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Early Childhood Caries (ECC) is an aggressive type of dental caries that affects preschool-age children. It has a high prevalence among Australia’s Aboriginal child population but can be prevented ...

Objective:To systematically review evidence for interventions to prevent early childhood caries (ECC) in Indigenous children in high-income countries.Search strategy:In November 2016, we searched M...

Introduction: Dental caries has a severe impact on young Australian Aboriginal children. With appropriate advice, dental caries is preventable; however, many Aboriginal children cannot access dental services. Aboriginal health workers (AHWs) are a valued member of Aboriginal communities and have regular contact with Aboriginal families. Once trained about dental health, AHWs have the ability to teach families with young children about preventing dental caries. This article reports on an oral health training course for AHWs. Objectives: To evaluate the training course in terms of its components, cultural appropriateness, course content and whether the participants felt competent to offer oral health advice. Methods: Sixty-one AHWs from twelve Aboriginal Controlled Community Health Services (ACCHS) participated in the training programme across New South Wales, Australia. Anonymous self-completed questionnaires were collected after the training to determine whether the participants felt prepared to offer ora...

Objective The aim of this study was to record preventive oral health care planned by dental therapists and oral health therapists (therapists) for patients with poor oral hygiene undergoing orthodontic treatment. Materials and methods A cross-sectional survey, using a clinical vignette of a patient with poor oral hygiene undergoing therapy with a fixed appliance, was undertaken to record the preventive care offered to this individual by therapists working across 15 Local Health Districts (LHDs). This orthodontic vignette was inserted between two dental caries-related vignettes. Data were coded and descriptive statistics were used to report the findings. Results One-hundred and seventeen therapists returned questionnaires (giving a response rate of 64.6%), of whom 82.0% (n = 95) completed the orthodontic vignette. Adopting motivational interviewing techniques to facilitate communication with the patient and their parent was recommended by 88.4% (n = 84) respondents, 98.0% (n = 93) offered oral-hygiene instruction, 70.5% (n = 67) recorded plaque levels and used disclosing solution and 60.0% (n = 57) offered dietary advice. Products recommended for use at home included fluoride toothpaste [1,450 ppm F (80.0%; n = 76) and 5,000 ppm F (59.0%; n = 24)] and casein phosphopeptide amorphous phosphates plus fluoride (CPP-ACPF) paste (33.3%; n = 32). Less than 20% offered fissure sealants. Conclusion Preventive advice and care was offered inconsistently by therapists in this study. To ensure that all therapists adopt a scientifically based approach to prevention, LHD clinical directors should implement continuous professional education programmes for therapists to improve patient's health outcomes.

Introduction The aim of this qualitative study was to measure the effect of a specifically designed orientation re-enactment DVD used to facilitate dental hygiene students transition from the classroom to a Residential Aged Care Facility (RACF) service-learning placement with less personal anxiety and more confidence in their role during the placement. Methodology Final year students (n = 47) were randomly allocated to one of 17 RACFs on the NSW, Central Coast, Australia. All students were then randomly allocated to a two-group study with the active group assigned to view the DVD prior to their placement. Students who viewed the DVD were asked not to discuss the content with students who were assigned to the control group. Post-placement focus groups were organized, recorded and transcribed verbatim. Data were collated, analysed and unitized into emergent themes. Representative quotes are presented in the results. The study was informed by 4 years of previous quantitative and qualitative process evaluation of the RACF programme. Results Focus group discussions identified that those students who had seen the DVD reported a shorter timeframe to successfully transition from the classroom to the RACF and stated that the DVD provided them with a realistic expectation of the RACF environment and their role in the placement experience. Conclusion The orientation DVD reduced student anxiety and improved student confidence in their role during the placement by providing a realistic orientation of the RACF environment.

Background: Many adolescents are at risk of dental caries and periodontal disease due to poor tooth brushing and dietary behavior. However, these oral health problems can be moderated by providing individuals with preventive care and advice. In New South Wales (NSW) Dental Therapists and Oral Health Therapists (Therapists) working in the public health system can help this vulnerable group by providing free dental care including advice on preventing dental caries and periodontal disease. The aim of this study was to identify factors that influence Therapists in the provision of preventive care to adolescents. Method: Sixteen Therapists working in four NSW Local Health Districts (LHDs) participated in three structured two hour focus group sessions to: identify motivators/enablers to providing oral health care for adolescents in a clinic-based setting; and to record their solutions and strategies to enhance preventive practice. These discussions were interactively mapped, audio-recorded for recall and coded for thematic analysis. Results: The participants identified personal self-health values, altruism, professional career satisfaction, professional clinical ethics, and their ability to relate and engage with adolescents as motivators to provide preventive care. They acknowledged that psychosocial determinants of health factors such as mental health, transient home concerns, knowledge of how to access timely oral health care, relying on others for transport, oral health literacy and dental phobias all impacted on their ability to provide effective preventive care to adolescents. These factors were the main reasons why they needed to reach out, advocate and invest time on preventive care for adolescents. Conclusion: The Therapists believed in the value of preventive oral health care but reported that there were some over whelming challenges that impacted on their ability to offer this service.

The study investigated the impact of Guinea Worm Disease on the lives of people living in rural areas of Nigeria. It examined the nature of Guinea Worm Disease, its severity and effect on the econo...

Introduction Community-based education programmes provide students with an experiential learning opportunity in a real-life context. The purpose of this study was to examine reflective journals to identify students' experiences and perceived learning during a 12-week placement programme in residential aged care facilities (RACF) on the NSW Central Coast, Australia. Methodology All final year dental hygiene students from the University of Newcastle, Australia attended an aged care orientation workshop prior to commencing the RACF student placement programme. Throughout the placement, students were asked to record their educational experiences in reflective journals. Student reflections were based on the ‘Gibbs Reflective Cycle’, diarising experiences and feelings. Qualitative data was analysed using the constant comparative method and unitised to identify emergent themes. Results Sixty-seven students completed reflective journals during the placement programme; emergent themes indicated students felt ill-prepared for the placement programme despite attending the orientation workshop. They were apprehensive and nervous prior to commencement of the placement. The general consensus after week 6 was that the placement became a more positive experience where students began to feel comfortable in the RACF environment and residents, and staff started to respond more positively to their presence. Overall, they thought the placement was challenging and confronting, but had improved their skills and knowledge in care of older people and increased their confidence in working with other healthcare professionals. Conclusion The reflective journals provided students with the opportunity to record and reflect on their experience and perceived learning during the placement programme. Student reflections identified negative experiences at the commencement of the placement, suggesting a need for additional orientation prior to the RACF programme.

Introduction: The growing population of elderly people is impacting on overstretched dental services in many countries, as many individuals are retaining natural teeth and may have dentures or implants, all of which influence the way in which the oral cavity must be cared for. A major difficulty for older residents is their decreasing level of motor and cognitive functioning to adequately self-care for their mouths. Hence, the role of the nurse is crucial. However, staff shortages, time factors and lack of awareness can lead to neglect of the mouth in this population. The loss of function is often exacerbated in individuals with mental health problems. Objectives: To improve the oral health of residents in an aged care mental health unit through the introduction of an innovative nursing intervention. Methods: Firstly, utilizing focus groups, nursing staff identified the main barriers to delivery of oral hygiene to residents as follows: lack of proper equipment; no protocol in place; lack of knowledge. Staff knowledge of oral health and hygiene was measured using a structured questionnaire before and after the intervention. A training program was devised by a dentist, dietician and nurse working in the unit. A multidisciplinary team met on several occasions to design a suitable vehicle and process to deliver oral hygiene. Oral health examinations were conducted at baseline, three months and 12 months. Interventions: Design and production of oral hygiene trolley; development of protocol for oral hygiene; staff education in oral health. Results: The program was successful in improving the oral health of residents with reductions in plaque scores, gingivitis and pocket depths. The oral hygiene protocol was positively accepted into a daily routine and the knowledge of staff in matters relating to oral health increased. Conclusions: A simple oral health intervention utilizing qualified nurses and a purpose-built oral hygiene trolley made significant improvements to the oral health of aged care residents.

IL-10 has several immuno-protective functions in the placenta The expression of IL-10 is genetically determined. The aim of this study was to investigate whether maternal periodontal disease and IL-10 gene polymorphisms, are associated with intra uterine growth restriction (IUGR). A total of 160 pregnant women were recruited from the Antenatal Clinic, St Mary's Hospital, Manchester, UK and enrolled into a prospective pilot study. The study included 92 Caucasians, 41 Asians and 27 Afro Caribbeans. The periodontal examination involved recording bleeding on probing and pocket depth indices on all teeth. ARMS-PCR was used for genotyping IL-10 gene at position −1082, −819 and −592. Birth weight was assessed using the individualised birth weight ratio (IBR), with intrauterine growth restriction IUGR defined as an IBR below the 5th percentile, x2 test was performed for statistical analysis. The −1082 A/A genotype, is associated with more increased BOP% sites (23% vsl4%, P = 0.069), and significantly wit...

This study investigates the relationship between maternal periodontal disease and intrauterine growth restriction and preterm labour. Periodontal disease was assessed by bleeding on probing indices. Periodontal bleeding did not correlate with either preterm labour or intrauterine growth restriction (using a corrected birth weight of

Objective To analyse the appropriateness of referrals received by Salford Primary Care Trust (PCT) for general anaesthetic (GA) extractions. To assess the adherence to General Dental Council (GDC) and Salford PCT guidelines. Methods A data collection form was completed for all patients who attended the GA assessment clinics over a three month period in 2006. Results Sixty-one referrals in total were assessed. Ninety-seven per cent of the 61 referrals received adhered to the Salford PCT proforma requirements, with only 33 per cent complying with GDC guidelines. Gross caries was cited as the major reason for referral (90%) of cases. Justification was given for GA in 97 per cent of cases. Major reasons cited were anxiety and multiple extractions in more than one quadrant. Twenty-one per cent of referrals were considered inappropriate. In only 18 per cent of cases did the specialist treatment plan correlate with the treatment requested. Conclusions There are a high number of inappropriate referrals r...

BACKGROUND The aim of this study was to investigate factors that influence dental therapists and oral health therapists (therapists) plan preventive oral health care for adolescents attending New South Wales public oral health services. METHODS A cross-sectional postal survey using two clinical vignettes was used to record the preventive care treatment plans offered by therapists working across 15 New South Wales local health districts. Data were tabulated and chi-square statistics used in the analysis. RESULTS One hundred and seventeen therapists returned questionnaires, giving a 64.6% response rate. The participants highlighted the importance of offering oral hygiene instruction (97.0%), dietary advice (95.0%) and topical fluoride applications (74.0%). Recommended home use products included fluoride toothpaste 5000 ppmF (59.0%) and casein phosphopeptide-amorphous calcium phosphate plus fluoride (CPP-ACPF) paste (57.7%). Over 50% used fissure sealants. More respondents (88%) would utilize motivational interviewing strategies for a patient with dental caries concerns; however, only 63% would use this technique for a patient in pain (p < 0.001). CONCLUSIONS Considerable variations were noted in therapists' recommendations for stabilizing and managing dental disease, suggesting a need for clinical directors to consider providing more advice to therapists on the scientific basis of preventing dental caries.

Aim: Electronic health record (EHR) data have great potential for reuse in research and patient care quality improvement initiatives. However, in dual systems, where both electronic and paper health records are used, inconsistencies and errors may occur. The objective of this study was to determine the degree of agreement between EHR clinical data and paper records for reuse in clinical oral health research and quality improvement initiatives. Methods: A random sample of 200 EHRs for adolescents from eight Area Health Services was obtained from the Information System for Oral Health New South Wales database of 29 599 records, and compared with 200 paper records for adolescents that were stored at clinics. The records were analysed for data reliability. The electronic records were percentage weighted to reflect the number of adolescents treated in each of the Area Health Services. Results: The results showed an overall 95.0% agreement between the 200 individual EHRs and the 200 clinic-stored paper records. In 1.5% of cases, information contained in the paper record was not uploaded into the EHR, and in 3.5% of cases, information contained in the EHR was missing from the paper record. Conclusions: It is possible to conclude that more deficiencies occurred in paper records compared with EHRs. These deficiencies should be taken into account if EHRs are to be reused for clinical oral health research or quality improvement initiatives. Considering the missing data and the great strides in information system technology, it would be logical to adopt one system, with a focus on electronic records to replace the paper records.

Background: Continuing professional development (CPD) is an essential component for dental Therapists and oral health Therapists to uphold registration with the Australian Dental Board. Evidence of CPD is considered an assurance of Therapists scientific clinical knowledge and competence to provide quality care to patients. Many vulnerable adolescents are at risk of dental caries and periodontal disease due to poor oral hygiene self-care practices and dietary behaviours. Therapists have a pivotal role to play in the provision of scientific-based clinical preventive care and advice to encourage adolescents towards oral health self-efficacy for lifelong benefits. The aim of this study was to record CPD clinical preventive care activities focused on adolescents undertaken by Therapists working in NSW Public Oral Health Services. Methods: A cross-sectional self-administered survey using a postal questionnaire was used to record the continuing professional development activities of Therapists working in all NSW Local Health Districts (LHDs) in relation to clinical preventive care offered to adolescents. Results: One hundred and seventeen Therapists (64.6%) responded to the survey. Approximately 20% of respondents had not undertaken CPD on preventive care for adolescents in the last two years, 33.3% documented less than 5 hours, and 35.1% more than 10 hours. Almost 88 percent of respondents received their CPD from within their LHDs, and ranked peer reviews and team building events for sharing information as key strategies to enhance their ability to offer clinical preventive care to adolescents. Conclusion: This study has shown that one third of all Therapists had received less than 5 hours CPD focussing on helping adolescents maintain their oral health in the last 2 years. In order to support Therapists continuing professional education, inter-professional peer reviews in partnership with dentists, visiting dental specialists, and whole team approaches should be regularly undertaken. In addition scoping of other modes of education such as the Information Communication Technology for broader reach are worthy of further investigation.

Historically, HIV positive patients have had difficulties accessing dental care. Unwillingness on the part of dentists and reluctance on the part of patients are thought to be responsible for such difficulties. This particular study aimed to investigate the provision of dental treatment for HIV positive patients in Manchester, based upon their personal experiences. The results indicate that two-thirds of the HIV positive population surveyed are registered with a dentist and, following diagnosis, regular dental attendance increased within this group. A considerable proportion (64%) of this population disclosed their HIV status to their dentist and almost two-thirds of these respondents felt there had been no change in their dentist's attitude post-disclosure. Conversely, four per cent had been refused treatment on revealing their HIV status. Twenty-five per cent of the population surveyed were not registered with a dentist and did not receive regular dental care. Fear that dentists would refuse tr...

To record the views of final year dental hygiene students from the University of Newcastle, Australia about a placement in 17 residential aged care facilities, on the NSW Central Coast.Final year dental hygiene students undertook a 12 week placement, 1 day per week, in 1 of 17 residential aged care facilities. They were asked to participate in focus group discussions after the placement to determine their ability to transition from the classroom to the real-life experience of the residential aged care facility placement.Students felt ill-equipped for the aged care placement program even though they had attended a pre-placement orientation. Students expressed feelings of being overwhelmed by the residential aged care environment, particularly by the smells and unexpected sights of the aged, fragile and cognitively impaired residents, and the difficulties in providing them with oral hygiene care.To enable students to transition from the classroom to the aged care environment in a more effective manner, a more realistic pre-placement orientation program is necessary.

Objectives Dental caries (decay) is a serious problem for young Aboriginal children, causing pain and stress. Treatment often involves extraction of teeth under a general anaesthetic. However, dental caries can be prevented by reducing the frequency of sugar consumption and brushing teeth twice a day with fluoride toothpaste. Such straightforward advice could be given to families by Aboriginal Health Workers who are trusted by their communities and have an existing advisory role. This paper reports on the development of dental health advice leaflets for use in Aboriginal communities. Methods An Aboriginal reference panel was recruited to comment on dental health advice leaflets prepared by an Aboriginal graphic designer. The panel was asked to consider the design, cultural appropriateness and practicality of the leaflets. Comments were collected through email and face-to-face discussions, which were collated and the leaflets altered accordingly. Results The advice from the panel resulted in greater use of pictures. For example large green ticks and red crosses highlighted healthy and unhealthy behaviours, respectively. The tooth brushing leaflet was amended to emphasise the safe storage of toothpaste in order to keep it out of reach of young children. The panel stated that all leaflets should incorporate the Aboriginal flag, and proposed that fridge magnets might be beneficial as all family members would benefit from seeing the messages every day. Conclusion The consultation process refined dental advice leaflets to reflect the views of an Aboriginal Reference Panel, in terms of design, cultural competence and practicality.

Background Dental Therapists and Oral Health Therapists (Therapists) working in the New South Wales (NSW) Public Oral Health Service are charged with providing clinical dental treatment including preventive care for all children under 18 years of age. Adolescents in particular are at risk of dental caries and periodontal disease which may be controlled through health education and clinical preventive interventions. However, there is a dearth of evidence about the type or the proportion of clinical time allocated to preventive care. The aim of this study is to record the proportion and type of preventive care and clinical treatment activities provided by Therapists to adolescents accessing the NSW Public Oral Health Service. Methods Clinical dental activity data for adolescents was obtained from the NSW Health electronic Information System for Oral Health (ISOH) for the year 2011. Clinical activities of Therapists were examined in relation to the provision of different types of preventive care for adolescents by interrogating state-wide public oral health data stored on ISOH. Results Therapists were responsible for 79.7 percent of the preventive care and 83.0 percent of the restorative treatment offered to adolescents accessing Public Oral Health Services over the one year period. Preventive care provided by Therapists for adolescents varied across Local Health Districts ranging from 32.0 percent to 55.8 percent of their clinical activity. Conclusions Therapists provided the majority of clinical care to adolescents accessing NSW Public Oral Health Services. The proportion of time spent undertaking prevention varied widely between Local Health Districts. The reasons for this variation require further investigation.

OBJECTIVES: This trial investigated the value of a school-based dental health education program in terms of changes in knowledge, reported behavior, and plaque scores. METHODS: A total of 2,678 pupils with a mean age of 12.1 years attending 28 schools participated in a school-based dental health education program. The study used a cluster randomized controlled study design. The health service administrators stipulated that all participants receive the intervention; to meet this requirement, a rolling program of two six-month periods was utilized. During the first six months, half the adolescents received the intervention program, the other half acting as controls. Throughout a further six-month period, all participants received the intervention program. This research design allowed comparisons between participants receiving the program for six and 12 months. At baseline, six, and 12 months, a random subsample of 40 children in each participating school had their plaque scores recorded and a questionnaire was used to record their knowledge of dental health and reported dental behavior. RESULTS: The analysis used the subjects clustered within the schools, which were the units of randomization. The intervention program produced statistically significant improvements (P < .001) in knowledge about periodontal disease and the frequency of sugar intake and dental caries in both assessment time periods. The reported frequency of brushing did not change, but the group who had received 12 months of the intervention were more likely (P < .05) to brush for over a minute. At six months the early intervention group had a statistically significant, 13 percent reduction in the mean proportion of sites with plaque compared with the late intervention group (P = .043). This difference was sustained at 12 months (P = .037). CONCLUSION: This cluster randomized control trial demonstrated that the intervention program resulted in an improvement in knowledge of dental disease and an increase in the reported duration of brushing. These improvements were accompanied by a significant improvement in oral hygiene and a reported reduction in gingival bleeding.

Background Early Childhood Caries (ECC) is a widespread problem in Australian Aboriginal communities causing severe pain and sepsis. In addition dental services are difficult to access for many Aboriginal children and trying to obtain care can be stressful for the parents. The control of dental caries has been identified as a key indictor in the reduction of Indigenous disadvantage. Thus, there is a need for new approaches to prevent ECC, which reflect the cultural norms of Aboriginal communities. Methods/Design This is a Phase II single arm trial designed to gather information on the effectiveness of a dental health education program for Aboriginal children aged 6 months, followed over 2 years. The program will deliver advice from Aboriginal Health Workers on tooth brushing, diet and the use of fluoride toothpaste to Aboriginal families. Six waves of data collection will be conducted to enable estimates of change in parental knowledge and their views on the acceptability of the program. The Aboriginal Health Workers will also be interviewed to record their views on the acceptability and program feasibility. Clinical data on the child participants will be recorded when they are 30 months old and compared with a reference population of similar children when the study began. Latent variable modeling will be used to interpret the intervention effects on disease outcome. Discussion The research project will identify barriers to the implementation of a family centered Aboriginal oral health strategy, as well as the development of evidence to assist in the planning of a Phase III cluster randomized study. Trial registration ACTRN12612000712808

Primary Care Trusts (PCTs) assumed new responsibilities for dentistry in 2005. In dental education it has been suggested that more emphasis is made of primary care outreach schemes. The paper considers the service quality implications of dental outreach teaching for PCTs with particular reference to access and acceptability. RESEARCH DESIGN AND CLINICAL SETTING: A pilot of outreach teaching for Manchester undergraduates in relation to adult dental care began in 2001. Six groups of eight students, working in pairs, spent one day per week in one of three community dental clinics in socially deprived areas. The evaluation of the first year used data from 908 patient treatment summaries, 139 patient questionnaires, and records of patient attendance.Access and acceptability measured by patients' demographic characteristics, patients' attendance at the clinics; patients' reasons for attendance, use of services and satisfaction with the service.In terms of access, the new service was used by local patients. Their main reasons for attending were convenience, a dental problem, free treatment, lack of access to a dentist, and lay referral. Some 41 percent attended initially because of an emergency, 30 percent said that if they had not attended the clinic they would have gone nowhere or did not know where they would have gone, and 49 percent had not attended a dentist for more than two years. In terms of acceptability most patients were positive about being treated by a student, 96 percent thought the quality of care excellent or good, and the same percentage said they would return to the clinic. The main areas of criticism were waiting times and appointments.Students can provide an accessible and acceptable local primary care dental service for adult patients in socially deprived areas as part of their undergraduate learning, and in a way that complements the existing services.

This study aimed to determine dental students' expectations of attending a community clinic to provide family dental care and to assess how well the course met their expectations. Prior to the start of the course, 30 final year students were asked about the type and number of patients they expected to treat, the types of treatment they thought they would provide and additional skills, if any, they might gain and also about any worries they had about the course. The responses were used to compile a questionnaire, completed by the students after finishing the course. The students treated more patients a day than expected and underestimated the range of treatments carried out at the clinics, particularly trauma and advanced restorative work. Additional communication skills and increased confidence and quality of work were among the cited gains. Concerns expressed prior to the course had largely been eliminated, although some students still had reservations about National Health Service paperwork, treatment planning and running late. It was concluded that The Family Dentistry Course more than fulfilled students' expectations and it gave them enhanced skills in patient management and clinical competency.

Background Limited research has been undertaken in Australia to assess the dental status of pre-school Aboriginal children. This cross-sectional study records the number of decayed, missing and filled teeth (dmft) and surfaces (dmfs) of pre-school Aboriginal children living in different locations in New South Wales (NSW), Australia. Methods A convenience sample of young children from seven Aboriginal communities in rural, remote and metropolitan areas of NSW, was recruited. One calibrated examiner recorded the dmft/s of children with written parental consent. Results 196 children were invited to participate and 173 children aged two to five years were examined, a response rate of 88.3 %. Forty percent (n = 69) of the children were diagnosed with dental caries with a mean of 2.1 (SD = 3.6). The dmft scores were significantly higher in remote locations when compared to rural (p =