Suchergebnisse

SummaryA survey was conducted of 300 state long‐term care facilities to determine prior training and needs for further instruction of dental staff in the management of patients in this setting. In addition, dental practitioners in two states, Missouri and Washington, were surveyed with respect to their qualifications and availability to treat persons with disabling conditions in the community.A large proportion of dentists who work in long‐term care facilities reported a lack of formal preparation for their area of dental practice. Many community dentists who stated a willingness to treat persons with disabling conditions also appeared to be inadequately prepared. Responses to the Missouri and Washington surveys were generally similar; apparent differences with respect to experience may have been caused by variation in survey criteria.Positive effects of training are beginning to carry over into practice. Larger numbers of recent graduates reported training and expressed willingness to treat patients with disabling conditions compared with dentists who have been in practice longer. Dentists with training and extensive experience probably best reflect available dental resources for persons with disabling conditions in the community.

A survey of incoming dental school patients compared 64 adult patients (DECOD) and 73 patients without disability (ND), regarding past dental experience, current needs, and basis for selecting the school's clinics. The responses indicated that, for DECOD patients, clinic selection was based largely on Medicaid acceptance, staff experience, and inability of other dentists to manage their disability; for ND patients, selection was based on lower fee structure. Both groups expressed high treatment need, but the rate was lower for DECOD than for ND patients. More DECOD patients reported severe dental anxiety and adverse effects of dental problems on general health. Chart records revealed that clinical findings exceeded perceived need for both DECOD and ND patients. While both groups had high periodontal disease rates (91%), DECOD patients had significantly poorer oral hygiene and less restorative need than ND patients. The findings suggest differences between persons with disabilities and other patient groups in difficulty of access to dental services in the community, reasons for entering the dental school system, and in presenting treatment need and/or treatment planning.

Chlorhexidine is effective when used as an oral rinse, but many disabled people cannot use such a protocol. A double‐blind cross‐over study tested the efficacy of applying chlorhexidine with a sponge‐swab, in a sample of 76 severely disabled adults, drawn from diverse rehabilitation settings. Two randomly assigned groups applied 10 mL 0.12% chlorhexidine gluconate (Perldex™, Procter & Gamble) or 10 mL placebo, using a "Toothette™" (Halbrand) once daily, 5 times per week for 10 weeks. All subjects received 10 mL 0.05 % NaF, applied similarly but separately from the test/placebo agent. Pre‐ and post‐trial measures included perceived level of function and oral status, that is, DMFS, plaque, calculus, pocket depth, and tooth stain. The protocol received high levels of compliance and acceptance. Compared with placebo, swabbing with chlorhexidine resulted in consistent, and, In part, significant improvements in plaque, gingivitis, and periodontal pocket depth. Side effects of chlorhexidine, that is, tooth stain and calculus, were relatively minor. Perceived Improvements in dental health were associated with improved physical health, appearance, and mouth odor. The results Indicate that chlorhexidine swabbing is a useful oral disease preventive protocol for persons with disability.

ABSTRACTThis study assessed the effectiveness of oral doxepin rinse for mucositis‐related pain management in patients following 1 week of repeated dosing. Patients with oral mucositis due to head and neck radiation therapy or hematopoietic stem cell transplant (HSCT) were recruited to participate in a 1‐week follow‐up study. Subjects who gave informed consent rinsed with doxepin (5 ml) during the initial visit and were then told to use doxepin rinse over the next week as needed, three to six times per day, and return for a follow‐up visit. At each visit, mucositis was scored using the Oral Mucositis Assessment Scale and oral pain was assessed using a visual analogue scale before and after rinsing. The use of a systemic analgesic was recorded, and side effects were documented. At the follow‐up visit, subjects were also asked to retrospectively report average pain scores they experienced over the past week, 5 and 15 minutes following rinse. Nine subjects were enrolled in the study. Statistically significant reductions in pain scores were reported for 2 hours following doxepin rinse during the initial visit (p < .05). Patients recalled that their pain significantly dropped within 5 minutes of rinsing over the week of repeated dosing (p < .05). At the follow‐up visit, subjects reported statistically significant pain reduction 5 minutes after doxepin rinsing (p < .05).These results indicate that doxepin rinsing continues to produce reduced intensity of pain levels over a 1‐week span of repeated dosing.

This study compared oral health and demographic characteristics of patients with and without disabilities at a dental school emergency clinic. Of 407 consecutive patients surveyed, 20.4% reported disabilities. Two groups matched by age and gender, those with disabilities (DIS, n = 79) and those without disabilities (ND, n = 177), were compared on questionnaire responses; two subgroups, DIS (n = 38) and ND (n = 44), were assessed clinically. The mean ages of the DIS and ND groups were 44.0 years (SD ± 11.6) and 43.0 years (SD ± 12.3), respectively. By chi‐squared analysis, DIS vs. ND subjects had significantly lower levels of education, employment, income, and dental Insurance, and greater dependence on Government funding. In the DIS group, 79.5% were not working, while 6.4% did work regularly. In the ND group, the corresponding values were 30.9% and 46.9%, respectively. In the DIS group, 51.9% identified Medicaid acceptance as the reason they sought care at the clinic, while 62, 7% of the subjects In the ND group identified the lower fee structure as the reason for clinic selection. More DIS than ND subjects reported dentists' unavailability and inability to manage the disability, lack of transportation, effect of dental problems on health, and referral by a health professional. DIS vs. ND subjects had significantly fewer sound teeth and more missing teeth. The results suggest that one in five dental school emergency clinic patients has disabilities.

A sample of 44 adults with severe disabilities completed a randomized single‐blind cross‐over study testing chlorhexidine swabbing under various conditions: with/without prior dental prophylaxis, reduced frequency of application (2 vs. 5 times per week), and prolonged use (42 weeks). All subjects received therapeutic doses of 10 mL 0.12% chlorhexidine gluconate (Peridex, Procter & Gamble) and 10 mL 0.05% NaF applied with a Toothette®xs (Sage Products). Clinical effectiveness of chlorhexidine swabbing compared with placebo was previously reported. In the present study, while initial benefits were observed to be independent of dental prophylaxis, significant reductions in periodontal scores were sustained by a combination of dental prophylaxis and swabbing protocol, at reduced frequency of application and over prolonged time. High levels of acceptance and compliance by subjects/caregivers were maintained. Subjects/caregivers reported improvements in dental health as well as in attitude, quality of life, and smile. Chlorhexidine swabbing at maintenance frequency, combined with periodic dental prophylaxis, may offer an effective and pragmatic long‐term preventive regimen for persons with disabilities.

Severe dental disease has been reported for patients receiving psychiatric treatment. This study compared the oral status of non‐institutionalized adults with chronic mental illness with a similar group without such history, and evaluated relative risk factors, for example, xerostomia, diet, hygiene, and poverty. A sample of 37 subjects with chronic mental illness (CMI) and 29 control subjects without mental illness were assessed for dental, medical and social history; head, neck, and oral soft tissue pathology; salivary flow; DMFS, gingivitis, loss of periodontal attachment, plaque, and calculus. The groups were equivalent in socioeconomic level, education, dental history, and home care. All subjects with CMI received psychotropic medications (mean of 3.8 drugs for 10.3 years). The CMI group had significantly higher incidence in the following variables: self‐reported dry mouth; consumption of carbonated beverages (P <.001); mucosal, lip, and tongue lesions (P <.01); coronal smooth surface caries (P<.001); severity of plaque (P<.001) and calculus (P<.01); and salivary flow (P<.05). No significant differences were evident in the M and F components of DMFS, in gingivitis or loss of attachment. The results indicate significant increases in risk factors and increased oral pathosis in persons with mental illness who live in community settings compared with a control group that showed dental neglect.