What factors are associated with dental general anaesthetics for Australian children and what are the policy implications? A qualitative study.

BACKGROUND: Dental general anaesthetics undertaken on young children are amongst the most common of all potentially preventable hospitalisations of children in Australia. They are costly for families and the community and entail some risk. The aim of the study was to explore the views of stakeholders about factors associated with children's dental general anaesthetics in Victoria, Australia and to identify policy implications. METHODS: Interviews with stakeholders were used to develop a framework of factors. Interview data were subject to qualitative analysis, informed by Interpretative Phenomenological Analysis. RESULTS: Eight themes that encompassed 30 main factors were identified through focused discussions with 16 stakeholders. While the safety of dental general anaesthetics has improved and mortality rates are low, side effects are common. Push factors for children's dental general anaesthetics include a perceived greater 'child-focus'; preferred models of care; low oral health literacy; parent guilt; convenience; and some dentists reluctance to treat high needs children in the clinic. Factors that may decrease the prevalence of dental general anaesthetics include: prevention of dental caries; using alternative approaches; an appropriate workforce mix; enhancing oral health literacy; and development of guidelines. CONCLUSION: The prevalence of hospitalisation of children to treat dental caries is increasing. Many factors influence the prevalence of paediatric dental general anaesthetics - relating to the child, parent, oral health professional, financial impact, health risk, and accessibility to facilities. There are quality of care and convenience benefits but also high costs and possible health risks. Family, workforce and health system factors have been identified that could decrease the prevalence of paediatric dental general anaesthetics.

The oral health status of older patients in acute care on admission and Day 7 in two Australian hospitals.

Objective: to determine the oral health status of older patients in acute care wards at admission and after 7 days. Methods: a prospective descriptive study was conducted in two acute tertiary referral hospitals in New South Wales, Australia. Oral health was assessed on admission (within 24 h) and Day 7 using the Oral Health Assessment Tool. Results: a total of 575 patients were admitted under the Geriatric teams at the two hospitals. Four hundred and thirty-five (76%) patients had oral cleanliness (debris) scores in the 'not healthy' range with food particles, tartar or plaque evident in at least one area in most areas of the mouth, teeth or dentures. At Day 7 206 were reassessed. One hundred and forty-nine patients (73%) were in the 'not healthy' range and of these 127 (62%) had the same score as on admission. Conclusion: poor oral health is common in older people admitted to hospital acute care wards and does not improve over a 7-day period. Given the link between oral health and general health the next steps are to determine how oral health can be improved in this setting and see whether this leads to better patient outcomes.

A pilot study on the feasibility of training nurses to formulate multicomponent oral health interventions in a residential aged care facility.

OBJECTIVES: This 10 weeks feasibility study investigated whether residential care nurses with 12 hours advanced oral health training in assessments and saliva testing could formulate, implement and monitor individualised oral care plans of early dementia residents. METHOD: Four trained lead advocate nurses using SXI-D, OHIP14, oral health assessment tool (OHAT) assessments and a modified saliva test formulated nurse scheduled comprehensive oral care plans (NSCOCPs) by selecting and scheduling preventive products and procedures multiple times throughout the day to alkalise the mouth of 8 residents as an adjunct to assisted brushing and high-fluoride toothpaste. RESULTS: Nurse assessments, saliva tests and care plans were validated against oral health therapist (OHT) findings. Care plan agreement between Nurse and OHT intervention selection and scheduling was high (75%-88%). Untrained nurse compliance was very high, 86%-99% for the 4930 scheduled interventions. Untrained nurses delivered multiple scheduled interventions by following NSCOCPs despite initially not understanding the reason for each of 9 interventions categories. NSCOCPs could track and monitor whether a recommended intervention had been completed by general nursing staff over 3 nursing shifts. CONCLUSION: The role of nurses may have to be expanded beyond traditional roles to meet the growth and changes in oral health needs in residential facilities. Intensive training of a few lead advocate nurses to assess risk and formulate individualised NSCOCPs provides a method to transfer knowledge to untrained staff and deliver multicomponent preventive interventions soon after entry into residential care where timely visits by dental professionals to examine residents and prescribe preventive interventions are infrequent or unlikely.

The Early Childhood Oral Health Program: promoting prevention and timely intervention of early childhood caries in NSW through shared care.

ISSUE ADDRESSED: Early childhood caries (ECC) continues to have high prevalence worldwide, despite being largely preventable. The Early Childhood Oral Health (ECOH) Program was established in New South Wales (NSW) using a model of shared responsibility for oral health, which involves a partnership between child health professionals, oral health professionals and parents of young children, to facilitate the primary prevention, early identification and early intervention of ECC. METHODS: An evaluation of the ECOH program was conducted, using mixed methods. Data were obtained through document review, surveys and interviews with program implementers, and analysis of the Information System for Oral Health (ISOH) database for public oral health services activity in NSW. RESULTS: Key achievements of the ECOH program include the establishment of governance mechanisms, policy, structures and responsibilities for implementation, support mechanisms for child health professionals, referral processes, communications resources, and the delivery of training. Parents receive oral health information, education and support through written resources and contact with child health professionals. Child and family health nurses interviewed reported routinely incorporating oral health promotion and early identification for ECC into their practices. The referral rate to public oral health services for children under five years of age by community health professionals has increased steadily since the program began, with the rate in 2009 five times higher than in 2007. CONCLUSIONS: Models of shared responsibility for oral health between parents, child health professionals and oral health professionals can facilitate primary prevention and early intervention for ECC.

The contribution of the Scottish doctor Robert Erskine to the development of Russian medicine in the 18th century.

The Scottish doctor Robert Erskine (1677-1718) became Chief Doctor of Russia and personal physician to Tsar Peter the Great. Extensive archival material documents his remarkable career. From schooling in the village of Alva and apprenticeship to an Edinburgh apothecary, he went on to study medicine in Paris and Utrecht and was admitted to the Royal Society in London. Recruited into the service of the Tsar, to whom he became a trusted friend and counsellor, Erskine played a central role in the modernisation of Russian medicine, pharmacy and natural science in the early 18th century. His untimely death at age 41 was marked with a state funeral in St Petersburg. Some historians in Russia assert that in their country, the development of medicine and the natural sciences took place without the transitional stages of iatrochemistry and iatrophysics which characterised the shift in scientific thinking throughout Europe in the early modern period. This study of archival records shows that Erskine held iatrophysical and iatrochemical views in common with his European contemporaries. His influence ensured that Russia was thoroughly involved in European developments in science and medicine in the 18th century.

A qualitative process evaluation of an oral health promotion program for older migrant adults.

ISSUES ADDRESSED: Qualitative process evaluation of a community-based health promotion program conducted to improve the use of oral health services, oral health knowledge, attitudes, and practices of older Greek and Italian adults living in Melbourne, Australia. METHOD: Fifteen focus groups were conducted with a sample of program participants (n=151) aged 55 and over, drawn from nine Italian and six Greek ethnic clubs. The focus groups sought participants' views about all aspects of the oral health promotion program and delivery, including the use of educational seminars; the preparation of simple language printed material known as the ORHIS (Oral Health Information Seminars/Sheets); and the distribution and demonstration of oral care products relevant to each individual seminar. RESULTS: Participants expressed positive views about the program and delivery approach. Findings indicated the importance of communicating dental information through a culturally relevant approach using easily understandable printed material in the participants' native languages; using the venue of their social clubs for health promotion efforts; and using an interactive and socially supportive approach that combined information giving, skills development and discussion in small groups over time. CONCLUSIONS: This process evaluation indicated that the ORHIS approach was perceived by participants as appropriate in assisting them to raise awareness of oral health issues and improving oral health knowledge and behaviours. This approach was highly acceptable to and valued by these communities. Findings suggest that when migrant populations are afforded greater consideration and time to learn about oral health concerns in an accessible and culturally relevant manner, the results may be quite positive.

Factors associated with self-reported use of dental health services among older Greek and Italian immigrants.

The authors discuss utilization of dental health services by older Greek and Italian immigrants in Melbourne, Australia. Their study involved 374 Greek and 360 Italian adults who completed a questionnaire and received an oral examination. Nearly 41% of Greek and 45% of Italian respondents had used dental services in the previous year. As barriers to care, Greek participants most often cited waiting lists and waiting time in the office. Italian participants most often identified cost, length of waiting lists and language barriers. Multivariate analyses associated recent use of dental services with number of teeth, oral health knowledge, age and occupation before retirement for both groups, as well as living arrangements among Greek participants and perceived barriers among Italian participants. Findings highlight the need for oral health promotion programs targeted toward older adults from immigrant populations and reductions of the structural barriers that prevent these adults from seeking oral health care.

Factors influencing perceived oral health of Japanese middle-aged adults.

The objective of this study was to analyze the relationships between subjective oral health symptoms and clinical oral health conditions on the perceived oral health of 1799 Japanese middle-aged adults. A self-administered questionnaire together with dental examinations was administered. A structural equation modeling analysis with Bayesian estimation was used to examine the factors influencing perceived oral health as a latent variable with 4 other latent variables: subjective oral health symptoms, clinical tooth conditions, clinical periodontal conditions, and other clinical oral conditions. For perceived oral health as the endogenous variable, only subjective oral health symptoms and clinical tooth conditions showed significant relationship. Clinical periodontal conditions and other clinical oral conditions did not show significant effects on the perceived oral health.

Dental caries and fluorosis experience of 8-12-year-old children by early-life exposure to fluoride.

BACKGROUND: It is important to evaluate concurrently the benefit for dental caries and the risk for dental fluorosis from early exposure to fluoride among children. AIM: To evaluate associations of different levels of exposure to fluoride in early childhood with dental caries and dental fluorosis experience in school children. METHODS: A Child Dental Health Survey (CDHS) was conducted among school children in the Australian state of New South Wales (NSW) in 2007. Trained and calibrated examination teams conducted oral epidemiologic examinations to assess caries experience as decayed, missing or filled tooth surfaces of the primary and permanent dentitions (dmfs/DMFS) and fluorosis using the Thylstrup & Fejerskov (TF) index on the maxillary central incisors only. A parental questionnaire collected information on residential histories and tap water usage to enable calculation of percentage of 3-year lifetime exposure to fluoride in water. Use of dietary fluoride supplements was also collected. Dental caries and fluorosis experience were compared among groups by levels of exposure to fluoride from water and fluoride supplements in bivariate and multivariable analysis, controlling for socioeconomic factors. RESULTS: Exposure to different fluoride sources varied in the group of 2611 children aged 8-12 years. Lower household income was significantly associated in both bivariate and multivariable analyses with the greater prevalence and severity of primary tooth caries among 8-10-year-old children and permanent tooth caries among 8-12 year old. Exposure to fluoride in water during the first 3 years of life was associated with both caries and fluorosis experience observed at age 8-12 years. Having higher percentage of 3-year lifetime exposure to fluoride in water was associated with higher prevalence of mostly mild fluorosis, but significantly lower prevalence and severity of caries in the primary and permanent dentitions. CONCLUSION: There were significant associations of dental caries and fluorosis experience with sources of early childhood fluoride exposure among children aged 8-12 years in New South Wales. Exposure to fluoridated water during the first 3 years of life was associated with better oral health of school-age children.

Utilisation of the Medicare Teen Dental Plan in NSW, 2008-2010.

AIM: To examine the use of the Medicare Teen Dental Plan in NSW, its uptake in the private and public dental sectors and to map the geographical pattern of program use. METHODS: Data describing the use of the Medicare Teen Dental Plan were assembled from a variety of sources including Medicare, the NSW Oral Health Data Collection and the NSW Teen Dental Survey 2010. RESULTS: In 2010, use of the Medicare Teen Dental Plan across the entire NSW eligible aged population ranged from 20 to 25.5%, with the average usage across all ages being 20.2%. For the period 2002 to 2010, the average utilisation rate for teenagers accessing public dental care was approximately 6.8%. CONCLUSION: As a single Dental Benefits Schedule item is used for service provided under the Plan, it is difficult to evaluate the mix of dental treatment items and the comparative value of the service provided unless these services are provided in a public dental service with a data collection that can flag care provided under a Medicare Teen Dental Plan voucher.

Economic evaluation of preventive dental programs: what can they tell us?

The role of public health program planners is to determine the effectiveness of public health programs, what recommendations should be made, what future initiatives should be taken, and what policies should be developed. At a basic level, to choose between competing alternatives, two characteristics of an intervention must be considered; these are its outcome and its cost. Based on cost and outcome, planners must select the option that offers the most advantages. Economic evaluation is commonly adopted by decision makers in the health sector to investigate the effectiveness of public health programs and to help plan future initiatives. Economic evaluation assists decision makers who must weigh the information it provides in the context of many and often competing options. In this way, an economic evaluation is an aid to decision making rather than the decision itself. Economic evaluation is becoming essential for informed decision making, with potential implications for public health policy and practice and for clinical practice too. While economic evaluations are commonly used in decision-making processes about health programs, few examples exist in the oral health literature. In the case of preventive oral health programs, economic analysis is often difficult, largely because it makes demands on epidemiological and demographic data that are hard to meet. This study will address the concepts and tools required to conduct economic evaluations of prevention programs. The emphasis will be on oral health and preventive dental programs, although the concepts presented could be useful for other public health programs by practitioners and managers with the aim of producing effective and efficient oral health programs.

Oral health promotion programme for older migrant adults.

OBJECTIVES: This study evaluated the impact of a community-based oral health promotion programme on the use of oral health services, oral health knowledge, attitudes, and practices of older Greek and Italian adults attending community clubs and living in Melbourne, Australia. METHODS: The oral health promotion intervention consisted of three components: a series of oral health seminars, held at the clubs in the participants' native languages, the provision of oral health care products, and the production of oral health information sheets. The intervention programme was known as the Oral Health Information Seminars/Sheets (ORHIS). The content of each session was determined following suggestions and findings from the data collected. A pre-test-post-test non-equivalent control group quasi-experimental design was chosen to evaluate the intervention. A total of 520 independent-living older adults, members of Greek or Italian social clubs participated in this evaluation. RESULTS: Participants who took part in the intervention responded with higher levels of achievement than those in the control groups. After controlling for baseline variables, experimental groups were significantly more likely than the control groups at post-test to have improved oral health attitudes, oral health knowledge, and self-assessed physical health status, as well as, self-reported oral hygiene practices and use of oral health services. DISCUSSION: The ORHIS approach was successful within the setting of social clubs, and highly acceptable to these communities. As such, it represents a helpful approach for the design of (oral) health interventions in older adults. Further research is required to test the long-tem impact including the economic evaluation of the ORHIS approach.