Enhanced community surveillance is a key pillar of the public health response to coronavirus disease 2019 (COVID-19). Asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a potentially significant source of transmission, yet remains relatively poorly understood. Disruption of dental services continues with significantly reduced capacity. Ongoing precautions include preappointment and/or at appointment COVID-19 symptom screening and use of enhanced personal protective equipment (PPE). This study aimed to investigate SARS-CoV-2 infection in dental patients to inform community surveillance and improve understanding of risks in the dental setting. Thirty-one dental care centers across Scotland invited asymptomatic-screened patients aged over 5 y to participate. Following verbal consent and completion of sociodemographic and symptom history questionnaire, trained dental teams took a combined oropharyngeal and nasal swab sample using standardized Viral Transport Medium–containing test kits. Samples were processed by the Lighthouse Lab and patients informed of their results by SMS/email with appropriate self-isolation guidance in the event of a positive test. All positive cases were successfully followed up by the national contact tracing program. Over a 13-wk period (from August 3, 2020, to October 31, 2020), 4,032 patients, largely representative of the population, were tested. Of these, 22 (0.5%; 95% CI, 0.5%–0.8%) tested positive for SARS-CoV-2. The positivity rate increased over the period, commensurate with uptick in community prevalence identified across all national testing monitoring data streams. To our knowledge, this is the first report of a COVID-19 testing survey in asymptomatic-screened patients presenting in a dental setting. The positivity rate in this patient group reflects the underlying prevalence in community at the time. These data are a salient reminder, particularly when community infection levels are rising, of the importance of appropriate ongoing infection prevention control and PPE vigilance, which is relevant as health care team fatigue increases as the pandemic continues. Dental settings are a valuable location for public health surveillance.
This study sets out to review the literature on 'the oral health of adults with intellectual disabilities' and would have benefitted from defining the term 'intellectual disabilities'. The research was carried out in the USA and it is important to appreciate the different terminology used in different countries, combined with the variety and complexity of disabilities limiting comparisons outside the host country.How good is the systematic review? First it has to be asked whether the review was focussed enough to be a systematic review as the question asked was very broad. Secondly, can the results be interpreted sufficiently to draw evidence-based conclusions? There was no attempt to carry out meta-analyses on specific outcomes (eg, DMFT), some studies had small population numbers and there were substantial differences between the included studies, limiting the potential to generalise conclusions.Papers from across the world were included in the review but the study could have benefitted from using wider search terms to capture more literature as well as the use of grey literature and additional contacts with experts in the field. The research question concentrated on intellectual disabilities without considering the implications of the consequences of confounding factors (educational ability or deprivation), or the severity of the disability which impact on oral health.The time period used to gather the literature has seen changes in the demographics of the population; 1 with an increased life expectancy and increase in the number of patients with complex and long-term medical needs. There has also been a change in cultural values with tooth loss being less acceptable. 2 There has been a shift away from living in institutions to living independently in the community with an appropriate level of care. As life expectancy has increased there has been a change in the patterns of oral disease and therefore the treatment plans associated with the disease and the disability.A non-weighted scoring system, totalling 10, was used to assess the quality of the studies included in the review with a minimum score of 3 allowing inclusion into the study. Use of these types of scoring systems is not recommended by the Cochrane Collaboration. 3 Owing to the methodological limitations the results of the review should be interpreted with care. The use of English only studies and narrow search terms must raise questions in relation to the reviews' conclusions which concentrate focus more on professionally focussed strategies to address disparities for patients with ID whichhave not yet been fully elucidated. Emma O'KeefeDepartment of Public Health, NHS Fife, Leven, Scotland, UK SUMMARY REVIEW/DELIVERY OF CAREData sources Medline, PubMed, Clinical Queries and PsychLIT.Study selection The studies were evaluated independently by two reviewers and only included studies that had been published in English since 1975. The studies included had to meet three criteria; adult humans with mental retardation or a similar ID, had at least ...
Enhanced community surveillance is a key pillar of the public health response to COVID-19. Asymptomatic carriage of SARS-CoV-2 is a potentially significant source of transmission, yet remains relatively poorly understood. Disruption of dental services continues with significantly reduced capacity. Ongoing precautions include pre- and/or at appointment COVID-19 symptom screening and use of enhanced personal protective equipment (PPE). This study aimed to investigate SARS-CoV-2 infection in dental patients to inform community surveillance and improve understanding of risks in the dental setting. Thirty-one dental care centres across Scotland invited asymptomatic screened patients over 5-years-old to participate. Following verbal consent and completion of sociodemographic and symptom history questionnaire, trained dental teams took a combined oropharyngeal and nasal swab sample using standardised VTM-containing testkits. Samples were processed by the Lighthouse Lab and patients informed of their results by SMS/e-mail with appropriate self-isolation guidance in the event of a positive test. Over a 13-week period (from 3August to 31October2020) n=4,032 patients, largely representative of the population, were tested. Of these n=22 (0.5%; 95%CI 0.5%, 0.8%) tested positive for SARS-CoV-2. The positivity rate increased over the period, commensurate with uptick in community prevalence identified across all national testing monitoring data streams. All positive cases were successfully followed up by the national contact tracing program. To the best of our knowledge this is the first report of a COVID-19 testing survey in asymptomatic-screened patients presenting in a dental setting. The positivity rate in this patient group reflects the underlying prevalence in community at the time. These data are a salient reminder, particularly when community infection levels are rising, of the importance of appropriate ongoing Infection Prevention Control and PPE vigilance, which is relevant as healthcare team fatigue increases as the pandemic continues. Dental settings are a valuable location for public health surveillance.
Dental caries in preschool children is a significant public health problem and largely preventable. Professionally applied fluoride varnish is one of a number of vehicles used for administrating topical fluoride to help prevent or control dental caries. 1 Eight trials were reviewed, with the majority of them scoring poorly using Jadad's scale to assess the quality of the study. There was limited reporting on the process of randomisation and overall the number of participants at follow up was low.Due to the heterogeneity of the studies included in the systematic review, meta-analysis was not attempted. There were variations in the participants' previous caries experience, type of intervention administered to the control group, the children's exposure to fluoride and the interval between the varnish applications.One of the outcome measures was the prevented fraction; this is the difference in caries increments between the treatment and control groups expressed as a percentage of the increment in the control group and ranged from 5 to 63%, with the highest values found in the more recent studies. All studies showed a positive effect and the heterogeneity of the studies meant that an overall estimate could not be calculated. The Cochrane Review 2 found that fluoride varnish reduced caries by 33% in the primary dentition, which is within this study's range. Two of the more recent studies in this Results Eight trials conducted in four countries China, the United States, Poland and Sweden were included. Most of the studies were of poor methodological quality. They were also heterogeneous in relation to participants' previous caries ex perience, type of intervention administered to the control group, children's exposure to other sources of fluoride and varnish ap plication interval. The absolute differences between caries incidences in the control and test groups ranged from 0.30 to 1.64 and the preventive fractions varied from 5% to 63%.Conclusions Fluoride varnish may be effective to decre ase dental caries incidence in preschoolers, but more randomised clinical trials of better methodological quality are necessary to provide conclusive evidence in this respect. 3A| 2C| 2B| 2A|1B| 1A|
A systematic review of risk factors during first year of life for early childhood caries.
Objective To measure agreement between dental therapists and the Scottish gold‐standard dentist undertaking National Dental Inspection Programme (NDIP) examinations. Methods A study of interexaminer agreement between 19 dental therapists and the national gold‐standard dentist was carried out. Pre‐calibration training used the caries diagnostic criteria and examination techniques agreed by the British Association for the Study of Community Dentistry (BASCD). Twenty‐three 5‐year‐old children (Primary 1) and 17 11‐year‐old children (Primary 7) children were examined. Agreement was assessed using kappa statistics on d3mft and D3MFT for P1 and P7 children, sensitivity and specificity values, and kappa statistics on d3t/D3T and ft/FT. Calibration data on P1 and P7 children from 2009–2012 involving dentists as examiners were used for comparison. Economic evaluation was undertaken using a cost minimization analysis approach. Results The mean kappa score was 0.84 (SD 0.07) ranging from 0.69 to 0.94. All dental therapists scored good or very good agreement with the gold‐standard dentist. This compares with historic NDIP calibration data with dentists, against the same gold‐standard dentist, where the mean kappa value was 0.68 (SD 0.22) with a range of 0.35‐1.00. The mean sensitivity score was 0.98 (SD 0.04) (range 0.88‐1.0) and mean specificity score was 0.90 (SD 0.06) (range 0.78‐0.96). Health economic analysis estimated that salary costs would be 33.6% lower if dental therapists were substituted for dentists in the year 2013, with an estimated saving of approximately £103 646 per annum on the national budget. Conclusion We conclude that dental therapists show a high level of interexaminer agreement, and with the appropriate annual training and calibration, they could undertake dental examinations as part of the NDIP programme.
This systematic review is carried out at a time when there are serious concerns relating to the prevalence of obesity; it is now a worldwide public health problem. It has implications for the planning and delivery of dental services and the management of individual dental patients. 1
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.