Implementation of a youth and young adult e-cigarette cessation program within a dental clinic setting : A SToHN feasibility study.

Introduction: While significant progress has been made to decrease tobacco smoking among youth and young adults, e-cigarettes threaten to reverse the progress. The purpose of this study was to test the feasibility of the ReACH Assessment of Knowledge for E-Cigarettes (RAKE) e-cigarette cessation program targeting youth and young adults in Texas. Methods: Seven dental practitioners and 12 patients participated in this pilot study. Patients aged 15 to 29 who reported current e-cigarette use were recruited by their dental practitioner. All participants completed pre-and post-assessments-practitioners receiving the RAKE training and patients the RAKE cessation intervention. Descriptive statistics were calculated. Results: After RAKE training, all practitioners reported the RAKE cessation program as useful and an important part of patient care. In addition, after completing the program (5A's), 67% (n=9) patients reported that the program was helpful, and 100% (n=12) would recommend the program to other ENDS users. Conclusions: Practitioners and patients enhanced their knowledge of e-cigarettes and their harm to health. In addition, practitioners demonstrated their ability to implement the RAKE cessation program within the practice, and patients approved of the use of the program. This study illustrated the feasibility and acceptability of conducting an e-cigarette cessation study in dental practices and a critical need to develop and disseminate the program to young patients.

Barriers and facilitators to discussing HPV with head and neck cancer patients: A qualitative study using the theoretical domains framework.

OBJECTIVE: The incidence of human papillomavirus-associated head and neck cancers (HPV-HNC) is increasing worldwide. Research in other clinical contexts has shown that healthcare professionals (HCPs) can find discussing HPV with patients challenging. However, limited research has been conducted in HNC. This study aimed to investigate barriers and facilitators to, discussing HPV among HCPs caring for patients with HNC in Ireland. METHODS: Semi-structured telephone/face-to-face interviews were conducted with HCPs. Barriers and facilitators to discussing HPV with patients were identified using the Theoretical Domains Framework (TDF). RESULTS: 20 HCPs (8 clinicians, 3 nurses, 9 allied healthcare professionals) were interviewed. Barriers to discussing HPV included professionals' lack of HPV knowledge, difficulties in talking about sexual issues with patients and lack of privacy to discuss HPV in busy clinic settings. Facilitators included increasing public and patient awareness of the link between HPV and HNC and professional education and skills development. CONCLUSIONS: This is the first theoretically informed study to identify barriers and facilitators to discussing HPV with HNC patients. HCPs consider HPV discussions to be an essential part of HNC patient care. PRACTICE IMPLICATIONS: Understanding the issues associated with patient-provider HPV communication will help develop effective interventions to support HCPs in their HPV discussions.

An Individualized Low-Intensity Walking Clinic Leads to Improvement in Frailty Characteristics in Older Veterans.

BACKGROUND: Sedentary lifestyle leads to worse health outcomes with aging, including frailty. Older adults can benefit from regular physical activity, but exercise promotion in the clinical setting is challenging. OBJECTIVES: The objective of this clinical demonstration project was to implement a Geriatric Walking Clinic for older adults and determine whether this clinical program can lead to improvements in characteristics of frailty. DESIGN: This was a clinical demonstration project/quality improvement project. SETTING: Outpatient geriatrics clinic at the South Texas Veterans Health Care System (STVHCS). PARTICIPANTS: Older Veterans, aged ≥60 years. INTERVENTION: A 6-week structured walking program, delivered by a registered nurse and geriatrician. Patients received a pedometer and a comprehensive safety evaluation at an initial face-to-face visit. They were subsequently followed with weekly phone calls and participated in a final face-to-face follow-up visit at 6 weeks. MEASUREMENTS: Grip strength (handheld dynamometer), gait speed (10-ft walk), Timed Up and Go (TUG), and body mass index (BMI) were assessed at baseline and follow-up. Frailty status for gait speed was assessed using Fried criteria. RESULTS: One hundred eighty five patients completed the program (mean age: 68.4 ±7 years, 88% male). Improvements from baseline to follow-up were observed in average steps/day, gait speed, TUG, and BMI. Improvement in gait speed (1.13 ±0.20 vs. 1.24 ± 0.23 meter/second, p<0.0001) resulted in reduced odds of meeting frailty criteria for slow gait at follow-up compared to the baseline examination (odds ratio = 0.31, 95% confidence interval: 0.13-0.72, p = 0.01). CONCLUSIONS: Our findings demonstrate that a short duration, low-intensity walking intervention improves gait speed and TUG. This new clinical model may be useful for the promotion of physical activity, and for the prevention or amelioration of frailty characteristics in older adults.

Does the dentist have a role in identifying patients with undiagnosed diabetes mellitus?

STATEMENT OF THE PROBLEM: Diabetes has become an epidemic and the incidence of undiagnosed diabetes is growing at an alarming rate. Diabetes is an associated risk factor for chronic periodontitis and has several other oral symptoms including dry mouth and oral infection. Expanding the role of the dentist may prove to be an efficient method of early detection and management of diabetes. PURPOSE OF THE STUDY: The aim of this paper is to critically analyse the literature and determine whether screening for undiagnosed diabetes mellitus is within the dentist's scope of practice. MATERIALS AND METHODS: A PubMed/Google Scholar/Google literature search was conducted of papers published in the English language in the years 1980-2013. Over 140 articles were examined. Reference lists of key articles were also sourced and analysed. The most pertinent articles are presented in this review. RESULTS: Screening for diabetes mellitus in the dental office should only be carried out for high-risk patients in order for such screenings to be cost-effective. CONCLUSIONS: Dentists have an ethical obligation and a duty of care to protect the well-being of their patients. A screening procedure to detect a serious underlying, undiagnosed systemic condition does not cause any harm to the patient and is in the patient's best interests.

Replacement of an obturator section of an existing two-piece implant-retained edentulous obturator.

There is an increasing number of people in the community who have postablative surgery for tumors of the maxilla. Postsurgical defects these individuals have are usually restored by means of a complete or partial denture obturator with various materials, including resilient silicone extensions. These patients require long-term maintenance of their obturator prostheses, which must be considered in the context of their general health and ongoing medical care. When a resilient silicone bulb is used to obturate the defect, the silicone sometimes deteriorates, whereas the denture base remains functional. This article describes a simple procedure to construct a replacement, resilient silicone bulb obturator while retaining the original complete or partial denture base.

Working with a dental hygienist in Ireland.

The category of dental hygienist was introduced in Ireland in 1990 in accordance with the scheme made by The Dental Council [An Chomhairle Fiacloireachta] under the provision of Part VII of the Dentists Act 1985. This paper sets out and discusses the instructions of the Dental Council for employing/supervising dentists and registered dental hygienists as they apply at the time of writing. The current status and possible future developments are also considered in relation to the delivery of patient care by the dental team.

Learning a clinical method to identify a mandibular reference position.

The teaching of clinical maxillomandibular relationships is an area of weakness in dental school curricula. Most difficulties arise when a reference position is required to adjust or reconstitute the maximum intercuspation of the dentition. The dentist-derived concept of the centric maxillomandibular relation position is used to solve this problem. There is no consensus on the definition of this term. In the descriptions of clinical technique for recording the centric maxillomandibular relation position, clinical criteria to judge whether or not the position required has been achieved usually are not given. The dorsal border paths of the envelope of movement were used to develop a clinical criterion to identify the centric maxillomandibular relation position. Force or "guidance" is not used in this method. Test-patients with normal masticatory systems were randomly selected and fitted with a mechanical tracking apparatus. 50 undergraduate dental students and dental nurses were randomly selected and given instruction in the clinical technique to identify the centric maxillomandibular relation position. The ability of these students to identify the reference position was assessed by having them perform the technique blindfolded on the test-patients on whom tracking apparatus was fitted. Sixty eight percent of the test-clinicians succeeded in using the method to identify the reference position. There was no significant difference in the abilities of subgroups to use the method successfully, e.g., women compared to men, 2nd year students to 3rd year students. It was concluded that the method was a satisfactory way of learning how to identify the centric maxillomandibular relation position in a gentle, non-invasive fashion.

Acute necrotizing ulcerative gingivitis is associated with attachment loss.

Acute necrotizing ulcerative gingivitis (ANUG) has been generally considered as a gingivitis. However, clinical impressions suggest that periodontal attachment loss is one of the sequelae of the disease. This study was designed to investigate the extent of probing attachment loss detectable following resolution of the acute phase of the disease. 13 patients (3 male, 10 female) aged on average 22.7 years were studied. The presence of interdental soft tissue cratering was used to determine whether a site was previously affected by ANUG. ANUG sites were compared with other sites using a paired Student t-test (N = 13). Patient mean probing attachment level was greater for ANUG sites (2.2 +/- 0.9) than for the mean of all other sites (0.8 +/- 0.7). It is concluded that greater loss of probing attachment is associated with sites affected by ANUG than with other sites studied.

Fibrous hyperplasia of the gingiva in organ transplant patients.

Recent improvements in immunosuppressive therapy have improved the survival rate of post organ transplant patients. These developments have introduced a new group of medically compromised patients to the general dental practitioner. This paper reviews the medical and dental complications of organ transplant patients with special reference to heart transplant patients. A case report of the management of Cyclosporin A induced gingival hyperplasia in a post heart transplant patient is presented. Guidelines for dental management of heart transplant patients are suggested.

Use of strips containing tetracycline hydrochloride or metronidazole for the treatment of advanced periodontal disease.

Strips containing tetracycline hydrochloride or metronidazole 25% in polyhydroxybutyric acid as a biodegradable polymer matrix, showed sustained release in simulated gingival fluid pH 6.6 at 37 degrees C. When evaluated in patients suffering from advanced periodontal disease, the greatest response to therapy was observed with tetracycline hydrochloride strips inserted into periodontal pockets at four-day intervals for 16 days, compared with an untreated control group. A reduction in plaque index, gingival index and pocket depth was observed. A favourable alteration occurred in the microbial flora of treated pockets with an increase in the proportion of cocci and decrease in gram-negative rods, fusiforms and spirochetes. Metronidazole strips or root-planning tended not to be as effective. The clinical improvement produced by each treatment was not maintained when treatment was terminated.