Exploring personality in Australian dentistry students: Implications for coping with a challenging degree.

INTRODUCTION: Dentistry is known to be a challenging degree and students are often under considerable academic pressure which may lead to stress and difficulties in coping. Personality influences coping ability, yet very little is known about the personality traits of dentistry students. This study aimed to describe the personality profiles of students enrolled in an Australian undergraduate dental degree. METHODS: Students enrolled in year one and two of the undergraduate dental programme at The University of Queensland were invited to complete an online survey which included the Temperament and Character Inventory (TCI). Personality was measured by four dimensions of temperament: Novelty Seeking, Harm Avoidance, Reward Dependence and Persistence; and three-character traits: Self-Directedness, Cooperativeness and Self-Transcendence. Data analysis was mostly descriptive, and t tests and univariate statistics compared groups. RESULTS: Participants (n = 134; 97% response rate; females = 51%) were generally single, spoke another language at home and lived in shared accommodation. The majority (55%) were 20-29 years old, and 40% were international students. The sample had average levels of all TCI traits, except for Cooperativeness which was high. CONCLUSIONS: This sample of dentistry students portrayed a profile of temperament and character similar to profiles of other health profession students with the intellectual ability and drives to undertake a competitive and challenging degree. Longitudinal studies are needed to track changes in personality throughout the degree. This would provide insight into how and when to best support students.

Porphyromonas gingivalis antibody levels and diagnosis of coronary artery disease in HIV-positive individuals.

BACKGROUND AND OBJECTIVE: Periodontal disease has been associated with cardiovascular disease in the general population. It is unknown whether IgG antibody levels for periodontal pathogens are associated with the diagnosis of coronary artery disease (CAD) in HIV-positive individuals. MATERIAL AND METHODS: Twenty-four HIV-positive individuals (cases) with stored plasma available in the 12 months before CAD diagnosis were age- and sex-matched 1:2 with 46 HIV-positive individuals without CAD (controls). Antibody levels to whole cell extracts from periodontal pathogens Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Fusobacterium nucleatum, as well as markers of inflammation sCD14, CXCL10 and high-sensitivity C-reactive protein, were compared between cases and controls using enzyme-linked immunosorbent assays. RESULTS: P. gingivalis-specific IgG levels (µg/mL) were significantly higher in individuals with CAD (median 1.48 [IQR 1.06-2.05]) compared to controls (0.70 [IQR 0.35-1.24], P<.001), and remained significantly higher following adjustment for traditional cardiovascular risk factors and HIV viral load (OR 21.6 [95% CI 3.73-125.63] P=.001). There was a borderline association between A. actinomycetemcomitans IgG antibody levels (cases, median 3.86 [IQR 3.19-4.72]; controls, 3.34 [IQR 2.59-4.07], P=.050) and no association found between F. nucleatum antibody levels and CAD. sCD14 levels (µg/mL) were higher in cases compared with controls (median 3.45 [IQR 3.03-4.11] vs 2.65 [IQR 2.32-2.99] P<.001), while CXCL10 (median 127 pg/mL [IQR 88-157] vs 153 [IQR 90-244] P=.321) and high-sensitivity C-reactive protein (median 3.44 mg/L [1.98-5.32] vs 1.85 [1.13-6.88] P=.203) levels were not different between cases and controls. CONCLUSION: Periodontal bacteria may be contributing to CAD risk in HIV-positive individuals.

Grassland to shrubland state transitions enhance carbon sequestration in the northern Chihuahuan Desert.

The replacement of native C4 -dominated grassland by C3 -dominated shrubland is considered an ecological state transition where different ecological communities can exist under similar environmental conditions. These state transitions are occurring globally, and may be exacerbated by climate change. One consequence of the global increase in woody vegetation may be enhanced ecosystem carbon sequestration, although the responses of arid and semiarid ecosystems may be highly variable. During a drier than average period from 2007 to 2011 in the northern Chihuahuan Desert, we found established shrubland to sequester 49 g C m(-2) yr(-1) on average, while nearby native C4 grassland was a net source of 31 g C m(-2) yr(-1) over this same period. Differences in C exchange between these ecosystems were pronounced--grassland had similar productivity compared to shrubland but experienced higher C efflux via ecosystem respiration, while shrubland was a consistent C sink because of a longer growing season and lower ecosystem respiration. At daily timescales, rates of carbon exchange were more sensitive to soil moisture variation in grassland than shrubland, such that grassland had a net uptake of C when wet but lost C when dry. Thus, even under unfavorable, drier than average climate conditions, the state transition from grassland to shrubland resulted in a substantial increase in terrestrial C sequestration. These results illustrate the inherent tradeoffs in quantifying ecosystem services that result from ecological state transitions, such as shrub encroachment. In this case, the deleterious changes to ecosystem services often linked to grassland to shrubland state transitions may at least be partially offset by increased ecosystem carbon sequestration.

Coping with an altered mouth and perceived supportive care needs following head and neck cancer treatment.

PURPOSE: Oral health is essential to general health and well-being and is severely impacted by head and neck cancer (HNC) and its treatment. This study aimed to describe how people who have been treated for HNC cope with altered oral health and function and to identify their supportive care needs. METHODS: A qualitative, descriptive approach was used. Data was collected from individual interviews with six participants 6 months after treatment. Data analysis was performed by qualitative content analysis involving inductive and directed approaches. Directed content analysis was guided by the Stress, Appraisal and Coping Model. RESULTS: Three themes describing changed oral health were identified from the data: dimensions of eating, maintaining oral health after treatment and adapting to the chronic side effects of treatment. A strong use of problem-focussed coping was described, in addition to the importance of peer support in adapting to the psychosocial outcomes of treatment. Support needs identified related to increased access to specialist dental oncology services post treatment, information needs and a need for more psychological support. CONCLUSION: The study findings describe the experience of a sample of people who have received treatment for HNC. Due to a demographically homogenous sample and the strong use of positive coping strategies, the results presented may not describe the experience of the wider HNC population; however, these results provide insight into factors that may influence positive coping.

Oral mucosal screening and referral attitudes of Australian oral health therapists and dental hygienists in Queensland.

OBJECTIVES: The aim of this study was to describe oral mucosal screening and referral attitudes of Australian oral health therapists (OHTs) and dental hygienists (DHs). METHODS: Questionnaires were distributed to participants who attended dental hygiene courses run in both regional and metropolitan Queensland. RESULTS: One hundred and two participants comprised 58 OHTs and 44 DHs, with a mean of 8.9 years since graduation. Thirty-four participants worked in regional locations, while 68 were from metropolitan areas. 97% of participants agreed that mucosal screening should be performed for all new and recall patients, while a minority (5%) agreed that patients will detect an oral mucosal change themselves. The majority (77%) agreed that oral cancer would be encountered in their practising career. Most participants (81%) felt comfortable discussing the presence of a suspicious lesion with patients and 88% agreed that it was their role to screen. In terms of barriers to oral cancer screening, lack of training was seen as the most prevalent barrier (56%) followed by lack of confidence (51%). Lack of time was seen as the third most prevalent barrier (40%), and lack of financial incentives was the least prevalent barrier (16%). CONCLUSIONS: Oral health therapists and DHs understand the importance of oral mucosal screening and are likely to be alert to oral mucosal changes. While lack of time and financial incentives was perceived to be impediments to mucosal screening, lack of confidence and training was the most prevalent barriers. This issue should be addressed through implementation of effective continuing education courses targeting oral cancer screening and referral practices.

Six-coordinate nitrito and nitrato complexes of manganese porphyrin.

Reaction of small increments of NO2 gas with sublimed amorphous layers of Mn(II)(TPP) (TPP = meso-tetra-phenylporphyrinato dianion) in a vacuum cryostat leads to formation of the 5-coordinate monodentate nitrato complex Mn(III)(TPP)(η(1)-ONO2) (II). This transformation proceeds through the two distinct steps with initial formation of the five coordinate O-nitrito complex Mn(III)(TPP)(η(1)-ONO) (I) as demonstrated by the electronic absorption spectra and by FTIR spectra using differently labeled nitrogen dioxide. A plausible mechanism for the second stage of reaction is offered based on the spectral changes observed upon subsequent interaction of (15)NO2 and NO2 with the layered Mn(TPP). Low-temperature interaction of I and II with the vapors of various ligands L (L = O-, S-, and N-donors) leads to formation of the 6-coordinate O-nitrito Mn(III)(TPP)(L)(η(1)-ONO) and monodentate nitrato Mn(III)(TPP)(L)(η(1)-ONO2) complexes, respectively. Formation of the 6-coordinate O-nitrito complex is accompanied by the shifts of the ν(N═O) band to lower frequency and of the ν(N-O) band to higher frequency. The frequency difference between these bands Δν = ν(N═O) - ν(N-O) is a function of L and is smaller for the stronger bases. Reaction of excess NH3 with I leads to formation of Mn(TPP)(NH3)(η(1)-ONO) and of the cation [Mn(TPP)(NH3)2](+) plus ionic nitrite. The nitrito complexes are relatively unstable, but several of the nitrato species can be observed in the solid state at room temperature. For example, the tetrahydrofuran complex Mn(TPP)(THF)(η(1)-ONO2) is stable in the presence of THF vapors (∼5 mm), but it loses this ligand upon high vacuum pumping at RT. When L = dimethylsulfide (DMS), the nitrato complex is stable only to ∼-30 °C. Reactions of II with the N-donor ligands NH3, pyridine, or 1-methylimidazole are more complex. With these ligands, the nitrato complexes Mn(III)(TPP)(L)(η(1)-ONO2) and the cationic complexes [Mn(TPP)(L)2](+) coexist in the layer at room temperature, the latter formed as a result of NO3(-) displacement when L is in excess.

Support needs and quality of life in oral cancer: a systematic review.

PURPOSE: This review aims to systematically review the literature describing quality of life (QoL) outcomes and support needs in patients with oral cancer along the cancer trajectory. This is needed to form an evidence base for the design of interventions that enhance outcomes for this group. METHODS: Six electronic databases were searched. The results were screened for eligibility, and articles were included if they described patient-reported QoL outcomes that were translatable to support needs in patients with oral cancer. Data were extracted and synthesized according to the support needs identified and their relative impact on QoL. Methodological quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. RESULTS: Thirty-one articles met the inclusion criteria. Support needs related to coping with the burden of radiotherapy in both psychosocial and physical aspects, swallowing dysfunction, dry mouth and oral functional deficits. Issues of depression, anxiety and malnutrition were identified as having a significant impact on QoL. CONCLUSIONS: Oral cancer support needs are highly subjective and varied in severity across the cancer continuum. Support needs that may warrant further investigation include management of changes to oral health and functioning, swallowing and nutritional compromise and psychological effects of cancer and treatment.

Hope language in patients undergoing epilepsy surgery.

Candidates for epilepsy surgery often use the word "hope" to express their attitudes and beliefs about surgery. However, studies suggest that hope has a multiplicity of meanings that are not well understood. The goal of this analysis was to evaluate whether Candidates for epilepsy surgery use hope language to express a traditional, expected optimism during presurgery interviews. We examined patients' uses of the word "hope" and its derivatives (hoping, hopeful, hopefully) through a secondary analysis of 37 interviews of adult patients prior to epilepsy surgery. Approximately 1/3 of all hope statements were coded as expressions of optimism, while 1/3 were not optimistic, and 1/3 had unclear meanings. In addition to traditionally optimistic uses of the term, other themes surrounding use of this word included ideas of dread, worry, uncertainty, and temporizing language. This information may help clinicians communicate more effectively with patients, enhancing the informed consent process for epilepsy surgery.

Shared learning for oral health therapy and dental students: enhanced understanding of roles and responsibilities through interprofessional education.

INTRODUCTION: To enhance interprofessional learning outcomes, The School of Dentistry at The University of Queensland redesigned first-year curricula. Courses for Bachelor of Oral Health (OHT) and Bachelor of Dental Science (DS) students were combined, and learning content created to support the development of skills, knowledge and attitudes required for the oral healthcare team to work effectively in providing the best possible care for patients. METHODS: Over a 2-year period, all commencing OHT and DS students were invited to participate in this study. One cohort (n = 93) was enrolled into a traditional, discipline-specific programme (TRAD), whereas the other cohort (n = 93) experienced an integrated learning programme (INT) with combined courses for OHT and DS students. The Readiness for Interprofessional Learning Scale (RIPLS) and a modified dental and dental care professional roles and responsibilities (DRR) survey were completed to determine students' awareness of dental professionals' roles and responsibilities, and their attitudes to interprofessional education and teamwork. RESULTS: Following completion of 1 year of learning, both INT and TRAD cohorts showed similar levels of readiness for shared learning. At the commencement of the second year of the study programme, however, there was a significantly better understanding of shared care amongst INT students. CONCLUSIONS: This study provides initial support for the integrated learning approach adopted by this university. The INT cohort had significantly improved understandings of the roles and responsibilities of dentists and oral health therapists. The results of this study have been used to refine ongoing curriculum developments.

Oral health therapists: what is their role in Australian health care?

The aim of this report was to examine the role of the oral health therapist (OHT) in the contemporary Australian context. The original intent of the OHT role was to address unmet community oral health need in a cost-effective manner. Although it was recognized that OHTs would need to deliver clinical treatment, particularly restorative services for children, the core of their education and their knowledge and proficiency is in oral health and public health promotion. Unmet oral health need persists, and this is especially urgent for the most disadvantaged. Some may argue that this provides evidence that OHTs should provide an expanded range of clinical services, including adult restorative treatment, and that additional training should be provided to enable this to occur. This report counters that view by showing that the current health system does not avail itself of the health promotion services that OHTs are already educated to deliver. Improved health outcomes within the Australian health system are achievable by bringing oral health into the general health system, by introducing models of care aimed at the early detection of risk and disease and by recognizing the importance of public health measures designed to prevent disease.

Root caries: a survey of Queensland dentists.

BACKGROUND: Root caries stands to be a significant burden for Australia's ageing population. The objective of this study was to describe Queensland dental practitioners' perceptions of root caries prevalence, presentation and predisposing factors as well as diagnosis and recording practices. METHODS: Using the Queensland Dental Board register, all 2,515 dentists and dental specialists practising in Queensland were invited to participate in a questionnaire-based postal survey. RESULTS: Of the 660 responses received, 638 were included for final analysis. Use of diagnostic measures such as surface elasticity and contour were reported frequently. A majority of respondents (77%) reported not recording root caries in a way that could be distinguished from coronal caries. Dietary analysis was the most commonly reported adjunctive aid for risk assessment. Recommendations for use of remineralizing agents were frequently reported (home use 90%; in office use 71%). Salivary impairment was reported to be an important risk factor for root caries by 93% of respondents, but only 18% reported performing salivary analysis. A large proportion of respondents (32%) considered patients with diabetes to be of low or no risk of root caries. CONCLUSIONS: While the Queensland dental practitioners who participated in this survey demonstrated an awareness of root caries and its predisposing factors, clinical risk assessment particularly for patients with diabetes should be further examined.

Academic integrity and plagiarism: perceptions and experience of staff and students in a school of dentistry: a situational analysis of staff and student perspectives.

INTRODUCTION: This project has investigated student and staff perceptions and experience of plagiarism in a large Australian dental school to develop a response to an external audit report. METHODS: Workshops designed to enhance participants' understanding of plagiarism and to assist with practical ways to promote academic integrity within the school were provided to all students and staff. Anonymous surveys were used to investigate perceptions and experience of plagiarism and to assess the usefulness of the workshops. RESULTS: Most participants felt that plagiarism was not a problem in the school, but a significant number were undecided. The majority of participants reported that the guidelines for dealing with plagiarism were inadequate and most supported the mandatory use of text-matching software in all courses. High proportions of participants indicated that the workshops were useful and that they would consider improving their practice as a result. CONCLUSIONS: The study provided data that enhanced understanding of aspects of plagiarism highlighted in the report at the school level and identified areas in need of attention, such as refining and raising awareness of the guidelines and incorporation of text-matching software into courses, as well as cautions to be considered (how text-matching software is used) in planning responsive action.

Creating effective and engaging information literacy programmes for the dental curriculum.

In this time of rapid expansion of the scientific knowledge base, subject matter runs the risk of becoming outdated within a relatively short time. Instead of adding more content to already crowded curricula, the focus should be on equipping students to adapt to their changing world. The ability to access, evaluate and apply new knowledge for the benefit of patients has been acknowledged as an important goal for dental education. Information literacy is key to achieving this. A template for an Information Literacy programme for undergraduate students is described. This was embedded within a compulsory course for each of the first and second years of the Bachelor of Oral Health programme and consisted of a hands-on workshop (attendance voluntary), information literacy quiz, self-evaluation and a summative assessment task, with the second year of the programme building upon the learning of the previous year. Effectiveness was measured in terms of demonstration of information literacy skills and confidence in using these skills. Integration of this programme within the learning activities and assessment of first- and second-year courses resulted in enhanced information literacy skills and confidence. Self-perceived high skill levels may be a potential barrier to student engagement with information literacy programmes.

The effect of sterilisation on the plasticity of multi-use Eschmann gum elastic bougies: a bench and manikin study.

We investigated the deterioration in plasticity of the multi-use Portex Tracheal Guide ('bougie') with repeated sterilisation. Six bougies were prepared by washing them between 0 and 100 times (in accordance with the manufacturer's guidelines). Two tests were employed: a bench test in which rapid serial photographs were taken of the bougies uncoiling from a preformed curve; and a manikin-based test in which the six bougies were used in a simulated difficult airway. The bench test demonstrated a progressive deterioration in plasticity with repeated washing. However, the manikin-based test showed no significant difference between bougies in the incidence of oesophageal placement (p = 0.74). Time to placement differed significantly only between the two most-washed bougies but was broadly similar. We suggest therefore that the manufacturer's limit of five washings may be unnecessarily cautious.

Facilitating Access to Dental Care for People Experiencing Homelessness.

INTRODUCTION: Fear, lack of information, and lower health literacy are prominent barriers preventing people experiencing homelessness from accessing dental services. Most of this population are eligible for free dental treatment in Australia, yet few access care. This study evaluated 3 models for facilitating access to dental services for people experiencing homelessness. METHODS: Three facilitated access models were developed and implemented at 4 community organizations. In model 1, dental appointments were booked on the spot after a screening by dental practitioners. Model 2 also involved dental screenings followed by appointments made via phone call from the service. In model 3, the community organizations referred clients directly to the service where appointments were made via a phone call to the client. The models were trialed with community organizations between 2017 and 2019. For each model, participant demographic information, attendance at subsequent dental appointments, and program operation resource use were collected. Cost-effectiveness was assessed as an incremental cost per additional person attending a dental appointment. RESULTS: A total of 76 people participated in model 1, 66 in model 2, and 43 in model 3. Model 1 was the most effective, leading to 84.2 (confidence interval, 75.8-92.7) of every 100 participants attending a dental appointment. Model 2 had a lower effectiveness of 56.1 (44.6-67.6), and model 3 was the least effective, with a mean of 29.3 (15.0-43.6) per 100 participants attending. Incremental cost-effectiveness ratios were $51 per additional person attending a dental appointment for model 3 (compared to no strategy) and $173 per additional person attending for model 1 (compared to model 3). CONCLUSIONS: Model 3 was the most cost-effective strategy of increasing access to dental care for people experiencing homelessness. Decision makers who find the effectiveness of model 3 insufficient should look instead to employ model 1 or a combination of these 2 models. The importance of face-to-face engagement to foster trust between the individual and health care practitioner was evident. KNOWLEDGE TRANSFER STATEMENT: This study provides a range of models for dental and community services to facilitate access to dental care for people experiencing homelessness. Decision makers should consider the needs of vulnerable populations, alternative model designs, and their cost-effectiveness when implementing models of facilitated access to dental care. Face-to-face engagement between clients and dental practitioners by inclusion of a screening stage appears to be instrumental in overcoming barriers to access clinical care.

Trends in Australian dental prescribing of antibiotics: 2005-2016.

BACKGROUND: Prescribing of antibiotics by dentists for surgical prophylaxis or as an adjunct to managing dental infections is a substantial part of the overall landscape for prescribed antibiotics in health care settings. METHODS: We explored trends in the antibiotic prescribing patterns of Australian dentists over the 12-year period, 2005-2016. We obtained data on dispensed prescriptions of antibiotics from registered dentists subsidized on the Pharmaceutical Benefits Scheme. RESULTS: Australian dentists were responsible for almost 7 million dispensed prescriptions of antibiotics over 12 years; an average of 24 prescriptions per year per dentist. The most commonly prescribed antibiotic was amoxicillin, followed by amoxicillin + clavulanic acid and metronidazole. These top three antibiotics constituted more than 80% of all antibiotics prescribed and their use increased dramatically over time. There was a large increase in the prescribing of broad-spectrum antibiotics over time, most of which occurred from 2011 to 2016. CONCLUSIONS: Excessive prescribing of broad-spectrum antibiotics runs contrary to national antimicrobial stewardship (AMS) initiatives and guidelines. Multifaceted educational strategies are essential to align prescribing with current best practice. High-level evidence to inform clear guidelines on antibiotic prescribing in dental infections, with audit and feedback, should reduce the inappropriate use of antibiotics in dentistry.

Leukotriene B4 release by human lung macrophages via receptor- not voltage-operated Ca2+ channels.

Increased numbers of macrophages and neutrophils in the lung is a key feature of chronic obstructive pulmonary disease (COPD). The major neutrophil chemotactic agent in the airways of COPD patients is leukotriene (LT)B(4) and is released by macrophages. The present study examines the role and mechanism of Ca(2+) in platelet-activating factor (PAF)-stimulated LTB(4) release from human lung macrophages. Macrophages were isolated from lung tissue of subjects undergoing lung resection surgery and monocyte-derived macrophages (MDM) were obtained from nonsmokers, smokers without obstruction and COPD patients. Cells were stimulated with PAF and LTB(4) release and [Ca(2+)](i) was measured. Lung macrophages and MDM released LTB(4) following stimulation with PAF (mean effective concentration: 0.08+/-0.06 microM (n = 5) versus 0.17+/-0.12 microM (n = 17), respectively). Compared with MDM, lung macrophages released approximately eight-fold more LTB(4). Neither smoking nor COPD altered MDM responses. PAF-stimulated LTB(4) release was abrogated by ethylene glycol tetraacetic acid suggesting a role for extracellular Ca(2+). This was substantiated by using store-operated channel blockers econazole, SK&F96365 and Gd(3+). However, econazole and SK&F96365 were more effective in MDM than lung macrophages. Neither LOE908 nor nifedipine could attenuate this response. These data suggest that platelet-activating factor-stimulated leukotriene B(4) release from human lung macrophages is mediated, in part, by Ca(2+) influx through receptor- but not voltage-operated Ca(2+) channels.