Lessons for dentistry from the flightdeck?

Valuing oral health: Accomplishments and challenges

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.

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.

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.

INTRODUCTION:Dental and oral health is a core component of general health and well-being. Few aspects of health are as accessible to personal control as oral hygiene which can be improved by simple behavioral changes. In recent years, dentists in the field of oral and dental health improvement have been research doing for measurement of validity and efficiency of available educational interventions. In this regard, meta-analysis integrates the results of different studies then determines the effect size of educational interventions. This study seeks to investigate the effective educational interventions on improving oral and dental health improvement in Iran by following the meta-analysis model.MATERIALS AND METHODS:The present research was a meta-analysis study. This research by using the technique of meta-analysis to integrate the results of different studies, to determine the effect size of an educational intervention on improving oral and dental health improvement in Iran. Seventeen studies accepted in methodology were collected in Iran during 2001–2018, and analyzed through meta-analysis. The research tool was meta-analysis checklist. Effect size for each study was manually calculated.RESULTS:The study findings showed that the rate of the effect size of educational intervention on Improving Oral and Dental Health Improvement in Iran was 0.62 (P ≤ 0.008) which according to Cohen's table was intermediate.CONCLUSION:Findings of this meta-analysis support of the effectiveness of educational interventions on improving oral and dental health improvement in Iran. It seems that the educational interventions on improving dental and oral health can be used as a method for improving oral and dental health in Iran.

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.

Background: This review article aims to emphasize the importance of oral and dental health, which is often overlooked but an indispensable element of overall health, and the striking effect of oral health on athletic performance, which has emerged in recent research in the field of sports medicine and dentistry. Materials and Methods: In the search for scientific literature for this review, data from the US National Library of Medicine (PubMed), MEDLINE, and SportDiscus were used, and the terms ‘’ oral health’’, sports injuries’’, ‘’ sportive performance’’, ‘’ dental health’’. “athletes’ health’’ were used. The relevant literature has also taken its source from the research of relevant articles from reference lists derived from data searches Results: It is widely acknowledged that optimal oral health plays an important role in overall well-being. It is also recognized that athletes face unique challenges due to the demands of intense training programs. It is worth noting that maintaining good oral and dental health has implications that extend beyond a bright smile. There is growing evidence that it can also have a significant impact on an individual's physical performance and overall health. It is worth noting that athletes may be particularly vulnerable to a range of oral health concerns that could potentially impact their performance and overall well-being. Conclusion: Athletes may sometimes experience common oral health issues such as tooth decay and periodontal diseases, which could be due to several factors. These may include an increased intake of sugar from sports drinks, dehydration during training which can lead to dry mouth, and potential trauma from contact sports. It is worth noting that these issues can have a significant impact on an athlete’s performance, beyond mere discomfort. They can affect nutrition intake, sleep quality, and even systemic inflammation levels.

BackgroundDuring the past two decades, several scientific publications from different countries have shown how oral health in the population varies with social determinants. The aim of the present study was to explore the relationship between self-reported oral and general health in relation to different measures of socioeconomic position.MethodsData were collected from a randomly selected sample of the adult population in Sweden (n = 3500, mean age 53.4 years, 53.1% women). The response rate was 49.7%. Subjects were interviewed by telephone, using a questionnaire including items on self-reported oral and general health, socioeconomic position and lifestyle.ResultsA significant gradient was found for both oral and general health: the lower the socioeconomic position, the poorer the health. Socioeconomic position and, above all, economic measures were strongly associated with general health (OR 3.95) and with oral health (OR 1.76) if having an income below SEK 200,000 per year. Similar results were found in multivariate analyses controlling for age, gender and lifestyle variables.ConclusionsFor adults, there are clear socioeconomic gradients in self-reported oral and general health, irrespective of different socioeconomic measures. Action is needed to ensure greater equity of oral and general health.

In Australia, Aboriginal adults experience higher levels of poor oral and general health than the non-Aboriginal population. This study compared self-rated oral and general health among Aboriginal adults in regional South Australia with participants in the National Survey of Adult Oral Health (NSAOH). Data were obtained from the Indigenous Oral Health Literacy Project (IOHLP) based in South Australia. Three sub-populations from the NSAOH were utilised for comparison: National Aboriginal, National non-Aboriginal and South Australian Regional Non-Aboriginal adults. All data were standardised by age group and sex, utilising Census data. Just over 70% of South Australian Regional Aboriginal participants gave a rating of 'excellent, very good or good' for general health, more than 17% lower than each of the other groups. Just over 50% rated their oral health highly, 20% fewer than the proportion for each other group. Stratifying by key socio-demographic factors did not account for all differences. Proportionally fewer South Australian Regional Aboriginal adults had high ratings of oral and general health than the Aboriginal and non-Aboriginal adults from the national survey, indicating that national-level data might underestimate the proportion of regional Aboriginal Australians with poor oral health.

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.

With increasing recognition of the important relationship between oral and systemic health, non-dental health professions schools and programs are now teaching their students about oral health in various ways. This study built on surveys of medical schools, primary care residency and fellowship programs, and other health professions programs conducted by the authors in 2017, which found some had made significant progress in integrating oral health into primary care training, while others lagged behind. The aim of the current study was to better understand the characteristics and climate of oral health education in non-dental health professions schools by conducting interviews with leaders of programs who had self-identified in the surveys as having a robust oral health curriculum. Hour-long interviews were conducted between October 2017 and March 2018 with 31 program directors or deans of medical specialty and allied health professions programs using a semi-structured interview guide. These interviewees were from 13 health disciplines. The coding of interview transcripts identified seven major themes: motivations to develop an oral health curriculum; rationale for curriculum topics covered; best aspects of the curriculum; evaluation and assessment strategies; relationships with dental providers and residents and dental hygienists; barriers and challenges; and advice and lessons learned. The interviewees reported a strong belief that oral health is an important health topic. Key elements that interviewees identified as helping them build robust oral health programs in their primary care curricula were the following: having an oral health champion; having some funding; building relationships with dental professionals; using local, state, and national resources; using curricular materials from existing sources; incorporating skills-based sessions; taking an IPE approach; and making oral health part of what the program already does. These findings should be useful for primary care schools and programs that are beginning to add oral health to their curricula and those seeking to improve their existing oral health education for their students.

Oral and periodontal health play a crucial role in the overall well-being of individuals, yet it is often overlooked, particularly among university students. This demographic, characterized by high stress levels, irregular schedules, and dietary changes, is at a heightened risk for oral health issues. Understanding the significance of oral and periodontal health is essential for this group, as it impacts academic performance, social interactions, and long-term health outcomes. Poor oral health can lead to distractions and discomfort, affecting concentration and attendance, while also influencing self-esteem and social dynamics. Additionally, there is a well-established link between oral health and systemic conditions such as cardiovascular disease and diabetes, making preventive care critical. Economically, maintaining oral health can reduce the need for costly treatments and align with students' often limited budgets. Forming good oral hygiene habits during university years is also important for lifelong health practices. Therefore, integrating oral health education and accessible care into university settings is crucial for supporting students' overall health, academic success, and future professional development.

To determine the relative importance of dental and medical features in relation to perceived oral and general health in a sample of 31-year-old individuals. The present study used information collected from the longitudinal Cardiff Survey, which commenced in 1981. The initial sample consisted of 1018 11-year-old Caucasian schoolchildren. Three hundred and thirty-seven individuals attended the latest examination in 2001 (aged 31 years). For every individual who attended in 2001, the following information was collected: perceived general and oral health recorded on a five-point Likert scale; self-reported medical history; SF-36v(2) questionnaire; assessment of dental features; and the Index of Complexity, Outcome and Need (ICON). Ninety-four and 82% of individuals reported good-excellent general and oral health, respectively. Females reported a higher level of physical health than males as measured using the SF-36v( 2). Four medical conditions were associated with perceived poor general health: mental [odds ratios (OR); 95% confidence limits (95% CI): 4.5; 1.1-18.4], gastrointestinal (OR 3.4; 95% CI 1.2-9.5) and genitourinary disorders (OR 7; 95% CI 1.6-30.2), and conditions that did not readily fit into a defined category or system (OR 12.8; 95% CI 3.9-42.3). The highest prevalence of dental factors was gingivitis followed by gingival recession and plaque. Photographically assessed dental factors associated with self-reported poor/fair oral health were fillings (OR 0.45; 95% CI 0.2-0.9), root caries/abrasion (OR 0.37; 95% CI 0.1-0.9) and gingivitis (OR 0.31; 95% CI 0.1-0.9). There was a statistically significant association between oral and general health. Of those individuals reporting fair-poor oral health (18%), the proportion also reporting fair-poor general health was 63.6%. Unexpectedly, per-unit increase in ICON score was also significantly associated with fair-poor general health (OR 0.97) with clinically relevant increases of 7 ICON units producing an OR of 0.82. The relative importance of the various dental and medical conditions has been identified. Further studies are required to explore the importance of ICON in perceived medical health and importance of the various conditions on oral and general health over different age groups.

Background: Oral health is an indispensible part of general health is an often ignored by masses including health care personnel. There have been health policies launched by the government recently including oral care but to what extent the people are aware of these policies are yet to be assessed. Aim: To assess the oral health status and perception pertaining to link between oral and systemic health, Ayushman Bharath Yojana and the concept of Universal Health Coverage (UHC) amongst the people visiting the exhibition on 64th Institute Day, AIIMS, New Delhi, India. Materials and Methods: People who came to the dental booth at the exhibition over a period of 3 days from 25th September 2019 to 27th September 2019, fulfilling the inclusion criteria were included in the study. Data collection was performed through clinical examination and open ended questionnaire for the assessment of perception regarding association between oral health and systemic health, concept of Universal Health Coverage and Ayushman Bharath Yojana. Result: Mean DMFT score was found to be 2.6 ± 3.4, 41.3% had bleeding on probing, 2.8% showed dental trauma and 2% had dental fluorosis. Nearly 73.6% felt that oral health does affect general health. Majority of the study population was not aware of the concept of UHC. Around 60% participants were aware of the Ayushman Bharath Yojana. Conclusion: The study findings conclude the need to spread awareness amongst masses about government health policies and effects of oral health on general health.

BackgroundGlobally, there is growing concern regarding mouth sores, occlusion, cost, ridge resorption, and retention, in the delivery of removable complete dentures fabrication services brought about by the aging of the population and poor oral healthcare. The therapy for edentulous patients can be realized through the use of conventional removable complete dentures, implant-supported prostheses, and computer-aided design/computer-aided manufacturing (CAD/CAM). In Uganda, the therapy for edentulous patients has predominantly been realized through the use of conventional removable complete dentures. There has been a discernible difference in the number of visits and remake rate between removable complete dentures that were made conventionally and digitally. This present study, therefore, aimed to explore dental clinicians’ and technologists’ experiences and perspectives on removable complete denture fabrication services.MethodsThe study employed a qualitative design, 25 in-depth interviews were conducted with dental clinicians and technologists at Makerere University Dental Hospital. Both practicing dental technologists and clinicians were purposively selected after providing written informed consent. Interviews’ audios were transcribed verbatim, coded in NVivo 14 and data were analyzed thematically.ResultsClinical and socio-demographic assessments like age, oral hygiene, ridge level, underlying health conditions, and mental stability of the patient were done by dental clinicians before removable complete denture fabrication. Dental technologists and clinicians mentioned patients having a lot of expectations relating to being able to eat whatever they like and improving physical appearance. However, the patients also had fears and concerns about discomfort, and some worried that they would swallow the dentures.ConclusionPrior assessments were the basis for planning for complete denture therapy. Patients’ fears and expectations can effectively be addressed in the consent process since adequate information can be shared and the patients can be psychologically prepared to receive the denture treatment.