Evaluation of a special needs dental workshop for health professionals and students in Trinidad and Tobago.

Aims: This study aimed to evaluate a special needs dental workshop for dentists, allied dental health professionals and students in Trinidad and Tobago. Methods: This feedback study conducted in 2019-2020, included two surveys, one at the time of the workshop and a second survey one year after it. The first survey utilized an anonymous self-administered questionnaire enquiring about the reason for attendance, profession/education, demographics, and difficulties faced in treating patients with special needs. The follow-up study used an online survey tool assessing the workshop and queried comments/suggestions. The Chi-square test served for statistical analysis. Results: Of the 176 attendees 131 participated (response: 74.4%). The majority (81.5%) were females. Most attendees were dental students (50.3%) or dentists (38.9%). Knowledge acquisition (73.1%) and professional development (14.2%) were the main motives for attendance while communication (31.8%) and non-compliance (34.5%) were the main problems faced in treating patients with special needs. The follow-up evaluation (post-workshop) (response: 72.5%) showed that most participants (90.5%) assessed the workshop as positive; 80% reported an increase in their knowledge and 64.2% perceived a need for further education. Conclusion: These findings suggest a considerable demand for special needs dental services and continuing education and show that workshops can actively affect patient care.

Oral health care practice patterns for geriatric patients: An American Dental Association Clinical Evaluators Panel Survey.

BACKGROUND: The geriatric adult population is expanding rapidly in the United States, with more of these patients expected to visit the dentist in the coming years. Understanding the dental community's preparedness and comfort treating this demographic is timely. METHODS: Survey questions were developed to assess how dentists treat geriatric patients, what challenges they face, and what tools they need to provide the best care. This set of questions was administered electronically and emailed to the American Dental Association Clinical Evaluators (ACE) Panel on March 29, 2022. After 2 weeks, the survey closed, and data were summarized descriptively. RESULTS: Of the 269 respondents, 59% indicated that treating geriatric patients is more challenging than treating nongeriatric patients. The most frequently cited challenges include comorbidities and their management (86%), cognitive impairment (68%), and home care needs for some of these patients (69%). The top 3 symptoms seen in these patients are dry mouth (89%), carious lesions (86%), and tooth wear (75%). Seventy-six percent of respondents reported being comfortable treating this demographic, and most (58%) indicated that training as a student contributed to this competency. CONCLUSIONS: Most respondents are comfortable treating geriatric patients, but they still face many challenges, with managing comorbidities with dental treatment a top concern. PRACTICAL IMPLICATIONS: A sound understanding of the impact of aging and associated medical treatments on oral tissues and patient management is essential. Equally important is finding innovative ways to improve access to care for this vulnerable population.

Challenges experienced in the dental care of persons with special needs: a qualitative study among health professionals and caregivers.

BACKGROUND: This study aimed to explore the challenges experienced in dental health care by professionals and caregivers of persons with special needs in Trinidad and Tobago. This research presented results from the first qualitative study which gained insight into the service component of dental care for people with special needs in this country. METHODS: This qualitative study was conducted between March and June 2021. Recruitment of participants used both purposive and snowball sampling. A semi-structured interview schedule was used in the interviews of dentists, (a dental assistant), physicians and caregivers of people with special needs. Narrative inquiry was used in data analysis. The transcripts were individually coded and a follow-up peer debriefing session to cross reference responses and increase the validity of the analysis was performed. RESULTS: Barriers related to the provision of dental care included readiness of health care professionals, the level of specialized care and the resources required for patient treatment. Caregivers encountered barriers such as cost and lack of accessible dental care for persons with special needs. Possible solutions were education of key stakeholders, policy intervention, advocacy and prevention strategies. CONCLUSIONS: Caregivers and allied health care professions experience multiple barriers when treating patients with special needs. Study participants indicated a need change in the provision and access of dental services for people with special needs. Education of healthcare professionals, improved social policies and health promotion is warranted.

Dental professionals' knowledge, attitudes, and practice behaviors related to human papillomavirus vaccination.

OBJECTIVES: In Arizona, human papillomavirus (HPV)-related cancers are declining, with the exception of oropharyngeal cancer (OPC). HPV-related OPC is largely caused by persistent infection with oncogenic HPV strains, many of which the 9-valent HPV vaccine offers protection. Little is known about dental professionals' willingness to promote the HPV vaccine to prevent OPC. The current study assessed Arizona dental professionals' knowledge, attitudes, willingness, and current practice behaviors related to HPV vaccine promotion. Responses between dentists and hygienists were also compared. METHODS: A convenience sample of 711 dentists and hygienists attending a regional conference were recruited and asked to complete a 34-item survey assessing knowledge and attitudes about HPV, the HPV vaccine, HPV-related OPC, and their willingness to promote and administer the HPV vaccine. Fisher's exact tests and Mann-Whitney U tests were used for data analysis. RESULTS: Most respondents answered HPV knowledge questions correctly but did not know HPV-related OPC has a more favorable prognosis than other head and neck cancers. Dentists were more confident discussing and recommending the HPV vaccine. Both dentists and hygienists were willing to refer patients to their non-dental primary care providers for vaccination; however, they were less confident in administering the vaccine if it fell within their scope of practice. They reported willingness to receive training to recommend the vaccine. CONCLUSIONS: Given the willingness of respondents to receive training related to HPV vaccine communication, future research should develop and test talking points and communication training to aid dentists and hygienists in their promotion of the HPV vaccine.

Protocols for treating patients with end-stage renal disease: a survey of nephrology fellowships.

RATIONALE/BACKGROUND: Approximately 14% of Americans are living with chronic kidney disease (CKD). The prevalence of end-stage renal disease (ESRD), the result of progressing CKD continues to rise by 21,000 per year. Currently, the only antibiotic prophylaxis guidelines for patients with ESRD undergoing dental treatment were published by the AHA in 2003. Presented in three parts, the first and second parts of this study found no consistent protocols amongst U.S. dental schools and U.S. GPRs and AEGDs, respectively. The goal of the third part of the project was to determine the current protocol being used to treat ESRD patients at U.S. nephrology fellowship programs. METHODS AND MATERIALS: An 18 multiple-choice question survey was e-mailed to 130 directors of nephrology fellowships within the U.S. regarding renal treatment protocol details and antibiotic prophylaxis for patients with renal disease. RESULTS: Note that, 34.6% of respondents reported having an established renal treatment protocol. For programs with a protocol, 69% of programs reported following AHA guidelines. CONCLUSION: There is a lack of consistent, established protocols amongst U.S. nephrology fellowships. It is suggested that updated and evidence based guidelines for the safe treatment of patients be developed.

Protocols for treating patients with end-stage renal disease: a survey of undergraduate dental programs.

RATIONALE/BACKGROUND: Approximately 14% of Americans are living with chronic kidney disease (CKD). The prevalence of end-stage renal disease (ESRD), the result of progressing CKD continues to rise by 21,000 per year. There are no updated, evidence-based antibiotic prophylaxis guidelines for patients with renal disease undergoing dental treatment. The most recent was a scientific statement from the American Heart Association (AHA) in 2003. Presented in three parts, the goal of the first part of this study is to determine the current protocol being used to treat renal patients at U.S. dental schools. METHODS AND MATERIALS: A 21 multiple-choice question survey was e-mailed to 58 clinic deans of accredited dental schools in the United States regarding renal treatment protocol details including antibiotic prophylaxis. RESULTS: Fifty-two percent of programs report having no established renal patient treatment protocol. For programs with a protocol, when using prophylactic antibiotics, 54% followed AHA protocol, whereas 62% used a modified protocol. CONCLUSION: There is a lack of consistent, established protocols among undergraduate dental programs. It is suggested that evidence-based guidelines for the safe treatment of patients be developed.

Protocols for treating patients with end-stage renal disease: a survey of AEGD/GPR dental residencies.

RATIONALE/BACKGROUND: Approximately 14% of Americans are living with chronic kidney disease (CKD). The prevalence of end stage renal disease (ESRD), the result of progressing CKD continues to rise by 21,000 per year.Currently the only antibiotic prophylaxis guidelines for patients with end-stage renal disease undergoing dental treatment were published by the AHA in 2003. Presented in three parts, the first part of this study found no consistent protocols amongst U.S. dental schools. The goal of the second part of the project was to determine the current protocol being used to treat ESRD patients at accredited U.S. AEGD and GPR programs. METHODS AND MATERIALS: A 20 multiple choice question survey was e-mailed to 262 directors of AEGDs and GPRs within the United States regarding renal treatment protocol details and antibiotic prophylaxis for patients with renal disease. RESULTS: 34% of respondents reported having an established renal treatment protocol. For programs with a protocol, 65.5% of programs reported following AHA guidelines. CONCLUSION: There is a lack of consistent, established protocols amongst U.S. AEGD and GPR programs. It is suggested that updated and evidence based guidelines for the safe treatment of patients be developed.

SCDA task force on a special care dentistry residency.

The Special Care Dentistry Association (SCDA) has acted on a proposal regarding the status of training in the care of patients with special needs. Two phases of action were undertaken. Phase 1: (a) examination of the literature on existing training and curricula in the care of patients with special needs and (b) a survey of existing postdoctoral programs in special needs. Phase 2: establish a group of experts who: (a) submitted to the Commission on Dental Accreditation a request to approve a postdoctoral general dentistry residency program in Special Care Dentistry and (b) created suggested accreditation standards for such postdoctoral programs. This article describes efforts by the SCDA to evaluate: The status of existing training of dental students in the care of patients with special needs. The number and characteristics of postdoctoral general dentistry programs offering formal training in the care of patients with special needs. Whether additional training in the care of patients with special needs is needed for dental students and -dentists. Possible actions by SCDA to impact the numbers of dentists trained each year in the care of patients with -special needs.

Oral surgery in a patient with cirrhosis and thrombocytopenia: a case report.

PURPOSE: While most oral surgical procedures can be safely performed in an outpatient setting, certain medical conditions may present a higher chance of postoperative complications. In particular, those predisposing the patient to bleeding abnormalities pose a potential risk when performing such treatments. The authors report a case involving full-mouth extractions in a patient with cirrhosis and thrombocytopenia after obtaining a platelet transfusion. METHODS/CASE: A 62-year-old Caucasian female presented to a university special care dental clinic requiring extractions. Her pertinent medical history was remarkable for cirrhosis and thrombocytopenia, with a platelet count of 32,000/uL. Upon medical consultation, the patient was appointed for a prophylactic platelet transfusion. The surgery was rendered uneventfully, and the patient achieved adequate hemostasis without hospitalization. CONCLUSION/CLINICAL RELEVANCE: Patients with cirrhosis pose a potential bleeding risk with dental surgical procedures. Pre-operative medical consultation, review of pertinent laboratory values, and prophylactic platelet transfusion allow these patients to be managed safely in an outpatient setting.