As the healthcare industry continues to change, dental providers are concerned about the different types of adverse events that can occur if systemic diseases are not well understood when treating patients. The purpose of this study was to explore the level of understanding among dental care providers of the relationship between oral care and systemic diseases and how these are linked to adverse events. The theoretical foundation that was used for this study was the Swiss cheese model. The research questions were designed to address the level of understanding among dental care providers of the link between oral care and systemic diseases as well as their perceptions of adverse events in dentistry and why they occur. Using a qualitative phenomenological approach, interviews were conducted with 10 dental care providers who practice in the New Jersey area. As I reviewed the field notes and listened to the audio recording, themes were developed to gain a deeper understanding of the research. The research findings revealed that dental providers have moderate knowledge of systemic disease and that some dentists had encountered an adverse event when providing oral care to patients; this experience led participants to look at patients' overall health instead of only oral care. Positive social change could result from improved training and education for dental providers to gain a better understanding of systemic diseases and systems such as the Swiss cheese model for preventing adverse events in patients with systemic diseases. Dental providers should be more involved with community services by providing health fairs to educate the public about why taking care of their oral health is as important as their physical health.

<p>The majority of Cameroonians depend on traditional medicines for their health care needs and about seven per cent of the average household health budget is spent on traditional medicines irrespective of their incomes. The aim of this study was (i) to assess the role of traditional healers (THs) in providing oral care services in Cameroon / (ii) to determine their cost of treatment and to investigate reasons why people visit THs. The present study was cross sectional and consisted of a sample of 21 THs and 52 clients with a history of dental problems. It utilized semi structured questionnaires and photographs to collect data. The mean age of THs was 46.0 years (range 20-77 years). Thirty per cent of THs were above 40 years and the majority males. Nearly a quarter of the THs practiced as herbalists and the remainder practiced both divination and herbalism. More than two thirds of Cameroonians, who patronize THs for their oral health needs, fall within the 20-40 year age group. THs in this region are experienced and enjoy good relationships with hospitals and other THs. However, collaboration between the oral health work force and THs is very poor as only 6% of all patients seen by THs are referred to the dentist. Socio-cultural and economic factors affect the oral health care seeking behavior of patients in this area and only 6.5% of patients visit dental clinics. Reasons for not attending dental clinics included cost, poor accessibility, superstition and fear.</p>

<p>The majority of Cameroonians depend on traditional medicines for their health care needs and about seven per cent of the average household health budget is spent on traditional medicines irrespective of their incomes. The aim of this study was (i) to assess the role of traditional healers (THs) in providing oral care services in Cameroon / (ii) to determine their cost of treatment and to investigate reasons why people visit THs. The present study was cross sectional and consisted of a sample of 21 THs and 52 clients with a history of dental problems. It utilized semi structured questionnaires and photographs to collect data. The mean age of THs was 46.0 years (range 20-77 years). Thirty per cent of THs were above 40 years and the majority males. Nearly a quarter of the THs practiced as herbalists and the remainder practiced both divination and herbalism. More than two thirds of Cameroonians, who patronize THs for their oral health needs, fall within the 20-40 year age group. THs in this region are experienced and enjoy good relationships with hospitals and other THs. However, collaboration between the oral health work force and THs is very poor as only 6% of all patients seen by THs are referred to the dentist. Socio-cultural and economic factors affect the oral health care seeking behavior of patients in this area and only 6.5% of patients visit dental clinics. Reasons for not attending dental clinics included cost, poor accessibility, superstition and fear.</p>

OBJECTIVE: Within the U.S. population approximately 20 percent of individuals are diagnosed with some type of disability and another 12 percent are considered severely disabled. Many times special health care needs (SHCN) patients with one condition are burdened by more than one disability. A variety of conditions such as behavioral issues, developmental disorders, and cognitive, congenital or systemic diseases have been proven to increase the risk of oral heath disease in individuals with SHCN. These conditions may affect the ability to communicate and limit dexterity for proper oral health maintenance, which is why caregivers must become advocates for these patients to insure their oral health needs are met. By communicating effectively with caretakers, dentists will be able to establish a positive impact on patients to make dental visits easier and less traumatizing. Unfortunately studies have found that dental and hygiene students graduate without feeling adequately prepared to treat patients with SHCN. With the proper education and training, more dental students and future dentists will take on the challenges that are brought by these individuals to provide the best care possible. Establishing a strong support system could potentially decrease oral health disparity in SHCN patients and improve overall care. The goal of this study was to assess whether or not there was a positive impact on the oral health of SHCN individuals when caregivers and oral health professionals worked together in a team treatment effort to fight against oral disease. METHODS: Study used a systematic review approach of literature where a PICO question was formed and the article selection process included a review of title, abstract, and application of inclusions and exclusion criteria. Printed-text and online databases such as Pubmed/MEDLINE, Google Scholar, and Web of Science were used to conduct a review of literature where a total of 210 papers were collected. After selection process, only four papers were eligible for systematic review. Pre-determined questions were used to determine the how involved caregivers and oral health professionals were during each study followed by an assessment using a point system, which scored caregiver and oral health professionals involvement during intervention. RESULTS: Selected studies showed heterogeneity in study design and sample size but all used multidisciplinary approach, which included some degree of caregiver and oral hygiene provider (OHP) collaboration. Two out of the four studies totaled nearly perfect scores in both caregiver and oral health professional involvement, which resulted in a positive effect on oral health care of SHCN patients. Case reports that included an interdisciplinary team approach to oral care procedures on patients, showed the benefits of teamwork and how collaborative practice between dental and medical professionals increased successful patient outcomes. Results illustrated the significant role that caregiver’s play in the dental team and how their absence during intervention treatment significantly lowered study scores for the overall success of patient care. CONCLUSIONS: Results demonstrated that studies with a well-rounded dental team, which included caregivers, OHP, health care professionals accompanied by social support systems, saw the greatest success and improvements in oral health care of SHCN patients. Nevertheless, a dedicated dental team where most members were present did not guarantee intervention success if caregivers did not show a significant involvement. Caregivers alone could positively impact oral health care of a patient more than if OHP worked alone. In conclusion, we found that each member of a dental team had the ability to impact change to an almost equal degree. For this reason, it is important for caregivers, OHP, dental staff and health care professionals to work together, support one another and communicate effectively to decrease oral health disparities in SHCN patients.

Magister Scientiae Dentium - MSc(Dent) / The majority of Cameroonians depend on traditional medicines for their health care needs and about seven per cent of the average household health budget is spent on traditional medicines irrespective of their incomes. The aim of this study was (i) to assess the role of traditional healers (THs) in providing oral care services in Cameroon; (ii) to determine their cost of treatment and to investigate reasons why people visit THs. The present study was cross sectional and consisted of a sample of 21 THs and 52 clients with a history of dental problems. It utilized semi structured questionnaires and photographs to collect data. The mean age of THs was 46.0 years (range 20-77 years). Thirty per cent of THs were above 40 years and the majority males. Nearly a quarter of the THs practiced as herbalists and the remainder practiced both divination and herbalism. More than two thirds of Cameroonians, who patronize THs for their oral health needs, fall within the 20-40 year age group. THs in this region are experienced and enjoy good relationships with hospitals and other THs. However, collaboration between the oral health work force and THs is very poor as only 6% of all patients seen by THs are referred to the dentist. Socio-cultural and economic factors affect the oral health care seeking behavior of patients in this area and only 6.5% of patients visit dental clinics. Reasons for not attending dental clinics included cost, poor accessibility, superstition and fear. / South Africa

BACKGROUND: Periodontitis is prevalent among adults 30 years and older and its prevalence increases with age. By 2040, there is an expected 50% increase in adults over the age of 65 years old in the US population. Therefore, it is essential to maintain good oral health and prevent tooth loss, pain, discomfort, and poor nutrition from improper chewing of food. Adults directly influence their periodontitis risk factors through at home oral care practices and smoking habits. Thus, the importance of home oral care practices and better choices in smoking habits may prevent the progression of periodontitis. The purpose of this study is to assess the association of at home oral care practices and smoking to periodontitis. The findings may be useful in future oral health education to emphasize the importance of oral hygiene care at home and smoking cessation. It may help dentists identify patients that will benefit from oral care instructions and smoking cessation and possibly aid in the development of prevention programs to combat the high prevalence of periodontitis in the foreseen growing population of the elders over the age of 65 in the U.S. OBJECTIVES: To assess the association of at home oral care practices to periodontitis and compare smokers and nonsmokers with respect to their oral care practices. We expect that people who regularly brush their teeth, floss, and use mouthwash twice or more per day, and who are nonsmokers will have less periodontitis. METHODS: Three categories of brushing: two to six times/week, once a day, or two or more/day in the past week were used. Additionally, three categories of flossing and rinsing: never, once to six times/week, or one or more times/day in the past week were also used. Odds ratio was calculated controlling for age, bone loss, gender, socioeconomic status, and smoking. Additionally, odds ratio was calculated for the oral care practices comparing smokers versus non-smokers. RESULTS: A total of 141 adults participated in the survey, 18% never flossed, 23% never rinsed, 6% brushed less than daily, and 35% had periodontitis. After controlling for variables, the lack of flossing was associated to periodontitis (odds ratio=1,88, 95% 1.00, p<0.0492) while rinsing and brushing were not associated with periodontitis. There were five times higher odds of periodontitis for a participant who never flossed compared to counterparts (95% CI 2.10-13.56). A dose response was not observed. After calculating for the odds ratio of the association of oral care practices to periodontitis among smokers versus non-smokers, the lack of flossing was positively associated with periodontitis such that smokers who never flossed had twice the higher odds of periodontitis compared to counterparts (odds ratio=4.20, CI 1.30-13.50, p<0.012). Participants who were smokers, with bone loss, and from low socioeconomic status had higher odds of having periodontitis. DISCUSSION: The lack of flossing was associated with higher prevalence of periodontitis. Smokers and especially daily smokers were more likely to engage in poor oral hygiene behaviors. Participants with bone loss, low socioeconomic status, and smokers were also associated with higher prevalence of periodontitis. Flossing at least once a week had a protective association to periodontitis. However, this was a cross-sectional study so a causal relation between the oral care practices and periodontitis cannot be established.

A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960’s when ICP monitoring was first introduced in the clinical setting. Until recently few studies have specifically examined the effect of oral care on ICP and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP. The purpose of this study was to describe the relationship between routine oral care interventions and the changes in ICP specifically focusing on the effect of intensity and duration of this intervention. Twenty-three patients with a clinical condition requiring ICP monitoring were enrolled over a 12 month period. Oral care provided by neuroscience intensive care nurses was observed and videotaped. Characteristics of the intervention were documented including products used, patient positioning, and duration of the intervention. A 1-5 subjective scale was used to score intensity of oral care. Wrist actigraphy data were collected from the nurses to provide an objective measure of intensity. Patient physiologic data were collected at 12 second epochs 5 minutes before, during and 5 minutes after oral care. The mixed effect repeated measures ANOVA model indicated that there was a statistically significant increase in ICP in response to oral care (p=0.0031). There was, however, no clinically significant effect on ICP. This study provides evidence that oral care is safe to perform in patients in the absence of pre-existing elevated ICP.

Thesis (MCur)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Ventilator-Associated Pneumonia (VAP) is a hospital acquired infection, not present or incubating at the time of admission and developing in patients during the process of care within the hospital setting. Between nine and twenty-seven percent of patients who are mechanically ventilated will develop ventilator-associated pneumonia. Mortality rates for ventilated patients who develop ventilator-associated pneumonia are estimated to be between 33-50%. The Institute for Healthcare Improvements (IHI) in 2006 recommended the use of ‘care bundles’ to reduce VAP but no statistically significant decline has been noted. Despite the completion of an extensive literature search for purposes of this review, no statistical data on nosocomial infections or nosocomial pneumonia relevant to South Africa was found. Mechanical ventilation, a support therapy used in approximately one third of patients, significantly increases the patient’s risk of developing this nosocomial pneumonia. Critically ill patients are by virtue of their critical illness more prone to the development of infections, especially ventilator-associated pneumonia. Consistent evidence suggests that oropharyngeal colonization can be associated with the development of VAP. Studies focusing on standard oral care, with or without the concurrent use of chlorhexidine, have not provided sufficient evidence for the use of chlorhexidine in VAP prevention. Chlorhexidine is an antiseptic agent, which when tested, proved to reduce total respiratory tract infections by up to 69% (DeRiso et al, 1996:1558). Objective: The aim of this study was to systematically appraise and review evidence on the effectiveness of chlorhexidine in reducing the incidence of ventilator-associated pneumonia in adult patients. The secondary aim was to systematically summarize evidence on the use of chlorhexidine in reducing mortality. Methodology: An extensive literature search of studies published in English was undertaken. Electronic databases searched were CENTRAL, CINAHL, EMBASE and MEDLINE. Reference lists of articles, textbooks and conference summaries were examined. Literature searches were conducted using Medical Subject Headings (MeSH). These included: Ventilator-associated pneumonia, chlorhexidine, VAP and oral care. Eight randomized controlled trials, investigating the efficacy of Chlorhexidine in ventilator-associated pneumonia prevention in adults met the inclusion criteria. The effect measure of choice was Risk ratio with 95% confidence intervals for dichotomous data using the random effects (Mantel-Haenszel) model; (p=value of 0.05). Heterogeneity was assessed using the Cochrane Q statistic and I². Results: Eight randomized controlled trials met the inclusion criteria for this review. Pooled risk ratio for the incidence of ventilator-associated pneumonia was 0.64 (95% CI; 0.44-0.91; p =0.18). Treatment with chlorhexidine decreased the risk of ventilator-associated pneumonia by 36%. There was no evidence of Chlorhexidine reducing mortality. Conclusions: Chlorhexidine is a cost effective safe treatment in the prevention of VAP. The use of 2% chlorhexidine may be more effective in reducing the incidence of VAP. No studies were found conducted in developing countries. More rigorously designed trials using 2% chlorhexidine are recommended. / AFRIKAANSE OPSOMMING: Agtergrond Ventilator-Geassosieerde Longontsteking (VAP) is 'n hospitaal verkry infeksie, nie teenwoordig met toelating nie. Ventilator-geassosieerde longontsteking word ontwikkel in pasiënte tydens die proses van sorg in die hospitaal. Tussen nege en sewe en twintig persent van pasiënte wat meganies geventileer word kry ventilator-geassosieerde pneumonie. Sterftesyfers vir geventileerde pasiënte wat ventilator-geassosieerde pneumonie ontwikkel is na raming tussen 33- 50%. Die Institute for Healthcare Improvements (IHI) het in 2006 die gebruik van 'sorg bundels' aanbeveel om VAP te verminder, maar geen statisties beduidende daling is aangeteken nie. Ten spyte van 'n uitgebreide literatuur soek, is geen statistiese data op nosokomiale infeksies of nosokomiale longontsteking toepaslik tot Suid-Afrika gevind nie. Meganiese ventilasie, 'n ondersteuningsterapie wat gebruik word in ongeveer een derde van die pasiënte, verhoog aansienlik die pasiënt se risiko vir die ontwikkeling van hierdie nosokomiale longontsteking. Kritiek siek pasiënte is op gronde van hul kritieke toestand meer geneig tot die ontwikkeling van infeksies, veral ventilator-geassosieerde pneumonie. Konsekwente bewyse dui daarop dat orofaringeale kolonisasie kan met die ontwikkeling van VAP geassosieer word. Studies wat fokus op standaard mond sorg, met of sonder die gelyktydige gebruik van chlorhexidine, het nie voldoende bewyse vir die gebruik van chlorhexidine in VAP voorkoming nie. Chlorhexidine is 'n antiseptiese agent, wat wanneer in een verewekansigde gekontroleerde studies (VGS) getoets was die totale respiratoriese kanaal infeksies verminder deur tot 69%. Doel: Die doel van hierdie sistematiese literatuuroorsig was om stelselmatig te evalueer en bewyse oor die effektiwiteit van chlorhexidine in die vermindering en voorkoms van ventilatorgeassosieerde pneumonie in volwasse pasiënte te hersien. Die sekondêre doel was om stelselmatig bewyse op te som op die gebruik van chlorhexidine in die vermindering van sterfte. Metodiek: 'n Uitgebreide literatuursoektog van studies wat in Engels gepubliseer is was onderneem. CENTRAL, CINAHL, EMBASE en MEDLINE was deursoek. Naslaanlyste van artikels, handboeke en konferensie opsommings is ondersoek. Die literatuur soektog is uitgevoer met behulp van Medical Subject Headings (MeSH). Dit sluit in: ventilator-geassosieerde pneumonie, chlorhexidine, VAP en mond sorg. Agt verewekansigde gekontroleerde studies (VGS), wat die doeltreffendheid van Chlorhexidine in ventilator-geassosieerde pneumonie voorkoming in volwassenes ondersoek, was ingesluit vir hierdie studie. Die effek mate van keuse was risiko ratio (RR) met 95% vertrouensintervalle met behulp van die ewekansige effekte (Mantel-Haenszel) model; (p = 0.05). Heterogeniteit is bepaal deur gebruik te maak van die Cochrane Q- statistiek en I². Hoof resultate: Agt verewekansigde gekontroleerde studies (VGS) het die insluiting kriteria vir hierdie oorsig gepas. Gepoelde risiko ratio vir die voorkoms van ventilator-geassosieerde pneumonie: Risiko Ratio (RR) was 0.64 (95% CI; 0.44-0.91; p=0.18). Gevolgtrekkings: Behandeling met chlorhexidine het die risiko van ventilator-geassosieerde pneumonie met 36% gedaal. Daar was geen bewyse van Chlorhexidine op die vermindering van mortaliteit nie. Chlorhexidine is 'n koste-effektiewe veilige behandeling in die voorkoming van VAP. Die gebruik van 2% chlorhexidine kan moontlik meer effektief wees in die vermindering van die voorkoms van VAP. Meer streng ontwerp studies met 2% chlorhexidine word aanbeveel.

Inom intensivvård bedrivs omvårdnad i en högteknologisk miljö. Flera av patienterna är i behov av andningshjälp i form av ventilatorbehandling vilket medför att patienten är sederad och har en endotrachealtub i trachea. Patienten kan inte själv utföra sin munvård och blir därför beroende av intensivvårdsjuksköterskans hjälp. Syftet med studien var att belysa intensivvårdssjuksköterskans erfarenhet av munvård av intuberade intensivvårdspatienter. Studien utfördes med en fokusgruppsintervju och analyserades med en kvalitativ innehållsanalys. Kategorierna som framkom i studien var att munvård handlar om prioritering, risker, teamarbete och kommunikation, utförande, patientperspektiv och ansvar. Förslag på fortsatt forskning skulle kunna leda till ett validerat bedömningsinstrument för munvård av intuberad patient samt evidensbaserade riktlinjer för munvård. / Intensive care is conducted in a high technological environment. Many of the patients are in need of breathing assistance with the help of a ventilator, which means that the patient is sedated and intubated. The patients can´t perform their oral care by themselves and therefore dependent on the help of intensive care nurses. The purpose of this study was to elucidate critical care nurses' experiences of oral care in intubated ICU patients. The study was performed with a focus group interview and analyzed by a content analysis. The categories that emerged from the study were that oral care is about priorities, risks, teamwork and communication, performance, patient perspective and responsibility. Suggestions for further research could lead to a validated assessment tool for oral care of intubated patients and evidensbased guidelines for oral care.

Many nurses lack evidence-based knowledge to deliver appropriate oral care, view oral care in the care-dependent patient as a comfort measure, and give it a low clinical priority. An estimated 44%-65% of hospitalized care-dependent patients do not receive adequate oral care, an intervention that can prevent aspiration pneumonia or pneumonitis. The purpose of this project was to develop a policy for use of an oral assessment tool and evidence-based guidelines for oral care in hospitalized care-dependent adults outside of the intensive care unit setting at a regional health system in the Southeast United States. The project used the theoretical foundations of relationship-based care and the logic model. A 14 member interdisciplinary team of institutional stakeholders from 2 acute care hospitals identified an evidence-based oral assessment tool, developed policy and practice guidelines to inform oral care, and developed both implementation and evaluation plans to pilot the project. The short-term goal of the project was to increase staff knowledge, evaluated with direct observation of assessments and documentation reviews. The long-term goal of this project was to reduce the risk of aspiration and resulting complications as evidenced by discharge diagnosis. The standards developed in this project create a process to ensure that care-dependent adults outside of the intensive care unit setting will receive an oral assessment daily, or every shift, as determined by the oral assessment score. The project advances nursing practice by addressing a gap in practice and promotes positive social change by improving the quality of care provided to all care-dependent patients. Improvement of patient outcomes from reduced risk for aspiration and reduced financial burden of unnecessary resources used to care for patients who aspirate and suffer complications are additional outcomes expected of this initiative.