Trusted evidence. Informed decisions. Better health. Cochrane Database of Systematic Reviews Analysis 4.1. Comparison 4 Oral health (OH) training of people with intellectual disabilities (ID) versus no training, Outcome 1 Gingival inflammation short term (< weeks

Introduction Evidence concerning the interactions between human health and planetary health has grown extensively in recent years. In turn, the perceived importance of environmental sustainability within higher education is growing at a rapid rate. This paper provides a summary of key elements as they apply to dentistry, and provides an introduction to the reader of an early consensus of how sustainability could be included as part of the dental curriculum. Methods The consensus opinion within this paper largely centres around discussion at the ADEE sustainability workshop at the annual conference in Berlin (August 2019). In order to help inform discussions at the workshop, a brief scoping questionnaire was circulated to potential participants regarding their understanding and current teaching practices in sustainability. An infographic was designed to help delegates remember the important elements of sustainable dentistry. Delegates discussed the concept of sustainability alongside the infographic, and how they could link these with the Graduating European Dentist (GED) curriculum. Results The discussions within the workshop largely centred around 4 main themes: Disease prevention and health promotion, Patient education and empowerment, Lean service delivery and Preferential use of strategies with lower environmental impact. Discussion It is apparent that there is a widespread need for teaching materials relating to environmental sustainability; this includes specific learning outcomes relating to the 4 educational domains of the Graduating European Dentist curriculum, and methods for teaching and assessing these outcomes. Conclusion This paper reports consensus on the first phase of a pan‐European working group on Sustainability in dental education.

This study aimed to investigate the impact of COVID-19 on the experiences of special care dentistry providers worldwide. An online survey was administered from 10 to 31 July 2020. Age, sex, years of professional activity, COVID-19 status, geographical area of origin and length of lockdown period were recorded for all participating dentists. The relationships between these variables and the changes in clinical activity, the treated patients’ COVID-19 status and the implementation of protective measures in the dental clinic were analyzed. A total of 436 (70.6% women) dentists from 59 countries responded to the survey. Clinical activity was reduced or stopped for 79.1% of respondents. The most common change was to limit treatment to urgent care only (53.7%). Treatment under general anesthesia or deep sedation was discontinued (51.0%) or reduced (35.8%) for the majority of respondents. Male dentists were more likely to maintain their clinical activity than female dentists (p < 0.001), and respondents from North America were more likely to do so than participants from other geographical regions (p < 0.001). Dentists from Latin America and the Caribbean were more likely to report treatment of confirmed cases of COVID-19 than those from Europe (p < 0.001). The implementation of protective measures in the dental office was determined by the survey participant’s sex, intensity of clinical activity and geographical area of origin. To conclude, the provision of special care dentistry was considerably reduced in response to the pandemic. Service maintenance was mainly related to the geographical area in which the surveyed dentists worked, further exacerbating pre-existing inequalities.

The population with intellectual disabilities (ID) show an increasing life expectancy. 1 As they age, they experience edentulism to a greater extent and at an earlier age, than the general population.However, unlike their counterparts in the general population, they are very unlikely to wear complete dentures, when edentulous. [2][3][4] A better understanding of the functional impact of edentulism, and in contrast, denture wear on this population would support informed and empowered treatment choices 5 and allow for improved functional assessment, particularly regarding difficulty eating.However, this relationship between dentition status, denture wear and eating remains unclear among this population. This lack of clarity may be in part due to the multidimensional nature of Summary Objectives: This study tests whether total tooth loss is a risk indicator for difficulty eating among a population with intellectual disability and whether complete denture wear mediates this risk. Methods: Dentate status and difficulty eating were reported for a Nationally representative sample of 690 adults over forty with intellectual disabilities as part of The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA). A logistic regression model tested the relationship between the Difficulty eating and Dentate status, controlling for the effects of other factors.Results: Of the 690 participants, 505 had some teeth (Group 1), 56 had no teeth and reported wearing dentures (Group 2) and 129 had no teeth, not using dentures (Group 3). A parsimonious regression model was developed including all 406 cases with no missing data. Adjusting for the effects of other factors, it was found that, compared to Group 1, the odds of difficulty eating was twice as great (OR = 2.01, 95% CI = 1.02-4.03) among people without teeth, not using dentures (Group 3). Conversely, edentulous participants who had dentures (Group 2) had far lower odds (OR = 0.21, 95% CI = 0.06-0.64) of reporting difficulty eating compared with Group 1. Conclusions:For adults with ID, total tooth loss was predictive of difficulty eating only when untreated. People with disabilities should be encouraged to maintain a functional dentition through preventive and conservative treatment. When adults with ID become edentulous, oral rehabilitation may reduce the risk of difficulty eating. Dental assessment should be undertaken if people with ID present with difficulty eating. K E Y W O R D Sageing, denture, difficulty eating, edentulism, intellectual disability | 171 MAC GIOLLA PHADRAIG et AL.

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Background A lack of robust data about the oral health of people with intellectual disabilities (IDs) contributes to health disparities. Appropriate research tools are therefore needed. This study reports the construction and evaluation of the Oral Status Survey Tool (OSST), designed to be administered with people with disabilities by non‐dental personnel. Method Oral Status Survey Tool construction and evaluation was achieved adopting a non‐clinical construction and content validation phase and a clinical phase to test concurrent validity, reliability and feasibility. Final refinements were also made. Results The OSST conceptual framework covered oral function (tooth count, denture wear and opposing pairs of teeth) and oral disease/treatment need (soft tissue status, oral cleanliness, gum condition, carious teeth and oral pain). A systematic literature review identified no existing suitable indices. Candidate items were identified and validated by experts generating content validation ratios. This framework was modified later to expand the function construct. In the initial clinical phase, 49 out of 60 participants underwent examination with OSST and standard dental assessments. All had mild to moderate IDs. Mean age was 43 years (SD = 16), and mean number of teeth was 22.1 (SD = 8.6). Data collectors included two dentists and three non‐dentists. Later, a further 17 adults (nine female and eight male) with mild/moderate IDs were included for refinement. At this stage, data collectors included two dentists and five non‐dentists. Concurrent validity was established for tooth count [intraclass correlation coefficient = 0.99 (95% confidence interval, CI: 0.99–0.99)], carious teeth [Gwet's AC2 = 0.94 (95% CI: 0.89–0.99)] and gum condition [Gwet's AC1 = 0.84 (95% CI: 0.64–1)]. For all final OSST items, inter‐rater reliability ranged from moderate to very good; median test–retest reliability ranged from moderate to good. Acceptability was demonstrated for data collectors and participants. Mean time to complete the OSST was 7 min. Conclusions The OSST is a novel tool that can record a range of clinical oral features including tooth count, denture wear, occluding pairs of teeth and functional dentition, oral cleanliness, gum condition, carious cavitation and oral pain that will be useful within health surveys of people with mild–moderate IDs and similarly neglected populations. The tool demonstrates promising attributes and acceptability. From this study, the OSST appears to be a robust tool that can be incorporated into general data collection for people with mild–moderate IDs and similar populations. A key feature is that it can be administered by well‐trained non‐dentists.

BackgroundRealist methods offer a novel approach to intervention design. Such novelty is needed for effective oral health promotion interventions with people with intellectual developmental disabilities (IDD) and their carers because existing interventions are poorly described and lack theoretical underpinning. In this study, the steps between inception and final intervention development are presented, with an aim to expand understanding of how realist theorizing can be used to develop interventions, and to demonstrate theory‐driven intervention development in the field of oral health promotion.MethodsIn this intervention development study, the use of realist methods to develop an intervention aiming to improve the oral hygiene of people with IDD is presented. Realist theories (RTs) arising from a mixed synthesis were used to develop the Keep My Teeth intervention. The use of realist theory in intervention development was mapped across seven domains and 18 actions with emphasis on how theory informed key actions.ResultsRealist theories informed many but not all actions in the development process. Where gaps arose, this was augmented with other systems of intervention development, such as the Behaviour Change Wheel (BCW) and Behaviour Change Technique (BCT) systems. The resulting intervention and underlying theory are presented using TiDieR criteria.ConclusionsIt is demonstrated how realist methods could be integrated with substantive theory when developing an intervention. RTs enhanced the contextualization of the intervention that was developed but were insufficient in their own right to guide the development process from conception to intervention. This was overcome by augmenting with substantive theory, in this case, using the BCW and BCT behaviour change systems, to select and specify the behaviours that needed to change. In essence, the BCTs guided which techniques to select, while the RTs guided how to develop and intervene. Robust intervention development in the field of oral health promotion is also presented in this study.