Preventive Oral Care Research Articles

To Strengthen the Teeth and Harden the Gums - Teeth blackening as medical practice in Asia, Micronesia and Melanesia

Teeth blackening with agents of plant and mineral origin used to be the most wide-spread form of bodily inscription in parts of Asia, Micronesia and Melanesia, and I argue here that it can be productively studied as a medical practice. Ethnographic evidence supports that teeth blackeners became integrated into indigenous systems of medicine in which they fulfilled different purposes. They aided the recovery from the physically challenging teeth filing procedure, provided a primary form of preventive oral care and treated acute oral afflictions. Frequently used teeth blackening agents were derived from plants (e.g., Paederia foetida L. or Punica granatum L.) which were traditionally considered of high medical value and, from a biomedical perspective, had a high content of bioactive constituents. Biomedical data also validate the usefulness of many blackening plant extracts for improving oral health and suggest efficacy against other diseases prevalent in tropical climates, e.g., diarrheal or intestinal parasitic diseases. An assessment of the risk-benefit balance of teeth blackening suggests that, despite concomitant carcinogenic and other toxic risks, especially from chronic application, the practice could have made a positive contribution to health status in many societies before Western contact. The unique dynamic of medical utility embedded in diverse symbolic ascriptions might have provided the basis for its adoption in so many cultures of Asia, Micronesia and Melanesia.

Provision of Oral Care for Hospitalized Patients among Nurses

Effective oral care for hospitalized patients is known to improve patient's quality of life, prevent serious infections and promote health and well-being. To assess the type and frequency of oral care delivered to hospitalized patients by nurses and to evaluate possible barriers. A cross-sectional survey of all cadres of nurses caring for hospitalized patients in University of Benin Teaching Hospital, Nigeria, was conducted in 2010. The questionnaire elicited information on the demography, provision of oral care, oral care methods, frequency of care and barriers to rendering oral care to hospitalized patients. A total of 384 questionnaires were completed and returned giving a 96.0% response rate. Majority (96.1%) believed that oral care should be given priority in hospitalized patients but fewer respondents (81.8%) provided oral care for hospitalized patients. The frequency of oral care was majorly once daily by 65.6% of the respondents. The preventive oral care services commonly rendered were toothbrushing (28.0%), use of mouthwashes (24.8%), oral toileting with warm saline (18.5%). Lack of oral care materials and uncooperative patients were identified barriers to the performance of oral care services. Half of the respondents (51.6%) claimed to have enough training on the effective provision of oral care for hospitalized patients. Atotal of 50.3% think that nurses are in better position to render care to hospitalized patients. The overall provision of oral care for hospitalized patients by the nurses revealed some deficiencies that can be corrected by ensuring adequate supplies and knowledge to respond to uncooperative patients. Key words: oral care, hospitalized patients, nurses

'Love Teeth Day' campaign in China and its impact on oral public health - the twentieth anniversary

The date 20 September has been designated 'Love Teeth Day' (LTD) in China since 1989. The aim of this nationwide campaign is to encourage all Chinese people to conduct preventive oral public health care and promote oral health education; therefore it is beneficial to improve the levels of oral health in the whole Chinese population. Public awareness of oral health in China has substantially improved following 20 years of hard work from dental professionals and relevant departments. The main activities were planned and conducted by the National Committee for Oral Health and local committees at provincial, county and municipal levels to support preventive oral care. The LTD campaign attracts more and more attention from the public on the prevention and control of oral diseases, which is considered to be an extremely pioneering health care programme in the field of Chinese dentistry. This review provides an overview of the huge LTD campaign over the past 20 years, aiming to share our experiences with international dental professionals.

Oral Health Attitudes and Practices Among a German Mexican Mennonite Farmworker Community

The oral health needs of migrant farm laborers are greater and more immediate than those of comparable populations. However, little is known about the conditions of oral health care among German-speaking Mexican Mennonites, a distinctive cultural subgroup of migrant farm laborers. The purpose of this study was to examine the oral health practices, perceived oral health status, and barriers to obtaining dental care among a community of Low German-speaking Mexican Mennonites residing in Southwest Kansas. Interviews were conducted with a sample of 25 individuals, with questions addressing access/barriers to care, oral health practices, and perceived oral health status. The most frequently identified barriers to dental care were limited finances, lack of adequate health/dental insurance, and limited awareness of available dental services. Although the majority of participants reported experiencing no problems related to language or scheduling dental appointments, the results also indicated low utilization levels of oral care services. Findings suggest that: (1) this population is at-risk for periodontal disease, (2) culturally appropriate programs are needed for preventive oral care education, (3) community and statewide support may help improve access to affordable oral health care.

Training rural women to improve access to oral health awareness programmes in remote villages in Nepal

Description of experiences and results of training rural women in Nepal to recognize basic oral health problems and to perform basic oral health promotion activities. Rural women from different districts of Nepal were trained in a 1-day course in oral health promotion as part of a 4-month vocational skills programme targeted at them. Their knowledge about preventive oral care, their recognition of basic oral health problems and their ability to perform basic oral health education were assessed qualitatively and quantitatively before and after the course. From 2006 to 2009, 141 women from 30 mostly rural districts were trained. Following the educational intervention, an overall trend towards improvement of their oral health awareness and their knowledge was documented. They proved to be competent in oral health promotion activities, in demonstrating oral hygiene techniques and in recognizing basic oral health problems. They were able to organize oral health awareness programmes in their villages and acted as advocates for the benefits of fluoridated toothpaste. After 3 years, they educated 2100 other community members, with at least 4000 children participating in their oral health awareness programmes. A community-oriented educational intervention programme for rural women in basic oral health promotion activities could be a successful culturally sensitive means to support access to oral health awareness programmes for Nepalese people in remote areas.

Children's tooth decay in a public health program to encourage low-income pregnant women to utilize dental care

BackgroundA community-based public health program to provide a dental home for women covered by the Oregon Health Plan (Medicaid) in Klamath County, Oregon USA was instituted with the long-term goal to promote preventive oral care for both mothers and their new infants provided by dental managed care companies.MethodsAs part of the evaluation of the program, children in Klamath and comparable non-program counties were examined in their 2nd year of life to begin to determine if benefits accrued to the offspring of the mothers in Klamath County.ResultsEighty-five and 58.9% of the children were caries free in the Klamath and comparison county samples, respectively (RR = 1.48, 95% CI 1.13, 1.93). The mean (SD) number of teeth with any decay was .75 (2.5) in the test population and 1.6 (2.5) in the comparison population (t = 2.08, p = .04).ConclusionsThe assessment showed that children of mothers in the Klamath County program were about one and a half times more likely to be caries free than children in the comparison counties. Additional controlled studies are being undertaken.

Enamel thickness in Asian human canines and premolars

Dental enamel thickness continues to feature prominently in anthropological studies of ape and human evolution, as well as studies of preventative oral care and treatment. Traditional studies of enamel thickness require physical sectioning of teeth for linear and scaled measurements. Recent applications of microtomographic imaging allow scientists to employ larger and more diverse samples, including global samples of recent humans as well as fossil hominin teeth. Unfortunately, little is known about the degree of enamel thickness variation among human populations, particularly across the dentition. This study employed microtomography to virtually image, section, and quantify the average enamel thickness of a sample of clinically extracted Indonesian canine and premolar teeth. This virtual sample was compared to physically sectioned African and European teeth. The results demonstrate that average enamel thickness is similar among human dentitions; no significant differences were detected within tooth positions, which is surprising given developmental differences between European and African canines and premolars. When populations were combined, differences were found in average enamel thickness between maxillary and mandibular premolars, and between canines and premolars within both dental arcades. This finding is potentially due to differences in premolar morphology and a trend of increasing enamel thickness distally throughout the dentition. The finding of limited population variation within tooth positions and significant variation between tooth positions is consistent with previous two-dimensional and three-dimensional studies of human molar enamel thickness. Average enamel thickness in canines and premolars does not differ between the sexes in our sample, although male teeth tend to have larger enamel and dentine cross-sectional areas, enamel–dentine junction lengths, and bi-cervical diameters. Males have significantly greater dentine area and enamel–dentine junction length than females for maxillary canines and premolars. The results of this study suggest that enamel thickness values in mixed-populations of humans are appropriate for comparisons with fossil hominins.

Oral Health Status of Vietnamese Children: Findings From the National Oral Health Survey of Vietnam 1999

The National Oral Health Survey of Vietnam 1999 was conducted to inform policy development. The aims were to describe the oral health status, to analyze its socioeconomic distribution, and to evaluate change over time in the oral health of Vietnamese children. A multistaged stratified sampling process was employed. Children aged 6 to 17 years were examined by trained and calibrated dental examiners. A parental questionnaire was used. Drinking water was analyzed. Preventive oral health behaviors and dental care utilization were infrequent. The decayed, missing, and filled surfaces referring to primary dentition (dmfs) and permanent dentition (DMFS) scores (SD) were 8.9 (11.3) and 2.5 (4.4), respectively. Primary caries experience was associated with fluoride level in drinking water, age, gender, residential status, and geographical location. Permanent caries was also associated with dental visiting and parental education. There was an increase in the prevalence of dental caries in the Vietnamese child population compared with 10 years earlier. The oral health of Vietnamese children was characterized by high level of dental caries with variation among socioeconomic groups. It suggests the need for a population oral health program that includes measures to target high-need children.

Long-term adverse effects of hematopoietic stem cell transplantation on dental development in children

The purpose of this study was to assess late effects of cytotoxic therapy with hematopoietic stem cell transplantation (HCT) on dental development in survivors of childhood cancer. Forty children who underwent allogeneic HCT for a variety of hematological malignancies were evaluated at a minimum of 2 years after transplantation. We obtained information on oral symptoms, exposed panoramic radiographs (PRG), and performed an oral examination. PRGs were scored for agenesis and root and/or crown abnormalities. The root-crown ratio was calculated, and dental age was assessed using Demirjian' s method. The studied group showed a significantly higher prevalence of tooth agenesis compared to normative data for first and second premolars in both the maxilla and mandible, as well as the second molars in the mandible (all p values <0.001). Children who were <3 years old at the time of cancer treatment had significantly more missing teeth than older children, F(2,37) = 7.58, p < 0.002. Root-crown ratios were lower in the study sample than those from normative data. In addition, the mean dental age was higher (as a result of earlier apical root closure) than the mean chronological age, t(28) = 2.47, p < 0.020. Nearly all children examined had dental development disturbances, including agenesis, short roots, and arrested root development. An oral/dental evaluation and preventative oral supportive care regimens should be part of programs monitoring late effects in long-term survivors of childhood cancer.

Providing a Dental Home for Pregnant Women: A Community Program to Address Dental Care Access – A Brief Communication

This paper describes a community-based intervention to provide a dental home for women covered by Medicaid in Klamath County, Oregon. In 2001, 8.8 percent of pregnant women served by Medicaid in Oregon received care. The long-term goal of the program is to promote preventive oral care for both mothers and their new infants. Pregnant women received home/Women, Infant and Children visits and were assigned a dental home under a dental managed care program [Dental Care Organization (DCO)]. All initial care was provided at the Oregon Institute of Technology Dental Hygiene Clinic under the contract with the DCO. Emergency, preventive, and restorative care was provided. Between February 2004 and January 2006, 503 pregnant women were identified; 421 women were contactable. Of these, 339 received home visits (339/421, 80.5 percent) and 235 received care (235/339, 69.3 percent). Overall, 55.8 percent of eligible women received care (235/421). Most who did not have a visit either moved or were not the caretaker of the baby. The missed appointment rate was 9 percent. A community health partnership led to a successful and sustainable model extending care to pregnant women and is being extended to promote preventive care for both new mothers and their offspring.

A survey of National Cancer Institute-designated comprehensive cancer centers’ oral health supportive care practices and resources in the USA

The oral complications and morbidity resulting from overall cancer therapy utilizing radiation, chemotherapy, and/or stem cell transplantation can have significant impact on a patient's health, quality of life, cost of care, and cancer management. There has been minimal health services research focusing on the status of medically necessary, oral supportive services at US cancer centers. A pre-tested, survey questionnaire was distributed to the directors of National Cancer Institute (NCI)-designated comprehensive cancer centers to assess each institution's resource availability and clinical practices, as it relates to the prevention and management of oral complications during cancer treatment. Sixteen of the 39 comprehensive cancer centers responded to the survey. Of the respondents, 56% of the centers did not have a dental department. The sites of delivery of oral supportive care services range from the provision of in-house dental care to community-based, private practice sites. No standard protocols were in place for either oral preventive care or for supportive services for oral complications during or after cancer therapy. Fifty percent of the responding comprehensive cancer centers reported orally focused research and/or clinical trial activities. Comprehensive cancer care must include an oral care component, particularly for those cancer patients who are at high risk for oral complications. This requires a functional team of oral care providers collaborating closely within the oncology team. Considering the number of cancer patients receiving aggressive oncologic treatment that may result in oral toxicity, the impact of oral conditions on a compromised host, and the potential lack of appropriate resources and healthcare personnel to manage these complications, future research efforts are needed to identify the strengths and weaknesses of present oral supportive care delivery systems at both NCI-designated cancer centers and community-based oncology practices.

A comparison of tobacco smoking among dentists in 15 countries

This study was conducted as a systematic review of all modern literature describing the prevalence and associations of tobacco smoking among dentists. A keyword search of appropriate MeSH terms was initially undertaken to identify relevant material. Reference lists of manuscripts were also examined to locate further publications. A total of 35 English-language studies published in the past 25 years met the inclusion criteria. Results suggest that the prevalence of smoking is generally quite low among dentists, and that it has also declined in many countries during recent years. The lowest rates were documented in the United States (USA), Thailand, Finland, Australia and Canada. When multiple studies were examined over time, it appears that dentists in Australia and the USA consistently report the lowest prevalence. Overall, this review suggests that dentists have one of the lowest smoking rates among all health professionals. There were a few exceptions however, namely Italy and Jordan, where dentists appear to be smoking at fairly high rates. Nevertheless, it is important that tobacco usage continues its decline in future years so that the dental profession may remain exemplars at the forefront of preventive oral care.

Treatment of pneumonia in elderly patients

Pneumonia represents the leading cause of infection-related death and the fifth cause of overall mortality, in the elderly. Several risk factors for acquiring pneumonia in older age have been reported, such as alcoholism, lung and heart diseases, nursing home residence and swallowing disorders. The clinical characteristics of pneumonia in the elderly differ substantially compared with younger patients, and the severity of the disease is strongly associated with increased age and age-related comorbidities. Streptococcus pneumoniae is the leading pathogen responsible for pneumonia in elderly; enteric Gram-negative rods should be considered in nursing-home-acquired pneumonia, as well anaerobes in patients with aspiration pneumonia. Antimicrobial therapy should take into account the most recent guidelines, which are briefly presented in this review. A special consideration should be given to the preventive measures, including vaccination, oral care and nutrition.

Integration of oral health into primary health care: the role of dental hygienists and the WHO stewardship

Interest in addressing the unmet oral health needs of the citizens of the world has manifested itself, lately, in noteworthy expressions of commitment. Oral health is integrated with general health and support for community programmes offering 'essential oral health' within primary health care (PHC) is increasing. The WHO Global Goals for Oral Health 2020 has assumed a more directed public health orientation, and the Global Oral Health Programme has its focus on modifiable oral risk behaviours. Last, but not the least, opportunities are being created, under the 'stewardship' of the World Health Organization (WHO), for the expansion of oral disease prevention and health promotion knowledge and practices in communities. A review of the literature on community-oriented oral health primary care reveals one dominant and disease-oriented practice model with dental practitioners being the principal and exclusive actors. One alternative to this biomedical model of care that may be better suited to translate health promotion principles into action at community levels is the practice that involves hygienists serving as primary oral health care providers. The WHO 'stewardship' should include the support of dental hygiene practice within PHC, many legislative restrictions and regulatory barriers would be relaxed, thus enabling dental hygienists to respond to the WHO's call for community-based demonstration projects. With their focus on preventive oral care, hygienists are 'best poised' to help accelerate the integration of oral health with primary care, particularly in the light of the compelling evidence confirming the cost-effectiveness of the care delivered by intermediate providers.

Oral hygiene care for residents with dementia: a literature review

This paper presents a literature review of oral hygiene care for adults with dementia in residential aged care facilities, including evidence for: (1) prevalence, incidence, experiences and increments of oral diseases; (2) use of assessment tools to evaluate residents' oral health; (3) preventive oral hygiene care strategies; and (4) provision of dental treatment. The impact of dementia on residential care is ever-increasing and regular oral hygiene care provision is challenging for cognitively impaired residents. Although an abundance of oral hygiene care recommendations for older people have been published, the supporting evidence has not been clearly delineated. A review was conducted of English language publications (1980-2002), using a two-step approach (keyword electronic database search, supplemented with secondary search of cited references). All 306 selected articles were critically reviewed and systematically categorized. Evidence confirmed clinicians' observations of poor oral health in older residents with dementia. Possible risk factors identified were: salivary dysfunction, polypharmacy, medical conditions, swallowing and dietary problems, functional dependence, oral hygiene care assistance and poor use of dental care. One comprehensive, reliable and validated oral assessment screening tool for residents with dementia had been published. Expert opinion indicated that oral assessment screening by staff and a dentist would be ideal at admission and regularly thereafter. Clinicians and researchers suggested that oral hygiene care strategies were effective in preventing oral diseases and appropriate for residents with dementia. These literature review findings supported the use of oral assessment screening tools by staff and efficacious preventive oral hygiene care strategies/products for adults with dementia in residential care facilities. Further research with this population is needed to develop and validate oral assessment tools and staff education programmes, trial preventive oral hygiene care strategies/products and trial dementia-focused behaviour management and communication strategies.

Oral hygiene care for adults with dementia in residential aged care facilities

Objective The objective of this systematic review was to report on the best available evidence relating to oral hygiene for adults with dementia in residential aged care facilities, including: documenting the prevalence and incidence, as well as the experiences and increments, of oral diseases and conditions the use of assessment tools by carers to evaluate oral health oral hygiene care strategies to prevent oral diseases and conditions the provision of dental treatment and the ongoing management of oral diseases and conditions. Inclusion criteria This review considered any randomised or non-randomised controlled studies, cohort studies, case-control studies, multiple time series studies, uncontrolled studies, descriptive studies and opinions of respected authorities (including theses and other publications) related to residents with dementia living in residential aged care facilities in Australia and overseas; community-dwelling adults with dementia; and special needs adult populations (for preventive oral hygiene care strategies and interventions). The review considered studies and publications designed to: quantify the oral health status of older adults living in residential aged care facilities; quantify the oral health status of adults with dementia living in the community and in residential aged care facilities; evaluate tools used to assess the oral health of residents by staff and carers working in residential aged care facilities; evaluate preventive oral hygiene care strategies and interventions used in special needs adult populations (including adults with dementia); and evaluate oral health care training and oral hygiene care provision, staff and carers working in residential aged care facilities. Dental outcome measures of interest were those relating to the prevalence, incidence, experiences and increments of oral diseases and conditions including: denture problems, coronal and root caries, periodontal diseases (plaque accumulation, gingivitis, loss-of-attachment), oral mucosal conditions, xerostomia and salivary gland hypofunction, tooth loss, difficulty chewing, behavioural problems and pain/discomfort. Related characteristics and outcomes of interest included: medical conditions, medications, cognitive status, functional status, nutritional status and sociodemographics. Search strategy The aim of the search was to locate relevant English-language studies and publications appearing between 1980 and 2002. The search utilised a two-step approach, involving an initial search of electronic databases using combinations of key words followed by a second extensive search carried out using the identified key words. This was supplemented with a secondary search of the references cited in the identified studies. Electronic database searched were: Cinahl, Embase, Psycinfo, Medline and Current Contents. Methodological quality All selected studies were critically appraised by two reviewers prior to inclusion in the review. Results In regards to relevance, incidence, experiences, and increments of oral diseases and conditions, possible risk factors identified included: saliva dysfunction, polypharmacy, comorbid medical conditions, swallowing and dietary problems, increased functional dependence, need for assistance with oral hygiene care, and poor access and utilisation of dental care. Evidence on the use of assessment tools by carers to evaluate residents' oral health showed that successful assessment of residents with and without dementia by nursing staff requires appropriate staff training by a dental professional. Coupled with appropriate training, an oral assessment screening tool designed for residents with dementia has been successfully used by nursing and care staff to identify residents requiring further review by dental professionals. Expert opinion in the field indicates that oral assessment screenings by a staff member and then by a dentist would ideally be undertaken upon admission to a facility, and regularly thereafter by staff and/or dentists as required. Clinicians and researchers suggested that oral hygiene care strategies to prevent oral diseases and conditions were found to be effective in preventing oral diseases, and thus are relevant for use in the resident with dementia. In regards to the provision of dental treatment and ongoing management of oral diseases and conditions, the use of adjunctive and preventive aids were found to be effective when introduced in conjunction with a staff training program: Expert opinion suggests that behaviour management techniques will increase the potential of performing oral hygiene care interventions. Conclusions This review suggests that the training of staff in the form of a comprehensive practically oriented program addressing areas such as oral diseases, oral screening assessment, and hands-on demonstration of oral hygiene techniques and products is likely to have a positive impact on the management of oral hygiene care within residential aged care facilities. The review also identified that regular brushing with fluoride toothpaste, use of therapeutic fluoride products and application of therapeutic chlorhexidine gluconate products are validated by research as effective for the general population and some populations with special needs.

A survey of current practice with regard to oral care for children being treated for cancer

The aim of the study was to establish current UK oral care practice for children with cancer. A telephone survey of all 22 United Kingdom Children's Cancer Study Group (UKCCSG) centres was undertaken. Nineteen (86%) of the centres reported using guidelines/protocols for mouth care. The use of routine preventive oral care therapies showed the greatest variation between centres. Four centres (18%) did not use any prophylactic oral care therapy other than basic oral hygiene, whereas seven (32%) routinely used a combination of three or more agents. Chlorhexidine was the most frequently administered prophylactic therapy (17/22 centres, 77%), followed by nystatin (11/22 centres, 50%). There was little variation in advice given to parents/patients on basic oral hygiene. Regarding dental check-ups, 9/22 centres (41%) recommended children to attend a hospital-linked dental clinic. Only at 8/22 centres (36%) did children undergo a dental check-up before commencing cancer treatment. The survey identified significant variation in preventive oral care therapies and dental check-ups at the UKCCSG centres. Attention needs to be given to establishing evidence based, effective strategies.

Oral hygiene care for adults with dementia in residential aged care facilities

Executive summaryObjective The objective of this systematic review was to report on the best available evidence relating to oral hygiene for adults with dementia in residential aged care facilities, including: documenting the prevalence and incidence, as well as the experiences and increments, of oral diseases and conditions the use of assessment tools by carers to evaluate oral health oral hygiene care strategies to prevent oral diseases and conditions the provision of dental treatment and the ongoing management of oral diseases and conditions. Inclusion criteria This review considered any randomised or non‐randomised controlled studies, cohort studies, case‐control studies, multiple time series studies, uncontrolled studies, descriptive studies and opinions of respected authorities (including theses and other publications) related to residents with dementia living in residential aged care facilities in Australia and overseas; community‐dwelling adults with dementia; and special needs adult populations (for preventive oral hygiene care strategies and interventions).The review considered studies and publications designed to: quantify the oral health status of older adults living in residential aged care facilities; quantify the oral health status of adults with dementia living in the community and in residential aged care facilities; evaluate tools used to assess the oral health of residents by staff and carers working in residential aged care facilities; evaluate preventive oral hygiene care strategies and interventions used in special needs adult populations (including adults with dementia); and evaluate oral health care training and oral hygiene care provision, staff and carers working in residential aged care facilities. Dental outcome measures of interest were those relating to the prevalence, incidence, experiences and increments of oral diseases and conditions including: denture problems, coronal and root caries, periodontal diseases (plaque accumulation, gingivitis, loss‐of‐attachment), oral mucosal conditions, xerostomia and salivary gland hypofunction, tooth loss, difficulty chewing, behavioural problems and pain/discomfort. Related characteristics and outcomes of interest included: medical conditions, medications, cognitive status, functional status, nutritional status and sociodemographics.Search strategy The aim of the search was to locate relevant English‐language studies and publications appearing between 1980 and 2002. The search utilised a two‐step approach, involving an initial search of electronic databases using combinations of key words followed by a second extensive search carried out using the identified key words. This was supplemented with a secondary search of the references cited in the identified studies. Electronic database searched were: Cinahl, Embase, Psycinfo, Medline and Current Contents.Methodological quality All selected studies were critically appraised by two reviewers prior to inclusion in the review.Results In regards to relevance, incidence, experiences, and increments of oral diseases and conditions, possible risk factors identified included: saliva dysfunction, polypharmacy, comorbid medical conditions, swallowing and dietary problems, increased functional dependence, need for assistance with oral hygiene care, and poor access and utilisation of dental care.Evidence on the use of assessment tools by carers to evaluate residents’ oral health showed that successful assessment of residents with and without dementia by nursing staff requires appropriate staff training by a dental professional. Coupled with appropriate training, an oral assessment screening tool designed for residents with dementia has been successfully used by nursing and care staff to identify residents requiring further review by dental professionals. Expert opinion in the field indicates that oral assessment screenings by a staff member and then by a dentist would ideally be undertaken upon admission to a facility, and regularly thereafter by staff and/or dentists as required.Clinicians and researchers suggested that oral hygiene care strategies to prevent oral diseases and conditions were found to be effective in preventing oral diseases, and thus are relevant for use in the resident with dementia.In regards to the provision of dental treatment and ongoing management of oral diseases and conditions, the use of adjunctive and preventive aids were found to be effective when introduced in conjunction with a staff training program:Expert opinion suggests that behaviour management techniques will increase the potential of performing oral hygiene care interventions.Conclusions This review suggests that the training of staff in the form of a comprehensive practically oriented program addressing areas such as oral diseases, oral screening assessment, and hands‐on demonstration of oral hygiene techniques and products is likely to have a positive impact on the management of oral hygiene care within residential aged care facilities. The review also identified that regular brushing with fluoride toothpaste, use of therapeutic fluoride products and application of therapeutic chlorhexidine gluconate products are validated by research as effective for the general population and some populations with special needs.

Oral hygiene care for adults with dementia in residential aged care facilities.

The objective of this systematic review was to report on the best available evidence relating to oral hygiene for adults with dementia in residential aged care facilities, including: INCLUSION CRITERIA: This review considered any randomised or non-randomised controlled studies, cohort studies, case-control studies, multiple time series studies, uncontrolled studies, descriptive studies and opinions of respected authorities (including theses and other publications) related to residents with dementia living in residential aged care facilities in Australia and overseas; community-dwelling adults with dementia; and special needs adult populations (for preventive oral hygiene care strategies and interventions).The review considered studies and publications designed to:1 quantify the oral health status of older adults living in residential aged care facilities;2 quantify the oral health status of adults with dementia living in the community and in residential aged care facilities;3 evaluate tools used to assess the oral health of residents by staff and carers working in residential aged care facilities;4 evaluate preventive oral hygiene care strategies and interventions used in special needs adult populations (including adults with dementia); and5 evaluate oral health care training and oral hygiene care provision, staff and carers working in residential aged care facilities.Dental outcome measures of interest were those relating to the prevalence, incidence, experiences and increments of oral diseases and conditions including: denture problems, coronal and root caries, periodontal diseases (plaque accumulation, gingivitis, loss-of-attachment), oral mucosal conditions, xerostomia and salivary gland hypofunction, tooth loss, difficulty chewing, behavioural problems and pain/discomfort. Related characteristics and outcomes of interest included: medical conditions, medications, cognitive status, functional status, nutritional status and sociodemographics. The aim of the search was to locate relevant English-language studies and publications appearing between 1980 and 2002. The search utilised a two-step approach, involving an initial search of electronic databases using combinations of key words followed by a second extensive search carried out using the identified key words. This was supplemented with a secondary search of the references cited in the identified studies. Electronic database searched were: Cinahl, Embase, Psycinfo, Medline and Current Contents. All selected studies were critically appraised by two reviewers prior to inclusion in the review. In regards to relevance, incidence, experiences, and increments of oral diseases and conditions, possible risk factors identified included: saliva dysfunction, polypharmacy, comorbid medical conditions, swallowing and dietary problems, increased functional dependence, need for assistance with oral hygiene care, and poor access and utilisation of dental care.Evidence on the use of assessment tools by carers to evaluate residents' oral health showed that successful assessment of residents with and without dementia by nursing staff requires appropriate staff training by a dental professional. Coupled with appropriate training, an oral assessment screening tool designed for residents with dementia has been successfully used by nursing and care staff to identify residents requiring further review by dental professionals. Expert opinion in the field indicates that oral assessment screenings by a staff member and then by a dentist would ideally be undertaken upon admission to a facility, and regularly thereafter by staff and/or dentists as required.Clinicians and researchers suggested that oral hygiene care strategies to prevent oral diseases and conditions were found to be effective in preventing oral diseases, and thus are relevant for use in the resident with dementia.In regards to the provision of dental treatment and ongoing management of oral diseases and conditions, the use of adjunctive and preventive aids were found to be effective when introduced in conjunction with a staff training program:Expert opinion suggests that behaviour management techniques will increase the potential of performing oral hygiene care interventions. This review suggests that the training of staff in the form of a comprehensive practically oriented program addressing areas such as oral diseases, oral screening assessment, and hands-on demonstration of oral hygiene techniques and products is likely to have a positive impact on the management of oral hygiene care within residential aged care facilities. The review also identified that regular brushing with fluoride toothpaste, use of therapeutic fluoride products and application of therapeutic chlorhexidine gluconate products are validated by research as effective for the general population and some populations with special needs.

Dental hygiene's interdisciplinary relationship with dental public health: a position paper

Dental hygienists' collaboration with social institutions, health-care workers and organisations, educational institutions, and dentistry can prevent oral diseases. Dental hygienists working in these organisations can reach an unprecedented number of people, thereby increasing preventive oral care to many undeserved. Working within a dental public health career increases choices and opportunities for the dental hygienist and benefits the public.