A paradigm shift in models of oral health care:An example and a call to action

The consequences of oral disease are wide-ranging and can have a major impact on an indi-vidual’s and that person’s family’s quality of life.A range of factors interact to determine a person’s oral and general health.Such factors can be biological,social,economic,political,cultural,or environmental,in addition to knowledge,attitudes and behaviors.Traditional models of oral health care,however,have generally ignored these factors and instead have focused on the treatment and management of existing pathology(tertiary prevention/downstream approach).This has had no effect on the rate of hospitalization or the inequitable distribution of dental diseases.To reduce the prevalence and severity of oral diseases at the individual and population levels,holistic evidence-informed prevention-based health-promoting models of care that focus on upstream determinants of health are required.The Oral Health Program at North Richmond Community Health in the state of Victoria,Australia,has developed an innovative model of oral health care based on the follow-ing principles:health promotion,disease prevention,risk-based access to care,client-and family-centered care,team-based provision of care,multidisciplinary care,and innovation.Evaluation of this approach is currently being conducted to study the sustainability of such a model under the current public dental service funding model.

Saving One Smile at a Time: Oral Health Promotion in Pediatric Primary Care Practice

Oral health continues to be a major issue affecting children these days. Early childhood caries are considered to be the most common chronic childhood disease in the United States. Despite the availability of Medicaid, millions of children can still not access a dental provider to receive proper care. Getting children in for dental care early in their lives saves money. Children that do not receive proper oral health care during their childhood are at higher risk for more complex and restorative care as they age. Plans to reduce childhood caries include more creative interventions such as oral assessment, education and fluoride varnish application in primary care practices. Pediatric primary care providers are trusted by parents to care for their children and have an ideal opportunity to make a lasting impression and create behavioral changes in oral health during their frequent contacts with children and families. Integrating oral health promotion is a simple task with numerous benefits for children and families, as well as primary care doctors’ offices. With proper professional and governmental support oral health promotion programs in primary care practice can further increase in number which can ultimately improve oral health outcomes, save time and prevent costly dental repairs, as well as benefit the practice through proper reimbursement.

Oral health in China-trends and challenges

For a long time, oral disease is one of the major problems of the public health for its high prevalence and incidence throughout the world, which is especially true for low-income populations. Since China＇s economic reform in 1978, great changes have taken place in China. These changes have significant impact on and have been reflected in oral disease trends in China. This paper provides an overview and assessment of the oral health status in China. It focuses on changes in the nation＇s demographic profile, in the marketplace, the oral disease status and trends. The paper also suggests some possible measures and strategies for bettering oral health in future China.

Nurses’ Knowledge, Attitude and Practice of Oral Care for Intensive Care Unit Patients

The aim of this study was to describe the intensive care unit (ICU) nurses’ knowledge, attitude, and practice of mouth care for their patients. This is a cross sectional hospital based study. A total of 154 ICU nurses were randomly selected from seven governmental hospitals in Khartoum state and were invited to take part in this study. 97.4% of ICU nurses had high knowledge of the importance of mouth care for ICU patients and similarly for the priority of mouth care. However, only 20% of nurses were found to apply good practice. 64.5% of the nurses received training in mouth care provision, and (81%) indicated that further training would be beneficial. The oral care practice of ICU nurses ranged between average among 57% and poor among 23%. The study highlighted the need for setting of ICU protocols and adoption of advanced training for ICU nurses.

Oral health status of Chinese residents and suggestions for prevention and treatment strategies

Objective:To understand the oral health status of urban and rural residents in China,the Fourth National Oral Health Epidemiological Survey (FNOHES) was conducted in 2015.Materials and methods:Based on the principles of multi-stage,stratified,equal capacity,and random sampling,the subjects included five groups of residents aged 3-5,12-15,35-44,55-64,and 65-74 years in all 31 provinces,municipalities,and autonomous regions except Hong Kong,Macao,and Taiwan.The total sample size was 172,425.The survey covered two areas,namely oral health status and knowledge,attitude and oral health behavior.Results:Residents in China had serious caries and poor periodontal condition.The prevalence of caries was above 50% in all age groups,subjects without periodontal disease accounted for <50%,and fewer than 50% of subjects brushed their teeth twice a day.Based on the results of the FNOHES,the following suggestions were proposed for improving the oral health in China in the future:to establish and improve the comprehensive prevention and control system for oral diseases,implement a comprehensive prevention and control strategy for priority groups,strengthen the oral health education for all people to improve oral health literacy,enhance dynamic monitoring to scientifically evaluate oral health status,and coordinate multi-party resources to establish and improve the oral health service security system.Conclusion:The oral health status of Chinese residents and their oral health behavior habits need to be improved.With the support of the administrative departments of the government and unremitting efforts of the oral health staff,all sectors of society must be coordinated to strengthen oral health education for the whole population.Furthermore,comprehensive prevention and control measures must be implemented for priority groups.

Nursing Activities at Health Surveys and Health Checkups during the Early Period of Operation of the Hiroshima ABCC—Oral History Study Based on Narratives of Three Japanese Nurses

Using an oral history approach, this study analyzed the narratives obtained from semi-structured interviews administered to three Japanese women who worked as nurses for the Hiroshima Atomic Bomb Casualty Commission (ABCC). The analysis of the data in the narratives showed details of the health surveys and health checkups conducted during the early period of operation of ABCC. During the early period of operation of ABCC some survivors showed negative behaviors toward the health surveys and health checkups at the ABCC. However, it can be inferred that dedicated nursing played an important role in alleviating the stress and emotional issues of survivors at the health surveys and health checkups. The findings of the study could be beneficial to research into nursing activities for patients exposed to radiation at the present day.

China's Oral Care System in Transition:Lessons to be Learned from Germany

Aim The objective of this discussion paper is to investigate whether the experience gained through the German paradigm shift in dental care can be of benefit in China＇s deliberations on the introduction of universal dental care for its people. Methodology A comparison of representative oral health outcome data from China and Germany, two countries at different stages in their development, is presented here in order to analyse whether the findings meet expected outcome and confirm the presumption that more developed countries perform better. Results The epidemiological comparison reveals surprising findings concerning the severity of dental diseases and, in particular, missing teeth per person in adults and rates of total edentulousness in seniors. In all of these areas German adults and seniors show significantly inferior outcomes compared with the Chinese population. The mainreason for these striking discrepancies, as it turned out, is the decisive role played by the treatment philosophies and strategies of German dentists. Conelusion and recommendations If dentists take a less interventionist approach, checking as well as treating dental diseases with preventive and strictly tooth-preserving methods, dental treatment results in oral health. Under these condi- tions it can be assumed that modem dentistry is generally good for the teeth. These findings are important for developing countries that are seeking to integrate dental care into their health care system. On the basis of long-term experience from highly industrialized Western countries and especially from Germany we will attempt to put forward proposals for creating an effective and efficient dental care system in China.

Professional Domiciliary Oral Care for Elderly in Nursing Homes—A Randomized Controlled Pilot Trial

Domiciliary dental care (DDC) makes regular dental visits possible for people with different functional limitations who otherwise would not be able to access a dental clinic. DDC also facilitates cooperation with nursing staff. To our knowledge, the effect of DDC on oral health among elderly people in nursing homes has not been studied. As part of a project to establish recommendations for DDC, the aim of this randomized, controlled, single-blind, pilot trial with three parallel arms was to study the effect of professionally conducted oral care intervention, in domiciliary setting, on gingival bleeding on probing, dental plaque and oral mucosa. For three months, the participants were given either A) monthly professional DDC with oral care intervention, B) monthly individual oral care instructions, or C) oral care as usual. A total of 102 (n = 107) individuals completed the study. After three months, gingival bleeding on probing was significantly reduced among more participants in groups A and B compared with group C (p < 0.0004). Dental plaque scores changed significantly over three months for group B compared with group C (p < 0.04). Mucosal-plaque scores were significantly reduced in group A compared with both group B and C (p < 0.0001). All other intergroup differences were statistically non-significant. Compared with care as usual, professional DDC has the most favourable effect on gingival bleeding, whereas individual oral care instructions result in the highest reduction of dental plaque. Both professional oral care interventions and individual oral-hygiene instructions should be included in a domiciliary oralcare programme.

Oral health status and performance of oral functions in children and adolescents in the treatment for overweight or obesity

The objective of this study was to evaluate the performance of oral functions and oral conditions in children and adolescents with overweight or obesity, investigating possible associations with treatment for weight reduction. Developing a cross-sectional research and quantitative approach with inductive and descriptive and critical analysis of data, such as from a range of 95%, the universe was represented by children and adolescents who were overweight or obese, in both sexes, treated at reference centers for the treatment of obesity by the National Health System, in Campina Grande, Paraíba, 2010-2012. As the control group considered subjects of the same age, in the process of screening for attention in the places listed, but without the condition of overweight or obese, the research was started after the approval by the Ethics Resarch Committee of the UEPB under the protocol number 0513.0.133.000-09. As instruments for data collection were used in the questionnaire and clinical examination, of the 70 surveyed, most were female, ranging in age from 3 to 17 years, overweight, without comorbidities and carriers of deleterious oral habits;especially the nail biting, significantly associated with female sex p < 0.05. Consistency was the preferred food paste and chewing quickly, unilaterally, without discomfort or gagging constant. There was a significant difference between the values of the DMFT index, the presence of visible biofilm and the frequency of halitosis, for groups with overweight or obesity, with association between time of treatment and medications.

Oral Cancer:Health Promotion and Visual Screening—A Study Report

Background: Oral cancer presents a heterogeneous geographic incidence. Annually, more than 275,000 new cases are diagnosed worldwide. In spite of the easy accessibility of oral cavity during physical examination, most malignancies are not diagnosed until late stages of disease. Methods: Oral health promotion was our main objective, risk factors were identified and oral cavity self-examination was promoted. The population considered (n = 1117) was divided in two main age groups—a youngest (individuals under 25 years old) mostly targeted for oral cancer awareness and oral cavity self examination promotion, and an older group having accumulated potential risk exposure. Results: The results obtained revealed smoking habits and fruits-vegetables consumption deficit as the highest risks factors found. Considering a Risk Factor Exposure Index analysis, individuals with secondary level of instruction and living in sub-urban areas assumed the highest risk exposure. Alcohol consumption had also contributed as a significant risk exposure. Conclusions: Some of these risk factors work as biological reward of quality of life deficit. A wide comprehension of the problem requires a multidisciplinary approach necessarily involving Health and Social Sciences in order to target the core of oral cancer health promotion. An effective epidemiological strategy must thus support three major aspects: population knowledge, sensitization and visual screening.

Oral Health and Self-Perception in the Elderly

Background: Investigating self-perception of oral health among the elderly may contribute towards changing public health and assistance policies in the area. Methods: The present study assessed the oral health status (tooth decay, need for treatment, periodontal status, use of and need for dental prosthesis, soft tissue alterations and self-perception of oral health) of 102 elderly people from two community groups in Fortaleza, Ceará State, Brazil. Results: Mean age was 69.9 years and 82.4% were female. Mean DMFT was 30.17 with a predominant missing component;63.7% were edentulous. Regarding prosthesis, 29.4% and 67.6% of elderly patients did not use upper and lower dentures respectively, while 66.7% and 78.4% required some type of upper and lower prosthesis respectively. Among valid sextants, 44.3% presented dental calculus and 34.3% presented loss of attachment from 6 to 8 mm. Soft tissue alterations were found in 58.8%. Despite of precarious clinical conditions and dental treatment needs, good oral health perception was found (49%), as well as satisfaction with the appearance of teeth and gums (60.8%). Conclusion: Subjects displayed unsatisfactory oral health conditions, accumulated over time and resulting from the lack of policies favoring this age group. There is a need for oral rehabilitation that enables the recovery of function and esthetics among the elderly, restoring their self-esteem and improving social interaction.

Understanding of Socially Vulnerable Individuals on Oral Health and Access to Dentist: A Brazilian Study

Social vulnerability experienced by collectors of recyclable materials has a strong influence on their understanding and confrontations health. This research aimed to explore the relationship between oral health and perception of subjects in a context of social disadvantage, in order to support concrete alternatives for action on (oral) health conference. This was a qualitative study carried out with representatives of an autonomous community of Brazilian collectors of recyclable materials. Data were collected through interviews and focus group treated with the technique of qualitative analysis. Respondents showed perceptions of etiology and care practices on oral health promoted beliefs and values collectively instituted in a social risk territory. Also, they associate the quality of their oral health and their difficulty of public access to the context of social vulnerability. This study suggests the adoption of protective, educational and interceptive in oral health practice in order to improve and enable the oral health status of this population.

Artificial intelligence in dentistry:Harnessing big data to predict oral cancer survival

BACKGROUND Oral cancer is the sixth most prevalent cancer worldwide.Public knowledge in oral cancer risk factors and survival is limited.AIM To come up with machine learning(ML)algorithms to predict the length of survival for individuals diagnosed with oral cancer,and to explore the most important factors that were responsible for shortening or lengthening oral cancer survival.METHODS We used the Surveillance,Epidemiology,and End Results database from the years 1975 to 2016 that consisted of a total of 257880 cases and 94 variables.Four ML techniques in the area of artificial intelligence were applied for model training and validation.Model accuracy was evaluated using mean absolute error(MAE),mean squared error(MSE),root mean squared error(RMSE),R2 and adjusted R2.RESULTS The most important factors predictive of oral cancer survival time were age at diagnosis,primary cancer site,tumor size and year of diagnosis.Year of diagnosis referred to the year when the tumor was first diagnosed,implying that individuals with tumors that were diagnosed in the modern era tend to have longer survival than those diagnosed in the past.The extreme gradient boosting ML algorithms showed the best performance,with the MAE equaled to 13.55,MSE 486.55 and RMSE 22.06.CONCLUSION Using artificial intelligence,we developed a tool that can be used for oral cancer survival prediction and for medical-decision making.The finding relating to the year of diagnosis represented an important new discovery in the literature.The results of this study have implications for cancer prevention and education for the public.

Effects of personalized oral hygiene management on oral health status of pregnant women

BACKGROUND The Cariostat caries activity test(CAT)was used to evaluate the effectiveness of personalized oral hygiene management combining oral health education and professional mechanical tooth cleaning on the oral health status of pregnant women.AIM To investigate whether personalized oral hygiene management enhances the oral health status of pregnant women.METHODS A total of 114 pregnant women who were examined at Dalian Women’s and Children’s Medical Center were divided into four groups:High-risk experimental group(n=29;CAT score≥2;received personalized oral hygiene management training),low-risk experimental group(n=29;CAT score≤1;received oral health education),high-risk control group(n=28;CAT score≥2),and low-risk control group(n=28;CAT score≤1).No hygiene intervention was provided to control groups.CAT scores at different times were compared using independent samples t-test and least significant difference t-test.RESULTS No significant difference in baseline CAT scores was observed between the experimental and control groups,either in the high-risk or low-risk groups.CAT scores were reduced significantly after 3(1.74±0.47 vs 2.50±0.38,P<0.0001)and 6 months(0.53±0.50 vs 2.45±0.42,P<0.0001)of personalized oral hygiene management intervention but not after oral health education alone(0.43±0.39 vs 0.46±0.33,P>0.05 and 0.45±0.36 vs 0.57±0.32,P>0.05,respectively).Within groups,the decrease in CAT scores was significant(2.43±0.44 vs 1.74±0.47 vs 0.53±0.50,P<0.0001)for only the high-risk experimental group.CONCLUSION Personalized oral hygiene management is effective in improving the oral health of pregnant women and can improve pregnancy outcomes and the oral health of the general population.

老年口腔卫生保健专业体系建立

口腔健康是全身健康的基础已逐渐成为我国社会大众的共识,不仅反映一个国家的经济文化水平,也逐渐成为人类社会文明修养的一项重要标志。老年人的口腔健康尤为重要,不仅可提高老年人的生活与生命质量,而且是检验人一生全身健康的重要指标。近30年来,刘洪臣等先后提出和努力实践推动独特的口腔卫生保健专业体系的建立,包括建立口腔卫生师国家职业、建立口腔卫生保健专业的教育培养体系、建立全国口腔卫生保健网络、提出口腔医学发展和就业的新方向与体系,为国家培养口腔卫生保健的专业人才,以提高全民的生命健康和生活水准,其中的重要环节就是确定老年口腔卫生保健的特点和保健模式,明确指出正确的口腔卫生保健对老年人口腔健康及全身健康尤为重要,提出了老年人口腔健康的10项标准,提出建立老年人的“一刷、二通、三冲”口腔卫生保健新模式,破除不正确的传统口腔健康观念,在全社会加强了老年人口腔卫生健康及常见病防治知识的普及,推动了完整正确的老年口腔健康观念的建立。1996年在解放军总医院率先探索建立了老年口腔病科,取得了显著的成果,同时推动了全国各级口腔医疗机构建立老年口腔病专科,目标是从口腔专科医院、三甲综合医院口腔科到乡镇、社区口腔医疗站建立老年口腔卫生保健体系,推广口腔全科医师及口腔全科助理医师的家庭口腔卫生保健一站式口腔医疗服务模式,使口腔卫生保健服务覆盖全人群与全生命周期,实现全社会人人都享有全面的口腔卫生保健。老年口腔卫生保健专业体系的建立,全方位推动了我国老年口腔保健事业的发展。

认知行为干预对固定矫正器正畸患者心理负担和自护能力的影响

目的:探讨认知行为干预对固定矫正器正畸患者心理负担和自护能力的影响。方法:选取2020年1月-2021年1月某院收治的90例固定矫正器正畸患者为研究对象,按照入院先后分为对照组和观察组,每组各45例;对照组采取常规干预,观察组采取认知行为干预;对比两组治疗依从性,干预前后心理负担[汉密尔顿焦虑自评量表(HAMA)、汉密尔顿抑郁自评量表(HAMD)]、舒适度和疼痛情况[Kolcaba简化舒适状况量表、视觉模拟评分法(VAS)]、自护能力[自我护理能力量表(ESCA)]及自我效能[口腔保健自我效能量表(SESS)]。结果:两组治疗依从性比较,观察组高于对照组(χ^(2)=5.404,P<0.05)。干预后,两组HAMA、HAMD评分均下降(P<0.05),且观察组均低于对照组(t=-8.993,-7.187;P<0.05);干预后,两组Kolcaba量表评分均升高(P<0.05),且观察组均高于对照组(t=10.804,P<0.05);两组VAS评分均降低(P<0.05),且观察组均低于对照组(t=-15.429,P<0.05);干预后,两组自我概念、健康知识水平、自我护理技能、自我护理责任感及ESCA量表总分均高于干预前(P<0.05),且观察组均高于对照组(t=6.692,3.663,5.640,5.183;P<0.05);干预后,两组口腔就诊、正确刷牙、平衡饮食得分均高于干预前(P<0.05),且观察组均高于对照组(t=4.295,7.013,7.427;P<0.05)。结论:对固定矫正器正畸患者采用认知行为干预效果显著,可提高治疗依从性,减轻心理负担,缓解疼痛,提高舒适度、自护能力和口腔保健自我效能。

青少年刷牙频率与血液指标的相关性:横断面观察性研究

目的分析青少年刷牙频率对血液指标的相关性,初步探讨刷牙频率对青少年全身健康的影响。方法采用便利抽样法,纳入济宁市第七中学2021级学生和济宁市体育训练中心体育训练学生为研究对象。采用单因素和多因素线性回归分析青少年刷牙频率对嗜酸性粒细胞百分比(eosinophil percentage,EOS%)、嗜酸性粒细胞计数(eosinophil count,EOS#)、嗜碱性粒细胞百分比(basophil percentage,BAS%)、嗜碱性粒细胞计数(basophil count,BAS#)、过氧化物歧化酶(superoxide dismutase,SOD)、胰岛素样生长因子1(insulin-like growth factor 1,IGF-1)、尿酸(uric acid,UA)等血液指标的影响。结果共纳入305名青少年(济宁市第七中学167名、济宁市体育训练中心138名),其中男性192名(62.95%),女性113名(37.05%)。根据每日刷牙频率分为3组,分别为≤1次组(40.33%,123/305)、2次组(53.77%,164/305)和≥3次组(5.90%,18/305)。单因素线性回归分析显示,每日刷牙2次与EOS%、EOS#、BAS%和BAS#均呈显著负相关(β均<0,P均<0.05),与SOD和IGF-1均呈显著正相关(β均>0,P=0.028,P=0.007);每日刷牙≥3次与UA呈显著负相关[β(95%CI):-0.16(-0.27~0.04),P=0.008]。多因素线性回归分析显示,每日刷牙2次与BAS%呈显著负相关(β<0,P=0.042)、与SOD和IGF-1均呈显著正相关(β均>0,P=0.036,P=0.012);每日刷牙≥3次与UA呈显著负相关(β<0,P=0.026)。亚组分析结果表明,男性青少年每日刷牙2次与IGF-1呈显著正相关(β>0,P=0.044),女性青少年每日刷牙≥3次与UA呈显著负相关(β<0,P=0.014)。结论青少年刷牙频率与多项影响全身健康的血液指标具有相关性,提示口腔健康与全身健康可能存在潜在关联。

广西壮族自治区三级医院ICU有创机械通气病人口腔健康现状及其影响因素

目的:调查广西壮族自治区三级医院重症监护室(ICU)有创机械通气病人口腔健康现状,并分析其影响因素。方法:采用便利抽样法,于2023年7月抽取广西壮族自治区5所三级医院的204例ICU有创机械通气病人为研究对象。采用一般资料问卷、Beck口腔评估量表(BOAS)进行调查。结果:204例ICU有创机械通气病人BOAS评分为(7.79±2.86)分,口腔健康无受损者62例(30.39%)。随机森林模型结果显示,重要性评分较高的前5位变量为机械通气时长、是否使用专用漱口水、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、是否使用牙刷、是否口唇保湿。逐步回归分析结果显示,APACHEⅡ评分、是否使用牙刷、是否使用专用漱口水、是否口唇保湿是ICU有创机械通气病人口腔健康的主要影响因素(P<0.05)。结论:口腔健康受损的ICU有创机械通气病人比例较大,其受多种因素影响,建议采用综合干预措施以促进病人口腔健康。