Preventive Oral Health - Essay Example

Preventive Oral Health Preventive practices have decreased oral diseases in some US populations in the last decades but growing population from immigrants, war refugees, and others as well as the increasing population of children from low-income families make oral care provision a challenge (Nowak, 2006). It has been noted that prevention and intervention are still unavailable for those who need it most among many infants and children, specifically from vulnerable populations mentioned earlier, although it is now generally accepted that health professionals that care for children and infants are in excellent position to address oral health. Health professionals, nevertheless, endorse prevention of oral diseases first to parents through proper oral hygiene for preventive purposes (Nowak, 2006). Pediatric Use of Dental Fluoride It has been noted among experts about the lack of information on what is the extent of damage on fluoride use to children (Moss, 2005). In fact, use of fluoride toothpaste is actually recommended during infanthood as soon as a substantial quantity of baby teeth have grown as part of the proper care for children's teeth, although it is also highly recommended that a pediatric dentist be sought for any necessary treatments such as the use of fluoride varnish (Jacobs, 2005). Starting in 1977 until 2003, the American Academy of Pediatric Dentistry or AAPD advocated the use of fluoride as "a safe and effective adjunct in reducing the risk of caries and reversing enamel demineralization," to the extent that AAPD encouraged public health officials, health care providers, parents and caregivers to "optimize fluoride exposure," (AAPD, 2003). Nevertheless, the "Policy on Use (cannot delete "Use" because it is the title of a policy!) of Fluoride" cautioned the use of topical fluoride-containing products to young children to prevent ingestion of excessive amounts of fluoride (Warren & Levy, 1999). Caries is strongly reduced with the combination of proper use of fluorides, good diet, oral hygiene and preventive measures (CDI, 1995). Fluoride Varnish Fluoride varnish is considered as one of the breakthrough innovations in dentistry. The simple coating of fluoride treatment can provide long-term dental relief. Accordingly, fluoride varnish has higher concentration of fluoride compared with other forms of dental enhancements. Fluoride varnish is less toxic and provides no harm to children. According to Autio (2000), fluoride varnish quickly adheres to teeth and it takes less time than other topical treatment to be released to the tooth surface nurturing the minerals in the teeth. Toxicity has been a major concern with fluoride treatment especially among children ages 6 and below. In previous studies, it has been proven that fluoride varnish has the lowest rate of fluoride in the blood plasma compared with other topical treatments making it a safer choice for children (Moss, 2005). The use of fluoride varnish has been commonly seen in Europe. Also, the commercialization of fluoride varnish has become a crucial component of its introduction to other locations such as the United States, and some parts of Asia. Most important, the efficacy of fluoride varnish has been widely recognized (Moss, 2005). Fluoride varnish is a liquid coating that is applied to the teeth using a brush. The liquid dries quickly minutes after the application. Fluoride varnish provides a protective coating of fluoride on teeth. According to studies (Moss 2005 and Autio, 2000). The fluoride is released over a period of months that strengthens teeth and prevents tooth decay. The fluoride varnish needs to be reapplied every 3-4 months to maintain its effectiveness. This tasteless liquid has been used in several dental clinics. It has also been proven to be effective in preventing tooth decay and other related dental problems (Autio, 2000 and Moss, 2005). Fluoride varnish is safe as approved by the American Dental Association (ADA). After the fluoride varnish is applied, it is possible that teeth discoloration is observed. On the onset the teeth will appear brownish and the color will soon turn to normal days after the application. After receiving the fluoride application, eating crunchy foods have to be prevented as this can damage the coating. Fluoride supplements such as drops, tablets, and mouth rinse can only be used the next day after the fluoride varnish is applied. Furthermore, brushing the teeth has to be undertaken the day after the treatment is applied in order to avoid risk of fluorosis and toxicity. Fluorosis is the result of rearranging the crystalline structure of a tooth's enamel while tooth is still growing as caused by fluoride (EWG, 2002). Indications and Contraindications of Fluoride Varnish Fluoride varnish is indicated for infants and children considered at risk of developing cavities. The HSMA (2005) provided the following risk list as follows: If a child had cavities in the past Has white spot lesions or stained fissures Use bottle past 1 year of age Sleeps with a bottle with liquid which is not water Breastfeeds at night With developmental disability Regularly uses oral medications with high sugar content Family has a history of caries Drinks non-water liquids in bottle or sippy cup throughout the day. Fluoride varnish is not advisable for children with a low risk of cavity formation and who consume fluoridates water, or receive fluoride treatments through a dental office (HSMA, 2002). Studies on Use of Fluoride Varnish Lewis, Lynch, and Richardson (2005) conducted a study on the capacity of pediatric health care providers to apply fluoride varnish. The results show that three major themes emerged in relation to the fluoride varnish diffusion process; these included: preexisting factors, communication, and logistics. Within preexisting factors, pediatric healthcare providers learned about fluoride varnish through their involvement in public health-related activities and were influenced to participate in the training by the concerns for their patients' oral health and difficulty gaining access to professional dental care. (We are talking about capacity of pediatric dentists, that is why there is pre-existing factor in the participation). Among communication factors identified as important were qualities of the training session and the communication that occurred within the practice about fluoride varnish. When staff were included in the fluoride varnish decision-making and planning process, the practice was more likely to be successful in implementing fluoride varnish. Logistic aspects included systems used to identify and capture eligible patients for fluoride varnish application. Other important logistic factors that were considered included division of labor and timing of the fluoride varnish application during the visit. Access to dental care was a persistent theme throughout the focus group discussions that had an impact on the other three primary themes (Lewis, et al., 2005). The Department of Health and Human Services in the state of Nevada (2005) published a manual promoting the use of fluoride varnish. The published manual identified the various benefits of fluoride varnish. Based on the manual, fluoride varnish can be undertaken without special dental equipment. Likewise, there is no need for professional dental cleaning before application. Moreover, fluoride varnish is easily applied. Its contact with saliva allows it to dry easily. Using fluoride varnish is cost-effective (Moss, 2005). In addition, application of the treatment requires no technical training. Most important, fluoride varnish is safe and can be tolerated by young children and even infants as it releases tolerable amounts in the blood. In determining the effectiveness of fluoride varnish for children conducted by Autio (2000) among 222 Children in Alachua Country, Florida over a nine-month period, it was found out that progression of dental cavities was arrested at around 80 percent to the test group and only 37 percent to the control group. during the nine months of the study. The test group received the fluoride varnish developed by Colgate-Palmolive called Duraphat at the start of the study and at a four month interval while the control group did not. Duraphat was originally formulated for people with hypersensitive teeth. "Toxicity and its effects such as nausea are always a concern with children under 6. Previous studies have shown that fluoride in patients' blood plasma is lowest among fluoride varnish users than users of other topical treatments. Less is swallowed," Autio (2000) reported. The low rate of fluoride varnish in patient's blood plasma was mentioned in a 1998 study (Bawden). In Autio's study, the target audience mentioned is children from low-income families where decay and cavities remain a problem. In fact, the study advocated, "easy application and positive results of varnish use makes it ideal to be administered routinely in the school system." In a more recent study, the UCSF (Weintraub, 2006) that examined cavity-free infants and young children, primarily from low income families in San Francisco summed up that, "Fluoride varnish, a dental preventive treatment, reduces the incidence of early childhood tooth decay in combination with dental health counseling for parents." Cannot delete quotation, I will be charged with plagiarism as this is directly taken out of the report! Out of the 280 who completed the study, those who did not receive any fluoride varnish were more than twice likely to develop tooth decay compared to the children assigned to the annual fluoride varnish group. Weintraub (2006) acknowledged that although the fluoride varnish may be administered during a child's first visit to the dentist, it would prove more difficult as very young children could hardly sit still. The randomized study included infants as young as six months of age with the average age of children in the study being 1.8 years old indicative of necessity for pediatric dentist. Young children were included in the study as infants who bottle feed or are feeding with liquids other than water are susceptible to cavities or caries (HRSA, 2005). There are practical reasons to adapt use of fluoride varnish for infants and young children not only for effectiveness in delaying caries or tooth decay, but due to convenience of use, economy and safety. Nevertheless, infants and children are brought directly to specialists dedicated to care for children, which are pediatricians for medical care and pediatric dentist for oral care. Therefore, a wider number of pediatric dentist apply fluoride varnish than general dentist and pediatricians. Since the target age bracket for the production of fluoride varnish is young children in particular, it does makes considerable sense to seek pediatric dentist for prevention of caries. However, it is crucial to a caries free environment to expand this knowledge to other areas of expertise. As Cassamassino (1994) himself said, "The paradox of pediatrics and thus pediatric research is that they ultimately benefit all people, since all adults are at one time children." Pediatric Dentists Cassamassino (1994) pointed out the gap between measuring effectiveness and safety against the changes in dental materials and techniques, as well as other factors that add up challenge in dental diseases. Pediatric dentists' roles in preventive, restorative and therapeutic techniques are very important in the process of bridging this gap. Moss (1988) also stressed the goals and targets set for the oral health of children, urging communities to be more vocal, more clinical, and more participative in the pediatric dental health care arena. This would mean that parents, social and health care providers become vigilant in the prevention, detection and treatment of dental illness for children as early as infanthood. The American Dental Association criticized pediatric dentistry for lack of "defining procedure and technique as all other dental specialties own peculiar body of knowledge, while only pediatric dentistry orients itself to the people it serves," of which Casamassimo (1994) commented as "difficult for dentistry to embrace" It seems there had been a negative impact of the emergence of pediatric dentists to general practitioners as they perceive pediatric dentists as competition, and less skilled. Cassamassino emphasized the pediatric oral health gained from scientists, behaviorists, endodontists and traumatologists as part of the pediatric dentists' knowledge base. To put it exactly, he encouraged fellow practitioners to "resist the political convenience of limiting pediatrics to some compartmentalized area of dentistry." In fact, the nobility of pediatric dentistry is its concern with solutions to the oral health problems of children. While some sectors of industrialized countries claim the victory over dental caries, Cassamassino (1994) noted the plight of the majority of the world population who continue to suffer from the disease, afflicting about 25% of the world's global population, the majority children. Innovation in Dentistry Technological innovations are crucial for the advancement of the art and science of clinical dentistry (Parashos and Mesher, 1995). Although some innovations are prvided with minimal support, others are slowly adopted and succeed previous techniques and instruments. The availability of dental literature concerning the reasons for the adoption, non-adoption, or rejection of new technology in dentistry is scarce. Aspects affecting adoption of new technology include a complex interplay of perceived benefits and advantages, and psychosocial and behavioral factors in decision-making. One of the most notable innovations promoted in the area of dentistry is the fluoride mouth rinse program. The School Fluoride Moth Rinse Program is initiated by the Department of Public health and Environment that provided safe and effective method for the prevention or reduction of dental decay in grade school children (DPHE, 2006). The creation of this program immediately caught the attention of several pediatric dentistry practitioners. Basically, the main goal of the program was to reinforce the protection of teeth and gums provided to children in their homes. The point of the study leads to the discussion of innovation discontinuation (Scheirer, 1990). According to the study, there were various reasons for the project's shelving. First, the political priorities of different areas are distinct of which some sectors such as the Fluoride Activist Network insist on the negative impact of fluoride use. Some leaders do value other measures to improve the health of the children. The second issue pertains to the lack of financial support. Initially, the government was able to shoulder the cost. The duration of the project, however, took its toll on the government's budget. Finally, the lack of support from a large number of entities has brought the ultimate end to the innovation. Since entities have contrasting views, it is expected that the project will remain as an innovation that never reached its full potential. Innovation Diffusion in Healthcare There are an abundance of examples of evidence-based innovations in health care. But the good qualities of an innovation in particular is no guarantee of successful dissemination. Diffusion of innovations is a primary challenge in all industries, including healthcare (Berwick, 2003). Some useful innovations were not disseminated ideally to all relevant locations. This discrepancy has prevented some innovations from flourishing and has affected healthcare provision. Indeed, the process of distributing the innovation continues to improve with the introduction of several mechanisms. Amidst major improvements it is evident that the diffusion needs to be further enhanced. Innovation in the context of healthcare is a complex issue (Plesk 2003). Incorporating the benefits of innovation in healthcare pertains to certain actions that need to be manifested. First, implementers have to avoid mechanistic and coercive approaches. This means that entities interested in the issues of adoption of an innovation have to review their perceptions and past approaches and question the extent to which these schemes are built on mechanistic and coercive models. Mechanical and complicated approaches will see only limited success. Coercion has to be used for selective purposes only, as it has usually been for inappropriately entrenched, self-serving interests (Plesk, 2003). Second, healthcare providers have to consider the better use of research and development functions (Plesk, 2003). Healthcare managers need to consider the strategies used by other industries, which allocate operating revenues to improve research and development, and concentrate on innovation in clinical, business, and service delivery processes. The goals of such responsibility have to include framing methods to engage the natural creativity of the entire healthcare workforce and building a receptive organizational context for change. Third, healthcare service providers have to devote sufficient attention and effort to social networking in healthcare. This network could serve as the primary tool that will spread innovation. To be effective, personnel at all levels will need enough time allotted for networking, exploring new ideas, and testing innovative ways of working. Modern and interactive communication technologies have be used to enable more individuals with process problems to connect easily to individuals with potentially useful ideas (Plesk, 2003). Fourth, healthcare organizations must see change as a fundamental necessity. It has been observed that most healthcare institutions consider change as a distinct and separate effort from the normal course of business. They often see innovation as a threat especially for those who have not acquired new technology, participated in developmental trainings or seminars. Hence, the personnel tend to wait for initiatives from the higher ups before pushing for innovations. Basically, healthcare organization leaders have to pursue orders of magnitude leaning towards a rapid-cycle test-of-change on subjects of interest across the spectrum of healthcare processes (Plesk, 2003). Elsewhere, there is a continuous research and development integrating traditional and local knowledge proven to be safe and effective, but most mainstream health practitioners focus on what has been established as "conventional" thereby ignoring preventive measures such as those practiced by "alternative therapies". The ultimate goal of such effort is to change the prevailing norm in the industry. In particular, researchers in the health service industry have to aid in this effort by classifying the experiences of successful organizations such as "alternative therapy" practitioners in order to establish a new benchmark in the healthcare industry. Lastly, there has to be progressive development of language and tools to support the creation of more receptive contexts for change in health care organizations. This task requires the earnest contribution of all entities involved in promoting change in healthcare organizations. Health services researchers and providers of financial resources have to dedicate more attention to the social sciences for understanding organizational context and its effect on innovation and change efforts. Taxonomy is needed, which depicts descriptive language, assessment tools, and advice for healthcare leaders on approaching the issues directly. Executives in healthcare organizations have to include goals for organizational development in their strategic plans. Moreover, governance boards have to hold leaders accountable and responsible for maintaining a focus on such issue. National advocates for innovation and professional societies have to combine material on organizational context in all efforts to spread innovation ideas through various means. OK, I suspect this last paragraph was lifted entirely from the article. Can you apply this more concretely to what is needed to make the dissemination of fluoride varnish work more effectively Conclusion: Childhood, or even infancy is a critical period to establish the overall health of an individual. To develop good and healthy habits, parents seek the help of professionals, and usually the first healthcare provider they seek is the pediatrician. With the premise that outlines the importance of a pediatrician, the branching of pediatric dentists is another development that is much welcome, as most growing populations need to address health care at the prevention phase. This would mean that most resources and even good health is best maintained through preventive practices. With the use of innovation such as fluoride varnish best indicated for infant and child use for preventive measures, it is necessary that its use be encouraged among pediatric dentists. Already, it was established that fluoride varnish could be a useful tool in eliminating caries in children. Fluoride varnish is probably most useful when applied by pediatric dentists since they are more likely to see children before tooth decay develops. There is little knowledge about how to disseminate an innovation among dentists and pediatricians. There is a need to encourage acceptance of pediatrically applied varnish among both dentists and pediatricians. It is also necessary to understand why and how pediatricians and dentists accept and decide to use fluoride varnish. To find this out, a survey on local dentists to determine attitudes and practices regarding fluoride varnish will be conducted. References Adams, D. A. et al. (1992) MIS Quarterly. "Perceived usefulness, ease of use, and usage of information technology: A replication." A Dictionary of Business. (2002). "Diffusion of innovation." Oxford: Oxford University Press. Atkisson, A. (1991). Making it Happen: Effective strategies for the changing world. "The innovation diffusion game." Autio, J. (2000). Painting Teeth with Fluoride Varnish is effective against Tooth Decay in Children. Jacksonville: University of Florida Health Science Center. Bawden, JW. (1998). "Fluoride Varnish: a useful new tool for public health dentistry." Public Health Dentistry, Fall 1998, 58, 4:266-269. Berwick, D. (2003). Journal of American Medical Association. "Disseminating innovations in healthcare." Cassamassino, Paul. (1994). "Pediatric Dentistry, Research, and the Future." J Dent Res 73(10) Clarke, R. (1991). A Primer in the Diffusion Innovation Theory. Canberra: Australian National University. Covin, J. G. and Slevin, D. P. (1991) Entrepreneurship Theory and Practice Fall: "A conceptual model of entrepreneurship as firm behavior." Center for Dental Information (CDI). "Fluoride: an Update for the year 2000." New Jersey. D'Aveni, R. (1994) Hypercompetition: Managing the Dynamics of Strategic Maneuvering. New York, NY: Free Press. Department of Health and Human Service. (2005). "Fluoride varnish manual." Nevada. Environmental Working group (EWG). (2002). "National Academy Calls for Lowering Fluoride Limits in Tap Water." March 22. Hitt, M. A et al. (1999) Entrepreneurship Theory and Practice. "Corporate entrepreneurship and cross-functional fertilization: Activation, process and disintegration of a new product design team." Kern County Children's Dental Health Network. (2005). "Fluoride varnish fact sheet." Jacobs, Johanna. "Dental Care - child." Adam Health Illustrated Encyclopedia. Oct. 12, 2005. Lewis, C., Lynch, H., and Richardson, L. (2005). Pediatrics. "Fluoride varnish use in primary care: What do providers think" Lumpkin, G. T. and Dess, G. G. (1996) Academy of Management Review "Clarifying the entrepreneurial orientation construct and linking it to performance." Moss, Stephen. (2005). "Flourosis." All Experts. From http://experts.about.com/q/Dentistry-966/flourosis.htm Nelson, R. and Winter, S. (1982). An Evolutionary Theory of Economic Change. Cambridge, MA.: Harvard University Press. Nowak, Arthur. "An Introduction to Infants' and Young Children's Oral Health." National Maternal and Child Oral Health Resources Center. Accessed October 2006. From http://www.mchoralhealth.org/PediatricOH/index.htm Parashos, P. and Mesher, H. (1995). The Diffusion of Innovation in Dentistry: A Review using Nickel-titanium Technology as an Example. Melbourne: University of Melbourne. Plesk, P. (2003). Complexity and the Adoption of Innovation in Healthcare. Washington, DC: National Institute for Healthcare Management Foundation. Rogers, E. (1995). Diffusion of Innovation 4th edition. New York: Free Press. Scheirer, M. (1990). Journal of Health and Social Behavior. "The life cycle on an innovation: Adoption versus discontinuation of the fluoride mouth rinse program in schools. Smith, M. (1997) Management Accounting. "Innovation drivers for competitive advantage." Spicer, E. (1967). Human Problems in Technological Change. New York: John Wiley and Sons, Inc. Warren, JJ and Levy SM. (1999). "A review of fluoride dentrifice related to dental fluorosis." Pediatr Dent, 21: 265-270. Weintrab, Jane. (2006). "Fluoride Varnish Helps Prevent Tooth Decay In Very Young Children." Journal of Dental Research Read More