Search

Background: Little is known about patients' or carers' reported experiences of dental care provided using dental behaviour support (DBS) techniques. Qualitative literature can provide unique insight into these experiences. Aim: To explore and synthesize qualitative literature related to patient experience of dental behaviour support. Methods: A PROSPERO‐registered systematic review of qualitative articles was undertaken. Studies were identified through MEDLINE, Embase and PsycINFO. Abstracts were screened by two reviewers and data were extracted to summarize the qualitative findings included within them. A thematic summary approach was used to synthesize the qualitative data identified. Results: Twenty‐three studies were included. Studies primarily explored experiences of dental care of children by speaking to their parents (n = 16), particularly regarding paediatric dental general anaesthesia (DGA) (n = 8). Studies of adults' experiences of DBS (n = 7) covered a range of techniques. Nine studies explored broader dental care experiences and did not study specific DBS approaches. A thematic synthesis identified five themes applicable across the studies identified: Trust and the therapeutic alliance supporting effective care delivery; considered information sharing often alleviated anticipatory anxiety; control and autonomy‐reduced anxieties; variations in the perceived treatment successes and failures of DBS techniques; and DBS techniques produced longer positive and negative impacts on patients beyond direct care provision. Conclusion: Qualitative research has been under‐utilized in research on DBS techniques. Care experiences of most DBS techniques outside of paediatric DGA are poorly understood. Building trust with patients and enabling autonomy appear to support positive patient‐reported experiences of care. [ABSTRACT FROM AUTHOR]

Objectives: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e‐Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. Methods: Following a registered protocol, a modified e‐Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. Results: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. Discussion: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care. [ABSTRACT FROM AUTHOR]

Background: Dental behavior support (DBS) describes all techniques used by dental professionals to ensure that dental care is safe, effective, and acceptable. There is a need to standardize outcome measures across DBS techniques to reduce heterogeneity, limit selective reporting, promote consistency, and optimize outcomes across DBS research. A comprehensive review of existing measures is a prerequisite to understanding potential outcomes related to the area of interest. Aim: This review had three aims: first, to identify the outcome measures (OMs) reported in trials of dental behavior support; second, to categorize the component DBS techniques reported within interventions according to emerging agreed terminology; and, third, to map outcome measures to intervention type. Methods: A scoping review of trials evaluating DBS techniques was undertaken from 2012 to 2022. The review was prospectively registered. Studies were identified through Medline, Embase, and PsycINFO. Study abstracts were screened by two reviewers. Data were extracted by single selector. Outcome measures were sorted according to measurement domains (physiological, behavioral, psychological, and treatment). Responses were assimilated and summed to produce a refined list of distinguishable outcome measures. Intervention types were categorized according to accepted descriptors. Frequencies were presented; associations between outcome domain and DBS type were also reported (Chi‐square test of independence). Results: A total of 344 trials were included in the review from an initial 14,793 titles / title and abstracts screened. Most involved children (n = 215), most were from India (n = 104), involving basic dental care (n = 117). The median number of outcome measures per trial was four (range = 1–12); 1,317 individual outcomes were reported, categorized as: psychological (n = 501, 38.0%); physiological (n = 491, 37.3%), behavioral (n = 123, 9.3%) or, treatment‐related (n = 202, 15.3%). DBS interventions were split between 239 (45.7%) pharmacological and 283 (54.1%) non‐pharmacological; 96.6% of interventions mapped to accepted descriptors. A significant relationship was noted between the type of intervention and the outcome domain reported. Conclusion: The findings demonstrate massive variation in outcome measures of DBS interventions that likely lead to unnecessary heterogeneity, selective reporting, and questionable relevance in the literature. A large range of DBS interventions were mapped according to BeSiDe list. There is a need for consensus on a core outcome set across the spectrum of DBS techniques. [ABSTRACT FROM AUTHOR]

Aim: To evaluate a modular didactic training intervention called Keep My Teeth designed by special care dentists, for a range of healthcare students to provide oral homecare for people with intellectual developmental disorders (PwIDD). Methods: To evaluate the intervention a one‐group pre‐test post‐test pre‐experimental research design was utilized. The intervention was delivered by virtual platforms or face‐to‐face, with a sub‐sample of participants also receiving practical training. Healthcare students included Speech and Language Therapy (SLT), Registered Nurse Intellectual Disability (RNID), Dental Science (DS), Dental Nursing (DN), and Dental Hygiene (DH). Results: Sixty‐three of the 147 trainees completed all surveys. A significant change in perspective on barriers was seen for most groups post‐training, with an increase in confidence in delivering oral care to PwIDD across disciplines; 67% of DH/DN students who took part in the practical training felt that the didactic training was just as effective without the practical training, while 42% of the DS students felt that was true. Conclusions: The training interventions provided seem to have increased the awareness of study participants in relation to barriers to care, and increased their self‐efficacy towards, and intention to perform, oral homecare behaviors. [ABSTRACT FROM AUTHOR]

Objectives: This paper describes treatments completed under dental general anesthesia (DGA) for a cohort of adults with disabilities. This patient cohort was followed up a number of years later to determine outcomes and identify factors that predict further use of DGA. Methods: A retrospective patient record review and cross‐sectional survey was carried out on a convenience sample of 64 patients who had previously received dental treatment under general anesthesia. Patient record review extracted data on patient demographics and treatment provided under DGA. Cross‐sectional survey a number of years post‐DGA collected data on oral care habits and current oral health based on a standardized clinical examination. Statistical analysis was carried out to identify predictors of repeat DGA. Results: Participants received extensive treatment under DGA including preventive care, restorations, extractions, and root canal treatment. At follow‐up 89.1% of participants had gingival disease and 56.3% had active dental caries. The mean number of teeth present was 21.2 (SD 6.9, range 6–32). Only caries risk status was found to be a significant predictor (p = 0.03) with those with a high caries risk status 6.9 times (95%CI 1.2–39.3) more likely to receive a second DGA. Conclusions: Dentists extract teeth for people with disabilities under DGA in the mistaken belief that this will avoid the need for further DGA. This study found that extraction of teeth does not prevent the need for repeated episodes of DGA. Therefore, dentists should stop extracting teeth for this reason. Rather, if dentists want to avoid further DGA, they should do the basics well: consistent, evidence‐based caries risk assessment and risk reduction. [ABSTRACT FROM AUTHOR]

Background: In Ireland, people with learning disabilities have poor oral health. This is in part due to inappropriate oral health services. Recognising the value of inclusive approaches to research and healthcare planning, this study sought to include a group of people with learning disabilities in priority setting for oral health services in Ireland. This study discusses the feasibility of the methods used to promote inclusive approaches in oral healthcare planning. Materials and Methods: A single focus group of six participants with communication and cognitive impairments agreed priorities for dental services using evidence-based research tools across five topics: "Access," "Cost," "Information," "Quality of Care" and "Treatment." Sorting was recorded photographically and discussion was video-recorded, transcribed and analysed using deductive content analysis. Conclusions: Participants were largely disempowered in their interactions with dental services. The method used in this study to empower potential service users with disabilities was successful and can be used by others who have an interest in inclusive healthcare priority setting.

Background: Realist methods offer a novel approach to intervention design. Such novelty is needed for effective oral health promotion interventions with people with intellectual developmental disabilities (IDD) and their carers because existing interventions are poorly described and lack theoretical underpinning. In this study, the steps between inception and final intervention development are presented, with an aim to expand understanding of how realist theorizing can be used to develop interventions, and to demonstrate theory‐driven intervention development in the field of oral health promotion. Methods: In this intervention development study, the use of realist methods to develop an intervention aiming to improve the oral hygiene of people with IDD is presented. Realist theories (RTs) arising from a mixed synthesis were used to develop the Keep My Teeth intervention. The use of realist theory in intervention development was mapped across seven domains and 18 actions with emphasis on how theory informed key actions. Results: Realist theories informed many but not all actions in the development process. Where gaps arose, this was augmented with other systems of intervention development, such as the Behaviour Change Wheel (BCW) and Behaviour Change Technique (BCT) systems. The resulting intervention and underlying theory are presented using TiDieR criteria. Conclusions: It is demonstrated how realist methods could be integrated with substantive theory when developing an intervention. RTs enhanced the contextualization of the intervention that was developed but were insufficient in their own right to guide the development process from conception to intervention. This was overcome by augmenting with substantive theory, in this case, using the BCW and BCT behaviour change systems, to select and specify the behaviours that needed to change. In essence, the BCTs guided which techniques to select, while the RTs guided how to develop and intervene. Robust intervention development in the field of oral health promotion is also presented in this study. [ABSTRACT FROM AUTHOR]

Introduction: Autism spectrum disorders (ASD) is a lifelong condition affecting communication and social interaction, characterised by repetitive or repeated patterns of behaviour. People with ASD experience poor systemic and oral health. They face reduced access to dental care related to provider barriers associated with lack of understanding of ASD, lack of training and a consequent reluctance to treat people with ASD. Materials and Methods: The effectiveness of training given by a person with autism to student dental care professionals was evaluated by measuring change in 62 students' openness to autism scale scores and confidence treating a person with autism. These students included third year dental students and second year dental nursing and hygiene students. This cohort was recruited as part of their curriculum and opted in for inclusion in the study. Data were analysed using SPSS®. Results: An increase in openness scale scores of 7.6% (p <.05) and in confidence of 4.9% (p <.05) between pre‐ and post‐training was observed. Openness scale score predicted level of confidence at baseline (OR = 0.21 (95% CI = 0.02–0.39)). Conclusion: An educational intervention delivered by a person with autism promoted modest increases in openness towards autism and confidence amongst dental care pre‐service professionals. Whilst the results suggest that peer‐led dental care professional teaching by people with autism may be beneficial, more research is needed. [ABSTRACT FROM AUTHOR]

Aims: This paper explores the variables which influence decision‐making processes in dentists providing dental care for people with disabilities under general anesthesia (GA). Methods: Face‐to‐face semi‐structured interviews were undertaken on a purposive sample. Audio recordings were transcribed and checked for accuracy. Using thematic content analysis methods open codes were developed inductively. Codes were analyzed further by three authors adopting a deductive approach, leading to final coding, sorting and themes, subtheme and framework development. Results: Three themes emerged. The first theme explored Shared Decision Making, or lack thereof, as it influenced clinical reasoning. The second (Systematic, Analytical) and third (Intuition, and heuristics) themes explored features of clinical judgment as considered under dual process theory. Dentists primarily used intuitive decision‐making processes and heuristic styled processes (or cognitive mental frames) assisted in intuition to extract teeth, without engaging type 2 processes. Conclusion: The dentists experience subtle modifiers to their decision‐making that ultimately promote extraction of teeth under GA for people with disabilities. Bias training, simulation and post‐hoc reflection are examples of recommendations which may be used to improve decision‐making in this area. [ABSTRACT FROM AUTHOR]

Aims: To share the need for agreement in terminology around how people are supported to receive dental care. Method: In this position paper, we make the case for a shift in behavior support in dentistry from an art to a science. Results: We outline why we need agreement on the definition of behavior support across dentistry, agreement on underlying theory, aims and values, and why we need agreement on terms for specific techniques. Conclusions: We share how patients and dental teams can benefit through better science, education and practice of dental behaviour support. [ABSTRACT FROM AUTHOR]

Aims: To identify the nonpharmacological patient-support techniques (nPSTs) reported, used or recommended for people with intellectual-developmental-disorders (IDD) to receive dental treatment; to identify their active ingredients and evaluate their effectiveness by adopting an existing taxonomy of behavior-change techniques (BCTs).Methods and Results: Following a protocol, a search strategy was undertaken using Medline, Embase, Cochrane Library, Scopus, Cinahl, and Psychinfo (EBSCO). Selection criteria were applied, with review and extraction in duplicate. A comprehensive list of nPSTs were identified and coded by their constituent behavior-change techniques (BCTs), where BCT-taxonomy-Version-1 criteria were satisfied. Quality assessment was undertaken and effectiveness of BCTs reported. From 915 screened articles, 23 were included. In 207 instances nPSTs were identified, representing 46 distinct nPST techniques, such as positive-reinforcement (n = 18) and tell-show-do (n = 9). Of the 207 nPST codes, 135 were coded as BCTs (65.2%). The most commonly coded BCT was demonstration of the behavior (BCT6.1; n = 25). Considering studies of interventions (n = 11), all were at moderate to critical risk of bias. No interventions or outcome measures were comparable across studies.Conclusion: This is the first review to bring together techniques dentists use in practice and theory-driven BCTs. A significant overlap between nPSTs and BCTs was evident supporting the use of BCT taxonomy to code dental interventions. No strong evidence supporting any intervention was identified. [ABSTRACT FROM AUTHOR]

Summary: Objectives: This study tests whether total tooth loss is a risk indicator for difficulty eating among a population with intellectual disability and whether complete denture wear mediates this risk. Methods: Dentate status and difficulty eating were reported for a Nationally representative sample of 690 adults over forty with intellectual disabilities as part of The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS‐TILDA). A logistic regression model tested the relationship between the Difficulty eating and Dentate status, controlling for the effects of other factors. Results: Of the 690 participants, 505 had some teeth (Group 1), 56 had no teeth and reported wearing dentures (Group 2) and 129 had no teeth, not using dentures (Group 3). A parsimonious regression model was developed including all 406 cases with no missing data. Adjusting for the effects of other factors, it was found that, compared to Group 1, the odds of difficulty eating was twice as great (OR = 2.01, 95% CI = 1.02‐4.03) among people without teeth, not using dentures (Group 3). Conversely, edentulous participants who had dentures (Group 2) had far lower odds (OR = 0.21, 95% CI = 0.06‐0.64) of reporting difficulty eating compared with Group 1. Conclusions: For adults with ID, total tooth loss was predictive of difficulty eating only when untreated. People with disabilities should be encouraged to maintain a functional dentition through preventive and conservative treatment. When adults with ID become edentulous, oral rehabilitation may reduce the risk of difficulty eating. Dental assessment should be undertaken if people with ID present with difficulty eating. [ABSTRACT FROM AUTHOR]

For some reason, once my patient is under general anesthesia (GA), I am more likely to extract teeth than if they were being treated awake. 3 Roberts GJ, Mokhtar SM, Lucas VS, Mason C. Deaths associated with GA for dentistry 1948 - 2016: the evolution of a policy for general anesthesia (GA) for dental treatment. Elective dental GA is safe even for most people with disabilities.3 In this sense, having to repeat treatment under GA is not a very risky outcome. [Extracted from the article]

Accessible summary This study asked a group of people with learning disabilities in Ireland what was important to them about their dental services., The group easily ordered their priorities according to five topics: Access, Cost, Information, Quality of Care and Treatment., The group's discussion revealed a disempowered group who had little control over how they interacted with dental services., We suggest ways to empower people with learning disabilities in their interactions with dental services., Abstract Background: In Ireland, people with learning disabilities have poor oral health. This is in part due to inappropriate oral health services. Recognising the value of inclusive approaches to research and healthcare planning, this study sought to include a group of people with learning disabilities in priority setting for oral health services in Ireland. This study discusses the feasibility of the methods used to promote inclusive approaches in oral healthcare planning. Materials and Methods: A single focus group of six participants with communication and cognitive impairments agreed priorities for dental services using evidence-based research tools across five topics: Access, Cost, Information, Quality of Care and Treatment. Sorting was recorded photographically and discussion was video-recorded, transcribed and analysed using deductive content analysis. Results: The group ranked priorities within each topic but found it difficult to meaningfully rank between topics. Across topics, issues of control, empowerment and choice were observed. Conclusions: Participants were largely disempowered in their interactions with dental services. The method used in this study to empower potential service users with disabilities was successful and can be used by others who have an interest in inclusive healthcare priority setting. [ABSTRACT FROM AUTHOR]

Objectives The objectives of this study were to describe the reported dentate status and complete denture use of older people with intellectual disability ( ID) and compare with those of older people in the general population in Ireland. Methods The first wave of the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing ( IDS- TILDA) study provides opportunity to measure edentulism and complete denture use in a nationally representative sample of older people with ID in Ireland. Data drawn from the first wave of IDS- TILDA were matched using propensity score matching with data from The Irish Longitudinal Study on Ageing ( TILDA), a study among older adults in Ireland. All IDS- TILDA variables showing significant association ( P < 0.05) with edentulism were entered into a regression model to identify predictors of edentulism. Result The proportion of the 478 IDS- TILDA participants with no teeth was higher (34.1 percent) than the proportion of participants with no teeth in the 478 matched TILDA participants (14.9 percent). Only age was predictive of edentulism among older adults with ID. Edentulism was prevalent earlier for those with ID. Notably, 61.3 percent of edentulous older people with ID were without dentures. Conclusion Older people with ID are more likely to be edentulous than those without ID in Ireland and when they lose their teeth, they are unlikely to use dentures. This suggests a need for targeted measures to maintain the teeth of this group and, in the short term, the provision of replacement teeth in this population, where indicated. [ABSTRACT FROM AUTHOR]

Purpose: To investigate dental attendance patterns and reasons for nonattendance among older adults with intellectual disabilities (ID) in Ireland., Methods: A cross-sectional survey of quantitative data and text analysis of qualitative data drawn from a nationally representative sample of 753 people with ID over 40 years of age in Ireland. Participants were considered as regular or irregular dental attenders for analysis of quantitative data. Text analysis grouped open-ended responses for analysis., Result: There were slightly more females. Mean age was 54.1 years (SD = 8.8). Almost half had moderate ID. A majority (86.5%) of respondents attended dental services within the last 2 years. Age and type of residence were associated with frequency of attendance (p < .01), as were dentate status and reported oral problems (p < .001). Text analysis revealed a lack of perceived need as a reason for not attending regularly., Conclusion: Older people with ID in Ireland report a very high level of regular dental attendance. Irregular attenders did not attend because they saw no need. There is a need to further study the importance of regular dental attendance for this population., (© 2014 Special Care Dentistry Association and Wiley Periodicals, Inc.)