Oral Health Beliefs and Behaviours among Adults with Sickle Cell Diseases in Ireland

Abstract

Background: The number of Adults Living with Sickle Cell Disease (ASkCD) in Ireland has risen, driven by recent immigration. A new multi-disciplinary national adult sickle service centre has been introduced to meet their medical and psychosocial needs. To date, the oral health needs, oral health beliefs and behaviours of this group are unknown. Anecdotal evidence suggests there is considerable ambivalence around oral health. Aim & Objectives: The study aims to analyse the oral health beliefs and behaviours of ASkCD attending Ireland's national adult sickle cell service centre while also identifying barriers to oral care. This information will be used to design improved oral healthcare pathways to prevent dental crises and investigate factors influencing dental service utilization. Method and Material: After obtaining ethical approval, a comprehensive cross-sectional survey was conducted amongst the entire population of ASkCD attending this service centre, employing a total population sampling approach. Participants autonomously completed a meticulously standardized and pilot-tested anonymous questionnaire during their transfusion therapy sessions. Oral health beliefs and behaviours were assessed using well-established measures (as outlined by Xiang et al. 2020). Furthermore, the survey thoroughly investigated sociodemographic factors, self-reported health and oral health status, oral health behaviours, and dental attendance patterns. The preliminary data analysis plan incorporates elementary descriptive statistics, with subsequent adoption of logistic regression to discern predictors of reported dental attendance drawn from a spectrum of health beliefs. Results: This study surveyed 214 participants (99% response rate) attending a national sickle cell service centre in Dublin, Ireland. Most participants were female (58.6%) and of Black or Black Irish/African ethnicity (88.2%), with a mean age of 30.2 years. The majority rated their general health (82.7%) and dental health (77.1%) positively. Few believed SkCD impacted their oral health (20.9%). The mouth was not routinely checked during annual health screenings (82.8%). Beliefs showed lower perceived susceptibility to caries (43.5%) and periodontal disease (26.3%). Positive attitudes toward oral health practices were prevalent, but cues to action were lacking. Dental attendance was infrequent, with cost and ambivalence as barriers. The likelihood of regular attendance increased with higher cue-to-action scores. Few participants reported sickle crises due to dental infections (n=2), though a minority reported dental treatment refusals (n=3). Many intended to visit the dentist only when experiencing trouble (53.3%), while some believed routine visits were unnecessary (39.4%), citing forgetfulness (24.2%) or lack of time (10.1%). Conclusion: This study reveals that ASkCD in Ireland generally perceive their oral health positively, yet there are gaps in their awareness of oral issues related to their condition. Despite a positive attitude toward oral hygiene practices, barriers such as cost and misconceptions about dental visits limit frequent dental attendance. Thus, a patient-centred oral healthcare model addressing these unique needs and beliefs is crucial for this population. The study's findings have broader implications for informing policy, enhancing practices, and advancing oral health promotion efforts. Further research and tailored interventions are necessary to improve their oral health outcomes.