Labels and descriptions of dental behaviour support techniques: A scoping review of clinical practice guidelines

Introduction: There is no agreed taxonomy of the techniques used to support patients to receive professional oral healthcare. This lack of specification leads to imprecision in describing, understanding, teaching and implementing behaviour support techniques in dentistry (DBS). Methods: This review aims to identify the labels and associated descriptors used by practitioners to describe DBS techniques, as a first step in developing a shared terminology for DBS techniques. Following registration of a protocol, a scoping review limited to Clinical Practice Guidelines only was undertaken to identify the labels and descriptors used to refer to DBS techniques. Results: From 5317 screened records, 30 were included, generating a list of 51 distinct DBS techniques. General anaesthesia was the most commonly reported DBS (n = 21). This review also explores what term is given to DBS techniques as a group (Behaviour management was most commonly used (n = 8)) and how these techniques were categorized (mainly distinguishing between pharmacological and non‐pharmacological). Conclusions: This is the first attempt to generate a list of techniques that can be selected for patients and marks an initial step in future efforts at agreeing and categorizing these techniques into an accepted taxonomy, with all the benefits this brings to research, education, practice and patients

Using the International Classification of Functioning, Disability and Health (ICF) to Describe Children Referred to Special Care or Paediatric Dental Services.

Children in dentistry are traditionally described in terms of medical diagnosis and prevalence of oral disease. This approach gives little information regarding a child\u27s capacity to maintain oral health or regarding the social determinants of oral health. The biopsychosocial approach, embodied in the International Classification of Functioning, Disability and Health - Child and Youth version (ICF-CY) (WHO), provides a wider picture of a child\u27s real-life experience, but practical tools for the application of this model are lacking. This article describes the preliminary empirical study necessary for development of such a tool - an ICF-CY Core Set for Oral Health. An ICF-CY questionnaire was used to identify the medical, functional, social and environmental context of 218 children and adolescents referred to special care or paediatric dental services in France, Sweden, Argentina and Ireland (mean age 8 years ?3.6yrs). International Classification of Disease (ICD-10) diagnoses included disorders of the nervous system (26.1%), Down syndrome (22.0%), mental retardation (17.0%), autistic disorders (16.1%), and dental anxiety alone (11.0%). The most frequently impaired items in the ICF Body functions domain were \u27Intellectual functions\u27, \u27High-level cognitive functions\u27, and \u27Attention functions\u27. In the Activities and Participation domain, participation restriction was frequently reported for 25 items including \u27Handling stress\u27, \u27Caring for body parts\u27, \u27Looking after one\u27s health\u27 and \u27Speaking\u27. In the Environment domain, facilitating items included \u27Support of friends\u27, \u27Attitude of friends\u27 and \u27Support of immediate family\u27. One item was reported as an environmental barrier - \u27Societal attitudes\u27. The ICF-CY can be used to highlight common profiles of functioning, activities, participation and environment shared by children in relation to oral health, despite widely differing medical, social and geographical contexts. The results of this empirical study might be used to develop an ICF-CY Core Set for Oral Health - a holistic but practical tool for clinical and epidemiological use

Labels and descriptions of dental behaviour support techniques: A review and agreement among experts.

The aim of this research process is to improve the practice, teaching and science of dental behaviour support (DBS) by first developing a universally accepted hierarchically structured list of DBS techniques to then develop clinical guidance, inform research methods and develop educational resources for the application, study and teaching of such techniques. These aims will be achieved in three phases of planning, development and application. This protocol relates to the development phase and defines the criteria for the first two of three studies therein, representing two of three integrated studies adopting multiple methods to answer our research question. The protocol for the third study will be published later

Total tooth loss and oral health service use among older people with intellectual disabilities in Ireland

Background and rationale As the population with Intellectual Disabilities (ID) age, the challenges to their successful ageing are unclear. It is important to understand how this population age: how their health changes into later life and how they and society, can respond to ensure successful ageing for all, while minimizing disparities. Total tooth loss is an accumulative disabling condition that reflects the burden of oral disease and the effectiveness of disease management over the life course, which increases in older age and seems to be more common among adults with ID than the general population. Research into the oral health of people with ID, has often explored both oral health and service use together, often with an emphasis on behaviour support, to allow appropriate health monitoring, service planning and policy. Given current oral health policy development in Ireland, research of this type is timely. Aim The aim of this study was to explore total tooth loss and oral health service use among older adults with intellectual disabilities in Ireland. To achieve this aim, two objectives were met by answering seven questions. The objectives of this study were to understand the prevalence, sequelae and impact of edentulism and to understand the frequency of dental attendance and use of behavioural supports among older adults with intellectual disabilities in Ireland. Methods This multi-methods study adopts quantitative, mixed methods and qualitative methodologies, conducted within the context of a larger longitudinal study on ageing and ID. The Intellectual Disability Supplement to The Irish LongituDinal study on Ageing (IDS-TILDA) is a unique longitudinal cohort study designed to explore features of ageing among older adults with ID. This study is comparable with The Irish Longitudinal Study on Ageing (TILDA). IDS-TILDA includes a nationally representative sample of adults with ID over 40 years of age who completed pre-interview questionnaires and interviews over two waves (concluding 2011 and 2014) of data collection. Six dentists, who treat people with ID regularly, were also interviewed to explain some of the quantitative findings from IDS-TILDA in a sequential-explanatory mixed-methods design and to explore their experiences of behaviour support used in providing this care, in a small qualitative descriptive study. Results A total of 753 people participated in Wave 1 and 708 in Wave 2. Relating to Objective 1, the reported prevalence of edentulism was 34% among adults with ID over fifty years of age in Ireland. This compared to 14.9% of the general population. Once edentulous, two thirds of adults with ID did not wear dentures. This compared to between 5% and 9% of edentulous adults without ID. Nine out of ten participants without teeth did not wear dentures because they did not want them. Only 8 out of 117 people without dentures reportedly wanted them. Reliance on carers to respond on participants? behalf was associated with not having dentures. Compared to people who have teeth, the odds of reporting difficulty eating was twice as high (OR=2.01, 95%CI=1.02-4.03) among edentulous participants without teeth or dentures and one fifth as high among edentulous participants who reportedly had dentures (OR =0.21, 95%CI=0.06-0.64), controlling for likely covariates. Edentulism is therefore a risk factor for difficulty eating among adults with ID, only if not treated with complete removable dentures. In fact, complete denture wear predicts a reduction in difficulty eating, relative to those who have teeth. Relating to Objective 2, the majority of older adults with ID in Ireland attended dental services regularly. This included 86.5% of the total sample, ranging from 95% of dentate and 60.5% of edentulous participants. This compared to literature based comparisons of 44% of dentate and 2.3% of edentulous adults over 65 years in Ireland. Most older adults who did not attend dental services, did so because they saw no need. This, in turn, was seen to be associated with the absense of both pain and teeth. Most older adults with ID reported the use of non-pharmacological support to receive dental care: 1% reported use of inhalation sedation; 2% Intravenous (IV) sedation; 8% general anaesthesia (GA) and 14% oral sedation for dental care. Expert dentists, who partook in the qualitative phase of this study, felt that these figures represented the unavailability of sedation and GA and inappropriate treatment. Compared to those who were not, participants reporting challenging behaviour (OR=2.3, 95%CI=1.43-3.20), significant difficulty speaking (OR=3.5, 95%CI=2.19-5.57) and obvious oral problems (OR=2.53, 95% (1.56-4.10) had greater odds of reporting treatment with GA or sedation rather than non-pharmacological supports. Experts applied behaviour support strategies, that they mostly learned ad hoc, to reduce reliance on, or increase the effectiveness of, pharmacological supports. Support strategies were selected through both rationalist and intuitive processes and were applied by the dentist iteratively assessing, applying, reassessing and adapting this approach. In this way the process formed through co-regulatory communication between dentist and patient. Discussion This study set out to study two seemingly distantly related phenomena: oral disease burden and oral health service use among adults with ID. This thesis considers edentulism as a barometer of both the experience of and the outcomes from oral disease. For adults with ID, this study demonstrates that oral health service use is high but outcomes are poor. This has a negative functional impact. This study suggests that GA and IV sedation are inaccessible, possibly making treatment inappropriate. Conclusion The oral health outcomes for people with ID are poor despite regular use of dental care. People with ID should be prioritised for appropriate services, through equitable policy. This thesis makes recommendations for practice, policy and research to ensure healthy ageing with appropriate support for all people in Ireland

Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management

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

Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management

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

Reported difficulty tooth and denture cleaning among an ageing population with intellectual disabilities in Ireland

Aims and objectives: This paper aims to describe reported difficulty and frequency in carrying out oral hygiene practices among an ageing population with intellectual disabilities in Ireland; Methods: This cross-sectional survey was based on a Nationally representative sample of people with intellectual disability over 40 years of age, randomly selected from a National Intellectual Disability Database as part of the first wave of the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA). Level of reported difficulty was used to categorise the sample into three groups: those reporting no difficulty, those reporting some difficulty and those who cannot care for their teeth / dentures at all. Summary statistics and bivariate correlations are reported based on this categorization. The sample was further categorized into those with and without reported difficulty cleaning their teeth / caring for their dentures, for purposes of logistic regression. Independent variables correlating (p < 0.05) with level of reported difficulty brushing / cleaning dentures were included in this regression model to identify factors predictive of difficulty caring for teeth/ dentures; Results: The mean age of participants was 54.1 years (SD 8.8). Out of 753 participants, 412 (55.5%) reported no difficulty cleaning their teeth / dentures, 159 (21.3%) had some or a lot of difficulty and 172 (23.2%) reported that they could not clean their own teeth / dentures at all. The regression model showed that type of residence, increasing level of ID and the presence of reported oral problems were predictive of reported difficulty cleaning teeth/taking care of dentures. Conclusions: This study showed that most people with ID in Ireland report no difficulties cleaning their teeth or taking care of their dentures. Even among those with some difficulty, the exact level of difficulty varied from little difficulty to complete inability

Communication based behaviour support for adults with intellectual disabilities receiving dental care: a focus group study exploring dentists\u27 decision making and communication

A better understanding of how communication-based behaviour supports are applied with adults with intellectual disabilities may reduce reliance on restrictive practices such as holding, sedation and anaesthesia in dentistry. In this study, we explore how communication is used by dentists who provide treatment for adults with intellectual disabilities. A descriptive qualitative study, adopting synchronous online focus groups, was undertaken with six expert dentists in Ireland. Members were contacted again in pairs or individually for further data collection, analysed using thematic content analysis. Two relevant categories emerged from the data, relating to the selection and application of communication-based behaviour support for adults with intellectual disabilities. Decision-making processes were explored. Building on these categories, a co-regulating process of communication emerged as the means by which dentists iteratively apply and adapt communicative strategies. This exploration revealed rationalist and intuitive decision-making. Implications for education, practice and research are identified