Exploring the appropriateness of antibiotic prescribing for dental presentations in Australian general practice-A pilot study.

AIMS: Dental pain is a common presentation in general medical practice for which patients are often prescribed antibiotics. The aim of this pilot study was to assess prescriptions by general medical practitioners (GPs) for dental presentations in Australia. METHODS: Anonymised electronic medical data relating to antibiotic prescribing across 2 periods (3 August-30 November 2019 and 3 August-30 November 2020) were extracted from 8 general practices in Victoria that contributed data to the University of Melbourne's Data for Decisions programme. Extracted de-identified data included antibiotics prescribed for dental presentations, practice site number, visit date, patient age, sex, reason for prescription, reason for visit and the regimen of the antibiotic. Appropriateness of the prescribed antibiotic was assessed against the Australian national dental guidelines Therapeutic Guidelines Oral and Dental. RESULTS: From 13 641 recorded prescriptions, 178 were recorded for dental presentations, representing 1.3% of all antibiotic prescriptions. When assessed against the guidelines, 23.6% (n = 42) were considered appropriate. The top 3 most commonly prescribed antibiotics were amoxicillin (n = 84, 47.2%), amoxicillin/clavulanic acid (n = 52, 29.2%) and metronidazole (n = 15, 8.4%). The reasons for inappropriate prescribing were as follows: third-line treatment being chosen, inappropriate spectrum, incorrect regimen or prescribing an antibiotic not recommended in the guidelines. CONCLUSION: These results indicate a need to better understand the potential patient drivers for antibiotic prescription for GPs and patients, and resources GPs need to manage dental presentations. These results will inform the codesign of targeted interventions to address any educational gaps and barriers to accessing dental treatment and thus improving antibiotic prescribing.

Geographic patterns of dental service use in the Child Dental Benefits Schedule: 6 years of claims in the Longitudinal Study of Australian Children.

ISSUE ADDRESSED: This article explores the geographic patterns of claims within the Australian Government's Child Dental Benefits Schedule (CDBS). BACKGROUND: The CDBS is a means-tested schedule implemented in 2014 to improve access to dental services for children. Under the schedule, eligible children receive funding to subsidise dental services. METHODS: This study used data from the Longitudinal Study of Australian Children and linked data from the Medicare universal healthcare system, to examine dental service use amongst a subset of children aged 10 and 14 years. Dental service items were classified using Two-step Cluster Analysis, and appointments were analysed using multinomial logistic regression. Geographic characteristics were included as predictor variables. RESULTS: The study found that the majority of dental appointments were non-operative (70.7%, n = 5808), with diagnostic, radiographic, and preventive items being the most common. There were slightly higher proportions of operative appointments (fillings and extractions) compared with non-operative appointments in remote and very remote areas, low socio-economic areas, and Queensland and Northern Territory. Cluster analysis identified eight groups of non-operative appointments and four groups of operative appointments. New South Wales had a higher proportion of 'prophylactic IV' appointments than any other State and Territory, which included debridement and topical fluoride services. CONCLUSION: Cluster analysis identified distinct groups of non-operative and operative appointments, each with unique characteristics. The distribution of appointments varied by State/Territory and region. SO WHAT: Further research and interventions are needed to ensure equitable access to services and a shift to preventive care for disadvantaged populations of Australian children. Exploring alternative funding models that support clinically relevant claims, rather than maximising financial benefits such as time-based renumeration models should be explored.

Dental implant maintenance teaching in Australia-A survey of education providers.

INTRODUCTION: Implant treatments and peri-implant maintenance continue apace, while the evidence for implant maintenance and home hygiene continues to be developed. Information sources for dental practitioners and patients in peri-implant health maintenance and disease management are generally not known. This study investigated the implant maintenance topics taught, the discipline backgrounds of convenors and presenters and information delivery methods within implant dentistry teaching in Australia. MATERIALS AND METHODS: An online survey was distributed to 56 convenors of implant dentistry and maintenance education programmes in Australia, garnering responses from 24 individuals which outlined 43 different education programmes. RESULTS: Lectures were the main delivery method for implant maintenance information across the different course types. Peri-implant diagnostics were generally taught according to current literature recommendations, but coverage varied in topics where the evidence is yet to be established (eg home hygiene, professional maintenance and implant review). Some educators reported awareness of limitations in their programmes. CONCLUSION: Implant dentistry education programmes in Australia vary widely in teaching implant maintenance, coverage of which should be current and evidence-based at all education levels. The structure of implant dentistry teaching at the continuing professional development level requires further development.

Dental educators' attitudes towards the teaching of dental amalgam.

OBJECTIVE: To ascertain dental educators' attitudes towards the teaching of dental amalgam at dental schools in Australia and identify preferred curricular approaches in a potentially "amalgamless" profession. METHODS: A mixed methods analysis was employed based on an open-ended response survey followed by a closed-ended questionnaire. Identification of key issues from the survey helped frame the questionnaire. Participants included those with expertise in operative and restorative dentistry, with direct involvement in curriculum development or delivery, at Australian dental schools. RESULTS: Participants numbered fifteen and represented seven of the nine dental schools in Australia. Key themes identified and explored included the following: (in)consistency of approach to teaching restorative dentistry; a perceived disconnect between undergraduate study and the "real world"; a need for a focus on teaching of alternatives to dental amalgam (80 per cent (strongly) agreeing); the contradictory nature of the evidence base and literature that is not readily understood; the need for more post-graduate education relating to adhesive restorative materials (86 per cent (strongly) agreeing); the need for dental amalgam to continue to be available; formal understandings (guidelines) as to the use of dental amalgam; dental schools in Australia being heard on these issues; and the relevance of this issue (100 per cent (strongly) agreeing the issue is topical and important). CONCLUSION: There is a broad consensus of dental educators at Australian dental schools as how best to approach the teaching of amalgam if a phase-down is to occur and the issues any such approach may face.

A survey of cariology teaching in Australia and New Zealand.

BACKGROUND: The Australian and New Zealand chapter of the Alliance for a Cavity Free Future was launched in 2013 and one of its primary aims was to conduct a survey of the local learning and teaching of cariology in dentistry and oral health therapy programs. METHODS: A questionnaire was developed using the framework of the European Organisation for Caries Research (ORCA)/Association of Dental Education in Europe (ADEE) cariology survey conducted in Europe in 2009. The questionnaire was comprised of multiple choice and open-ended questions exploring many aspects of the cariology teaching. The survey was distributed to the cariology curriculum coordinator of each of the 21 programs across Australia and New Zealand via Survey Monkey in January 2015. Simple analysis of results was carried out with frequencies and average numbers of hours collated and open-ended responses collected and compiled into tables. RESULTS: Seventeen responses from a total of 21 programs had been received including 7 Dentistry and 10 Oral Health programs. Key findings from the survey were - one quarter of respondents indicated that cariology was identified as a specific discipline with their course and 41% had a cariology curriculum in written format. With regard to lesion detection and caries diagnosis, all of the program coordinators who responded indicated that visual/tactile methods and radiographic interpretation were recommended with ICDAS also being used by over half them. Despite all respondents teaching early caries lesion management centred on prevention and remineralisation, many taught operative intervention at an earlier stage of lesion depth than current evidence supports. Findings showed over 40% of respondents still teach operative intervention for lesions confined to enamel. CONCLUSION: Despite modern theoretical concepts of cariology being taught in Australia and New Zealand, they do not appear to be fully translated into clinical teaching at the present time.

Oral health-related knowledge, attitudes and self-efficacy of Australian rural older adults.

OBJECTIVE: A cross-sectional study was conducted involving older adults from social clubs within a regional local government area in the state of Victoria, Australia, to identify factors associated with knowledge, and attitudes about oral health, as well as perceived self-efficacy. METHODS: Participants underwent an oral health interview, followed by a comprehensive oral clinical examination. RESULTS: A total of 225 older adults participated in this study. The mean age was 70.7 (range: 55-96) years. The majority was females (62.0%) and had incomplete secondary education or less (56.1%); 34.2% were fully edentulous. The mean oral health knowledge score was 24.7 (SD 3.8). None of the socio-demographic and oral health variables yielded a significant effect on the knowledge score. The attitude score had a mean of 5.0 (SD 1.6). Four variables remained significant in the multivariate analysis [p < 0.0001]. A dentate female, with tertiary education, had better oral health attitudes. Higher oral health knowledge scores were associated with a better attitude. The overall self-efficacy mean value was 83.1% (SD 10.6). Dental visits and oral health knowledge remained significant in the attitudes multivariate analysis [p < 0.01]. CONCLUSION: Findings indicate that there were some misconceptions in oral health among this group of older adults. These are important influences on the success/failure of an oral health programme. Oral health education is needed to increase older adults' oral health knowledge, in particular of oral cancer, and to some extent periodontal disease, and improves attitudes and oral health self-efficacy. Oral health knowledge, attitudes and self-efficacy were minimally explained by socio-demographic and clinical variables.

Primary care dentistry: An Australian perspective.

INTRODUCTION: Primary care dentistry is the first point of contact that someone has with the dental system and is predominantly focused on the treatment and prevention of dental caries and periodontal disease. The aim of this paper was to review the Australian primary dental care system. METHODS: This paper reviews the primary dental care system in Australia, drawing on data reporting on the dental workforce, funding sources for dental care, oral health outcome measures and dental visiting patterns. RESULTS: Primary dental health care in Australia is predominantly provided by dentists working in private practice, with the number of dentists per 100,000 people in Australia increasing from 46.9 in 2000 to 65.1 in 2022. However, there has been a gradual shift over the past twenty years towards greater service provision by other members of the dental team who now represent one quarter of the dental workforce, and some expansion of publicly funded dental care. Despite this dentistry remains isolated from the rest of primary health care, and the lack of government funding means that many people continue to miss out of necessary dental care, particularly those living in regional and rural Australia and from low-income groups. CONCLUSIONS: Australians should be able to access primary dental care services when and where they need it with adequate financial protection, from services that are well integrated into the broader primary health care system to ensure they are able to achieve optimal oral and general health. For many Australians, this is not currently the case. CLINICAL SIGNIFICANCE: Australia is at a crossroads with respect to access to dental care, and there is a need for stronger advocacy from stakeholders to improve oral health outcomes and reduce inequalities.

Exploring the validity of the Sydney Burnout Measure.

This study aimed to examine the convergent validity of a new measure of burnout, the Sydney Burnout Measure (SBM) by comparison against the field standard measure - the Maslach Burnout Inventory (MBI). A second aim was to consider burnout's association with psychological distress. 1483 dental professionals completed the two burnout measures as well as two measures of psychological distress. The overall correlation between total scores on the two measures (and on shared constructs) was high, and thus the convergent validity of the SBM was supported. Further, the SBM and MBI total scores correlated highly with total scores on the two measures of distress. Exploratory structural equation modelling (ESEM) also identified substantial overlap between the measures, especially in relation to the exhaustion subscales of the burnout measures and their overlap with psychological distress items. While future research is required to determine which burnout measure and its associated burnout definition is most valid, our findings argue for further consideration of how burnout may best be conceptualized, as well as whether the syndrome is worthy of elevation to mental disorder status.

Factors associated with suicidal ideation and suicide attempts by Australian dental practitioners.

INTRODUCTION: To investigate factors associated with suicidal ideation and suicide attempts amongst Australian dental practitioners. METHODS: A self-reported online survey of 1474 registered dental practitioners in Australia was conducted from October to December 2021. Participants reported thoughts of suicide in the preceding 12 months, prior to the preceding 12 months and prior suicide attempts. RESULTS: Overall, 17.6% reported thoughts of suicide in the preceding 12 months, 31.4% prior to the preceding 12 months, and 5.6% reported ever having made a suicide attempt. In multivariate models, the odds of suicidal ideation in the preceding 12 months were higher in dental practitioners who were male (OR = 2.01), had a current diagnosis of depression (OR = 1.62), were experiencing moderate (OR = 2.76) or severe psychological distress (OR = 3.58), had self-reported illicit substance use (OR = 2.06) or had previous self-reported suicide attempts (OR = 3.02). Younger dental practitioners had more than twice the odds of recent suicidal ideation than those aged 61+ years, with higher resilience having decreasing odds of suicidal ideation. LIMITATIONS: This study did not address help seeking behaviours directly related to suicidal ideation, so it is not clear how many participants were actively seeking mental health support. The response rate was low and results may be subject to responder biases, with practitioners experiencing depression, stress and burnout being more willing to participate. CONCLUSION: These finding highlight a high prevalence of suicidal ideation amongst Australian dental practitioners. It is important to continue to monitor their mental health and develop tailored programs to provide essential interventions and supports.

Provision of oral health care to adult patients by dental therapists without the prescription of a dentist.

OBJECTIVES: Dental therapists are increasingly been seen as part of the solution to assist in improving access to dental care for underserved populations. The aim of this article is to report the outcomes of an educational bridging program designed to provide university-educated dental therapists with the appropriate knowledge and skills required to enable them to translate their current clinical scope of practice to adult patients aged 26+ years. METHODS: Ten dental therapists completed an educational program approved by the Dental Practice Board of Victoria as a pilot. Feedback from patients and supervising and supporting dentists was provided during the project. RESULTS: Supervising and supporting dentists rated the knowledge and clinical skills of participants as good to high at the completion of the education program and considered them safe to treat adults patients. Patients were very satisfied with the dental treatment provided. Eight participants successfully completed the assessment and were permitted by the Dental Practice Board of Victoria to extend their clinical scope of practice to adult patients. CONCLUSIONS: Feedback from patients and dentists indicated that, following the completion of an educational bridging program, dental therapists with a university education were able to develop the knowledge and skills required to treat adult patients aged 26+ years without the prescription or supervision of a dentist. Enabling dental therapists to treat adult patients may have a role to play in improving access to dental care for underserved populations.

Edentulism and dental caries in Victorian nursing homes.

OBJECTIVES: The aim of this project was to investigate edentulism and dental caries in nursing home residents in Victoria, Australia. BACKGROUND: The Australian population is ageing with a growing number of people living in nursing homes. These residents are at increased risk for dental caries, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. MATERIALS AND METHODS: Clinical dental examinations were conducted at 31 nursing homes in Melbourne and regional Victoria between May 2005 and June 2006. A total of 510 residents were examined out of 1345 eligible participants. Socio-demographic and medical history was collected via questionnaire. RESULTS: Just over half of the residents were dentate (53.9%), and dentate residents had a mean of 14.4 teeth present and 2.66 untreated decayed teeth. Residents who required total assistance with oral hygiene had more decayed teeth and fewer filled teeth than residents who did not require assistance. CONCLUSIONS: Nursing home residents in Victoria are retaining an increasing number of natural teeth and have more tooth surfaces at risk for dental caries. Untreated dental caries was a significant problem for residents, particularly for those who are dependent on others for their daily oral hygiene care.

Oral hygiene and periodontal disease in Victorian nursing homes.

OBJECTIVE: To investigate oral hygiene and periodontal disease in residents of Victoria nursing homes. BACKGROUND: The Australian population is ageing with a growing proportion of elderly Australians living in nursing homes. With declining edentulism rates, periodontal disease is becoming more prevalent in this population. MATERIALS AND METHODS: A total of 275 dentate residents from 31 Victorian nursing homes had a questionnaire and clinical examination using the Visual Plaque Index and a modified Community Periodontal Index. RESULTS: Self-reported oral hygiene habits of residents were poor, with less than one-third of residents cleaning their teeth twice daily or more. Periodontal health was found to be extremely poor, and the prevalence of 4 mm+ periodontal pockets was 35.6%, with 10.2% having 6 mm+ pockets. Logistic regression found that age, gender, number of teeth present and oral hygiene were all strongly associated with the prevalence of 4 mm+ periodontal pockets. CONCLUSION: Poor oral hygiene and the presence of significant plaque and calculus were common findings in this study. Periodontal diseases are a significant problem for residents in nursing homes. Addressing this health issue will require improved training for carers and better access to appropriate dental services.

Impact of COVID-19 on the provision of paediatric dental care: Analysis of the Australian Child Dental Benefits Schedule.

OBJECTIVES: Oral health is essential to maintaining good overall health, and access to dental care is necessary for the early detection, prevention and control of oral diseases. The COVID-19 pandemic has seen a significant disruption in the provision of dental services globally. The aim of this study was to investigate the impact of COVID-19 on dental services provided in Australia through the Child Dental Benefits Schedule. METHODS: This study was a retrospective analysis of Medicare data on utilization of the Child Dental Benefits Schedule obtained from the Australian Government. Data were analysed for the period February to September 2020, with the number of services provided per month across five categories (diagnostic, preventive, restorative, endodontic and oral surgery) compared with the monthly average for 2019 (95% CI) and the same month for 2019. Total services by month were reported for 2017, 2018 and 2019 to compare the yearly trend with 2020. Differences in services provision by State/Territory were also described. RESULTS: Over the period of March to September, there were 881 454 fewer dental services provided in 2020 than 2019, with the largest decline seen in April. There was a greater decline in preventive and diagnostic services, and a smaller decline in endodontic and oral surgery services. A second wave of COVID-19 in Victoria saw 198 609 fewer dental services provided in that state from July to September 2020 than 2019. Dental service provision had still not returned to normal levels across Australia by September 2020. CONCLUSION: The COVID-19 pandemic has had a significant impact on the provision of dental services to children from lower socioeconomic backgrounds who already experience higher levels of dental disease and disadvantage in accessing dental care. Although the restriction of dental services was deemed necessary in order to minimize the risk of transmission of COVID-19 in the dental setting, the impact of these restrictions on oral health will be long lasting. Given the chronic and progressive nature of dental disease, the deferral of necessary dental care is likely to contribute to poorer oral health and long-term problems for many Australians.

Patient-reported oral hygiene and implant outcomes in general dental practice.

BACKGROUND: This study investigated the possible correlations between patient-performed implant hygiene and peri-implant success and disease, as well as patient-reported outcomes, in a community-based cohort. METHODS: Fifty-one patients (78 implants) from two private general practices were surveyed on their dental implant treatment history, oral hygiene instructions (OHI) received, home hygiene habits and current implant concerns. Their dentition, plaque/calculus scores and clinical implant parameters were examined. Correlations between hygiene habits, risk factors, implant success and peri-implant disease rates were assessed. RESULTS: Implants had a patient-reported mean time in function of 6.7 years. Floss (74.4%), interdental brushes (IDB) (44.9%) and mouthwash (39.7%) were commonly used, while 7.7% of implants were only cleaned by brushing. Over half (56.4%) of implants fulfilled the success criteria, 61.5% had peri-implant health, 24.4% had mucositis and 7.7% had peri-implantitis. Only brushing (P < 0.001) and detectable plaque/calculus (P < 0.001) were significantly associated with more peri-implant disease. Local prosthetic factors affecting cleaning accessibility significantly reduced implant success (P < 0.001). Patients reported mixed recall of implant OHI, 7.7% of implants were aesthetically unsatisfactory and 9.0% had peri-implant symptoms. CONCLUSIONS: Lack of interproximal cleaning and the presence of plaque/calculus were significantly associated with peri-implant disease in a community-based general practice setting, and patients reported mixed recall of OHI.

Dental Implant Hygiene and Maintenance Protocols: A survey of oral health practitioners in Australia.

Purpose: Dental implant care and maintenance is of critical importance as implants grow in popularity as a tooth replacement option. The purpose of this study was to investigate the implant-related training and clinical practices of oral health practitioners (OHPs) in Australia regarding oral hygiene instructions (OHI) and maintenance protocols, and to better understand their role in providing peri-implant services.Methods: A 42-item web-based survey was forwarded to the members of the Dental Hygienists Association of Australia and the Australian Dental and Oral Health Therapists' Association. Survey items included participant's demographics, types of peri-implant services provided in the workplace, implant-related information sources, peri-implant diagnostic preferences, implant maintenance protocols and oral hygiene instructions (OHI) for dental implants. Descriptive statistics were used to analyse the data. Comparisons were made with a similar survey of the implant maintenance preferences of general dentists in Australia.Results: One hundred fifty-four Australian OHPs completed the electronic survey (n=154). Nearly all respondents (96.7%) considered implant home hygiene and peri-implant health to be strongly associated. Dental qualification (64.9%) and association-sponsored professional development courses (50.6%) were the most common sources of implant assessment/management information. Brushing (88.7%) and the use of an interdental brush (78.1%) were the most popular implant-specific OHI provided. All of the respondents reported performing oral hygiene assessments around dental implants; 94.0% performed supragingival cleaning, 67.5% subgingival cleaning, 55.0% treated peri-implant mucositis and 38.4% peri-implantitis. Dental floss (80.9%), rubber-cup prophylaxis (59.6%), plastic/carbon curettes (52.5%) and plastic-tipped ultrasonics (43.3%) were the most common devices used for implant maintenance.Conclusion: Australian OHPs reported providing peri-implant services generally in agreement with the current literature and demonstrated a greater focus on prevention as compared with Australian dentists. Oral health practitioners in Australia expect to be highly involved in dental implant maintenance care and provide the majority of preventive, periodontal and OHI services in their workplaces.

Factors associated with the recruitment and retention of dentists in the public sector.

OBJECTIVES: There is an increasing demand for public dental services in Australia, with many community dental clinics unable to meet this demand because of an inadequate number of dentists in the workforce. The aim of this study was to identify factors contributing to the recruitment and retention of dentists in the public sector. METHODS: A postal questionnaire survey of 180 dentists (response rate 75.6 percent) working in the Victorian public sector was undertaken to investigate the characteristics of public sector dentists, job satisfaction, remuneration, perceptions of public dentistry, future career intentions, and issues that relate to recruitment and retention of staff. RESULTS: Victorian public dentists' main reason for entering the public sector was to work in a community-based setting in a supportive and mentored environment. The main factors related to dentists leaving the public sector were poor remuneration, lack of clinical experience, and frustration with administrative policies. Victoria's oral health workforce shortages in the public sector are mainly attributed to retention issues. The potential for mentoring and a desire for helping those in need were factors attracting dentists to work in the public sector. CONCLUSION: There was a disproportionate number of female dentists in the public sector compared with the general population, and female dentists had a lower mean salary than male dentists regardless of experience. A range of factors were associated with retention, and gradual frustration because of poor remuneration and lack of professional autonomy were significant reasons for the decision to leave the public sector.

Pattern of dental caries experience on tooth surfaces in an adult population.

OBJECTIVES: To determine the pattern of caries experience across teeth and surfaces in an adult population depending on age and exposure to water fluoridation. METHODS: Between November 2002 and March 2003 a total of 973 subjects aged 17-51 years had a clinical examination using visual and tactile criteria. Subsequent to this examination, bitewing radiographs were taken and viewed separately. Approximal and occlusal surfaces of molars and premolars were examined on the radiographs. RESULTS: Caries experience was relatively low, with mean DMFS scores of 3.21, 5.12, 9.61, 13.04 and 24.35 for subjects aged 17-20, 21-25, 26-30, 31-35 and 36-51 years respectively. The first molar teeth had the greatest caries experience, and occlusal surfaces had more caries experience than approximal surfaces. Subjects with a lifetime exposure to fluoridated drinking water had significantly lower caries experience than those who had no exposure to fluoridated drinking water. CONCLUSION: This study showed that caries prevalence, although relatively low in the study population, was found predominantly in occlusal surfaces, with an increasing prevalence in approximal surfaces of posterior teeth in older subjects. Subjects with a lifetime exposure to fluoridated drinking water had a lower level of caries experience than those with no exposure to fluoridated drinking water, and this was more noticeable in approximal surfaces than occlusal surfaces.

Comparison of radiographic and clinical diagnosis of approximal and occlusal dental caries in a young adult population.

OBJECTIVES: The aims of the study were: (1) to determine if bitewing radiographs provided additional diagnostic yield for occlusal and approximal dental caries in adults aged between 17 and 30 years of age when compared with a clinical examination only, (2) how this translated into the measurement of dental caries experience, and (3) to determine the influence of water fluoridation on the diagnosis of dental caries in occlusal and approximal surfaces by clinical examination alone and by radiographic examination. METHODS: Between November 2002 and March 2003 a total of 879 subjects aged 17-30 years had a clinical examination using visual and tactile criteria. Subsequent to this examination, bitewing radiographs were taken and viewed separately and blind. Approximal and occlusal surfaces of molars and premolars were examined on the radiographs. RESULTS: Between 22.9-32.9% of approximal caries and 75.9-82.9% of occlusal caries was detected by clinical examination, while 93.1-97.1% of approximal caries and 33.1-42.6% of occlusal caries was detected by radiographic examination. In addition, while only 0.97% of clinically sound approximal surfaces and 0.83% of clinically sound occlusal surfaces were diagnosed with dentine caries on the radiographs, 67.1-77.1% of approximal caries was detected by radiographs alone, an additional diagnostic yield of 204-336%. The DS score increased 45-46% and the DMFS score increased 6-11% from the clinical examination with the addition of the radiographic information (P<0.001). CONCLUSIONS: The prevalence of approximal and occlusal caries was underestimated when clinical means only were employed. There was a significant increase in DS and DMFS scores from the clinical examination only when radiographic information was added across all age groups (P<0.001). This study confirms the value of bitewing radiographs in caries diagnosis.

Dental therapists' expanded scope of practice in Australia: a 12-month follow-up of an educational bridging program to facilitate the provision of oral health care to patients 26+ years.

OBJECTIVES: Prior to 2009, dental therapists' scope of clinical practice in Victoria was limited to patients 25 years or younger. However, increases in dental demand by adults 26+ years required an alternative approach to service delivery. This paper outlines the self-reported confidence and knowledge level of dental therapists at 3, 6, and 12 months postcompletion of an educational program aimed at providing them with the skills to treat adults aged 26+ years. The study also surveyed dentists in the practice about the dental therapists' knowledge and the impact of their extended scope of practice on the clinics' operation. METHODS: After completion of their educational program, the dental therapists who participated were surveyed at 3, 6, and 12 months postcompletion to assess their self-reported confidence levels and knowledge. Senior dentists at the clinic were surveyed to understand the impact of the subsequent change in practice of the dental therapists who undertook this training, as well as any concerns of perceived educational gaps. RESULTS: Surveys showed increased self-reported confidence levels by the dental therapists at 3, 6, and 12 months after completion of the program. Dental therapists and mentoring dentists identified that further education was needed in areas such as oral medicine, pathology, medically compromised patients, medications, prosthodontics, and referrals. CONCLUSIONS: Dental therapists felt confident and knowledgeable postprogram to treat patients 26+ years, within their scope of practice. Dentists generally felt that dental therapists, after completing the educational program, were confident and knowledgeable. Educational areas to focus on in future programs were identified.

Exposure to fluoridated drinking water and dental caries experience in Australian army recruits, 1996.

OBJECTIVES: The purpose of this study was to investigate a group of young Australian adults to determine their caries experience and measure associations between caries experience and age, gender, socioeconomic status, education level and lifetime exposure to fluoridated water. METHODS: This was achieved through a cross-sectional study involving Australian Army recruits seen for their initial dental examination on enlistment into the Australian Army. A total of 499 recruits had a clinical examination with the aid of bitewing radiographs and an orthopantomograph (OPG). Sociodemographic and fluoride exposure data were obtained via a questionnaire. RESULTS: This study showed that subjects with a lifetime exposure to fluoridated water reported a 23% lower level of caries experience than subjects with no exposure to fluoridated water, with a greater effect on proximal surfaces compared to smooth and occlusal surfaces. Female subjects had a level of caries experience 25% higher than male subjects, while subjects from the lowest socioeconomic background had a level of caries experience 89% times greater than subjects from the highest socioeconomic group. CONCLUSIONS: Although it is not possible to directly establish a causal relationship from a cross-sectional study such as this, the results from this study show a dose-response relationship which suggests that there are benefits of lifetime exposure to fluoridated drinking water through young adulthood.