A SURVEY OF THE EXPERIENCE, KNOWLEDGE AND ATTITUDE OF DENTAL PRACTITIONERS IN BULGARIA ABOUT CHILD ABUSE AND NEGLECT

Aim: To study the experience, knowledge and attitude of dental practitioners in Bulgaria about child abuse and neglect. Material and methods: An anonymous questionnaire was conducted on 265 dental practitioners from several regions of Bulgaria. The questionnaire consists of 15 questions, including demographic characteristics and questions about their attitude, knowledge and actions in suspected cases of child abuse and neglect. Results: Only 1/4 of the respondents, n=60 (22.3%), reported having suspected cases of Child Abuse and Neglect, and only 5.7% of them were reported to the authorities. The notification to the relevant institutions increases with the professional experience up to 30% to 40%. The most common reason for not reporting was lack of knowledge of the way or procedures of reporting (40.4%), fear of subsequent violence against the child - 23.4% and fear of consequences for the child when the relevant institutions interfere - 12.8%. Irregular dental visits were considered the most significant indicator of neglect of children's oral health. Need for additional education and training on recognizing the signs of child abuse and neglect were reported from 72.5% of the participants. Conclusions: The present study showed uncertainty in recognizing and reporting suspected cases of child abuse and neglect, especially for the younger dentists and for those without a certain specialty. There is a clear need for additional education of dental practitioners, as well as certain legal guidelines on the procedures of reporting and recording suspected cases, along with reliable support from the relevant institutions.

Oral Health in Communities and Neighborhoods (OHICAN) Pilot Project: The Burden of Poor Oral Health

Poor oral health afflicts many low-income and other vulnerable populations. Lack of access to oral health can lead to unnecessary tooth decay, periodontal disease, pain, and the advancement of oral cancer. The absence of preventive care often leads to unnecessary and expensive visits to hospital-based emergency departments to address the pain of dental disease but not the causal conditions. The consequences on inequitable access to dental care are significant for individuals, families and communities. The OHICAN pilot project looked to address the lack of equitable access to care by creating new points of access, training medical providers to perform oral exams and apply fluoride when indicated, thus increasing the oral health workforce, utilizing technology to bridge clinical practice, education, training and research, educating stakeholders to allow dental hygienists to provide preventive care under general supervision, and creating business models that will assist others who seek to create a dental home for those they serve. Social, political and economic forces all contribute to varying degrees in terms of equity in healthcare. The work of OHICAN was designed to create a blueprint for potential solutions to these issues in order to foster oral health equity. Changes to improve access to dental care can take place in a relatively short period of time when all who care and are impacted by this continued unmet oral health need work together.

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

Introduction: Reducing social inequality along with oral health inequality in Wales is a policy objective. In this ecological study the relationships between deprivation, dental workforce and oral health are explored. Method: Twenty two Unitary Authorities (UAs) serving the population of Wales were studied. The number of dentists were obtained from NHS Business Services as well as the 2019 population figures from StatsWales. As data for whole time equivalent General Dental Practitioner (GDP) workforce were not available, GDP sites were used. The condition of teeth at the age 12 years was used as a measure of oral health from the most recent epidemiological survey available. The relationship between oral health and workforce was established using the Welsh Index of Multiple Deprivation (WIMD).Results: Associations were observed between dental sites and population as well as between oral health and deprivation. A new composite variable called the University of South Wales Dental Index (USWDI) was introduced by combining the number of dentists with their corresponding WIMD of the most deprived 10% of the population. Using regression modelling the USWDI demonstrated its superiority in using either the number of dentists or the WIMD most deprived 10% alone to predict decayed, missing and filled teeth (DMFT).Conclusion: Workforce levels have increased and there has been a corresponding improvement in oral health over two decades. At the same time deprived subgroups continue to experience relatively higher levels of disease. A proportion of the general dental services delivered in Wales has continued to be based on the principle of supply induced demand for care rather than oral health need. Improving oral health in a diverse population like Wales cannot be achieved by increasing dental workforce alone. It is necessary to account for levels of deprivation. USWDI as a predictor of DMFT could be a useful tool to monitor the macro delivery of oral health care for the future in Wales.

The Balance between Oral Health Needs and Supply Induced Demand in Welsh Dental Services

IntroductionReducing social inequality along with oral health inequality in Wales is a policy objective. In this ecological study the relationships between deprivation, dental workforce and oral health are explored. MethodTwenty-two Unitary Authorities (UAs) serving the population of Wales were studied. The number of dentists were obtained from NHS Business Services as well as the 2019 population figures from StatsWales. As data for whole time equivalent General Dental Practitioner (GDP) workforce were not available, GDP sites were used. The condition of teeth at the age 12 years was used as a measure of oral health from the most recent epidemiological survey available. The relationship between oral health and workforce was established using the Welsh Index of Multiple Deprivation (WIMD).ResultsAssociations were observed between dental sites and population as well as between oral health and deprivation. A new composite variable called the University of South Wales Dental Index (USWDI) was introduced by combining the number of dentists with their corresponding WIMD of the most deprived 10% of the population. Using regression modelling the USWDI demonstrated its superiority in using either the number of dentists or the WIMD most deprived 10% alone to predict decayed, missing and filled teeth (DMFT).ConclusionWorkforce levels have increased and there has been a corresponding improvement in oral health over two decades. At the same time deprived subgroups continue to experience relatively higher levels of disease. A proportion of the general dental services delivered in Wales has continued to be based on the principle of supply induced demand for care rather than oral health need. Improving oral health in a diverse population like Wales cannot be achieved by increasing dental workforce alone. It is necessary to account for levels of deprivation. USWDI as a predictor of DMFT could be a useful tool to monitor the macro delivery of oral health care for the future in Wales.

Multimorbidity and oral health: need for new models of care

Multimorbidity is defined as patients living with two or more chronic health conditions. The prevalence of multimorbidity is increasing, driven by the ageing population, and represents a major challenge to all healthcare systems because these patients are heavy users of services. The link with oral health is growing although there is need for further robust evidence. There is also need for new models of care to address oral health in patients with multimorbidity.