A disability-based exploration of psychosocial barriers and enablers to accessing dental services for people with clinically severe obesity: A qualitative study

"Dental team-based education" Dental team perspectives and experiences about weight stigma: a qualitative analysis

BACKGROUND

There is evidence from qualitative and quantitative studies of the presence of weight stigma in the dental setting from the patient perspective. However, the perspectives of various members of the dental team and their observations and experiences of weight stigma are unknown. Given dental specialists in Special Needs Dentistry (SND) are often referred patients living with severe obesity for dental management, their perspectives are of specific importance, particularly with respect to currently employed and recommended weight stigma reduction strategies.

AIMS

Our qualitative study aimed to identify and explore among dental professionals and support staff in Australia, their perspectives and experiences of weight stigma. We aimed to identify any currently employed, and recommendations for, stigma reduction from SND specialists.

METHODS

Focus groups and semi-structured interviews (n = 34 participants) were conducted with two groups; dental professionals and support staff from regional New South Wales; and SND specialists in Australia. Recordings were transcribed verbatim and analysed using thematic (inductive) analysis.

RESULTS

Key themes emerged related to observed experiences with weight stigma, with differing perspectives based on professional roles. The impact of weight stigma on dental management was highlighted. Stigma reduction strategies with an educational focus were also identified from SND specialist participants.

CONCLUSION

The current study explored observations of weight stigma in various dental settings and perspectives which differed based on participant awareness and professional role. The negative impact of weight stigma on preventive dental discussions was identified. Stigma reduction strategies need to target the identified barriers and address the complex drivers of weight stigma before implementation. The findings of the current study emphasise the role for team-based education, led and guided by SND specialists through their professional advocacy roles and encourages the development of a dental team action plan to respond to observed experiences of weight stigma in the workplace.

Acceptance among the public of weight screening and interventions delivered by dental professionals: observational study

OBJECTIVE

The objective of this study was to explore the acceptability to the public of receiving weight screening and the offer of support to lose weight from dental teams.

METHODS

A cross-sectional survey was conducted with recruitment of adults from dental practices and community and hospital settings in England and the National Institute for Health and Care Research (NIHR) Be Part of Research initiative.

RESULTS

A total of 3580 participants were recruited across 22 dental sites and the NIHR Be Part of Research initiative. Sixty percent (n = 2055/3430) of participants reported that they would be comfortable with their height and weight being measured at a dental appointment. Male participants and those of non-White race and ethnicity had significantly increased odds of accepting weight screening (odds ratio [OR]: 1.98, 95% CI: 1.66-2.36; OR: 2.07, 95% CI: 1.42-3.03). Fifty-seven percent (n = 1915/3375) of participants reported that it would be acceptable for their dental team to offer support to help with weight management. Male participants and those of non-White race and ethnicity had significantly increased odds of accepting support (OR: 1.79, 95% CI: 1.49-2.13; OR: 1.62, 95% CI: 1.11-2.37). The most accepted form of support was provision of information on local weight-management programs (n = 1989/2379, 83.6%).

CONCLUSIONS

The public is largely receptive to receiving weight screening and the offer of weight interventions from dental teams. Feasibility studies to test the implementation of lifestyle weight interventions in dental settings are required.

Dental team barriers and enablers for the dental management of adults with severe obesity: a qualitative analysis

BACKGROUND

Broad challenges regarding the dental management of people with severe obesity experienced by general dentists have been minimally explored. The perspectives of the dental team regarding these multifaceted issues are currently unknown and they potentially impede the delivery of optimal dental care to this population and contribute to poor oral and general health.

AIMS

Our qualitative study aimed to identify and explore barriers and enablers in the dental management of adults with severe obesity among dental professionals and support staff in Australia.

METHODS

Focus groups and semi-structured interviews (n = 34 participants) were conducted with dental professionals (n = 23) and support staff (n = 11). Recordings were transcribed verbatim and synthesised using thematic, inductive analysis.

RESULTS

Multiple barriers to adequate provision of dental care for people living with severe obesity in both general and specialist dental settings were identified. Key themes emerged related to the clinical challenges reported by participants in providing dental management for people living with severe obesity, appropriateness of existing bariatric dental service provision and safety of care. Enablers to access were identified, including increased availability of bariatric dental chairs, environmental modifications, education of both patients and the entire dental team and for guideline development.

CONCLUSION

The current study explored multiple barriers to optimal dental management of people living with severe obesity in both general and specialist dental settings. Enablers should be used to inform future practice. The optimisation of existing bariatric dental service provision requires urgent review with solutions guided by systemic change. Study findings suggest a review of current health systems, economics, access barriers, policies and procedures and education and training beyond the individual level are needed. Future directions to improve the dental management of people living with severe obesity are proposed.

Class 3 Obesity and Oral Health in Adults: A Scoping Review of the Challenges for Oral Healthcare Services

Background: Obesity is one of the most neglected public health problems affecting both developed and developing countries. The most clinically severe obesity (Class 3 obesity) has both clinical and service delivery implications on dental services. However, associations between Class 3 obesity and oral health are minimally explored in the literature and thus poorly understood. Aims: This scoping review aimed to explore the existing evidence on Class 3 obesity and oral health. Methods: A literature search was performed via Medline, Scopus, Google scholar and Embase research databases. Results: A total of 375 papers were sourced from the database search. Twenty seven full-text papers were included in the final literature review. Results revealed findings from both quantitative and qualitative studies. Papers included results pertaining to associations with dental disease, oral health and associated behaviours, oral health-related quality of life and the barriers experienced by adults with Class 3 obesity in accessing dental services. Conclusions: While mixed findings were identified, this scoping review reports associations between Class 3 obesity and poor oral health across various domains including clinical parameters and oral health related quality of life. The literature has also highlighted important barriers to dental care in those with the most severe Class 3 obesity. Based upon our findings, we have summarised current oral health management implications and directions for future research.

Unique dietary and oral hygiene behaviors in a cohort with clinically severe obesity: A cross sectional study

BACKGROUND

An association between increased risk of dental caries with increased levels of clinically severe obesity has been reported. Data linking body mass index (BMI) and dietary behaviors, including at-risk dietary factors and oral hygiene habits, are lacking in a cohort with clinically severe obesity. This study aimed to explore the dietary and oral hygiene behaviors in individuals with clinically severe obesity attending a hospital-based obesity service.

METHODS

Adult patients attending a hospital-based obesity service in Greater Western Sydney with clinically severe obesity were invited to participate in a self-administered survey, which collected data on their nutritional and oral hygiene behaviors. Demographic data (age, gender) and BMI were extracted from the participants' medical records. The primary outcome was the relationship between BMI and frequency of toothbrushing. RESULTS: Of the 82 individuals who consented to participate, 81 (98.8%) completed the study questionnaire. The median BMI of the cohort was 49.1 kg/m2 (interquartile range [IQR]: 43.2-57.3 kg/m2) and median age 51 (IQR: 39-63) years. BMI was not significantly correlated with individual oral health behaviors (p > .05). Many participants reported dietary risk behaviors, which have the potential to influence their oral health.

CONCLUSIONS

While oral health behaviors were not associated with increasing BMI, patients with clinically severe obesity in this study reported unique dietary behaviors and mixed oral hygiene habits that may complicate nutritional and dental management. Awareness of these behaviors among clinicians including dental professionals is required in this cohort.

Public and dental teams' views about weight management interventions in dental health settings: Systematic review and meta-analysis

Collaborative approaches across healthcare to address obesity are needed but intervention in dental settings is not widely implemented. Here we systematically synthesized the views of both the public and dental teams about delivering weight management interventions in dental settings and identified potential barriers to implementation. A systematic review of five databases from inception to April 3, 2023 was completed. Proportional meta-analyses were performed with quantitative data and thematic analysis of qualitative data. A total of 7851 studies were screened and 33 included in the review. The prevalence of height and weight screening in dental settings varied (4%-87%) with an average of 29% undertaking screening (p = <0.01; 95% CI: 14%-46%). A significant proportion of the public were supportive of weight screening in dental settings (83%; p = <0.01; 95% CI:76%-88%). Significant barriers to providing weight screening and/or intervention included fear of offending patients (57%; 95% CI: 45%-68%) and a lack of time (48%; 95% CI: 30%-66%). Qualitative data revealed further barriers including stigmatizing views of dental teams toward people living with overweight/obesity. Enablers of weight discussion included associating weight with oral health. Overall, whilst some barriers were identified, there is potential for weight management interventions to be used more routinely in dental settings.

Pre-doctoral dental students' knowledge, training, perceptions, and attitudes regarding obesity and treatments: A survey study

OBJECTIVE

The aims of this study were to assess first-year predoctoral dental students' knowledge, training, perceptions, and attitudes on obesity and to compare knowledge, perceptions, and attitudes before and after attending an educational presentation.

METHODS

A presentation explaining the impact of obesity and its treatments on oral health was developed and presented to first-year predoctoral dental students (D1's) in the Doctor of Dental Medicine program. Before ("pre") and after ("post") the presentation, attending students were given the opportunity to take an anonymous and voluntary survey. Questions on the survey covered topics on knowledge, training, perceptions, and attitudes about obesity.

RESULTS

Thirty-four of the 213 students in the course (response rate = 16.0%) attended the presentation and completed both the pre- and post-surveys. Most participating students reported receiving 0-5 h of education on obesity since starting their dental education. Regarding pre-survey answers to knowledge-based items, the percentage of students answering, "strongly agree" (representing the greatest knowledge level) ranged from 5.9% to 61.8% across items. Significant improvements from pre- to post-survey were observed for all knowledge-based items except a statement that obesity is associated with serious medical conditions. Significant improvements were also found for perception-based items asking about accommodations for patients and the importance of assessing dietary habits. Additionally, at post-survey, students reported significantly less discomfort asking about dietary habits and weight loss medications.

CONCLUSION

Dental curricula policy makers and developers should consider the incorporation of obesity and its treatments, with nutrition experts teaching the content.

Poor dental service utilization in those with clinically severe obesity: A neglected issue with solutions needed

Data linking body mass index (BMI) and dental service utilization with oral and general health, quality of life, wellbeing, and mental health are lacking. Adult patients with clinically severe obesity attending a hospital-based obesity service in Greater Western Sydney were invited to participate in a cross-sectional survey that collected data on dental utilization and visiting patterns, dental anxiety, and oral health-related quality of life (OHRQoL). General health data were obtained from participants' medical records. Of the 82 individuals who consented to participate, 81 (98.8%) completed the study questionnaire, and 74 (91.3%) answered additional screening questions related to their general wellbeing and mental health. Of the participants, 50 (61.7%) reported that their last dental visit was more than 1 year ago, 43 (53.1%) visited only as needed and 22 (27.2%) participants reported favourable dental visiting patterns. Twenty-four (29.6%) participants reported high levels of dental anxiety, and low levels of OHRQoL compared with national data. Screening questions suggested low general wellbeing and poor mental health in this patient cohort. Within this group, BMI was not significantly correlated with any of the variables of dental service utilization, dental anxiety, OHRQoL, wellbeing, or mental health (p > .05). There was a negative correlation between dental anxiety and dental utilization (p < .05). Patients with clinically severe obesity reported poor dental utilization, low OHRQoL, and high levels of dental anxiety. This study highlighted the frequency of medical complications, lack of wellbeing, and poor mental health, which were evident in this cohort and may complicate dental management.

Weight stigma among dental professionals and in the dental setting: a scoping review

Background Weight stigma refers to discriminatory acts and ideologies targeted towards individuals because of their body weight and/or size. Weight stigma in healthcare settings generates major health disparities. To date, there have been no previous reviews exploring the issue of weight stigma among dental professionals (DPs) and in the dental setting.Aims To synthesise current evidence on weight stigma among DPs and in dental care settings via a scoping review.Methods A comprehensive search was carried out across four relevant electronic databases (Medline, Scopus, Psychinfo and Cinahl). A total of 25 full-text papers were included in the scoping review.Results Most papers addressed the subject of weight stigma as a secondary finding (20 papers). Both quantitative and qualitative study methods were used to explore weight stigma across the broad categories of attitudes and beliefs about obesity, weight-based discussions, obesity education and training and service implications of obesity. Recommendations regarding weight stigma among DPs and in the dental setting were proposed but have not been formally assessed.Conclusion Further studies addressing weight stigma in dental settings, including causes and consequences among DPs, are required to better inform and address this issue.

Weight stigma experienced by patients with obesity in healthcare settings: A qualitative evidence synthesis

Weight stigma research is largely focused on quantifiable outcomes with inadequate representation of the perspectives of those that are affected by it. This study offers a comprehensive systematic review and synthesis of weight stigma experienced in healthcare settings, from the perspective of patients living with obesity. A total of 1340 studies was screened, of which 32 were included in the final synthesis. Thematic synthesis generated three overarching analytical themes: (1) verbal and non-verbal communication of stigma, (2) weight stigma impacts the provision of care, and (3) weight stigma and systemic barriers to healthcare. The first theme relates to the communication of weight stigma perceived by patients within patient-provider interactions. The second theme describes the patients' perceptions of how weight stigma impacts upon care provision. The third theme highlighted the perceived systemic barriers faced by patients when negotiating the healthcare system. Patient suggestions to reduce weight stigma in healthcare settings are also presented. Weight stigma experienced within interpersonal interactions migrates to the provision of care, mediates gaining equitable access to services, and perpetuates a poor systemic infrastructure to support the needs of patients with obesity. A non-collaborative approach to practice and treatment renders patients feeling they have no control over their own healthcare requirements.