Singapore dentists' attitudes toward dental care provision for older adults with disabilities

OBJECTIVES

This study aimed to assess dentists' attitudes toward providing dental care for older adults with disabilities in Singapore and the factors influencing their willingness to provide care.

BACKGROUND

Dentists face a rapidly ageing patient demographic. Practitioner unwillingness to circumvent the attending challenges of care provision prevents older adults from accessing the dental care necessary for better oral and systemic health. Previous studies have reported on dentists' attitudes toward caring for older adults with disabilities; however, these are mostly limited to dependent older adults and exclude frail, community-dwelling older persons.

METHODS

A cross-sectional study was conducted in 2020 using a self-administered questionnaire. Quantitative data analysis was presented in the form of descriptive statistics, followed by bivariate analyses.

RESULTS

There were 193 respondents, a response rate of under 9%. Dentists were less willing, confident and involved in the care of older adults with disabilities as the individual's severity of impairments increased. Less than half of respondents were willing to treat individuals with severe disabilities in cooperation (23.3%), swallowing (30.6%), mobility (33.7%) and communication (45.1%). Dentists with training in geriatric dentistry were more willing to provide care. However, younger dentists, general dental practitioners, private practitioners and public sector dentists had specific restraining and driving forces, which further modulated their willingness to provide care.

CONCLUSIONS

The current areas of training needs among Singapore dentists are in severe impairments of swallowing, communication, cooperation and mobility. Further geriatric dentistry training may effectively increase dentists' willingness to provide care; however, additional specific targeted interventions are also needed.

Semi-flipped classroom-based learning interventions in a traditional curriculum of oral medicine: students' perceptions and teaching achievements

BACKGROUND

In recent years, flipped classes have emerged and become popular in college medical education. However, due to the huge medical learning system and the limited pre-class study time of students, it is difficult to implement in all courses. And then we adopted the semi-flipped classes (SFCs) to evaluate its teaching effect. This study analysed three educational methods that can be used in oral medicine courses: online education, offline education, and semi-flipped classes.

METHODS

We used two surveys to evaluate the three educational methods. In the first survey 46 teachers and 238 undergraduates shared their experience of the live-streaming and traditional offline courses offered in the different oral medicine curricula; we used anonymous questionnaires to evaluate their class experience. In the second survey 94 students shared their experience of the semi-flipped and traditional classrooms. Students who attended the SFCs in the experimental group learned about the oral mucosa disease by themselves using an online video course and then participated in offline interaction with teachers. The evaluation of the above educational methods was conducted using the anonymous questionnaires and final exam assessment.

RESULTS

According to the first survey, teachers and students both agreed that the overall teaching experience and learning effectiveness in offline education are superior to those in online education. According to the second survey, students who participated in the SFCs performed better in the final exam than those who participated in the simple offline classes. Additionally, the survey showed that the new teaching method helped students gain more knowledge and positively influenced their clinical practice.

CONCLUSIONS

Compared with the online and offline educational methods, the SFC showed better results in both the questionnaire and final exam assessment. Hence, the effectiveness of medical education can be improved by adopting a teaching mode that combines online and offline teaching methods. Scientific and logical SFCs designs, along with their effective implementation, would eventually make SFCs an important tool for medical education.

Glutaryl Melatonin Niosome Gel for Topical Oral Mucositis: Anti- Inflammatory and Anticandidiasis

BACKGROUND

Glutaryl melatonin, which is synthesized from melatonin and is a pineal glandderived neurohormone with anti-inflammatory and anti-oxidant properties, was comparatively investigated for its potential use as a topical anti-inflammatory agent.

OBJECTIVE

Glutaryl melatonin, synthesized and screened for in vitro anti-candidiasis and in vitro and in vivo anti-inflammatory activities, was formulated as a niosome gel for topical oral evaluation in 5- fluorouracil-induced oral mucositis in mice.

METHODS

In vitro anti-fungal activity in Candida albicans, in vitro anti-inflammatory activity in Escherichia coli liposaccharide-induced RAW cells and in vivo anti-inflammatory activity using a croton oilinduced ear edema model in ICR mice were investigated. Mucositis in mice (n= 6/group, 10-week-old mice) was induced by intraperitoneal injections of 5-fluorouracil, and the mice were subjected to a topical oral application of niosome gel containing melatonin (2% w/w) or glutaryl melatonin (2% w/w) and were compared with mice subjected to blank, fluocinolone acetonide (0.5% w/w) and control conditions.

RESULTS

Glutaryl melatonin, at a 14.2 mM concentration, showed the highest fungicidal effect on C. albicans using the broth dilution method, indicating a nonsignificant difference from 1 μM of nystatin (p = 0.05). Nitric oxide, interleukin-6 and tumor necrosis factors were analyzed by ELISA. Liposaccharide-induced RAW cells were significantly reduced by glutaryl melatonin (p < 0.01). Ear edema inhibition of glutaryl melatonin was significant 1 h after application compared with that of melatonin (p = 0.03). Food consumption and body weight of the 5-fluorouracil-treated mice were significantly lower than those of the normal mice before all treatments (p < 0.05). Differences in the amount of licking behavior, which were observed in the control group for 5 min, were noticeable in the 5- fluorouracil-treated mice but not in the mice treated with the glutaryl melatonin niosome gel.

CONCLUSION

Glutaryl melatonin exhibited mild anti-candidiasis and anti-inflammatory properties. The incorporation of glutaryl melatonin in a niosome gel formulation, demonstrated the potential for topical oral applications to reduce oral discomfort caused by 5-fluorouracil treatment in mice.

Current management strategies for the pain of elderly patients with burning mouth syndrome: a critical review

Burning Mouth Syndrome (BMS), a chronic intraoral burning sensation or dysesthesia without clinically evident causes, is one of the most common medically unexplained oral symptoms/syndromes. Even though the clinical features of BMS have been astonishingly common and consistent throughout the world for hundreds of years, BMS remains an enigma and has evolved to more intractable condition. In fact, there is a large and growing number of elderly BMS patients for whom the disease is accompanied by systemic diseases, in addition to aging physical change, which makes the diagnosis and treatment of BMS more difficult. Because the biggest barrier preventing us from finding the core pathophysiology and best therapy for BMS seems to be its heterogeneity, this syndrome remains challenging for clinicians. In this review, we discuss currently hopeful management strategies, including central neuromodulators (Tricyclic Antidepressants - TCAs, Serotonin, and Norepinephrine Reuptake Inhibitors - SNRIs, Selective Serotonin Reuptake Inhibitors - SSRIs, Clonazepam) and solutions for applying non-pharmacology approaches. Moreover, we also emphasize the important role of patient education and anxiety management to improve the patients’ quality of life. A combination of optimized medication with a short-term supportive psychotherapeutic approach might be a useful solution.