Exploring facilitators and barriers associated with oral care for inpatients with dysphagia post-stroke.

OBJECTIVE: To explore the attitudes, facilitators and barriers in providing oral care for inpatients with dysphagia post-stroke as perceived by healthcare professionals. BACKGROUND: Dysphagia is a common complication of stroke and is associated with a higher incidence of aspiration pneumonia, malnutrition and dehydration. In the acute phase of stroke recovery, a dental professional is not usually part of the multidisciplinary team caring for the patient and oral care is the responsibility of the healthcare professionals in the stroke unit. There is a lack of high-quality evidence to demonstrate the most effective method of providing oral care for patients with dysphagia post-stroke. MATERIALS AND METHODS: This was a single-site study conducted with healthcare professionals working in the Stroke Unit of Cork University Hospital in Ireland, using focus groups and a qualitative thematic analysis approach. RESULTS: A total of three focus groups were conducted in the Stroke Unit with 17 healthcare professionals. The focus groups included representation from all healthcare professional groups providing direct clinical care to patients on the Stroke Unit including geriatric medicine, dietetics, speech and language therapy, healthcare assistance, nursing, occupational therapy and physiotherapy. A qualitative thematic analysis was carried out and seven overarching themes emerged from the data. Three themes related to facilitators to providing oral care for this patient group: (i) a focus on oral care in both policy and practice, (ii) expanding professional roles in the provision of oral care, (iii) perceived importance of oral care in recovery and rehabilitation. Four themes related to barriers to the provision of oral care for this patient group: (i) lack of confidence and concerns related to the perceived risk for patients with dysphagia, (ii) unique challenges of patient and stroke-related factors, (iii) lack of resources and time and (iv) perceived importance of oral care in recovery and its relative importance with competing demands. CONCLUSION: Members of the stroke multidisciplinary team believe that they all have a part to play in the delivery of oral care for patients with dysphagia post-stroke. Opportunities exist for the development of multidisciplinary interventions to improve the oral cavity assessment and oral care provided in the Stroke Unit.

First trimester miscarriage: patient care considerations for the dental team.

First trimester miscarriage is common, occurring in approximately 6.4-12.0% of pregnancies. Women who experience first trimester miscarriage will often have no other significant health conditions and the healthcare professional they most frequently visit could be their dentist or dental care professional. For this reason, it is important that the dental team is aware of the management of first trimester miscarriage in order to allow for a better understanding of the patient's experience and situation. The choice of language used by healthcare professionals with patients who are grieving is also important to ensure effective and open communication.This article aims to provide the dental team with knowledge of first trimester miscarriage, how the effects of this can be relevant within the dental setting, and how to communicate effectively and appropriately with patients who have experienced this traumatic event.

Dental implications of new oral anticoagulants for atrial fibrillation.

UNLABELLED: As dental professionals, we should all be familiar with the most common oral anticoagulant, warfarin, and how to manage our patients that are taking it. However, several new oral anticoagulants which have recently been approved by the National Institute for Health and Care Excellence (NICE) are now being prescribed for patients in the United Kingdom. These new oral anticoagulants fall into two different categories: a direct thrombin inhibitor dabigatran etexilate (Pradaxa Boehringer-Ingelheim, Bracknell, Berkshire) and activated Factor X inhibitors rivaroxaban (Xarelto Bayer HealthCare, Newbury, Berkshire) and apixaban (Eliquis Bristol-Myers Squibb, Uxbridge, Middlesex). These new drugs will have potential consequences for how dental practitioners manage patients requiring dental treatment, especially extractions and minor surgical procedures. CLINICAL RELEVANCE: It is important that dentists are aware of new anticoagulants which are being prescribed for patients to ensure that they receive safe and appropriate dental treatment. As healthcare professionals we should also be aware of how and when to report adverse drug reactions.