Systematic review of longitudinal studies on the association between cluster of health-related behaviors and tooth loss among adults.

OBJECTIVES: To systematically review longitudinal studies on the association between cluster of/multiple health-related behaviors and tooth loss among adults. MATERIALS AND METHODS: Inclusion criteria were prospective and retrospective longitudinal studies; adults; multiple or cluster of behaviors; tooth loss, one or more tooth lost and complete tooth loss. Exclusion criteria were intervention studies; cross-sectional studies; case-control studies; children under 18 years-old; single behavior. Two reviewers searched three databases up to April 2023. Open Grey and Google Scholar were searched for grey literature. RESULTS: Twelve longitudinal studies were included in this review. Nine studies had good quality, two had poor quality, and one had fair quality according to New-Castle-Ottawa Scale. According to ROBINS-E tool, nine studies were judged as moderate risk of bias while two studies were at low risk of bias and one study had serious risk of bias. One study assessed cluster of behavior, while others examined a number of separate health-related behaviors in relation to tooth loss. Meta-analysis was not feasible because of the high heterogeneity in exposure, measure of outcomes, covariates, sample size, and follow-up time. The research found an association between tooth loss and oral hygiene practices (two studies), dental attendance (four studies), smoking (six studies), and alcohol consumption (three studies). CONCLUSION: This review provides evidence of a longitudinal association between cluster of/multiple health related-behaviors and tooth loss.

Re-audit of the use of flumazenil following midazolam-induced conscious sedation.

INTRODUCTION: Flumazenil is an antagonist drug of Benzodiazepam (BDZ) that has been used as a reversal agent of midazolam-induced conscious sedation (CS) in both emergency and elective procedures. For CS procedure, a high-quality record keeping and clinical justification prior to admission of flumazenil are recommended. Clinical Audit (CA) enables clinicians to evaluate the quality and standard of recorded clinical procedures. METHODS: This re-audit investigated the reasons for the use of flumazenil and record keeping's quality with particular emphasis on CS. In this retrospective reaudit, the authors looked at the patients' records who had received dental care under CS in the Sedation and Special Care Department of (SSCD), United Kingdom from January to June 2022. RESULTS: Out of 665 patients who received midazolam-induced CS, 21 patients were administered IV Flumazenil. The commonest reason (9, 42.8%) was due to prolonged recovery. CONCLUSION: This re-audit highlighted the need for administrating flumazenil in certain patient groups, and/or circumstances (not emergency). The importance of maintaining high-quality record keeping is discussed.

Feasibility of minimum intervention oral healthcare delivery for individuals with dental phobia.

BACKGROUND: People with dental phobia often present with more active dental caries and fewer teeth. Minimally Intervention oral Healthcare offers a possible solution to address the high care needs of this group. The aim was to determine this patient group's eligibility and willingness to participate and the effect of MIOC, compared to treatment as usual (TAU), on their oral health outcomes for planning a future randomised controlled trial (RCT). Minimum intervention oral healthcare (MIOC) comprises of four interlinked domains. In the first domain, we identified and diagnosed the disease status and participants' anxiety status (≥ 19 MDAS). In the second domain, an individualised prevention-based personalised care plan was designed. During this process, patients with dental phobia were exposed to the dental environment in a stepped manner ('graded exposure') and had their urgent care provided with conscious sedation. In the 3rd domain, we took a minimally invasive operative approach to restore teeth while preserving tooth substance and limiting the use of fear-provoking stimuli (e.g., rotary instruments) when possible. At the review and the recall appointment(s) (4th domain), the patients' oral health care behaviours, disease risk/susceptibility and fear levels were re-assessed. METHODS: This two-arm randomised feasibility trial (N = 44) allocated participants to the experimental arm (MIOC) or the control arm (treatment as usual [TAU]). The primary outcomes were the eligibility and willingness to participate and feasibility to conduct a trial of MIOC for people with dental phobia. The secondary outcomes were oral health status, oral health related quality of life and care completion. A written and verbal consent for participation and dental care provision were obtained. RESULTS: Forty-four people diagnosed with dental phobia were allocated randomly to the two study arms. At the six-month recall after completed care, the outcome of each study arm was assessed. It was feasible to conduct a clinical trial (eligibility rate [56%], completion rate [81%], declined to participate [12%]). The intervention group showed improvements in all health care outcomes, and oral health related quality of life. CONCLUSION: A clinical trial of MIOC vs TAU in people with dental phobia is feasible. Preliminary findings suggest that patients in the MIOC arm are more likely to successfully complete their course of treatment. The study was 'retrospectively registered' on 02/05/2018 (ISRCT15294714) with the International Standard Randomised Controlled Trial (ISRCT).

Models of dental care for people experiencing homelessness in the UK: a scoping review of the literature.

Background People who experience homelessness have poor oral health and face barriers to accessing care. Recommendations have been outlined for health services to address their needs, termed 'inclusion health'. The Smile4Life report recommended three 'tiers' of dental service: emergency, ad hoc and routine care. Other medical services have developed into different models of care, for example mainstream practices with enhanced services for people who experience homelessness. There is little understanding of how inclusion health recommendations have been implemented across dental settings.Aims To describe and compare dental services that exist for people who experience homelessness in the UK.Methods Two Medline searches were performed in October 2020 to assess the models of dental care for people who experience homelessness in the UK.Results Nine dental services in the UK were identified who treated people who experience homelessness. Most did not explore definitions of homelessness. There were a mixture of models, including using blended approaches, such as different sites and appointment types, to flex to the needs of their population.Conclusion Many services that are dedicated to treat this population are based in the community dental services which allows for flexible models of care due to sporadic patient attendance, high treatment requirements and complex needs. More research is required to determine how other settings can accommodate these patients, as well as understanding how more rural populations access dental care.

Ethnic inequalities in child oral health behaviours among five- and eight-year-old children from England, Wales and Northern Ireland.

Aim To examine whether there are ethnic inequalities in child oral health behaviours and the role of parental socioeconomic status (SES) in explaining them.Methods Data from 2,186 five- and eight-year-olds of white, Asian, Black and other ethnicity, who participated in the 2013 Children's Dental Health Survey, were analysed. Parents reported their children's toothbrushing and dental attendance. Logistic regression was used to explore ethnic inequalities in child behaviours, adjusting for demographic factors and parental SES.Results Children of Asian ethnicity were less likely to start brushing early in life (odds ratio [OR]: 0.25; 95% confidence interval [CI]: 0.15-0.43), brush regularly (OR: 0.56; 95% CI: 0.32-0.97) and have a check-up last year (OR: 0.28; 95% CI: 0.16-0.49) than those of white ethnicity. Children of Black ethnicity were less likely to have a check-up last year (OR: 0.39; 95% CI 0.17-0.89) than those of white ethnicity. Children of other ethnicity were less likely to start brushing early in life (OR: 0.41; 95% CI: 0.23-0.77) and brush regularly (OR: 0.45; 95% CI: 0.23-0.87) than children of white ethnicity. Inequalities in toothbrushing frequency and regular dental attendance between children of Black and white ethnicity were fully attenuated after adjustment for parental SES.Conclusion There were ethnic inequalities in child toothbrushing and dental visiting, with children of Asian ethnicity being the most affected. Parental SES only explained part of these inequalities.

Sexual hallucinations during conscious sedation for dentistry - an update of the phenomenon.

Background Sexual hallucinations have been suggested as an infrequent side effect during sedation and cases can result in sexual assault allegations. The aim of this article is to review the literature on this rare side effect during sedation.Methods Publications were chosen using inclusion criteria: hallucinations and/or alleged sexual assaults and/or paradoxical reactions to either sedation or anaesthesia, that were of a sexual nature. Non-English language papers were excluded. Studies were analysed for: methodological quality, sedative agent, dose, population, treatment undertaken and outcome of the hallucination.Results Twenty-eight publications were reviewed. There was literature discussing sexual hallucinations to midazolam (13 studies), propofol (12 studies) and nitrous oxide (three studies). This side effect to sedative agents has a low incidence and can depend on factors like the sedation agent, dosage and type of procedure undertaken.Conclusions Current literature suggests that on rare occasions, sedation may induce sexual hallucinations and higher dosages are more likely to be implicated. In an occurrence of this side effect, presence of a third party and record-keeping is essential. Thorough patient assessment, appropriate clinician training and adhering to national dental sedation guidelines will help maintain the excellent safety record of UK dental sedation.

Minimum intervention oral healthcare for people with dental phobia: a patient management pathway.

Dental phobia is relatively common among adults and often associated with poorer oral health as a consequence of delaying dental treatment until advanced disease has caused intolerable symptoms. The increased rates of active disease may also have an impact on oral health-related quality of life (OHR QoL).Minimum intervention oral healthcare (MIOC) combines four key domains: detection and diagnosis, prevention and control of oral disease, minimally invasive (MI) operative interventions and review/recall. Team delivery and patient-focused care are the underpinning tenets to these four domains. The MIOC approach offers advantages to both patients with dental phobia and the oral healthcare team involved in their long-term management. This paper presents an adaptation of MIOC for patients with dental phobia, which is founded on a comprehensive assessment approach followed by the provision of dental care with behavioural management techniques in combination with conscious sedation. This approach has the potential to provide a comprehensive personalised patient management pathway for delivering better oral health for this vulnerable patient group in a primary care setting.

A curriculum for behaviour and oral healthcare management for dentally anxious children-Recommendations from the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE).

BACKGROUND: Dentists need training in the management of children's anxiety (DA), fear (DF) and behaviour management problems (DBMP) but little is known of their competence on this topic. AIM: To report dentists' opinions and attitudes about protective stabilisation and pharmacological techniques for the management of children with DA/DF/DBMP; to propose a postgraduate curriculum focussing on DA/DF/DBMP. DESIGN: A survey of 301 Brazilian dentists and later a modified Delphi process to outline the curriculum in two phases: (a) face-to-face discussions with 33 early career researchers mentored by six researchers, both from UK and Brazil; (b) online discussions by eight early and senior researchers on the knowledge, experience, and competencies necessary for a specialist in paediatric dentistry in Brazil that should be included in the core curriculum of postgraduate courses. RESULTS: Almost all (99.0%) of the survey respondents provide treatment to children with DA/DF/DBMP, and 91.2% do not systematically diagnose these conditions; 94.3% use protective stabilisation, and 20.0%-30.0% have training in pharmacological techniques. The four-domain framework supporting the proposed curriculum is as follows: DA/DF/DBMP assessment, non-pharmacological and pharmacological approaches, and decision-making. CONCLUSION: Dental curricula should be customised to solve the misconceptions and promote a comprehensive and positive attitude to DA/DF/DBMP by paediatric oral healthcare practitioners.

The impact of dental phobia on care planning: a vignette study.

Introduction A high percentage of people with dental phobia have poor oral health. This may be the result of delayed treatment or differences in care planning by the oral health care team.Aim This study sought to determine the effect, if any, of dental phobia and complexity of dental care on the proposed care plan devised by clinicians for patients.Design An experimental analogue study with independent variables of the presence of phobia and complexity of treatment need. Dependent variables included frequency of care planning elements such as periodontal treatment, prevention, restorations, root canal treatment, extraction and provision of crowns, bridges and prostheses.Participants Seventy-nine UK-based dental practitioners.Analysis The association between the case status (phobic versus non-phobic, simple versus complex) and the outcome variables were assessed using a chi-square test for association. Logistic regression analyses were also used to determine the predictors of care planning elements.Results There were no differences in care planning for phobic and non-phobic patients. Complexity of treatment need had significant effects on advanced periodontal treatment, restorations anterior and posterior, root canal treatment, provision of crowns, and extractions.Conclusions Care planning is influenced by patients' dental needs and not their phobic status.

The Effect of Radiotherapy for Treatment of Head and Neck Cancer on Oral Flora and Saliva.

PURPOSE: Radiotherapy causes xerostomia in patients treated for head and neck cancer. This study investigated changes in quality and quantity of saliva after radiotherapy and possible associations between these changes and alterations in oral flora. MATERIALS AND METHODS: The study was a prospective cohort study of patients receiving radiotherapy for head and neck cancer. Suitable patients were recruited before treatment commenced, and informed consent was obtained. Patients were examined, and provided unstimulated and stimulated saliva samples. Quantity of saliva, buffering capacity and pH were measured. Oral flora was cultured from the saliva samples. Oral clearance of glucose and of lactose was measured. These interventions were repeated at intervals after radiotherapy had been completed. RESULTS: Eighteen patients were recruited. Stimulated and unstimulated saliva flow rates, glucose clearance, salivary pH and buffering capacity were significantly reduced after radiotherapy. Candida albicans counts were significantly increased. These increases were significantly correlated with reductions in stimulated and unstimulated salivary flow rates. Counts of lactobacilli, Streptococcus mutans and Bifidobacteriaceae increased, but not statistically significantly. CONCLUSIONS: Therapeutic radiotherapy significantly reduced the quality and quantity of saliva in head and neck cancer patients. These reductions were associated with increased C. albicans counts.

Hungry for nothing: should dental patients fast prior to conscious sedation?

OBJECTIVE: This research explores the attitudes of medical professionals towards fasting patients prior to the use of conscious sedation. MATERIALS AND METHODS: Questionnaires were completed by a total of 113 dentists, anaesthetists and dental nurses in order to identify current practices and opinions concerning the employment of pre-operative fasting in the context of conscious sedation in dentistry. RESULTS: Seventy-eight (69%) respondents did not recommend fasting, compared with 35 (31%) who did. Those who did not recommend fasting were able to state significantly more adverse effects (P<0.01) of fasting when compared to the 35 (31%) who advocated fasting. Significantly more anaesthetists (80%) than dentists (14%) advised fasting patients (P<0.001). Thirty-two of 39 (82%) respondents mentioned the risk of aspiration to be the main reason for recommending that patients be fasted. CONCLUSION: Medical professionals in dentistry provide a wide range of conflicting views on the employment of fasting prior to conscious sedation reflecting the lack of homogeneity in literature surrounding this topic.