Evaluation of a comprehensive daily mouth care program for long-term care facilities

Objective: A randomized, controlled clinical trial involving 2 long-term care facilities was designed to test whether a comprehensive daily mouth care program for LTC facilities could reduce gingivitis, denture stomatitis and debris on teeth and dentures. A questionnaire was also used to assess an improvement in knowledge, behaviour and attitudes of nursing staff with respect to the provision of daily mouth care. Materials and Methods: A four month, random, controlled clinical trial of a comprehensive daily mouth care program for caregivers in a long-term care facility was evaluated using both a questionnaire conducted with caregivers and an oral examination of residents. Two, 51-bed extended long-term care facilities in Vancouver, British Columbia owned and operated by one individual were asked to participate in the evaluation of the program. The program was implemented in one site, while the other site acted as a negative control. Nine caregivers from the test site and 13 from the control site completed both the pre and post questionnaire related to mouth care knowledge, performance and attitude. Twenty-four residents from the test site and 19 from the control site gave consent and were available for oral examination at baseline, 1 and 4 months. Gingivitis was measured using the Modified Gingival Index, and denture stomatitis using Newton's Classification. The debris (food and plaque) was quantified using the Modified Debris Index. Results: No statistically significant change in the caregiver's knowledge, attitude or behaviour was found after the implementation of the program. At both the test and control site there was no improvement in mean debris on teeth or gingivitis scores. There was a statistically significant decrease in debris on dentures at the test site and a decrease in denture stomatitis that was not statistically significant. A decrease in debris on dentures and stomatitis was evident at the control site, but due to small numbers the findings could not be analyzed statistically. Conclusion: The comprehensive daily mouth care program used did not result in a decrease in debris on teeth or gingivitis in residents of a long-term care facility. A decrease in debris on dentures and stomatitis was evident indicating caregivers were better able to clean dentures than teeth. Although staff may appreciate the structure and guidance of a mouth care program it did not result in an improvement in clinical outcomes, attitude, knowledge or behaviour.Dentistry, Faculty ofGraduat

The relationship of perceived oral health, body image and social interactions among institutionalized elders

Objective: Social interactions among frail elders in long-term care facilities are limited, but to what extent body image and perceived oral health influence their social relations are poorly understood. A positive body image and the perception of adequate oral health are linked to increased social contacts, as well as improved health and well-being irrespective of age. However, as frailty increases it is unclear if appearance and oral health priorities remain stable. This study explored the relationship between oral health, body image and social interactions among a diverse group of frail elders. The research question underlying the study is “how are social interactions influenced by perceived oral health and body image in elderly people who live in long-term care facilities?” Methods: Open-ended interviews were conducted with a purposefully selected group of cognitively intact, institutionalized elderly men and women who exhibited varying degrees of frailty, social engagement and oral health conditions, and lived in one of eight long-term care facilities. The interviews were analyzed using a constant comparative technique, and a second interview with each participant checked the trustworthiness of the analysis. Results: Three major categories influenced the social interactions of the participants: 1) perceived oral health; 2) priorities and perceived access to care; 3) institutionalization and frailty. The major categories were influenced by the coping and adapting strategies, health status, dependency, institutional culture, investment, support, personality, socio-economic status, comfort, function, cleanliness and noticeability of oral conditions among the participants. Conclusions: Perceived oral health and body image among institutionalized frail elders were influenced by comfort, hygiene, cleanliness and noticeability of oral conditions. These findings were similar to reports of elders who reside in the community; however the extent to which social interactions were negatively impacted depended on multiple aspects of living in a care facility, degree of frailty, and priorities of care.Dentistry, Faculty ofGraduat

A preparedness model for the provision of oral health care during unfolding threats: the case of the covid-19 pandemic

Background: The aim of this study was to appraise a recently developed preparedness model for the provision of oral health care during a threat such as the COVID-19 pandemic from the perspectives of oral health care providers, administrators/staff, and patients. Methods: An exploratory qualitative inquiry via at-a-distance semi-structured interviews and group discussions engaged a purposefully selected sample of oral health care workers and patients in British Columbia (BC), Canada. Participants were asked to appraise a preparedness model by considering how to prepare for oral care during a pandemic, while answering open-ended questions about the model content and visual presentation. Interviews and group discussions occurred between April 2020 and January 2021, were audio recorded, and transcribed verbatim. An inductive coding process was used to identify themes, subthemes, and categories of information until saturation was achieved. Results: Seventy-four participants, including 19 dentists, 15 dental hygienists, 10 certified dental assistants, 9 administrators, and 21 patients, suggested modifications to the recently developed preparedness model. Individual interviews (41 participants) and group discussions (33 participants in groups ranging from 2 to 9 attendees each) lasted for an average of 53 min. Eighty-four hours of audio recordings led to more than 1110 single-spaced pages of transcripts. The thematic analysis identified 82 codes, 12 categories, and four main themes: life-long learning, critical thinking, personal and professional risk, and patient-centred care. These themes were understood within provider characteristics and social and environmental contexts. Participants highlighted the need for the model to focus on information and communication, developing awareness and understanding, inferring risks, and performing oral health care during a threat such as a pandemic or disease outbreak. A modified portrayal of the model was suggested to better represent participants’ perspectives. Conclusion: A recently developed preparedness model for the provision of dental care during an unfolding threat like the COVID-19 pandemic was appraised and modified by oral health care workers. Future studies are warranted to evaluate the modified model for use in the event of another unfolding threat collaboratively with providers, patients and stakeholders.Dentistry, Faculty ofOral Health Sciences (OHS), Department ofReviewedFacult

COVID-19 pandemic : Students’ perspectives on dental geriatric care and education

Objectives: With the emergence of the COVID-19 pandemic in Canada and the curtailment of clinical and face-to-face university instruction in British Columbia on March 16, 2020, the opportunity arose to explore how third- and fourth-year undergraduate dental students critically considered the impact of the pandemic on education and the practice of dental geriatrics. Methods: All third- and fourth-year undergraduate dental students within a dental geriatric module were asked to provide a written guided reflection on the question: “In your opinion, what factors make outbreaks (or pandemics) like COVID-19 relevant to the practice of dental geriatrics?” Reflections were gathered from March 12 to May 8, 2020. Thematic analysis was conducted to identify and interpret patterns of meaning within the reflections by means of an interactive coding process. Results: A total of 115 reflections, between 291 and 710 words each, were received from 56 third-year (62.5% male) and 59 fourth-year (42.6% male) students. Five main themes emerged: experiencing uncertainties, frailty as a moderator, constraints in accessing care, preparedness protocol, and redefining care. The frequency in which the same codes, categories, and themes were assigned varied from 16 to 140 times. Conclusions: Students’ reflections highlighted the effects of the pandemic, not only on their education but also on frail older adults themselves and the profession of dentistry in general. Further studies are warranted to explore how this curtailment might impact educators’ approaches to geriatric education, as well as the way graduating students will set up their practices and approach geriatric care in the future.Dentistry, Faculty ofReviewedFacult

Assessing patients’ attitudes to opt-out HIV rapid screening in community dental clinics: a cross-sectional Canadian experience

Background: As a public health initiative, provided-initiated HIV screening test in dental settings has long been available in the U.S.; it was only in 2011 that such setting was used in Canada. The objective of this paper was to assess patients’ response to, and attitudes towards, an opt-out rapid HIV screening test in a dental setting in Vancouver, Canada. Methods A cross-sectional evaluation design using a self-complete survey questionnaire on self-perceived values and benefits of an opt-out rapid HIV screening was employed. An anonymous 10-item questionnaire was developed to explore reasons for accepting or declining the HIV rapid screening test, and barriers and facilitators for the HIV screening in dental settings. Eligible participants were male and female older than 19 years attending community dental clinics and who were offered the HIV screening test between June 2010 and February 2015. Results From the 1552 age-eligible patients, 519 completed the survey and 155 (10 %) accepted the HIV screening due to its convenience, and/or free cost, and/or instant results. From the 458 respondents who did not accept the screening, 362 (79 %) were between the ages of 25 and 45 years; 246 (53.7 %) had identifiable risk factors for contracting HIV; and 189 (41.3 %) reported having been tested within the last 3 months. Those tested in less than 3 months had 3.5 times higher odds to decline the HIV screening compared to those who have been tested between 3 months and 1 year. Conclusions Convenience, cost-free and readily available results are factors influencing rapid HIV screening uptake. Although dental settings remain an alternative venue for HIV screening from the patients’ perspectives, dental hygiene settings might offer a better option.Dentistry, Faculty ofNon UBCOral Health Sciences (OHS), Department ofReviewedFacult

Data set and methodology involving pedagogical approaches to teach mental health and substance use in dental education

Objective In this Data note, we provide a raw data set in the form of brief self-guided reflections. We also present the methodological approach to generate these reflections including an educational vignette so that other dental schools can plan for their teaching activities involving mental health and substance use topics. Data description Between 2015/16 and 2018/19, the University of British Columbia’s (UBC) undergraduate dental and dental hygiene students submitted optional written guided reflections to address ‘how can an educational vignette, depicting a patient with a history of substance use and mental health disorders accessing dental care, promote an open dialogue about stigma?’ From a total of 323 undergraduate students, 148 anonymous reflections between 200 and 400 characters each were received. The main ideas that may emerge from the reflections include ‘exploring power relations’ and ‘patient-centered care approach to counteract stigma’.Dentistry, Faculty ofNon UBCOral Biological and Medical Sciences (OBMS), Department ofOral Health Sciences (OHS), Department ofReviewedFacultyResearcherOthe

The role of an educational vignette to teach dental students on issues of substance use and mental health disorders in patients at the University of British Columbia: an exploratory qualitative study

Background Inverted classroom approaches and the use of vignettes have been suggested in health care education. The objective of this study was to use an educational vignette to discuss issues of stigma around substance use and mental disorders within undergraduate Doctor of Medicine in Dentistry (DMD) and Bachelor of Dental Science in Dental Hygiene (BDSc-DH) students at the University of British Columbia, Canada. Our research question was “how can an educational vignette, depicting a fictitious patient with a history of substance use and mental health disorders accessing dental care, promote an open dialogue about stigma?” Methods An educational vignette was developed based on individuals’ lived-experiences with a variety of substance use and/or mental health disorders. This vignette was used to generate in-class discussion involving all the DMD and BDSc-DH undergraduate students enrolled between 2015/16 and 2018/19 who attended a mandatory 2.5 h didactic session using an inverted classroom approach. Students were also encouraged to provide a post-class voluntary written reflection, between 200 and 300 words, around stigma. The authors took written field notes on students’ response to the vignette and used excerpts from students’ de-identified reflections to illustrate the impact of such an educational tool. Results A total of 323 DMD and BDSc-DH students attended the didactic sessions between 2015/16 and 2018/19, and 148 reflections were submitted over the same time period. The inverted classroom approached showed to be engaging and collaborative. The vignette promoted open dialogue and was determined to be a conducive tool to generate in-class discussion and reflection. Major themes from the textual data included ‘exploring power relations’ and ‘patient-centered care approach to counteract stigma’. The vignette also enabled the discussion of positive experiences characterized by empathy, reassurance and communication, although it might not have prompted all students to participate in class or in writing the reflections. Conclusion The inverted classroom approach and the vignette seemed to be an effective way to facilitate dialogue and reflection for most students. This study highlighted the need to explore innovative ways in which to continuously prepare current and future oral health care providers to professionally address the needs of patients with a history of substance use and/or mental health disorders.Dentistry, Faculty ofNon UBCOral Health Sciences (OHS), Department ofReviewedFacult

Stigma of addiction and mental illness in healthcare: The case of patients' experiences in dental settings.

OBJECTIVE:To explore the ways in which stigma is experienced in healthcare and dental settings by patients with a history of addiction and mental illness. METHODS:Audio-recorded, semi-structured interviews with a purposefully selected convenience sample of residents from two community treatment centres in Vancouver, Canada were conducted. The interview guide contained questions about experiences while seeking health and dental care and was based on an existing framework of labeling, stereotyping, exclusion, discrimination, and power imbalance. Interviews were transcribed verbatim for coding and thematic analysis. RESULTS:Twenty-five participants between 23 and 67 years of age were interviewed; 17 were males. Most had a self-reported history of depression combined with use of alcohol and crack-cocaine; most of them only sought dental care for emergency purposes. Textual analysis of more than 300 pages of transcribed interviews revealed that participants perceived stigma when they were negatively stereotyped as 'unworthy', labeled as 'different', excluded from the decision-making process, discriminated against, 'treated unfairly', and felt powerless when interacting in the heath and dental care systems. Conversely, positive experiences were characterized by empathy, reassurance and good communication, which were empowering for patients. CONCLUSIONS:When associated with stigma, mental illness and addictions have negative implications for accessing health and dental care. From our participants' perspectives, it seems that the lack of understanding about their life conditions by the healthcare professionals was the origin of stigma. We suggest that an increased social awareness of these health issues be enhanced among current and future health and dental care professionals to help improve care experiences for this marginalized population

Self-reported characteristics of participants (N = 25).

<p>Self-reported characteristics of participants (N = 25).</p

A visual representation of stigma (domains and their respective themes).

<p>A visual representation of stigma (domains and their respective themes).</p