Aims and objectives
To identify current evidence on the role of nurses and allied health professionals in the oral health management of stroke patients, detailing their current knowledge, attitudes ...and practices and the potential benefits of an integrated oral care programme.
Background
Stroke has disabling oral health effects, such as dysphagia and hindered brushing due to upper limb hemiparesis. Together, these can increase bacterial load, increasing risk of pneumonia. In general management of stroke, nurses play a key role in early identification, assessment and referral, while occupational therapists, dieticians and speech pathologists are important in rehabilitation. While this should logically apply to the oral care of stroke patients, there is currently limited information, especially in Australia.
Design
Scoping review.
Method
A literature search was conducted using multiple databases regarding the oral health management of stroke patients by nondental professionals, and 26 articles were reviewed.
Results
The Australian National Clinical Guidelines for Stroke accentuate the need for oral care following stroke and suggest how hospital staff need to be involved. Currently, there are no Australian studies. However, international literature suggests that lack of oral health knowledge by nurses and poor patient attitude are reflected in infrequent assistance with stroke patient oral hygiene. There is limited information regarding the benefits of nursing‐driven oral hygiene programme in reducing pneumonia incidence, and only few studies show that involving nurses in assisted oral care reduces plaque. There are some suggestions that involving nurses and speech pathologists in oral rehabilitation can improve dysphagia outcomes.
Conclusion
Managing oral health poststroke is vital, and there is a need for an appropriate integrated oral care service in Australia.
Relevance to clinical practice
Nondental professionals, especially nurses, can play a key role in the poststroke oral health management of stroke patients to reduce complications, especially pneumonia.
To assess Sydney Dental Hospital (SDH) clinicians’ beliefs, attitudes, and experience in identification and response to domestic violence (DV) in a public dental setting prior to the implementation ...of Domestic Violence Routine Screening (DVRS).
An anonymous cross-sectional survey was conducted amongst SDH clinicians from one general and two specialist clinics between November and December 2022 following completion of DVRS training and prior to DVRS implementation. The survey consisted of 10 questions addressing clinicians’ characteristics (demographic and educational history), their knowledge, perception, and previous experience responding to women disclosing DV. The study was approved by RPAH Ethics Committee.
Thirty-two clinicians participated (73% response), with 56% aged 25-34, 47% with more than 10 years of clinical experience (32% 5-10 years and 22% less 5 years) and 60% were general dentists. Most participants (75%) reported they had previously managed DV disclosures, and 63% agreed that responding to DV disclosure was part of their role, but 79% were not at all or only slightly confident in responding to DV disclosure prior to DVRS training. Nearly 60% considered that more training was needed, and their concerns included dealing with an ambiguous situation (95%), engaging with women to complete the screening (79%), responding to DV disclosures (79%) and child protection mandatory reporter requirements (63%).
A large proportion of clinicians had previously managed DV disclosure prior to DVRS implementation and agreed that screening was part of their role but identified the need for more targeted training and support to increase their confidence in responding to DV and undertake DVRS.
As the incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing, knowledge of OPSCC risk factors, such as HPV infection and sexual behaviour, is important for dental clinicians and ...patients, and this study aimed to determine the attitude, knowledge and behaviour of dentists regarding HPV and OPSCC.
This cross-sectional quantitative study, approved by the University of Sydney Ethics Committee, was conducted between 2020-2021 and involved Australian dentists responding to an online survey. The questionnaire link was distributed through the Australian Dental Association publications, magazines, Facebook and ADX conference. Data were evaluated via SPSS using a combination of univariate and bivariate analyses, and a p-value ≤ 0.05 was considered significant.
Of 114 participants, 58.8% were from NSW/ACT, 55.3% were female, 52.6% were from private practice, and 47.4% had ≥16 years of experience. Those who practised for 16+ years (79.6%) had more knowledge of the association between oral HPV and OPSCC, and dentists who accessed information through the university, colleagues or television were less knowledgeable about HPV/OPSCC than those who attended continuing education courses. While the majority agreed that oral HPV testing would be beneficial for early OPSCC diagnosis (79.8%) and patient education (64.0%), a large proportion (70.1%) felt uncomfortable discussing oral sex as a cancer prevention method, and 51.8% had never received sexual health education.
Dental practitioners understand the importance and are ideally placed to discuss HPV and the risk of OPSCC, but additional training is required. Continuing education through ADA courses, publications, conferences, seminars, and dental and medical journals provided the updated information most effectively.
Early childhood caries is a common chronic childhood disease and maternal oral health is a risk factor. Improving the oral health behaviours of pregnant women/young mothers can positively influence ...the oral health of children and reduce their caries risk. Such preventative strategies have been undertaken by non-dental professionals producing mixed results encompassing various interventions across the perinatal period. However, no comprehensive review of these studies has been undertaken. The aim of this review was to assess the effectiveness of maternal oral health programs undertaken during the antenatal and/or postnatal period by non-dental health professionals to reduce early childhood caries.
A systematic search of five databases was undertaken using key search terms. Studies were included if they (a) involved quantitative study designs with a control; (b) were published in English; (c) reported on interventions delivered by non-dental professionals (d) delivered the intervention to expectant mothers or mothers with young infants up to 24 months; (e) measured outcomes when the child was under 5 years; (f) measured changes in oral health outcomes of children clinically and oral health behaviours of mothers or children. No restrictions were placed on the study quality and setting.
Nine studies met the inclusion criteria and involved interventions delivered by diverse non-dental professionals across the antenatal (n = 1), postnatal (n = 6) and perinatal period (n = 2). Most studies were of low methodological quality (n = 6). The interventions focussed on oral health education (n = 8), dental referrals (n = 3) and oral health assessments (n = 1). Interventions conducted in either the postnatal or antenatal periods showed meaningful improvements in children's clinical and mother's behavioural oral health outcomes. The outcomes appear to be sustained when a suite of interventions were used along with referral reminders. There were mixed results from interventions across the perinatal period.
Non-dental professionals can promote maternal oral health by providing oral health education, risk assessment and referrals. Combining these interventions could provide a sustained improvement in oral health outcomes for children although current evidence is weak. More high-quality studies are needed to confirm these findings and determine whether the antenatal and/or postnatal period is best suited to deliver these interventions.
Background:
Maintaining good oral health remains a challenge among those hospitalised after stroke. Stroke nurses and allied health clinicians have a potential role in providing oral care, but no ...studies in Australia to date have explored their perceptions and needs.
Aims:
To explore the perspectives of nursing and allied health stroke clinicians regarding oral care for stroke patients across acute care and stroke rehabilitation settings.
Methods:
This study followed an exploratory qualitative design, using a constructivist approach. Participants from two metropolitan public hospitals were purposively recruited to participate in focus groups. Data was thematically analysed.
Results:
Twenty-one clinicians participated. Clinicians’ knowledge and practices relating to oral healthcare for stroke patients were inadequate. Most staff felt they did not have adequate knowledge, resources and training to administer oral care in this setting and proposed enhancing education of stroke clinicians, patients and informal caregivers, as well as improving quality point of care resources. There was overall support for the integrated dental care after stroke model of care.
Discussion:
This study revealed many gaps in current care and highlighted areas for improvement. Patients and their caregivers needed to be actively engaged as partners to improve oral healthcare within acute and rehabilitation stroke settings.
Conclusion:
This study provided insight into nurses’ and allied health stroke clinicians’ current knowledge and practices of oral care in various stroke settings. The findings from this study will inform development of a model of care to train stroke nurses in providing oral care.
The aim of this study was to explore the perception of patients with cardiovascular disease towards oral health and the potential for cardiac care clinicians to promote oral health.
A needs ...assessment was undertaken with twelve patients with cardiovascular disease attending cardiac rehabilitation between 2015 and 2016, in three metropolitan hospitals in Sydney, Australia. These patients participated in face-to-face semi-structured interviews. Data was analysed using thematic analysis.
Results suggested that while oral health was considered relevant there was high prevalence of poor oral health among participants, especially those from socioeconomic disadvantaged background. Awareness regarding the importance of oral health care its impact on cardiovascular outcomes was poor among participants. Oral health issues were rarely discussed in the cardiac setting. Main barriers deterring participants from seeking oral health care included lack of awareness, high cost of dental care and difficulties in accessing the public dental service. Findings also revealed that participants were interested in receiving further information about oral health and suggested various mediums for information delivery. The concept of cardiac care clinicians, especially nurses providing education, assessment and referrals to ongoing dental care was well received by participants who felt the post-acute period was the most appropriate time to receive oral health care advice. The issues of oral health training for non-dental clinicians and how to address existing barriers were highlighted by participants.
The lack of oral health education being provided to patients with cardiovascular disease offers an opportunity to improve care and potentially, outcomes. In view of the evidence linking poor oral health with cardiovascular disease, cardiac care clinicians, especially nurses, should be appropriately trained to promote oral health in their practice. Affordable and accessible dental care services for people with cardiovascular disease should be considered and offered by health services in Australia.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
ObjectivesTo critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy ...and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.Design and settingThe evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.ParticipantsData were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.Cost measuresData included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.Outcome measuresUtility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.ResultsCompared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only ‘cost-effective’ in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was ‘cost-effective’ in all scenarios except at 3 months scenario.ConclusionsThe midwives’ only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives’ and dentists’ combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.Trial registration numberACTRN12612001271897; Post-results.
Background
Poor maternal oral health may be associated with adverse pregnancy and infant outcomes. However, women seldom seek dental care during pregnancy, and misconceptions by prenatal care ...practitioners about oral health care during pregnancy may contribute to the problem. The aim of this study was to review current knowledge, attitudes, and behavior of dental and prenatal care practitioners about oral health care during pregnancy.
Methods
This review examined all studies published in English that explored the knowledge, attitude, behavior, and barriers faced by dentists, general practitioners, midwives, and obstetricians/gynecologists with respect to oral health care during pregnancy.
Results
Despite acknowledging the importance of maternal oral health, many dentists are uncertain about the safety of dental procedures and are hesitant in treating pregnant women. General practitioners and midwives are poorly informed about the impact of poor maternal oral health and rarely initiate this topic during prenatal care. Many general practitioners also believe that dental procedures are unsafe during pregnancy. Obstetricians/gynecologists are well informed about perinatal oral health and are supportive of dental procedures, but because of lack of training in this area and competing health demands they seldom focus on oral health care during their prenatal care.
Conclusion
No real consensus exists among dentists and prenatal care practitioners with respect to oral health care during pregnancy. This issue poses a significant deterrent for pregnant women seeking dental care. Practice guidelines in perinatal oral health are needed for health professionals to emphasize this important aspect of prenatal care. (BIRTH 39:3 September 2012)
Stroke is a serious cerebrovascular disease and is one of the world's leading causes of disability. Maintaining good oral health is a challenge among those hospitalised after stroke. A ...multidisciplinary approach to oral care involving non-dental professionals can be beneficial in improving oral health outcomes for patients. The aim of this study was to understand the perceptions of stroke survivors regarding oral healthcare across acute and rehabilitation settings.
A descriptive qualitative approach was used. Face-to-face semi-structured interviews were conducted. A framework analysis was employed to analyse the data. Patients who had recently experienced a stroke were purposively recruited across both acute and rehabilitation settings, at two metropolitan hospitals in Sydney, Australia. In total, 11 patients were interviewed.
Although participants recognised the importance of oral health, few understood the link between oral and general health. Regular oral hygiene practices varied since having stroke, with a few receiving oral care assistance from nurses. Time, cost and lack of information were some barriers to accessing dental services, while supportive measures such as coordination of oral care, financial subsidy and nurse assistance were strategies proposed to support oral care practices amongst stroke survivors.
There is scope to improve current models of oral care in stroke. While stroke survivors understand the importance of oral care, an integrated oral health model with a multidisciplinary approach could improve health outcomes.
To investigate factors influencing the low uptake of smoking cessation brief interventions (COHS, 2021), despite high prevalence of smokers amongst the patient population within the public dental ...system (AIHW, 2022, SLHD, 2019).
It was a mixed-method low-negligible risk research of a convergent-parallel mixed method design. Data collection methods included semi-structured interviews with eight Sydney Local Health District (SLHD) Community Oral Health Clinic (COHC) dentists, and clinical record analysis of fifty patient records from SLHD COHCs. Each interview transcript was coded for thematic analysis, and data items from the clinical record analysis were analysed using descriptive statistics. The study was approved by SLHD Ethics Committee.
From clinical record audits, although 84% completed the ‘Ask’ step of the smoking cessation brief intervention, less than 10% undertook the ‘Advise’ and ‘Act’ steps. Factors identified as influencing smoking cessation brief intervention implementation included the characteristics of patients, the oral health status of patients, and dentist-perceived barriers. Nature of public patients, types of clinical services provided, and lack of training and time were some of the key reasons identified during dentist interviews.
A flexible and tailored intervention approach suited to both the clinicians and intended audience is required, especially in priority populations seen in public dental clinics who experience more significant difficulty with accomplishing a sustained smoking cessation intervention.
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