Global oral health policies and recommendations for children with special health care needs and their applicability and effectiveness during the COVID -19 pandemic: a systematic review.

AIM: This systematic review aims to assess effectiveness of oral health policies, recommendations and guidelines in safeguarding oral health of children with special healthcare needs during COVID-19. BACKGROUND: This systematic review evaluated the adaptation of global oral health policies for children with special healthcare needs (SHCN) during the COVID-19 pandemic, to provide evidence-based insights to inform policymakers and healthcare providers amid the ongoing global health crisis. The study focused on assessing the effectiveness of these adaptations in ensuring equitable access to quality dental care for this vulnerable group. METHODS: A PRISMA guided online search through LILIACS, PubMed, Scopus, COCHRANE and grey literature was conducted. The search strategy incorporated a combination of subject headings (MeSH terms) and free-text terms related to "oral health," "dental health," "policy," "effectiveness," "dental practice guidelines," "oral health policies," and "special care needs children." Eligibility criteria included oral health policies, recommendations and guidelines targeting individuals/children with special care needs. Both qualitative and quantitative studies published in English from 2008 to 2023 were included. RESULTS: Sixteen guidelines, recommendations and policies, from six authorities were identified. These documentations addressed six different areas mentioned broadly as comprehensive care, ethical considerations, preventive and therapeutic measures, equity, patient-centric treatment, and reducing disparities signaling a paradigm shift. International collaborations and standardization of guidelines indicated a unified approach. The review also emphasized on a commitment to continuous improvement through quality measurement, systematic referral management, and needs assessment. With the exception of two documents, the remaining guidelines did not address COVID-19 or provide specific adaptations for it. The lack of emphasis on individual condition was notable, as the guidelines generally took a more generalized approach toward individuals with special healthcare needs. CONCLUSIONS: In conclusion, this review assessed the impact of COVID-19 on oral healthcare for individuals with special needs. It underscores global and local efforts for equitable access, patient-centric care, and preventive measures. The lessons learned advocate for a resilient, inclusive healthcare framework capable of meeting diverse needs. PROSPERO REGISTRATION: CRD 42023452475.

A dental workforce strategy to make Australian public dental services more efficient.

BACKGROUND: Dental services can be provided by the oral health therapy (OHT) workforce and dentists. This study aims to quantify the potential cost-savings of increased utilisation of the OHT workforce in providing dental services for children under the Child Dental Benefits Schedule (CDBS). The CDBS is an Australian federal government initiative to increase dental care access for children aged 2-17 years. METHODS: Dental services billed under the CDBS for the 2013-2014 financial year were used. Two OHT-to-dentist workforce mix ratios were tested: Model A National Workforce (1:4) and Model B Victorian Workforce (2:3). The 30% average salary difference between the two professions in the public sector was used to adjust the CDBS fee schedule for each type of service. The current 29% utilisation rate of the CDBS and the government target of 80% were modelled. RESULTS: The estimated cost-savings under the current CDBS utilisation rate was AUD 26.5M and AUD 61.7M, for Models A and B, respectively. For the government target CDBS utilisation rate, AUD 73.2M for Model A and AUD 170.2M for Model B could be saved. CONCLUSION: An increased utilisation of the OHT workforce to provide dental services under the CDBS would save costs on public dental service funding. The potential cost-savings can be reinvested in other dental initiatives such as outreach school-based dental check programmes or resource allocation to eliminate adult dental waiting lists in the public sector.

Implementation and evaluation of an interdisciplinary preventive program to prevent early childhood caries.

OBJECTIVES: Since early childhood caries (ECC) is a major disease in the public health sector, an interdisciplinary prevention concept to avert this disease was developed, launched in a project region, and evaluated. It was examined whether the emergence of ECC could be prevented or curbed with the newly developed program. MATERIALS AND METHODS: The program encompasses seven pulses of information from an interdisciplinary team (gynecologists, midwives, pediatricians, dentists, municipal social services, and the public health office). The primary dependent variables were caries experience and prevalence among the 3- to 4-year-olds who took part in the ECC prevention program, compared to children of the same age without such measures. The effect of the prevention program was assessed by means of a "historical" comparison. The dental diagnoses were performed by two calibrated dentists based on the "ICDAS collapsed." Data on diet and preventive behavior were gathered using a standardized parental questionnaire. The significance was tested using the nonparametric Mann-Whitney U test. RESULTS: There were 661 3- to 4-year-olds in the control group and 706 in the test group. The mean d3-6mf-t for the control group (0.92) was significantly higher than that for the test group (0.46). While 78.8% of the children examined in the control group exhibited predominantly sound primary dentition, this was the case for 86.3% of the test group. The proportion of children with S-ECC was 7.9% in the test group and 14.5% in the control group. The test group differed significantly from the control group both in terms of reported diet and dental hygiene habits. CONCLUSIONS AND CLINICAL RELEVANCE: The interdisciplinary prevention program presented here is an effective concept for preventing ECC and considerably helps reduce problems in the treatment of small children.

Interdisciplinary Community-Based Oral Health Program for Women and Children at WIC.

Objectives To evaluate the women, infants, and children (WIC) Oral Health Program in a county in Florida. Methods The non-traditional interdisciplinary program of the current study was designed to reach at-risk populations with untreated dental diseases and limited access to care; it provides oral health education, dental screenings, preventive dental services, and referrals for women, children, and families at WIC offices. We evaluated the health status of patients enrolled in the program and the services provided. Results From 2013 to 2016, the program provided dental screenings for 576 children and 180 women. Caries prevalence for 3-5 year olds was 46.0%. Only 6.6% (12/114) of pregnant women were eligible for comprehensive dental care under Medicaid (< 21 years). Further, 71.2% (47/66) of all pregnant women had unmet dental care needs. Conclusions for Practice Our results suggested that many children and women had untreated dental diseases and need preventive services and dental care. Also, many pregnant women were not covered by Medicaid. This program demonstrates that collaboration with the WIC program can improve access to oral health services for underserved populations.

Which factors most influence referral for restorative dental treatment under sedation and general anaesthesia in children with complex disabilities: caries severity, child functioning, or dental service organisation?

BACKGROUND: The UN Convention on the Rights of the Child gives all children right to the highest standard of services for treatment and rehabilitation. For children with disabilities, sedation and general anaesthesia (GA) are often indicated for dental treatment; however, accessibility to this varies. The International Classification of Functioning, Disability and Health - Child and Youth version (ICF-CY) enables a biopsychosocial description of children undergoing dental treatment. AIM: To investigate conscious sedation and GA in children with complex disabilities and manifest caries and analyse how caries, child functioning, and dental service organisation relate to dental GA (DGA), comparing Argentina, France, and Sweden using the ICF-CY. DESIGN: Quantitative, cross-sectional; data collected through structured interviews, observation, and dental records. RESULTS: Sedation and DGA were common. Children with limitations in interpersonal interactions and relationships were more likely to have had DGA (OR: 5.3, P = 0.015). Level of caries experience was strongly correlated with experience of DGA. There were significant differences between countries regarding caries prevalence, sedation, DGA, and functional and environmental factors. CONCLUSIONS: Although caries experience and child functioning are important, dental health service organisation had the most impact on the incidence of DGA, and for the use of conscious sedation, for children with complex disabilities.

An assessment of strategies to control dental caries in Aboriginal children living in rural and remote communities in New South Wales, Australia.

BACKGROUND: A community-led oral health service for Aboriginal people in Central Northern NSW identified the need for oral health promotion, as well as dental treatment; in three remote communities with limited access to dental services. A three-stage plan based on the Precede-Proceed model was used to develop a school-based preventive oral health program. The program will be piloted in three schools over 12 months aimed at improving the oral health of local Aboriginal children. METHODS: The proposed program includes four components: daily in-school toothbrushing; distribution of free fluoride toothpaste and toothbrushes; in-school and community dental health education and the installation of refrigerated and chilled water fountains to supply a school water bottle program. Primary school children will be issued toothbrushing kits to be kept at school to facilitate daily brushing using a fluoride toothpaste under the supervision of trained teachers and/or Oral Health Aides. School children, parents and guardians will be issued free fluoride toothpaste and toothbrushes for home use at three-monthly intervals. Four dental health education sessions will be delivered to children at each school and parents/guardians at local community health centres over the 12 month pilot. Dental education will be delivered by an Oral Health Therapist and local Aboriginal Dental Assistant. The program will also facilitate the installation of refrigerated and filtered water fountain to ensure cold and filtered water is available at schools. A structured school water bottle program will encourage the consumption of water. A process evaluation will be undertaken to assess the efficiency, feasibility and effectiveness of the pilot program. DISCUSSION: The proposed program includes four core evidence-based components which can be implemented in rural and remote schools with a high Aboriginal population. Based on the Precede-Proceed model, this program seeks to empower the local Aboriginal community to achieve improved oral health outcomes. TRIAL REGISTRATION: TRN: ISRCTN16110292 Date of Registration: 20 June 2018.

The possibility of modification and improvement of dental services in Poland for children and adolescents with special emphasis on orthodontic service.

AIM: World Dental Federation reveals that dental caries is one of the most common diseases in the world, and as much as 90% of the population is facing oral cavity problems. About 28% of teenagers aged 10 and 15 absolutely needs orthodontic treatment and about another third of this age group represents very serious cases. The aim of this study is to verify the authorial model which modifies and facilitates the system of dental services in Poland with a special emphasis on orthodontic service. MATERIAL AND METHODS: The research was carried out with the method of diagnostic survey through a survey questionnaire. For this study, 1159 people were questioned for the research. In order to check the reliance between the variables Pearson chi-square test and the test of the Highest Reliability were used. Average market prices and the "prices expected" by the Greater Poland Voivodship Department of National Healthcare System were used to price dental services. RESULTS: The research revealed that the highest percentage of people who used only private dental services is between 19 and 64 years of age and the lowest percentage is represented by the elderly, i.e. subjects over 65 years of age. As for the dental services offered by the National Health Fund, the highest percentage of patients are children and adolescents under 18 and the lowest percentage of patients is represented by people in the working age. The tendency towards private healthcare is in direct proportion to parents' increase in the level of education. The main reason why parents take their children to a private dentist is the long waiting time for the visit offered by the National Health Fund as well as better materials and equipment offered by private dentists. The costs connected with extending the basket of guaranteed services for children and youngsters are combined with the increase in National Health Fund expenditure reaching EUR 7,014,151. The lack of refunding dental services for patients aged 19-64 will generate savings reaching about EUR 34,756,765. CONCLUSION: The reduction of public funds allocated for dental treatment of patients aged 19-64 will generate savings which will satisfy the needs connected with the increase in the range of refunded orthodontic treatment with the use of orthodontic permanent braces for patients under 18 years of age. The solution suggested will only slightly affect people in the working age as they reveal a strong tendency for treatment financed with their private funds.

Oral Health Integration Into a Pediatric Practice and Coordination of Referrals to a Colocated Dental Home at a Federally Qualified Health Center.

We have integrated preventive oral health measures into preventive care visits for children at a federally qualified health center in Boston, Massachusetts. The program, started in 2015, covers 3400 children and has increased universal caries risk screening in primary care to 85%, fluoride varnish application rates to 80%, and referrals to a dental home to 35%. We accomplished this by minimizing pressures on providers' workflow, empowering medical assistants to lead the initiative, and utilizing data-driven improvement strategies, alongside colocated coordinated care.

Preventive and invasive treatment in special needs patients: a German retrospective study.

OBJECTIVES: Data on dental treatment of children with special healthcare needs (CSHCN) are sparse. Hence, this study provides information about the changes in the dental condition in a cohort of CSHCN treated in a university dental department in Germany. MATERIAL AND METHODS: Patient records of CSHCN treated from January 2004 to December 2012 were screened retrospectively for medical diagnoses (ICD-10) and the type of treatment performed with outpatient dental care (ODC) or general anesthesia (GA). Follow-up data of patients adhering to the recommended recall were recorded, including time and further treatments. RESULTS: A total of 795 CSHCN with a mean age of 6.8 years were included. In 41.6 % (331/795) of cases, treatment was performed under ODC, and 58.4 % (464/795) received GA. Caries experience in CSHCN treated under GA was significantly higher (7.9 d3/4mft/0.9 D3/4MFT) than in ODC (2.5 d3/4mft /0.9 D3/4MFT). Over time, patient flow shifted from invasive (IC) to preventive-based care (PC). CONCLUSION: Caries-related treatments were most frequent under GA and ODC, though initial caries experience was higher in GA patients. The choice of GA or ODC was statistically independent from the medical condition. CLINICAL SIGNIFICANCE: This study provides characteristics of a large population of CSHCN treated with and without GA for dental care.

Evaluation of a regional German interdisciplinary oral health programme for children from birth to 5 years of age.

OBJECTIVES: The aim of this prospective birth cohort study was to evaluate the effect of the interdisciplinary oral health programme (OHP) for early childhood caries (ECC) in 5-year-old German children. MATERIAL AND METHODS: All parents of newborns (n = 1162; born 2009/2010) were visited after birth by the communal newborn visiting service of Jena, Thuringia, and advised on general and dental health. In the first year of life, children were invited to attend a dental examination in the Jena University Hospital. Participating children were included in a caries-risk-related recall system with continuous oral care over 5 years. The caries-risk assessment tool of the AAPD was used to determine the likelihood of carious lesion development and to categorize the children at low, moderate or high risk for caries. High-risk children received fluoride varnish. Families (n = 563) who gave their approval for final examination after 5 years were invited again and examined by a blinded clinician. Dental caries was scored using WHO diagnostic criteria expanded to d1-level without radiography. Children were allocated to prevention (PG) and control group (CG) and matched on the basis of age, sex, ethnicity and socio-economic status (SES). RESULTS: Two hundred and eighty-nine children (mean age 5.2 ± 0.7 years; 46.7 % female) were examined. Children in the PG (n = 174) showed significantly lower caries prevalence and experience (10.9 %, 0.2 ± 0.7 d3-4mft) than children in the CG (57.4 %, 2.9 ± 3.8 d3-4mft). Multivariate analysis found that low SES, early start of tooth brushing, supervision/regular second brush by parent, regular dental visits and duration of breast-/bottle-feeding >1 year were significantly related to d3-4mft. CONCLUSIONS: The OHP was an effective approach for preventing early childhood caries in preschool children. CLINICAL RELEVANCE: A programme consisting of early maternal counselling, establishment of a dental home, and inclusion of the children in a caries-risk-related recall system with continuous dental care and fluoride varnish application can prevent ECC. TRIAL REGISTRATION: German Clinical Trials Register DRKS00003438, https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003438.

What the child "SAID" to the dentist: A UK randomized controlled trial.

BACKGROUND: The electronic Survey of Anxiety and Information for Dentists (eSAID) allows children to tell dentists about their feelings and coping preferences. It is a computer "quiz" with 26 questions and free-text responses that produces a report for the children that they can then hand to their dentist. This is the first study to report the use of eSAID in a hospital paediatric dental clinic. METHODS: This was a randomized controlled trial to evaluate whether children thought that eSAID benefitted them, made them less anxious, and improved cooperation and their treatment satisfaction. Fifty-one children aged 8-13 years were randomized to complete either eSAID or a control version in the waiting room before their scheduled dental appointment. The study group had a 26-item questionnaire; the control had only two items. Both groups scored their anxiety on a 7-point anxiety scale at the start and again at the end of the quiz. All subjects handed the resultant eSAID report as a printout to their dentist. Dental treatment proceeded as planned. After treatment, each child reported how they thought the eSAID quiz had benefitted them by scoring on a 10 cm Visual Analogue Scale and their satisfaction on the Modified Treatment Evaluation Inventory. The operating dentists scored the children's cooperation using a 10 cm Visual Analogue Scale. RESULTS: Overall, the baseline anxiety levels were low (study: mean 1.2; control: mean 1.5). The study group's post-survey anxiety reduced by 0.4, whereas controls' increased by 0.2; this difference is statistically significant (p = .04). However, it made no difference to the children's self-reported benefit (p = .30), satisfaction (p > .05), or cooperation (p = .34). CONCLUSIONS: eSAID reduced pre-treatment anxiety but made no difference to children's perceived benefit, satisfaction, or cooperation. Future study should include known anxious children.

Dentoalveolar oral surgery in children and adolescents: organization and surgical treatment in a large, Danish municipal dental service.

OBJECTIVE: To describe a population-based organization of dentoalveolar surgical service for 0 to 18-year old subjects in a Danish municipal dental service, and analyze the type of dentoalveolar surgical interventions needed. MATERIAL AND METHODS: The study was conducted in the Municipality of Aarhus, Denmark during five consecutive school-years. An internal referral system was established within the municipality where patients could be referred to colleagues with a higher level of competencies and more experiences with paediatric dentoalveolar surgery. The analysis includes a total of 1812 children and a total of 2854 surgical interventions. RESULTS: Almost 80% of the patients, representing more than 80% of the dentoalveolar surgical interventions needed, were referred internally. Denudations were the most frequent treatment type (40.3%) carried out, followed by removal of third molars (18.0%). Furthermore, 22 odontomas and 100 supernumerary teeth were removed. CONCLUSIONS: The need of dentoalveolar surgery in children and adolescents is relatively low, but includes a wide range of interventions. An organizational system, where dentists can refer to colleagues who have developed special competencies in this field, results in most of these surgical patients being referred and treated internally.

Client perspectives on an Aboriginal community led oral health service in rural Australia.

OBJECTIVE: An oral health service was implemented, using a unique community development approach, for Northern NSW Australian Aboriginal communities in 2013-14. This study examined the views of children (and parents) who accessed the service, including: the extent of reported dental problems, oral health knowledge, attitudes and behaviour, accessibility of oral health services, satisfaction and cultural sensitivity of the service. METHODS: A survey of the children who accessed this service was conducted between October 2014 and December 2014. RESULTS: A total of 49 (71%) Aboriginal children aged 4-14 (or parents of), provided responses to the survey. All agreed that healthy teeth were important (100%), but many thought oral disease leading to extraction was normal (68%). High levels of oral pain were reported (66%), half (53%) reported brushing morning and night. Access to the new dental health service was reported as 'easy' (92%). Many walked (47%) or were driven (35%) in <30 min (90%). All respondents were happy with their dental treatment, and that their Aboriginal heritage was respected by the oral health team (100%). CONCLUSION: The implementation of a new community led oral health service to Northern NSW Aboriginal communities was shown here to be well-utilised, respected and in an area of high need. The collaborative approach could be continued to be utilised to implement targeted, community led health promotion programs to facilitate and encourage better oral health practices for the Aboriginal children in these communities.

Community engagement to enhance trust between Gypsy/Travellers, and maternity, early years' and child dental health services: protocol for a multi-method exploratory study.

BACKGROUND: Gypsy/Travellers have poor health and experience discrimination alongside structural and cultural barriers when accessing health services and consequently may mistrust those services. Our study aims to investigate which approaches to community engagement are most likely to be effective at enhancing trust between Gypsy/Travellers and mainstream health services. METHODS: This multi-method 30-month study, commenced in June 2015, and comprises four stages. 1. Three related reviews: a) systematic review of Gypsy/Travellers' access to health services; b) systematic review of reviews of how trust has been conceptualised within healthcare; c) realist synthesis of community engagement approaches to enhance trust and increase Gypsy/Travellers' participation in health services. The reviews will consider any economic literature; 2. Online consultation with health and social care practitioners, and civil society organisations on existing engagement activities, including perceptions of barriers and good practice; 3. Four in-depth case studies of different Gypsy/Traveller communities, focusing on maternity, early years and child dental health services. The case studies include the views of 32-48 mothers of pre-school children, 32-40 healthcare providers and 8-12 informants from third sector organisations. 4. Two stakeholder workshops exploring whether policy options are realistic, sustainable and replicable. Case study data will be analysed thematically informed by the evaluative framework derived from the realist synthesis in stage one. The main outputs will be: a) an evaluative framework of Gypsy/Travellers' engagement with health services; b) recommendations for policy and practice; c) evidence on which to base future implementation strategies including estimation of costs. DISCUSSION: Our novel multi-method study seeks to provide recommendations for policy and practice that have potential to improve uptake and delivery of health services, and to reduce lifetime health inequalities for Gypsy/Travellers. The findings may have wider resonance for other marginalised populations. Strengths and limitations of the study are discussed. TRIAL REGISTRATION: Prospero registration for literature reviews: CRD42015021955 and CRD42015021950 UKCRN reference: 20036.

Challenges identified in a pilot outreach dental service for Traveller children in Hackney, East London.

IMPETUS FOR ACTION: Inequity of dental health and dental service use for Travellers in the UK. National guidance on improving community oral health, stresses an imperative to involve and engage with "those whose economic, social and environmental circumstances or lifestyle place them at high risk of poor oral health or make it difficult for them to access dental services". SOLUTION: Oral health promotion and simple treatments were provided on two Traveller sites from a mobile dental unit (MDU) over a 5-day period and patients with extensive oral disease were referred to a fixed-site clinic for continued care. OUTCOMES: Most children, 60%, reportedly brushed once daily or less, only 40% brushed twice daily. Obvious visual caries were evident in 23 out of the 35 children (66%). A moderate to high risk of developing future caries was identified in 92% of Traveller children based on their existing diet, oral hygiene practices and caries experience. FUTURE: Oral care was successfully provided on an MDU, but this is an expensive resource and should not be considered a permanent solution. Oral health promotion messages delivered in the families' homes or local community settings through their established health services, such as health visitors or community nurses, may help to reinforce good oral hygiene and diet practices and needs robust evaluation.

Evaluation of an interdisciplinary preventive programme for early childhood caries: findings of a regional German birth cohort study.

OBJECTIVES: The aim of this prospective birth cohort study was to evaluate the effect of the interdisciplinary preventive programme (PP) for early childhood caries in 3-year-old children in Germany. MATERIAL AND METHODS: From July 2009 to October 2010, all parents of newborns (n = 1162) were visited after birth by the communal newborn visiting service of Jena, Thuringia, and advised on general and dental health. In the first year of life, children were invited to a dental examination in Jena University Hospital. Participating children were included in a risk-related recall system with continuous oral care over 3 years. Caries-risk assessment tool of the AAPD was used for risk categorizing. High-risk children received fluoride varnish biannual. In 2013, the total birth cohort (participants and non-participants) was invited to evaluate the PP. Dental caries was scored using WHO diagnostic criteria expanded to d1-level without radiography. Data were analysed statistically (multivariate logistic regression). RESULTS: Seven hundred fifty-five children (mean age 3.26 ± 0.51 years) were examined. Children in the PP (n = 377) showed significantly lower caries prevalence and experience than non-participants (15.6 vs. 37.8 %, 0.9 ± 3.3 d1-4mfs vs. 2.6 ± 5.2 d1-4mfs). Lack of vitamin D supplements (OR = 1.9, CI 0.99-3.51), familial caries experience (OR = 2.2, CI 1.27-3.73) and visible plaque on teeth (OR = 6.5, CI 4.41-9.43) were significant risk factors for caries development, whereas regular dental care (OR = 0.5, CI 0.38-0.79) had a protective effect. CONCLUSIONS: The PP was an effective interdisciplinary approach for preventing early childhood caries in small children. CLINICAL RELEVANCE: Early dental visits with caries-risk-related preventive dental care are necessary to prevent early childhood caries (ECC). TRIAL REGISTRATION: German Clinical Trials Register DRKS00003438, https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003438.

[Motivation for Prevention in Childhood as a Basis for long-Term Dental Health: The Augsburg Model]. / Motivation zur Prävention im Kindesalter als Basis für eine nachhaltige Zahngesundheit - Das Augsburger Modell.

Oral health promotion programs have been shown to be more effective the earlier they are started. In the city of Augsburg, the activities of the School Dental Service were replaced by a cooperation model in 2001, which provides a reasonable combination of group and individual dental prophylaxis. Three epidemiological evaluations show continuously increasing rates of natural healthy primary teeth in preschool children of all population groups. The Augsburg cooperation model "child and youth dental health" represents a practice-oriented approach in accordance with the new German prevention law.

Flying blind: trying to find solutions to Indigenous oral health.

Objective The aim of the present study was to identify all published evidence about oral health in Indigenous children in Australia and to determine trends in Indigenous oral health over time. Methods PubMed was used to search for published peer-reviewed articles that reported caries (decay) prevalence rates and/or caries experience (based on caries indices) in Indigenous children. Studies included in the analysis needed to report clinical oral health data (not self-reported dental experiences), and articles were excluded if they reported caries in only a select, specific or targeted sample (e.g. only children undergoing hospital admissions for dental conditions). Results The review identified 32 studies that met the inclusion criteria. These studies reported data from the Northern Territory (n=14), Western Australia (n=7), South Australia (n=7), Queensland (n=7), New South Wales (n=1), Australian Capital Territory (n=1) and Tasmania (n=1). Of the studies, 47% were in rural locations, 9% were in urban locations and 44% were in both rural and urban locations. Data are limited and predominantly for Indigenous children living in rural locations, and there are no published studies on caries in Indigenous children living in Victoria. Conclusions The present study documents the published prevalence and severity of caries in Indigenous children living in Australia and highlights that limited oral health data are available for this priority population. Although risk factors for oral disease are well known, most of the studies did not analyse the link between these factors and oral disease present. There is also inconsistency in how caries is reported in terms of age and caries criteria used. We cannot rely on the available data to inform the development of policies and programs to address the oral health differences in Indigenous populations living contemporary lives in metropolitan areas. What is known about the topic? Many studies report that Indigenous people have poorer general health in Australia compared with non-Indigenous people. What does this paper add? This paper documents the available published prevalence and experience of caries for Indigenous children in Australia. It demonstrates significant limitations in the data, including no Victorian data, inconsistency with reporting methods and most data being for Indigenous children who are living in rural locations. What are the implications for practitioners? It is important for practitioners to have access to oral health data for Indigenous children in Australia. However, the present study highlights significant knowledge gaps for this population group and identifies ways to collect data in future studies to enable more meaningful comparisons and policy development.

Changes in the oral health of the children of Dili, Timor Leste, between 2002 and 2014.

INTRODUCTION: This research compared the oral health status of school children in Dili (the capital of Timor Leste) in 2002 and 2014. METHODS: The 2014 oral health survey of Dili's children replicated the methods of an AusAID-supported oral health survey conducted in 2002. Equal numbers of children were invited to participate from four age groups (6-8, 9-11, 12-14 and 15-17 years). For the 2014 survey, the subdistricts of Dom Aleixo, Cristo Rei, Metinaro and Vera Cruz were randomly selected for inclusion. A questionnaire was used to collect data on demographics and oral health behaviours. Oral epidemiological examinations were conducted by four dentists and five dental nurses. RESULTS: The 2014 survey in Dili recruited 758 participants for the questionnaire and 655 children for the oral examination. In 2014, a lower proportion of children reported brushing their teeth the previous day (97% vs 100%, p=0.01) and a larger proportion reported having toothache (40% vs 19%, p<0.001) (sometimes to very often) during the previous 12 months. The mean number of decayed, missing or filled teeth in the primary plus permanent dentition (dmft + DMFT) was greater in 2014 than in 2002 (4.2 vs 3.5, p=0.01). There was no difference in the prevalence of decay in the primary dentition (39% vs 37%, p=0.61) or the mean number of decayed, missing or filled (dmft) teeth in the primary dentition in 2014 compared to 2002 (2.0 vs 1.8, p=0.47). However, the prevalence of decay in the permanent dentition was greater in 2014 (70% vs 53%, p<0.001) as was the mean DMFT (2.3 vs 1.7, p=0.04). The prevalence of gingival bleeding (65% vs 81%, p<0.001) and calculus (57% vs 86%, p<0.001) was lower in 2014. CONCLUSIONS: There was an increase in dental caries experiences in Dili school children between 2002 and 2014, associated with more permanent teeth dental caries experiences.

Collaboration Between Medical Providers and Dental Hygienists in Pediatric Health Care.

UNLABELLED: Basic preventive oral services for children can be provided within the medical home through the collaborative care of medical providers and dental hygienists to expand access for vulnerable populations. BACKGROUND: Because dental caries is a largely preventable disease, it is untenable that it remains the most common chronic disease of childhood. Leveraging the multiple visits children have with medical providers has potential to expand access to early preventive oral services. Developing interprofessional relationships between dental providers, including dental hygienists, and medical providers is a strategic approach to symbiotically expand access to dental care. Alternative care delivery models that provide dental services in the medical home expand access to these services for vulnerable populations. The purpose of this article is to explore 4 innovative care models aimed to expand access to dental care. METHODS: Current activities in Colorado and around the nation are described regarding the provision of basic preventive oral health services (eg, fluoride varnish) by medical providers with referral to a dentist (expanded coordinated care), the colocation of dental hygiene services into the medical home (colocated care), the integration of a dental hygienist into the medical care team (integrated care), and the expansion of the dental home into the community setting through telehealth-enabled teams (virtual dental home). Gaps in evidence regarding the impacts of these models are elucidated. CONCLUSION: Bringing preventive and restorative dental services to the patient both in the medical home and in the community has potential to reduce long-standing barriers to receive these services, improve oral health outcomes of vulnerable patients, and decrease oral health disparities.