Public Oral Health Care Research Articles

Rising trend of dentist-prescribed antibiotics in Brazil: 2011-2021.

To describe the trends in antibiotic prescribing by dental practitioners and to investigate the relationship between these trends and some factors of public oral health services in Minas Gerais (MG), Brazil. This was a time-series analysis of antibiotics prescribed by dental practitioners between January 2011 and December 2021. The outcome variables were number of defined daily doses (DDD) and DDD/1000 population/year in a sample of cities in MG. Covariates were public oral healthcare factors, such as coverage, estimates of dental procedures, and frequency of dental pain. Linear time-series regression models were used to examine trends and the influence of covariates on antibiotic prescribing. Overall, the number of prescriptions increased by 334.69% between 2011 and 2021, with amoxicillin being the most commonly prescribed drug (78.53%). The number of DDD for all antibiotics increased from 17,147.13 to 77,346.67 and the average DDD/1000 inhabitants/year was 126.66 (SD: 130.28). The linear time-series regression model showed that for each one-year increase, the average log DDD/1000 inhabitants increased by 0.35 (standard error = 0.07, p < 0.001). No covariates were found to be associated with the outcome. In Minas Gerais, Brazil, a significant upward trend was observed in the number of prescriptions and the number of DDD of antibiotics prescribed by dental practitioners. No influence of factors related to public oral healthcare services on the outcome was observed, thereby emphasizing the need for further research on factors influencing medication use in dental practice.

National waiting time monitoring in oral healthcare - The role of triage dental nurses.

Our study analyzed dental nurses' use and use behavior determinants of electronic patient IS modules in telephone triage. The modules were implemented in public oral healthcare organizations' patient ISs to digitalize the national waiting time monitoring system. For the cross-sectional survey, we collected data from dental nurses using convenience sampling and applied a modified UTAUT as the theoretical framework. The results indicate that using the module for different purposes varied, and the nurses used it sparsely in recording data for monitoring national waiting times. Using the module was laborious, and triage work was busy. Dental nurses' low system usage resulted in poor-quality data for waiting time monitoring. As healthcare data is increasingly used for purposes other than clinical decision making, we must ensure that healthcare professionals performing clinical tasks perceive data recording for non-clinical purposes as meaningful and have time for proper data entry.

A policy option towards improving efficiencies in Victorian public oral healthcare.

International oral health policy directions led by the World Health Organisation call for the inclusion of oral health within universal health coverage. The aim of this study is to perform a budget impact analysis of a policy option for a more cost-efficient oral health workforce skill-mix (dentists and oral health therapists) to provide public oral healthcare in Victoria, Australia. Two hypothetical standard care pathways were developed. A dynamic population Markov model in TreeAge software, with a time horizon of 6years. Two scenarios were modelled to determine: (1) base-case scenario: the threshold the dentist workforce could reduce per year, while achieving the same service delivery outputs, and (2) alternative scenario: the potential cost-savings for utilising an optimally cost-efficient oral health workforce skill-mix. The threshold analysis showed a minimum reduction of 13% of the dentist workforce being replaced with oral health therapists can occur without having any impact on the same service delivery outputs. Under the alternative scenario, the potential cost-savings would be AUD$1,425,037 (standard deviation 58,954). Governments and policy-decision makers should consider strategies in training, attracting, and retaining oral health therapists to achieve an optimally cost-efficient oral health workforce skill-mix when delivering public oral healthcare.

Digital national waiting time information system - View of Finnish public oral healthcare managers

ObjectivesThe study evaluated the digital national waiting time information system from the point of view of oral healthcare managers in Finland in 2021. The information system (IS) was implemented in 2014, primarily to monitor waiting times in public healthcare. The system reported the information on realised waiting times on the Internet. MethodsWe gathered the data using a cross-sectional survey. Evaluating the system was based on a modified IS success model with the dimensions of information quality, system quality, individual impact and organisational impact. We used convenience sampling when including in the study managers working in public primary oral healthcare in the spring of 2021. ResultsThe managers (n = 97) perceived it as easy to access the waiting time information on one website, but they evaluated the information as low quality. The information on realised waiting times supported them in the management of current waiting times to a minor degree. The managers associated the information inaccuracy in the national system with dental nurses’ poor data entry in electronic patient ISs in oral healthcare organisations. The inaccuracy meant that waiting time monitoring data was not valid. ConclusionsOur modified IS success model was sufficient to ascertain that poor information quality likely influenced the effectiveness of managers in information-driven waiting time management. Information must be relevant and accurate to promote the success of ISs. Further research is required to explore how to improve the design of national ISs from the point of view of different stakeholders in healthcare.

Awareness of the concept and role of public oral health care in Korea among oral health professionals

Awareness of the concept and role of public oral health care in Korea among oral health professionals

Evaluation of the Empower model of care for partial denture clients in a public oral health care setting.

To evaluate the effectiveness of the Empower model of care (EMC) on reducing the addition of teeth to removable partial dentures (RPD). Data reports were generated through the Titanium electronic database to retrieve all clients at Monash Dental Services (MHDS) who participated in the EMC or received an RPD prior to the implementation of EMC was assessed over a two-year period to determine if they had additional teeth added to their partial dentures (PD). A logistic regression was performed testing whether a combination of socio-demographic and clinical variables, provided a multivariate explanation of the EMC outcome. Prior to EMC, 2034 patients attended MHDS requiring RPDs with 363 returning to have teeth added. From 2018 to 2020, 38 of 584 participants in EMC returned to have teeth added to their PDs. Those in the 'High' risk group were two times more likely to return requiring additional teeth (OR = 1.99; 95%CI:1.31-3.02); each additional year of age increased the odds of requiring additional teeth (OR = 1.03; 95%CI:1.02-1.04). Participants of the EMC were more than two times less likely to require additional teeth (OR = 0.42; 95%CI:0.29-0.59). The variance in requiring additional teeth accounted for using the full model was 9.1% (η2 = 0.091). This analysis confirms the effectiveness of the EMC. This approach assists denture wearers to maintain good oral health and provides an effective way of managing public health funds by reducing denture repairs and additions. © 2023 Australian Dental Association.

Evaluation of the availability of secondary dental care within the Brazilian public health system: a cross-sectional study

To achieve the goal of comprehensive care provided between primary and secondary care, the interface must be without barriers. This cross-sectional study evaluated the availability of secondary dental care services in public health services in Brazil. This study focused on reference Dental Specialty Centers (DSCs) with 18,114 Oral Health Teams (OHTs) that adhered to the second cycle of the “National Program for Improving Access and Quality of Primary Care” (PMAQ-AB). Questions about the availability of DSCs for patient referrals by OHTs and the type of dental specialties provided by municipalities in DSCs were analyzed descriptively and compared per Brazilian macro-region. Seventy-five percent of OHTs reported the existence of DSCs for patient referral. The most available specialties at DSCs included minor oral surgery (90.1%), endodontics (82.0%), patients with special needs (81.5%), and periodontics (80.5%). The OHTs presented a mean of 5.77 (±2.08) referable specialties. OHTs from the South and Southeast regions reported the availability of more specialized consultations. The most available specialties in all regions included minor oral surgery, endodontics, patients with special needs, and periodontics. The best results were found in the Southeast, followed by the Northeast and South regions. Brazilian public oral health shows a structure of secondary oral health care, however, a difference was observed among the OHTs, especially as regards the frequency and availability of specialties. More investments in public oral health care in Brazil are required to improve the availability of secondary dental care in regions with lower economic development.

Signalling waiting times to citizens on public oral healthcare providers’ websites

Objective: The study aimed to analyse the usefulness of signalling waiting times to citizens on the websites of public primary oral healthcare providers in Finland. Finnish laws require this signalling. Material and methods: We gathered data with two cross-sectional surveys in 2021. One electronic questionnaire was for Finnish-speaking citizens in Southwest Finland. The other was for public primary oral healthcare managers (n = 159). We also gathered data on 15 public primary oral healthcare providers’ websites. For the theoretical framework, we combined the agency and signalling theories. Results: Of the citizen respondents (n = 411), 57% knew about the waiting time signalling on the websites. The respondents considered waiting time a high-priority criterion in choosing a dentist, but they rarely searched for information anywhere on the choice of a dentist, wanting to visit the dentist they had earlier visited. The quality of signalled waiting times was low. One out of five managers (response rate 62%) answered that signalled waiting times were based on speculation. Conclusions: Waiting times were signalled to comply with the legislation rather than to inform citizens and to reduce information asymmetry. Further research is needed to acquire information on rethinking waiting time signalling and its desired goals.

Dental service voucher for adults: patient experiences in Finland

Objective To investigate how patients experienced a new dental service voucher, what influenced the patient experience, and the use of such vouchers. Materials and methods An SMS-linked patient survey was sent to all patients (n = 1,000) that had received the voucher. The survey consisted of 23 questions (20 multiple choice, 3 open-ended), included themes like access to treatment, use of the voucher, and patient experience. Statistical analyses included Chi-square, Fisher’s exact, Mann-Whitney U tests, and Spearman’s rank correlation. Results The response rate was 25.7%. Patient experience was on average very good. Of the respondents, 148 (57.6%) reported that the voucher was very simple to use, 160 (62.3%) considered that they were helped very well, and 149 (58%) would have very willingly used a voucher again. Those who used the voucher reported an overall better patient experience, as did those with good oral health. Of those reporting unused service vouchers, 14 (67%) preferred to use the public oral health care services instead. Conclusions Notwithstanding a relatively low response rate, the results can be utilized to identify patients who need more support in using the voucher, and therefore to target information and guidance more effectively.

Adherence to individualized recall intervals for oral health examinations.

The aim of this follow-up study was to investigate whether adults attend an oral health examination (OHE) based on their individual recall interval (IRI) without a reminder recall system. The study population included adults who were attending an OHE recommended by their dentists based on their IRI in public oral healthcare clinics of Helsinki City January1, 2009-December 31, 2009. The inclusion criteria were as follows: alive until the end of IRI, length of the IRI of 12-60 months, and study participants had not been treated successfully by a dental specialist during the IRI period (n = 41,255). We used a multinomial model to identify the factors associated with the timing of OHE. The following predictors were included: oral health indices such as Decayed Teeth and the Community Periodontal Index, the length of the IRI based on an OHE in 2009, age, gender, socioeconomic status, presence of chronic diseases, and emergency appointment. Results were presented as odds ratioswith 95% confidence intervals. The OHE based on IRI occurred for 7505 individuals (18.2%) and the OHE was late for 9159 individuals (22.2%). A total of 24,591 (59.6%) adults did not undergo follow-up OHE based on the IRI period of on time or late. Those who came on time for follow-up OHE experienced less caries than those who came later. There was not much difference in periodontal health between the groups. The models indicated that having an emergency appointment was associated with a higher probability of having an OHE. A long IRI (37-60 months) was associated with a higher probability of not participating in OHE even late. It would be beneficial for patients to take appointments based on the recall interval. The results of this study indicated that more needs to be done to increase awareness in the adult population of the benefits and availability of follow-up OHEs based on their IRI in oral healthcare.

Why and when older people lose their teeth: A study of public healthcare patients aged 60 years and over in 2007-2015.

This register-based study on public sector patients aged 60 years and over assessed annual age-specific volume of and reasons for tooth extractions as well as changes in these across the period 2007-2015. Alongside the rapidly ageing population, the demand for public oral healthcare services is growing. Damaged teeth may induce a long-lasting inflammation burden in old age. Data used the electronic documentation of oral healthcare procedures recorded according to healthcare regulation. The study population consisted of all patients over 60 years of age (n=216 059) who were treated 2007-2015 in public oral health care available to all citizens of Helsinki, Finland. Data for the 9-year time series included reasons for tooth extractions and were aggregated by patient age into 5-year groups. Statistical analyses included rates and proportions, mean values, correlation coefficients and linear regression modelling. Extraction patients (n=48 623) were more likely in the older age groups: 21.8% in the age group 60-64 and 27.5% in the age group 90+. Mean number of tooth extractions among all patients was 0.4 per patient and 1.7 per extraction patient. Among all tooth extractions (n=82 677), main reasons were caries 29.5%, apical periodontitis 19.4%, tooth remnant 19.4% and periodontitis 18.0%. Tooth remnant predominated as extraction reason in the oldest age groups, while apical periodontitis displayed an upward trend by calendar year. Tooth extractions attributable to caries were common in all old-age groups, tooth remnant extractions were most common in older age groups, and apical periodontitis abounded as extraction reason during 2007-2015.

Responding to emerging oral healthcare needs with CARE: Design of the CARE curriculum model.

The release of the National Institutes of Health report, Oral Health in America: Advances and Challenges, in 2022 identified a pressing concern about oral healthcare and that "the job is far from finished." The High Point University Workman School of Dental Medicine utilized this report as inspiration to facilitate the design of the Clinician-Advocate-Researcher-Entrepreneur Curriculum. The aspiration was to create a novel curriculum and experiential model to prepare learners for the future of dental medicine, including addressing these public oral healthcare needs. This article describes how we conducted this process in three steps: defining the curriculum philosophy, outcomes, and structure. We present this example for those interested in curriculum design and modifications. Our goal is to encourage educators to explore opportunities to enhance dental education as a critical component of the complex system that impacts oral healthcare broadly.

Are We Getting Any Better? A Critical Analysis of Selected Healthy People 2020 Oral Health Indicators in 1999-2004 and 2013-2016, USA.

Oral health disparities are prevalent in the American population and are influenced by various social determinants. This study aimed to analyze oral health disparities in the US between 1999–2004 and 2013–2016 according to sociodemographic characteristics. This analytic cross-sectional study analyzed five oral health indicators from Healthy People 2020. A binomial test was used to compare proportions between baseline and follow-up. Only the indicator for non-treated cavities among children reached its goal. White children had the greatest decrease (−15.4%; p = 0.0428) in dental caries. Higher income determined better outcomes for adolescents (−27.54%; p = 0.00032 dental caries) and adults (−15.96%; p = 0.0143 tooth extractions). However, adults 35–44 years with the highest income had a significant increase (40.74%, p = 0.0258) in decayed teeth. This study provides evidence to suggest that some progress has been made towards reducing oral health disparities in the US, primarily among children. However, trends for certain indicators remain disparate between different racial/ethnic and income groups. Applications for the findings of this study should address the intersectional nature of social determinants of health and should center on improving the equity of services offered by public oral healthcare.

Oral healthcare management practices in Brazil

Universal health coverage is a global target included in the United Nations Sustainable Development Goals agenda for 2030. Healthcare in Brazil has universal coverage through the Unified Health System (SUS), which guarantees health as basic right to the Brazilian population. Considering the principles of SUS, public oral healthcare management is a huge challenge. Aim: To identify good management practices for quality care adopted by local public oral healthcare managers and teams around Brazil. Methods: This study was registered with PROSPERO (CRD42017051639). Five databases (PubMed, Embase, Web of Science, Scopus and Lilacs) as well as the reference lists and citations of the included publications were searched according to PRISMA guidelines. Results: A total of 30,895 references were initially found, which were evaluated according to the defined eligibility criteria. Twenty qualitative studies, eight surveys and two mixed-model studies were selected. The practices (codes) were organized into three main groups (families), and the Frequency of the Effect Size (FES) of each code was calculated. Among the 20 codes identified, the most relevant ones were: Diagnosis and Health Planning (FES=80%) and Family Health Strategy (FES=66,7). The Intensity of the Effect Size of each study was also calculated to demonstrate the individual contribution of each study to the conclusions. Conclusion: The evidence emerging from this review showed that healthcare diagnosis, planning, and performance based on the family health strategy principles were the most relevant practices adopted by public oral healthcare managers in Brazil. The widespread adoption of these practices could lead to improved oral healthcare provision and management in Brazil.

Knowledge, Attitude and Practice of Standard Precautions amongst Allied Oral Healthcare Personnel In Lagos State

Abstract Background: Allied oral healthcare practitioners such as dental technologists, dental therapists, dental technicians, dental nurses etc., are invariably exposed to patients' blood or/and body fluids and this poses a health risk to oral healthcare workers and patients. This study aimed to assess the knowledge, attitude and practices of standard precautions (SP) amongst allied oral healthcare workers in Lagos State. Methods: This study was a cross-sectional study which entailed the distribution of structured, self-administered questionnaires to a consecutively recruited convenience sample of 113 allied oral healthcare practitioners in both private and public oral healthcare facilities in Lagos State. Data entry and analysis was done using SPSS. Bivariate analysis was done to determine association between variables. P < 0.005 was considered significant. Results: Most (85%) of respondents displayed good overall knowledge of standard precautions. Majority (77%) of respondents had a positive attitude towards standard precautions. Overall practice of standard precautions amongst the participants in the study was good (92%). However, most (74.3%) of the respondents exhibited moderate correctness in the practice of standard precautions, while few (14.2%) demonstrated a high level of correctness; those with poor level of overall correctness in the practice of standard precautions were the least (11.5%). Factors chiefly associated with low or no compliance with standard precautions were lack/inadequate provision of personal protective equipment (85%), inadequate awareness on need for standard precautions (72.6%), stress associated with compliance (67.3%), and lack of basic amenities e.g. soap, water (64.6%). Conclusion: The study showed that the knowledge, attitude and practice of standard precautions among allied oral healthcare workers in both private and public healthcare facilities was fair as majority had good knowledge, attitude and practice of standard precautions. However, there is an urgent need to address the issues with reference to the barriers to compliance with standard precautions identified in the study.

Is the third molar erupting at a younger age than before?

Objectives The aim of this study was to update the much-cited knowledge, published over half a century ago, of the age of eruption of the third molar in the Finnish population. Methods The study followed a retrospective and cross-sectional protocol and included 710 digital panoramic radiographs of patients (49.3% men, 50.7% women) aged 15–23 years visiting the public oral health care services of the City of Helsinki in 2015. Age and sex of the subjects were recorded. The radiographs were examined for inclination of the third molars in both jaws and vertically located teeth were further classified into four stages of eruption: (A) in bone, (B) alveolar emergence, (C) gingival emergence, and (D) complete emergence. Statistics included chi-squared, Mann–Whitney U, and median tests. Results Of altogether 2502 third molars, 53.0% (n = 1325) were in vertical position. The median age of gingival emergence (stage C) of the third molar varied between 19.8 and 20.8 years, and the median age of reaching the occlusal level (stage D) between 20.8 and 21.8 years depending on sex and the jaw. Conclusion The median ages for the third molar to pierce the gum were lower than reported over half a century ago.

An artificial intelligence based referral application to optimize orthodontic referrals in a public oral healthcare system

An artificial intelligence expert system called the Computational Formulation of Orthodontic referral Decisions (CFOD) was created in order to provide decision-making for orthodontic diagnosis and referral in the Emirates public oral healthcare system. Purpose: The study purposes were to validate and implement the CFOD system, and to quantify GP and pediatric dentist referral patterns to the orthodontist specialist before and after implementation of the CFOD system. Materials & Methods: The CFOD system was created using eight mandatory malocclusion variables and a technology and programming stack including PHP, Codelgniter, MySQL and WampServer. The CFOD system was implemented and clinical dentists were trained following validation by 15 experienced orthodontist experts. Pre- and post CFOD system orthodontic referral patterns were analyzed. Results: Seven of eight mandatory malocclusion variables (except crowding) were directly correlated (r = 1) with orthodontist expert evaluation which validated the CFOD system. A comparison of referral patterns of orthodontic patients before and after implementation and training of the CFOD system demonstrated a 10-fold increase for GP referrals and 2-fold for pediatric dentist referrals. Conclusions: An artificial intelligence expert system for orthodontic patient referral can improve the efficiency of a large public oral healthcare system such as found in the United Arab Emirates.

Public Oral Health Care During COVID-19: Time for Reflection and Action.

Public Oral Health Care During COVID-19: Time for Reflection and Action.

Türkiye, Ankara'da Kamu Ağız ve Diş Sağlığı Merkezlerinde Çalışan Diş Hekimleri Arasında Çenenin İlaçla İlişkili Osteonekrozu Farkındalığı

Türkiye, Ankara'da Kamu Ağız ve Diş Sağlığı Merkezlerinde Çalışan Diş Hekimleri Arasında Çenenin İlaçla İlişkili Osteonekrozu Farkındalığı

Appreciative inquiry in evaluating integrated primary oral health services in Quebec Cree communities: a qualitative multiple case study.

ObjectiveThe Strategic Regional Plan of the Cree Board of Health and Social Services of James Bay (CBHSSJB), serving the Quebec Cree communities, mandates the objective of integrating oral health within primary healthcare. Emerging evidence suggests that the integration of oral health into primary healthcare can decrease oral health disparities. This research study aimed to answer the following research question: how and to what extent does the integration of oral health into primary healthcare address the oral health needs of the Cree communities?DesignWe used a multiple-case study design within a qualitative approach and developmental evaluation methodology. The Discovery, Dream, Design and Destiny model of appreciative inquiry was selected as a study framework among existing frameworks of the developmental evaluation.SettingFour purposefully selected Cree communities.ParticipantsHealthcare providers, administrators and patients at the community wellness centres and hospital.Outcome measuresIntegration of oral health into primary healthcare.ResultsA total of 36 interviews and 6 focus group discussions were conducted. We identified ten themes in discovery and dream phases. The Discovery phase identified the strengths of the organisation in facilitating enablers of integration including strategic planning, organisational structure, cultural integration, coordinated networks and colocation. In the Dream phase, participants’ oral healthcare stories expressed various dimensions of integration and their wish for strengthening integration via extending public oral healthcare programmes, increasing resources and improving organisational management. In the Design phase, recommendations were formulated for a future action plan within the CBHSSJB.ConclusionThis study results suggested that the CBHSSJB has been successful in implementing oral health integration into primary care following its strategic planning. At present, the organisation could extend the level of integration into full integration by following study recommendations derived from the perspective of local stakeholders.