Evaluation of a capacity building clinical educational model for oral health clinicians treating very young children.

OBJECTIVE: There are significant levels of dental caries in Australian school-aged children, with children aged five years having a mean dmft of 1.3. It has also been identified that, in general, oral health clinicians lack confidence to treat very young children and this study aimed to increase capacity of public sector oral health clinicians to treat preschool children. BASIC RESEARCH DESIGN: An educational program was developed, implemented and evaluated for its capability to increase the confidence and knowledge of oral health clinicians and dental assistants in providing oral care for children aged 12 months to 5 years. RESULTS: In 2011 and 2012, the course was delivered to 36 clinicians (22 dentists, 12 dental therapists, and two oral health therapists) and showed increases in their confidence and knowledge for participants when providing dental procedures to preschool children. CONCLUSIONS: The educational program that was developed and implemented has met its objective of increasing the knowledge and confidence of practicing oral health clinicians and dental assistants in the management of preschool children. Strategies to further enhance the outcomes of this educational program have been proposed.

Commentary on the senate select committee into the provision of and access to dental services in Australia: an opportunity for reform.

A recent Senate Select Committee has tabled its report into the provision of and access to dental care in Australia. The Senate Committee heard: There are significant barriers for many people accessing dental care, including high costs, trauma and fear, long waiting times and inaccessible services. There are service gaps, including a lack of special needs dentists, limited mobile services, very few Aboriginal dentists and sparse services in regional areas. There are significant impacts of poor oral health, including pain and suffering, shame and low self-esteem, poor nutrition and poorer general health. There are benefits to good oral health, including the ability to smile, eat and talk, improved confidence, increased productivity and being more employable. There were 35 recommendations for reform centred around the need to put the mouth back in the body and covered by five broad themes: More equitable access. Better integration. National data and coordination. Awareness and education. Culturally safe and accessible care. This paper provides an overview of the problem and focuses on the recommended funding reforms necessary to improve access to dental care.

Mental health, psychological distress and burnout in Australian dental practitioners.

BACKGROUND: Dental practitioners are known to experience a high level of stress, but little is known about the mental health of Australian dental practitioners. The aim of this study was to investigate the prevalence of mental health conditions among Australian dental practitioners. METHODS: A cross sectional survey of 1483 Australian dental practitioners was carried out from October to December 2021. Participants reported aspects of mental health including depression, anxiety disorder, burnout (Sydney Burnout Measure) and psychological distress (Kessler Psychological Distress Scale and General Health Questionnaire 12). RESULTS: Self-reported psychological distress was high, with 32.0% rated as having moderate or severe psychological distress and 59.4% a high likelihood of minor (or more severe) psychological distress. One in four participants (24.8%) were classified as likely to be experiencing burnout, with 25.9% reporting ever having a diagnosis of depression, 11.4% a current diagnosis of depression, 23.1% ever having a diagnosis of anxiety disorder and 12.9% a current diagnosis of anxiety disorder. CONCLUSION: Australian dental practitioners reported a high burden of psychological distress, burnout and mental health issues, suggesting a need for education and programmes to support their mental health and wellbeing. © 2023 Australian Dental Association.

Australian dental practitioners experience of burnout.

BACKGROUND: The aim of this study was to investigate factors associated with burnout in Australian dental practitioners. METHODS: A cross-sectional survey of 1483 Australian dental practitioners was conducted from Oct to Dec 2021. Participants reported burnout using the Sydney Burnout Measure, and aspects of mental health including psychological distress, depression, and anxiety disorders. Predictors of burnout were explored using a generalized linear model with a stepped approach including demographic, health and risk factor variables. RESULTS: One in four participants were classified as likely to be experiencing burnout. Burnout was associated with working in a regional/rural location (ß = 2.82, p < 0.001), an academic/non-clinical role (ß = 5.01, p = 0.037), more years of experience as a dental practitioner (ß = 0.08, p = 0.022), a current diagnosis of depression (ß = 2.38, p = 0.049), moderate/severe psychological distress (ß = 7.16, p < 0.001), poor self-rated physical health (ß = 5.84, p < 0.001) and increasing alcohol consumption (ß = 0.17, p = 0.020). Participants who scored high on resilience (ß = -0.23, p = 0.002) or perfectionism (ß = -0.24, p < 0.001) had lower burnout scores. CONCLUSION: Australian dental practitioners appear to be at high risk of burnout which may impact on their health and wellbeing and ability to deliver patient care. There is a need for support services to manage burnout and education to address workplace and environmental factors that may contribute to burnout.

Dentists' preferences in implant maintenance and hygiene instruction.

BACKGROUND: This study investigated the preferences of dentists in Australia in providing professional implant maintenance and implant-specific oral hygiene instructions (OHI). METHODS: General dentists were surveyed online about their preferences in peri-implant diagnostics, maintenance provision, armamentarium used, and implant OHI techniques and frequency. RESULTS: Most of the 303 respondents (96%) provided maintenance services; 87.6% reviewed implants regularly while 10.7% only performed diagnostics after detecting clinical signs/symptoms. Supragingival prosthesis cleaning was performed by 77.9% of respondents, 35.0% performed subgingival debridement, 41.9% treated peri-implant mucositis and 18.2% treated peri-implantitis. About 15% did not treat nor refer peri-implant disease, including significantly more non-implant providers and dentists without implant training. Maintenance armamentarium commonly included floss (76.3%), prophylaxis (73.9%), plastic curettes (43.3%) and stainless-steel ultrasonics (38.0%). Brushing (86.5%), flossing (73.9%) and interdental brush use (68.3%) were most commonly recommended. Implant OHI was repeated routinely by 57.4% of dentists who provided it. Dentists with greater implant training and experience were more likely to perform reviews and complex maintenance procedures. CONCLUSIONS: Peri-implant diagnostics performed, treatments provided and armamentarium varied among dentists. Implant providers and those with higher levels of training had more preventative approaches to implant OHI. Possible shortcomings in disease management and OHI reinforcement were identified.

Participation in continuing professional development by dental practitioners in Victoria, Australia in 2007.

BACKGROUND: Mandatory continuing professional development (CPD) was introduced in 2005 in Victoria, Australia to ensure that dental practitioners maintained their skills, knowledge and kept up-to-date with current topics in dentistry. The aim of this study was to investigate the participation, impact on practice and attitudes of Victorian dentists and dental specialists to CPD activities since the commencement of mandatory CPD. METHODS: A cross-sectional survey of a random sample of registered dentists and dental specialists (n = 895) was conducted from May to August 2008 using an anonymous, postal, self-administered questionnaire. RESULTS: The response rate was 66%. More than three quarters of practitioners believed mandatory CPD is a reasonable requirement for continued registration. Dentists reported attending an average of 30.9 h of certifiable clinical CPD whilst specialists attended an average of 33.2 h of certifiable clinical CPD over a 12-month period. Nearly three quarters of respondents reported changing their practice as a result of CPD activities, whilst one quarter attended CPD mainly to meet the mandatory requirements. CONCLUSIONS: Overall there was a positive attitude towards mandatory CPD and a high level of participation in CPD activities by Victorian dentists and specialists in 2007, although nearly half of the respondents attended <20 h of certified clinical CPD during 2007. A number of barriers exist, particularly for rural and female practitioners in accessing CPD, and further research is required to examine the benefits derived from mandatory CPD.

Implant education patterns and clinical practice of general dentists in Australia.

BACKGROUND: This study aimed to understand trends in dentists' implant training attendance and correlation to treatment provision. Implant-specific oral hygiene instruction coverage in training programs was investigated. METHODS: A cross-sectional web-survey of dentists registered in Australia was conducted. Respondents were asked about their background, implant training history and treatment provision. Results were analysed by implant provision characteristics and graduation decade. RESULTS: Three hundred and three responses from general dental practitioners (GDPs) were received and analysed. The highest implant training levels attained post-graduation were postgraduate non-specialist qualification (7.9% of respondents), continuing professional development (CPD) (73.6%) versus none (18.5%), with differences between implant providers and non-providers (P < 0.001), different graduation decades (P < 0.001) and those restoring implants or performing surgery as well (P < 0.001). University-based CPD was attended less than dental association/society or implant company CPD. Non-providers were significantly less likely to recall implant oral hygiene instruction sources (P < 0.001). Most GDPs (74.9%) provided implant services, with younger GDPs beginning earlier after graduation. About 16% of respondents did not provide implants once established career-wise. CONCLUSIONS: Dentists might be providing implant treatments increasingly earlier in their careers. Respondents with more training were significantly more likely to perform more complex procedures, while implant training attendance trends varied by graduation decade.

Participation in continuing professional development by Victorian dental practitioners in 2004.

BACKGROUND: Continuing professional development (CPD) has been long considered an integral component of professional practice across a range of health professions. It is believed to ensure the maintenance of practitioner clinical competence and knowledge of current concepts. This study investigated the participation in and attitudes of Victorian dental personnel to CPD activities. METHODS: A self-administered cross-sectional survey of a random sample of registered dental care providers (n = 451) was conducted from March to June 2005 using an anonymous, postal, self-administered questionnaire. RESULTS: The response rate was low (48.1 per cent). Nearly 90 per cent of respondents attended a CPD course in 2004, with the mean hours of attendance ranging from 8.3 to 36.9 hours, depending on registration category. Nearly half of the dentists attended more than 20 hours of CPD courses, while less than 20 per cent of prosthetists attended more than 15 hours of CPD courses. Three-quarters of respondents supported mandatory CPD as a condition of registration. CONCLUSIONS: There was a high level of participation in continuing professional development activities by surveyed Victorian dental care providers in 2004, although more than half of the dentists and specialists, and nearly two-thirds of therapists, hygienists and prosthetists would fail to meet the new DPBV mandatory requirements for CPD.

Effect of ozone and Tooth Mousse on the efficacy of peroxide bleaching.

BACKGROUND: The aim of this in vitro study was to investigate the effect of Tooth Mousse and ozone on the bleaching effectiveness of peroxide (P). METHODS: Sixty enamel specimens were stained by tea infusion. P (8% carbamide peroxide solution) and the P/TM (50:50) blend were prepared freshly as required. The specimens were divided randomly into six groups: Group A - ozone followed by P; Group B - ozone concurrently with P; Group C - P alone; Group D - ozone followed by P/TM; Group E - ozone concurrently with P/TM; and Group F - P/TM alone. Ozone exposure was of 40 seconds duration. Digital photographic images were recorded at baseline and endpoint under standardized lighting and desiccation conditions. CIELAB L*a*b* values were determined. RESULTS: The addition of TM to P or the application of ozone with P did not significantly affect bleaching effectiveness compared with P alone. The application of ozone prior to P significantly decreased bleaching effectiveness as indicated by the DeltaL*, Deltaa*, DeltaE and %L* values. The addition of TM to the P did enhance the aesthetic by increasing the lustre and translucency of the treated enamel. CONCLUSIONS: The results of this study suggest that Tooth Mousse may be applied concurrently with the bleach, and not reduce bleaching effectiveness.

Dental service provision in Victorian residential aged care facilities.

BACKGROUND: The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are at high risk of developing dental diseases, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. Traditionally, dental service provision has been problematic and sporadic for these residents. METHODS: A postal survey of a random sample of Victorian general dentists and Directors of Nursing (DONs) of Victorian RACFs was undertaken in 2006 to ascertain the participation of dentists in the provision of dental care and to identify factors impacting on the organization and provision of dental care for residents. RESULTS: The response rate for dentists was 57.3 per cent, and for DONs 64.4 per cent. Half of the dentists reported that they had provided care to residents of aged care facilities in the past 12 months, and they spent an average of one hour per month providing care. Overall, dentists were concerned with their level of undergraduate education and training in various aspects of dentistry for residents of aged care facilities. DONs reported significant difficulty obtaining adequate dental care for their residents. Common problems identified by both dentists and DONs included a preference for dentists to treat residents in their own practice, dentists not willing to go to RACFs and a lack of portable dental equipment for dentists to use. CONCLUSIONS: There were low levels of interest and participation from Victorian dentists in providing dental care for residents of aged care facilities. Dentists had a strong preference for treating patients at their own practice, and there were a number of significant barriers that appeared to impact on the provision of dental care in RACFs.

Complaints about dental practitioners: an analysis of 6 years of complaints about dentists, dental prosthetists, oral health therapists, dental therapists and dental hygienists in Australia.

BACKGROUND: Previous research has found dental practitioners at elevated risk of complaint compared with other health professions. This study aimed to describe the frequency, nature and risk factors for complaints involving dental practitioners. METHODS: We assembled a national dataset of complaints about registered health practitioners in Australia between January 2011 and December 2016. We classified complaints into 23 issues across three domains: health, performance and conduct. We compared rates of complaints about dental practitioners and other health practitioners. We used negative binomial regression analysis to identify factors associated with complaints. RESULTS: Dental practitioners made up 3.5% of health practitioners, yet accounted for approximately 10% of complaints. Dental practitioners had the highest rate of complaints among fourteen health professions (42.7 per 1000 practitioners per year) with higher rates among dentists and dental prosthetists than allied dental practitioners. Male practitioners were at a higher risk of complaints. Most complaints about dentists related to treatments and procedures (59%). Around 4% of dentists received more than one complaint, accounting for 49% of complaints about dentists. In 60% of closed cases no regulatory action was required. Around 13% of complaints resulted in restrictive actions, such as conditions on practice. CONCLUSION: Improved understanding of patterns may assist regulatory boards and professional associations to ensure competent practice and protect patient safety.

Dentists' restorative decision-making and implications for an 'amalgamless' profession. Part 4: clinical factor.

BACKGROUND: The Minamata Convention embodies a worldwide reduction in the production and use of mercury and mercury-containing products and processes, including a phase-down of dental amalgam. This will change the approach to the use of direct restorative materials in the near future. There is little research as to the influence of clinical factors on dentists' decision-making which may be of use when determining the impact of any change. METHODS: An online survey relating to aspects of and attitudes to the use of direct restorative materials was distributed to all dentists who were members of the Australian Dental Association and/or members or fellows of the Royal Australasian College of Dental Surgeons. Data were statistically analysed. RESULTS: There were 408 respondents to the survey. Eighty-seven per cent of respondents (strongly) disagreed that amalgam was a technically more difficult material to place compared with resin composite, 82% (strongly) disagreed that placement time for amalgam was longer than that for resin composite and 69% (strongly) disagreed that amalgam was more difficult to finish than resin composite. Eighty-three per cent of respondents stated they were confident in their ability to place amalgam restorations. Where physical properties were of importance, indirect restorations were preferred (e.g. parafunction) 54%. The factors considered most important when choosing a direct restorative material included moisture control and aesthetics; least important factors were cost and time to place. CONCLUSIONS: There is consensus that amalgam is not more technically difficult to use, place or finish than resin composite and vice versa. There is recognition that both amalgam and resin composite have limitations in terms of physical properties. When choosing a direct restorative material, clinical factors considered to be of greatest importance are moisture control, aesthetics and the need to apply minimally invasive approaches. There is little difference in the opinions of users and non-users of amalgam with respect to these findings.

Dentists' restorative decision-making and implications for an 'amalgamless' profession. Part 5: knowledge factors.

BACKGROUND: A phase-down of amalgam in Australia is possible given the Australian Government intends to ratify the Minamata Convention. There is little research as to the influence of a dentist's knowledge on decision-making, which may be of use when determining the impact of any change. METHODS: An online survey relating to aspects of and attitudes to use of direct restorative materials was distributed to all dentists who were members of the Australian Dental Association or Members or Fellows of the Royal Australasian College of Dental Surgeons. RESULTS: There were 408 respondents. Fifty-eight per cent agreed that there was consistency in undergraduate teaching. Fifty-two per cent stated that there was a difference between undergraduate teaching and the 'real world'. Postgraduate education was ranked the most important influence on decision-making. Ninety-six per cent stated that knowledge of the evidence base is important and 89% believed that they practised evidence-based dentistry. CONCLUSIONS: Dental schools need to maintain teachers' and students' understanding of the evolving technology of direct restorative materials. There is a perceived disconnect between undergraduate teaching and the 'real' world. The evidence base is viewed as confusing, contradictory and not readily understandable. The creation of clinical guidelines would be useful.

The growing problems of dental caries and obesity: an Australian perspective.

Preventable diet-related diseases such as dental caries and obesity are a growing global problem, causing a significant burden on public health systems. Although there has been good evidence for the links between sugar consumption and dental caries for many decades, we are now seeing stronger links implicating sugar in obesity. There is a growing worldwide movement to tackle these problems by targeting the consumption of sugar-sweetened beverages through a range of public policy measures.

Dentists' restorative decision-making and implications for an 'amalgamless' profession. Part 3: Dentists' attitudes.

BACKGROUND: The Minamata Convention has agreed to a worldwide reduction in the production and use of mercury-containing products and processes. This will change the approach to use of direct restorative materials in the future. There is little research exploring the attitudes of dentists to any change. METHODS: A survey relating to the use of direct restorative materials was distributed to dentists who were members of the Australian Dental Association or Members and Fellows of the Royal Australasian College of Dental Surgeons. Data were statistically analysed. RESULTS: There were 408 respondents. Responses to statements concerning attitudes toward a phase-down of amalgam depended on whether the respondent used amalgam, year of primary dental qualification and association with academia. Thirty per cent of respondents indicated they do not use amalgam. The mean use of amalgam for all direct restorative procedures was 18%. CONCLUSIONS: Dentists are concerned over potential implications of a phase-down of amalgam and much should be done to address these concerns. Many dentists are undecided as to what are the implications, which may reflect a lack of understanding of the issues. It is incumbent on policy-makers to produce and disseminate information relating to the issues identified by this research.

Dental demographics and metrics of oral diseases in the ageing Australian population.

One of the biggest challenges currently facing the dental profession in Australia is the provision of quality and timely dental care to the elderly. Adults aged 65+ years are an exponentially growing section of the community with rapidly changing dental needs, thanks in part to improvements in oral health over the past 60 years that have resulted in a dramatically decreased rate of edentulism and subsequently an increased number of teeth present. This is a challenge not only for the public dental services, but also public health policy makers, private dental practitioners, professional organizations and dental education providers. It is an issue that crosses a range of dental care providers, not only dentists but also dental prosthetists and dental hygienists, whose role in the provision of dental services has been slowly growing in Australia. Furthermore, with evidence of links between oral and systemic health, this issue has significant impacts for the broader health system.

Dentists' restorative decision-making and implications for an 'amalgamless' profession. Part 1: a review.

The Minamata Convention has agreed to a worldwide reduction and ultimate elimination in the production and use of mercury containing products. This will have implications for the practice of dentistry. Australian organizations' pronouncements on the issue are limited and research examining the Australian context dated. The restoration of teeth with direct materials has changed significantly since the 1980s. Up to this time amalgam was the material of choice for direct posterior restorations. Its properties and guidelines for placement were, and remain, well established. Resin composite has replaced amalgam as the material of choice in many clinical situations. Despite inherent clinical disadvantages compared to amalgam, there continues to be a shift toward greater use of resin composite. There is consensus worldwide that the restoration of posterior teeth using resin composite now exceeds that of amalgam. The reasons for this are reviewed in this article along with current evidence and commentary relating to direct restorative and evidence-based decision-making, minimally invasive approaches, and approaches to education. The implications for these in an 'amalgamless' profession are identified.

Dentists' restorative decision-making and implications for an 'amalgamless' profession. Part 2: a qualitative study.

In some countries the use of amalgam has been restricted, and the dental profession may be forced into using alternatives to amalgam by a combination of public opinion and legislation, including the proposal that the material be 'phased-down'. The limited research that exists as to restorative decision-making is quantitative in nature and focuses on 'when' a restoration is placed. There is little qualitative research exploring 'why' a material is chosen. Purposive sampling of a representative group of dentists registered in Australia was carried out in two phases; initially six interviews followed by a focus group of six different participants who were audio-recorded. Qualitative data were analysed using computer aided qualitative data analysis software. The findings suggest that dentists' restorative decision-making is a complex interplay of factors. These may be categorized as 'clinical', 'knowledge', 'patient', 'practice type', 'biological' and 'environmental'. Use of amalgam is influenced by each of these to varying degrees. Quantitative analysis of the influences on restorative decision-making is recommended. While the potential future 'phase-down' of amalgam as a restorative material was of concern, there was a general sense of resignation or apathy to the matter. The implications for public health authorities, dental organizations and educators are noted.

Fluoride content of tank water in Australia.

BACKGROUND: The aims of this study were to: (1) analyse the fluoride content of tank water; (2) determine whether the method of water collection or storage influenced fluoride content; and (3) survey participant attitudes towards water fluoridation. METHODS: Plastic tubes and a questionnaire were distributed through dentists to households with water tanks in Victoria. A midstream tank water sample was collected and fluoride analysed in triplicate using ion chromatography RESULTS: All samples (n = 123) contained negligible amounts of fluoride, with a mean fluoride concentration of <0.01 ppm (range: <0.01-0.18 ppm). No statistically significant association was found between fluoride content and variables investigated such as tank material, tank age, roof material and gutter material. Most people did not know whether their tank water contained fluoride and 40.8% preferred to have access to fluoridated water. The majority thought fluoride was safe and more than half of the respondents supported fluoridation. Fluoride content of tank water was well below the optimal levels for caries prevention. CONCLUSIONS: People who rely solely on tank water for drinking may require additional exposure to fluoride for optimal caries prevention.

Minimum intervention dentistry--a new horizon in public oral health care.

Public dental patients suffer from poorer oral health than the general population. Management of dental caries tends to focus on surgical interventions, such as restorations and extractions, rather than prevention and early intervention of the disease process. The current public dental system struggles to address the lifestyle and broader health issues affecting oral health and although an immediate dental problem can usually be alleviated, it can often be through the unnecessary removal of tooth structure, which invariably leads to other health and quality of life problems. There is widespread recognition by oral health clinicians that the restorative approach to the management of dental caries in the public sector is failing to improve oral health outcomes for many public patients. Oral health experts have recently adopted a national consensus statement on minimum intervention dentistry indicating their intention to work together to develop ways to implement this approach across the public dental sector. It is clear that, despite some significant challenges and required changes, the momentum for minimum intervention dentistry continues to grow across Australia. There is an urgent need to undertake research to assess the cost-effectiveness of this approach in the public sector.