Health Sciences Center (LSUHSC) School of Dentistry interprofessional school health educational model to improve oral health assessment and referral for children with ND/ID in an inner-city school system. During this project, dental hygiene students and elementary school nurses were paired to assess the oral health status of 255 inner-city children with developmental disabilities, improve referral/access to dental care for those identified as having need, and propose dental hygiene curriculum changes that would incorporate participation in a "real-life public health setting" for those with ND/ID. Following the program, 66 percent of dental hygiene students said their likelihood of participating in future oral health programs had increased and 75 percent of school nurses rated the educational process as very good or excellent. Modifications in dental hygiene curricula that provide students with training and experience in oral health risk assessment and referral for people with ND/ID is recommended to address the new Commission on Dental Accreditation educational standards 2-18 and 2-26 (implemented January 1, 2005) and dental standard 2-26 (implemented January 1, 2006), which state that dental hygiene and dental graduates must be competent in assessing the treatment needs of patients with special needs.

Value of a community pediatrics rotation for residents

Value of a community pediatrics rotation for residents

Determinants of Dental Referral Practices Among WIC Nutritionists in North Carolina

To examine the effects of knowledge and confidence on dental referral practices among WIC nutritionists in North Carolina. A questionnaire consisting of 118 Likert scale-type questions was administered to 92% of all WIC nutritionists in North Carolina (n = 324). The relationship of knowledge and confidence with frequent dental referrals was tested using logistic regression. Regression results found that confidence in performing oral health risk assessments (OR = 2.12; 95% CI = 1.13, 3.96), confidence in making dental referrals (OR = 3.02; 95% CI = 1.45-6.29), and confidence in expected outcomes that parents would seek dental care when advised to do so (OR = 3.11; 95% CI = 1.62, 5.97) were associated with more frequent dental referrals. The more confident WIC nutritionists feel about oral health, the more likely they are to make dental referrals. Screening and referral by WIC workers may benefit children by improving access to dental care, as the WIC clinic is frequently the first point of contact with a health professional.