Patterns and predictors of dental hospitalizations in patients with acquired brain injury from pre-injury to acute and post-acute injury

Abstract

BACKGROUND:

Acquired brain injury (ABI) can cause long-term disability and functional impairment.

OBJECTIVE:

This study aims to determine the prevalence of dental hospitalizations in an ABI cohort across different phases of injury and identify factors associated with such hospitalizations.

METHODS:

The cohort comprises patients with ABI (n = 683), traumatic (n = 282) and non-traumatic (n = 401) who were admitted to a neurorehabilitation service in Western Australia between 1991 and 2016. De-identified patient data were linked to the Hospital Morbidity Data Collection. The incidence of dental hospitalizations was calculated per 1,000 person-years (PY), and associated factors were investigated using multilevel mixed-effects logistic regression.

RESULTS:

Dental hospitalizations significantly increased from pre-injury (3.35/1,000PY) to acute injury (302.65, Δ+299.3) and remained elevated in the post-acute phase (23.98, Δ+20.63). Dental caries had the highest incidence rate among all diagnoses in the pre-injury and post-acute phases (0.68 and 8.93, respectively), followed by gingivitis and periodontal diseases (3.60) in the post-acute phase. Tooth extractions were performed more often than restorative and preventive treatment in the pre-and post-injury phase, p < 0.001. Dental hospitalizations were associated with the type of ABI, age at injury, remoteness, and history of pre-injury hospitalization.

CONCLUSION:

Implementing comprehensive preventive dental care can reduce potentially preventable dental hospitalization among ABI patients.

Keywords

Brain injuries traumatic stroke disabled person hospitalization dental care Australia

Get full access to this article

View all access options for this article.

References

Adams

H. P.

Jr , Del Zoppo,

, Alberts,

M. J.

, Bhatt,

D. L.

, Brass,

, Furlan,

, et al. (2007) Guidelines for the early management of adults with ischemic stroke: A guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists, Stroke 38(5), 1655–711.

Acharya,

, Khan,

, Hoang,

, Bettiol,

, Goldberg,

, Crocombe,

(2018) Dental conditions associated with preventable hospital admissions in Australia: A systematic literature review, BMC Health Services Research 18(1), 1–12.

Adams

H. P.

Jr , Del Zoppo,

, Alberts,

M. J.

, Bhatt,

D. L.

, Brass,

, Furlan,

Adnan,

, Slade,

G. D.

, Spencer,

A. J.

(2009) Factors influencing caries experience among adults with physical and intellectual disabilities, Community Dentistry and Oral Epidemiology 37(2), 143–54.

Ajwani,

, Jayanti,

, Burkolter,

, Anderson,

, Bhole,

, Itaoui,

, et al. (2017) Integrated oral health care for stroke patients–a scoping review, Journal of Clinical Nursing 26(7-8), 891–901.

Australian Institute of Health andWelfare. (2018).ADiscussion of Public Dental Waiting Times Information in Australia: 2013-4 to 2016-17: Canberra.

Australian Institute of Health and Welfare. (2022). Oral health and dental care in Australia. Canberra: Australian Institute of Health and Welfare.

Australian Rehabilitation Outcomes Centre. (2013). Aroc impairment coding guidelines. Retrieved from https://documents.uow.edu.au/content/groups/public/@web/@chsd/@aroc/doc-uments/doc/uow125260.pdf

Australian Statistical Geography Standard (ASGS): Volume 5 remoteness structure. (2011). Canberra: Australian Bureau of Statistics.

10.

Azimi,

, Lima,

, Slack-Smith,

, Bourke,

, Calache,

, Junaid,

, et al. (2022) Factors associated with dental hospitalizations in children with intellectual disability or autism spectrum disorder: A Western Australian population-based retrospective cohort study, Disability and Rehabilitation 44(19), 5495–503.

11.

Azimi,

, Wong,

, Lai,

, Bourke,

, Junaid,

, Jones,

, et al. (2022). Dental procedures in children with or without intellectual disability and autism spectrum disorder in a hospital setting. Australian Dental Journal.

12.

Bangee,

, Martinez-Garduno,

C. M.

, Brady,

M. C.

, Cadilhac,

D. A.

, Dale,

, Hurley,

M. A.

, et al. (2021) Oral care practices in stroke: Findings from the UK and Australia, BMC Nursing 20(1), 1–8.

13.

Bailey,

R. L.

, Ledikwe,

J. H.

, Smiciklas-Wright,

, Mitchell,

D. C.

, Jensen,

G. L.

(2004) Persistent oral health problems associated with comorbidity and impaired diet quality in older adults, Journal of the American Dietetic Association 104(8), 1273–6.

14.

Brain Injury Australia. About brain injury. Retrieved from https://www.braininjuryaustralia.org.au

15.

Calrk,

, Larkins,

, Croker,

(2017) Disparities in dental health of rural Australians: Hospitalization rates and utilisation of public dental services in three communities in North Queensland, Rural and Remote Health 17(1), 1–10.

16.

Carlisle,

, Larkins,

, Croker,

17.

Caffery,

, Bradford,

, Meurer,

, Smith,

(2017) Association between patient age, geographical location, Indigenous status and hospitalization for oral and dental conditions in Queensland, Australia, Australian Journal of Primary Health 23(1), 46–52.

18.

Chen,

, Cohen,

, Chen,

(2010) How big is a big odds ratio? Interpreting the magnitudes of odds ratiosin epidemiological studies, Communications in Statistics—Simulation and Computation® 39(4), 860–4.

19.

Chrisopoulos,

, Harford,

, Ellershaw,

(2016). Oral health and dental care in Australia: Key facts and figures 2015. Australian Institute of Health and Welfare.

20.

Corrigan,

J. D.

, Hammond,

F. M.

(2013) Traumatic brain injury as a chronic health condition, Archives of Physical Medicine and Rehabilitation 94(6), 1199–201.

21.

Crocombe,

L. A.

, Allen,

, Bettiol,

, Khan,

, Godwin,

, Barnett,

, et al. (2019) Geographical variation in preventable hospital admissions for dental conditions: An Australia-wide analysis, Australian Journal of Rural Health 27(6), 520–6.

22.

da Rosa,

S. V.

, Moysés,

S. J.

, Theis,

L. C.

, Soares,

R. C.

, Moysés,

S. T.

, Werneck,

R. I.

,et al. (2020) Barriers in access to dental services hindering the treatment of people with disabilities: A systematic review, International Journal of Dentistry 2020.

23.

Derbi,

, Borromeo,

(2016) The perception of special needs dentistry amongst general dentists within Western Australia, Australia, J Gerontol Geriatr Res 5(4), 2.

24.

Dickinsen,

(2012) Maintaining oral health after stroke, Nursing Standard (through) 26(49), 35.

25.

Echlin,

(1949) Traumatic subdural hematoma—acute, subacute and chronic: An analysis of seventy operated cases, Journal of Neurosurgery 6(4), 294–303.

26.

Edwards,

D. F.

, Hahn,

M. G.

, Baum,

C. M.

, Perlmutter,

M. S.

, Sheedy,

, Dromerick,

A. W.

(2006) Screening patients with stroke for rehabilitation needs: Validation of the post-stroke rehabilitation guidelines, Neurorehabilitation and Neural Repair 20(1), 42–8.

27.

Elsworthy,

A. M.

, Claessen,

S. M.

, Graham,

, Guo,

, Innes,

K. C.

, Loggie,

C. L.

, et al. (2013). Australian classification of health interventions: ACHI: Tabular list of interventions.

28.

Foundation,

N. S.

(2010). Clinical Guidelines for Stroke Management. National Stroke Foundation, Melbourne, Vic, Australia.

29.

Filiatrault,

, Arsenault,

A. B.

, Dutil,

, Bourbonnais,

(1991) Motor function and activities of daily living assessments: A study of three tests for persons with hemiplegia, The American Journal of Occupational Therapy 45(9), 806–10.

30.

Fortner,

, Wen,

(1999). The definition, incidence and prevalence of acquired brain injury in Australia: Australian Institute of Health and Welfare.

31.

Frieden,

T. R.

, Houry,

, Baldwin,

(2015). Report to congress on traumatic brain injury in the United States: Epidemiology and rehabilitation. Atlanta, GA: National Center for Injury Prevention and Control.

32.

Glick,

, Williams,

D. M.

, Kleinman,

D. V.

, Vujicic,

, Watt,

R. G.

, Weyant,

R. J.

(2016) A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health, British Dental Journal 221(12), 792–3.

33.

Graven,

, Brock,

, Hill,

, Joubert,

(2011) Are rehabilitation and/or care co-ordination interventions delivered in the community effective in reducing depression, facilitating participation and improving quality of life after stroke? Disability and Rehabilitation 33(17-18), 1501–20.

34.

Janket,

S. J.

, Jones,

J. A.

, Rich,

, Meurman,

, Garcia,

, Miller,

(2003) Xerostomic medications and oral health: The Veterans Dental Study (part I), Gerodontology 20(1), 41–9.

35.

Kothari,

, Pillai,

R. S.

, Kothari,

S. F.

, Spin-Neto,

, Kumar,

, Nielsen,

J. F.

(2017) Oral health status in patients with acquired brain injury: A systematic review, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 123(2), e7.

36.

Kothari,

, Spin-Neto,

, Nielsen,

J. F.

(2016) Comprehensive oral-health assessment of individuals with acquired brain-injury in neuro-rehabilitation setting, Brain Injury 30(9), 1103–8.

37.

Kothari,

S. F.

, Nascimento,

G. G.

, Jakobsen,

M. B.

, Nielsen,

J.F.

, Kothari,

(2021) Changes in oral health related quality of life and its associated factors in individuals with brain injury, Brain Injury 35(6), 718–24.

38.

Kothari,

S. F.

, Nascimento,

G. G.

, Jakobsen,

M. B.

, Nielsen,

J. F.

, Kothari,

(2021) Periodontitis and orofacial health-related systemic impairment in patients with brain injury: A factor analysis approach, Brain Injury 35(1), 96–102.

39.

Kothari,

S. F.

, Nascimento,

G. G.

, Jakobsen,

M. B.

, Nielsen,

J. F.

, Kothari,

(2020) Oral health: Something to worry about in individuals with acquired brain injury? Brain Injury 34(9), 1264–9.

40.

Kothari,

S. F.

, Nascimento,

G. G.

, De Caxias,

F. P.

, Jakobsen,

M. B.

, Nielsen,

J. F.

, Kothari,

(2021) Effectiveness of standard oral care plan during hospital stay in individuals with brain injury, Frontiers in Neurology 12, 2250.

41.

Kothari,

S. F.

, Spin-Neto,

, Nielsen,

J. F.

(2016) Comprehensive oral-health assessment of individuals with acquired brain-injury in neuro-rehabilitation setting, Brain Injury 30(9), 1103–8.

42.

Kruger,

, Tennant,

(2015) Potentially preventable hospital separations related to oral health: A -year analysis, Australian Dental Journal 60(2), 205–11.

43.

Lim,

M. A. W. T.

, Liberali,

S. A. C.

, Borromeo,

G. L.

(2020) Utilisation of dental services for people with special health care needs in Australia, BMC Oral Health 20(1), 1–9.

44.

Mann,

, Troeung,

, Wagland,

, Martini,

(2021) Cohort profile: The acquired brain injury community REhabilitation and support services OuTcomes CohoRT (ABI-RESTaRT), Western Australia, BMJ Open 11(9), e052728.

45.

Masel,

B. E.

, DeWitt,

D. S.

(2010) Traumatic brain injury: A disease process, not an event, Journal of Neurotrauma 27(8), 1529–40.

46.

Mortensen,

, Pedersen,

A. R.

, Nielsen,

J. F.

, Kothari

(2020) Construct and content validity of the Functional Oral Intake Scale; Analyses from a cohort of patients with acquired brain injury, Brain Injury 34(9), 1257–63.

47.

Nguyen,

T. M.

, Tonmukayakul,

, Calache,

(2019) A dental workforce strategy to make Australian public dental services more efficient, Human Resources for Health 17(1), 1–9.

48.

Odgaard,

, Kothari,

(2019) Survey of oral nursing care attitudes, knowledge and practices in a neurorehabilitation setting, Journal of Oral Rehabilitation 46(8), 730–7.

49.

Pillai,

R. S.

, Iyer,

, Spin-Neto,

, Kothari,

S. F.

, Nielsen,

J. F.

, Kothari,

(2018) Oral health and brain injury: Causal or casual relation? Cerebrovascular Diseases Extra 8(1), 1–15.

50.

Pink,

(2011). Australian statistical geography standard (ASGS): Volume 5—remoteness structure. Canberra: Australian Bureau of Statistics.

51.

Pradhan,

, Slade,

, Spencer,

(2009) Access to dental care among adults with physical and intellectual disabilities: Residence factors, Australian Dental Journal 54(3), 204–11.

52.

Smith,

, Kruger,

, Tennant,

(2006) A four-year retrospective study of adult hospitalization for oral diseases in Western Australia, Australian Dental Journal 51(4), 312–7.

53.

Statistics,

A. B. O.

(2011). Socio-economic indexes for areas (SEIFA). Canberra: Australian Bureau of Statistics.