Oral Neglect Research Articles

Oral neglect as a marker of broader neglect: a cross-sectional investigation of orodental consultation letter of leukemic admitted patients in Iran

BackgroundLeukemia is the main malignant hematologic disease of children with different oral manifestations and clinical features. Attention to the oral manifestations is essential for better management. This study assessed the oral and dental consultations conducted in the admitted leukemic patients of an Iranian teaching hospital.MethodsIn this descriptive cross-sectional study, medical records of patients admitted in Yazd Shahid Sadoughi Hospital were evaluated. Records of 300 patients with leukemia were randomly selected. Data including demographic information on age, sex, type of oral problems, prescribed instructions and leukemia type were extracted from archived records and registered on the checklist. Finally, Data were analyzed by SPSS17 using Chi-square test.ResultsThe results showed the average age ± SD of patients were 24.36 ± 23.91 with a range of 4 days to 86 years. Among 300 files, 167 belonged to males (55.7%) and 133 pertained to females (44.3%). The most prevalent type of underlying disease was ALL (Acute lymphocytic leukemia) with the frequency of 180 persons (60%). Only 12 (4%) of patients were referred to a specialist due to oral problems. Of all cases of consultation requests, 75% received consultation because of dental problems and 25% for mucosal problems. There was a statistically significant difference between age and consultation request (P = 0.002).ConclusionsAccording to the results of this study, orodental consultation request rate for admitted leukemic patients was low. Pediatric hematologist and oncologists to some extent had more interest to consult due to oral and dental problems rather than others.

The Impact of Dental Neglect on Oral Health Among 16-30-Year-Olds in Dhulikhel, Kavrepalanchok, Nepal

Introduction: Oral health status is linked to oral health behaviour and dental neglect can be an important parameter for assessment of oral health status. Such evaluation will help in providing and planning appropriate health promotion activities to target population.
 Objective: To assess socio-demographic variations in Dental Neglect (DN) and to determine the association between DN and oral health.
 Methods: Analytical cross-sectional study done at dental hospital in Dhulikhel from September-November 2020. A sample of 327 aged 16-30 years were selected by convenience sampling technique. Demographic details along with DN were collected through the DN questionnaire. Both self-reported oral health and oral health status were assessed. Oral health status was determined by using the Oral Hygiene Index-simplified (OHI-S) and the Decayed Missing Filled index (DMFT).
 Results: Majority 170 (52%) of the sample were from high DN group. A total of 187 (57.2%) of the participants rated their oral health status as all right. Higher number of participants were seen in the fair group of oral hygiene status. Significant correlations were found between education and OHI-S scores. Mean DMFT score was 3.6±1.6 which had higher mean Decayed (D) component as compared to the Missing (M) and Filled (F) components in the index.
 Conclusion: Dental neglect is present among the study population and is associated with self-reported oral health status. Disparities were observed between the socio-demographic variables and DN. The DN Scale can be used in dental health promotion and also in evaluation of health promotion interventions.

Association between dental caries, odontogenic infections, oral hygiene status and anthropometric measurements of children in Lagos, Nigeria

Dental caries is a significant public health problem afflicting about a third of the world’s population which impacts nutrition, quality of life and systemic health. Aim: We explored associations between dental caries, odontogenic infections, oral hygiene and anthropometric measurements of children in Lagos, Nigeria. Methods: A pretested validated questionnaire was administered on 278 children who also received anthropometric assessment and dental examinations. Caries was scored according to WHO criteria and untreated dental caries by the Pulpal Exposure, Ulceration, Fistula, Abcess (PUFA/pufa) index. The weight for age (WAZ), height for age (HAZ), and weight for height (WHZ) parameters evaluated nutritional status. Categorical and continuous data were analysed by χ2-test and ANOVA. Regression analysis was done and statistical significance set at p ≤ 0.05. Results: The prevalence of Decayed, Missing, and Filled Teeth (DMFT + dmft) > 0 was 220 (79.1%) and the proportion of d+D teeth in dmft+DMFT index was 194 (70.0%). The prevalence of odontogenic infections due to caries (PUFA + pufa > 0) was 172 (61.8%). 74 (26.6%) children were stunted; 12 (4.3%) were underweight while 30 (10.8%) were wasted. Children with PUFA + pufa > 1 had increased risk of wasting (OR: 2.45; 95% CI: 1.16-4.88). Children with DMFT+dmft >5 were also significantly underweight with odds ratios of 2.34 (95% CI 1.04-4.33). Conclusions: There was significant association between untreated dental caries, odontogenic infections and stunting, wasting and being underweight among the children studied. Policy makers should be aware of the additional burden that oral neglect has on anthropometric indices.

Geriatric Health Experts Validate Oral Neglect Timelines for the Institutionalized Elderly.

The purpose of this follow-up Delphi survey was to have an expert panel of 31 academic geriatric physicians, geriatric nurses, and medical directors of nursing homes evaluate the original timeline set to avoid oral neglect of nursing home residents. The Oral Neglect in Institutionalized Elderly (ONiIE) timelines defined oral neglect as having occurred when >7 days for acute oral diseases/conditions or >34 days for chronic oral disease/conditions had passed between initial diagnosis and offering access to dental care to the long-term care (LTC) nursing home resident. The results of this follow-up Delphi survey validated those originally defined ONiIE timelines as 90% of this panel agreed with the original timelines. This ONiIE definition adds a broad-based validation for the ONiIE timelines for setting an oral health standard of care for institutionalized elderly residents of nursing homes and should now be used to protect the vulnerable elderly residing in LTC nursing homes.

Extent of Elder Abuse Training in Dental Hygiene Curricula and Program Directors' Perceptions of Importance of and Barriers to Implementation.

Research published in 2002 reported limited elder abuse training in U.S. dental hygiene curricula although its importance has increased with an aging population. The aims of this study were to determine the current extent of elder abuse training in U.S. dental hygiene curricula and to explore dental hygiene program directors' perspectives on the topic. A 25-item online survey was distributed to all 361 program directors, coordinators, and/or department chairs of Commission on Dental Accreditation (CODA)-accredited dental hygiene programs via email in August 2017. A response rate of 27.2% (n=98) was achieved. A large percentage of the respondents (83.3%) included elder abuse training in their program curricula; for most (58.7%), one to three curriculum hours were spent on the topic. A large percentage (89%) agreed the topic was at least somewhat important to include, and 29.5% said a personal or professional elder abuse experience influenced the depth of instruction at their program. Various barriers to inclusion were identified. At least 40% of these educators perceived their graduates to be appropriately competent in their ability to recognize elders' oral neglect (63.5%) and general neglect (48.7%) and to document potential signs of elder abuse (43.8%). Lower percentages perceived that their graduates were competent in the areas of communication regarding elder abuse (21.9%) and reporting suspected abuse (32.4%). Despite rising awareness about elder abuse among dental hygienists and widespread incorporation of the subject in dental hygiene curricula, these results suggest that there are still deficiencies in training. To prepare dental hygiene graduates to confidently recognize and respond to elder abuse, educators should seek to overcome barriers by modifying instruction and embracing interprofessional collaboration.

Dental anxiety and the status of first permanent molars in 11 and 15 years old children

Summary Introduction Fear of dental procedures is one of the main reasons for oral health neglect. The first permanent molars are functionally very important. Dental anxiety may compromise their health as well as the health of all other teeth. The aim of the study was to determine dental anxiety level and the status of first permanent molars in healthy school aged children. Methods This study included 105 students, 11 and 15 years of age, from two elementary schools in Foca (Bosnia and Herzegovina). Dental Anxiety Scale (DAS), questionnaire was used to determine the level of dental fear in patients. The status of first permanent molars was recorded using Klein-Palmer DMFT (decayed, missing, filling teeth) system. The number of healthy first permanent molars (with or without sealant) was registered as well. Results More than one third of respondents involved in this study (33.3%), suffered from severe dental anxiety (DAS = 13–20 points). Statistically significant difference in answers to questions was not observed between respondents of different age but higher level of the fear was registered in girls compared to boys (p < 0.05). Less than 50% of all examined first permanent molars were healthy and sealed fissures were recorded in 9.4% of them. The percentage of decayed molars was about 11%, 7% extracted and 35% filled. Conclusion Application of prophylactic measures is beneficial for dental health preservation. They are pain free and can be used to minimize fear by establishing dentist-patient relationship based on confidence.

Applications of forensic odontology in pediatric dentistry: A brief communication

Forensic odontology is the application of dentistry to law and delineates the overlap between dental and legal professions. Pedodontist plays an important role in forensic odontology by applying his expertise in various fields such as accidental or nonaccidental oral trauma, child abuse and neglect, age determination, dental records, and mass disasters by examination of the teeth and jaws structure for clues. These dental findings/records may be helpful in forensic identification wherein an unidentified individual can be identified using dentition. Information of teeth record remains throughout life and beyond, due to their physiologic variations, pathology, and effects of therapy. Lip prints and palatal rugae patterns can also lead us to important information and help in person's identification. Teeth can also help in determining gender of the skeletonized remains using dental DNA. Forensic odontology also plays role in crime investigation caused by dentition, such as bite marks. Odontologist can help physician in evaluation of bite marks due to abuse. The aim of this article is to discuss the role of pedodontist in various aspects of forensic odontology and procedures needed for examination, identification, and investigations of bite marks.

Oral health and the frailty syndrome.

The frailty syndrome is an ever-growing area of study among older adults because of its association with an increased risk of falls, hospitalization, institutionalization, dependency and mortality. Frailty is neither a disease nor a disability but is better understood as a medical syndrome of multisystem dysregulation that results in a diminished ability to overcome everyday stressors. The prevalence of frailty in any given population can vary widely, in part because of the way in which it is defined and measured, but in general it is higher among women and in those with advanced age and declining health. Whilst it is largely understood that older adults will differ biologically, psychologically and socially, and that each of these domains can impact oral health, we are only beginning to investigate how the mouth is affected in frailty. Given that both hard and soft structures contribute to oral health and disease status among older adults with varying degrees of impairment and disability, frailty adds yet another dimension to be considered. This paper will discuss how frailty can influence and be influenced by oral disorders, as well as the potential relationship to oral neglect and the resultant consequences among this vulnerable population.

Elderly Abuse, Violence and Neglect in Haryana-A Case Study

At national level, almost a third of elderly victims are abused in their own home and almost as many are abused in residential care. The most common type of abuse was physical, followed by acts of neglect or omission. Increasing cases of elder abuses are largely an outcome of changing global phenomena where the family bonds are not as strong as in the past and elders are being marginalised. The paper is an attempt to examine the nature and causes of elderly abuse and to record the feelings of the elderly. Five hundred responded above 60 years age were randomly selected from rural and urban areas of district Rohtak. It is found that though there is not any major case of elder abuse, yet oral abuses and neglect are reported. Contrary to the common perception, sons are largely responsible for abuse and neglect. About 27.6 per cent of the respondents admitted that they have met out one or the other type of abuse. The percentage of abused females is larger than their counterparts. The abused feel sad and depressed. Nearly 21 per cent abused respondents reported depression and about 6 per cent thought to commit suicide.

Effectiveness of professional oral health care intervention on the oral health of residents with dementia in residential aged care facilities: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE The objective of this review is to critically appraise and synthesize evidence on the effectiveness of professional oral health care intervention on the oral health of aged care residents with dementia. More specifically the objectives are to identify the efficacy of professional oral health care interventions on general oral health, the presence of plaque and the number of decayed or missing teeth. INCLUSION CRITERIA Types of participants This review will consider studies that include residents with a formal diagnosis of dementia currently residing in permanent care in Residential Aged Care Facilities. This review will exclude participants that have not received a formal diagnosis of dementia as well as those who are not living as a permanent admission in Residential Aged Care Facilities. Studies conducted on community dwelling individuals with a formal diagnosis of dementia will be excluded. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate the efficacy of professional oral health care performed by a dental hygienist. These studies involve professional oral health care performed by a dental hygienist using a toothbrush, interdental brushes, floss and hand scalers if necessary to remove plaque and food debris and in some instances hardened calculus or tartar. If there are studies involving the professional oral health care being performed by dentists or a combination of dentists and dental hygienists they will be included in the analysis. This review will exclude interventions involving staff training interventions and interventions performed by nurses/assistant nurses. TRUNCATED AT 250 WORDS

Some clarification of trigger signs for dental neglect.

ASSIA, EBSCO-CINAHL, Cochrane CENTRAL, EMBASE, ERIC, MEDLINE, SCOPUS, OpenGrey, Proquest-Social Services/Sociological Abstracts, Web of Knowledge-Conference Proceedings Citation Index and ISI Science Citation/ Social Science Citation Index. There were no language restrictions and authors were contacted for primary data and additional information when required. Studies were considered eligible if they were primary studies of children (0 to 18 years) with confirmed oral neglect and with detail of dental, intra- and extra-oral features. Exclusion criteria included; studies of sexual or physical abuse or those where there was oral neglect suspected but no detail was given. All characteristics associated with dental neglect were considered outcomes. Each article was independently reviewed by two reviewers from a panel of 22 trained reviewers with a third reviewer resolving any disagreement. A specifically designed tool for quality assessment was used. Three thousand eight hundred and sixty-three citations and abstracts were scanned, 83 studies were reviewed and nine (with 1595 children aged 0 to 15 years) met the inclusion criteria, including two case control studies. There were not enough data to allow meta-analysis to be carried out.The features most commonly recorded as being characteristics of dental neglect were; failure to seek, or delay in seeking dental treatment, failure to follow advice or complete treatment, and this often co-existed with an adverse impact of dental neglect on the child including pain and swelling. A 'threshold' level of dental caries, that allowed dental neglect to be defined, could not be established from the available literature. There was limited literature on this topic. The main characteristics of dental neglect highlighted were failure/delay in seeking dental care, with adverse consequences. However, due to a lack of research and additionally, a deficiency in the data on precise clinical features, it was not possible to make the distinction between dental caries and dental neglect.

Schizophrenia and periodontal disease: An oro-neural connection? A cross-sectional epidemiological study.

Background:Schizophrenia is a psychosis characterized by delusions and hallucinations occurring in clear consciousness. Studies have shown that the cytokines may modulate dopaminergic metabolism and schizophrenic symptomatology in schizophrenia. Cytokine involvement in periodontal disease is also well documented. To date, however, there has been relatively little research assessing periodontal status of patients with schizophrenia. The present study was therefore mainly intended to understand the exact link, if any, between periodontal disease and schizophrenia.Materials and Methods:A total of 250 schizophrenic patients (140 males and 110 females), between 25 and 55 years of age, were selected from the out patient department of National Institute of Mental Health and Neural Sciences, Bangalore and their periodontal status was assessed as part of this cross-sectional epidemiological survey.Results:ANOVA showed that there was increased evidence of poor periodontal condition, as evidenced by gingival index and plaque index in patients who had been schizophrenic for a longer duration of time (P < 0.001). So also, higher probing pocket depths were found in schizophrenics suffering from a longer period of time than others (P < 0.001).Conclusions:Although oral neglect might be a cause of poor periodontal health in schizophrenics, the possible link between periodontal diseases giving rise to schizophrenia cannot be overlooked due to the presence of cytokine activity which is present both in schizophrenia and periodontal disease.

Dental health of young children prenatally exposed to buprenorphine. A concern of child neglect?

To study the oral health and dental neglect of prenatally buprenorphine-exposed 3-year-old children. The study consisted of 51 children who as newborns tested positive for buprenorphine in a urine screen. The control group comprised 68 children previously unexposed to narcotics. The dentist examined the children and interviewed their guardians. Buprenorphine-exposed children exhibited significantly more early childhood caries than did the control group. Caries indices, the number of decayed, missing and filled teeth or tooth surfaces and decayed teeth were greater in the buprenorphine-exposed children than the control children (p = 0.004, p = 0.004, p = 0.001, respectively). In the buprenorphine group, more children showed visible plaque (p = 0.003) and fewer children were caries-free (p = 0.009) than in the control group. The control children's teeth were also brushed more often than the buprenorphine-exposed children's teeth (p = 0.001) and the parents were more involved in their children's tooth brushing than were those in the buprenorphine-exposed group (p = 0.035). More caries and dental neglect were found in buprenorphine-exposed children than in controls. These findings highlight the importance of routine dental appointments, caries screening and preventive care for children in substance-abusing families.

Early treatment of obesity not to refine arthroplasties in patients with osteoarthritis

ext.– Managing the elderly involves all disciplines of Medicine, ursing and Allied Health. The World Health Organization has lready identified poor oral and dental health in the elderly as n emerging health issue; however, little progress has been made. here is an urgent need for a greater understanding of the impliations of poor oral health to be appreciated by all health care orkers. Apart from the systemic consequences of poor oral health ny resultingpainanddiscomfort canbedevastating, compounding sychosocial issues, disrupting family dynamics, frustrate carers nd Residential Aged Care Facility staff and thwart harmonious elationships amongst residents. As appearance, function and comort suffers so may an elderly person’s self esteem and confidence. roviding appropriate oral and dental care for the elderly is not bout providing expensive contemporary dental treatment. Rather t is about understanding an older person’s functional needs and ddressing oral health education for the aged, their family or carer nd those involved in delivering care in Residential AgedCare Facilties. We cannot allow oral and dental health deficits to lead to ncreased morbidity and mortality. A clean and healthy mouth is ssential to limit the potential for aspirational pneumonia arising rom oral and dental neglect in one of the most vulnerable cohorts n the community. isclosure.– No significant relationships. eference [1] Petersen, et al. Global oral health of older people – call for public health action’ community. Dental Health 2010;27(Supplement 2):257–68.

Defining oral neglect in nursing homes

Defining oral neglect in nursing homes

Defining Oral Neglect in Institutionalized Elderly: A Consensus Definition for the Protection of Vulnerable Elderly People

The authors administered surveys to develop an operational definition of oral neglect in institutionalized elderly (ONiIE) in the United States. The authors administered a Delphi technique survey involving three rounds to a panel of 19 geriatric dental experts in 1995 to arrive at a definition of ONiIE. The authors validated the 1995 ONiIE definition by administering a Delphi technique survey involving four rounds to a subset of eight experts from the 1995 panel. The panelists in the 2009 survey validated the 28 oral diseases or conditions that were part of the 1995 ONiIE definition and added one new oral condition-bleeding. They also reached consensus agreement for each of the 29 listed oral diseases and conditions regarding both the diagnostic stage at which those diseases and conditions should be included in a definition (mild, moderate, or severe) and the specified time period required to constitute neglect (that is, total "time to qualify as neglect" was eight days for acute conditions and 35 days for chronic conditions). An expert-driven consensus ONiIE definition was established. It consists of 29 oral diseases and conditions, each of which has been associated with a diagnostic stage and a specified time period required to constitute neglect. Since federal legislation that funds payments to nursing homes for the care and housing of their residents requires that there shall be no oral neglect, this validated consensus ONiIE definition provides a utilitarian means to enforce that legislative expectation.

The Importance of Oral Health for Cardiothoracic and Vascular Patients

Prior to cardiothoracic or vascular surgery, a patient's oral health is not usually a high priority for the surgical team. Yet, oral neglect often mirrors systemic disease and the need for proper dental care is often unmet. In the perioperative period, the presence of untreated decayed teeth and periodontal disease can result in a potent odontogenic infection with significant consequences. Patients can unknowingly present for such operations with undetected oral infections that can magnify the likelihood of an adverse outcome, increase costs, morbidity, and possibly mortality. Considering scheduling constraints and the urgency of the procedure, a pre-operative dental screening is suggested for patients who undergo elective cardiothoracic or vascular surgery, to ensure that any oral infection is diagnosed and definitively treated. Implementing such an effective and preventive approach can improve surgical outcome and overall patient health.

Defining ‘Oral Neglect in Institutionalized Elderly’ for Public Policy Use: The ONiIE Project

Defining ‘Oral Neglect in Institutionalized Elderly’ for Public Policy Use: The ONiIE Project

Gerostomatologie - eine Herausforderung auch für den Öffentlichen Gesundheitsdienst

The dental services of the public health service (OGD) should not confine themselves to dental screening in kindergartens and schools but also turn their attention to the advancement of oral health in the special risk groups of the senior citizens. Although government resources are limited, new capacities could be gained by restructuring. Is it really prudent, in a lifetime perspective, for the OGD to solely focus on the oral health of youths while oral neglect in long-term care carries on unabated? A stronger support by the OGD of gerodontology should be instituted on its boards, publicised in health reports, and implemented in supervisory bodies for quality management of the long-term care facilities. An endorsement of the structures of long-term care insurance and training facilities would be desirable. The OGD could assist the fitter seniors through specific education to participate in dental prevention programmes and motivate physicians to inspect the oral cavity. Furthermore, recommendations regarding the structuring of geriatric dental care by the OGD would be helpful. The OGD is a vital partner to gerodontology. Therefore, further projects should be conducted in cooperation with dental organisations.

Financing Oral Health Services for People with Special Needs: Projecting National Expenditures

Low-income people with disabilities or who are elderly have more dental disease, more missing teeth, and more difficulty obtaining dental care than other members of the general population. These realities lead to untreated infection, increased medical costs and needless suffering for the most vulnerable members of our society. It is critical we provide adequate reimbursement for oral health services in order to avoid the tragic and costly consequences of oral neglect. This article focuses on the financial implications of delivering oral health services to low-income individuals who are "aged, blind, and disabled" in the United States. The experience of providing oral health services in California for these populations is extrapolated to predict the cost implications of a national reimbursement system for ABD adults under Medicaid and reform Medicaid oral health programs for vulnerable children. The new federal dollars required to implement this legislation would be more than offset by a conservatively estimated 0.5 percent reduction in costly emergency room and hospital charges for the treatment of serious dental problems, as well as a reduction in the prevalence and severity of several general health conditions. Treating and/or preventing oral infection and disease for the ABD populations in our country will significantly reduce overall health care costs, improve quality of life, and end needless suffering for America's most vulnerable citizens. Treating and/or preventing oral infection and disease for this population simply is the right thing to do.