The role of non-dental health professionals in providing access to dental care for low-income and minority patients

Urgent dental care use in the North East and Cumbria: predicting repeat attendance

Introduction Around one-third of the UK population are 'problem-orientated dental attenders', only seeking care when suffering with dental pain and often on a repeated basis to secondary care. Little is known about attendance in primary care. The aim here was to examine the period prevalence of repeat urgent care attenders and establish predictors of repeat attendance in primary care.

Methods Data on urgent and emergency dental care attendances in primary dental care in the North East and Cumbria were analysed from 2013-2019. Variables included: patient sex; ten-year age band; lower super output area; and Index of Multiple Deprivation. Period prevalence was calculated and data were considered year by year to identify trends in attendances. Analysis was with descriptive statistics and predictors of repeat attendance were identified using logistic regression modelling.

Results Over the six-year period, there were 601,432 attendances for urgent primary dental care, equating to a period prevalence of 2.76% for the geographic population studied. In total, 16.15% of attendances were repeat attendances (period prevalence 0.45%) and predictors included being a woman and residence in deprived and rural areas. All urgent care attendances decreased over the six-year period, with one-off attendances beginning to increase again in 2019, while repeat attendances stabilised.

Conclusion Interventions to encourage regular dental attendances should be targeted at patients from the most deprived and rural areas of the North East and Cumbria; however, a decrease in repeat attendance was noted in these areas.

Predictors of being a repeat attender for urgent and emergency dental care included being a woman and living in the most deprived and rural areas of the North East and Cumbria.

Over a six-year period (2013-2019), the number of one-off urgent and emergency dental care attenders to primary care in the North East and Cumbria decreased before beginning to increase.

Over the same period, the number of repeat urgent and emergency dental care attenders to primary care in the North East and Cumbria decreased before stabilising.

The Barber Pole Might Have Been an Early Sign for Patient-Centered Care: What Do Interprofessional Education and Interprofessional Collaborative Practice Look Like Now?

In 2009, the Interprofessional Education Collaborative (IPEC) was initiated. Its release of interprofessional collaborative practice (ICP) core competencies in 2011 was pivotal for the engagement of health care professionals, including dentistry; in patient-centered, collaborative efforts for interprofessional education (IPE); and ICP. Thereby, IPEC is helping to put into application, in North America, the 2010 World Health Organization (WHO) Framework for Action on Interprofessional Education and Collaborative Practice. This article introduces IPE/ICP in 5 phases of evolution, emphasizing dental influence and inclusion, from historical perspectives through current applications that are expanded on in the accompanying articles elsewhere in this issue.

Oral health conceptual knowledge and its relationships with oral health outcomes: Findings from a Multi-site Health Literacy Study

OBJECTIVES

In 2010, a health literacy instrument designed to measure oral health conceptual knowledge was introduced. This developmental work was limited in that it included a relatively small and homogeneous study population and few oral health measures against which to test concurrent validity. The purpose of the present investigation is to expand upon the earlier work by utilizing a larger study sample and additional outcome variables.

METHODS

Data for this report came from the Multi-site Oral Health Literacy Research Study (MOHLRS), a large, cross-sectional survey conducted at two university-based dental clinics in the United States. MOHLRS included multiple assessments administered during face-to-face interviews. Conceptual knowledge was measured with the Comprehensive Measure of Oral Health Knowledge (CMOHK). Questions about self-efficacy, utilization, and dental beliefs and attitudes were also asked. Covariates included recruitment site, age, gender, race/ethnicity, education level, and languages spoken.

RESULTS

Overall, 18% of 909 adult participants exhibited "low" conceptual knowledge. CMOHK scores were significantly associated with three health literacy instruments, the REALM, Short-test of functional health literacy in adults (TOFHLA), and confidence filling out forms. In both bivariate and multivariable analyses, CMOHK scores were also significantly associated with dental beliefs and attitudes and self-efficacy to prevent both dental caries and periodontal disease. CMOHK scores were not associated with utilization, measured either as having a dental visit or a dental cleaning in the last year.

CONCLUSIONS

The present investigation provides additional support for the CMOHK's validity. Researchers are encouraged to incorporate oral health conceptual knowledge into their theoretical frameworks, especially as it relates to beliefs and self-efficacy.

Describing the role of Australian community pharmacists in oral healthcare

OBJECTIVES

To investigate community pharmacist's attitudes, beliefs and practices towards oral health in the Australian setting, describe the frequency and nature of consumer enquiries relating to oral health, and gain insight regarding smoking cessation support for people experiencing oral health problems.

METHODS

An online questionnaire was developed based on previous research, validated to ensure accuracy and reliability, and convenience sampling used to advertise across major pharmacy organisational websites and newsletters to maximise community pharmacist responses.

KEY FINDINGS

One hundred and forty-four valid community pharmacist responses were descriptively analysed. The majority of pharmacists (93%) believed it was their role to deliver oral health advice in the community and almost all (97%) pharmacists believed further education would benefit their practice. The top four consumer enquiries pharmacists reported confidence in handling related to analgesic medication to relieve oral-related pain (95.8%), mouth ulcers (95.1%), oral thrush (94.4%) and toothache (93.8%); and the most frequently reported consumer enquires were those where the majority of pharmacists reported high confidence in handling. A small proportion of pharmacists (8%) always enquired about patient smoking status, and nearly all pharmacists (97%) desired further education and training to benefit their practice in oral healthcare.

CONCLUSION

This study highlights that Australian pharmacists have an important role in oral health and there is opportunity to enhance this role, and address risk factors such as smoking with further training, support and education. The findings from this study can guide future research into the development of appropriate training programmes, standards, and best oral healthcare practices for Australian pharmacists.

Dental treatment needs and health care-seeking behaviours of patients with acute odontogenic infections in Lithuania

AIMS

To assess patients with acute odontogenic maxillofacial infections (AOMIs), regarding their functional dentition and dental treatment needs, and identify factors explaining these outcomes.

METHODS

During a 1-year period, 160 patients with AOMIs were treated at the specialised dental care centre of Vilnius University. Both oral status and specific dental treatment needs were evaluated for each patient. For the restorative dental treatment need, we examined if patients needed fillings, crowns or bridges. Periodontal dental treatment needs were based only on the most severe cases, and patients were allocated either to a group for which periodontal treatment was recommended or to a group that did not need periodontal treatment. Based on these clinical assessments, four ratios for specific dental treatment needs (restorations, extractions, endodontic treatment and periodontal treatment) and two summative ratios (total dental treatment needs and presence of a functional dentition) were calculated. The questionnaire included variables from various domains.

RESULTS

Patients with AOMIs retained one-third of their functional dentition and the mean ± standard deviation of their total dental treatment needs was 46.0 ± 29.7%, of which 32.4 ± 17.1% related to the need for restorations. Higher dental treatment needs were associated with a low level of education, low income, irregular oral self-care, systemic diseases and self-treatment of acute dental conditions before seeking professional help.

CONCLUSIONS

Patients with AOMIs retained one-third of their functional dentition, and almost half of their dentition were in need of dental treatment.

Factors associated with no dental treatment in preschoolers with toothache: a cross-sectional study in outpatient public emergency services

Many parents rely on emergency services to deal with their children's dental problems, mostly pain and infection associated with dental caries. This cross-sectional study analyzed the factors associated with not doing an oral procedure in preschoolers with toothache attending public dental emergency services. Data were obtained from the clinical files of preschoolers treated at all nine dental emergency centers in Goiania, Brazil, in 2011. Data were children's age and sex, involved teeth, oral procedures, radiography request, medications prescribed and referrals. A total of 531 files of children under 6 years old with toothache out of 1,108 examined were selected. Children's mean age was 4.1 (SD 1.0) years (range 1-5 years) and 51.6% were girls. No oral procedures were performed in 49.2% of cases; in the other 50.8%, most of the oral procedures reported were endodontic intervention and temporary restorations. Primary molars were involved in 48.4% of cases. With the exception of "sex", the independent variables tested in the regression analysis significantly associated with non-performance of oral procedures: age (OR 0.7; 95% CI 0.5-0.8), radiography request (OR 3.8; 95% CI 1.7-8.2), medication prescribed (OR 7.5; 95% CI 4.9-11.5) and patient referred to another service (OR 5.7; 3.0-10.9). Many children with toothache received no oral procedure for pain relief.

Children's oral health and the role of the pediatrician

PURPOSE OF REVIEW

Oral health is an integral part of the overall health of children. Pediatricians must be competent in issues of oral health and disease if they are to fulfill their role as professionals dedicated to the health of children. This review will update pediatricians on the epidemiology of child oral disease, highlight the importance of good oral health in special populations of children, and examine the role pediatricians can play in maintaining children's oral health.

RECENT FINDINGS

Dental caries continues to be a common chronic disease of childhood and has increased in the youngest age groups. Oral disease has implications beyond the mouth and can cause significant problems for children with other chronic diseases. Pediatricians receive very little education on oral health during their medical training and numerous barriers exist to incorporating oral health into practice. Despite these facts, opportunities exist to both increase knowledge and overcome the barriers to incorporating oral health into daily practice. Collaboration with other child health professionals to improve children's oral health will make the job of the pediatrician easier.

SUMMARY

Pediatricians have an opportunity to increase their knowledge of children's oral health, incorporate it into their daily clinical routine, and improve the overall health of children.

The need for dental care among adults presenting to an urban ED

OBJECTIVE

The study aimed to estimate the prevalence of need for dental care among patients in the ED and assess associated characteristics.

METHODS

This was a cross-sectional study conducted in the emergency department (ED) of a level I trauma center between June 1 and August 31, 2009. All ED patients were prospectively screened during randomly selected 8-hour blocks of time; consenting patients completed a survey on sociodemographics and health. The treating clinician completed an oral health examination to determine the patient's need for dental care as none (continue usual care), early (need to be seen soon), or urgent (need to be seen immediately). Data were analyzed using logistic regression.

RESULTS

There were 4670 patients who presented to the ED, 2787 (59.7%) were eligible, 1190 (63.2%) consented and enrolled, and 653 (54.9%) had a dental examination. Of these, 388 (59.4%; 95% confidence interval [CI], 56%-63%) had no need for dental care, 199 (30.5%; 95% CI, 27%-34%) had an "early need," and 66 (10.1%; 95% CI, 8%-12%) had an "urgent need." Logistic regression showed the need for dental care was associated with age, ethnicity, and having not had a routine checkup/cleaning in the last 3 years.

CONCLUSIONS

Of the patients presenting to the ED, 40.6% were in some need of dental care. This need was not associated with insurance or socioeconomic status as shown in previous studies. Age, ethnicity, and no routine oral care in the last 3 years were all associated with early/urgent need for oral health care.