Radiographic and ultrasonographic evaluation of the esophagus in the horse

The purpose of this study was to describe the radiographic and ultrasonographic appearance of the esophagus of ten healthy horses. Contrast radiography showed variations in the long-axis shape of the esophagus at the thoracic inlet. Administration of a large volume contrast medium by intubation showed stasis of contrast material for several minutes in two of the ten horses. The wall thickness of the non-distended esophagus on ultrasound was 2.6 +/- 0.3 mm with significant differences depending on the location. Distention of the esophagus by intubation or by a bolus of water or concentrate resulted in a decrease in wall thickness and it facilitated measuring with less variation. Stasis at the thoracic inlet was seen in five of the ten horses, when a water bolus was administered. Ultrasonographic evaluation of 100g spontaneously swallowed commercial concentrate was better than fluid (water bolus or 2.5mL/kg contrast medium) administration via intubation to assess esophageal motility at the thoracic inlet. Stasis seen at the thoracic inlet after bolus administration by intubation should not be regarded as an abnormal finding, and swallowing, with the subsequent peristaltic wave, has a positive influence on the bolus passage time

Willingness of dental professionals to participate in special care dentistry

Objectives: To assess dental professionals’ characteristics and willingness to participate in the future organization of Special Care Dentistry (SCD) for patients with motor disabilities (MD), patients with developmental disabilities (DD) and older adults (OA), in Flanders, Belgium. Methods: An online questionnaire survey around received education, providing care and future organization of SCD was performed between December 2020 and January 2021. Descriptive, bivariate (Mann-Whitney U Test, Pearson Chi-Square and Fisher’s Exact Test) and binomial logistic regression analyses were performed with profession (dentist of dental hygienist) as explanatory variable (adjusted for covariates years of experience and gender). The project was approved by the Ghent University Hospital ethics committee (B6702020000556). Results: The survey was completed by 308 dentists (response rate 7.7%) and 51 dental hygienists (response rate 35.2%). There was a higher proportion of male dentists (40.6% vs. 1.6%; P<0.001) and dentists had more years of experience (median 31; range [1-55]) than dental hygienists (median 1; range [0-25]; P<0.001). A higher proportion of dentists treated SCD patients (96.4% vs. 87.0%; P<0.05). The adjusted models revealed that a higher proportion of dental hygienists than dentists had received education about all included SCD target groups (MD: OR 6.21, 95%CI [2.37-16.29]; DD: OR 6.21, 95%CI [2.37-16.29]; OA: OR 3.70, 95%CI [1.40-9.75]). Furthermore, more dental hygienists were open to (a) receive future education about SCD patients (MD: OR 6.70, 95%CI [1.88-23.83]; DD: OR 5.13, 95%CI [1.43-18.37]; OA: OR 2.47, 95%CI [0.91-6.70]), (b) use mobile dental equipment (OR 5.41, 95%CI [2.33-12.54]) and (c) be part of an oral healthcare network for patients with MD (OR 4.09, 95%CI [1.52-11.00]), patients with DD (OR 4.88, 95%CI [1.82-13.10]) or older adults (OR 4.64, 95%CI [1.73-12.43]) in future. Conclusions The results suggest that dental hygienists are more open to play a role within the future organization of SCD in Flanders

Review of the dental treatment backlog of people with disabilities in Europe

Aim: To describe the oral health and treatments needs of people with disabilities in Europe. Methods: A comprehensive literature search was conducted using Medline and Embase with a timeframe from January, 2008 till December, 2017 and citation tracking was done. Articles in English, French and Dutch were included. Results: Forty-two articles were included. A variety of oral health problems and treatment needs was seen. More untreated caries, less fillings, more extractions and less prosthetic rehabilitation were seen in people with disabilities compared to people without disabilities. Oral hygiene and periodontal conditions were poor. In people with disabilities, a higher risk for dental trauma, orthodontic problems and tooth wear was also detected. Discussion: Results need to be interpreted with caution because of the variety of people with disabilities included in this literature review. However, a backlog of treatment was a common finding in people with disabilities. Different factors contribute to their oral health and treatment needs. These determinants can be situated at the level of the person with a disability (biological factors), his/her lifestyle, the environment and the organization of oral healthcare. Training and motivating people with disabilities, their family and caregivers are suggested to improve their oral health. Furthermore training of dental students and dentists about the treatment needs and treatment possibilities in people with disabilities should be envisaged in order to make dentists feel more comfortable in treating this target group

Review of the dental treatment backlog of people with disabilities in Europe

Aim: The present research aims at reviewing the oral health conditions and treatment needs of people with disabilities in Europe. Methods: A comprehensive literature search was conducted using Medline and Embase with a timeframe from January 2008 until December 2017. Subsequently, a citation tracking was undertaken. Articles in English, French and Dutch were included. Results: Forty-two articles were included. A variety of oral health problems and treatment needs was reported. More untreated carious lesions, less restorations, a higher number of extractions and less prosthetic rehabilitations were seen in people with disabilities compared with other individuals without disabilities. The oral hygiene level and the periodontal conditions were poor. Moreover, a higher risk of dental trauma, orthodontic problems and tooth wear were reported. Discussion: Different determinants contribute to the oral health condition and treatment needs of people with disabilities. These determinants can be inherent in persons with a disability (biological factors), their lifestyle, the environment or the organization of oral health care. A treatment backlog was a common finding in people with disabilities. However, results need to be interpreted with caution because of the variety of people with disabilities included in this literature review. Proposed solutions can be put at the level of daily oral care, through oral health promotion programs and the creation of a supportive environment, but also at the level of dental attendance, facilitating the access to oral health care services and focusing the training of dental students and dentists. Conclusion: This comprehensive review clearly shows a dental treatment backlog in people with disabilities. Solutions require efforts from the caregivers and dental professionals

The perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders, Belgium

Objectives: To assess the perception of oral health and oral care needs, barriers and current practices as perceived by managers and caregivers in organizations for people with disabilities in Flanders. Materials and methods: Two questionnaires were developed, one for managers and one for caregivers. The questionnaires were distributed in all 570 organizations for people with disabilities in Flanders. The survey was carried out in February 2018. Results: Sixty-five managers completed the questionnaire and 63 of them could be linked to 57 unique organizations (10% of the contacted organizations). Managers perceived oral health to be better (P = 0.019) and mentioned less oral health needs (P = 0.049), when collaboration with a dentist was reported. When an oral health policy had been established in their organization, oral health was also perceived to be better (P = 0.048). The responses of 91 caregivers were included for analysis and 87 of them could be linked to 39 unique organizations (7% of contacted organizations). Seventy percent and 75% of the caregivers mentioned to have enough/comprehensive theoretical knowledge and practical skills, respectively, and 46% were interested in receiving oral health education. Most interest was shown in practical education and education customized to clients’ needs. In organizations with an oral health project, more caregivers indicated that the organization was open to oral health questions than in organizations without such a project (97% compared with 81%; P = 0.045). When there was a collaboration with a dentist, the organization was more open to caregivers’ questions (96% compared with 72%; P = 0.004) and a clear contact point was more readily available (81% compared with 48%; P = 0.004). Furthermore, caregivers were more interested to receive oral health education (P = 0.023) and mentioned to be more aware of the oral health of their clients (P = 0.015). About 23% and 30% of the caregivers indicated that guidelines were used in their organization for cleaning natural teeth and prostheses, respectively. Conclusions: Despite the low response rate to the survey and reaching the management and caregivers of only 10% and 7% of the organizations respectively, this study indicates relevant issues to be incorporated when formulating recommendations for oral health promotion in people with disabilities in Flanders. Clinical relevance: The results of this survey could affect the development of strategies and interventions to ameliorate the oral health of people with disabilities

The perception of oral health among care staff in residential care organizations for people with disablities in Flanders (Belgium)

AIM(S) People with disabilities in residential care often depend on care staff for their oral health. In 2018, a survey assessing the perceptions about oral health and oral care delivery was carried out among residential care managers and staff in Flanders. The current study aimed to assess the needs around oral health in residential care in-depth. METHODS Eight focus groups were conducted between November 2019 and November 2020 in three waves. Sampling of the waves was driven by findings obtained during the process. In the first wave, three focus groups were organized with predominantly (para)medical staff (e.g. nurses and speech therapists) of different residential care organizations. To also explore the perceptions of care staff carrying out daily oral healthcare (e.g. nurse aids and care workers), a second wave with three additional focus groups was conducted. Finally, findings were supplemented with two groups focusing on caregivers of home care organizations (third wave). All focus groups were recorded and transcribed verbatim in Microsoft® Word. Data were analysed in NVivo applying inductive thematic analysis. The study was approved by the Ghent University Hospital ethics committee under national registration number B670201941973. RESULTS A total of 39 participants were included in the study. Daily oral healthcare was performed by both care staff of the residential organization and caregivers of home care organizations. Deficient communication between all parties involved was found to be a barrier of care continuity. Furthermore, there were few opportunities for oral health education and skills training. Care staff also reported barriers visiting oral healthcare professionals (dentist/dental hygienist). CONCLUSIONS Care staff perceive barriers for both carrying out daily oral healthcare and referral to professional oral healthcare. Oral health promotion initiatives in residential care for people with disabilities should at least focus on these two aspects of oral healt

Perceptions on oral care needs, barriers, and practices among managers and staff in long-term care settings for older people in Flanders, Belgium : a cross-sectional survey

Background and Objectives This study aimed to explore oral health perception and oral care needs, barriers, and current practices as perceived by managers and staff in long-term care organizations for older people in Flanders. Research Design and Methods This is a cross-sectional study where 2 questionnaires were developed, one for managers and one for caregivers, and were validated in Flemish long-term care organizations. Descriptive analyses and multivariable generalized linear models evaluated the main outcomes and their associations with determinants such as the size of the organization, the presence of an oral health policy, collaboration with a dentist, among others. Results A total of 145 managers and 197 caregivers completed the questionnaire. More than 50% of caregivers and managers perceived their residents' oral health as mediocre to good. Collaboration with a dentist (B = 0.84) and oral health care involvement (B = 0.08) within the organization showed a strong association with a positive perception of oral health. Lack of time (57%) and care resistance (70%) were the most important barriers perceived by caregivers. Guidelines concerning oral care were not available or were unknown to 52% of the caregivers. Having an oral health policy within the organization was strongly associated with the correct use of guidelines for daily care of natural teeth (B = 1.25) and of dental prosthesis (B = 1.15). Discussion and Implications The results emphasize that collaborating with a dentist and the presence of an oral health policy in care organizations are important for a positive perception of the oral health of the residents and for the adoption of guidelines by caregivers and managers. In addition, training on handling care refusal should be included in the overall training. These results are crucial input for the development of a methodology for implementing a structured oral care policy in long-term care facilities