Susan Hyde

Welfare Dental Intervention Improves Employment and Quality of Life

Chronic, untreated oral disease adversely affects one’s systemic health, quality of life, and economic productivity. This study evaluated the effect of rehabilitative dental treatment on the oral-health-related quality of life and employment of welfare recipients. Three hundred and seventy-seven participants in a novel welfare dental program received oral examinations, questionnaires, and rehabilitative dental treatment. Seventy-nine percent of participants exhibited improvement in their oral-health-related quality-of-life scores following dental treatment. Improved OHIP-14 change scores were associated with being Caucasian or African-American, initial poor general health, severity of treatment urgency, worse baseline oral-health-related quality-of-life scores, subsequent patient satisfaction with the Dental Program, and resolution of their chief complaint (all p < 0.04). Those who completed their dental treatment were twice as likely to achieve a favorable/neutral employment outcome (OR = 2.01, 95%CI = 1.12, 3.62). Thus, oral health improved the quality of life and employment outcome for this welfare population.

Giving Policy Some Teeth: Routes To Reducing Disparities In Oral Health

Despite improvements in oral health status and clear links between oral and systemic health, oral health is not accorded the same importance in health care policy as is general health. This review of oral health disparities over the life span documents the results of this inequity. Dental concerns and unmet dental treatment needs, especially among vulnerable populations, are not well addressed in oral health policies. We offer examples of discrepancies between policy and needs and examples of successful interventions that integrate oral health care with informed policy.

Caregiver Acceptability and Preferences for Early Childhood Caries Preventive Treatments for Hispanic Children

OBJECTIVE The objective of this study was to determine caregiver treatment acceptability and preferences for five preventive dental treatments for early childhood caries in young Hispanic children. METHODS We interviewed 211 parents/caregivers of Hispanic children attending Head Start programs regarding their acceptability of, and preferences for, five standard preventive dental treatments for young children. Treatments assessed were toothbrushing with fluoride toothpaste, fluoride varnish, and xylitol in food for children, and xylitol gum and chlorhexidine rinse for mothers. The interview assessment included presentation of illustrated cards with verbal description of treatment, photograph/video clip, and treatment samples. Parents rated the acceptability of each treatment (1-5 scale) and treatment preferences within each of 10 possible pairs. Individual treatment preferences were summed to create overall preference scores (range 0-4). RESULTS All treatments were rated as highly acceptable, however, there were differences (range 4.6-4.9; Friedman chi-square = 23.4, P < 0.001). Chlorhexidine, toothbrushing, and varnish were most acceptable, not different from each other, but more acceptable than xylitol in food (P < 0.05). Summed treatment preferences revealed greater variability (means ranged 1.4-2.6; Friedman chi-square = 128.2, P < 0.001). Fluoride varnish (2.6) and toothbrushing (2.5) were most highly preferred, and differences between preferences for xylitol in food (1.4), xylitol gum (1.5), and chlorhexidine (2.1) were all significant (P < 0.001). Preferences for chlorhexidine were also significantly greater than those for the xylitol products (P < 0.001). CONCLUSIONS All five treatments were highly acceptable, however, when choosing among treatments overall, fluoride varnish and toothbrushing were favored over other treatments.

Developing an Acceptability Assessment of Preventive Dental Treatments

OBJECTIVES Early childhood caries (ECC) is very prevalent among young Hispanic children. ECC is amenable to a variety of preventive procedures, yet many Hispanic families underutilize dental services. Acceptability research may assist in health care planning and resource allocation by identifying patient preferences among efficacious treatments with the goal of improving their utilization. The purposes of this study were (a) to develop a culturally competent acceptability assessment instrument, directed toward the caregivers of young Hispanic children, for five preventive dental treatments for ECC and (b) to test the instruments reliability and validity. METHODS An instrument of five standard treatments known to prevent ECC was developed, translated, reviewed by focus groups, and pilot tested, then tested for reliability The instrument included illustrated cards, brief video clips, and samples of the treatments and was culturally appropriate for low-income Hispanic caregivers. In addition to determining the acceptability of the five treatments individually, the treatments were also presented as paired comparisons. RESULTS Focus groups and debriefing interviews following the pilot tests established that the instrument has good face validity. The illustrated cards, product samples, and video demonstrations of the five treatments resulted in an instrument possessing good content validity. The instrument has good to excellent test-retest reliability, with identical time 1-time 2 responses for each of the five treatments 92 percent of the time (range 87 to 97 percent), and the same treatment of the paired comparisons preferred 75 percent of the time (range 61 to 90 percent). CONCLUSIONS The acceptability instrument described is reliable and valid and may be useful in program planning efforts to identify and increase the utilization of preferred ECC preventive treatments for target populations.

A systematic review of silver diamine fluoride: Effectiveness and application in older adults

OBJECTIVE This systematic review examines the effectiveness of silver diamine fluoride (SDF) in the management of caries in older adults. BACKGROUND Silver diamine fluoride has been extensively researched and proven effective for caries prevention and arrest in children. Limited studies support its effectiveness in adult and older adult populations. MATERIALS AND METHODS Multiple databases were searched according to specified inclusion-exclusion criteria. Quality assessment used modified Centre for Evidence-Based Medicine worksheets. RESULTS Three randomised controlled trials were identified that addressed the effectiveness of SDF on root caries in older adults, but none addressed coronal caries. Root caries prevented fraction and arrest rate for SDF were significantly higher than placebo. The prevented fraction for caries prevention for SDF compared to placebo was 71% in a 3-year study and 25% in a 2-year study. The prevented fraction for caries arrest for SDF was 725% greater in a 24-month study and 100% greater than placebo in a 30-month study. No severe adverse effects were observed. CONCLUSION This systematic review evaluates the use of SDF for both root caries prevention and arrest in older adults. Existing reports of SDF trials support effectiveness in root caries prevention and arrest, remineralization of deep occlusal lesions and treatment of hypersensitive dentin.

Does fraud trump partisanship? The impact of contentious elections on voter confidence

ABSTRACT Fraudulent elections can reduce citizen trust in elections and other political institutions. But what about the impact of contentious elections that resolve successfully, leading to democratizing change? Do national movements toward democracy trump individual experiences with electoral manipulation? Using public opinion survey data collected before and after the 2004 Orange Revolution in Ukraine, we evaluate changes in voter confidence in electoral practices, political institutions, and democracy. Although national trends show increased voter confidence overall, subnational variation suggests pervasive partisan differences in opinions about election quality and institutional confidence. Remarkably, we find that direct exposure to fraud matters far less than anticipated; voters who were personally exposed to fraud felt no more or less confident than their co-partisans. We show that partisanship and the national electoral context may interact in ways that complicate the effects of democratizing elections, suggesting important avenues for future research.

Prevention of tooth loss and dental pain for reducing the global burden of oral diseases

Population ageing is a global phenomenon and is predicted to become one of the most significant social transformations of the 21st century. The anticipated demographic shift provides governments the opportunity to proactively align policies with the estimated demands for housing, transportation, social protection, and health and well-being. Oral health is a fundamental component of health and physical and mental well-being, and is influenced by the individuals changing experience, perceptions, expectations and ability to adapt to circumstances. As such, prevention of oral disease and maintenance of oral health contributes to the systemic health, well-being, and quality of life of older adults. Dental caries, periodontal disease, and tooth loss in older adults are global health concerns because they are highly prevalent worldwide, socio-economic inequalities contribute to these diseases, many of the risk factors are modifiable, and these diseases result in compromised oral health-related quality of life. Oral care must be tailored to the needs and level of dependency of older adults through the use of evidence-based approaches and inter-professional collaboration. The persistence of between countries and within countries oral health disparities indicate that population-based policies are also needed to address the underlying social, environmental, and economic causes of oral diseases.

Nursing Case Management Strategies for Adults with Serious Mental Illness Seeking Dental Services

ABSTRACT A university-community partnership initiated a dental screening and nursing case management program for Medicaid-insured adults with serious mental illness (SMI). Forty-three adults with SMI participated in dental screening; 72% participated in case management. Per client, an average of six case management contacts was made. After 6 months, 87% (27/31) had attended at least one dental appointment, with a 13% no-show rate; 8 completed treatment, 4 had ongoing treatment, 12 had interrupted care, and 3 were lost to follow-up. Adults with SMI experienced high unmet dental needs; nursing case management strategies aided clients to initiate and complete dental care.