K. Pateman

How do Australians living with MS experience oral health and accessing dental care? A focus group study

OBJECTIVES The symptoms of multiple sclerosis (MS) can affect oral care and access to dental services, but there is limited literature describing the oral health and perceived oral healthcare needs of people with MS. This study aimed to explore the oral health experiences, oral health behaviours and barriers to accessing dental care perceived by people living with MS in Australia. METHODS Six focus groups were held across two metropolitan areas (Brisbane, Queensland and Melbourne, Victoria) and one regional area (Toowoomba, Queensland). Focus group data were analysed using thematic analysis. RESULTS Living with MS was a highly individual experience due to the range of symptoms that may be experienced. In addition to having different symptom experiences to others with MS, individual symptoms also differed on a daily basis as the disease relapsed and remitted. The physical expressions of MS directly and indirectly affected the oral health of participants. Additionally, oral health was affected by the side effects of medications and orofacial pain symptoms. Depending on the symptoms experienced by the individual, personal oral hygiene was affected and professional dental appointments were difficult. Participants also experienced structural barriers to accessing professional dental care including difficulty accessing transport to-and-from dental appointments, space limitations in the dental surgery and financial barriers to care. DISCUSSION Dental care was perceived to be inflexible and was not tailored to individual experiences of MS, which contributed to perceptions of poor quality and appropriateness of care. It is important for dental professionals to offer tailored and individualized dental care when treating people with MS. Our findings suggest that there needs to be greater interprofessional communication and referral to manage atypical dental pain symptoms. Oral health education for people with MS should include altered strategies to performing daily oral hygiene, the management of xerostomia and advice regarding low cariogenic diets suitable for dysphagia. Additionally, policy and strategies to improve the oral health of people with MS should focus on enhancing access through transport, reducing the cost of dental services to the individual and providing domiciliary oral health care.

Managing the oral side effects of medications used to treat multiple sclerosis

BACKGROUND Many medications used to manage multiple sclerosis (MS) affect oral health. This review aimed to identify the oral side-effects of the current drugs recommended in Australia to treat MS and make dental practitioners aware of the range of symptoms. METHODS The Australian Therapeutic Guidelines and the Australian Medicines Handbook were searched for medications used to treat MS. For each medication, the generic name, class, route of administration, dosage and drug company reported side-effects were extracted from the online Monthly Index of Medical Specialties (MIMs) database. Meylers Side-effect of Drugs Encyclopaedia was used to identify any additional oral adverse reactions to medications used to treat MS. RESULTS Fourteen drugs were identified for the treatment of MS progression and 13 drugs for the treatment of MS symptoms. For these medications, 18 oral side-effects were documented: xerostomia was the most common, followed by dysgeusia, dysphagia, mouth ulceration and sinusitis. Anticholinergic drugs caused xerostomia while immunosuppressants resulted in more infection-related side-effects. CONCLUSIONS Dental practitioners should be aware of the range of symptoms likely to be reported by this population. Clinicians are encouraged to continue providing dental care for their patients who develop MS and refer complex cases to specialists.

Joining the dots: Can UW-QoL free-text data assist in understanding individual treatment experiences and QoL outcomes in head and neck cancer?

The diagnosis and treatment of head and neck cancer (HNC) affects multiple domains of quality of life (QoL), including physical, social, emotional, and psychological functioning. Health‐related quality of life (HRQoL) is a subset of QoL and has emerged as an important patient reported outcome of HNC treatment, aligned with an increasing focus on survivorship. The University of Washington quality‐of‐life survey (UW‐QoL) is among the most widely used HNC‐specific QoL measures. It is the only HNC specific measure to include a free‐text question, prompting for the identification of issues not measured by the questionnaire. Despite its wide use, relatively few studies have reported findings from the free‐text data, and some authors have cited methodological difficulties in transforming textual data as a reason for this. Qualitative research involving interviews and focus groups has added richness to epistemological understandings of QoL and supportive care needs post‐HNC. There are several theoretical approaches available to guide qualitative analysis. Content analysis is a commonly used method to analyse open‐ended text data and may involve an inductive or deductive approach. As qualitative inquiry positions the researcher as the “instrument” responsible for data analysis and interpretation, qualitative analysis is often time consuming and resource‐intensive. Multiple strategies are needed to ensure rigor in interpretation. In response to this and to facilitate the analysis of large data sets, software or machine‐driven methods of text data analysis have been developed. Machine‐driven approaches include learning‐