Risk For Poor Oral Health Research Articles

Developing and pilot testing an oral health screening tool for diabetes care providers

BackgroundPeople with poorly managed diabetes are at greater risk of periodontal disease. Periodontal disease that is not effectively managed can affect glycaemic levels. Diabetes care providers, including general practitioners and diabetes educators, are encouraged to promote oral health of their clients. However, valid and reliable oral health screening tools that assess the risk of poor oral health, that are easy to administer among non-dental professionals, currently do not exist. Existing screening tools are difficult to incorporate into routine diabetes consultations due to their length. Thus, this study aimed to develop and pilot a short oral health screening tool that would identify risk of existing oral diseases and encourage appropriate referrals to the dental service.MethodsA three-item screening tool was developed after a comprehensive review of the literature and consensus from an expert panel. The tool was then piloted as part of a larger cross-sectional survey of 260 adults with diabetes who were accessing public diabetes clinics at two locations in Sydney, Australia. As part of the survey, participants completed the three-item screening tool and a 14-item validated tool, the Oral Health Impact Profile (OHIP-14), which has been used previously in the preliminary validation of screening tools. Sensitivity and specificity analyses were then undertaken comparing the results of the two tools.ResultsA statistically significant correlation was found between the shorter screening tool and the OHIP-14 (rho = 0.453, p < 0.001), indicating adequate validity. The three-item tool had high sensitivity (90.5%, 95% CI 84.9%, 94.7%), with a specificity of 46.3% (95% CI 37.7%, 55.2%). The negative predictive value was 81.4% (95% CI 71.3, 89.3). No single item performed as well regarding sensitivity and negative predictive value when compared to the three items collectively.ConclusionsThe three-item screening tool developed was found to be valid and sensitive in identifying risk of poor oral health, requiring oral health referrals, among people with diabetes in this pilot. This is a simple, accessible tool that diabetes care providers could incorporate into their routine consultations. Further validation against comprehensive dental assessments is needed to reassess the tool’s specificity and sensitivity in diverse settings.

Oral health in patients with severe inflammatory dermatologic and rheumatologic disease.

Poor oral health (OH) is a risk factor for systemic disease and lower quality of life (QoL). Patients with inflammatory dermatologic/rheumatologic diseases report more oral discomfort, dry mouth, and periodontal disease than controls. Medications used to treat these conditions can also adversely affect OH. The aim was to assess the OH of patients with chronic inflammatory dermatologic/rheumatologic diseases treated with systemic/biologic therapy, compared to controls. Patients with chronic inflammatory dermatologic/rheumatologic diseases treated with systemic/biologic therapy were recruited from outpatient clinics across two university hospitals. All patients had a standardized World Health Organisation OH assessment performed consisting of an OH exam and questionnaire. Age- and sex-matched controls without chronic inflammatory disease were recruited from a pigmented lesion clinic. Charts of patients with chronic inflammatory dermatologic/rheumatologic diseases were reviewed to assess OH documentation. One hundred patients were examined (50 cases and 50 controls). Patients with inflammatory dermatologic/rheumatologic diseases (cases) had poorer periodontal status (mean loss of attachment 6.9mm vs. 1.9mm controls, p=0.01), more missing teeth (mean 7.7 vs. 4.4 controls, p=0.029), more dry mouth (82% vs. 20% controls, p=0.001), and less frequent tooth brushing (60% vs. 80% controls, p=0.037). Of 250 patient charts which were reviewed, 98.4% (n=246) had no documentation of OH. Patients with severe inflammatory dermatologic/rheumatologic conditions have poorer OH and OH-related QoL. Clinicians should appreciate the risk of poor OH in this cohort and have a low threshold for involving OH professionals in care pathways for severe inflammatory disease.

774 KEEP SMILING! IMPROVING ORAL HEALTH ON AN ACUTE MEDICINE FOR THE ELDERLY WARD

Abstract Good oral health in older patients is important for numerous reasons including facilitating fluid and nutritional intake, communication and quality of life. It is an essential component of providing holistic care and should be a daily care requirement during a hospital admission. Poor oral health leads to adverse outcomes including periodontitis, tooth loss, pneumonia and cardiovascular disease. Frail, elderly and those with dementia are at increased risk of poor oral health. Our group decided to undertake quality improvement work to improve our patient’s oral health care during their hospital stay. Baseline data was collected in our acute medicine for the elderly ward which looked at a variety of factors which influence good oral health. This included access to drink, nursing assessment of dentition on admission and daily review of mouth care documented by nursing and medical staff. Following this, we implemented an educational session for medical staff to promote good oral care. Results showed an improvement in ensuring patients had their drink within arm’s reach (94% to 100%). Daily medical review of a patient’s oral health also increased from 0% to 24%. Conclusion We have made small steps in improving medical review and documentation of our patient’s oral health whilst in hospital. There is still a need for further improvement in assessment and documentation in order to minimise complications associated with poor mouth care. We have undertaken further educational sessions to our nursing colleagues and we plan to introduce a ward ‘oral health champion’ as part of our ongoing improvement work.

Exploring associations between multidimensional frailty and oral health in community-dwelling older people. A pilot study.

ObjectiveTo determine the associations between four validated multidimensional self‐report frailty scales and nine indices of oral health in community‐dwelling older persons.Materials and MethodsThis pilot study was conducted in a sample of 208 older persons aged 70 years and older who visited two dental practices in the Netherlands. Frailty status was measured by four different self‐report frailty questionnaires: Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI), Sunfrail Checklist (SC), and the Sherbrooke Postal Questionnaire (SPQ). Oral health was assessed by two calibrated examiners.ResultsThe prevalence of frailty according to the four frailty measures TFI, GFI, SC, and SPQ was 32.8%, 31.5%, 24.5%, and 49.7%, respectively. The SC correlated with four oral health variables (DMFT, number of teeth, percentage of occlusal contacts, Plaque Index), the TFI with three (number of teeth, percentage of occlusal contacts, Plaque Index), the GFI only with DPSI, and the SPQ with the number of teeth and the number of occlusal contacts.ConclusionOf the studied multidimensional frailty scales, the SC and TFI were correlated with most oral health variables (four and three, respectively). However, it should be noticed that these correlations were small.Clinical relevanceThe SC and TFI might help to identify older people with risk of poor oral health so that preventive care can be used to ensure deterioration of oral health and maintenance of quality of life. Vice versa early detection of frailty by oral care professionals could contribute to interprofessional management of frailty.

Which factors are associated with the number of dental providers employed in correctional settings?

Individuals experiencing incarceration are at increased risk of poor oral health. The purpose of this study was to identify state-level factors that influence the number of oral healthcare providers employed in US correctional settings. This ecological study utilized the National Survey of Prison Health Care (NSPHC) to identify the total number of dentists employed in US correctional facilities. Descriptive statistics were calculated and a linear regression was used to identify predictors of the total number of dentists employed in correctional settings by state. The mean number of dentists and dental hygienists/assistants per 10,000 individuals experiencing incarceration was 9.33 ± 4.54 and 11.53 ± 7.02, respectively. The only significant contributor to dental employment was healthcare spending per individual experiencing incarceration (Coefficient=0.96; p=0.004). These findings illustrate the need to develop novel methods of encouraging oral healthcare providers to join the correctional healthcare workforce.

Dental care utilization in Massachusetts before and after initiation of medication for opioid use disorder: A cross-sectional study of a state all-payer claims database.

Individuals with opioid use disorder (OUD) are at higher risk of poor oral health. Medication for opioid use disorder (MOUD) has been shown to improve outcomes for patients with OUD, but it is unknown how initiation of MOUD affects access to oral health services. This was a retrospective analysis of all individuals in the Massachusetts All-Payer Claims Database prescribed oral buprenorphine-naloxone or injectable naltrexone from 2013 to 2016. We evaluated dental utilization in the year before and after beginning MOUD. A logistic regression predicting dental utilization was conducted. Among the 54,791 individuals, rates of dental utilization were low both before and after MOUD (10.5% and 10% with a dental visit, respectively). Of those who did not have a dental visit in the year before starting MOUD, 95.1% did not have a dental visit in the year after. Rates of various procedure types were comparable before and after MOUD. In a logistic regression, a prior dental visit was associated with 9.82 times the odds (95% CI 9.14-10.55) of having a dental visit after starting MOUD; increasing age, being prescribed naltrexone, having a mood disorder or HIV, year of initiation or being on Medicaid were also associated with having a dental visit. Male patients and those with Medicare or private insurance were less likely to have a dental visit. Initiating MOUD did not substantially result in increased dental access or substantial changes in dental procedures received. Patients receiving treatment for OUD may require additional support to access dental care.

Development of a Measure of Fearful Implicit Associations with Dental Stimuli in Youth.

Youth with dental anxiety are at an increased risk of poor oral health but current tools used to identify dental anxiety in children in clinical settings are hampered by several limitations. This study assessed the psychometric properties of a measure of implicit associations with dental stimuli, the Affective Misattribution Procedure for dental stimuli (AMP-D) in 68 youth between the ages of 9 and 17 years. Measures of self-reported dental anxiety and parental perceptions of child dental anxiety were also administered. The internal consistency of the AMP-D was high (KR-20 = 0.96) and 1-week test-retest reliability was in the acceptable range (r = 0.75). The AMP-D was correlated with self-reported dental anxiety, providing evidence of construct validity. The psychometric properties of the AMP-D suggest it could be a useful tool in identifying youth with dental anxiety, particularly when concerns regarding self-representation may compromise the validity of self-reported anxiety.

A scoping review of oral health outcomes for people with cerebral palsy.

Good oral health is important for good overall health. Studies have reported poorer oral health outcomes for people with cerebral palsy, but there has been no synthesis of the evidence surrounding this and, there are no clear oral health recommendations for people with cerebral palsy globally. This review synthesizes the existing knowledge base on oral health in people with cerebral palsy and provides recommendations for future research. A scoping review was conducted to assess the current literature. Databases were searched using relevant search terms. Study outcomes were synthesized according to their reported outcomes. One hundred seventy three studies were included in this review. Children with cerebral palsy have an increased risk for dental caries and untreated caries. Higher saliva osmolality is a major contributor to increased dental caries. People with cerebral palsy are more likely to experience tooth wear and bruxism. Children and their care-givers have poor oral health related quality of life. There is a large unmet need for oral healthcare in this group. There is no suggested plan for the prevention of poor oral health for this group. A high number of studies included related to research is conducted in low- and middle-income countries, care should be taken in applying results outside this context. There is a lack of research conducted in people with cerebral palsy, 18 years and over. There is a higher risk for poor oral health in people with cerebral palsy and there is a large unmet need to dental care in this group. This study highlights the need for further research to focus on adults with cerebral palsy and an of understanding the oral health care outcomes in the context of settings. The authors recommend the inclusion of classification systems and the integration of disability inclusive language in future studies.

The impact of oral health education taken by personal support workers caring for a geriatric population in a long‐term care facility: A mixed‐methods study

To evaluate the impact of an online oral health education module on personal support workers' (PSW) knowledge and beliefs in their care for long-term care (LTC) residents in one Canadian LTC residence. LTC residents are dependent on PSWs for their oral health needs. However, PSWs receive minimal to no oral health education placing residents at risk for poor oral health. A mixed-methods convergent design comprising a before-and-after questionnaire (N=88), focus groups (N=23) and interviews (N=4) exploring module learning. Analysis of each data set was followed by their amalgamation and comparison. The online module had limited impact on the PSWs' knowledge and beliefs regarding resident oral health care. The quantitative results demonstrated knowledge improvements in two domains and changes in two belief domains. However, the qualitative results demonstrated new knowledge was not developed or sustained in practice. Themes that emerged include the following: lack of module recall, unmet learning needs and methods for oral care delivery, and timing of oral care in a busy clinical environment. Online oral health education alone has limited impact on PSWs' knowledge and beliefs. Research evaluating multifaceted education interventions including hands-on training with a dental expert is warranted.

Oral Health Status Among Adults With and Without Prior Active Duty Service in the U.S. Armed Forces, NHANES 2011-2014.

Many veterans qualify for health benefits but generally not dental care. This study examines differences in oral health status between veterans and nonveterans in the U.S. to determine how various factors, including socioeconomic, general health, and tobacco use, impact former service members' oral health. Data from 11,539 dentate adults participating in the National Health and Nutrition Examination Survey (2011-2014) were used. Outcome variables included decayed teeth (DT), missing teeth (MT), filled teeth (FT), caries experience (DMFT), and periodontitis (PD). Covariates included demographic and socioeconomic factors, deployment, smoking, depression, hypertension, hyperlipidemia, and diabetes. Logistic regression modelling was used to assess associations between these factors and oral health outcomes. Veterans represent about 9% of the U.S. population. There was a higher prevalence of PD, MT, FT, and DMFT among veterans than nonveterans. Veterans were more likely to have PD (OR, 1.8; 95% CI, 1.3 to 2.5) and higher DMFT (OR, 2.9; 95% CI, 2.4 to 3.4); however, after controlling for other covariates, military service was only associated with FT (OR, 1.3; 95% CI, 1.1 to 1.6) and higher DMFT (OR, 1.6; 95% CI, 1.2 to 1.9). Because veterans are more likely to originate from groups at a higher risk for poor oral health (older adults, smokers, males, diabetics), the prevalence of adverse oral health conditions are higher among veterans compared to nonveterans. Overall, military service is not associated with PD or untreated dental caries but is associated with indicators suggesting veterans have had more dental treatment (FT and DMFT). There is substantial unmet oral health care need primarily related to periodontitis among veterans.

Oral Health and Autism Spectrum Disorders: A Unique Collaboration between Dentistry and Occupational Therapy.

Children with autism spectrum disorders (ASD) are at risk for oral health disparities. With the dramatic rise in ASD prevalence to 1 in 54 children, it is likely that an increasing number of dental practitioners will encounter or be asked to treat children with ASD. This paper reviews explanations related to the increasing prevalence of ASD, provides reasons why children with ASD are at increased risk for poor oral health, and discusses unique interprofessional collaborations between dental practitioners and occupational therapists. Occupational therapists and dentists can work together to plan modifications to the dental environment or adapt dental protocols to reduce some of the barriers encountered by those with ASD, provide desensitization strategies before the clinic visit, or help a child with emotional regulation during clinical treatments.

Exceptional Design for an Adult Oral Health Screening Program, Qatar

Introduction: As a result of an increased life expectancy and reduced fertility, it is anticipated that by 2050 about half of the world’s population will be aged 60 years and above. This increased longevity has posed a challenge of adding health to life as progressive improvements in older people’s health that translate to longevity may be stalled. Physiological aging is usually associated with multiple chronic diseases, frailty, polypharmacy, and the loss of dependency and autonomy for daily living activities. Besides, reduced dexterity, impaired vision, and lower tactile associated with physiological aging pose an increased risk to oral hygiene. Furthermore, older adults, especially those with cognitive impairment, have more compromised oral health. Aims and Objectives: The aim of this heuristic designed project is to screen all adult patients, including those with a history of chronic diseases living and seeking dental services at the public sectors and other sectors in Qatar. To improve the treatment of oral health diseases, the overall oral health of older adults, and to develop a data repository of oral diseases in the elderly population under one national umbrella for the first time in Qatar. Project Design: This project is consisting of two tests, pre-test, and post-test design. The use of this design will allow us to understand the oral health challenges in Qatar. This screening’s expected outcome will reveal the critical factors and challenges that affect the oral health logistic system. It will also help in improving and identifying all oral health problems. Help in testing whether Qatar’s older population’s oral health screen effectively reduces the risk of poor oral health among this group. Oral health screening will be implemented as a regular intervention that will be delivered using the Oral Health Assessment Tool (OHAT) such as tongue, lips, saliva, dental pain, natural teeth, gums and oral tissue, and dentures. Expected Outcomes: The project is anticipated to support the practical application and real operational status of healthcare settings. Besides, it is anticipated that this project will optimize the chances for maximum impact once the program is implemented. Furthermore, it is expected that the project will include an essential part for decision making, evaluation, and justifications and will also hold key evaluation features for program impact and monitoring. Another expected outcome of this project is its ability to document programs effectively and identify significant opportunities for improvement with collected data. Finally, it is expected that this project will result in a model outline that will be implemented in both Qatar and across the globe to help merge the public sector and other sectors’ dental health data on a national level. Recommendation: Since the number of adults with a history of chronic diseases and have oral conditions is still unknown in Qatar due to the lack of a database, the authors recommend this project to help in building the background and database to assist dental practitioners, and policymakers develop specific and targeted programs that will support and provide treatment for the targeted population to improve the quality of life.

Association between primary heath care and dental service use among supportive housing tenants with behavioral health conditions.

Homeless persons are at high risk for poor oral health. Supportive housing can improve housing stability for persons with behavioural health conditions, but its impact on dental service use has been little studied. Data for this evaluation come from matched public service records for eligible applicants to a New York City supportive housing program (NY III) targeting chronic homelessness. NY III tenants (N=5678) were compared with applicants not placed in housing (N=6536) and applicants placed in other supportive housing programmes (N=4823). Regression analysis was used to assess the association between supportive housing, primary care use, clinical severity and the likelihood of dental visits. Over four observation years, 71% of applicants had at least one dental visit for any cause and 57% for preventive dental care. Incidence of dental visits was lower for persons with physical disability (IRR=0.91; 95% CI=0.85, 0.97, P=.003), psychiatric hospital stays (IRR=0.78; 95% CI=0.68, 0.88, P<.001) and age over 54. Persons engaged in primary care (IRR=1.26; 95% CI=1.21, 1.31, P<.001) and outpatient mental health care (IRR=1.16; 95% CI=1.12, 1.21, P<.001) had greater incidence of dental visits. Supportive housing was associated with greater dental service use. The positive association between primary care, mental health care and dental care suggests important points of entry for dental care. Oral health education and service referrals in supportive housing and primary care settings may improve oral health service delivery to persons experiencing social exclusion due to homelessness, mental illness and poor oral health.

Comparing how patients value and respond to information on risk given in three different forms during dental check-ups: the PREFER randomised controlled trial

BackgroundThis study aims to compare patient preference for, and subsequent change in, oral health behaviour for three forms of risk information given at dental check-ups (verbal advice compared to verbal advice accompanied by a traffic light (TL) risk card; or compared to verbal advice with a quantitative light fluorescence (QLF) photograph of the patient’s mouth).MethodsA multi-centre, parallel-group, patient-randomised clinical trial was undertaken between August 2015 and September 2016. Computer-generated random numbers using block stratification allocated patients to three arms. The setting was four English NHS dental practices. Participants were 412 dentate adults at medium/high risk of poor oral health. Patients rated preference and willingness to pay (WTP) for the three types of information. The primary outcome was WTP. After receiving their check-up, patients received the type of information according to their group allocation. Follow-up was by telephone/e-mail at 6 and 12 months. Mean and median WTP for the three arms were compared using Wilcoxon signed-rank tests. Tobit regression models were used to investigate factors affecting WTP and preference for information type. Secondary outcomes included self-rated oral health and change in oral health behaviours (tooth-brushing, sugar consumption and smoking) and were investigated using multivariate generalised linear mixed models.ResultsA total of 412 patients were randomised (138 to verbal, 134 to TL and 140 to QLF); 391 revisited their WTP scores after the check-up (23 withdrew). Follow-up data were obtained for 185 (46%) participants at 6 months and 153 (38%) participants at 12 months. Verbal advice was the first preference for 51% (209 participants), QLF for 35% (145 participants) and TL for 14% (58 participants). TL information was valued lower than either verbal or QLF information (p < 0.0001). Practice attended was predictive of verbal as first preference, and being older. Practice attended, preferring TL the most and having fewer than 20 teeth were associated with increased WTP; and living in a relatively deprived area or having low literacy decreased WTP. There were no significant differences in behaviour change on follow-up.ConclusionsAlthough a new NHS dental contract based on TL risk stratification is being tested, patients prefer the usual verbal advice. There was also a practice effect which will needs to be considered for successful implementation of this government policy.Trial registrationISRCTN, ISRCTN71242343. Retrospectively registered on 27 March 2018.

Presenting patients with information on their oral health risk: the PREFER three-arm RCT and ethnography

BackgroundA new NHS dental practice contract is being tested using a traffic light (TL) system that categorises patients as being at red (high), amber (medium) or green (low) risk of poor oral health. This is intended to increase the emphasis on preventative dentistry, including giving advice on ways patients can improve their oral health. Quantitative Light-Induced Fluorescence (QLF™) cameras (Inspektor Research Systems BV, Amsterdam, the Netherlands) also potentially offer a vivid portrayal of information on patients’ oral health.MethodsSystematic review– objective: to investigate how patients value and respond to different forms of information on health risks. Methods: electronic searches of nine databases, hand-searching of eight specialist journals and backwards and forwards citation-chasing followed by duplicate title, abstract- and paper-screening and data-extraction. Inclusion criteria limited studies to personalised information on risk given to patients as part of their health care.Randomised controlled trial (RCT)– setting: NHS dental practice. Objective: to investigate patients’ preferences for and response to different forms of information about risk given at check-ups. Design: a pragmatic, multicentred, three-arm, parallel-group, patient RCT. Participants: adults with a high/medium risk of poor oral health attending NHS dental practices. Interventions: (1) information given verbally supported by a card showing the patient’s TL risk category; (2) information given verbally supported by a QLF photograph of the patient’s mouth. The control was verbal information only (usual care). Main outcome measures: primary outcome – median valuation for the three forms of information measured by willingness to pay (WTP). Secondary outcomes included toothbrushing frequency and duration, dietary sugar intake, smoking status, self-rated oral health, a basic periodontal examination, Plaque Percentage Index and the number of tooth surfaces affected by caries (as measured by QLF).Qualitative study– an ethnography involving observations of 368 dental appointments and interviews with patients and dental teams.ResultsSystematic review – the review identified 12 papers (nine of which were RCTs). Eight studies involved the use of computerised risk assessments in primary care. Intervention effects were generally modest, even with respect to modifying risk perceptions rather than altering behaviour or clinical outcomes. RCT – the trial found that 51% of patients identified verbal information as their most preferred form, 35% identified QLF as most preferred and 14% identified TL information as most preferred. The median WTP for TL was about half that for verbal information alone. Although at 6 and 12 months patients reported taking less sugar in drinks, and at 12 months patients reported longer toothbrushing, there was no difference by information group. Qualitative study – there was very little explicit risk talk. Lifestyle discussions were often cursory to avoid causing shame or embarrassment to patients.LimitationsOnly 45% of patients were retained in the trial at 6 months and 31% were retained at 12 months. The trial was conducted in four dental practices, and five dental practices were involved in the qualitative work.ConclusionsPatients prefer personal, detailed verbal advice on oral health at their check-up. A new NHS dental practice contract using TL categorisation might make this less likely.Future workResearch on how to deliver, within time constraints, effective advice to patients on preventing poor oral health. More research on ‘risk work’ in wider clinical settings is also needed.Trial registrationCurrent Controlled Trials ISRCTN71242343.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.

Are oral health education for carers effective in the oral hygiene management of elderly with dementia? A systematic review

Elderly with dementia or cognitive impairment are at increased risk of poor oral health. Oral health education programs targeting carers may be an effective strategy to improve oral hygiene. The aim of this review was to assess the effectiveness of oral health education programs for carers on the oral hygiene of elderly with dementia. A literature search was performed to identify studies published in five electronic databases (PubMed, MEDLINE, EMBASE, CINAHL, and PsycINFO), without time and language restrictions. Two independent coders extracted data and assessed the risk of bias for each included study. Of the 243 studies, only four studies met the inclusion criteria. All four studies reported a significant improvement for some oral health measures in dementia elderly following a carer oral health education program. The included studies did not report any other relevant outcomes of interest for this review. This review identifies limited evidence for a carer oral health education as an efficient means to improve oral health in dementia elderly. The review also clearly highlights the need for well-designed, high-quality studies with more relevant outcome measures to better address this knowledge gap.

Oral hygiene negligence among institutionalized mentally disabled children in Mysore city-A call for attention.

Background:Oral health is integral part of general health. In certain conditions especially among mentally disabled, oral health is neglected. Studies have shown that mentally disabled population has the risk of poor oral health. People with disabilities deserve the same opportunities for oral health and hygiene as those who are healthy, but sadly dental care is the most common unmet health care need of the disabled people.Methodology:This comparative, descriptive cross-sectional study was conducted among institutionalized mentally disabled and normal children of age group 6–13 years in Mysore city.Results:Majority of mentally disabled children, that is, 36.73% (n = 180), had poor oral hygiene when compared with normal children, that is, 9.18% (n = 45). This difference was statistically highly significant (P < 0.000). The significant differences in the gingival status and severity of mental disability were seen (P < 0.001). The result showed that the gingival health worsens with increase in the severity of mental disability.Conclusion:The present study showed the dental negligence among mentally disabled children where the parents, caretakers, and dentists are responsible. Oral health promotion programs should be conducted for special group children, their parents, as well as caretakers.

The Effect of a Community Based Educational Intervention on Oral Health Knowledge Levels of Adult Caregivers of Young Children in the Rural Upper Peninsula of Michigan

ABSTRACTLow levels of oral health literacy in parents and caregivers may place a child at risk for poor oral health (Miller, Lee, DeWalt, & Vann, 2010). The purpose of this project was to determine baseline oral health literacy levels for a sample of adult caregivers of young children living in rural communities and to determine the effectiveness of a community-based education program on increasing these baseline levels of knowledge. A convenience sample of sixty-four participants who attended educational programs aimed at adult caregivers of young children comprised the sample. The Upper Peninsula Oral Health Literacy Assessment Survey was administered prior to and after participants attended the educational programming. A paired sample t-test was utilized to analyze the data. There was a statistically significant increase in oral health literacy levels after the implementation of a community-based educational program. Scores reflecting oral health literacy rose from 68.8% on the pre-test to 92.6% on the post-test. This study confirms a need for further oral health education. Increasing oral health literacy levels in adult caregivers of young children may lead to an increase in oral health seeking behaviors and a decrease in preventable dental caries in the pediatric population.

Oral Care Experiences of Latino Parents/Caregivers with Children with Autism and with Typically Developing Children.

As a result of various barriers, several pediatric populations are at risk for poor oral health, including children with disabilities and children from under-represented populations, such as Latinos. To this end, this study aimed to better understand the factors that affect the oral health experiences of 32 Latino parents/caregivers from 18 families (n = 8 with a typically developing child and n = 10 with a child with Autism). Using a qualitative descriptive methodology, each family was interviewed twice. Interviews were audio-recorded, transcribed verbatim, and coded thematically to identify the individual, social, systemic, and culturally rooted factors contributing to oral health disparities in the families. The three themes that arose were “Why would I want to start trouble?”: Latino parents’ dissatisfaction with dental treatments, costs, and fear of the dentist and health care providers because of their ethnic minority status as key factors inhibiting receipt of dental care; “We have to put our children first”: prioritizing the oral care activities of their children over their own individual oral care needs; and “We always keep baking soda around”: familial and cultural influences on oral care habits. Understanding the oral health beliefs and experiences of Latino parents and caregivers of children with and without autism is critical for developing targeted prevention and intervention programs and reducing oral health disparities.

Feasibility of integrating a dental hygienist into an inpatient medical team for patients with diabetes mellitus.

Patients who are hospitalized face a high risk of poor oral health and experience a decline in oral hygiene over the course of hospitalization. Due to the documented links between diabetes and periodontal disease as well as the prevalence of diabetes in the hospitalized population, patients with type 2 diabetes mellitus were chosen as the population of interest for a pilot program of dental hygienist-led care provision in the hospital. Inclusion criteria were established by agreement of a dentist and physician. Nursing and medical staff were provided with multiple opportunities to learn about the dental hygienist's role throughout the pilot. The dental hygienist utilized a fully mobile dental unit and bedside suction unit and followed all standard infection control procedures. This intervention identified a number of suboptimal oral health practices among patients and was perceived positively by patients and providers. No adverse events occurred.