Oral health behind bars: a study of oral disease and its impact on the life quality of an older prison population

Oral health services in prison settings: A global scoping review of availability, accessibility, and model of delivery

This review aimed at evaluating the state of availability, accessibility and model of delivery of oral health services in prisons, globally. Five databases of peer-reviewed literature and potential sources of grey literature were systematically searched. Inclusion criteria encompassed oral health papers related to prisons globally, with exclusion of certain article types. Selection involved independent evaluations by two researchers, followed by quality assessment. Data on the availability of oral health interventions in prisons came from 18 countries, while information on the model of delivery of the services is scarce. In addition, two sets of individual and organizational barriers toward oral health service uptake in prisons were revealed and discussed in the text. Lack of oral health services in prisons affects people living in prisons and jeopardizes their reintegration. Urgent and concrete international actions are required to ensure the availability, accessibility, and quality of oral health services among people living in prisons.

A Cross-Sectional Assessment of Effects of Imprisonment Period on the Oral Health Status of Inmates in Ghaziabad, Delhi National Capital Region, India

Background: Incarcerated individuals usually exhibit high oral health needs than the average population. Several factors contribute to these needs both before incarceration and during the sentence itself. Inmates are a marginalized group, who are at a higher risk for a variety of medical, dental, and emotional disorders than the general population. The aim of the study was to assess of effects of the imprisonment period on the oral health status of inmates.

Material and Methods: A total of 532 inmates with imprisonment up to three years, three to six years, and six to ten years were included in the study. Incidence and prevalence of dental caries, decayed, missing, filled teeth (DMFT) index, and periodontal and prosthetic status were evaluated in detail.

Results: Results showed that the prevalence of dental caries was relatively high among the convicts. It was found that 98.2% of the inmates had one or more teeth decayed. Additionally, 31.2% (pocket >4mm) of the inmates had poor periodontal status with 4.5% of the subjects having a loss of attachment score of 4-5mm or more. A total of 3.5% of the inmates had full dentures, either upper or lower arch. The relative need for full prosthesis was projected to be around 1.4% of the studied population.

Conclusion: Within the limitations of the study, the authors found that dental healthcare delivered and received by the inmates is much below the acceptable limit. Additionally, the incidence of dental caries in inmates was unexpectedly higher with tooth decay in 98.2% of subjects. Hence, the need of the hour is to critically incorporate and reinforce our efforts with a special focus on the risk factors of oral health.

Defining an age cut-off for older offenders: a systematic review of literature

PURPOSE

In the literature, 65 years is commonly used as the age to designate an older person in the community. When studying older prisoners, there is much variation. The purpose of this paper is to investigate how researchers define older offenders and for what reasons.

DESIGN/METHODOLOGY/APPROACH

The authors reviewed articles on health and well-being of older offenders to assess terminology used to describe this age group, the chosen age cut-offs distinguishing younger offenders from older offenders, the arguments provided to support this choice as well as the empirical base cited in this context.

FINDINGS

The findings show that the age cut-off of 50 years and the term "older" were most frequently used by researchers in the field. The authors find eight main arguments given to underscore the use of specific age cut-offs delineating older offenders. They outline the reasoning provided for each argument and evaluate it for its use to define older offenders.

ORIGINALITY/VALUE

With this review, it is hoped to stimulate the much-needed discussion advancing towards a uniform definition of the older offender. Such a uniform definition would make future research more comparable and ensure that there is no ambiguity when researchers state that the study population is "older offenders".

Impact of incarceration on nutritional status and oral health among male inmates of central jail of Jaipur city, India

AIM

Prison is an especially difficult environment for promoting oral health and leads to the exacerbation of unhealthy behaviors. This study set out to assess the impact of incarceration on nutritional status and oral health among the male prison inmates of Central Jail of Jaipur city, Rajasthan, India.

MATERIAL AND METHOD

A cross sectional study was conducted among 181 male inmates. Dental caries and periodontal status were assessed by using modified the Decayed Missing Filled Teeth (DMFT) index and Community Periodontal Index (CPI) and Loss of Attachment (LOA) index as per the WHO methodology 1997. Nutritional status was assessed by Body Mass Index (BMI) and weight (kg)/height (m2).

RESULTS

Out of 181 inmates, 141 (77.90%) had normal BMI. The majority (n=128, 70.70%) of inmates were incarcerated for less than 6 years. A significant difference (P<0.05) was found between age and periodontal status. A significant difference was observed (P<0.05) in the CPI score 3 and LOA 0 and 1 score. However, no significant difference (P>0.05) was observed in DMFT and period of incarceration. Age was the significant (P<0.001) risk factor for CPI and LOA.

DISCUSSION

Dental caries and periodontal health deteriorates with age and period of incarceration. Oral hygiene maintenance along with comprehensive oral care can be accomplished by establishing dental care facilities in prisons.

Oral health status and oral health care use among formerly incarcerated people

BACKGROUND

Incarceration carries adverse consequences for health, yet there is limited research on the association between incarceration and oral health outcomes. The authors examined the relationship between former incarceration and 2 self-reported oral health outcomes-periodontal disease and oral health care use-and assessed the degree to which postrelease factors mediate the relationship between former incarceration and oral health outcomes.

METHODS

The authors analyzed nationally representative observational data from the National Longitudinal Study of Adolescent to Adult Health by using multivariate logistic regression. Karlson-Holm-Breen mediation analysis was used to assess how much former incarceration and oral health outcomes are confounded by material hardship, health insurance coverage, and poor health behaviors.

RESULTS

Incarceration history is associated with periodontal disease (odds ratio [OR], 1.454; 95% confidence interval [CI], 1.042 to 2.029) and oral health care use (OR, 1.433; 95% CI, 1.248 to 1.646) after control variables are taken into account. However, the confounding variables fully mediate the association between incarceration and periodontal disease (OR, 1.143; 95% CI, 0.815 to 1.605) and oral health care use (OR, 1.133; 95% CI, 0.980 to 1.309).

CONCLUSIONS

Formerly incarcerated people in the United States have worse oral health outcomes than their never-incarcerated counterparts, and much of this relationship can be explained by socioeconomic status and health behaviors.

PRACTICAL IMPLICATIONS

Formerly incarcerated people have scarce resources and lack knowledge about oral health care. Health care professionals should encourage formerly incarcerated people to focus on oral health care. Because modifiable risk behaviors confound much of this relationship, targeted interventions may provide benefits for improving oral health care among this vulnerable population.

Oral health and oral health-related habits of Finnish prisoners

Objectives/Aims:

This cross-sectional study aimed to examine oral health and oral health-related habits among prisoners at the Pelso Prison in Finland.

Materials and Methods:

Participants in this cross-sectional study comprises 100 inmates. A calibrated dentist recorded the decayed, filled and missed teeth as well as periodontal status (bleeding-on-probing, pocket probing and Community Periodontal Index) among the participants (n=100). Fifty inmates were also interviewed for marital status, education and oral health-related habits. The Ethical Committee of the Northern Ostrobothnia Hospital District and the Criminal Sanctions Agency approved the study protocol.

Results:

The participants were on average 35 years old and had 5 (s.d. 5.1) decayed teeth in need of restorative treatment, whereas DMFT was 17 (s.d. 8.9). Half of the study population had periodontal disease in need of professional treatment. Almost all reported brushing their teeth daily. Two-third ate sweets, one-third drank fizzy drinks and majority smoked every day. Almost two-third had used illicit drugs at some point of their lives. Almost all drunk alcohol once a week or more often. No statistically significant associations were discovered between dental treatment need and explanatory factors.

Discussion

Prisoners appear to be a homogenous group with poor oral health and harmful health behaviours.

Dental triage Hydebank Wood Prison and young offenders centre, Belfast

OBJECTIVE

The aim of this study was to devise and test a triage protocol to prioritise patients' dental needs in a prison environment. Secondary aims were to include in the triage process oral health promotion and information about accessing prison dental services. Also to work collaboratively with the prison staff to improve referrals to the dental services.

METHOD

The triage system was devised to have three strands: (1) an oral health assessment conducted by the dental nurse during the induction process for each new prisoner; (2) a simple oral health examination conducted in monthly screening clinics; (3) the prioritisation of referrals from prison landing staff using the prisons computer system PRISM. The triage was evaluated by assessing the first 100 patients' records with regard to the prioritisation of the triage category at the time of the clinical dental examination.

RESULTS

Of the 100 patients triaged 95% were prioritised into the correct triage category. Seventy-two percent of patients were seen in the appropriate timeframe. Referral patterns from prison landing staff were improved along with interdisciplinary working in the prison. All new prisoners were seen within 72 hours of committal and received oral health advice and information on accessing dental services.

CONCLUSION

This is the first triage system to be introduced into Hydebank Wood Prison, facilitating a targeted approach to dental care. It has improved access to the prison dental services; introduced oral health advice and information into the regular prison healthcare structure; and improved the efficiency of the clinical dental sessions. It is hoped to strategically address problems with waiting times and inequity in service utilisation.

Dental caries status of inmates in central prison, Chennai, Tamil Nadu, India

Aim:

To understand the dental health among prison inmates, we assessed the dental caries status of central prison inmates in Chennai, India.

Materials and Methods:

A total of 1060 inmates from three divisions of the central prison in Chennai were assessed by a single investigator for dental caries status based on World Health Organization specifications.

Results:

Among the inmates, 58.2% of males and 54.2% of females had decayed teeth. About 4.1% of males and 2.9% of females had filled teeth. The mean decayed, missing, filled teeth index was 5.1 and 3.9 for female and male prisoners, respectively. The prevalence of dental caries was highest among inmates younger than 24 years age.

Conclusion:

Our study suggests that a high proportion of prison inmates was affected by dental caries, which necessitates the need for initiating oral health promotion activities among prison inmates.

Dental caries experience and use of dental services among Brazilian prisoners

This ross-sectional study involving 127 male prisoners evaluates the use of dental services and dental caries among Brazilian inmates. Data were collected by interview and clinical examination. Sociodemographic and sentencing information as well as use of dental services, self-reported dental morbidity, self-perception, and oral health impacts were investigated. The mean DMFT index value was 19.72. Of the components, the decayed component showed the highest mean value (11.06 ± 5.37). Statistically significant association was found between DMFTs with values from 22 to 32 and oral health satisfaction (p = 0.002), difficulty speaking (p = 0.024), shame of talking (p = 0.004) and smiling (p < 0.001). Regarding the use of dental services, 80% had their last dental appointment less than one year ago, with most visits occurring in prison (80%), with restorative treatment (32%), followed by dental pain (26.4%), being the main reasons for such appointments. Most prisoners used dental services provided by the prison. Although restorative treatment has been the main reason for the use of dental services, “decayed” and “missing” components contributed to the high mean DMFT index.

Assessment of dental prosthetic status and needs among prisoners of haryana, India

This cross-sectional study was planned to evaluate the prosthetic status and treatment needs using WHO (1997) format among prisoners of Haryana state, India. 1,393 subjects with age range of 35.26 ± 12.29 years were examined. Of the study subjects, 11 (0.8 %) were completely while 606 (43.5 %) were partially edentulous. Of these 617 subjects, 305 (49.4 %) were edentulous only in posterior region. Dental caries accounted for loss of teeth in 325 (52.7 %) subjects. 44 (7.1 %) subjects were wearing some prosthesis. Regarding dental arch wise prosthetic need, 335 (54.3 %) subjects needed prosthesis in maxillary arch while 482 (78.1 %) needed prosthesis in mandibular arch. With advancing age there was an increase in the number of complete dental prosthesis required. There was no statistically significant difference between length of imprisonment and prosthetic need, except for need of a combination of prosthesis. Only one-fourth of the prisons had a dentist. The prisoners were taken to a hospital outside the prison in case of health needs. Prosthetic needs of prisoners were high. The lack of dental infrastructure in prisons makes the provision for multi-visit conservative dental treatments very difficult leading to higher tooth mortality. People who migrate back and forth across the prisons and communities represent a public health opportunity that should be addressed.

Ageing prisoners' health care: analysing the legal settings in Europe and the United States

BACKGROUND

Relatively little is known about the current health care situation and the legal rights of ageing prisoners worldwide. To date, only a few studies have investigated their rights to health care. However, elderly prisoners need special attention.

OBJECTIVE

The aim of this article is to critically review the health care situation of older prisoners by analysing the relevant national and international legal frameworks with a particular focus on Switzerland, England and Wales, and the United States (U.S.).

METHODS

Publications on legal frameworks were searched using Web of Science, PubMed, MEDLINE, HeinOnline, and the National Criminal Justice Reference Service. Searches utilizing combinations of keywords relating to ageing prisoners were performed. Relevant reports and policy documents were obtained in order to understand the legal settings in Switzerland, England and Wales, and the U.S. All articles, reports, and policy documents published in English and German between 1774 to June 2012 were included for analysis. Using a comparative approach, an outline was completed to distinguish positive policies in this area. Regulatory approaches were investigated through evaluations of soft laws applicable in Europe and U.S. Supreme Court judgements.

RESULTS

Even though several documents could be interpreted as guaranteeing adequate health care for ageing prisoners, there is no specific regulation that addresses this issue completely. The Vienna International Plan of Action on Ageing contributes the most by providing an in-depth analysis of the health care needs of older persons. Still, critical analysis of retrieved documents reveals the lack of specific legislation regarding the health care for ageing prisoners.

CONCLUSION

No consistent regulation delineates the provision of health care for ageing prisoners. Neither national nor international institutions have enforceable laws that secure the precarious situation of older adults in prisons. To initiate a change, this work presents critical issues that must be addressed to protect the right to health care and well-being of ageing prisoners. Additionally, it is important to design legal structures and guidelines which acknowledge and accommodate the needs of ageing prisoners.

Dentition status and treatment needs of prisoners of Haryana state, India

PURPOSE

This paper aims to explore prisoner dental health in Haryana, India.

DESIGN/METHODOLOGY/APPROACH

The authors assessed the prevalence of dental caries and the treatment needs of prisoners in all 19 prisons in Haryana. The results were compared with the prison populations of other countries and the general population of Haryana.

FINDINGS

The mean age of 1,393 subjects examined was 35.26±12.29 years. A large number of the subjects reported to be in need of dental treatment. The number of decayed teeth was found to be similar to the general population of Haryana but the number of filled teeth was quite low. The number of teeth missing and the need for tooth extraction was high. Social implications - Long-standing prisoner dental problems indicated a need for dental treatment in prisons.

ORIGINALITY/VALUE

This is the first study of its kind covering all 19 prisons in Haryana, India. The results indicate that the government needs to further consider and address the oral health needs of prisoners.

Predictors of self-efficacy and self-rated health for older male inmates

AIMS

The aims of this study were to examine: (1) the relationships between self-efficacy for health management and (a) health-promoting behaviours, (b) health-monitoring behaviours, and (c) self-rated health status in older male prisoners; and (2) the variations in self-rated health status and self-efficacy for health management by inmate characteristics of older men in prison.

BACKGROUND

The greying of the inmate population around the globe can be attributed to increases in punitive crime control practices, life expectancy; and the ageing baby boom generation. Older inmates are typically not a healthy group. Therefore, the needs of burgeoning numbers of older, sicker inmates are issues of international significance.

METHODS

A descriptive, correlational, survey was conducted from late 2007 to mid-2008 with Bandura's self-efficacy model as the guiding framework.

RESULTS/FINDINGS

Participants were 131 male inmates, aged 50 and older. A statistically significant positive relationship was found between self-efficacy for health management and the indexes measuring health-promoting behaviours (r=0.550; P<0.001), health-monitoring behaviours (r=0.323; P=0.001), and the single item rating for self-rated health (τ(b)=0.411; P<0.001). There was a tendency for education to be positively related to self-rated health but not self-efficacy (τ(b)=0.140; P=0.054 and τ(b)=0.105; P=0.122, respectively). Years of incarceration was not significantly related to self-rated health or self-efficacy.

CONCLUSION

These research findings support Bandura's self-efficacy theoretical work and its applicability to health-related research in prisons. Nurses are front line healthcare providers in prison, who are in a key position to implement interventions that promote greater inmate self-efficacy for healthy behaviours and chronic disease management.

Older inmates' pursuit of good health: a focus group study

Many intersecting factors, including the graying of the broader society, a paradigm shift away from rehabilitation, fewer opportunities for parole, and retrospective prosecutions, contribute to an exponential increase in number of older inmates. Elderly prisoners are likely to live in small, tight quarters with other inmates; have chronic health conditions; and encounter multiple barriers to health promotion. Using focus groups, data on perceived challenges to health promotion and self-care strategies were collected from 42 male inmates 50 and older. Cost issues, prison personnel and policies, food concerns, fellow inmates, and personal barriers challenged older inmates' abilities to maintain their health in prison. However, they did engage in self-care strategies, including accessing resources and support, staying positive, managing diet and weight, engaging in physical activity, and protecting self. A key motivator for pursuing good health was to be respected and perceived as healthy and strong by fellow inmates. Development and testing of programs to enhance inmates' self-management of chronic conditions and to facilitate health promotion are in order.

Older inmates' pursuit of good health: a focus group study

Many intersecting factors, including the graying of the broader society, a paradigm shift away from rehabilitation, fewer opportunities for parole, and retrospective prosecutions, contribute to an exponential increase in number of older inmates. Elderly prisoners are likely to live in small, tight quarters with other inmates; have chronic health conditions; and encounter multiple barriers to health promotion. Using focus groups, data on perceived challenges to health promotion and self-care strategies were collected from 42 male inmates 50 and older. Cost issues, prison personnel and policies, food concerns, fellow inmates, and personal barriers challenged older inmates' abilities to maintain their health in prison. However, they did engage in self-care strategies, including accessing resources and support, staying positive, managing diet and weight, engaging in physical activity, and protecting self. A key motivator for pursuing good health was to be respected and perceived as healthy and strong by fellow inmates. Development and testing of programs to enhance inmates' self-management of chronic conditions and to facilitate health promotion are in order.

Oral health related quality of life among imprisoned Dutch forensic psychiatric patients

Because dental health and oral pathology may affect forensic psychiatric patients' well being, it is important to be able to assess oral health related quality of life (OH-QoL) in these patients. Two studies were conducted among Dutch forensic psychiatric male patients to assess the psychometric properties and some potential predictors of the Oral Health Impact Profile-14 (OHIP-14) as a measure of OH-QoL. Study 1 involved 40 patients who completed the OHIP-14 before receiving professional dental care and were retested 3 months later. The internal consistency was good, the test-retest correlations were fair, and over the 3 months follow-up no significant changes in OH-QoL were observed. Study 2 consisted of 39 patients who completed an improved version of the original OHIP-14, as well as measures to validate of the OHIP. Dental anxiety and unhealthy dentition jointly explained 26.7% of the variance in OH-QoL, and the better patients performed their oral hygiene behavior, the better their OH-QoL. It is concluded that the Dutch OHIP-14 is a useful instrument, and that nurses, especially in forensic nursing, should pay particularly attention to dental anxiety when encouraging patients to visit OH professionals and to perform adequate oral hygiene self-care.

Oral health-related quality of life: a critical appraisalof assessment tools used in elderly people

OBJECTIVE

The purpose of this study was to undertake a critical appraisal of oral health-related quality of life (OHRQoL) measurements used for research in the elderly.

BACKGROUND

A variety of OHRQoL measurements have been developed in the past 20 years as a result of increased concern about the impact of oral conditions on a person's quality of life. There is need for an assessment aimed at prioritising the recommended measurements to be used for different purposes in the elderly.

MATERIALS AND METHODS

Original English language papers using measurements to assess OHRQoL in the elderly were identified from Web of Science, EMBASE, PubMed, Medline and Lilacs databases. The search included all papers published from 1985 to February 2007. The criteria of assessment were: (i) measurement criteria (number of items and domains, and classification of the results found for each measurement); (ii) quantitative-qualitative criteria (frequency, acceptability, reproducibility, reliability, sensitivity and capability of being reproduced in other language versions).

RESULTS

In a total of 152 papers selected, 20 measurements were identified. However, only seven fulfilled all the measurement and quantitative-qualitative criteria.

CONCLUSION

Geriatric Oral Health Assessment Index, Subjective Oral Health Status Indicators, Oral Health Impact Profile-49, Dental Impact on Daily Living, Oral Health Impact Profile-14, Oral Impact on Daily Performances and German Version of the Oral Heath Impact Profile were considered as instruments of choice to assess OHRQoL in the elderly. The other 13 instruments identified require further research aimed at a validation process and the use of a language other than English.

Developing a short form of Oral Health Impact Profile (OHIP) for dental aesthetics: OHIP-aesthetic

OBJECTIVES

To develop and evaluate shortened forms of the Oral Health Impact Profile (OHIP) for discriminating dental aesthetics problems and evaluating dental aesthetic outcomes.

METHODS

Eighty-seven subjects self-completed the 49-item OHIP at baseline and 63 at follow up (8 weeks later), with the intervention of applying an array of tooth-whitening products. Expert-based approach and regression analysis (on baseline data) were undertaken to derive two subset questionnaires (OHIP-conceptual and OHIP-regression). Their discriminatory ability for dental aesthetics and their responsiveness to tooth whitening were compared with the original OHIP-49, Slade's OHIP-14 and a Chinese short-form version of OHIP.

RESULTS

The measures developed were strongly associated with self-rating of dental aesthetics (P < 0.001) unlike OHIP-49 (P = 0.03) or other OHIP short forms (P > 0.05). The measures were also reliable (Cronbach's alpha 0.86) and comparable with the other OHIP forms. In terms of effect size, OHIP-conceptual was more effective in measuring changes than the one based on the regression analysis, the original OHIP-49, OHIP-14 and the Chinese version of the short-form OHIP. It also exhibited a less susceptibility to floor effects than other OHIP forms.

CONCLUSION

A modified short form of the OHIP derived (OHIP-conceptual) was the most favorable in discriminating dental aesthetics, was reliable and most sensitive to the dental aesthetics intervention - tooth whitening.

Health-related research on older inmates: An integrative review

The literature on older inmates' health is fragmented and insufficiently developed. In this integrative review, 21 research articles on health and older inmates were identified, critiqued, and synthesized to determine: the minimum age criterion most commonly used; health-related variables explored; health status; the health impact of incarceration; and aging-specific policies, programs, and facilities. Age 50 and older was used most often. The top three health variables were psychiatric conditions, physical illnesses, and substance abuse. Self-reports of health status varied across studies; however, inmates consistently reported health declines since incarceration. Older inmates' health needs appear often to be left unmet. Nursing investigations are needed leading to practice innovations to enhance prisoners' self-management to reduce disease burden and fiscal and societal costs.

The impact of third molar symptoms, pain, and swelling on oral health-related quality of life

PURPOSE

This study was designed to assess the impact of "pain and swelling" associated with third molars on patients' quality of life before surgery.

PATIENTS AND METHODS

The data for these analyses were obtained from a larger ongoing study designed to examine the surgical and medical management of problems associated with third molars. Data from 480 patients with 4 third molars scheduled for removal were used in the analysis. Questionnaires administered presurgery assessed patients' medical and dental history, their reasons for seeking third molar removal, and sociodemographic characteristics. Adverse impacts on oral health-related quality of life were measured using the 14-item Oral Health Impact Profile (OHIP) questionnaire. The primary outcome variable was the percentage of people reporting 1 or more of the 12 non-pain-specific OHIP items "fairly often" or "very often" during the 3 months before enrollment.

RESULTS

One third (178 of 480) of patients said they were seeking third molar surgery because of current or previous symptoms of pain/swelling, and 17% reported 1 or more of the 12 non-pain-specific OHIP items. In the multivariate logistic regression model, the odds of one or more impacts was greater for people who presented because of symptoms (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.7 to 4.8), who were aged 25 years or more (OR, 1.9; 95% CI, 1.1-3.3), and who had a self-reported history of tooth loss due to pathology or trauma (OR, 2.9; 95% CI, 1.9 to 5.5).

CONCLUSIONS

Adverse impacts on quality of life occurred for 1 in 8 patients seeking third molar surgery, and the odds increased 3-fold for patients who had experienced pain/swelling compared with those who were asymptomatic.