Oral health is critical for total body health and well-being; however, little improvement in oral health status has occurred in the U.S. over the past 20 years. Tooth decay and gum disease remain ...highly prevalent, with more than 90% and 50% of adults suffering from these conditions, respectively. To combat this lack of improvement, alternative approaches to dental care are now being suggested. One such alternative therapy is probiotics for oral care. In the oral cavity, probiotic strains have been shown to reduce levels of oral pathogens, inhibit the formation of dental caries, and reduce the levels of bacteria that cause halitosis. However, as the oral care probiotic market expands, many products contain bacterial species and strains with no documented health benefits leading to confusion and mistrust among consumers and clinicians. This confusion is enhanced by the regulatory status of probiotic products which puts the onus of safety and efficacy on the manufacturer rather than a central regulatory body. The overarching goal of this review is to provide consumers and clinicians with documented evidence supporting (or refuting) the health benefits of oral care probiotics marketed for sale in the United States. This includes defining what constitutes an oral care probiotic product and a strain level analysis of candidate probiotics from the genera Streptococcus, Lactobacillus, Bifidobacterium, and Bacillus. Additionally, prebiotics and postbiotics will be discussed. Finally, a set of considerations for consumers and clinicians is provided to empower probiotic product decision making. Together, this review will improve understanding of oral care probiotics marketed in the US for dental professionals and consumers.
Background
Oral care is one of the fundamental nursing care procedures used to decrease oral colonization, dental plaque, respiratory infections, and patient stay and cost.
Aims
This study aimed to ...identify intensive care unit (ICU) nurses' self‐assessment of oral care frequency, skill competency, documentation, oral care tools, and obstacles to oral care quality. In addition, it proposed exploring associations between nurses' attitudes about the importance of oral care and the priority of other interventions.
Study design and setting
A cross‐sectional descriptive study was conducted in two ICUs (trauma and general) in the main teaching hospital in Upper Egypt. Of 105 nurses selected using convenience sampling, 91 completed the questionnaire.
Results
About 60.4% of ICU nurses did not attend any oral care training programme, 40.7% reported performing oral care four times per shift in intubated patients, 62.6% reported that their skills needed improvement, 37.4% saw themselves as competent, and 86.8% documented oral care in patients' records. Significant positive correlations were found, indicating that nurses' attitudes towards the importance of oral care showed the same tendency as the priority given to other interventions, such as eye care, bowel care, documentation, hygiene, catheters, feeding, and wound care (correlation coefficient r = 0.290, 0.511, 0.333, 0.425, 0.431, 0.345, and 0.337, respectively). Furthermore, a toothbrush (84.6%) was often used, while chlorhexidine was not used (90.1%). The major obstacles to the provision of oral care as perceived by the nurses were the fear of aspiration and life‐threatening interventions (95.6%), inadequate nurse–patient ratios (94.5%), irregular competency evaluations (92.3%), unavailability of oral care guidelines (92.3%), and shortage of time (84.6%).
Conclusion
The participating nurses were mindful of the importance and priority of oral care. Many of them did not attend oral care training programmes and considered that their skills needed improvement. Moreover, ICU nurses reported many obstacles hindering oral care quality.
Relevance to clinical practice
This research identifies the importance of developing in‐service oral care training programmes to improve ICU nurses' skill competency. High‐quality oral care can be provided by focusing on and overcoming obstacles that hinder nurses' oral care practice.
An Oral Care Program (OCP) was implemented in home care nursing teams in a northern province of the Netherlands to improve the oral health and hygiene of older people who make use of formal home care ...in 2018-2019. The aim of the current study was to evaluate the experiences of the stakeholders involved (older people, home-care nurses and dental hygienists) and to report the experienced impact of OCP, with a qualitative approach. Three dental hygienists, nine home care nurses, and eight older people were interviewed with semi-structured interviews, which were audio recorded, transcribed and analyzed using thematic analysis. The codes derived were grouped into nine main themes. OCP was experienced as mostly positive by all stakeholders involved. The educational part lead to more awareness towards oral care, but should be repeated regularly. Personalized oral care plans for older people were experienced positively, however, obtaining oral care behavior changes appeared to be difficult. Collaboration between dental hygienists and home care nurses lead to a positive experience from both sides The method and intensity of collaboration varied between the teams. To provide better access to oral health care for older people in the community, a long term collaboration between home care nursing teams and dental care professionals in their working area should be established.
The world population is aging. This phenomenon is accompanied by an increase in the number of elderly with dementia, whose oral hygiene care is a challenge.
This paper presents a literature review of ...oral health status and the need for oral care in people with dementia, as compared to people without dementia and also of the relationship between periodontal disease and cognitive impairment.
A systematic review was conducted in PubMed, CINAHL, and the Cochrane Library. Fifty-six articles met the inclusion criteria and were consequently included for quality assessment and data extraction.
No significant differences were found between both groups with regard to the number of present teeth, DMFT Index, edentulousness/use of denture, and orofacial pain. Coronal/root caries and retained roots were more common in people with dementia than in those without dementia. Most of the participants with dementia presented gingival bleeding or inflammation and they suffered from the periodontal disease more than people without dementia.
Poor oral health is a common condition among the elderly with dementia. The education process of caregivers might improve the oral health status of people with dementia. Finally, periodontal disease might contribute to the onset or progression of dementia.
The new coronavirus SARS-CoV-2, the cause of COVID-19, has become a public health emergency of global concern. Like the SARS and influenza pandemics, there have been a large number of cases ...coinfected with other viruses, fungi, and bacteria, some of which originate from the oral cavity. Capnocytophaga, Veillonella, and other oral opportunistic pathogens were found in the BALF of the COVID-19 patients by mNGS. Risk factors such as poor oral hygiene, cough, increased inhalation under normal or abnormal conditions, and mechanical ventilation provide a pathway for oral microorganisms to enter the lower respiratory tract and thus cause respiratory disease. Lung hypoxia, typical symptoms of COVID-19, would favor the growth of anaerobes and facultative anaerobes originating from the oral microbiota. SARS-CoV-2 may aggravate lung disease by interacting with the lung or oral microbiota via mechanisms involving changes in cytokines, T cell responses, and the effects of host conditions such as aging and the oral microbiome changes due to systemic diseases. Because the oral microbiome is closely associated with SARS-CoV-2 co-infections in the lungs, effective oral health care measures are necessary to reduce these infections, especially in severe COVID-19 patients. We hope this review will draw attention from both the scientific and clinical communities on the role of the oral microbiome in the current global pandemic.
Background
Pneumonia is common in nursing home residents and is a leading cause of hospitalization and death. Nursing home residents with cerebrovascular diseases and impaired consciousness are at ...high risk of aspiration pneumonia. Professional and mechanical oral care by dentists and hygienists in addition to daily oral care by caregivers was shown to be effective in preventing pneumonia in nursing home residents. However, professional and mechanical oral care has not been widely provided in Japan, while daily oral care by caregivers has been widely provided as a basic service in nursing homes. This study aimed to evaluate the cost‐effectiveness of providing professional and mechanical oral care for preventing pneumonia in nursing home residents.
Methods
Using a decision tree and Markov modeling, we conducted a cost‐effectiveness analysis from the payer's perspective (social insurers and patients) in Japan.
Results
The incremental cost‐effectiveness ratio for professional and mechanical oral care compared with daily oral care only was calculated as 4,079,313 Japanese yen (¥; 33,994 United States dollars US$, US$1 = ¥120) per quality‐adjusted life year.
Conclusions
Using the official value of social willingness to pay for a one‐quality‐adjusted life year gain in Japan of ¥5 million (US$41,667) as the threshold to judge cost‐effectiveness, providing professional and mechanical oral care is cost‐effective. Our results suggest professional and mechanical oral care for preventing pneumonia in nursing home residents could be justifiable as efficient use of finite healthcare resources. The results have implications for oral care in nursing homes both in Japan and worldwide.
Patients with a history of stroke often present with numerous neurologic deficits and varying degrees of disability. Ambulation problems requiring the use of a wheelchair can make accessing and ...receiving dental care difficult for these patients. Side effects from medications can compromise their oral health and complicate care. Possible dexterity limitations decrease their ability to maintain their oral health. Innovative care plans and adaptations may be needed to accommodate the needs of these patients but care generally can be provided safely and effectively in the outpatient dental setting.
The oral cavity is one of the most common sites impacted by hematopoietic stem cell transplantation (HSCT) with acute complications including mucositis, bleeding, salivary gland dysfunction, ...infection, and taste alteration. These complications may result in significant morbidity and can negatively impact outcomes such as length of stay and overall costs. As such, oral care during HSCT for prevention and management of oral toxicities is a standard component of transplant protocols at all centers. The objective of this study was to evaluate the current oral care practices for patients during HSCT at different transplant centers within the Eastern Mediterranean region.
An internet-based survey was directed to 30 transplant centers in the Eastern Mediterranean region. The survey included five sections asking questions related to (1) transplant center demographics; (2) current oral care protocol used at the center and type of collaboration (if any) with a dental service; (3) use of standardized oral assessment tools and grading systems for mucositis; (4) consultations for management of oral complications; and (5) oral health needs at each center. Data are presented as averages and percentages.
A total of 16 responses from 11 countries were collected and analyzed, indicating a response rate of 53%. Eight centers reported that a dentist was part of the HSCT team, with four reporting oral medicine specialists specifically being part of the team. Almost all centers (15/16; 93%) had an affiliated dental service to facilitate pre-HSCT dental clearance with an established dental clearance protocol at 14 centers (87%). Dental extraction was associated with the highest concern for bleeding and the need for platelet transfusion. With respect to infection risk, antibiotic prophylaxis was considered in the setting of low neutrophil counts with restorative dentistry and extraction. All centers provide daily reinforcement of oral hygiene regimen. The most frequently used mouth oral rinses included sodium bicarbonate (68%) and chlorhexidine gluconate (62%), in addition to ice chips for dry mouth (62%). The most frequently used mucositis assessment tools were the World Health Organization scale (7/16; 43%) and visual analogue scale for pain (6/16; 37%). Mucositis pain was managed with lidocaine solution (68.8%), magic mouth wash (68.8%) and/or systemic pain medications (75%).
Scope and implementation of oral care protocols prior to and during HSCT varied between transplant centers. The lack of a universal protocol may contribute to gaps in oral healthcare needs and management for this group of patients. Further dissemination of and education around available oral care guidelines is warranted.
Clinical relevance.
Considering oral care during HSCT a standard component of transplant protocols, the current study highlights the common oral care practices for patients at centers within the Eastern Mediterranean region.
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