This research analyzes transcripts of semi-structured interviews with patients presenting with tooth pain at a rural dental clinic in North Florida. The primary objectives are to identify the strategies patients use to manage their pain and to elucidate the decision-making process leading to the clinic visit. Although respondents understood that their condition was not self-limiting, only about one-half contacted the clinic within several days of the onset of their pain. Most tried one or more lay management strategies.

Nursing assistants' opinions of oral health care provisionUnderstanding the attitudes and perceptions about oral health in nursing assistants (NAs) may facilitate efforts to improve daily oral care in long-term-care settings. By exploring the attitudes of individuals charged with dally oral care, we may gain insight into the level of care provided for the residents. To explore motivation for oral care by NAs, we developed a 2Sitem survey. The survey included descriptive information and a 2Gitem Likert-type instrument dealing with oral care for self-care and dependent individuals. Factor analysis was used to test the validity of the constructs intended to be mea sured by the survey items. The results indicated favorable responses to knowledge items and items related to the importance of oral health in general. However, the responses to questions related to amount of time to perform mouth care, the risk of being bitten by a resident, resident cooperation, and myths about oral health in aging revealed signiflcant variation by NAs descriptive variables. An understanding of the implications of NAs' perceptlons, values, and knowledge may provide impetus for new strategies for improving oral health and daily care in long-termcare facilities.

The first ever Surgeon General's Report on Oral Health emphasizes that oral health is essential to the general health and well-being of all Americans, and that oral health can be achieved. But it will require that we think about and approach oral health activities in a different manner. If we desire to influence the mind-set of health care providers, the public, policymakers, and institutions, how do we get from what we know about the relationship of oral health and general health to integrating the notion into everyday actions? The Surgeon General's Report on Oral Health has elevated this issue to the forefront of health care and provided us with an extraordinary opportunity. The challenge: Lead with action and catalyze integration into multiple forums-public, private, and professional-and engage in activities that will change how oral health is perceived broadly. Ultimately, geriatric oral health and the health of all access-limited populations should benefit. To continue preserving the oral health of the millions of older individuals who now enjoy it and to ensure it for those who lack it will require change on multiple societal levels: the health care providers, the neighborhood, the community; Federal, state, and local governments; and the nation as a whole. It means addressing and overcoming multiple barriers to oral health care, which may include problems or disparities in: education, economics, the environment, cultural and social issues, and the health care system itself. To change perceptions, we must remove the barriers to care, educate the stakeholders who can influence or benefit from training programs, conduct broader, population-based research, build public and private partnerships, develop a stronger health care infrastructure, and expand initiatives that target specific risks for declining oral health. In addition to seeking new answers to these problems, it is imperative that we apply what we already know.

Significant morbidity can result in patients being treated for head and neck cancer (H&NC) if dental disease is not under control before medical therapy is initiated. This study compared the rates of dental consultation in three teaching hospitals in a midwestern metropolitan area for patients being treated for H&NC. One of the hospitals has an oral and maxillofacial surgery (OMFS) clinic, while the other two hospitals have general dental and OMFS clinics. The medical records of 104 H&NC patients were retrospectively examined for a rate of referral to dental professionals, type of medical treatment, and oral complications with medical/surgical therapies. The results of the study showed statistically significant differences between hospitals related to the rates of dental consultation and oral complications. The dental consultation rates were low overall, ranging from 12.1 to 39.5%. These rates were not influenced by the presence of a general dental clinic. Because dental interventions can reduce the severity or prevent oral complications in H&NC patients, efforts to explain these results and enhance cooperative protocols represent a significant need.

Background NICE neonatal jaundice guideline (CG 98) recommends the use of transcutaneous bilirubinometers (TsB) by community midwives to test babies with visible jaundice. Cost and lack of evidence have limited implementation across UK. We report results from a service evaluation project looking at the introduction of bilirubinometers to community in ABMU. Method One midwife of 36 covering Morriston hospital catchment area and 2 of 37 covering POW hospital catchment were provided with TsB and training. Activity monitored between March to August 2013. Care bundle developed and used. Results 184 babies reviewed, 6 tested with TsB and 1 referred for hospital assessment by project midwife to Morriston. 264 babies reviewed, 69 tested and 2 referred to POW.100% of babies referred by the 3 project midwives to hospital required treatment. Of the 38 babies referred to Morriston without TsB testing by other midwives only 40% were admitted. 60% were discharged home after a medical evaluation and blood test for bilirubin. Average waiting time was 4 h 15 min. 26% babies received a second review. All parents reviewed by project midwives were highly satisfied with care. Conclusion Transcutaneous biliribinometers are 100% effective in identifying neonates requiring treatment for jaundice in first 2 weeks in community. Availability of bilirubinometers to community midwives will reduce referrals to secondary care, improve quality of care and reduce parental anxiety and cost. The pilot project helped ABMU win innovative project funding from Welsh Government. TsB and training are now being provided to all midwives in AB.