Addressing bottlenecks in the dental practice

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

Valuing oral health: Accomplishments and challenges

Firmly establishing oral health care professionals’ roles as vaccinators within the health care system

BackgroundWhile the US population overall has experienced improvements in oral health over the past 60 years, oral diseases remain among the most common chronic conditions across the life course. Further, lack of access to oral health care contributes to profound and enduring oral health inequities worldwide. Vulnerable and underserved populations who commonly lack access to oral health care include racial/ethnic minority older adults living in urban environments. The aim of this study was to use a systematic approach to explicate cause and effect relationships in creating a causal map, a type of concept map in which the links between nodes represent causality or influence.MethodsTo improve our mental models of the real world and devise strategies to promote oral health equity, methods including system dynamics, agent-based modeling, geographic information science, and social network simulation have been leveraged by the research team. The practice of systems science modeling is situated amidst an ongoing modeling process of observing the real world, formulating mental models of how it works, setting decision rules to guide behavior, and from these heuristics, making decisions that in turn affect the state of the real world. Qualitative data were obtained from focus groups conducted with community-dwelling older adults who self-identify as African American, Dominican, or Puerto Rican to elicit their lived experiences in accessing oral health care in their northern Manhattan neighborhoods.ResultsThe findings of this study support the multi-dimensional and multi-level perspective of access to oral health care and affirm a theorized discrepancy in fit between available dental providers and patients. The lack of information about oral health at the community level may be compromising the use and quality of oral health care among racial/ethnic minority older adults.ConclusionsWell-informed community members may fill critical roles in oral health promotion, as they are viewed as highly credible sources of information and recommendations for dental providers. The next phase of this research will involve incorporating the knowledge gained from this study into simulation models that will be used to explore alternative paths toward improving oral health and health care for racial/ethnic minority older adults.

Nurses are key in the delivery of the basic package of oral care in the primary health care system. Whereas oral health care training is essential for apt oral care delivery, the scope and training approaches for the primary health care nurse are not well established. A mentorship approach has rarely been explored for oral health training. This study aimed to develop a basic package of oral health care training program for primary health care nurses in Kenya. It also evaluated and compared the effects of workshop and mentorship approaches on a basic package of oral care training outcomes. The Analysis, Design, Development, Implementation and Evaluation (ADDIE) instructional model was used to develop the training program. This used a scoping review approach to inform the design and development stages of the training. Implementation followed a quasi-experimental design to deliver a 1-y postworkshop mentorship program (experiment) against a workshop-only (control) group. The Kirkpatrick framework was used for evaluation. A training program with 7 learning areas and 37 subtopics covering nurses' basic package of oral care tasks was developed and evaluated. Summative analysis included 67 nurses (experiment, n = 33; control, n = 34) and 1,128 parents (experiment, n = 570; control, n = 558). Improvement was noted in nurses' overall knowledge (47.9% to 64.7%), confidence (77.3% to 92.2%), and oral health care services delivery (0.3% to 35.8%). Overall parental child oral health practices improved from 31.3% to 44.4%. The experiment group exhibited significantly higher scores for confidence, oral health care services delivery, and parental child oral health practices. Longitudinal decay in knowledge and confidence was lower in the experiment group. A basic package of oral health care training program for primary health care nurses in Kenya was successfully developed and evaluated. For all outcomes evaluated, the mentorship approach yielded better results than the workshop approach did. These results highlight mentorship as an integral component in a basic package of oral care training.Knowledge Transfer Statement:This study of primary health care nurses in Kenya provides insights to inform oral health and primary health care policy makers about oral health education, oral urgent treatment, referral, and oral health service documentation training requirements. It shows how planning and prioritization for in-service oral health training sessions could be maximized with limited resources. It also demonstrates the benefit of a mentorship training approach over a workshop-only approach to ensure optimal outcomes of oral health indicators.

To assess the value of Smiles for Life: A National Oral Health Curriculum (SFL) in influencing oral health practices of primary care professionals (PCPs).The National Maternal and Child Oral Health Resource Center’s Partnership for Integrating Oral Health Care into Primary Care (PIOHCPC) project is working with five project teams in Georgia, Illinois, Maryland, Michigan, and Rhode Island that are integrating interprofessional oral health core clinical competencies into primary care practice. The competencies were developed to facilitate change in the clinical practice of PCPs working with vulnerable or underserved populations that lack or have limited access to oral health care.An initial PIOHCPC project requirement was for PCPs (physicians, nurse practitioners, nurse midwives, nurses) to complete at least two SFL courses based on their project population of focus (eg, pregnant women, children, adolescents). The curriculum consists of the following courses: Course 1: Relationship of Oral and Systemic Health; Course 2: Child Oral Health; Course 3: Adult Oral Health; Course 4: Acute Dental Problems; Course 5: Oral Health for Women: Pregnancy and Across the Lifespan; Course 6: Caries Risk Assessment, Fluoride Varnish, and Counseling; Course 7: The Oral Exam; and Course 8: Geriatric Oral Health. Three months after completion of the SFL courses, a 10‐question feedback form was sent to PCPs.PCPs working in primary care settings (community health centers, local health department, medical center women’s health clinic) serving pregnant women, children, and adolescents who completed at least two SFL courses as part of the PIOHCPC project.Thirteen PCPs (three physicians, three nurse practitioners, three nurse midwives, four nurses) completed the feedback form. One hundred percent of respondents strongly agreed/agreed that SFL courses (1) reinforced the importance of oral health to a patient’s overall health and well‐being, (2) increased their awareness of and familiarity with oral health issues in their patients, and (3) increased their confidence in integrating oral health care into primary care. Seventy‐seven percent of respondents strongly agreed/agreed that SFL courses helped reduce barriers to incorporating oral health care into primary care. Sixty‐two percent of respondents strongly agreed/agreed that integrating oral health care into primary care improved their patients’ oral health outcomes. The majority (ranging from 85 to 100 percent) of PCPs strongly agreed/agreed that SFL courses helped them integrate the interprofessional oral health core clinical competencies into primary care.Three months after completing SFL courses, PCPs indicated that the curriculum had a positive influence on oral health practices in the primary care setting. These findings are consistent with a 2017 study that examined SFL influence on clinical practice and found that the curriculum positively influenced oral health practices in the primary care setting. Additional feedback could be gathered 1 year post‐training to assess retention of PCPs’ practices related to integrating oral health care into primary care.Oral health training is essential for enhancing PCPs’ knowledge and practices related to integrating oral health care into primary care. To respond to the need to integrate oral health care into primary care, SFL should be considered as a training for PCPs.Health Resources and Services Administration.

ObjectiveThe total years lived with disability among older people, and the concomitant burden of tooth loss in ageing societies have increased. This study is an overview of the burden of oral diseases and access to oral care in an ageing society. MethodsWe selected key issues related to the burden of oral diseases and access to oral care and reviewed the relevant literature. ResultsThe rising number of older people with teeth increases their oral health care needs. To improve access to oral care, affordability of care is a great concern with respect to universal health coverage. In addition, accessibility is a crucial issue, particularly for vulnerable older adults. To improve oral care access, attempts to integrate oral health care into general care are being made in ageing countries. For this purpose, provision of professional oral care at home through domiciliary visits and provision of daily oral health care by non-dental professional caregivers are important. Oral health care for older people reduces general diseases such as pneumonia and malnutrition, which in turn could reduce further healthcare costs. ConclusionsTo address the growing burden of oral care in ageing societies, special provision of oral health care to vulnerable older people, and integration of oral care with primary care will be required.

BackgroundThe oral health of refugees and asylum seekers is understudied. However, oral health has important implications for overall health and wellbeing. This study addresses this gap by characterizing oral health care utilization in Médecins du Monde (MdM) clinics across mainland Greece from 2016 – 2017.MethodsA retrospective cross-sectional study design was used to estimate proportional morbidities for caries, extraction, developmental, periodontal disease, preventive, and other oral health outcomes. The association between physical health conditions and consultations of interest – upper respiratory tract infections (URTIs) and reproductive health consultations – and oral health were compared using odds ratios (OR) and 95% confidence intervals (CIs). Oral health outcomes between Afghans and Syrians were compared using odds ratios and 95% CIs.ResultsCaries (39.44%) and extractions (28.99%) were highly prevalent in our study population. The utilization of preventive dental consultations (37.10%) was high, particularly among males. Individuals with at least one upper respiratory tract infection (OR = 1.52; 95% CI: 1.30 – 1.77; Or = 1.90; 95% CI: 1.53 – 2.36) and women and girls with reproductive health consultations (OR = 1.30; 95% CI: 1.03 – 1.66; OR = 2.03; 95% CI: 1.49 – 2.76) were more likely to have any dental or caries specific consultations. The observed patterns in oral health needs differed between Afghans and Syrians, with Afghans more likely to have preventive screenings and less likely to have caries, extractions, or other conditions.ConclusionsDisplaced populations utilizing MdM dental clinics had high levels of oral health needs, particularly for caries and extractions. The connection between oral and overall health was seen in the study population, and these findings reinforce the public health importance of oral health for improving health and wellbeing of displaced populations. Evidence-informed policy, practice, and programming inclusive of oral health are needed to address both oral and overall health of refugees and asylum seekers in Greece. Future research should investigate not only oral health care needs but also knowledge and beliefs that inform utilization patterns among displaced populations.

BACKGROUND Oral health of nursing home residents is generally poor, largely due to age-related conditions that increase their vulnerability and make them more dependent on others for oral care. Poor oral health can significantly impact general health and well-being, highlighting the important role of caregivers in preventing, detecting, and addressing residents’ oral health problems in time. The interRAI Suite of instruments, widely used for comprehensive health assessments, offers the opportunity for non-dental caregivers to assess oral health as part of general health and well-being and facilitates the integration of oral health in general care planning. OBJECTIVE Based on interRAI data, this study explored the associations between oral health and general health outcomes of nursing home residents in Flanders (Belgium) and the Netherlands. METHODS This cross-sectional study included baseline interRAI assessments of 2362 Flemish and Dutch residents aged 65 years and older, collected by caregivers (e.g., nurses, nurse aids, etc.) between October 2020 and February 2024. Validated outcome scales (e.g., Activities of Daily Living Hierarchy scale, Cognitive Performance Scale, Depression Rating Scale), health conditions such as diabetes, low weight (BMI ≤19), as well as family support and participation in social activities, included in the interRAI instrument, provided information on residents’ general health and well-being. Oral health was defined according to the nine items of the optimized oral health section for inclusion in the interRAI instruments, the OHS-interRAI. Adjusted logistic regression models were used to explore the associations between oral and general health outcomes. RESULTS Oral health problems were interconnected, with conditions in one oral structure impacting the health of others. When controlling for confounding variables, dependency on others for personal care and hygiene was significantly associated with poor oral hygiene (OR 1.7, 95% CI 1.1-2.4), chewing difficulties (OR 2.2, 95% CI 1.3-3.5), compromised teeth (OR 1.7, 95% CI 1.1-2.5), and the need for dental referral (OR 1.8, 95% CI 1.4-2.3). Natural dentition and gender had a significant impact on oral health status. Low weight was associated with poor chewing function (OR 2.0, 95% CI 1.1-3.6) and dry mouth (OR 1.8, 95% CI 1.0-3.2), both associated with oral discomfort or pain (OR respectively 6.8, 95% CI 3.3-14.0 and 3.5, 95% CI 1.8-6.9). Family support was identified as a facilitator in mitigating oral health problems. CONCLUSIONS The interRAI instrument, including the OHS-interRAI, is a valuable tool for monitoring residents' health and identifying areas requiring additional support. The results demonstrated the importance of prioritizing oral health as an integral component of comprehensive care. Recognizing the interconnection between oral health and other health conditions, including indicators of well-being, can guide caregivers and other healthcare professionals in incorporating preventive and supportive oral care practices into daily care routines, contributing to improved resident health and well-being outcomes.

Background: The Global Burden of Disease Study 2017 estimates that oral diseases affected 3.5 billion people worldwide, with untreated dental caries being among the most prevalent non-communicable diseases. If left untreated, it could lead to pain, swelling, and eventual tooth loss. Tooth loss results in changes in diet, impairment of speech, and reduces one’s quality of life. A 2016 study found that almost 1 in 3 Singaporeans aged 60 and above did not have any teeth. As such, oral health should be part of the comprehensive care for the general well-being of older adults in the community. Aim: To Increase awareness of oral health knowledge among older adults with chronic diseases from 33% to 83% in 3 months. Methodology: We recruited the community-dwelling participants who are i) aged 60 years and above, ii) with a minimum of 8 natural teeth, iii) able to comprehend simple instructions, and iv) perform basic activity of daily living. Focused discussions were conducted to explore issues and concerns pertaining to oral health among the participants, followed by individual health coaching with return demonstration. Pre- and post-intervention questionnaires about oral hygiene awareness and Oral-health related Quality of Life (OHRQoL) were conducted. The General Oral Health Assessment Index (GOHAI) questionnaire was used to evaluate the oral health self-perception in older adults. Results: Seventy-seven participants were included. The educational aid was enhanced with emphasis on oral care and appropriate escalation to seek timely treatment. The post-intervention results showed that there were significant improvements in oral hygiene awareness from 33% to 83% (p<0.05). There was a reduction in the oral pain and discomfort, as reflected by the improvement in the GOHAI score from 47 vs 50 (p<0.05). Conclusion: The findings highlighted the importance and benefits of increasing oral hygiene awareness through targeted health coaching among older adults in the community. The project team will continue to advocate these enhanced interventions and plan to incorporate oral hygiene assessment and health coaching as standard community nursing practice in the future. Sustainability: This project is able to achieve the sustainability through incorporating oral frailty assessment and health coaching to community nursing practice, active outreach, and capability building. Singapore General Hospital community nursing team continues to promote Oral Health Movement 8020 in collaboration with National Dental Centre, Singapore at various community engagement platforms.

BackgroundThe recognised relationship between oral health and general health, the rapidly increasing older population worldwide, and changes in the type of oral health care older people require have raised concerns for policymakers and health professionals. Nurses play a leading role in holistic and interprofessional care that supports health and ageing. It is essential to understand their preparation for providing oral health care.Objective: To synthesise the evidence on nursing students’ attitudes towards, and knowledge of, oral healthcare, with a view to determining whether oral health education should be incorporated in nursing education.MethodsData sources: Three electronic databases - PubMed, Scopus, and CINAHL.Study eligibility criteria, participants and interventions: Original studies addressing the research objective, written in English, published between 2008 and 2019, including students and educators in undergraduate nursing programs as participants, and conducted in Organisation of Economic Co-operation and Development countries.Study appraisal and synthesis methods: Data extracted from identified studies were thematically analysed, and quality assessment was done using the Mixed Methods Appraisal Tool.ResultsFrom a pool of 567 articles, 11 met the eligibility criteria. Findings documented five important themes: 1.) nursing students’ limited oral health knowledge; 2.) their varying attitudes towards providing oral health care; 3.) the need for further oral health education in nursing curricula; 4.) available learning resources to promote oral health; and 5.) the value of an interprofessional education approach to promote oral health care in nursing programs.Limitations: The identified studies recruited small samples, used self-report questionnaires and were conducted primarily in the United States.ConclusionsThe adoption of an interprofessional education approach with a focus on providing effective oral health care, particularly for older people, needs to be integrated into regular nursing education, and practice. This may increase the interest and skills of nursing students in providing oral health care. However, more rigorous studies are required to confirm this. Nursing graduates skilled in providing oral health care and interprofessional practice have the potential to improve the oral and general health of older people.

BackgroundSocioeconomic status and oral health care habits may change throughout adult life. This calls for age-stratified analyses of oral health in the adult population to uncover differences that could be of importance for organizing adequate oral health care services. The aim of the present study was to describe self-reported oral health in different age groups in a general adult population in Norway, and to explore associations between self-reported oral health and age groups, sociodemographic factors, use of dental services, number of teeth and dental caries.MethodsWe used data from a cross-sectional study of almost 2000 Norwegian adults, 20–79 years old. The study included both a structured questionnaire and a clinical examination to assess sociodemographic variables, use of dental services, self-reported oral and general health as well as dental caries and number of teeth. For analysis, the participants were divided into three age groups: young adults (20–29 years), middle-aged adults (30–59 years), and senior adults (60 years and older). Differences among groups were analyzed by cross-tabulation, and logistic regression analyses were used to assess associations between variables.ResultsForty-eight percent of the participants rated their oral health as good. Almost half of the participants had at least one carious tooth, with the highest caries prevalence among the young adults. To be caries free was strongly associated with reporting good oral health among the young and middle-aged adults. One third of the senior adults had fewer than 20 teeth, which was associated with reporting moderate or poor oral health. Less than half of the young adults reported regular use of dental services, and 40% of them had postponed dental visits for financial reasons during the past 2 years. Regardless of age group, having to postpone dental visits for financial reasons or having poor-to-moderate general health were associated with high odds for reporting moderate or poor oral health.ConclusionsThat there were important age-group differences in self-reported and clinical measures of oral health and in the use of dental health services demonstrates the importance of age-stratified analyses in oral health research. Many adults, especially among the young, faced financial barriers for receiving dental health services, which was associated with poorer self-reported oral health. This argues for a need to revisit the financing of oral health care for adults in Norway.

Oral and dental health problems in early childhood remain a major public health concern worldwide, including in Indonesia. Early Childhood Caries (ECC) is one of the most common oral health problems among preschool children and may negatively affect quality of life and child development. Preventive efforts to address oral health problems in early childhood cannot be separated from the role of parents, as children are highly dependent on parental guidance in forming daily health behaviors. Parental oral health care behaviors, such as supervising toothbrushing, regulating the consumption of cariogenic foods, and utilizing dental health services, represent an essential component of family-based health promotion strategies. This review aims to analyze parental oral health care behaviors as part of health promotion efforts for early childhood based on studies published between 2020 and 2025. A narrative literature review approach was applied by searching scientific articles through Google Scholar, PubMed, and DOAJ databases. Included articles focused on parental roles, knowledge, and behaviors related to early childhood oral health care and their contribution to the prevention of oral health problems. The findings indicate that parental oral health care behaviors are significantly associated with early childhood oral health status. Parents with higher levels of knowledge and health literacy tend to implement more consistent and preventive oral health practices for their children. In addition, health promotion interventions involving parents have been shown to be effective in improving children’s oral health behaviors and reducing the risk of oral health problems. This review concludes that parental oral health care behavior is a key component of early childhood health promotion and should be strengthened through sustainable family-based education and empowerment strategies

BACKGROUND AND AIM: This study investigated whether mothers’ knowledge about oral health of children during early ages influences the oral health care behavior of their children during adolescence and beyond. METHODS: This descriptive, cross-sectional, analytic study was carried out among 440 12-13-year-old students from 2 schools in Tehran, Iran, and their mothers in 2015. A self-report questionnaire consisting of 4 sections (demographic characteristics, socioeconomic information, oral health knowledge, and oral care behavior) was designed to assess the influence of mothers’ oral health care behavior in controlling early childhood caries (ECC) on their children’s oral health knowledge and behavior during their adulthood. Pearson’s correlation coefficient, chi-square test, and chi-square linear-by-linear association test were conducted to assess the effect of gender, father’s education, mother’s education, first dental care, first dental check-up, and teacher’s advice about oral health in school on oral health knowledge and behavior. RESULTS: A positive relationship was observed between first dental check-up, oral health knowledge (P = 0.05; CI = 95%) and flossing (P < 0.001; CI = 95%). Surprisingly, no differences were found between first dental check-up and tooth brushing frequency (P = 0.26; CI = 95%). CONCLUSION: The current study showed the importance of mothers’ knowledge and behavior toward their children’s oral health during early ages and its impact on the oral health care behavior of children in adulthood. This indicates that prevention behaviors starting as early as possible in childhood will cause better outcomes in adulthood.

Context: It is needless to state that health and hygiene go hand in hand and of the various categories of hygiene, oral hygiene has a colossal contribution to positive health for any individual. Zealous and correct lifestyle characteristics are related to high standards of oral hygiene, and good habits must be inculcated in the early years of one's life. With this background, a study was conducted among some school-going adolescents. Aims: The aim of this study is to find out the status of their oral hygiene and oral health along with their associated risk factors. Methodology: It was a school-based, observational, cross-sectional study conducted among students of standard 7th, 8th, and 9th of the school who were approached, and the parents of 151 students gave their consent for the oral checkup. Students first filled in a self-administered questionnaire following which their oral health and hygiene were examined. Data were analyzed using statistical package of social science software version 16.0 (IBM, SPSS Inc., Chicago, USA) Descriptive statistics and inferential statistics were performed. Results: Among 151 students, 64.2% had poor oral health, 52.3% and 64.2% student had unsatisfactory awareness toward oral health and oral hygiene practice, respectively. Females had better oral health awareness and better practice scores than males. Factors such as satisfactory practice of oral hygiene (odds ratio [OR] = 6.7 [3.4–12.2]); satisfactory awareness toward oral health (OR = 2.9 [1.9–3.5]); and gender (OR = 2.9 [1.5–5.8]) were associated with good oral health. Awareness toward oral health (OR = 5.8 [2.8–12.2]) are also strongly associated with the good practice of oral hygiene. In the final model of multivariable logistic regression analysis, factors such as the practice of oral hygiene (adjusted OR [AOR] = 6.8 [3.2–14.5]) and awareness toward oral health (AOR = 2.1 [1.3–3.6]) retained significance. Conclusion: Oral health promotion programs and periodic health checkups are needed.