Exploring medical and dental practitioner perspectives and developing a knowledge attitude and practice (KAP) evaluation tool for the common risk factor approach in managing non-communicable and periodontal diseases.

BACKGROUND: The Common Risk Factor Approach (CRFA) is one of the methods to achieve medical-dental integration. CRFA addresses shared risk factors among major Non-communicable Diseases (NCDs). This study aimed to explore the perspectives of dental and medical practitioners concerning CRFA for managing NCDs and periodontal diseases and to create and validate a tool to evaluate the Knowledge, Attitude, and Practice (KAP) of medical and dental practitioners in relation to utilization of CRFA for management of NCDs and Periodontal diseases. METHODS: This research employed a concurrent mixed-method model and was carried out from January 2021 to February 2022, focusing on medical and dental practitioners in South India. In the qualitative phase, online interviews were conducted with dental and medical practitioners, recorded, and transcribed. Thematic analysis was applied after achieving data saturation. In the quantitative phase, a KAP questionnaire was developed. The sample size was determined by using the G power statistical power analysis program. A sample size of 220 in each group (dentists and medical practitioners) was estimated. Systematic random sampling was used to recruit the potential participants. The data obtained through the online dissemination of KAP tool was analysed and scores were standardized to categorize the KAP. RESULTS: Qualitative thematic analysis identified four major themes: understanding of common risk factors, risk factor reduction and disease burden, integrating CRFA into clinical practice, and barriers to CRFA. In addition, thematic analysis revealed seventeen subthemes. For the quantitative phase, standardization was applied to a 14-item KAP questionnaire for medical practitioners and a 19-item KAP questionnaire for dental practitioners. The total KAP score for medical practitioners in the study was 21.84 ± 2.87, while dental practitioners scored 22.82 ± 3.21, which indicated a high level of KAP regarding CRFA. Meta integration of qualitative and quantitative data identified eight overarching themes: four were concordant, three were discordant, and one theme provided the explanatory component. CONCLUSION: The study's structured, validated questionnaire showed that both medical and dental professionals had a high knowledge of CRFA. However, they were not appreciably aware of the risk factors that are shared between NCDs and periodontal disease. Both groups were interested in the idea of using CRFA in integrated medical and dental care.

A Cross-Sectional Study to Assess Diabetes as a Risk Factor for Root Caries Amongst the Elderly Population in Udupi District, Karnataka State, India.

Objectives: To compare the prevalence of root surface carious lesions among the nondiabetic and diabetic elderly population and its association with various risk factors. Methods: An observational analytical cross-sectional study was conducted among 800 elderly participants, 431 males and 369 females, aged 50 years and above, with a minimum of ten teeth present, with 400 being diabetic and 400 nondiabetic from the various hospitals of the Udupi district. Demographics, socioeconomic status, oral hygiene practices, oral abusive habits, and history of type 2 diabetes were collected using an interviewer-administered questionnaire followed by an intraoral examination to assess root caries. The primary outcome measure was the presence of any carious or filled root surface. Binary logistic regression univariate analysis was done for all the predictor variables, and those with significant associations were further analyzed by multivariate analysis with the enter method in a single-step model. An appropriate nomogram was designed for risk prediction. Results: Overall, the root caries prevalence was 37.3%, and the mean root caries index was 14.28%. The prevalence of root caries was 46% in people with diabetes and 28.5% in nondiabetics. Participants with type 2 diabetes, less education, low socioeconomic status, and using finger cleaning had a significantly higher risk of developing root caries. Additionally, those who used removable partial dentures (RPDs) were found to be 4.65 times more likely to have root caries than those who did not use RPDs. Conclusion: Elderly diabetics are at a higher risk for developing root caries and are strongly advised to maintain good oral hygiene practices and to undergo periodic dental evaluations. Therefore, it is crucial to emphasize early diagnosis and treatment of root caries in this population.

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.

Interprofessional collaboration in Paediatric Obstructive Sleep Apnoea (POSA) treatment: Assessment of professional orientation levels amongst otolaryngologists in South India.

Objective: The primary goal was to assess the knowledge, attitude and practice among otorhinolaryngologists regarding orthodontic intervention for Paediatric Obstructive Sleep Apnoea (POSA). Methods: An online survey was conducted by sending an email invitation to members of The Association of Otorhinolaryngologists of Karnataka, India. A total of 141 otorhinolaryngologists participated in the survey. Results: Most of the participants (70.2%) agreed that orthodontic interventions help in opening up the airway, but very few knew about its application in nasal obstruction management. Conclusion: Otorhinolaryngologists are aware of dental effects of POSA and they believe that an interprofessional team is essential for its management. This learning can also be used to initiate interprofessional collaborations and academic and curricular improvisations for enhanced health outcomes.

Utilization of health insurance by patients admitted for dental surgical procedures at a tertiary care hospital in Coastal Karnataka: a retrospective study.

Background: There are various medical insurance options available in India. However, unlike many other countries, dental insurance plans are rare. The aim of this study was to assess the utilization of various government and private health insurance schemes by patients admitted for dental surgical procedures at a tertiary care hospital in coastal Karnataka, India. Methods: A study was conducted retrospectively to gather data on the socio-demographics, bill details, insurance, and benefits claimed by patients admitted to the Department of Oral and Maxillofacial Surgery at a tertiary care hospital from May 2016 to September 2022. Results: Out of 1750 patients, only 856 (48.9%) patients had availed of insurance, 395 patients (22.6%) utilized government health insurance policies, and 461 patients (26.3%) availed of private health insurance plans. Among Government schemes, primarily Ayushman Bharat-Arogya Karnataka was used by 262 (30.6%) patients, followed by Employees' State Insurance Scheme by 110 (12.9%) patients. Among private schemes, 212 (24.8%) patients used the policies purchased by them, 19 (2.2%) patients' medical expenses were paid by their employers, 105 (12.3%) patients utilized Manipal Arogya Suraksha and 124 (14.5%) patients used Medicare provided by the hospital. Bivariate linear regression confirmed that the total bill amount, out-of-pocket expenditure by the patient, and insurance amount reimbursed to the hospital were significantly associated with the type of insurance (government vs. private). The study noticed a gradual rise in insured patients every year. Conclusion: Greater utilization of health insurance should be encouraged because the cost of dental treatment has always hindered the use of oral health services worldwide. This study highlights that the benefit available to the patients were mainly through general health insurance schemes, not specifically dental health insurance. Insurance schemes covering dental must be promoted more aggressively in the media, highlighting their available benefits, merits, and demerits.

Seasonal Variations in the Groundwater Fluoride of Swarna River Basin in Southern India: A GIS-based Study.

Objectives: The study aimed (1) to assess fluoride concentration of groundwater along the Swarna river basin in Udupi District; (2) to investigate variations in fluoride concentration with respect to rainfall status in Udupi district; and (3) to develop a spatial distribution map for the groundwater fluoride concentration in Udupi district. Materials and Methods: Water samples were procured from 30 different sampling points across three time zones in a year: pre-monsoon, monsoon, and post-monsoon. The samples thus collected were analyzed for fluoride ion concentration using fluoride ion selective electrodes (Orion™). Mean determination readings at each time zone were calculated. Repeated-measures analysis of variance was done to analyze whether there was a difference in the concentration of fluoride over different time zones. Results: The mean (SD) pre-monsoon concentration was 0.25 (± 0.07) ppm, whereas the mean monsoon and post-monsoon concentrations were 0.26 (± 0.09) and 0.57 (± 0.23) ppm, respectively. There was a significant increase in post-monsoon fluoride levels when compared with the pre-monsoon and monsoon levels. Conclusion: The groundwater fluoride concentration in the Swarna river basin was found acceptable for human consumption at all the sampled sites and across all time zones. As the fluoride concentration was found to be lower than the recommended values for dental caries prevention at most of the sampling sites, use of topical fluorides needs to be encouraged.

Evaluation of Parental Dental Fear and Anxiety (DFA) on Adolescent Dental Treatment: A Narrative review.

Background: Parental dental fear and anxiety (DFA) is an important factor, which has an impact on adolescence receiving dental treatment and maintenance of their oral health. It is necessary to recognize and know how parental DFA affects the dental treatment of children and adolescents. Aim: This narrative review was planned with the objective of evaluating parental DFA influence on adolescent dental treatment. Materials and Methods: A broad search of literature published between 2005 and 2021 from electronic databases through Scopus, PubMed, Web of Science, Google Scholar was performed. We included the studies in which parental dental anxiety was a major criterion affecting different dental health conditions. Articles referring to adolescents facing different oral health problems were also included. This narrative review included 12 articles of which 8 cross-sectional studies, 3 longitudinal studies, and 1 descriptive study, all of which met the inclusion criteria and the specified age group of adolescents ranging between 10 and 19 years. Results: After screening 83 abstracts, 12 articles were selected, which included all the inclusion criteria. In this study, we found that parental DFA showed a positive association with their adolescent's DFA, which hinders the dental treatment received. Conclusion: Parental DFA influences the adolescent behavior and can impact the seeking of dental treatment. Hence, it is important to address parental DFA prior to the intervention and treatment. An appropriate address will facilitate in reducing or eliminating DFA in adolescents.

Community social responsibility of continued and appropriate use of silver amalgam as dental restorative material in southern India: A cross-sectional study.

Background: For more than 150 years, dental amalgam (DA) has been popular as a dental restorative material. Many organizations oppose its use due to perceived toxicity and environmental concerns. Hence, this study aimed to explore the continued use of DA from a South Indian dental practitioners' perspective. Methods: This cross-sectional study was conducted among fifty-two private and public dental practitioners of Udupi district in Southern India. A self­administered questionnaire was distributed, that involved assessment of their preferences, continuation of use and concerns of using DA as a restorative material. The percentage contribution of each variable was calculated. Preferences for continuation of use of silver amalgam based upon the age, experience and mercury toxicity as a risk factor were analyzed using Students-t test and Fisher's Exact Test test. Results: Most dentists were satisfied (87%) with the results of the DA, found minimal failures (96%) and found DA more economical (89%). More than half (54%) of the participants reported that they would not continue the use of DA owing to mercury toxicity and environmental concerns. Dentists with higher age and longer clinical experience preferred continuation of DA. Conclusions: Despite satisfaction with DA for its minimal failure, longevity and affordability, the authors found that most practitioners did not prefer its continued usage. This highlights their concerns over mercury toxicity and soft tissue lesions and accentuates their community social responsibility. There is also an urgent need to educate dentists on mercury hygiene, mercury waste management and disposal.

Attitude towards shared learning activities and Interprofessional education among dental students in South India.

BACKGROUND: Interprofessional Education (IPE) and Interprofessional Collaboration (IPC) are being introduced in healthcare institutions gradually to enable comprehensive learning and its application to enhance community health outcomes. OBJECTIVES: To assess the attitude of dental students towards Interprofessional Education (IPE) and Interprofessional Collaboration (IPC) To assess whether Readiness for Interprofessional Learning Scale (RIPLS) is a suitable instrument to measure the attitude of under graduate dental students towards IPE. To assess how the study year and gender affect the attitude of under graduate dental students towards IPE. METHODS AND MATERIALS: The research design was a cross-sectional survey. The dental students of first to fifth year based on availability of students and the existing academic calendar were participated in the study. A total number of 417 validated RIPLS questionnaire were distributed to dental students studying in two dental institutions at Manipal in South India in the year 2017 with the collected response rate of 81.53%. Principal component analysis of the responses was applied to the data along with Varimax rotation and Cronbach alpha to confirm the internal consistency of the questionnaire. Independent sample t test and ANOVA were used to assess the differences between the groups. RESULTS: Seventy five percent of the respondents were females, and the mean age was 21.26 years (SD = 1.34). The mean scores in RIPLS and all its subscales were high. The mean scores were also higher as the year of study increased and with female students. Senior and female dental students had more encouraging attitudes towards shared learning. CONCLUSIONS: The RIPLS can be utilised to determine the different subscales of learning namely learning behaviour, attitudes, teamwork and collaboration, professional identity perspectives, and roles and responsibilities towards interprofessional education of dental students. The dental students with an Indian outlook, perspective and training had a favourable attitude towards interprofessional learning.

The association of secondhand smoke exposure and dental caries in children and adolescents: a literature review.

Secondhand smoke (SHS) is an important public health concern, especially for children. SHS not only affects the physiology of children who are exposed to it but also has adverse effects on their general and oral health. This review highlights how the exposure of children to SHS is linked to dental caries and examines the factors that foster the association. Research shows that there is an independent association between SHS exposure and dental caries, especially in primary teeth. However, the association between SHS exposure and dental caries in permanent teeth must be explored further through well-designed studies because statistically significant evidence is lacking.

The Impact of Sibling Behavior on Oral Health: A Narrative Review.

OBJECTIVE: The repetition of any behavior until it becomes a learned behavior begins in childhood. Oral health practices being no exception to this, are also acquired at this tender age, and have the potential of greatly affecting one in their lives. Oral health behaviors are learned through a multifactorial interplay, of which the family is a crucial and relatively unexplored area and will be highlighted in this review. This review discusses gender differences among siblings in relation to oral health, familial influence on acquisition and maintenance of oral hygiene habits, media influence on oral health attitudes and more. METHODS: A thorough literature search between 1972 and 2017 was done using Scopus, PubMed, and Google Scholar databases, results reviewed, prioritized, and findings compiled. The keywords of the search strategy was as below: Siblings, sibling behavior, sibling oral health, siblings in dentistry, maternal oral health, family influence on oral health. 35 studies were evaluated for the review. The keywords were limited to activities of siblings and their behavior patterns in relation to dentistry and oral health. RESULTS: Results showed that sibling dynamics have been involved in influencing the learning of oral health behaviors in children. Other factors include peer pressure and maternal influences. CONCLUSION: Sibling relationships play a vital role in shaping behavior characteristics including tooth brushing, oral hygiene, dental perceptions, and snacking behaviors which are pertinent to dentistry.

Dental caries experience in high risk soft drinks factory workers of South India: a comparative study.

BACKGROUND: The consumption of soft-drinks has been associated with dental caries development. OBJECTIVE: The aim was to evaluate dental caries experience amongst the workers working in soft-drink industries located in South India and compare it with other factory workers. To evaluate the validity of specific caries index (SCI), which is newer index for caries diagnosis. MATERIALS AND METHODS: This was a cross-sectional study carried out among 420 workers (210 in soft-drinks factory and 210 in other factories), in the age group of 20-45 years of Udupi district, Karnataka, India. Index used for clinical examination was decayed, missing, filled surfaces (DMFS) index and SCI. RESULTS: The mean and standard deviation (SD) of decayed surface (5.8 ± 1.8), missing surface (4.3 ± 2) and filled surface (1.94 ± 1.95) and total DMFS score (12.11 ± 3.8) in soft-drinks factory workers were found to be significantly higher than the other factory workers. The total SCI score (mean and SD) was found to be significantly higher in soft-drinks factory workers (5.83 ± 1.80) compared with other factory workers (4.56 ± 1.45). There was a high correlation obtained between SCI score and DMFS score. The regression equation given by DMFS = 1.178 + 1.866 (SCI scores). CONCLUSION: The caries experience was higher in workers working in soft-drinks factory and this study also showed that specific caries index can be used as a valid index for assessing dental caries experience.

Prevalence and risk factors for dental erosion among 11- to 14-year-old school children in South India.

This cross-sectional survey was conducted to assess the prevalence and severity of dental erosion and to determine the potential risk factors for dental erosion among 11- to 14-year-old school children in South India. The total sample size for the study was 605, of which 303 school children were from private schools and 302 from public schools. A questionnaire was designed to record information about socio-demographic characteristics, oral hygiene practices, dietary habits and risk factors for dental erosion. Chi square test, bivariate analysis and Logistic regression analysis were performed to analyse the data. The children who consumed lemon several times a day (OR = 13.41, P < 0.001), and those who preferred carbonated drinks (OR = 2.80, P = 0.007) had a higher tendency to develop dental erosion. The overall prevalence of dental erosion was found to be low (8.9%). Erosion was found to be greater in posterior teeth (65.6%) than anterior teeth (34.4%). Loss of enamel only with loss of surface contour was observed in most (94.8%) of the cases. The prevalence of dental erosion was found to be low in school children. Private school children were affected more by dental erosion. Frequency of lemon consumption and consumption of carbonated drinks were identified as risk factors.