Blanaid Daly

The management of dental anxiety: time for a sense of proportion?

Dental anxiety and fear are common and potentially problematic, both for the patient and for the dental team in managing such patients. Furthermore, dental fear still presents a major barrier to the uptake of dental treatment. This article will take as its premise an assumption that anxiety manifests at different levels and that consequently management of dental anxiety involves both assessment and proportionate intervention. Methods for undertaking both assessment and management are outlined.

Promoting physical health for people with schizophrenia by reducing disparities in medical and dental care

Acquiring a diagnosis of schizophrenia reduces life expectancy for many reasons including poverty, difficulties in communication, side‐effects of medication and access to care. This mortality gap is driven by natural deaths; cardiovascular disease is a major cause, but outcomes for people with severe mental illness are worse for many physical health conditions, including cancer, fractures and complications of surgery. We set out to examine the literature on disparities in medical and dental care experienced by people with schizophrenia and suggest possible approaches to improving health.

Oral health care needs and oral health-related quality of life (OHIP-14) in homeless people.

OBJECTIVES The aim of this study was (i) to determine the oral health status and oral health care needs of this population, (ii) to assess oral health-related quality of life using OHIP-14 and (iii) to explore whether there is a relationship between oral health status and oral health-related quality of life. METHODS A convenience sample was drawn from eight facilities catering for homeless people in south east London. Participants were invited to attend an outreach dental clinic and receive a clinical oral health and treatment needs assessment. The impact of oral disease was assessed using OHIP-14. RESULTS There were 102 people from a range of vulnerable housing situations invited to participate in the study. The mean age was 39.5 (SD +/- 12.3) and 92% (n = 92) were men. The mean DMFT of dentate participants (n = 94) was 15.5 (SD +/- 7.6), mean DT was 4.2 (SD +/- 5.2), mean MT was 6.8 (SD +/- 6.0) and mean FT was 4.6 (SD +/- 4.8). Normative needs were extensive with 76% having a restorative need, 80% having a need for oral hygiene measures and periodontal treatment and 38% having a prosthetic treatment need. Ninety one per cent of homeless people experienced at least one impact and the mean number of impacts (n = 90) was 5.9 (SD +/- 4.8).The most commonly experienced oral health-related quality of life impacts were in the dimension of pain, with aching in the mouth having a prevalence of 65% and discomfort while eating foods having a prevalence of 62%. Forty-four per cent felt handicapped by their oral condition. The experience of oral impact had only a slight relationship with clinical status and there were no differences in clinical status or oral impact by vulnerability of housing situation. CONCLUSIONS Oral health care needs were extensive and greater than that of the general population in the UK, although disease levels were similar. While homeless people experienced many more oral impacts (as measured with OHIP-14) compared with adults of the same age in the general population in the UK, there was only a slight relationship with clinical status and oral health-related quality of life.

Patterns of dental service use among homeless people using a targeted service

OBJECTIVE The objective of this study was to describe the patterns of dental service use among homeless people using a targeted dental service from 1992 to 2001. METHOD A case-note review of a selection of patients (n = 204) was undertaken using a pre-designed data abstraction form. RESULTS For those presenting at their first contact, 40 percent (n = 68) expressed need in relation to oral pain and disease/tissue damage, and 28 percent (n = 33) in relation to dental checking and oral prophylaxis. Most homeless people had normative need for dental treatment (93 percent: n = 153). The dental service was delivered using a mix of outreach and fixed site clinics, with 75 percent (n = 153) of all first contacts made at outreach clinics. The targeted service was moderately successful at getting people to attend the fixed site service for continuing care, with 51 percent (n = 87) attending for subsequent visits. Location of first contact with the targeted dental service did not predict subsequent attendance. Those who did attend for further care tended to have normative needs for periodontal disease and dental decay and have their presenting complaint met. Only 23 percent (n = 46) of people completed a treatment plan, over a mean of 8.2 (standard deviation +/- 9.4) visits. No factors appeared to predict completion of treatment. CONCLUSIONS While the small sample limits the findings in this study, it is hypothesized that the presence of the dental service promoted uptake of dental care. Flexible attendance tended to result in multiple visits and delayed outcomes, which themselves could have acted as barriers to care.

Dental tooth surface loss and quality of life in university students.

Aim To determine the relationship between toothwear into dentine and oral health-related quality of life impacts in a sample of university students not attending for dental treatment. Methods A cross-sectional survey of 1010 university students was undertaken. Clinical examination, including the Smith & Knight (1984) index of tooth erosion, was performed and completion of the Oral Health Impact Profile-49 (OHIP-49) measure of oral health-related quality of life was arranged. Results Seventy-seven per cent of the students had at least one tooth with tooth surface loss into dentine. Overall OHIP scores were similar for individuals with different levels of severity of tooth surface loss. Individuals with severe tooth surface loss were more likely to report that their appearance had been affected by, and that they had felt self-conscious because of, the condition of their mouth and teeth. Conclusions Tooth surface loss into dentine was prevalent among the young adults who were examined in this study. They reported that it had little impact on oral health-related quality of life at the non-clinical levels seen in this study.

Dentist–patient communication: what do patients and dentists remember following a consultation? Implications for patient compliance

Background There is a lack of information about the extent to which patients recall key facts of dental consultations. Forgetting health advice undermines adherence with such instructions and is a potential problem. This study assessed the quantity and type of information recalled in a dental consultation, dentist–patient agreement over the contents of the consultation, and the relationship of such recall with patient satisfaction. Methods Using a cross-sectional design, questionnaire data were obtained from patients recruited through a letter and presenting for a routine dental consultation. General issues discussed, specific information about oral health given, dentist-performed procedures, and agreed future actions were reported independently in writing, by patients and also by the treating dentist immediately postconsultation. Additionally, patients completed a dental visit satisfaction questionnaire. Results Responses (n = 26, 55% response rate) were content-analyzed, and data on the number and type of information that was recalled were obtained. Interrater reliability was established. Inferential testing showed differences in dentist–patient recall, dentist–patient agreement, and the association between patient recall and satisfaction. Dentists recalled more information than patients (P = 0.001). Dentists further reported giving more dental health education (P = 0.006) and discussing more future actions (P = 0.002) than patients actually remembered. Technical (eg, crowns/bridges) rather than psychosocial (eg, pain/embarrassment) issues were reported more often (P = 0.001) by both dentists and patients. Dentist–patient agreement over issues discussed and procedures performed was higher (kappa = 0.210–0.310) than dental health education agreement and agreed future actions (kappa = 0.060–0.110). There was no relationship between patient recall and patient satisfaction with the consultation (P = 0.240). Conclusion Patients do not recall as much advice and agreed actions about future dental care as dentists believe they have discussed. These results have implications for patient adherence with oral health instructions.

Characteristics of patients attending for cognitive behavioural therapy at one UK specialist unit for dental phobia and outcomes of treatment

Aim To describe the characteristics of patients attending a psychologist-led cognitive behavioural therapy (CBT) service for individuals with dental phobia and the outcomes of treatment.Method Analysis of routinely collected assessment and outcome data from 130 patients attending a single secondary service providing CBT for dental phobia.Findings The patients comprised 99 women and 31 men, with an average age of 39.9 years (SD 14.8). Approximately 77% of the patients scored at levels suggestive of dental phobia on the Modified Dental Anxiety Scale (MDAS). Fear of dental injections and the dental drill were the most common high scoring items on the MDAS. Ninety four percent of patients reported one or more impacts of their mouth, teeth and gums on their life using the OHIP-14. A minority of patients had co-morbid psychological conditions – 36.9% had high levels of general anxiety and 12.3% had clinically significant levels of depression. Suicidal ideation was reported by 12% of patients and four (3%) reported recent intent to commit suicide. Of all patients referred 79% went on to have dental treatment without sedation and 6% had their dental treatment under sedation. The average number of CBT appointments required before a patient received dental treatment without sedation was five.Conclusions CBT offers an effective technique for helping dentally anxious patients receive treatment without sedation. Those interested in running such services should be cognizant of the moderately high level of co-morbid psychological conditions in this group.

Promoting good dental health in older people: Role of the community nurse

Good dental health enables a person to eat, speak, and socialise. It contributes to nutrition, general health, and quality of life. The dental health of people living in the UK has improved in the last 40 years, and older people are retaining their natural teeth throughout their life; nontheless, a significant proportion of people over 75 years still rely on partial and full dentures. Dental disease in all age groups is readily prevented by daily oral hygiene and adherence to a healthy diet, avoidance of smoking, and sensible alcohol intake. Some older people may simply need reminding and encouragement to carry out oral hygiene, while more dependent adults may need support and active help to do so. Nursing teams and health professionals play a key role in promoting oral health by supporting oral hygiene and adequate nutrition, preventing discomfort, and detecting dental diseases early. This article gives a brief overview of how nursing teams and health professionals can promote oral health and provides details of resources from which further detailed information may be obtained.

Vagus nerve stimulation therapy (VNST) in epilepsy – implications for dental practice

Epilepsy is a chronic condition which affects about 1% of the population. It is important that the dental team is aware of the management of epileptic seizures and epileptic syndromes including recent advances in seizure management. As people with epilepsy often get a warning aura before seizures begin, the management of the condition has increasingly involved measures to prevent the seizure, once the aura has begun. Vagus nerve stimulation therapy (VNST) in epilepsy involves the use of an implantable electronic device and is being increasingly used in the UK to control severe treatment resistant epilepsy. As a result, more patients will be presented to clinicians in the primary healthcare setting and hospital services with these devices in place. Members of the dental team need to understand the principles of epilepsy control, how VNST is used in the management of intractable epilepsy, how the VNST system operates and the implications of VNST use for dental practice including medical devices, interactions and safety features.

The Kilkenny integrated Oral Health Project

The Kilkenny Health Project, started in 1985, aims to reduce the level of risk factors in the community for coronary heart disease through health promotion. Dental disease and coronary heart disease share risk factors of tobacco use, alcohol consumption and poor dietary patterns. A baseline oral health survey demonstrated significant levels of dental disease in Kilkenny in the 429 adults and 523 children who were examined there in 1987. Seventy one per cent of adults required treatment for periodontal disease and 49% of children surveyed required treatment for dental decay. The Kilkenny Oral Health Project was developed as a community participation project aiming to reduce the level of common risk factors in the community for coronary heart disease and dental disease. It has run parallel with the main Kilkenny Health Project and is one of the first health promotion projects which has an integrated health message preventing dental disease and coronary heart disease.