To explore the attitudes, facilitators and barriers in providing oral care for inpatients with dysphagia post-stroke as perceived by healthcare professionals.
Dysphagia is a common complication of ...stroke and is associated with a higher incidence of aspiration pneumonia, malnutrition and dehydration. In the acute phase of stroke recovery, a dental professional is not usually part of the multidisciplinary team caring for the patient and oral care is the responsibility of the healthcare professionals in the stroke unit. There is a lack of high-quality evidence to demonstrate the most effective method of providing oral care for patients with dysphagia post-stroke.
This was a single-site study conducted with healthcare professionals working in the Stroke Unit of Cork University Hospital in Ireland, using focus groups and a qualitative thematic analysis approach.
A total of three focus groups were conducted in the Stroke Unit with 17 healthcare professionals. The focus groups included representation from all healthcare professional groups providing direct clinical care to patients on the Stroke Unit including geriatric medicine, dietetics, speech and language therapy, healthcare assistance, nursing, occupational therapy and physiotherapy. A qualitative thematic analysis was carried out and seven overarching themes emerged from the data. Three themes related to facilitators to providing oral care for this patient group: (i) a focus on oral care in both policy and practice, (ii) expanding professional roles in the provision of oral care, (iii) perceived importance of oral care in recovery and rehabilitation. Four themes related to barriers to the provision of oral care for this patient group: (i) lack of confidence and concerns related to the perceived risk for patients with dysphagia, (ii) unique challenges of patient and stroke-related factors, (iii) lack of resources and time and (iv) perceived importance of oral care in recovery and its relative importance with competing demands.
Members of the stroke multidisciplinary team believe that they all have a part to play in the delivery of oral care for patients with dysphagia post-stroke. Opportunities exist for the development of multidisciplinary interventions to improve the oral cavity assessment and oral care provided in the Stroke Unit.
Internationally, evidence-based practice (EBP) is recognised as a foundational element of healthcare professional education. Achieving competency in this area is a complex undertaking that is ...reflected in disparities between 'best EBP' and actual clinical care. The effective development and implementation of professional education to facilitate EBP remains a major and immediate challenge. To ascertain nuanced perspectives on the provision of EBP education internationally, interviews were conducted with five EBP education experts from the UK, Canada, Australia and New Zealand. Definitive advice was provided in relation to (1) EBP curriculum considerations, (2) teaching EBP and (3) stakeholder engagement in EBP education. While a considerable amount of EBP activity throughout health profession education is apparent, effectively embedding EBP throughout curricula requires further development, with a 'real-world' pragmatic approach that engenders dialogue and engagement with all stakeholders required.
Objective
To assess the oral‐health‐related quality of life (OHRQoL) in a cohort of Irish older patients and explore associations with overall health status.
Background
The impact of oral health ...conditions on older individuals’ quality of life may be influenced by patients’ general health status.
Materials and Methods
This paper reports a cross‐sectional study, which analysed baseline data from patients aged over 60 years. Patients were recruited from two different environments, namely Cork University Dental Hospital and St. Finbarr's Hospital, to take part in two research studies. All patients completed the Oral Health Impact Profile (OHIP‐14) and EuroQol‐5D (EQ‐5D) questionnaires. All patients provided a comprehensive overview of their general medical status. Data from the Quality of Life questionnaires were analysed to check for differences between healthy and frail elders and explore associations between OHRQoL and general health.
Results
The patient sample comprised 146 (44.6%) male and 181 (55.4%) female participants, with a mean (SD) age of 73.96 (6.9). Frail patients reported a higher mean OHIP‐14 score compared to non‐frail patients (P < 0.001). Pearson's correlation analysis showed a negative association between OHIP‐14 and EQ‐5D scores. Regression analysis showed that among frail individuals, better general health corresponded to poorer OHRQoL. In the non‐frail cohort, better general health was related to better OHRQoL, although these results were not statistically significant.
Conclusions
General health was not significantly associated with the way that patients perceive their oral health within this patient cohort. However, factors such as objective oral health, denture wear and patient's expectations may play a role in this association.
Aims
To evaluate the dental attendance, oral hygiene habits, and dietary habits of adults with Cystic Fibrosis in the Republic of Ireland.
Methods and Results
A cross‐sectional study was carried out ...using a structured anonymous questionnaire. A total of 71 adults with Cystic Fibrosis responded. While the majority of respondents (66.2%) saw a dentist in the preceding year, 15.5% had not attended a dentist for over 2 years. Smoking and alcohol consumption levels were low. 63.4% brushed twice or more daily, with 70.4% using a Fluoride containing toothpaste. 62% did not use any interdental cleaning aid. 5.6% changed their toothbrush at least once a month, but for 22.5% it was over 6 months. 70.4% used fluoride toothpaste. 38% snacked three or more times daily and 29.5% consumed fizzy drinks at least once daily.
Conclusions
The alcohol and tobacco consumption in this study group was low. However, a large proportion frequently consumed sugar‐rich foods, and they did not change their toothbrush, brush their teeth, or attend the dentist as regularly as is advised. More targeted advice may be necessary to improve the oral hygiene habits of adults with Cystic Fibrosis.
Canine ramps Hayes, Martina
Journal of the Irish Dental Association,
8/2022
Journal Article
As we age, physiological or pathological tooth wear can alter our occlusion from canine-guided (or ‘canine-protected’) lateral excursion, to group function. Group function itself is not problematic, ...but the burden of lateral excursion can be damaging to compromised teeth. It may be desirable to restore the patient to canine-guided lateral excursion to protect heavily restored teeth. A minimally invasive option is the canine ramp.
BACKGROUND AND OBJECTIVES: The use of Oral Nutritional Supplements (ONS) is widespread among patients with long- and short-term medical conditions. Although ONS serve an important purpose in the ...management of malnutrition, their effect on the oral hard and soft tissues is not well understood. The aim of this article is to conduct an analysis of the available literature relating to ONS and their impact on the oral environment. METHODS: This study was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines adapted by Liberati. The PICO question is as follows: Population: Individuals (both children and adults) Intervention: Use of Oral Nutritional Supplements Comparison: Individuals not taking Oral Nutritional Supplements Outcome: Increased risk of oral disease (specifically dental caries, periodontal disease or candida) The research question was “Are people who take ONS at higher risk of oral diseases than the general population?” Eligibility criteria The results obtained from the literature search were filtered, according to these inclusion and exclusion criteria: Inclusion criteria • Individuals were prescribed Oral Nutritional Supplements • All studies were included, including, case–control, cohort, cross-sectional or case studies. • Studies were included if they directly compared the association between ONS and oral health i.e. Effect of ONS on the oral environment had to be one of the aims of the study • Studies on human subjects or in vitro experiments • Published in English language • Studies from 1960 to the present day Exclusion criteria • Studies not in English • Review articles and case series were excluded • Studies including the use of other nutritional supplements such as vitamin or herbal supplements were not included. • Other supplemental feeding methods such as enteral or parenteral feeding were not examined 4 databases were searched: Medline (via Ebsco), Embase, Web of Science Core Collection, Google Scholar. Risk of bias was assessed using the ROBINS-I tool. RESULTS: A total of 58 records were identified through databases and searching bibliographies. 50 publications were excluded from the review, based on study title and abstract. The full text of eight articles were assessed for eligibility. No article answered the primary aim of the systematic review. Three articles discussed the secondary aim of the systematic review and these were included in the qualitative systematic review. The main outcome of the first study showed that the ONS had higher cariogenic potential than milk due to it’s higher acidogenicity. However, there was no statistical difference in dentine demineralisation and no significant difference in viable micro-organisms present. The main outcome of the second study showed that Escherichia coli, Staphylococcus aureus and C. albicans all grew at room temperature in the dairy-based ONS collected, and that C. albicans also grew in the juice which was milk protein-free and lipid-free. The third study showed that ONS were “potentially cariogenic” on enamel. DISCUSSION: Two studies were deemed as being at “low” of bias, however another study was deemed to be at “serious” level of bias. All studies stressed the possibility of dental disease caused by oral nutritional supplements, however there is not enough research available to imply causation. Due to the high sugar content of these supplements, and the known dental implications of this, it would be beneficial to carry out more research into this area.
The prevalence of caries is set to increase in the coming years as a result of a growing ageing population and a concomitant reduction in levels of edentulousness. Evidence for management of caries ...in older adults is scarce compared to that for the child population, however, similar principles of risk assessment, prevention and minimal intervention should be applied by dental health professionals. Early identification of high-risk older adults facilitates the implementation of risk reduction strategies, such as topical fluoride regimes. When operative intervention cannot be avoided, Atraumatic Restorative Technique (ART) may allow for conservative cavity preparation and has the advantage of being suitable for the domiciliary setting.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To assess the effects and costs of primary, secondary and tertiary strategies to prevent oral disease in ...dependent older people.
Fostering a culture of clinical effectiveness in healthcare is crucial to achieving optimum outcomes for patients. Evidence-based practice (EBP) is a cornerstone of clinical effectiveness. An EBP ...capacity-building project commenced in Ireland in 2016, in collaboration with the Centre of Evidence-Based Medicine in Oxford. A key part of this project, reported here, was the development of a competency framework for education in EBP and clinical effectiveness to ensure responsiveness of education standards and curricula of healthcare professionals in this area.
Following a review of national and international reports, professional guidance documents and empirical literature pertaining to clinical effectiveness education (CEE), a preliminary competency framework was developed. Stakeholder consultations were conducted over a 6-month period, which consisted of 13 focus groups (n=45) and included representatives from clinical practice, higher education and professional training sectors, regulator/accrediting bodies, the Department of Health (Ireland) and patient/service user groups.
An overarching interprofessional competency framework for CEE was proposed and included the following domains: EBP, quality improvement processes, implementation strategies and collaborative practice: a total of 16 competencies and 60 indicators.
A competency framework for CEE for health and social care professionals is presented. It is intended that this framework will provide guidance to healthcare educators and regulators in the construction and revision of curricula, learning outcomes, teaching and assessment strategies, and graduate/clinician attributes.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To assess the effects and costs of primary, secondary and tertiary strategies to prevent oral disease in ...dependent older people.
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