This randomised clinical trial aimed to compare the impact of two different tooth replacement strategies for partially dentate older patients namely; removable partial dentures (RPDs) and ...functionally orientated treatment based on the shortened dental arch (SDA) concept, on Oral Health-related Quality of Life (OHrQOL).
89 patients completed a randomised clinical trial. Patients were recruited in two centres: Cork University Dental Hospital (CUDH) and a Geriatric Day Hospital (SFDH). 44 patients were randomly allocated to the RPD group and 45 to the SDA group where adhesive bridgework was used to provide 10 pairs of occluding contacts. The impact of treatment on OHrQOL was used as the primary outcome measure. Each patient completed the Oral Health Impact Profile (OHIP-14) at baseline, 1, 6, 12 and 24 months after treatment.
Both treatment groups reported improvements in OHIP-14 scores at 24 months (p<0.05). For the SDA group OHIP-14 scores improved by 8.0 scale points at 12 months (p<0.001) and 5.9 scale points at 24 months (p<0.05). For the RPD group OHIP-14 scores improved by 5.7 scale points at 12 months (p<0.05) and 4.2 scale points at 24 months (p<0.05). Analysis using ANCOVA showed that there were significant between group differences recorded in both treatment centres. 24 months after intervention the SDA group recorded better OHIP-14 scores by an average of 2.9 points in CUDH (p<0.0001) and by an average of 7.9 points in SFDH (p<0.0001) compared to the RPD group.
Patients in the SDA group maintained their improvements in OHrQOL scores throughout the 24 month study period. For the RPD group the initial improvement in OHrQOL score began to diminish after 6 months, particularly for those treated in SFDH. Thus, the benefits of functionally orientated treatment increased over time, particularly for the older, more systemically unwell cohort in SFDH.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
There are two dental schools in the Republic of Ireland, graduating approximately 90 new dentists annually following successful completion of a five-year undergraduate course. Currently, once these ...graduates have been awarded their degree, they have no legal requirement to complete post-graduation training, foundation training or continuing professional development. While the vast majority will do this voluntarily, it sets a high bar for dental educators to prepare these students to practice independently in primary dental care. As in other jurisdictions, there can often be a disconnect between the ethos taught to students for delivering primary dental care in dental schools and remuneration systems once graduates enter the workforce. Changing demographics will need to be reflected in our undergraduate curricula with explicit teaching in the area of gerodontology.
Background
Chronic dental and oral diseases, such as dental caries and periodontal disease, continue to be a significant health problem among older adults. Given the rapidly changing profile of the ...ageing population, and their complex health needs, there is a need to develop new evidence‐based approaches to oral health care. Recently, care philosophies have been developed that take a minimally invasive, functionally oriented, approach to oral health care with a focus on providing a reduced, but healthy, natural dentition which can be maintained with support of better oral hygiene.
Method
A review of the literature concerning use of minimal intervention dentistry (MID) to manage caries and toothloss in partially dentate older adults was undertaken.
Results
A variety of chemotherapeutic agents are available to prevent development of root caries and/or arrest root caries lesions, with professionally applied solutions (ie 22 500 NaF, 38% SDF or 40% CHX) every 3 to 6 months demonstrating best outcomes. Application of 38% SDF annually in high‐risk, institutionalised older adults is effective in arresting root caries. Atraumatic restorative treatment can be used successfully to manage active carious lesions and limit the removal of natural tooth tissue. Finally, functionally oriented treatment planning to manage partial toothloss is successful in terms of quality of life impact and cost‐effectiveness.
Conclusion
Available evidence is somewhat limited and more long‐term studies are need. However, currently available evidence suggests that minimal intervention dentistry can be predictable and cost‐effective in older adults.
Oral health impacts systemic health, individual well-being, and quality of life. It is important to identify conditions that may exacerbate oral disease to aid public health and policy development ...and promote targeted patient treatment strategies. Developmental defects can increase an individual's risk of dental caries, hypersensitivity, premature tooth wear, erosion, and poor aesthetics. As part of an ongoing study assessing oral health in adults with cystic fibrosis at Cork University Dental School and Hospital, a systematic review of available literature was conducted to assess the prevalence of enamel defects in people with cystic fibrosis.
To critically evaluate the literature to determine if the prevalence of developmental defects of enamel is higher in people with cystic fibrosis (PwCF).
Data Sources: Three online databases were searched Embase, Scopus, and Web of Science Core Collection. Studies that examined an association between cystic fibrosis and developmental defects of enamel were included in this systematic review.
The initial search identified 116 publications from the following databases Embase, Web of Science Core Collection, and Scopus. Eleven studies were included for qualitative analysis. Nine studies concluded that PwCF had a higher prevalence of enamel defects than control people and one study found no difference in cystic fibrosis (CF) status. All studies had a risk of bias that may influence study results and their interpretation.
The results of the systematic review show a consistent pattern that PwCF have a higher prevalence of DDE than people without CF. Genetic dysfunction, chronic systemic infections, and long-term antibiotic use are possible aetiological causes. This review highlights the need for future studies to investigate if DDEs are caused by the underlying CFTR mutation or as a consequence of disease manifestations and/or management.
Objective
The aim of this systematic review was to compare cumulative failure rates of different restorative materials in carious class V lesions on the root surfaces of adult patients.
Background
...The prevalence of root caries is set to increase in the coming years as a result of ageing of the population and a concomitant reduction in levels of edentulousness. Evidence is needed to assist practitioners to select the most appropriate restorative material for use in these lesions.
Methods
A search of the literature was undertaken using the electronic databases of PubMed, Embase, CENTRAL and OpenSIGLE using keywords relevant to the search question. Two review authors conducted the electronic search independently, and any conflict was resolved by discussion. The references quoted in the full text articles extracted were hand searched for any further eligible studies.
Results
Sixty non‐duplicate citations were screened. Following review of the titles, s, texts and application of the pre‐determined inclusion/exclusion criteria, five studies remained.
Conclusion
There is a need for more research in this area as many of the studies identified in this systematic review treated post‐radiation, xerostomic patients which are not typical of the general population. Increased adherence to CONSORT guidelines for reporting is also advised to facilitate future systematic review and meta‐analysis in this area.
Background
Cystic fibrosis (CF) is the most common autosomal recessive condition in Caucasian populations globally. To date, there has been very little research conducted into the oral health of ...adults with CF possibly due to historic premature mortality. The purpose of this survey was to ascertain knowledge, attitude and practices among dental professionals regarding the oral health of people with cystic fibrosis (PWCF) as part of a larger study being conducted in Ireland.
Methods
A cross‐sectional survey of dental practitioners in Ireland was conducted via an online questionnaire. The survey contained close‐ended questions, and clinical scenarios which allowed for both close‐ended and free text responses in relation to the provision of dental treatment for PWCF. Data was subject to descriptive data analysis using IBM SPSS 29.
Results
The results from the survey indicate a wide variety in the knowledge, attitudes and practices of dental practitioners regarding the oral health of PWCF. There is significant variation in the provision of dental treatment and the conditions under which such treatment is provided.
Conclusion
There is a paucity of information and guidelines specific to this vulnerable population which can make the provision of dental treatment challenging for practitioners. Dental professionals may benefit from continuing professional development and further education targeting patient‐specific populations.
A cross‐sectional study of Irish dental practitioners revealed a paucity of information, guidance and standardized oral healthcare treatment for adults with cystic fibrosis despite the identification of disease‐specific risks to oral health in people with cystic fibrosis.
Across the European Union costs for the treatment of oral disease is expected to rise to €93 Billion by 2020 and be higher than those for stroke and dementia combined. A significant proportion of ...these costs will relate to the provision of care for older people. Dental caries severity and experience is now a major public health issue in older people and periodontal disease disproportionately affects older adults. Poor oral health impacts on older people's quality of life, their self-esteem, general health and diet. Oral health care service provision for older people is often unavailable or poor, as is the standard of knowledge amongst formal and informal carers. The aim of this discussion paper is to explore some of the approaches that could be taken to improve the level of co-production in the design of healthcare services for older people.
People's emotional and practical response to challenges in health and well-being and the responsiveness of systems to their needs is crucial to improve the quality of service provision. This is a particularly important aspect of care for older people as felt, expressed and normative needs may be fundamentally different and vary as they become increasingly dependent. Co-production shifts the design process away from the traditional 'top-down' medical model, where needs assessments are undertaken by someone external to a community and strategies are devised that encourage these communities to become passive recipients of services. Instead, an inductive paradigm of partnership working and shared leadership is actively encouraged to set priorities and ultimately helps improve the translational gap between research, health policy and health-service provision.
The four methodological approaches discussed in this paper (Priority Setting Partnerships, Discrete Choice Experiments, Core Outcome Sets and Experience Based Co-Design) represent an approach that seeks to better engage with older people and ensure an inductive, co-produced process to the research and design of healthcare services of the future. These methods facilitate partnerships between researchers, healthcare professionals and patients to produce more responsive and appropriate public services for older people.
To investigate the attitudes of adults with Cystic Fibrosis (CF) towards dental attendance and any perceived barriers to treatment.
A cross sectional survey in the form of a structured, anonymous ...questionnaire was used to obtain information regarding adults with CF's feelings towards dentists and dental treatment. The final version of the questionnaire was based on a collaborative effort between researchers at Cork University Dental School and Hospital and Cystic Fibrosis (CF) patient advocates from CF Ireland. Participants were recruited via CF Ireland's mailing list and social media channels. The responses underwent descriptive statistical analysis and inductive thematic analysis.
A total of 71 people (33 Male: 38 Female) over the age of 18 living with CF in the Republic of Ireland responded to the survey. 54.9% of respondents were unhappy with their teeth. 63.4% felt that CF had an impact on oral health. 33.8% were anxious about attending their dentist. Respondents believed that CF has impacted on their oral health due to the medications and dietary requirements involved, as well as tiredness and other side effects of CF. Reasons for being anxious about attending the dentist included cross infection concerns, issues with the dentist, with tolerating treatment, and with the teeth themselves. Respondents wanted dentists to be aware of the practicalities of dental treatment for people with CF, especially their discomfort with lying back. They also want the dentist to be aware of the impact that their medication, treatment and diet has on their oral health.
Over one third of adults with CF reported anxiety about attending the dentist. Reasons for this included fear, embarrassment, cross infection concerns and problems with treatment, especially being in the supine position. Adults with CF want dentists to be aware of the impact that CF can have upon dental treatment and oral health care.
A large body of evidence has been generated since the technique's early days, reporting on its high survival rates, particularly in single-surface restorations in permanent teeth 4–7, its ...cost-effectiveness 7 and its patient-acceptability 8. In a country where a considerable amount of children still require dental extraction due to caries under general anaesthesia, with a cost of €819.97 per child 14, ART could be a way to avoid such procedures and associated costs. ...the aim of this study was to investigate the knowledge and attitudes of Irish dentists on the use of ART and possible barriers to its effective implementation. All participants were asked to sign a consent form and all the information collected was kept confidential.2.1 Transcription and data analysis Qualitative data from the recorded discussions were transcribed verbatim, and thematic analysis was conducted with the use of N-Vivo software (NVivo qualitative data analysis software; QSR International Pty Ltd. Version 8, 2008). ...ART was considered inferior to conventional treatment by 45% of dentists. ...GDPs don't feel they can charge the same for ART as they do for conventional restorations (66.3%).
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