AbstractObjectiveTo develop an instrument to evaluate the credibility of anchor based minimal important differences (MIDs) for outcome measures reported by patients, and to assess the reliability of ...the instrument.DesignInstrument development and reliability study.Data sourcesInitial criteria were developed for evaluating the credibility of anchor based MIDs based on a literature review (Medline, Embase, CINAHL, and PsycInfo databases) and the experience of the authors in the methodology for estimation of MIDs. Iterative discussions by the team and pilot testing with experts and potential users facilitated the development of the final instrument.ParticipantsWith the newly developed instrument, pairs of masters, doctoral, or postdoctoral students with a background in health research methodology independently evaluated the credibility of a sample of MID estimates.Main outcome measuresCore credibility criteria applicable to all anchor types, additional criteria for transition rating anchors, and inter-rater reliability coefficients were determined.ResultsThe credibility instrument has five core criteria: the anchor is rated by the patient; the anchor is interpretable and relevant to the patient; the MID estimate is precise; the correlation between the anchor and the outcome measure reported by the patient is satisfactory; and the authors select a threshold on the anchor that reflects a small but important difference. The additional criteria for transition rating anchors are: the time elapsed between baseline and follow-up measurement for estimation of the MID is optimal; and the correlations of the transition rating with the baseline, follow-up, and change score in the patient reported outcome measures are satisfactory. Inter-rater reliability coefficients (ĸ) for the core criteria and for one item from the additional criteria ranged from 0.70 to 0.94. Reporting issues prevented the evaluation of the reliability of the three other additional criteria for the transition rating anchors.ConclusionsResearchers, clinicians, and healthcare policy decision makers can consider using this instrument to evaluate the design, conduct, and analysis of studies estimating anchor based minimal important differences.
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BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Background
Evidence-informed oral health policies (OHP) can be instrumental in ending the neglect of oral health globally. When appropriately developed and implemented, OHP can improve the efficiency ...of healthcare systems and the quality of health outcomes. However, more than half of the countries in the World Health Organization (WHO) African region do not have an oral health policy or even the existence of a policy in need of additional and more national-specific OHP as part of non-communicable diseases and universal health coverage agendas. The objective of this protocol's study is to determine the barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of OHP in the WHO Africa region.
Methods
We will conduct a systematic search in Global Health, Embase, PubMed, PAIS, ABI/Inform, Web of Science, Academic Search Complete, Scopus, databases that index gray literature, and the WHO policy repositories. We will include qualitative, quantitative, or mixed-methods research studies and OHP documents published since January 1, 2002, which address stakeholders' perceptions and experiences regarding barriers to and facilitators for the creation, dissemination, implementation, monitoring, and evaluation of OHP in countries part of the WHO African region. We will produce descriptive statistics (frequencies and proportions) for quantitative data and conduct descriptive content analysis for qualitative data.
Discussion
To effectively establish evidence-based OHP in the WHO African region, it is crucial to recognize existing challenges and opportunities for progress. The findings of this review will be relevant for Chief Dental Officers at ministries of health, administrators of dental schools, or academic institutions in the WHO African region and will inform a stakeholder dialogue meeting in Kenya in November of 2023.
Registration
Open Science Framework:
https://doi.org/10.17605/OSF.IO/9KMWR
Research on caregivers for children with intellectual disabilities, particularly those with autism spectrum disorder (ASD), has highlighted several obstacles to achieving better oral health. These ...include challenges with tolerating oral care, sensory processing differences, uncooperative behaviors, and communication impairments. There is limited understanding of what caregivers would consider "successful assistance" in improving oral health for these children.
This pilot study aimed to examine caregivers' and user's experiences with a Kids Smart Electric Toothbrush used by children with ASD.
It involved open-ended interviews and questionnaires with caregivers prior to utilization of the toothbrush and after 4 weeks of product use by the child.
Seventeen children with ASD, aged 5-12, participated. A total of 58.8% of caregivers said their child brushed more often, and all reported brushing at least twice a day by week 4. Caregivers reported that children became more independent while brushing their teeth and achieved better quality brushing. Caregivers' frustration with the brushing process, satisfaction with the device, and need to assist the child with brushing were improved. Caregivers did encounter some technical difficulties with the app.
This study will assist in exploring "smart" toothbrush technologies for oral hygiene in children with ASD.
An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated evidence-based ...clinical recommendations for the arrest or reversal of noncavitated and cavitated dental caries using nonrestorative treatments in children and adults.
The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane database of systematic reviews to identify randomized controlled trials reporting on nonrestorative treatments for noncavitated and cavitated carious lesions. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions.
The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition. Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. The panel also provided a recommendation against the use of 10% casein phosphopeptide-amorphous calcium phosphate.
Although the recommended interventions are often used for caries prevention, or in conjunction with restorative treatment options, these approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these interventions based on effectiveness, safety, and feasibility.
A growing variety of intraoral appliances are being used in dental practice. Insight about the range of applications and practice workflow as well as factors effecting change in practice trends was ...sought.
A survey was developed to ascertain intraoral appliance use, fabrication methods, staff involvement, and patient experiences in dental practice. The survey was sent to ADA Clinical Evaluators Panel members on July 25, 2022, in Qualtrics and remained open for 2 weeks. After 1 week, those who had not responded yet were sent reminders. Data were analyzed descriptively in SAS Version 9.4.
Of the 286 respondents (a 28% response rate), 88% reported providing patients with intraoral appliances apart from providing patients with removable partial dentures. More than one-half of the respondents reported offering bleaching trays (88%), flippers or Essix retainers (83%), splints (81%), athletic mouthguards (72%), orthodontic retainers (60%), fluoride trays (56%), and clear aligners (55%). The biggest changes to practice in the past 5 years with respect to intraoral appliances have been intraoral scanning (56%) and the increase in the variety of intraoral appliances in use. Although 72% reported dental assistants were involved in obtaining impressions and fabricating models for intraoral appliances and 76% reported that laboratory technicians were involved in fabricating intraoral appliances, nearly all (97%) respondents indicated that the dentist was involved in the delivery of appliances to patients. Patient education about the use of their appliances appeared to be delivered using multiple approaches, given that it was reported to occur orally (95%), in print (61%), and visually (42%). That 90% of respondents reported having engaged in continuing education courses about intraoral appliances aligns with these appliances becoming a routine part of dental practice, with both increasing applications and improvements in the relevant technology.
Intraoral appliances were found to be used commonly in dental practice, and often multiple members of the dental care team were engaged in the fabrication processes.
There likely will be ongoing interest in relevant learning opportunities about technologic advances as well as the increasingly diverse list of applications for intraoral appliances.
With an increased emphasis on considering optimal oral health in the context of overall health and well-being, there is interest in understanding how practicing dentists are using information about ...their patients' overall health status.
A survey tool was developed to understand how dentists assess the health status of their patients, the frequency at which they are gathering this information, and how they work with their medical colleagues. Emails with an electronic survey link were sent to 997 American Dental Association Clinical Evaluators (ACE) panel members on November 23, 2021. The survey closed after 2 weeks, and data were analyzed descriptively.
A total of 258 (26%) ACE panel members responded to the survey. At initial visits, the dentist (60%) often discusses and reviews the patient's medical history, but in subsequent appointments, this task is often completed by the dental assistant (34%) or dental hygienist (32%). At every dental visit, 75%, 66%, and 33% of the respondents ask about and record changes to medical history, medication list, and visits with other health care professionals, respectively. Of the respondents, 85% collect at least 1 vital sign, and more than 90% use the medical history, medication list, and patient interview. A total of 32% of respondents reported disease monitoring is in their scope of practice, and, among them, cardiovascular conditions are the most frequent health condition seen. On average, 12% of patients are referred to another health care provider weekly.
Most dentists use the patient's medical history and medication list and collect vital signs, but the frequency and application of these assessments vary.
Optimal oral health is integral to overall health, and identifying opportunities to improve communication and data sharing among all health care professionals can affect the patient's health positively.
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