'Don't forget the mouth!': a process evaluation of a public oral health project in community-dwelling frail older people.

BACKGROUND: Older people are encouraged to remain community dwelling, even when they become care-dependent. Not every dental practice is prepared or able to provide care to community-dwelling frail older people, while their ability to maintain oral health and to visit a dentist is decreasing, amongst others due to multiple chronic diseases and/or mobility problems. The public oral health project 'Don't forget the mouth! (DFTM!) aimed to improve the oral health of this population, by means of early recognition of decreased oral health as well as by establishing interprofessional care. A process evaluation was designed to scientifically evaluate the implementation of this project. METHODS: The project was implemented in 14 towns in The Netherlands. In each town, health care professionals from a general practice, a dental practice, and a homecare organization participated. The process evaluation framework focused on fidelity, dose, adaptation, and reach. Each of the items were examined on levels of implementation: macro-level, meso-level, and micro-level. Mixed methods (i.e., quantitative and qualitative methods) were used for data collection. RESULTS: The experiences of 50 health care professionals were evaluated with questionnaires, 22 semi-structured interviews were conducted, and the oral health of 407 community-dwelling frail older people was assessed. On each level of implementation, oral health care was integrated in the daily routine. On macro-level, education was planned (dose, adaption), and dental practices organized home visits (adaption). On meso-level, health care professionals attended meetings of the project (fidelity), worked interprofessionally, and used a screening-referral tool of the project DFTM! in daily practice (dose, adaption, reach). On micro-level, the frail older people participated in the screening of oral health (fidelity, dose), had their daily oral hygiene care observed (adaption) and supported if necessary, and some had themselves referred to a dental practice (reach). The semi-structured interviews also showed that the project increased the oral health awareness amongst health care professionals. CONCLUSIONS: The project DFTM! was, in general, implemented and delivered as planned. Factors that contributed positively to the implementation were identified. With large-scale implementation, attention is needed regarding the poor accessibility of the oral health care professional, financial issues, and increased work pressure. Trial registration The Netherlands Trial Register NTR6159, registration done on December 13th 2016. URL: https://www.trialregister.nl/trial/6028.

Experience with bruxism in the everyday oral implantology practice in the Netherlands: a qualitative study.

OBJECTIVE: To explore how bruxism is dealt with by accredited oral implantologists within daily clinical practice. MATERIALS AND METHODS: Nine semi-structured interviews of oral implantologists practicing in non-academic clinical practices in the Netherlands were performed, and thematic analysis was conducted using a framework-based approach. RESULTS: Oral implant treatments in bruxing patients were a generally well-accepted practice. Complications were often expected, with most being of minor impact. Contradictive attitudes emerged on the topic of bruxism being an etiologic factor for peri-implant bone loss and loss of osseointegration. Views on the ideal treatment plan varied, though the importance of the superstructure's occlusion and articulation features was repeatedly pointed at. Similarly, views on protective splints varied, regarding their necessity and material choice. Bruxism was diagnosed mainly by clinical examination, alongside with patient anamnesis and clinician's intuition. There was little attention for awake bruxism. DISCUSSION: Bruxism was generally not considered a contraindication for implantological treatments by accredited oral implantologists. Views on the interaction between bruxism and bone loss/loss of osseointegration varied, as did views on the ideal treatment plan. CONCLUSIONS: There is a need for better understanding of the extent to which, and under which circumstances, sleep and/or awake bruxism can be seen as causal factors for the occurrence of oral implant complications.

Why seek treatment for temporomandibular disorder pain complaints? A study based on semi-structured interviews.

AIMS: To identify potential predictors of self-reported sleep bruxism (SB) within children's family and school environments. METHODS: A Aims: To assess possible differences between care seekers and non-care seekers with temporomandibular disorder (TMD) pain complaints, by using semi-structured interviews. METHODS: Semi-structured interviews were held with 16 subjects who had TMD- pain complaints: 8 care seekers and 8 non-care seekers, matched for age, sex, pain intensity, and fear of movement. Subjects were selected from a previously held survey study, with their consent. The interviews were audiotaped, transcribed verbatim, and analyzed according to qualitative content analysis. RESULTS: From the analysis, seven themes differentiating care seekers from non-care seekers were identified: catastrophizing, pain management, assertiveness, critical attitude towards health care, confidence in medical care, recognition, and adequate referral. CONCLUSION: Aspects upon which care seekers differed from non-care seekers were mainly person-related characteristics. Next to these characteristics, it appeared that inadequate referrals may play a role in care seeking. The use of semi-structured interviews may further improve insights into processes that determine care seeking among people with TMD pain complaints.

Care seeking for orofacial pain.

AIMS: To determine the contribution of a wide range of factors to care-seeking behavior in orofacial pain patients, expressed as (A) decision to seek care and (B) number of health care practitioners visited. METHODS: Subjects with orofacial pain complaints were recruited in seven TMD clinics and from a nonclinical population sample. They received a questionnaire including a wide range of possible predictors. To study which predictive variables were associated with the decision to seek care and with the number of health care practitioners visited, multiple regression models were built. RESULTS: Two hundred three persons with orofacial pain participated in the study. Of these participants, 169 (140 females) had visited at least one health care practitioner (care seekers), while the other 34 persons (25 females) did not (non-care seekers). The decision to seek care was not only associated with the pain intensity (P < .05), but, in women, also with fear of jaw movements (P < .01): Women with more fear of jaw movements were more likely to seek care. Pain intensity and disability were not associated with the number of health care practitioners visited. Instead, the main predictors were catastrophizing (P = .004) and the use of painkillers (P = .008). CONCLUSIONS: Pain intensity and fear of jaw movements play an important role in the decision to seek care for orofacial pain. The continuous search for help is associated with catastrophizing and the use of painkillers.

The reproducibility and responsiveness of a patient-specific approach: a new instrument in evaluation of treatment of temporomandibular disorders.

AIMS: To evaluate the choice of activities on the Patient Specific Approach (PSA) in a sample of temporomandibular disorder (TMD) patients and to determine the clinimetric properties of the visual analog scale (VAS) scores of the PSA, in terms of reproducibility and responsiveness. METHODS: At treatment start, TMD patients reported the PSA activity which represents the most important activity that is impaired due to their TMD complaints. The amount of hindrance during this activity was rated on a VAS. During two follow-up measurements, patients used the VAS to rate the amount of hindrance and appraised their overall complaints in terms of "much worsened," "slightly worsened," "remained stable," "slightly improved," or "much improved." To determine the reproducibility and responsiveness, an intraclass correlation coefficient and receiver operating characteristics-curve were then calculated. RESULTS: Of the 132 patients who fulfilled baseline measurements, 13% reported an activity that is not included in existing TMD-disability questionnaires. The reproducibility of the VAS scores of the 78 patients who reported that their complaints had "remained stable" at second measurement was good (intraclass correlation coefficient = 0.73). The responsiveness of the PSA was high, and the cutoff score for important improvement, where sensitivity (0.85) and specificity (0.84) were as much as possible the same, was 58%. CONCLUSION: The PSA for TMD patients is a new and easy-to-use tool in treatment evaluation. Moreover, the VAS score of the PSA has good reproducibility and responsiveness.