Family-centred oral health promotion through Victorian child-health services: a pilot.

Maternal and Child Health Services (MCHS) provide ideal settings for oral disease prevention. In Victoria (Australia), child mouth-checks (Lift-the-Lip) and oral health promotion (OHP) occur during MCHS child visits. This study trialled Tooth-Packs (OHP resources, toothbrushes, toothpastes) distribution within MCHS to (i) assess the impacts of Tooth-Packs distribution on child and family oral health (OH) behaviours and knowledge, including Maternal and Child Health Nurses (MCHN) child referral practices to dental services, and (ii) determine the feasibility and acceptability of incorporating Tooth-Packs distribution into MCHN OHP practices. A mixed-methods evaluation design was employed. MCHN from four high-needs Victorian Local Government Areas distributed Tooth-Packs to families of children attending 18-month and/or 24-month MCHS visits (baseline). Families completed a questionnaire on OH and dietary practices at baseline and 30-month follow-up. Tooth-Packs distribution, Lift-the-lip mouth-checks and child OH referrals were conducted. Guided discussions with MCHN examined intervention feasibility. Overall, 1585 families received Tooth-Packs. Lift-the-lip was conducted on 1493 children (94.1%). Early childhood caries were identified in 142 children (9.5%) and these children were referred to dental services. Baseline to follow-up behavioural improvements (n = 230) included: increased odds of children having ever seen an OH professional (OR 28.0; 95% CI 7.40-236.88; p < 0.001), parent assisted toothbrushing twice/day (OR 1.76; 95% CI 1.05-3.00; p = 0.030) and toothpaste use >once/day (OR 2.82; 95% CI 1.59-5.24; p < 0.001). MCHN recommendations included distribution of Tooth-Packs to at-risk children <12-months of age. MCHS provide an ideal setting to enable timely family-centred OHP intervention and adoption of good OH behaviours at an early age.

Midwives' perspectives of their ability to promote the oral health of pregnant women in Victoria, Australia.

BACKGROUND: Midwives have a potential role in promoting the oral health of pregnant women although they have little formal training in this area. The aim of this study was to explore the perspectives of midwives in Victoria towards incorporating oral health promotion into their antenatal practice after undergoing training through the Midwifery Initiated Oral Health (MIOH) online education program. METHODS: A purposive sample of thirty-nine midwives from maternity services across Victoria, Australia were invited to participate in an online MIOH education program in October 2012. The program included three self-paced modules covering oral health screening, referral processes, and theoretical and practical skill assessments. A mixed methods design was used to capture midwives perspectives. Evaluation questionnaires, completed pre- and post-training, captured knowledge and confidence (confidence likert scale), and also included five opened-ended questions post-training. Open-ended questions, feedback forms and unsolicited emails formed the data for qualitative analysis. Data were analysed using content and thematic analysis and descriptive statistics. RESULTS: Thirty-three midwives completed the MIOH education program and demonstrated a significant increase (51.5%) in their confidence to promote oral health. All participants viewed the program as suitable, acceptable and useful for their practice and were happy to recommend the course to other Victorian midwives. Participants indicated that it would be feasible to incorporate oral health into the first antenatal booking visit and recognised that oral health promotion was within their scope of practice. CONCLUSIONS: This study has shown that the MIOH education program is a valued resource that can assist midwives to increase their confidence and skills to incorporate oral health promotion into their practice. A key barrier identified was time constraints during antenatal care booking visits. However, it is evident that with relevant training it would be feasible and acceptable for Victorian midwives to incorporate oral health promotion within their practice. The current engagement with midwives in Victoria and other parts of Australia provides an opportunity to continue to explore and define the role of antenatal health care professionals in oral health promotion at a state and national level.

The evaluation of an oral health education program for midwives in Australia.

BACKGROUND: Antenatal care providers are now recommended to promote oral health during pregnancy and provide dental referrals. However, midwives in Australia are not trained to undertake this role. To address this shortcoming, an online evidence based midwifery initiated oral health (MIOH) education program was systematically developed as a professional development activity. AIM: This study aimed to evaluate the effectiveness of the program in improving the oral health knowledge of midwives and assess their confidence to promote maternal oral health post training. METHODS: The program was evaluated using a pre-post test design involving 50 midwives purposively recruited from two states in Australia. The pre-post questionnaire contained 24 knowledge items previously pilot tested as well as items exploring confidence in promoting oral health and perceptions of the program. FINDINGS: The results showed a significant improvement in the oral health knowledge (↑21.5%, p<0.001) of midwives after completion of the program. The greatest improvement in knowledge occurred in key areas vital in promoting maternal oral health namely the high prevalence of dental problems and its impact on birth and infant outcomes. The majority also reported being confident in introducing oral health into antenatal care (82%) and referring women to dental services (77.6%) after undertaking the education program. CONCLUSION: The MIOH education program is a useful resource to equip midwives with the necessary knowledge and skills to promote oral health during pregnancy. The program is accessible and acceptable to midwives and can potentially be transferable to other antenatal care providers.

Investigation of infection control practices and knowledge of hepatitis C among body-piercing practitioners.

BACKGROUND: Body piercing has become increasingly popular, leading to concerns about the associated risk of hepatitis C virus (HCV) transmission during piercing. Many body-piercing practitioners (BPPs) have recently entered the industry but little is known about their training and understanding of HCV transmission. This study measured BPP knowledge about HCV and infection control procedures. It also tested for HCV contamination within body-piercing establishments. METHODS: BPPs completed a questionnaire about the number and type of piercings performed, their methods for disposing of and reprocessing piercing equipment, and their training and knowledge of HCV. Environmental swabs were collected and tested for HCV RNA. RESULTS: BPPs at 35 establishments were recruited. A total of 31 BPPs had training as a BPP, ranging from 1 hour to 6 years (median: 15 days). Reprocessing of equipment was variable; 8 establishments inadequately reprocessed piercing guns and 4 inadequately reprocessed forceps or guiding equipment. All BPPs were aware of HCV but many did not know how the virus was transmitted. A total of 19 BPPs performed extra cleaning after piercing a customer known to be HCV positive. No environmental swabs tested were positive for HCV RNA. CONCLUSIONS: This study showed that many BPPs had inadequate training, and lacked knowledge and understanding of HCV transmission, infection control, and universal precautions. To reduce the risk of HCV transmission, BPPs should be required to undergo formal training in infection control before being registered as BPPs.