Barriers and Motivations to Provide Dental Care to Adult Patients with Movement Disorders.

Patients with movement disorders, like Parkinson's and Huntington's diseases, tend to have poor oral health. Although contributing factors have been proposed, the willingness and ability of dentists to treat this patient population are still unknown. Our objective is to understand the current barriers and motivations of dentists to treat this patient population as a path to improved care and quality of life. A total of 176 dentists in Texas were surveyed through a structured questionnaire which contained both closed and open-ended questions. Nearly 30% of participants reported having no barriers to treating these patients and 26.7% reported that no such patients have visited their practice. Barriers reported included lack of education on the topic (17.6%) and longer appointments than average (14.8%). A main motivation to treat these patients was more training and education on the subject (38.6%). Poor oral health in patients with movement disorders may not be due to barriers encountered by dentists, but rather encountered by patients, such as access to and use of dental treatment. General dentists are willing to provide care for adult patients with movement disorders and continuing education for these providers is preferred over referral to a specialist.

Oral Health Assessment by Lay Personnel for Older Adults.

Oral health is an often-undervalued contributor to overall health. The literature, however, underscores the myriad of systemic diseases influenced by oral health, including type II diabetes, heart disease, and atherosclerosis. Thus, assessments of oral health, called oral screenings, have a significant role in assessing risk of disease, managing disease, and even improving disease by oral care. Here we present a method to assess oral health quickly and consistently across time. The protocol is simple enough for non-oral health professionals such as students, family, and caregivers. Useful for any age of patient, the method is particularly key for older individuals who are often at risk of inflammation and chronic disease. Components of the method include existing oral health assessment scales and inventories, which are combined to produce a comprehensive assessment of oral health. Thus, oral characteristics assessed include intraoral and extraoral structures, soft and hard tissues, natural and artificial teeth, plaque, oral functions such as swallowing, and the impact this oral health status has on the patient's quality of life. Advantages of this method include its inclusion of measures and perceptions of both the observer and patient, and its ability to track changes in oral health over time. Results acquired are quantitative totals of questionnaire and oral screening items, which can be summed for an oral health status score. The scores of successive oral screenings can be used to track the progression of oral health across time and guide recommendations for both oral and overall health care.

Parkinson's Disease Oral Health Module: Interprofessional Coordination of Care.

Introduction: Patients with Parkinson's disease (PD) suffer progressive neurodegeneration and experience motor and nonmotor symptoms. Oropharyngeal dysfunctions are increasingly recognized as nonmotor PD symptoms that negatively impact a patient's quality of life. This module was primarily created to update dental health professionals and educate dental students on the oral health needs of patients with PD, with an emphasis on interprofessional collaboration and evidence-based dentistry. The module may also benefit other health professionals from different disciplines working with patients with PD. Methods: The module was developed to be delivered in one 55-minute large-group session followed by a short assessment and case study discussion. Associated materials include PowerPoint slides with transcript, a narrated video version of the PowerPoint lecture, a quiz, and the case study. Thirty-four first-year dental students were invited to watch the narrated presentation, complete a pre-/postsurvey, and take the quiz. Results: All participants agreed dental schools should provide education regarding oral health in patients with neurological disorders, as only 29% of them had previously taken a related class. After watching the presentation, students reported that most of the information was new content and that the difficulty level met their expectations. All students reported that the lecture increased their interest in interprofessional collaboration. In a quiz taken immediately after the presentation, the class average grade was 82.7, with 94% of the class passing the quiz with a grade of 70 or more. Discussion: Educating dental professionals regarding care of patients with PD must emphasize interprofessional collaborations among health care providers.

Incorporating oral health into interprofessional care teams for patients with Parkinson's disease.

Parkinson's disease (PD) is a progressive neurodegenerative disorder that primarily affects the motor system. However, non-motor symptoms such as cognitive, autonomic, sleep-related and sensory dysfunctions are often reported. A subgroup of non-motor symptoms, oropharyngeal problems, also affects these patients in ways that greatly deteriorate quality of life. Each patient may develop a different set of non-motor symptoms, making interprofessional collaboration among health care providers a must to treat patients with PD. In this review, we argue that dental health professionals must be included in this interprofessional health care team. Patients with PD are at a higher risk for developing oral health problems that can exacerbate or be exacerbated by other non-motor symptoms, such as mental health and dysphagia This accelerates decline in quality of life and even increases the risk of death by aspiration pneumonia. Dentists can create preventive oral health plans as soon as a diagnosis is made and promptly treat a patient's dental problems, preventing them from affecting other health areas. We describe major oral health concerns and how health professionals and dentists can participate and collaborate to improve the health of patients with PD.

Strategies to improve dental health in elderly patients with cognitive impairment: A systematic review.

BACKGROUND: Cognitive impairment is the gradual loss of one's ability to learn, remember, pay attention, and make decisions. Cognitively impaired elderly people are a challenging patient population for dental health care professionals and may be at higher risk of developing oral health diseases. The authors systematically reviewed interventions effective at improving dental health in patients with cognitive impairment and described research gaps remaining. TYPES OF STUDIES REVIEWED: In a comprehensive search of multiple databases, the authors identified 2,255 studies published in the English language from 1995 through March 2016. The authors included studies if the investigators evaluated oral health measures after an intervention in patients 65 years or older with cognitive impairment or dementia. Nine full-text articles met the criteria for inclusion. RESULTS: Only 1 study was a randomized control trial, whereas all others lacked appropriate controls. Investigators studied the effects of dental treatments, battery-powered devices for oral hygiene, and training of care staff members. Most interventions improved some aspect of the oral health of patients with dementia, and results were more pronounced when patients required assistance while performing oral hygiene tasks or had poor oral health at baseline. CONCLUSIONS AND PRACTICAL IMPLICATIONS: A basic care plan for patients with dementia should, at the minimum, match prevention strategies recommended for healthy elderly patients. Dental health care professionals should promote oral hygiene education for caregivers for elderly patients with cognitive impairment. There is a wide gap in knowledge regarding effective methods specifically to improve oral health in patients with dementia.

Recognizing and reporting elder abuse and neglect.

Elder abuse (physical, sexual, or psychological) and neglect (by caretakers or self-neglect) are major public health problems. Most cases are not identified by clinicians and reported to the appropriate government agencies. There are some barriers to clinician identification and reporting of cases of elder abuse or neglect. These barriers mainly result from a lack of clinician education and comfort regarding this topic. We propose that clinician understanding of the phenomenon of elder mistreatment, familiarity with a simple approach to screening and identification of cases, awareness of risk factors and warning signs, and awareness of appropriate interventions will help to eliminate these barriers and result in clinicians properly fulfilling their duty to help protect their most vulnerable elderly patients.