Community dental health最新文献

This paper summarises the proceedings of a workshop organised by the European Association of Dental Public Health, held in Montpellier in September 2022. The full proceedings were transcribed and are available on the Community Dental Health website (https://www.cdhjournal.org/article/973). The WHO Action Plan for Oral Health provides a golden opportunity to help raise the profile of oral health, to put oral health on the global public health agenda and ultimately improve oral health. It is to be applauded. However, delivery will present a challenge. Those challenges and opportunities are detailed in this paper.

Objective: To identify and investigate any differences in utilisation of the, Sussex Community NHSFT, Special Care Dental Service (SCDS) across multiple demographic factors, including ethnicity, socio-economic groups and age in the Crawley area.

Method: Data were audited for all new patients seen at the Crawley Special Care Dental Centre from November 2020-October 2021. Demographic data were compared to population data from the 2011 Census. Deprivation data, using Index of Multiple Deprivation, were also examined against utilisation and failure to attend appointments.

Results: A total of 1250 new patients accessed the Crawley SCDS between November 2020 and October 2021. The data suggests good equity to the service being utilised by the local community; the proportions of patients utilising the service over the course of a year from different ethnic groups reflected the demographic profile of Crawley. The proportion of failed appointments showed no correlation with deprivation decile. There was also no association between ethnic group and proportion of failed appointments.

Conclusion: Ensuring equal utilisation of healthcare for all population groups has become a priority for healthcare providers. This audit found minimal inequities in utilisation of the Special Care Dental Service at Crawley.

Objective: To assess the demographic and time trends in hospitalisation rate for Pulp and Periapical Diseases (P&PDs) over 20-years (1998-99 to 2017-18), amongst children and adolescents (under age 19 years) in all states and territories of Australia. P&PDs are considered potentially preventable, with the possibility of them resulting in emergency presentations if timely treatment is not provided. They can result in treatment under general anaesthesia, which is costly.

Design: Retrospective analysis of hospitalisation for pulp and periapical diseases.

Setting: Public and private hospitals across Australia.

Main outcome measures: The number of hospitalisations (measured using the number of separations or cases of hospital admission) for all pulp and periapical diseases by age-group.

Results: There were about 40,000 hospitalisations regarding P&PDs over the 20 years among Australian children under 19 years old. The rate of admissions ranged from means of 28.5 to 44.1 per 100,000 population. The number of admissions increased over 20 years for all children, except those younger than 4 years. Children aged 5-9 years had the highest rate of admissions and, more days in hospital per admission than other age groups. Most children only had one-day admissions.

Conclusion: Pulp and periapical diseases hospitalisation rates have increased over two decades. Additional approaches to improve child dental health in Australia need to be considered.

Domestic violence and abuse (DVA) is a significant public health problem both globally and in the UK. Dental professionals are aptly place to detect the signs of DVA and support patients to disclose DVA. However, dental professionals may lack confidence to identify and refer patients experiencing DVA; training needs in these areas were identified in Staffordshire. Glow DVA charity and the local Dental Public Health teams worked collaboratively to develop DVA training and resources specific to the needs to the dental team; these were provided to participating dental practices in the North-Staffordshire region. Feedback from the training was positive and the training was refined to better meet the needs of the dental team.mKey challenges included obtaining dental team buy in, securing funding for the continuation of the initiative and minimising the disruption to the dental team when attending training sessions or when managing a DVA disclosure. The implementation of the training highlighted the importance of DVA champions within the third sector organisations to develop and evolve the project, within dental practices to support implementation, and within the local Dental Public Health team to facilitate dental team buy-in and sustained engagement. Future plans include developing the patient-facing resources, finding ways to formally accredit dental teams for taking part in the DVA programme, and evaluating the impact of the training programme on DVA screening, identification and referral.

Background: Dental caries is considered a major global health issue and among the most challenging diseases worldwide. An effective way of preventing dental caries is the fissure sealant (FS) therapy.

Objective: To determine the effectiveness of an educational intervention developed based on the health belief model (HBM) for parents' perception of FS therapy for their children.

Methods: Quasi-experiment among 300 parents of 6-12 year-old children, 150 in the intervention group (IG) and 150 in the control (CG), in the south of Iran recruited via both clustering and convenience sampling. Data were collected using a validated questionnaire collecting demographic information, knowledge and data on HBM constructs and FS behaviour. Eight intervention sessions, 40-60 minutes long, were held for over month. The primary outcome was child's receipt of fissure sealants 3 months after the intervention.

Results: The two groups had similar knowledge and the HBM constructs at baseline. After the intervention, the receipt of FS therapy was 65% and 12% in the IG and CG, respectively (p ⟨ 0.001, Chi Sq.). ANCOVA supported post-test differences between the intervention and control groups when accounting for baseline scores (p⟨0.05).

Conclusions: The educational HBM-based intervention improved parents' perceptions and their children's receipt of FS therapy. The intervention affected the HBM constructs. Barriers to healthy oral/dental behaviours may be reduced by interventions at multiple layers (beyond the individual level).

Objectives: Despite high rates of oral disease in Indigenous communities globally, progress is slow in implementing policies and practices so the depth of inequity is addressed and oral health outcomes improve. Indigenous communities are often poorly consulted in the process. This paper responds to this inequity by seeking to create a respectful intercultural space at international dental conferences where Aboriginal health practitioners and dental public health researchers can discuss ways forward for oral health in Indigenous communities.

Methods: Participatory action research informed by Indigenist methodologies guided this research. Two roundtable discussions between Australian Aboriginal and non-Aboriginal participants were recorded, transcribed and analysed for themes related to problems and potential solutions to dental disease in Indigenous communities. Follow-up discussions on participants' reflections engaging in this intercultural space were recorded and analysed.

Results: Two Aboriginal health practitioners and five non-Aboriginal international dental public health researchers identified the importance of inclusion where intercultural engagement and collaboration with Indigenous Peoples were integral to conducting research in this context and improving oral health outcomes.

Conclusions: Creating a safe, respectful space between Aboriginal health practitioners and non-Aboriginal dental public health researchers at an international conference fostered dialogue to better understand barriers and enablers to good oral health outcomes. Intercultural engagement and discussion is a step towards mutual understanding of oral health perspectives and experiences that can foster equity and enable more collaborative responses to improve oral health outcomes.

Background: Studies have reported varying relationships between periodontitis and non-alcoholic fatty liver disease (NAFLD). This review aimed to summarise evidence by pooling published data on the association between periodontitis and NAFLD.

Methods: PubMed, CENTRAL, Web of Science, and Embase databases were searched for cross-sectional, case-control, or cohort studies published up to 20th June 2022. The PICO statement was: In the general Population does the presence of periodontitis (Intervention) as compared to no periodontitis (Comparison) lead to NAFLD (Outcome). All included studies were to report the association between periodontitis and NAFLD using odds ratios (OR) or risk ratios with 95% confidence intervals (CI). Random effects meta-analysis was conducted to obtain pooled OR with 95% CI.

Results: Meta-analysis of seven studies with data of 192,815 participants found no association between periodontitis and NAFLD (OR: 1.04 95% CI: 0.97, 1.12). There was medium heterogeneity in the meta-analysis (I²=58%). The results did not change with the exclusion of any study. A small risk of NAFLD was noted in periodontitis patients on analysis of two cohort studies. Results were non-significant for other study types. Subgroup analysis based on the study population and diagnostic method for NAFLD also failed to find relationships.

Conclusion: Current evidence fails to demonstrate a link between periodontitis and NAFLD.

Background: The Black population has poorer oral health than other racial groups; however, little is known about the mechanisms that explain this difference.

Objective: To study the association between race and tooth loss and map the evidence on factors associated with tooth loss in Black older populations.

Methods: Scoping review following the PRISMA Extension for Scoping Reviews conducted according to the recommendations of the Joanna Briggs Institute. A three-step search strategy was applied, and data were collected between April and July 2021. Searches were performed in the PubMed, Lilacs, and SciELO databases. The grey literature was searched using Google Scholar (https://www.scholar.google.com/). The reference lists of included studies were used as additional sources. Studies published in English and Portuguese of the association between tooth loss and different racial groups and the factors associated with tooth loss and tooth retention in Black older adult populations were included.

Results: Twenty-one of 913 original articles published between 1995 and 2020 were included. Of these, 75% were research articles, 15% were reports, and 10% dissertations. Eighty per cent reported cross-sectional and 20% longitudinal data. African ancestry was associated with increased odds of tooth loss in older adult populations. Periodontal disease, female sex, and advanced age were the exposures most frequently associated with tooth loss.

Conclusion: Race, educational level, advanced age, and oral diseases such as periodontitis are associated with increased tooth loss in Afro-descendant older populations.

Objective: Rapid review of the literature on strategies to increase participation rates in school-based epidemiological surveys.

Basic research design: Rapid review. MEDLINE and Embase databases were searched for articles written in English from 2000 onwards. Synthesised evidence and primary research were included as data sources from peer reviewed journals and reports.

Interventions: Any strategy aiming to increase participation in school-based health surveys. The comparator was usual procedure or an alternative strategy to increase participation.

Main outcome measures: Primary outcomes included participation and consent rates. Secondary outcomes were feasibility, acceptability and adverse effects.

Results: The search identified 591 unique records, of which 587 were excluded. Four studies were suitable for inclusion, including one systematic review, one randomised controlled trial, one cross-sectional study and one retrospective analysis. Based on very low certainty evidence, recommendations for maximising participation rates in one systematic review of US studies included: promoting the survey to school staff, parents and students; disseminating study information using direct rather than mediated methods; offering incentives to schools, staff and participants; following up non-responders; and employing a research team member to co-ordinate and monitor recruitment. However, UK studies found that different strategies did not increase participation more than that achieved by a standard approach (delivery of covering letter/consent forms via the child with no follow-up of non-responders).

Conclusion: Given the lack of evidence of effectiveness of alternative strategies in the UK, additional measures beyond existing standard approaches for active consent cannot be recommended.

Objective: The frequency of Preventable Infectious Dental Disease (PIDD) visits in medical centers was examined pre and post establishment of expanded dental access and adoption of an integrated medical-dental care delivery model.

Methods: A retrospective observational study of patient attributes and frequency of unscheduled PIDD visits between January 1, 1990 and February 29, 2020. Chi-squared tests compared (a) the number of PIDD visits (pre/post dental center establishment), (b) age at first diagnosis, (c) gender, (d) race, (e) primary insurance at the time of PIDD visits and (f) healthcare setting where visit occurred.

Results: System-wide, 21,957 unique patients were documented with a total of 34,892 PIDD visits as the primary diagnosis. Patients between 18-30 years and patients with Medicaid had the highest frequency of PIDD visits in medical settings. Following the establishment of dental centers, reduced relative risk of PIDD visits was observed for patients with no health insurance or self-pay/other coverage. PIDD visits in primary care settings was 0.87 times as likely as PIDD visits at ED/UCs after dental centers opened.

Conclusions: The number of PIDD visits to medical centers increased before the dental infrastructure was established, followed by a decline afterwards, inclusive of disparity populations. Some residual persistence of PIDD visits to primary care settings was identified. This study reinforced importance of dental healthcare access for achieving appropriate PIDD management while reducing PIDD visits to medical settings.