Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing
implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
PREVALENCE OF EROSION
Historically, tooth wear was generally believed to be caused by attrition and abrasion, and erosion was seldom considered or even examined. Today, dental erosion, which results from chemical processes, is widely considered to be a major cause of tooth wear (Erpacal et al., 2018). Estimates of the prevalence of tooth wear are complicated by studies that use different indices of measurement, many of which address tooth wear in general, not erosion specifically. Nevertheless, the results from several studies show that the prevalence of erosion- related tooth wear has increased in children and young adults over the past few decades (Jarkander, et al., 2018). The global prevalence for dental erosion among deciduous teeth has an estimated range of 30%–50% and a range of 20%–45% for permanent teeth among adults (Schlueter & Luka, 2018). Many such studies have suggested that dental erosion is a common
problem. However, varying definitions and scoring systems that measure the presence and amount of dental erosion can make it difficult to standardize the results of these studies (Johansson et al., 2017). The authors report that the worldwide prevalence of dental erosion in children and adolescents remains unclear due to outside variables, such as testing indices, types of teeth examined, and sample size. Overall, the progression of erosion has been found to increase with age (Dental Health Foundation, 2019). Other researchers have reported that this increase has a skewed distribution toward those with four or more dietary acid intakes per day, a low buffering capacity of stimulated saliva and use of a hard-bristle toothbrush (Rappeport & Coleman, 2018).
PATHOGENIC PROCESSES IN EROSION
Attrition, erosion, and abrasion are the major mechanisms by which teeth wear. These mechanisms seldom operate singly, and the overlap of two or more of them adds to the complexity Erosion as a multifactorial phenomenon The three major types of tooth wear—erosion, attrition, and abrasion—rarely occur alone in a given individual. Recognizing and assessing all three conditions is important to prevent further loss of tooth structure. Abrasion and attrition in conjunction with erosion can accelerate damage and complicate diagnosis and treatment. These three processes may interact in the initiation and progression of lesions “synchronously or sequentially, synergistically or additively” (Jarkander et al., 2018). Both enamel and dentin can be affected by erosion. It is more common for dentists to associate erosion with enamel loss; however, gingival recession exposes cementum on the root surface, and erosion of the cementum can expose dentin. Enamel does not show structural damage when the pH is greater than 5.5 (Mitrani, 2019). However, erosion of dentin has been reported at a pH level of 6.7, with a pH of 7.0 assigned a neutral value (Chockattu et al., 2018). Chemical factors Specific chemical factors that have been associated with erosion can be intrinsic, such as regurgitation, or extrinsic (Guignon, 2020; Mitrani, 2019). Examples of extrinsic sources are acidic beverages, foods, medications, and environmental acids (American Dental Association, 2021; Schlossman & Montana, 2017). The most common of these extrinsic sources are dietary acids. Most fruits and fruit juices have a very low pH, and carbonated drinks and sports drinks are also very acidic. For example, some of the most popular carbonated beverages have pH levels ranging from 2.5 to 3.6 (Guignon, 2020). The erosive potential of acidic foods and beverages does not depend on pH alone but is also strongly influenced by the mineral content, titratable acidity (the buffering capacity), and calcium-chelation properties of the foods and beverages. As other components of these agents—such as calcium, phosphate,
of the phenomenon of tooth wear (Dental Health Foundation, 2019; Erpacal, et al., 2018).
Understanding the interactions of chemical, biological, and behavioral factors is important in determining the extent of erosion: ● Chemical factors such as pH, titratable acidity, mineral content, clearance on tooth surface, and calcium- chelation properties are determinants of the erosive potential of agents such as acidic foods and beverages (Guignon, 2020; Touyz & Nassani, 2018). ● Biological factors such as saliva, acquired pellicle, tooth structure, and positioning in relation to soft tissues and the tongue are also central to the pathogenesis of dental erosion (Sengupta, 2018; Noble & Faller, 2018). ● Behavioral factors such as eating and drinking habits, excessive oral hygiene, and unhealthy lifestyle are predisposing factors for dental erosion (Sengupta, 2018). and fluoride—may modify the erosive potential (Sengupta, 2018). Also, factors such as frequency and method of intake of acidic agents, as well as how soon teeth are brushed after intake, may influence susceptibility to erosion (Touyz & Nassani, 2018). Certain drugs and fumes can also serve as extrinsic sources of erosion. Numerous case reports describe extensive erosion secondary to chewing vitamin C preparations, certain medications, and various supplements (Guignon, 2020; Mitrani, 2018). The degree of saturation with respect to the tooth mineral, which is the driving force for dissolution, is determined by the pH value and mineral content (calcium, phosphate, and fluoride) of a food or beverage (Carvalho & Karger, 2020). Citric acid is a component of many sports drinks, many of which have a pH between 3.16 and 3.70, values that can cause the dissolution
Page 86
Book Code: DHFL2624
EliteLearning.com/Dental
Powered by FlippingBook