The phenomenological approach in dentistry - a narrative review

PURPOSE

Phenomenology is a branch of philosophy that focuses on human lived experience. Illness including dental diseases can affect this living experience. Within the dental literature, there is very little reported on the use of phenomenology compared to other healthcare sciences. Hence, the aim was to review the literature and provide an overview of various applications of phenomenology in dental research.

METHODS

This study was a narrative review using literature in the last 10 years identified by web-based search on PubMed and Scopus using keywords. A total of 33 articles that were closely related to the field and application in dentistry were included. The methodology, main results, and future research recommendations, if applicable, were extracted and reviewed.

RESULTS

The authors in this study had identified several areas such as orofacial pain and pain control research, dental anxiety, dental education, oral healthcare perceptions and access, living with dental diseases and dental treatment experience in which the phenomenological method was used to gain an in-depth understanding of the topic.

CONCLUSIONS

There are several advantages of using the phenomenological research method, such as the small sample size needed, the diverse and unique perspective that can be obtained and the ability to improve current understanding, especially from the first-person perspective.

Artificial intelligence and smile design: An e-Delphi consensus statement of ethical challenges

PURPOSE

Smile design software increasingly relies on artificial intelligence (AI). However, using AI for smile design raises numerous technical and ethical concerns. This study aimed to evaluate these ethical issues.

METHODS

An international consortium of experts specialized in AI, dentistry, and smile design was engaged to emulate and assess the ethical challenges raised by the use of AI for smile design. An e-Delphi protocol was used to seek the agreement of the ITU-WHO group on well-established ethical principles regarding the use of AI (wellness, respect for autonomy, privacy protection, solidarity, governance, equity, diversity, expertise/prudence, accountability/responsibility, sustainability, and transparency). Each principle included examples of ethical challenges that users might encounter when using AI for smile design.

RESULTS

On the first round of the e-Delphi exercise, participants agreed that seven items should be considered in smile design (diversity, transparency, wellness, privacy protection, prudence, law and governance, and sustainable development), but the remaining four items (equity, accountability and responsibility, solidarity, and respect of autonomy) were rejected and had to be reformulated. After a second round, participants agreed to all items that should be considered while using AI for smile design.

CONCLUSIONS

AI development and deployment for smile design should abide by the ethical principles of wellness, respect for autonomy, privacy protection, solidarity, governance, equity, diversity, expertise/prudence, accountability/responsibility, sustainability, and transparency.

Two-Year Trajectories of Dental Anxiety in Parents and Their Association with Parents' and Children's Oral Healthcare Procedures in FinnBrain Birth Cohort Study

We aimed to identify parents' dental anxiety trajectories and the association of the trajectories with the number of parents' and their children's oral healthcare procedures in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale at gestational weeks (gw) 14 and 34, as well as 3 and 24 months (mo) after childbirth. Oral healthcare procedures from gw14 to 24 mo were obtained from the national patient data register and categorized as preventive and treatment. Trajectories were identified with latent growth mixture modelling for 2068 fathers and 3201 mothers. Associations between trajectories and procedures adjusted for education were analyzed using unordered multinomial logit models. Fathers' trajectories were stable low (80.1%), stable high (3.4%), stable moderate (11.0%), moderate increasing (3.9%) and high decreasing (1.6%). Mothers' trajectories were stable low (80.7%), stable high (11.2%), moderate increasing (5.3%) and high decreasing (2.8%). Mothers with decreasing dental anxiety had a higher number of preventive and treatment procedures. Fathers with decreasing dental anxiety had a higher number of preventive and treatment procedures, while fathers with increasing dental anxiety had fewer procedures. Children of mothers with stable low dental anxiety had higher number of preventive procedures. There seems to be a two-way association between dental anxiety trajectories and oral healthcare procedures.

Grey Wolf Optimizer with Behavior Considerations and Dimensional Learning in Three-Dimensional Tooth Model Reconstruction

Three-dimensional registration with the affine transform is one of the most important steps in 3D reconstruction. In this paper, the modified grey wolf optimizer with behavior considerations and dimensional learning (BCDL-GWO) algorithm as a registration method is introduced. To refine the 3D registration result, we incorporate the iterative closet point (ICP). The BCDL-GWO with ICP method is implemented on the scanned commercial orthodontic tooth and regular tooth models. Since this is a registration from multi-views of optical images, the hierarchical structure is implemented. According to the results for both models, the proposed algorithm produces high-quality 3D visualization images with the smallest mean squared error of about 7.2186 and 7.3999 μm2, respectively. Our results are compared with the statistical randomization-based particle swarm optimization (SR-PSO). The results show that the BCDL-GWO with ICP is better than those from the SR-PSO. However, the computational complexities of both methods are similar.

Patterns, barriers, and utilization of oral healthcare provided at primary health centers (PHCs) and its association with oral health status among rural population in Rohtak district, Haryana: A household cross-sectional study

Introduction

Access to oral healthcare is limited in rural areas, resulting in disparities in oral health services. Primary health centers (PHCs) are essential for providing integrated oral healthcare to rural populations. This study examines the patterns, barriers, and utilization of oral healthcare at PHCs in Rohtak district, Haryana.

Materials and Methods

In this 6-month household cross-sectional study, data were collected from a sample of 600 participants residing in rural areas under the jurisdiction of three randomly selected PHCs in Rohtak district. The study employed multistage cluster systematic random sampling procedures. Data collection included structured questionnaires and clinical oral examinations following the type-III ADA classification. Participants' oral health status was evaluated using the WHO oral health assessment form for adults (2013). Descriptive and analytical statistics were used for data analysis.

Results and Discussion

Dental caries and periodontal diseases were more common in older age groups. Barriers to oral healthcare among the elderly include fear of dental procedures and low dental literacy. Proximity to PHCs influenced dental service utilization, with higher rates among participants living near a PHC, that is, within 5 km of a PHC.

Conclusion

Age, gender, proximity to PHCs, household size, and socioeconomic status play crucial roles in the utilization of oral health services among the rural population. Addressing these factors is essential for improving oral healthcare and overcoming barriers. It is crucial to enhance the accessibility, affordability, and availability of oral health services at PHCs to promote better oral health and overall well-being in rural areas.

Orthodontic Pain and Dietary Impact Considering Age Groups: A Comparative Study

(1) Background: orthodontic treatment can frequently be associated with discomfort and pain, a significant factor contributing to treatment discontinuation. (2) Methods: This study, conducted on 160 orthodontic patients across different age groups, aimed to explore the influence of age on patients' responses to treatment, particularly regarding changes in dietary patterns and weight loss. The patients were categorized into three age groups and assessed through a questionnaire about pain perception, pain latency, dietary changes, and weight loss associated with orthodontic appliances. (3) Results: Younger patients (6-12 years) reported lower pain levels, shorter pain latency and fewer alterations in dietary habits compared to adults (over 18 years). Females over 18 represented a significant portion of the sample, suggesting a self-driven inclination towards orthodontic treatment for aesthetic reasons. Fixed orthodontic appliances induced more significant pain than removable ones. Adults experienced more changes in dietary habits and weight loss than younger individuals. (4) Conclusions: the results provide valuable insights for orthodontic practitioners aiming to mitigate adverse effects and improve overall patient experience during treatment.

Signalling waiting times to citizens on public oral healthcare providers' websites

Objective: The study aimed to analyse the usefulness of signalling waiting times to citizens on the websites of public primary oral healthcare providers in Finland. Finnish laws require this signalling.Material and methods: We gathered data with two cross-sectional surveys in 2021. One electronic questionnaire was for Finnish-speaking citizens in Southwest Finland. The other was for public primary oral healthcare managers (n = 159). We also gathered data on 15 public primary oral healthcare providers' websites. For the theoretical framework, we combined the agency and signalling theories.Results: Of the citizen respondents (n = 411), 57% knew about the waiting time signalling on the websites. The respondents considered waiting time a high-priority criterion in choosing a dentist, but they rarely searched for information anywhere on the choice of a dentist, wanting to visit the dentist they had earlier visited. The quality of signalled waiting times was low. One out of five managers (response rate 62%) answered that signalled waiting times were based on speculation.Conclusions: Waiting times were signalled to comply with the legislation rather than to inform citizens and to reduce information asymmetry. Further research is needed to acquire information on rethinking waiting time signalling and its desired goals.

Awareness, Attitudes, and Perceptions of Oral Healthcare among First Year Dental, Medical, and Nursing Students

BACKGROUND

It has been reported that poor oral health can worsen general health conditions. Good collaboration between health professionals is important to provide proper oral healthcare. Thus, there is a need for oral healthcare interprofessional education (IPE). This study aimed to determine the baseline level of awareness, attitudes, and perceptions of oral healthcare among first-year students of dentistry, medicine, and nursing at Universitas Indonesia.

METHOD AND PARTICIPANTS

A cross-sectional descriptive analytical study using a previously published questionnaire was conducted involving 442 students, consisting of dental students (DS), medical students (MS), and nursing students (NS) in Universitas Indonesia.

RESULTS

Most students have shown good oral healthcare awareness, attitudes, and perception with no statistically significant difference between the groups (p < 0.05). The majority of the students did not perceive that (1) geriatric and nursing knowledge are required to practice oral care, (2) oral healthcare should be provided in cancer hospitals, and (3) oral healthcare can prevent cardiovascular disease and improve anorexia.

CONCLUSIONS

This study showed that there were aspects of oral healthcare that should be improved in all student groups. Thus, oral healthcare IPE should be given to all students working in healthcare to develop knowledge and interprofessional collaboration in oral healthcare.

The experiences of people living with environmental sensitivities concerning oral health and access to dental services

PURPOSE

Because people living with environmental sensitivities are poorly acknowledged in our society, we still know very little about their experiences navigating in the health care system, especially with respect to dental services. Our objective, therefore, was to describe their dental care pathway and better understand their experiences accessing oral health services.

MATERIALS AND METHODS

A qualitative descriptive study was conducted in partnership with organizations supporting people with environmental sensitivities. Through a criterion sampling technique, 12 people living with environmental sensitivities in Quebec (Canada) were invited to participate in individual semi-structured interviews. These interviews lasted around 90 min and were transcribed to be thematically analysed.

RESULTS

Participants faced major barriers accessing dental services and thus lived for long periods of time with unmet dental needs. Their dental care pathways were often delayed or even interrupted for several reasons. First because they were exposed to pollutants upon leaving their house, which rendered their trip to the dentist perilous. Second because dentists lacked knowledge about environmental sensitivities and seemed reluctant to accommodate them.

CONCLUSIONS

We invite governments, dental professionals, and researchers to develop policies and clinical approaches for improving people living with environmental sensitivities' quality of life and access to dental services.IMPLICATIONS FOR REHABILITATIONAlthough environmental sensitivities are recognized as disability in several countries such as Sweden and Germany, people with these conditions face major barriers to access healthcare services.Dental professionals, for instance, are reluctant to acknowledge environmental sensitivities as a disability and seldom accommodate sufferers' special needs.We invite dentists to foster holistic and person-centered approaches and be receptive to the health conditions and needs of people with environmental sensitivities.Dentists could address oral health needs of people with environmental sensitivities by doing home-visits with portable dental equipment as this removes barriers related to their exposure to pollutants.

Dental and nursing collaboration in oral healthcare research in palliative care inpatient settings

Collaboration between palliative care nurses and oral health professionals has been frequently recommended to ensure optimal oral healthcare. However, the importance of this collaboration to the success of evidence-based protocols, involving oral healthcare interventions in the inpatient palliative care setting, is less discussed. Feasibility requires consideration during the planning, intervention and implementation phases of any clinical trial; all of which typically rely on good collaboration with nursing staff. Therefore, it is imperative that nursing staff appreciate the need for oral healthcare at the end of a person's life. Nursing and dental collaboration is critical to the feasibility of running research trials in this group and can help overcome some of the logistical and ethical challenges in this vulnerable population.

Comparative Evaluation of Dental Caries Score Between Teledentistry Examination and Clinical Examination: A Systematic Review and Meta-Analysis

Dental caries is a common dental health problem affecting all age groups across the globe. Accurate detection and assessment of dental caries are crucial for effective treatment and preventive measures. Teledentistry, which involves remote dental assessment using digital technologies, has shown promise as a potential tool for caries screening. This systematic review and meta-analysis aims to compare the dental caries scores obtained from clinical examinations and teledentistry assessments. Literature searches were conducted across databases such as PubMed, Embase, the Cochrane Library, Scopus, the Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO by using predefined search terms and inclusion criteria. Two reviewers separately extracted the data. The study designs, evaluation techniques, dentition types, mean scores, and follow-up times of the included studies were examined. The New Castle-Ottawa Scale was used to assess the risk of bias. Review Manager (RevMan) (computer program) Version 5.4, The Cochrane Collaboration 2020, was used for the quantitative assessment of the data. Eight studies met the inclusion criteria and were included in the review. The findings revealed that teledentistry assessments (based on intraoral photographs captured using smartphones or intraoral cameras) demonstrated comparable accuracy to traditional clinical examinations in detecting and assessing dental caries. Among the four studies that were quantitatively analysed, no significant difference was noted at p = 0.09. A mean difference of 0.64 (95% confidence interval (CI): -0.10; 1.38) suggested that clinical examination and teledentistry-based checkup were on par with each other for the detection of dental caries. The New Castle-Ottawa scale (NOS) grading indicated that the studies were of good quality. Teledentistry may be an effective approach for identifying and evaluating dental caries. However, further research is required to substantiate the findings observed in the present review.

Lipocalin 2, synthesized using a cell-free protein synthesis system and encapsulated into liposomes, inhibits the adhesion of Porphyromonas gingivalis to human oral epithelial cells

BACKGROUND AND OBJECTIVE

Lipocalin 2 (LCN2), a glycoprotein expressed in epithelial cells and leukocytes, has an antibacterial effect and plays a role in innate immunity. The delivery of LCN2 encapsulated in liposomes to oral epithelium may be useful to prevent oral infectious diseases. This study aimed to investigate the inhibitory effect of LCN2, artificially synthesized using a cell-free protein synthesis (CFPS) system, on the adhesion of Porphyromonas gingivalis to oral epithelial cells in order to approach oral healthcare using LCN2.

METHODS

LCN 2 was synthesized using a CFPS system and assayed by Western blotting, mass spectrometry and enzyme-linked immunosorbent assay (ELISA). The bilayer liposomes were prepared by the spontaneous transfer method using 1,2-dioleoyl-sn-glycero-3 phosphocholine (DOPC), 3-sn-phosphatidylcholine from Egg Yolk (Egg-PC), and 1,2-dioleoyl-sn-glycero-3 phosphoethanolamine (DOPE). The cellular and medium fractions derived from the culture of oral epithelial cells with liposome-encapsulated LCN2 were assayed by Western blotting and ELISA. The effect of the synthesized LCN2 on adhesion of the labeled P. gingivalis to oral epithelial cells was investigated as an evaluation of its antibacterial activity.

RESULTS

The synthesized LCN2 protein was identified by Western blotting; its amino acid sequence was similar to that of recombinant LCN2 protein. The additions of DOPE and octa-arginine in the outer lipid-layer components of liposome significantly increased the delivery of liposomes to epithelial cells. When oral epithelial cells were cultured with the synthesized and liposome-encapsulated LCN2, LCN2 was identified in the cellular and medium fractions by Western blotting and its concentration in the cellular fraction from the culture with the synthesized LCN2 was significantly higher than that of a template DNA-free protein. The synthesized LCN2 and liposome-encapsulated LCN2 significantly inhibited the adhesion of P. gingivalis to oral epithelial cells compared with template DNA-free protein.

CONCLUSION

LCN2 was artificially synthesized by a CFPS system, encapsulated in liposomes, and delivered to oral epithelial cells, and demonstrated an antibacterial action against P. gingivalis. This approach may become a useful model for oral healthcare.

3D Extruded Graphene Thermoelectric Threads for Self-Powered Oral Health Monitoring

Flexible sensors play a crucial role in intelligent electronic devices, while strain-sensing is the fundamental feature for these sensors of different fields. Therefore, developing high-performance flexible strain sensors is essential for building the next generation of smart electronics. Here, a self-powered ultrasensitive strain sensor based on graphene-based thermoelectric composite threads through a simple 3D extrusion method is reported. The optimized thermoelectric composite threads show a large stretchable strain of over 800%. After 1000 cycles of bending, the threads still maintain excellent thermoelectric stability. The thermoelectric effect-induced electricity can realize ultrasensitive strain and temperature detection with high resolution. As wearable devices, the thermoelectric threads can also realize self-powered physiological signals monitoring, including the opening degree of mouth, occlusal frequency, and force of the tooth during the eating process. It provides significant judgment and guidance for promoting oral healthcare and developing good eating habits.

Using Codesign to Develop a Novel Oral Healthcare Educational Intervention for Undergraduate Nursing Students

To build a nursing workforce that is equipped to undertake oral health promotion and screening, an educational program was needed. With codesign being used in multiple settings, it was selected as the approach to use, with Mezirow's Transformative Learning theory as the underpinning framework. This study aimed to develop an oral healthcare educational intervention for nursing students. Using a six-step codesign framework, nursing students and faculty staff were invited to participate in two Zoom™ Video Communication workshops to codesign the learning activities to be used in the classroom. The codesign process was evaluated through focus groups and analysed using a hybrid content analysis approach. A multifaceted oral healthcare educational intervention was developed. Learning material was delivered using a range of different learning and teaching resources such as dental models, podcasts, and an oral health assessment across two subjects. Multiple approaches to recruitment, the inclusion of participants, and good facilitation of workshop discussions were critical to the codesign of the educational intervention. Evaluation revealed that preparing participants prior to the workshops acted as a catalyst for conversations, which facilitated the codesign process. Codesign was a useful approach to employ in the development of an oral healthcare intervention to address an area of need.

Assessment of Occlusal Force and Local Gas Release Using Degradable Bacterial Cellulose/Ti3C2Tx MXene Bioaerogel for Oral Healthcare

Dental diseases resulting from movement disorders and volatile gases are very common. The classic method for detecting occlusal force is effective; however, its function is one-time rather than real-time monitoring, and the technology is very time-consuming. Herein, we report a multifunctional, flexible, and degradable bacterial cellulose/Ti₃C₂T_x MXene bioaerogel for the accurate detection of occlusal force and early diagnosis of periodontal diseases. Combining the mechanical properties of MXene and the abundant functional groups of bacterial cellulose, 3D porous bioaerogels exhibit both pressure-sensitive and ammonia (NH₃)-sensitive responses. By integrating these substances into a flexible array, the resulting device can distinguish the intensity, location, and even the time sequence of the occlusion force; moreover, it can provide NH₃ gas and occlusion force response signals. Therefore, this technology is promising for both disease diagnosis and oral health. In addition, the introduction of a renewable biomaterial allows the bioaerogel to degrade completely using a low-concentration hydrogen peroxide solution, making the device environmentally friendly and satisfying the demands for sustainable development.

National sample surveys show poor households face catastrophic expenditure for oral healthcare services in India

Introduction:

Globally people pay out-of-pocket (OOP) to access Oral healthcare services. In India, there is limited evidence on estimates of OOP expenditure. We undertook an analysis of national sample survey data on household health care expenditure to understand the expenditure pattern for Oral healthcare services and the catastrophic burden.

Method:

The expenditure reported for Oral healthcare services from two surveys: 71^st round and 75^th round, published by National Sample Survey Office (NSSO) was extracted. Based on monthly household consumption expenditure three economic groups were made: poor, middle- and rich-income groups. The OOP expenditure pattern while accessing day-care services and hospitalization and in public and private sector and the catastrophic expenditure were analysed.

Results:

A total of 204 and 155 households from two national surveys reported to have accessed day-care Oral services respectively. The median OOP expenditure in public sector remained same at US $ 4 in both surveys. Over 35% of 78 households in 71^st round and 42% of 167 in 75^th round used public sector hospitalization services. The median expenditure of hospitalization doubled from US$ 58 (IQR 21–263) in 71^st round to US $ 125 (IQR 45-363) in 75^th round. Households from poor income groups spent seven times more for Oral healthcare services during the recent survey and faced catastrophic expenditure.

Conclusion:

The OOP expenditure for Oral healthcare has significant catastrophic household expenditure among the poor. There is a need to increase investment in public sector and insurance to protect poor against hospitalization expenditure in private sector.

Oral Healthcare and Idiopathic Thrombocytopenic Purpura: Early Recognition, Dental Management and Case Report

A 47-year-old Caucasian man, in good general, oral and periodontal health, presented with a non-bleeding bluish lesion on the back of his tongue, presumably due to an ecchymotic area of traumatic origin which was left untreated. The day after, other ecchymotic-type lesions on the mucous membranes of the cheeks and the upper lip, a bleeding lesion at the apex of the tongue and gingivorrhagia, along with petechiae on the back, scalp, lower limbs and feet, occurred, with rapid clinical deterioration, requiring immediate hospitalization. Oral, dermatological, and hematological evaluations lead to idiopathic thrombocytopenic purpura (ITP) diagnosis and hydrocortisone prescription, with a complete recovery in the next few days.The presented case of ITP, with early intra-oral manifestations, aimed both to emphasize the role of oral healthcare workers in theearly recognition of ITP, which may be especially relevant for those cases with extremely fast platelet depletion, high risk of internal bleeding and consequent potentially fatal complications, and in the differential diagnosis of the diseasethat may be aided by the diagnostic protocol described, and to provide dentists with recommendations on oral care management of cases of ITP, both in dental and multi-disciplinary settings.

The dental healthcare professionals' competence in mentoring students in the clinical practice

OBJECTIVE

The aim of this study was to evaluate dentists', dental hygienists' and dental assistants' competence in mentoring students and to identify distinct mentor profiles.

METHODS

The study employed a cross-sectional design. Data were collected using the Mentors' Competence Instrument (MCI), which includes 45 items structured under seven mentoring competence sub-dimensions. The data were collected during autumn 2017 from dentists, dental hygienists and dental assistants working in the Finnish primary healthcare (n = 1097) using a paper survey, whilst dentists (n = 26) who have completed mentoring education in one university completed an electronic questionnaire. Cases with more than 5% missing data (n = 164) were listwise deleted, whilst the remaining data (n = 933) underwent analysis. K-mean clustering was used to identify significantly different mentor profiles, whilst comparisons of mentoring competence between the identified profiles were performed with Kruskal-Wallis and Mann-Whitney tests.

RESULTS

Three distinct mentor profiles (A, B and C) that differed in the level of mentoring competence were identified. The participants in profile A encompassed mostly dental assistants, profile B included mostly dental assistants and dentists, and profile C mainly comprised dentists and dental assistants. Profiles A, B and C differed significantly in terms of education, job title, role of mentor and participation in mentoring education. The largest difference in competence was observed between participants of profiles A and C. Each profile differed significantly from the other two across all seven competence areas. Most of the participants had not previously received any mentoring education.

CONCLUSION

There is room for improvement in the competence of dentistry student mentors, especially regarding knowledge of effective mentoring practices, goal-oriented mentoring, mentor characteristics and motivation for mentoring. Every mentor that works with oral healthcare students should receive mentoring training.

Oral Cancer and Precancer: A Narrative Review on the Relevance of Early Diagnosis

Oral cancer (OC) is an uncommon malignancy in Western countries, being one of the most common cancers in some high-risk areas of the world. It is a largely preventable cancer, since most of the different risk factors identified, such as tobacco use, alcohol consumption, and betel nut chewing, are behaviors that increase the likelihood of the disease. Given its high mortality, early diagnosis is of utmost importance. Prevention and the anticipation of diagnosis begin with identification of potentially malignant lesions of the oral mucosa and with local conditions promoting chronic inflammation. Therefore, every lesion must be recognized promptly and treated adequately. The clinical recognition and evaluation of oral mucosal lesions can detect up to 99% of oral cancers/premalignancies. As stated by the World Health Organization, any suspicious lesion that does not subside within two weeks from detection and removal of local causes of irritation must be biopsied. Surgical biopsy remains the gold standard for diagnosis of oral cancer. Adjunctive tools have been developed and studied to help clinicians in the diagnostic pathway, such as toluidine blue vital staining and autofluorescence imaging. In the near future other methods, i.e., identification of salivary markers of progression may help in reducing mortality due to oral cancer.

Academic detailing in oral healthcare - results of the ADVOCATE Field Studies

Background: Academic detailing (AD) is a defined form of educational outreach that can be used to influence decision making and reduce unwarranted variation in healthcare delivery. This paper describes the results of the proof of concept phase of the ADVOCATE Field Studies. This study evaluated the feasibility, acceptability and usefulness of AD reinforced with feedback data, to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs).Methods: In the Field Studies, six groups of GDPs (n = 39) were recruited in The Netherlands, Germany and Denmark. Each group had four meetings reinforced with feedback data for open discussions on dental practice and healthcare delivery. Conventional and directed content analysis was used to analyze the qualitative data collected from focus group interviews, debriefing interviews, field notes and evaluation forms.Results: A total of nine themes were identified. Seven themes related to the process of the Field Studies and covered experiences, barriers and facilitators to AD group meetings, data collection and the use of an electronic dashboard for data presentation and storage. Two themes related to the outcomes of the study, describing how GDPs perceived they made changes to their clinical practice as a result of the Field Studies.Conclusions: The ADVOCATE Field Studies approach offers a novel way of collecting and providing feedback to care providers which has the potential to reduce variation oral healthcare delivery. AD plus feedback data is a useful, feasible approach which creates awareness and gives insight into care delivery processes. Some logistic and technical barriers to adoption were identified, which if resolved would further improve the approach and likely increase the acceptability amongst GDPs.

A pragmatic, multi-centered, stepped wedge, cluster randomized controlled trial pilot of the clinical and cost effectiveness of a complex Stroke Oral healthCare intervention pLan Evaluation II (SOCLE II) compared with usual oral healthcare in stroke wards

BACKGROUND

Patients with stroke-associated pneumonia experience poorer outcomes (increased hospital stays, costs, discharge dependency, and risk of death). High-quality, organized oral healthcare may reduce the incidence of stroke-associated pneumonia and improve oral health and quality of life.

AIMS

We piloted a pragmatic, stepped-wedge, cluster randomized controlled trial of clinical and cost effectiveness of enhanced versus usual oral healthcare for people in stroke rehabilitation settings.

METHODS

Scottish stroke rehabilitation wards were randomly allocated to stepped time-points for conversion from usual to enhanced oral healthcare. All admissions and nursing staff were eligible for inclusion. We piloted the viability of randomization, intervention, data collection, record linkage procedures, our sample size, screening, and recruitment estimates. The stepped-wedge trial design prevented full blinding of outcome assessors and staff. Predetermined criteria for progression included the validity of enhanced oral healthcare intervention (training, oral healthcare protocol, assessment, equipment), data collection, and stroke-associated pneumonia event rate and relationship between stroke-associated pneumonia and plaque.

RESULTS

We screened 1548/2613 (59%) admissions to four wards, recruiting n = 325 patients and n = 112 nurses. We observed marked between-site diversity in admissions, recruitment populations, stroke-associated pneumonia events (0% to 21%), training, and resource use. No adverse events were reported. Oral healthcare documentation was poor. We found no evidence of a difference in stroke-associated pneumonia between enhanced versus usual oral healthcare (P = 0.62, odds ratio = 0.61, confidence interval: 0.08 to 4.42).

CONCLUSIONS

Our stepped-wedge cluster randomized control trial accommodated between-site diversity. The stroke-associated pneumonia event rate did not meet our predetermined progression criteria. We did not meet our predefined progression criteria including the SAP event rate and consequently were unable to establish whether there is a relationship between SAP and plaque. A wide confidence interval did not exclude the possibility that enhanced oral healthcare may result in a benefit or detrimental effect.

TRIAL REGISTRATION

NCT01954212.

Digital Oral Medicine for the Elderly

Sustainable oral care of the elderly requires a holistic view of aging, which must extend far beyond the narrow field of dental expertise to help reduce the effects of sociobiological changes on oral health in good time. Digital technologies now extend into all aspects of daily life. This review summarizes the diverse digital opportunities that may help address the complex challenges in Gerodontology. Systemic patient management is at the center of these descriptions, while the application of digital tools for purely dental treatment protocols is deliberately avoided.

'MI' reflections on a pandemic-governed 2020

Oral/dental healthcare delivery in the post-pandemic era will be different, with challenges to overcome and positive opportunities to take. Managing the needs, wants and expectations of all stakeholders must be communicated and actioned effectively, moving forwards. It is the responsibility of all stakeholders to work together to help provide high quality, evidence-based pragmatic oral healthcare delivery for the future. Patient-focused, team-delivered, minimum intervention oral healthcare (MIOC) is applicable to all patients at all stages of their lives and underpins long-term delivery of better oral and systemic health to all. Guidance, peer-support, whole-team training along with agile commissioning and suitable incentivisation will need to support the paradigm shift to prevention-based MIOC clinical practice.

Improving oral healthcare using academic detailing - design of the ADVOCATE Field Studies

Background: Academic detailing (AD) is a defined form of educational outreach that can be deployed to intrinsically motivate practitioners towards improving quality of care. This paper describes the design of the ADVOCATE Field Studies. This proof of concept study aims to evaluate the feasibility, acceptability and usefulness of AD, reinforced with feedback information to promote prevention-oriented, patient-centred and evidence-based oral healthcare delivery by general dental practitioners (GDPs). Methods: Six groups of GDPs will be recruited; two groups of six to eight GDPs in each of three countries - the Netherlands, Germany and Denmark. GDPs will meet for four Academic Detailing Group (ADG) meetings for open discussions using comparative feedback data to stimulate debate about their dental practice performance and care delivery. Group meetings will be moderated using the AD methodology. Qualitative data will be collected through focus group interviews, an online discussion forum, field notes and debriefs of ADG meetings and analysed by conventional content analysis using MaxQDA software. Discussion: The results of the study will provide novel information on the feasibility, perceived acceptability and usefulness of AD and feedback data for GDPs to improve oral healthcare delivery.

Anticariogenic activity of Nelumbo nucifera leaf extract in oral healthcare

BACKGROUND

We aimed to evaluate the antimicrobial effect of the Nelumbo nucifera leaf extract. There have been no studies related to dental caries inducing bacteria up to now.

OBJECTIVE

This study reviewed the inhibitory effect of glucose transferase (GTase) activation and acid production to confirm the anticariogenic activity of Nelumbo nucifera leaf extract.

METHODS

This study used 100 g Nelumbo nucifera leaves cultivated in Yeongcheon-si, Gyeongbuk, after adding 70% methanol tenfold. The leaves were then concentrated (Gotary vacuum evaporator; N-Nseries, EYELA Co., Japan) and were placed under an aspirator (A-3S, EYELA Co., Japan) and a freeze dryer (Ilshin Lab Co., Korea). The anticariogenic effect of Nelumbo nucifera leaves extract was investigated using the growth inhibitory effect, as well as GTase activation.

RESULTS

Among the nine kinds of oral-disease-causing bacteria, the Nelumbo nucifera leaf extract most effectively inhibited the growth of Streptococcus anginosus (S. anginosus), but it was difficult to inhibit the growth of Streptococcus oralis (S. oralis). For the anticariogenic effect of Nelumbo nucifera leaf extract, GTase activation was inhibited by at least 50% in all the nine types of bacteria, including Streptococcus mutans (S. mutans). It was shown that Nelumbo nucifera leaf extract had the strongest GTase activation inhibitory effect (85%) in S. anginosus. In addition, Nelumbo nucifera leaf extract showed an acid production inhibitory effect in the nine types of strains by maintaining almost pH 6.2 even after being cultured for 24 hours in the Nelumbo-nucifera-leaf-extract-added culture, while the control culture without Nelumbo nucifera leaf extract showed only about pH 5.0 after 4 hours.

CONCLUSIONS

In conclusion, Nelumbo nucifera leaf extract showed the strongest GTase activation inhibitory effect in S. anginosus. Based on this, it was confirmed that Nelumbo nucifera leaf extract showed anticariogenic activity against oral cavity disease microorganisms.

Utilization of a Mobile Dental Vehicle for Oral Healthcare in Rural Areas

Oral diseases remain one of the major global public health challenges, and the worldwide urban–rural disparities in oral health are significant. Residents in rural areas generally suffer from a higher prevalence and severity of dental caries and periodontal disease, yet they face numerous difficulties and barriers in accessing oral healthcare. Conventional strategies, such as building of dental clinics or, hospitals, or the provision of outreach services by using disposable materials, are neither practical nor effective in rural settings. Mobile dental vehicles (MDVs) have been proposed as an alternative strategy to supplement the traditional oral healthcare in many regions. They have usually been utilized in school-based oral health programs, providing dental care to the homeless or migrants, and screening programs for the population for various oral diseases. Due to their high mobility, MDVs are particularly valuable for the underserved populations living in rural areas. The advance of dental devices enables MDVs to be operated in a self-sufficient manner. This allows the MDV to function almost as well as a conventional dental clinic, providing a variety of dental treatments, including scaling, restoration, and oral surgery. This article discusses the use of MDVs as a solution to urban–rural inequality in receiving oral healthcare.

Biological Activities of Essential Oils: From Plant Chemoecology to Traditional Healing Systems

Essential oils are complex mixtures of hydrocarbons and their oxygenated derivatives arising from two different isoprenoid pathways. Essential oils are produced by glandular trichomes and other secretory structures, specialized secretory tissues mainly diffused onto the surface of plant organs, particularly flowers and leaves, thus exerting a pivotal ecological role in plant. In addition, essential oils have been used, since ancient times, in many different traditional healing systems all over the world, because of their biological activities. Many preclinical studies have documented antimicrobial, antioxidant, anti-inflammatory and anticancer activities of essential oils in a number of cell and animal models, also elucidating their mechanism of action and pharmacological targets, though the paucity of in human studies limits the potential of essential oils as effective and safe phytotherapeutic agents. More well-designed clinical trials are needed in order to ascertain the real efficacy and safety of these plant products.

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.

Occupational violence against dental professionals in southern Nigeria

OBJECTIVE

To determine the prevalence of workplace violence in Oral healthcare centres against Nigerian dental professionals.

METHODS

A questionnaire-based cross-sectional survey of 175 randomly selected dental professionals working in Oral healthcare centres of University Teaching Hospitals in Southern Nigeria was conducted.

RESULTS

The survey response rate was 78.9%. The respondents were dentists (58.0%), dental nurses (18.1%), dental technologists (12.3%), dental therapists (8.0%) and dental record officers (3.6%). The prevalence of violence in Nigerian Oral healthcare centres was 31.9%. There was no statistically significant difference in the prevalence of violence against dentist and dental auxiliaries. Violence was often associated with long waiting time (27.3%), cancellation of appointment (13.6%), outcome of patient's treatment (11.4%), alcohol intoxication (9.1%), psychiatric patient (6.8%,) patient's bill (4.5%) and others (27.3%). Non-physical violence in form of loud shouting (50.0%) threat (22.7%), sexual harassment (6.8%) and swearing (2.3%) constituted the majority while physical violence in form of bullying and hitting constituted the remaining 18.2%. The main perpetrators of the violence were patients (54.5%) and patient's relatives/friends (18.2%). The expressed impact of violence among the respondents include fear (18.2%), impaired job performance (15.9%), psychological problems (13.6%) and off duty (9.1%). No impact was declared by 43.2% of respondents.

CONCLUSION

The prevalence of workplace violence in Oral healthcare centres against dental professionals in Southern Nigeria was significant and had a substantial effect on dental professionals' well-being thus necessitating urgent attention.