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Dental health in persons with disability

Devinsky, Orrin; Boyce, Danielle; Robbins, Miriam; Pressler, Mariel
Systemic and structural barriers limit dental health for individuals with special healthcare needs (SHCN), who have poorer dental hygiene, higher rates of dental disorders, and less access to oral care. We aimed to understand these barriers directly from the patient and caregiver population as well as review the literature on oral health of individuals with SHCN. We reviewed the literature on individuals and caregivers of those with SHCN to identify barriers to dental healthcare faced by these individuals. We focused on clinical and educational interventions to support clinicians treating this population. For the literature review, PubMed, Google, and Google Scholar were searched. We also relied upon the knowledge gained during the course of routine clinical care and patient advocacy activities. Published manuscripts were searched for the following Medical Subject Heading (MeSH) term: "Dental Care for Disabled" and the following subheading: pharmacology, adverse effects, ethics, methods, standards, and therapy. Relatively few dentists have formal training on caring for those with SHCN. Barriers faced by these individuals include accessibility, comorbidities, communication challenges, and barriers to home oral hygiene. Strong care coordination and communication between dentists, caregivers, and other providers is essential for positive outcomes. Our current dental healthcare system has failed to meet the needs of those with SHCN. The comfort and dignity of the patient are of paramount importance.
PMID: 32531727
ISSN: 1525-5069
CID: 4478732

Management of medically complex patients

Chapter by: Ferraiolo, Debra; Robbins, Miriam R; Spivakovsky, Silvia; Veitz-Keenan, Analia; Phelan, Joan A
in: Clinical cases in dental hygiene by Theile, Cheryl M; Weinberg, Mea A; Segelnick, Stuart L (Eds)
Hoboken, NJ : Wiley-Blackwell, 2018
pp. 237-261
ISBN: 1119145023
CID: 3441332

Recent Recommendations for Management of Human Immunodeficiency Virus-Positive Patients

Robbins, Miriam R
Human immunodeficiency virus (HIV) infection has become a chronic condition. HIV is not a valid reason to deny, delay, or withhold dental treatment. There are no absolute contraindications and few complications associated with comprehensive oral health care treatment delivered in an outpatient setting for asymptomatic HIV-infected patients and clinically stable patients with AIDS. Consultation with the patient's medical provider and modifications in the delivery of dental treatment may be necessary when treating patients with advanced HIV disease or other comorbid conditions. Oral health care is an integral and important part of comprehensive health care for all patients with HIV/AIDS.
PMID: 28317571
ISSN: 1558-0512
CID: 2494892

Neurologic Diseases in Special Care Patients

Robbins, Miriam R
Neurologic diseases can have a major impact on functional capacity. Patients with neurologic disease require individualized management considerations depending on the extent of impairment and impact on functional capacity. This article reviews 4 of the more common and significant neurologic diseases (Alzheimer disease, cerebrovascular accident/stroke, multiple sclerosis, and Parkinson disease) that are likely to present to a dental office and provides suggestions on the dental management of patients with these conditions.
PMID: 27264859
ISSN: 1558-0512
CID: 2910832

Periodontal disease's contribution to Alzheimer's disease progression in Down syndrome

Kamer, Angela R; Fortea, Juan O; Videla, Sebastia; Mayoral, Angela; Janal, Malvin; Carmona-Iragui, Maria; Benejam, Bessy; Craig, Ronald G; Saxena, Deepak; Corby, Patricia; Glodzik, Lidia; Annam, Kumar Raghava Chowdary; Robbins, Miriam; de Leon, Mony J
People with Down syndrome (DS) are at an increased risk for Alzheimer's disease (AD). After 60 years of age, >50% of DS subjects acquire dementia. Nevertheless, the age of onset is highly variable possibly because of both genetic and environmental factors. Genetics cannot be modified, but environmental risk factors present a potentially relevant intervention for DS persons at risk for AD. Among them, inflammation, important in AD of DS type, is potential target. Consistent with this hypothesis, chronic peripheral inflammation and infections may contribute to AD pathogenesis in DS. People with DS have an aggressive form of periodontitis characterized by rapid progression, significant bacterial and inflammatory burden, and an onset as early as 6 years of age. This review offers a hypothetical mechanistic link between periodontitis and AD in the DS population. Because periodontitis is a treatable condition, it may be a readily modifiable risk factor for AD.
PMID: 27239536
ISSN: 2352-8729
CID: 2124952

Incorporating Experiential Learning Techniques to Improve Self-Efficacy in Clinical Special Care Dentistry Education

Watters, Amber L; Stabulas-Savage, Jeanine; Toppin, James D; Janal, Malvin N; Robbins, Miriam R
The New York University College of Dentistry has introduced a clinical rotation for fourth-year dental students that focuses on treating people with special health care needs (PSN). The aim of this study was to investigate the hypothesis that clinical experience in treating patients with special health care needs during predoctoral education is associated with increased self-assessed student ability and comfort and therefore self-efficacy. The study also investigated whether other characteristics, such as prior personal or volunteer experience with this population, service-mindedness, and/or the inclination to treat underserved populations, were associated with comfort in treating PSN. A survey was used to assess changes in students' perceived knowledge, beliefs, and attitudes regarding treating PSN before and after the clinical experience for July 2012-June 2013. The survey included questions about students' service-mindedness, comfort, perceptions of abilities of PSN and educational importance of learning to treat PSN, desire for clinical experience, and future intent or interest in treating PSN. Out of 364 students invited to participate, 127 surveys were returned, for a response rate of 34.9%. The results showed statistically significant increases on six items following training: impressions about the importance of oral health among PSN, comfort in treating people with cognitive disabilities and with medical complexities, intent to treat PSN in future practice, interest in including PSN in postgraduate training, and belief that PSN could be treated in the private practice setting. These students reported preferring to learn in the clinical setting over didactic instruction. This clinical experience was associated with improved self-efficacy in treating PSN and increased intentions to treat this population in future practice. Improvements were particularly evident among those with the least prior experience with PSN and were independent of other aspects of the students' past experience, future goals, or personality characteristics.
PMID: 26329025
ISSN: 1930-7837
CID: 1762182

Dental management of a patient with advanced Alzheimer's Disease : a case report and literature review on the attitude/belief of caregivers of Chinese ancestry

Chapter by: Toppin, James D; Nguyen, Khiem; Patel, Dharti N; Robbins, Miriam R; Lee, Ryan S
in: Clinical & Educational Scholarship Showcase by
[New York NY : NYU College of Dentistry. NYU Academy of Distinguished Educators], 2014
pp. 16-16
ISBN: n/a
CID: 959672

Treatment of a patient in special needs dental clinic with complex medical history and complex dental needs : a case report

Chapter by: Toppin, James D; Lewis-Smith, Morgan; Lee, Ryan S; Robbins, Miriam R; Patel, Dharti N
in: Clinical & Educational Scholarship Showcase by
[New York NY : NYU College of Dentistry. NYU Academy of Distinguished Educators], 2014
pp. 16-16
ISBN: n/a
CID: 959682

Effective communication strategies regarding oral hygiene instructions for caregivers of patients with special needs : a study design of 3 methods

Chapter by: Toppin, James D; Viviano, Virginia; Lewis-Smith, Morgan; Patel, Dharti N; Lee, Ryan S; Robbins, Miriam R
in: Clinical & Educational Scholarship Showcase by
[New York NY : NYU College of Dentistry. NYU Academy of Distinguished Educators], 2014
pp. 27-28
ISBN: n/a
CID: 960022

Home-use whitening toothpastes for whitening teeth in adults

Brennan, Mary M; Hallas, Donna; Jacobs, Susan K; Robbins, Miriam; Northridge, Mary
ISSN: 1361-6137
CID: 1441582