Search

Introduction: There is a maldistribution of dental professionals working in rural and remote regions of Australia. This study investigates dental graduates from a newly established rural clinical school (RCS) at Charles Sturt University (CSU), New South Wales, Australia, and records graduates' workforce locations and views on working in both metropolitan and rural practice., Materials and Methods: In late 2015 to early 2016, CSU graduates of 2013 and 2014 were asked to complete a telephone interview related to their employment choices. Thirty-nine interviews (68% of contactable graduates) were completed. Qualitative framework analysis was applied to identify trends and themes., Results: More than half of the graduates were working rurally, with 67% working full-time and 77% in private practice. Key influencing factors on graduates related to rural employment were as follows: family and personal relationships, developing clinical skills, rural community, lifestyle, professional support, mentorship, job availability, full-time employment and financial incentives. Key barriers to working rurally included leaving family and friends, small patient base, low salary, partner factors, and professional and personal isolation., Conclusion: More than half of the CSU graduates were working in rural communities, demonstrating initially positive rural workforce outcomes. Reasons for choosing to work rurally were complex and spanned a broad spectrum of social, personal, professional development and support, community, economic, environmental and lifestyle factors. Future workforce strategies should apply a broad multifactorial approach to consider the complex interrelated employment factors. Furthermore, increased evaluation is required of the CSU programme, with increased workforce outcomes and exploration of employment retention factors., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: In Australia and globally, there is an increasing problem of unmet oral health needs of older people above 65 residing in aged care facilities. Various workforce models have been trialled to implement oral health care programmes in aged care facilities, but the evidence behind these programmes and their underlying workforce models is not known., Objective: To systematically review the literature on the effectiveness, and economic feasibility of the current workforce models addressing oral care in aged care facilities., Methods: CINAHL, Cochrane CENTRAL, MEDLINE, EMBASE, EMB Reviews, NHS Economic Evaluation Database and grey literature were searched. Studies were included if they described an oral health workforce model with a clinical intervention and defined oral health outcome measures. Analysis was conducted using the NHMRC guidelines for scientific and economic evaluations., Results: Twenty-eight studies were included. Four distinct workforce models of care were identified. 60% of the studies demonstrated short-term effectiveness in clinical measures. Workforce models were similar in their effectiveness, with varying levels of quality within each model. Although three studies considered individual components of economic feasibility, only one provided a comprehensive economic analysis of both the costs and health outcomes., Conclusions Implications of Findings: All workforce models of care had some positive impact on oral health for residents of aged care. Oral health should be included as a health focus in age care facilities. Future studies should include longer-term health outcomes with rigorous economic analysis to ensure sustainably delivered workforce models of care for oral health management within aged care., (© 2020 Gerodontology Association and John Wiley & Sons Ltd.)

Australia has a complex history of providing public dental services to its communities. From the early days of Colonial settlement, the provision of dental care to the Australian public has largely been driven and influenced by organized groups and associations of dentists. The Constitution of Australia, under Section 51 xxiii A, allows for the Commonwealth to provide for medical and dental services. Unlike the United Kingdom, however, dental services have not been embedded into a universal national health service agenda. In 1974, that the Australian Government through the Australian School Dental Program provided the first funding and national direction for public dental services - and that, limited to children. The Commonwealth Dental Health Program 1993-1997 was the second national endeavor to provide public dental services, this time to financially disadvantaged adults. Since that time, public dental service responsibility has been shuttled between States/Territories and the Commonwealth. A new paradigm for public dental services in Australia requires strong Commonwealth leadership, as well as the commitment of State and Territories and the organized dental profession. The National Health and Hospitals Reform Commission provided the most recent scenario for a radical change in mission. This paper canvases the competing roles of strategic, functional, and structural issues in relationship to social network and policy issues, which must be recognized if Australians truly seek to reform public dental services., (© 2012 John Wiley & Sons A/S.)

Background: The Oral Health Assessment Tool (OHAT) was a component of the Best Practice Oral Health Model for Australian Residential Care study. The OHAT provided institutional carers with a simple, eight category screening tool to assess residents' oral health, including those with dementia. This analysis presents OHAT reliability and validity results., Methods: A convenience sample of 21 residential care facilities (RCFs) in urban and rural Victoria, NSW and South Australia used the OHAT at baseline, three-months and six-months to assess intra- and inter-carer reliability and concurrent validity., Results: Four hundred and fifty five residents completed all study phases. Intra-carer reliability for OHAT categories: percent agreement ranged from 74.4 per cent for oral cleanliness, to 93.9 per cent for dental pain; Kappa statistics were in moderate range (0.51-0.60) for lips, saliva, oral cleanliness, and for all other categories in range of 0.61-0.80 (substantial agreement) (p < 0.05). Inter-carer reliability for OHAT categories: percent agreement ranged from 72.6 per cent for oral cleanliness to 92.6 per cent for dental pain; Kappa statistics were in moderate range (0.48-0.60) for lips, tongue, gums, saliva, oral cleanliness, and for all other categories in range of 0.61-0.80 (substantial agreement) (p < 0.05). Intraclass correlation coefficients for OHAT total scores were 0.78 for intra-carer and 0.74 for inter-carer reliability. Validity analyses of the OHAT categories and examination findings showed complete agreement for the lips category, with the natural teeth, dentures, and tongue categories having high significant correlations and percent agreements. The gums category had significant moderate correlation and percent agreement. Non-significant and low correlations and percent agreements were evident for the saliva, oral cleanliness and dental pain categories., Conclusion: The Oral Health Assessment Tool was evaluated as being a reliable and valid screening assessment tool for use in residential care facilities, including those with cognitively impaired residents.

Objective: To identify similarities and differences in oral health attitudes, behaviour and values among freshman dental students., Design: Cross-cultural survey of dental students., Setting: 18 cultural areas., Participants and Methods: 904 first-year dental students completed the Hiroshima University-Dental Behavioural Inventory (HU-DBI) translated into their own languages. Individual areas were clustered by similarity in responses to the questions., Results: The first group displayed an 'occidental-culture orientation' with the exception of Brazil (Cluster 1 comprised: Australia, United Kingdom, Ireland, Belgium and Brazil, Cluster 2: Germany, Italy, Finland and France). The second group displayed an 'oriental-cultural orientation' with the exception of Greece and Israel (Cluster 3 comprised: China and Indonesia, and Cluster 4: Japan, Korea, Israel, Hong Kong, Malaysia, Thailand and Greece). Australia and United Kingdom were the countries that were most alike. Ireland was the 'neighbour' to these countries. Greece and Malaysia had similar patterns of oral health behaviour although geographic conditions are very different. Although it was considered that in Hong Kong, occidental nations have affected the development of education, it remained in the oriental-culture group. Comparison with the data from the occidentals indicates that a higher percentage of the orientals put off going to the dentist until they have toothache (p < 0.001). Only a small proportion of the occidentals (8%) reported a perception of inevitability in having false teeth, whereas 33% of the orientals held this fatalistic belief (p = 0.001)., Conclusions: Grouping the countries into key cultural orientations and international clusters yielded plausible results, using the HU-DBI.

This paper reports on two studies exploring similarities and contrasts in knowledge, attitudes and opinions on fluorides and fluoridation of two culturally different population groups. The first study compares the attitudes and opinions of parents of primary (elementary) schoolchildren in Melbourne, Australia, and Yokohama, Japan, and the second study compares the attitudes and opinions of dentists drawn from the same geographic areas. A self-administered questionnaire collected data on 517 parents and 629 dentists. The questionnaires were of similar design and content for both parents and dentists. They included a series of knowledge and attitudinal statements on preventive dentistry and use of fluorides. Attitudinal responses were measured on a 5-point agree-disagree Likert scale. Data were analyzed using both bivariate and multivariate techniques. Australian parents appeared better informed on the benefits of water fluoridation and held more favorable opinions on fluorides and fluoridation than their Japanese counterparts. Similarly, Australian dentists held more positive attitudes toward the use of fluorides and fluoridation than their Japanese peers. Cultural norms and experiences appear to shape parental attitudes, whereas the focus of dental education and dental practice on restorative treatments in Japan appears to be a substantial influence on the attitudes and opinions held by Japanese dentists.

To compare cross-cultural differences of dental health behavior, 376 dental students in Japan and 213 in Australia were surveyed using a twenty-item Hiroshima University-Dental Behavior Inventory (HU-DBI) questionnaire (in Japanese and English versions respectively). The mean DBI score of Year 1 Australian students was significantly greater than that of their Japanese peers (Australian 6.56, Japanese 5.57; P < 0.001), which suggested a higher level of dental health awareness in Australian students on entry. Only 7 percent of the Japanese students had been told by their dentist that they were performing a high level of plaque control, as contrasted with 50 percent of the Australian students. Furthermore, while only a small proportion of the Australian students (8 percent) reported a belief that they may eventually require dentures, 37 percent of the Japanese students held this belief (P < 0.001). The mean HU-DBI score of the Japanese students was lower than that of the Australian students until Year 4. Differences between the genders were not a major feature.

Seven-hundred and sixty dentists, selected randomly from all States and Territories except Victoria, responded to a questionnaire survey on beliefs, attitudes and the techniques used in the management of children with anxiety or behaviour problems. The most common techniques used were permitting the child some degree of control over terminating treatment if difficulties were experienced, coaxing and reinforcing positive behaviours, and furnishing waiting areas with child-oriented play materials. Most respondents never used TV or video-tape distraction strategies, film or video-modelling tape or hypnosis. More than half of the respondents believed there was insufficient information available to them on current anxiety/behaviour management techniques. The use of particular management techniques varied by gender, age, university of graduation, State or Territory of residence, and membership of the Australian and New Zealand Society of Paediatric Dentistry. Patterns of use of particular techniques showed similarities and contrasts with other studies. Patterns of use in the national sample were almost identical to the frequency and pattern of use by Victorian dentists. In contrast, however, North American studies have reported a higher frequency of use of hand-over-mouth, and lower use of general anaesthesia within the armamentarium of techniques and strategies used by dentists to manage anxious or difficult children.

This article discusses the historical shifts between the treatment-oriented, instructional and primary preventive approaches to oral health promotion, especially in school-based programs in New Zealand and Australia. While in the past much effort has been put into treatment-oriented and instructional programs, their impact has been limited. Among those primary preventive activities that have demonstrated clear benefits are various types of fluoridation and adhesive sealants for the occlusal surfaces of teeth. Further emphasis on primary prevention over treatment is needed to better insure the success of school-based oral health promotion programs. In addition, more effort needs to be put into policy direction, linkages within the educational system, planning, and evaluation.

Dental health education attempts to change behaviour by altering an individual's knowledge, attitudes, and beliefs about health matters. Perception of vulnerability to illness and dental disease is a central, but poorly understood, health belief. In this study of 303 New Zealand and 297 Australian schoolchildren perceived vulnerability was measured by the degree of expectancy to which subjects believed they would contract health problems. The pattern of health problem expectancy was consistent across age groups, cultures, and other demographic divisions. High expectancies of general health problems and dental caries were associated with potential preventive dental visits and with potential denture wearing. New Zealand schoolchildren, and children from lower socioeconomic backgrounds, had higher expectancies of general health problems and dental caries than Australian or middle class children.

Since 1975, more than 100,000 Indo-Chinese refugees from Vietnam, Kampuchea, and Laos have been resettled in Australia. This dental survey was undertaken to compare the dental health of 104 Australian-born and 126 Indo-Chinese adolescents from a State high school within a high migrant area of Melbourne. The mean DMFT score for the Australian-born group was 3.37 teeth, compared with 6.05 for the Vietnamese group, and 3.10 for the Kampuchean-Laotian group. More restorations and extractions were required by the Vietnamese subjects compared with the Australian-born and Kampuchean-Laotian subjects. Almost all subjects had gingivitis, however the proportion of Indo-Chinese subjects with shallow and deep pockets was greater than that of the Australian-born subjects. The periodontal health of the Kampucheans and Laotians was the most severe of the Indo-Chinese groups. These findings indicate that the Indo-Chinese adolescent refugees represent a high risk group for dental problems within the Australian population.

Three hundred and ten children from three schools were examined before and after a dental health promotion program targeted at one of the schools. Parents of subjects at the experimental school were visited at home by a community health worker who provided individualized information on dental services and preventive strategies. Parents of subjects at the control school were provided with similar information by way of general written documentation, not tailored to specific needs, and distributed as part of the traditional school take home system. The experimental hypothesis proposed that, at re-examination, subjects from the experimental school would show a measurable improvement in caries increment, and a reduced plaque index over subjects from the control schools. Although the individualized social intervention strategy did not demonstrate a major shift in use of dental services or improvement in health status some improvement in caries experience was obtained in the target group. The multifactorial nature of dental disease and the limited contact of the health worker with the families involved would account for the low success rate of this strategy.

This study compared the oral health status of 600 6-16-yr-old young persons: 297 from Heidelberg, Victoria, Australia (an area of recent water fluoridation and a predominantly marketplace delivery system) and 303 from Dunedin, New Zealand (an area with established water fluoridation and a long-standing school based public delivery system). A greater proportion of Heidelberg subjects, in each of three age groups, were caries free. Level of dental plaque varied both with study area and with age group. Dunedin subjects in the younger age groups had lower mean levels of plaque than their Heidelberg peers. The New Zealand dental service delivery system was consistently closer, in each age group, to meeting defined dental needs than the Australian system. The similarities and contrasts between this study and the WHO-ICS illustrate the importance for planners to consider carefully differences in local conditions which may affect service and morbidity projections.

Since 1975 more than 100,000 Indochinese refugees have settled in Australia. This study compared the dental health knowledge, attitudes, and behaviors of 131 Indochinese and 107 Australian-born adolescents from a state high school in Melbourne, Victoria. The Australian-born subjects demonstrated the highest level of dental knowledge, and the Kampuchean/Laotian subjects the least. Of the three birthplace groups (Australia, Vietnam, Kampuchea/Laos), the Kampuchean/Laotian group were more likely to believe that their dental health was controlled by external forces. The Kampuchean/Laotian group presented the highest proportion of subjects believing they needed dental treatment. In contrast, however, the Kampucheans and Laotians had the lowest perceived value of preventive dental visits with the Australian-born adolescents presenting the highest proportion. The dental health behaviors of the Kampucheans and Laotians were generally the least favorable and those of the Australian-born subjects the most favorable, although all groups were well short of the conventional ideal. One-third of the Kampuchean and Laotian subjects said they had never been to the dentist before. Few Indochinese subjects claimed to be regular visitors to the dentist. Analysis of data using the framework of the Health Belief Model provided little explanatory power in predicting preventive behaviors. A greater understanding of cultural variations between ethnic groups and targeted dental health education programs would appear to be beneficial strategies for improving oral health of high risk adolescents.