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Contains fulltext : 218135.pdf (Publisher’s version ) (Open Access) OBJECTIVES: People following a vegetarian diet could be more prone to oral health problems than people following a nonvegetarian diet. The aim of this systematic review was to examine the possible impacts of following a vegetarian diet on dental hard tissues, focusing on caries development, dental erosion and number of natural teeth. METHODS: PubMed, EMBASE, Web of Science and CINAHL were searched systematically up until 17 April 2019. Original studies comparing dental health (exclusively focusing on dental hard tissues) in vegetarians and nonvegetarians were selected. Study characteristics and outcome data were extracted, and the quality of the studies was assessed using the Newcastle-Ottawa Scale. When a dental health characteristic was reported in three or more papers in a comparable way, a meta-analysis was performed. RESULTS: Twenty-one papers reporting on 18 studies were included in this review. In meta-analyses, the vegetarian diet was associated with a higher risk for dental erosion (odds ratio: 2.40 [95% confidence interval: 1.24, 4.66]; P = .009) and a lower decayed, missing and filled teeth (DMFT) score (mean difference: -0.15 [95% confidence interval: -0.29, -0.02]; P = .023), although the quality of most included studies was poor and the findings for DMFT score became insignificant when only studies on adults were included in the meta-analysis. A meta-analysis for the other dental characteristics was not possible due to the limited number of eligible studies. There was inconsistent evidence for a link between following a vegetarian diet and dental caries or the number of natural teeth. CONCLUSIONS: Within the limitations of the present study, the findings suggest that following a vegetarian diet may be associated with a greater risk of dental erosion.

Contains fulltext : 232775.pdf (Publisher’s version ) (Open Access) The present scoping review has the objective of providing an overview of meta-research in dentistry. A search of the PubMed database was performed for the period 11 October 2014 to 10 October 2019. Study selection and data extraction were performed independently by one author; prior to this, a random sample of 10% of the retrieved titles and abstracts were independently screened by two authors, achieving agreement of >80% on eligibility for initial inclusion, corresponding to good agreement. The following information was extracted from the full text of each article: meta-research area of interest; study design; type of studies evaluated in the meta-research; type of methodology used in assessment of the primary research; conflicts of interest reported; sponsorships reported; dental discipline; journal of publication; country of the first author; number of citations; and impact factor. A total of 7800 documents were initially retrieved. After analysis of the title/abstract and the full text of each article, and a snowballing procedure, 155 meta-research studies were identified and included. The 'methods' and 'reporting' meta-research areas were the most prevalent, with 73 (47%) and 61 (40%) studies, respectively. General dentistry, and orthodontics and dentofacial orthopaedics were the dental specialties with the greatest number/proportion of included studies with 45 (29%) and 28 (18%) studies, respectively. These findings may help to prioritize future meta-research in dentistry, consequently avoiding unnessecary investigations, and increasing the value of oral and dental research.

© 2020 The Authors. International Dental Journal published by John Wiley & Sons Ltd on behalf of World Dental FederationObjectives: Quality measures offer opportunities for evaluation and improvement of the quality of oral health care. This study describes the development of a core set of oral health care quality measures for adults in the Netherlands, which can be used in dental practice. Materials and methods: A comprehensive two-stage approach was used, consisting of: (1) identification of an initial set of measures based on appraised literature; and (2) a four-round modified RAND/UCLA Appropriateness Method to establish measures that are relevant, appropriate and important to oral health care. Measures were rated anonymously on a nine-point Likert scale, ranging from 1 (lowest rating) to 9 (highest rating), followed by a group discussion to reach consensus. Multiple key stakeholder groups in the Dutch oral health care field were involved in the Delphi rounds, including dental professionals, scientists and representatives from Dutch oral health care organisations. Results: The study resulted in a core set of 13 oral health care quality measures. The measures cover domains related to oral disease outcomes, oral treatment and preventive services, patient experiences, patient safety, and organisational aspects of oral health care. In addition, the study led to the identification of 49 structural aspects of oral health care that are important to measure. Discussion: To our knowledge, this is the first study combining appraised literature from a systematic review and a rigorous multi-stage procedure with extensive stakeholder involvement to develop a core set of oral health care quality measures. In the next phase, the measures will be tested on feasibility, reliability, and will be piloted and implemented in practice.

IntroductionPeriodontitis has been considered a sixth complication of diabetes. The aim of this study was to assess the impact of periodontal treatment on diabetes-related healthcare costs in patients with diabetes.Research design and methodsA retrospective analysis was done, exploiting unique and large-scale claims data of a Dutch health insurance company. Data were extracted for a cohort of adults who had been continuously insured with additional dental coverage for the years 2012–2018. Individuals with at least one diabetes-related treatment claim in 2012 were included for analysis. A series of panel data regression models with patient-level fixed effects were estimated to assess the impact of periodontal treatment on diabetes-related healthcare costs.ResultsA total of 41 598 individuals with diabetes (age range 18–100 years; 45.7% female) were included in the final analyses. The median diabetes-related healthcare costs per patient in 2012 were €38.45 per quarter (IQR €11.52–€263.14), including diagnoses, treatment, medication and hospitalization costs. The fixed effect models showed €12.03 (95% CI −€15.77 to −€8.29) lower diabetes-related healthcare costs per quarter of a year following periodontal treatment compared with no periodontal treatment.ConclusionsPeriodontitis, a possible complication of diabetes, should receive appropriate attention in diabetes management. The findings of this study provide corroborative evidence for reduced economic burdens due to periodontal treatment in patients with diabetes.

Introduction People around the world are increasingly affected by multimorbidity, where conditions in different medical specialties can correlate in complex ways. This increases the relevance of multidisciplinary integrated care pathways. Modern software solutions provide vast opportunities to enhance information exchange between patients and various healthcare professionals, thereby improving patient-centered and inter-professional care. This paper describes the development and validation of a mobile patient application which exploits Patient Reported Outcomes to enhance patient-centered medical-dental integration with a focus on integrated management of periodontitis and diabetes. Methods This study was part of a multidisciplinary project for enhancement of medical-dental integration. The Intervention Mapping Protocol was supplemented by the RAND/UCLA Appropriateness Method, including literature reviews, focus group discussions and a Delphi panel in cooperation with various stakeholders. A mobile application was developed in close collaboration with patients, physicians and dentists. The usability of the application’s core components was validated in two medical and two dental practices using the System Usability Scale (SUS). Results 39 questions were identified to provide relevant patient-reported information which can be collected via a mobile application to enhance integrated management of periodontitis and diabetes. Usability testing of the application’s core components (14 questions) among 137 participants in medical and dental practices indicated a good SUS score of 77.88 (±12.17). Discussion The systematically developed mobile application offers the potential to provide physicians and dentists with treatment-relevant information to enhance medical-dental integration, thereby reducing the workload of medical staff, improving the quality of routinely collected data, and enabling automated data processing. This unique, novel, and validated approach can serve as an open framework for the development and evaluation of interdisciplinary healthcare software.

Introduction: There is a growing body of evidence for associations between oral and other chronic non-communicable diseases. Early recognition and diagnosis can be important in treating these diseases and better integration of primary and dental care could improve patient care. With the Dent@Prevent project, we aim to develop an electronic decision support system (DSS) and interactive mobile application to promote better collaboration between general practitioners (GPs) and dentists. Methods: A mixed-methods approach, including a systematic literature review, routine data analysis, focus groups with GPs and dentists and a Delphi-method with GPs, dentists and patients, is used to acquire information to develop the interactive mobile application that assesses patient-reported measures and the DSS that supports GP and dentist decision-making in an evidence-oriented way. Both the mobile application and DSS will be piloted to validate the use of these products. Results Findings: from the systematic literature review yielded a primary focus for the mobile application and DSS on links between diabetes and periodontitis. From the focus groups with dentists and GPs it appeared that GPs are generally less aware of interactions between oral and non-communicable diseases than dentists. Furthermore, several intervention points and integration of care processes were discussed as a basis for the DSS. The developed mobile application includes patient-reported measures for diabetes and periodontitis risks, as well as measures of patient experiences and perceptions towards the integration of care. The DSS is being designed to support the GP and dentist to recognize respectively an increased risk for periodontitis in their diabetes patients and an increased risk for diabetes in their patients with periodontitis, and to care for their patients accordingly. Discussions and conclusions: Electronic decision support systems for integration of primary and dental care might provide innovative and novel possibilities to improve integration of care through better informed decision making, including at the health policy level. Lessons learned: Clinicians may be unaware of interactions between oral and non-communicable diseases, which may reduce the chance for early recognition of disease in both sectors of care. Limitations: The Delphi-method was used to determine the content of the mobile application with regards to measures of patient experiences and perceptions. It was performed with an anonymized panel including dentists, GPs and patients. Because of this anonymity, the characteristics such as gender and age of the panel are unknown. Furthermore, because of limited scientific evidence on integrated care for diabetes patients with periodontitis, several development steps of the DSS depend on expert opinions from clinicians which may not be generally representative. Finally, the DSS we are developing is a pilot version but this seems a sensible approach towards stepwise creation of the DSS. Suggestions for future research: The mobile application and DSS have to be tested and validated in real-life settings before implementation in actual practice. Once the mobile application and DSS have been validated, the system can be evaluated to assess the efficiency of the intervention to promote integrated health under day-to-day practice conditions.