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Purpose: The purpose of this Doctorate in Nursing Practice (DNP) quality improvement (QI) project is to improve the oral health status of adults with intellectual and developmental disabilities (IDD). Background: Adults with IDD suffer from poor oral health status at a rate of 3 to 4% higher than those without IDD. Studies show poor oral health is linked with chronic diseases such as heart disease, respiratory infections, obesity, and type 2 diabetes mellitus (T2DM). Personal and system barriers contribute to the oral health disparities of adults with IDD. Research supports evidence-based interventions to improve the oral health status of adults with IDD. Methods: An eight-question comprehensive needs assessment survey designed to evaluate the respondents’ baseline knowledge of the oral health care needs of adults with IDD and which evidence-based intervention was most preferred to improve the oral health status of adults with IDD was developed in collaboration with The Arc of Spokane. The author of this project used Qualtrics software to create the questionnaire and disseminated the survey using The Arc of Spokane’s social media platform and email server list. The survey was available to recipients for two weeks. Results: There were 35 completed surveys returned. The survey results indicated that the respondents had a strong understanding of the complex issues facing adults with IDD. The majority of the respondents were caregivers. The most preferred evidence-based intervention to improve the oral health status of adults with IDD was for community organizations like The Arc of Spokane to form strategic partnerships with local dental residency and dental hygiene 8 programs, enriching dental school curricula and increasing oral healthcare services to disabled adults. Conclusions: The conclusion of this DNP QI project emphasizes the importance of oral healthcare services to minimize poor health outcomes, improve the quality of life for adults living with IDD, and ease

The aims of this study were to investigate the clinical effectiveness and patient acceptability of a modified glass ionomer cement placed using the atraumatic restorative treatment (ART) technique to treat root caries, and to carry out microbiological analysis of the restored sites. Two clinically visible root surface carious lesions per participant were restored using ART. One was restored with commercial glass ionomer cement (GIC) (ChemFil® Superior, DENTSPLY, Konstonz, Germany) which acted as the control. The other carious root lesion was restored with the same GIC modified with 5% chlorhexidine digluconate (GIC-CHX; test). Patient acceptability and restoration survival rate were evaluated at baseline and after 6 months. Plaque and saliva samples around the test and control restorations were collected, and microbiological analysis for selected bacterial and fungal viability were completed at baseline, and after 1, 3, and 6 months. In total, 52 restorations were placed using GIC and GIC-CHX in 26 participants; 1 patient was lost to follow-up. After reviewing the restorations during their baseline appointments, participants indicated that they were satisfied with the appearance of the restorations (n = 25, 96%) and did not feel anxious during the procedure (n = 24, 92%). Forty-eight percent (n = 12) of the GIC-CHX restorations were continuous with the existing anatomic form as opposed to six for the GIC restorations (24%), a difference which was statistically significant (p = 0.036). There was no statistically significant reduction in the mean count of the tested microorganisms in plaque samples for either type of restorations after 1, 3, or 6 months. Restoration of carious root surfaces with GIC-CHX resulted in higher survival rates than the control GIC. ART using GIC-CHX may therefore be a viable approach for use in outreach dental services to restore root surface carious lesions where dental services are not readily available, and for older people and special ne

Purpose Severe mental illness (SMI) may interfere with parental caregiving practices and offspring development. Adhering to preventive well-child visits and maintaining good oral hygiene during early childhood requires parental involvement. Whether these activities are affected by parental SMI is unclear. The purpose of the present study was to determine whether children exposed to parental SMI are at increased risk of non-attendance to preventive well-child visits and vaccinations at age 0-5 years and of child dental caries experience at age 5 years. Furthermore, interactions between maternal psychiatric and sociodemographic variables in relation to an adverse child outcome were assessed. Methods Data were obtained from national Danish health registers. All children born in Denmark between January 1997 and December 2010 were followed from birth until their 6th birthday. Results 679,339 children were included in the study (51% male). Of these, 49,059 children (7.8%) had at least one parent with a lifetime SMI diagnosis. Children of parents with SMI had elevated odds of missing well-child visits and vaccinations (OR 1.41; 95% CI 1.39-1.44,p <0.0001), and of child dental caries (OR 1.58; 95% CI 1.55-1.62,p <0.0001). In the presence of maternal SMI, low socioeconomic classification and single-mother status added more to the elevated risk than specific maternal diagnosis or timing of last psychiatric contact. Conclusion Parents with SMI are less compliant with preventive child healthcare activities than parents without SMI. This indicates a need for practical support to these families in order to prevent inequality in health among their offspring.

Background and objectives: Steinert's disease or myotonic dystrophy type 1 (MD1), (OMIM 160900), is the most prevalent myopathy in adults. It is a multisystemic disorder with dysfunction of virtually all organs and tissues and a great phenotypical variability, which implies that it has to be addressed by different specialities with experience in the disease. The knowledge of the disease and its management has changed dramatically in recent years. This guide tries to establish recommendations for the diagnosis, prognosis, follow-up and treatment of the complications of MD1. Material and methods: Consensus guide developed through a multidisciplinary approach with a systematic literature review. Neurologists, pulmonologists, cardiologists, endocrinologists, neuropaediatricians and geneticists have participated in the guide. Recommendations: The genetic diagnosis should quantify the number of CTG repetitions. MD1 patients need cardiac and respiratory lifetime follow-up. Before any surgery under general anaesthesia, a respiratory evaluation must be done. Dysphagia must be screened periodically. Genetic counselling must be offered to patients and relatives. Conclusion: MD1 is a multisystemic disease that requires specialised multidisciplinary follow-up., Antecedentesyobjetivos:LaenfermedaddeSteinertodistrofiamiotónicatipo1(DM1),(OMIM160900)eslamiopatíamásprevalenteeneladulto.Esunaenfermedadmultisisté-micaconalteracióndeprácticamentetodoslosórganosytejidosyunavariabilidadfenotípicamuyamplia,loqueimplicaquedebaseratendidapordiferentesespecialistasquedominenlasalteracionesmásimportantes.Enlosúltimosa ̃nossehaavanzadodemaneraexponencialenelconocimientodelaenfermedadyensumanejo.Elobjetivodelaguíaesestablecerrecomen-dacionesparaeldiagnóstico,elpronóstico,elseguimientoyeltratamientodelasdiferentesalteracionesdelaDM1.Materialymétodos:Estaguíadeconsensoseharealizadodemaneramultidisciplinar.Sehacontadoconneurólogos,neumólogos,cardiólogos,endocrinólogos,neuropediatrasygenetistasquehanrealizadounarevisiónsistemáticadelaliteratura.Recomendaciones:SerecomiendarealizarundiagnósticogenéticoconcuantificaciónprecisadetripletesCTG.LospacientesconDM1debenseguircontrolcardiológicoyneumológicodeporvida.Antesdecualquiercirugíaconanestesiageneraldeberealizarseunaevaluaciónrespira-toria.Debemonitorizarselapresenciadesíntomasdedisfagiaperiódicamente.DebeofrecerseconsejogenéticoalospacientesconDM1yasusfamiliares.Conclusión:LaDM1esunaenfermedadmultisistémicaquerequiereunseguimientoenunida-desespecializadasmultidisciplinares

Background: Limited evidence exists to inform best practice approaches to implement school-based dental screening to address child retention via referral for dental services. This research tested the null hypothesis that a targeted school-based dental check-up program (intervention) has a 75% child retention rate for public dental care (H0 = 0.75). Methods: A prospective non-randomised controlled trial was conducted with a convenience sampling approach in metropolitan Melbourne, Australia. Children in the intervention group were recruited from two preschools and two primary schools from a low socioeconomic area. Children in the standard care group were recruited from the local public dental service. Statistical analysis was performed using Stata IC Version 12. Results: Children in the intervention (45%) were significantly less likely to have never had a dental check-up compared to standard care (20%) (p < 0.001). There was no significant difference for the child retention rate for the intervention group when compared against the null hypothesis (p = 0.954). The total society costs were AU$754.7 and AU$612.2 for the intervention and standard care groups, respectively (p = 0.049). Conclusions: This validation study provides evidence that a targeted school-based dental check-up program can achieve a 75% child retention rate and should be considered for program expansion

Background and objectives: Steinert's disease or myotonic dystrophy type 1 (MD1), (OMIM 160900), is the most prevalent myopathy in adults. It is a multisystemic disorder with dysfunction of virtually all organs and tissues and a great phenotypical variability, which implies that it has to be addressed by different specialities with experience in the disease. The knowledge of the disease and its management has changed dramatically in recent years. This guide tries to establish recommendations for the diagnosis, prognosis, follow-up and treatment of the complications of MD1. Material and methods: Consensus guide developed through a multidisciplinary approach with a systematic literature review. Neurologists, pulmonologists, cardiologists, endocrinologists, neuropaediatricians and geneticists have participated in the guide. Recommendations: The genetic diagnosis should quantify the number of CTG repetitions. MD1 patients need cardiac and respiratory lifetime follow-up. Before any surgery under general anaesthesia, a respiratory evaluation must be done. Dysphagia must be screened periodically. Genetic counselling must be offered to patients and relatives. Conclusion: MD1 is a multisystemic disease that requires specialised multidisciplinary follow-up., Antecedentesyobjetivos:LaenfermedaddeSteinertodistrofiamiotónicatipo1(DM1),(OMIM160900)eslamiopatíamásprevalenteeneladulto.Esunaenfermedadmultisisté-micaconalteracióndeprácticamentetodoslosórganosytejidosyunavariabilidadfenotípicamuyamplia,loqueimplicaquedebaseratendidapordiferentesespecialistasquedominenlasalteracionesmásimportantes.Enlosúltimosa ̃nossehaavanzadodemaneraexponencialenelconocimientodelaenfermedadyensumanejo.Elobjetivodelaguíaesestablecerrecomen-dacionesparaeldiagnóstico,elpronóstico,elseguimientoyeltratamientodelasdiferentesalteracionesdelaDM1.Materialymétodos:Estaguíadeconsensoseharealizadodemaneramultidisciplinar.Sehacontadoconneurólogos,neumólogos,cardiólogos,endocrinólogos,neuropediatrasygenetistasquehanrealizadounarevisiónsistemáticadelaliteratura.Recomendaciones:SerecomiendarealizarundiagnósticogenéticoconcuantificaciónprecisadetripletesCTG.LospacientesconDM1debenseguircontrolcardiológicoyneumológicodeporvida.Antesdecualquiercirugíaconanestesiageneraldeberealizarseunaevaluaciónrespira-toria.Debemonitorizarselapresenciadesíntomasdedisfagiaperiódicamente.DebeofrecerseconsejogenéticoalospacientesconDM1yasusfamiliares.Conclusión:LaDM1esunaenfermedadmultisistémicaquerequiereunseguimientoenunida-desespecializadasmultidisciplinares

Background and objectives: Steinert's disease or myotonic dystrophy type 1 (MD1), (OMIM 160900), is the most prevalent myopathy in adults. It is a multisystemic disorder with dysfunction of virtually all organs and tissues and a great phenotypical variability, which implies that it has to be addressed by different specialities with experience in the disease. The knowledge of the disease and its management has changed dramatically in recent years. This guide tries to establish recommendations for the diagnosis, prognosis, follow-up and treatment of the complications of MD1. Material and methods: Consensus guide developed through a multidisciplinary approach with a systematic literature review. Neurologists, pulmonologists, cardiologists, endocrinologists, neuropaediatricians and geneticists have participated in the guide. Recommendations: The genetic diagnosis should quantify the number of CTG repetitions. MD1 patients need cardiac and respiratory lifetime follow-up. Before any surgery under general anaesthesia, a respiratory evaluation must be done. Dysphagia must be screened periodically. Genetic counselling must be offered to patients and relatives. Conclusion: MD1 is a multisystemic disease that requires specialised multidisciplinary follow-up., Antecedentesyobjetivos:LaenfermedaddeSteinertodistrofiamiotónicatipo1(DM1),(OMIM160900)eslamiopatíamásprevalenteeneladulto.Esunaenfermedadmultisisté-micaconalteracióndeprácticamentetodoslosórganosytejidosyunavariabilidadfenotípicamuyamplia,loqueimplicaquedebaseratendidapordiferentesespecialistasquedominenlasalteracionesmásimportantes.Enlosúltimosa ̃nossehaavanzadodemaneraexponencialenelconocimientodelaenfermedadyensumanejo.Elobjetivodelaguíaesestablecerrecomen-dacionesparaeldiagnóstico,elpronóstico,elseguimientoyeltratamientodelasdiferentesalteracionesdelaDM1.Materialymétodos:Estaguíadeconsensoseharealizadodemaneramultidisciplinar.Sehacontadoconneurólogos,neumólogos,cardiólogos,endocrinólogos,neuropediatrasygenetistasquehanrealizadounarevisiónsistemáticadelaliteratura.Recomendaciones:SerecomiendarealizarundiagnósticogenéticoconcuantificaciónprecisadetripletesCTG.LospacientesconDM1debenseguircontrolcardiológicoyneumológicodeporvida.Antesdecualquiercirugíaconanestesiageneraldeberealizarseunaevaluaciónrespira-toria.Debemonitorizarselapresenciadesíntomasdedisfagiaperiódicamente.DebeofrecerseconsejogenéticoalospacientesconDM1yasusfamiliares.Conclusión:LaDM1esunaenfermedadmultisistémicaquerequiereunseguimientoenunida-desespecializadasmultidisciplinares

BACKGROUND: At present, there are numerous caries risk assessment tools (CRATs) being promoted for disease management. However, the evidence to inform CRAT selection is unclear. AIM: This review aimed to assess the strength of evidence to inform the selection of CRATs for children ages 6 years and less. DESIGN: MEDLINE was the principal search database for this review. Other key databases, the reference lists of included articles, known cariology literature and experts were also consulted. Peer-reviewed papers describing CRATs and their development methodology were included. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist guided the quality assessment. The reporting of the key measurement properties (reliability, validity and responsiveness) informed the quality assessment. RESULTS: The search resulted in ten papers, reporting on eight different CRATs. The identified CRATs were: Caries Management By Risk Assessment (CAMBRA), Cariogram, National University of Singapore CRAT (NUS-CRAT), MySmileBuddy, Dundee Caries Risk Assessment Model, University of North Carolina Risk Assessment Models, University of Michigan pediatric dental clinic caries risk assessment sheet and American Academy of Pediatric Dentistry (AAPD) CRAT. Common across all CRATs was the lack of information to determine the levels of evidence for the measurement properties of reliability and construct validity. Studies on tools that were assessed as having strong evidence for content validity, identified the relevant risk factors for caries in the population being studied, before developing and testing their respective CRATs. CONCLUSIONS: The evidence to inform the selection of current CRATs for children is mostly yet to be established. Overall, the NUS-CRAT studies reported the most information to inform the assessment of its measurement properties and as a result this tool attained a higher quality rating than other CRATs studied. This article is prot

Background: Over the past two decades, there has been a decrease in dental diseases in Australia; however, the number of preventable dental hospital admissions has not diminished. This review reports on the factors associated with preventable dental hospital admissions in Australia. Methods: A search of five databases was conducted using Medical subject headings/Emtree terms and Index terms. All original studies, published between January1965 and March 2018 in English, based on the Australian population, and examining the prevalence of oral conditions as a cause for emergency department presentations and hospital admissions were included. The mixed method appraisal tool was used to evaluate the included studies. Results: Eleven cross-sectional studies met inclusion and exclusion criteria. All the studies, except one from Tasmania, were from Western Australia. The most common reasons for preventable dental hospital admissions were dental caries, followed by embedded or impacted teeth. Malignant neoplasms were reported as main causes of preventable dental hospital admissions in the older population. Conclusions: Most studies on preventable dental hospital admissions were from one Australian state (Western Australia). Further research is required to determine the national prevalence and incidence of preventable dental hospital admissions. A periodic audit of preventable dental hospital admission data is needed for delivery of a fair and effective dental services.

Drug use causes several health hazards to oral health, increasing the prevalence of dental caries and periodontal diseases, representing a serious public health problem. This study aimed to evaluate the prevalence of dental and periodontal caries in institutionalized drug users. It is an epidemiological, cross-sectional, census-based, analytical study with institutionalized drug users, carried out from August 2016 to June 2017. Standardized examiners applied a form to collect sociodemographic data and on drug consumption. Dental caries were evaluated through the DMFT index and periodontal disease through clinical indicators: bleeding at probing, plaque index, gingival index, probing depth and level of clinical insertion. A total of 112 males, mean age 36.7 years (Dp ± 11.5) were evaluated. The most commonly used drug was alcohol (92.0%) for about 19.4 years (Dp ± 11.08), followed by tobacco (70.95%) on average for 18.0 years (Dp ± 11.66), marijuana (65.2%) for 13.7 years (Dp ± 8.22), cocaine (53.3%) for 8.5 years (Dp ± 6.00) and crack (50.0%) for 11.1 year (Dp ± 7.18). It is concluded that the prevalence of caries was 97.3% and of periodontal disease 51.5%. The studied population presented high prevalence of dental caries and periodontal disease and there was a correlation between alcohol and tobacco use time with periodontal disease and with higher DMFT., O uso de drogas traz diversos malefícios para a saúde bucal, aumentando a prevalência das doenças cárie dentária e periodontal, representando um sério problema de saúde pública. Este estudo objetivou avaliar a prevalência das doenças cárie dentária e periodontal em usuários de drogas institucionalizados. Estudo epidemiológico, transversal, censitário e analítico realizado com usuários de drogas institucionalizados no período de agosto de 2016 a junho de 2017. Examinadores padronizados aplicaram um formulário para coleta de dados sociodemográficos e consumo de drogas. A cárie dentária foi avaliada através do índice CPO-D e a doença periodontal através dos indicadores clínicos: sangramento à sondagem, índice de placa, índice gengival, profundidade de sondagem e nível de inserção clínica. Foram avaliados 112 indivíduos do sexo masculino, média de idade de 36,7 anos (Dp±11,5). A droga mais consumida foi o álcool (92,0 %) por cerca de 19,4 anos (Dp±11.08), seguido do tabaco (70,95%) em média por 18,0 anos (Dp±11,66), maconha (65,2%) por 13,7 anos (Dp±8,22), cocaína (53,3%) por 8,5 anos (Dp±6,00) e crack (50,0%) por 11,1 anos (Dp±7,18). Conclui-se que a prevalência da doença de cárie foi 97,3% e da doença periodontal 51,5%. A população estudada apresentou alta prevalência de cárie dentária e doença periodontal e houve correlação entre o tempo de uso do álcool e tabaco com a doença periodontal e com maior CPO-D., El uso de drogas trae diversos problemas para la salud bucal, aumentando la prevalencia de las enfermedades de caries y periodontales, representando un serio problema de salud pública. Este estudio tuvo como objetivo evaluar la prevalencia de las enfermedades periodontales y caries en usuarios de drogas institucionalizadas. Estudio epidemiológico, transversal, censitario y analítico realizado con usuarios de drogas institucionalizadas en el período de agosto de 2016 a junio de 2017. Los examinadores estandarizados aplicaron formulario para recolección de datos sociodemográficos y consumo de drogas. Las caries dentales fueron evaluadas a través del índice CPO-D y la enfermedad periodontal a través de los indicadores clínicos: sangrado al sondeo, índice de placa, índice gengival, profundidad de sondeo y nivel de inserción clínica. Se evaluaron 112 individuos del sexo masculino, media de edad de 36,7 años (Dp ± 11,5). La droga más consumida fue el alcohol (92,0%) por cerca de 19,4 años (Dp ± 11.08), seguido del tabaco (70,95%) en promedio por 18,0 años (Dp ± 11,66), (65,2%) por 13,7 años (Dp ± 8,22), cocaína (53,3%) por 8,5 años (Dp ± 6,00) y crack (50,0%) por 11, 1 años (Dp ± 7,18). La prevalencia de la enfermedad caries fue del 97,3% y de la enfermedad periodontal 51,5%. Se concluye que la población estudiada presentó alta prevalencia de caries y enfermedad periodontal y existió correlación entre el tiempo de uso del alcohol y tabaco con la enfermedad periodontal y con mayor CPO-D.

The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to: (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention.

Objectives: Information on the significance of dental care in older adults is limited. We hypothesized that regular dental visits has an effect on the number of remaining teeth and periodontal conditions in older subjects. Materials and Methods: 1020 randomly selected individuals age 60 - 96 from the Swedish National Study on Aging and Care Blekinge received a comprehensive oral health examination. Results: Dentate women and men had, on average 18.4 teeth (SD +7.6,) and 18.9 teeth (SD + 7.5) respectively (NS). In the youngest group (60 and 66 years old) with less than one dental visit per year, 37 % had >20 teeth, compared with 73 % among those with at least annual visits. Among the old-old, comparable figures were 1.8 % and 37% respectively. Across age groups, bleeding on probing was 23 %. When adjusting for age, and number of teeth GLM univariate analysis failed to demonstrate an effect of dental visit frequency on alveolar bone loss (p = 0.18), the number of periapical lesions (p = 0.65), or the number of endodontically treated teeth ( p = 0.41). Frequent dental visitors had more teeth than infrequent visitors (p = 0.001). Conclusions:Tooth loss and alveolar bone loss severity increase with age. Individuals with regular dental visits retained more teeth but the frequency of dental visits had no impact on plaque deposits, gingival inflammation, or alveolar bone levels., Svensk titel: Frekventa tandvårdsbesök reducerar risken för tandförluster men påverkar inte förekomsten av parodontit hos äldre individer

Objective To describe and analyse the reporting of methodology relating to reliability in caries epidemiological studies conducted in the Nordic countries between 1990 and 2001. Basic research design. Basic research design Literature searches were conducted in the Medline database, and reference lists of all obtained publications were scrutinised for additional studies. Publications fulfilling the inclusion criteria were assessed for study design, and methodological aspects relating to reliability were assessed according to recommendations for evidence-based medicine (EBM). The frequency of endorsement of the assessed items was analysed. Moreover, the type and strength of evidence was evaluated. Main outcome measures Reporting of predetermined methodological items relating to reliability and the frequency of endorsement of the assessed items were of primary interest. Results Initially, 724 publications were located in the literature searches. Of 133 eligible publications obtained, 32 fulfilled the inclusion criteria and remained throughout the analyses. The majority of the studies reported the reliability methodology, which was generally inadequate. The frequencies of endorsement ranged from 0% to 69 %. All publications contributed to a low strength of evidence. In this context, it was proposed that prospective longitudinal studies with a random sample selection be classified as type-2 (2b) level of evidence. Conclusion There seems to be a need to improve the reporting and the methodology relating to reliability in caries epidemiological publications. Reporting of random sample selection and at least two of the items assessed seems to discriminate between high and low quality with respect to the reported methodology relating to reliability.