Special Care in Dentistry最新文献

Aim: Actinomycosis is a chronic, suppurative, granulomatous bacterial infection caused by Actinomyces, a gram-positive anaerobic bacterium commonly present on mucosal surfaces. Although not classified as an opportunistic infection, it frequently affects immunocompromised individuals.

Methods and results: We report the case of a 54-year-old woman with acute myeloid leukemia who developed oral mucosal pain, odynophagia, and severe halitosis during hospitalization. Clinical examination revealed two ulcerated lesions on the hard palate, with a reported progression over three months. Computed tomography showed a perforation in the anterior maxilla. Due to severe thrombocytopenia (10 000/mm³), a biopsy was performed after platelet transfusion. The differential diagnosis initially included leukemic infiltration, oral carcinoma, and opportunistic infection. Histopathological analysis confirmed the diagnosis of actinomycosis. The patient was treated with oral Amoxicillin 1 g every 12 hours.

Conclusion: Diagnosing Actinomyces infections can be challenging due to their varied clinical presentations and similarity to malignant lesions. Despite its rarity, actinomycosis should be considered in the differential diagnosis of ulcerated palatal lesions, especially in immunocompromised patients.

This is a narrative review of contemporary radiotherapy for head and neck cancers, the role of pre-radiation dental clearance, and rationale for a targeted approach to pre-radiation treatment. Emphasis is placed on avoiding delay in the start of radiation. The goals of this article are to facilitate communication between the dentist and radiation oncologist, succinctly summarize current recommendations, and give suggestions on what qualifies as high priority dental care in the pre-radiation setting.

Aims: Oral health of long-term care (LTC) residents remains a concern despite many years of evidence-based interventions. This study aimed to explore the social organization of care contributing to poor oral health of residents in LTC homes.

Materials and methods: Institutional ethnography (IE) was used from the healthcare aide (HCA) standpoint. The oral care provided by HCAs in the LTC homes was explored through observations and interviews that focused on HCAs' interactions with institutional texts. Data analysis included text-work-text (TWT) mappings to illustrate how oral care was socially organized.

Results: HCAs determined how and when to provide oral care for residents. Standardized assessments designed by the regulatory health authority to assist LTC homes in complying with care standards were insufficiently detailed to guide the oral care provided by HCAs. HCAs lacked knowledge about oral care beyond tooth-brushing and denture care.

Conclusions: In the absence of effective institutional texts, HCAs used their discretion, relying on their personal experiences, to inform the oral care provided for residents. This study helps to understand the organizational factors that contribute to poor oral health and offers alternative intervention strategies.

Aims: Nigeria's rapidly aging population presents urgent challenges for the healthcare system, particularly in oral health, which remains an overlooked aspect of well-being. While older adults are especially vulnerable to dental issues such as tooth loss, periodontal disease, and oral pain, access to care remains limited due to systemic, economic, and cultural barriers. This qualitative study explored the lived experiences of older Nigerians in accessing and utilizing dental care, with the goal of identifying key barriers, facilitators, and policy-relevant insights.

Methods: Fifteen participants aged 50-83 years were purposively selected from urban and peri-urban areas of Ilorin, North-Central Nigeria. Using a semi-structured interview guide, data were collected through face-to-face interviews and analyzed thematically following Braun and Clarke's methodology.

Results: Three overarching themes emerged: (1) barriers to accessing dental care, including high treatment costs, geographic inaccessibility, mobility challenges, and long waiting times; (2) facilitators of care, such as family support, employment-based insurance, and culturally supportive health beliefs; and (3) perceptions of dental care, with participants recognizing its importance for nutrition, dignity, and overall quality of life. Findings reveal that dental care for older adults in Nigeria is shaped by a combination of structural neglect and individual adaptation. While participants valued preventive care, financial constraints, poor infrastructure, and a lack of geriatric-trained professionals limited consistent access. However, social support networks and respectful provider interactions were critical enablers of care.

Conclusions: This study points to the need for age-inclusive health policies that integrate dental services into primary healthcare, expand insurance coverage, and strengthen community-based outreach. Addressing these gaps is not only a matter of public health, but of equity, dignity, and the right to age well.

Aims: Ageism, also known as age-based discrimination, refers to the discrimination individuals face due to their older adult status. This type of discrimination is recognized internationally as a problem that has negative effects on individuals. The Ageism Scale for Dental Students (ASDS) was developed to evaluate dental students' attitudes toward providing oral healthcare to older adults and has been successfully implemented across different cultures. The aim of this study is to translate and validate the ASDS in Turkish (ASDS-Tr).

Methods: This study utilized the original 27-item ASDS along with five demographic questions. The study group consisted of 270 undergraduate students from the Istanbul University Faculty of Dentistry.

Results: The scale items assessing dental students' attitudes toward older adults were analyzed using Principal Component Analysis (PCA). The final PCA model comprised 15 items and five components, explaining a total variance of 58.9%. The Cronbach's α coefficient for these 15 items was 0.582, indicating acceptable internal consistency.

Conclusion: ASDS-Tr has undergone a preliminary validation study for use in Turkey, yielding positive results. The preliminary validation of ASDS-Tr produced 15 items scale with five components with acceptable validity and reliability. This scale aims to effectively assess dental students' attitudes toward older adults in Turkey.

Cardiovascular disease is the leading cause of morbidity and mortality worldwide, making it inevitable that dentists will encounter patients with this condition. A thorough understanding of the medical and surgical management of these patients is essential to ensure safe and effective delivery of dental care. A comprehensive preoperative evaluation, optimal perioperative tissue management, and thorough review of postoperative instructions are each critical in reducing the risk of postoperative bleeding and avoiding medical complications when rendering dental services. Additionally, the need for antibiotic prophylaxis and current recommendations for pre-surgical dental intervention will be discussed. This review aims to help elucidate the current guidelines and existing literature, providing insight into best practices for managing this common, yet complex, patient population.

People with special health care needs and caregivers alike cite dentistry as among the most inaccessible primary health care services. As the population of people living with disabilities increases, there is both a moral and demographic imperative to improve dental education to better serve these patients. It is a significant challenge for many dental schools to provide the breadth and depth of clinical experiences required to produce dentists competent in treating this patient population. Community-based clinical education could provide additional clinical training opportunities in special needs dentistry and represent a potential solution to existing barriers in dental education.

Aims: Individuals with complex medical and social needs often face barriers to health care, leading to poor health outcomes. The Nurse Practitioner-Dentist Integrated Practice Model (NPD Model) integrates a nurse practitioner (NP) within the dental team to enhance chronic disease management, improve access to care, and support interdisciplinary collaboration. This study evaluates a dental school pilot program's clinical and financial impact.

Results: We first examine a case study illustrating the NPD Model's positive impacts on a patient with diabetes and periodontal disease. We also analyze data from patient primary care visits between September 2023 and April 2024 to understand patient demographics, patterns of primary care utilization, clinical outcomes, and financial sustainability. Our results support our hypothesis that the NPD Model facilitates comprehensive, person-centered health care by an interdisciplinary provider team and is especially impactful for individuals with complex medical and social needs; it is also economically feasible in an academic dental setting.

Conclusion: The NPD Model enhances patient-centered care for medically complex individuals by integrating medical and dental services. The NPD Model holds significant potential to be extrapolated to other dental and medical settings, including hospital-based primary care clinics and emergency rooms.