Oral health professionals screening for undiagnosed type-2 diabetes and prediabetes: the iDENTify study.

BACKGROUND: As part of an evaluation of an oral healthcare practice-based model that identifies patients with prediabetes or type-2 diabetes, this study reports on the proportion of patients identified with clinically confirmed type-2 diabetes (T2D)/prediabetes and barriers of implementation of the model. METHODOLOGY: Urban and rural oral healthcare practices were invited to participate. Participating practices invited eligible patients to participate in the screening program using the Australian Type-2 Diabetes Risk Assessment Tool (AUSDRISK). Participants were categorised as low, intermediate, or high-risk for prediabetes/T2D. Patients in the intermediate or high-risk category were referred to their General Medical Practitioner (GP) for further investigation. RESULTS: Fifty-one oral healthcare practices and 76 Oral Health Professionals (OHP) participated (60 Dentists, 8 Dental Hygienists, 8 Oral Health Therapists). 797 patients were screened; 102 were low-risk; 331 intermediate-risk; and 364 high-risk for T2D. Of the 695 participants in the intermediate or high-risk groups, 386 (55.5%) were referred to their GP for T2D assessment. Of them, 96 (25.0%) results were returned to OHPs. Of the returned results, six were (6.3%) diagnosed with pre-T2D. CONCLUSION: Patients found to have undiagnosed T2D/prediabetes (6.3%) were within the expected range reported in the literature. Findings indicate that identifying individuals at an elevated risk of having or developing T2D is effective, feasible and could be incorporated into oral healthcare settings. However, this integration may require additional OHPs training and education to ensure that patients at elevated risk of T2D are referred for further assessment.

Preparedness for practice of newly qualified dental practitioners in the Australian context: an exploratory study.

BACKGROUND: The current study explored the perspectives of preparedness for dental practice from a range of relevant stakeholders (i.e., educators, employers, final-year students, graduates, practitioners, and professional associations) using an anonymous online survey in which participants described either their preparedness for practice, or the preparedness of graduates they have encountered, across six domains. RESULTS: A total of 120 participants completed the survey. Participants were from several Australian states and territories; regional, rural, and urban locations; and working in the public and private sector. Students and new graduates generally felt prepared for activities in all the identified domains. Stakeholders reported consistently that the knowledge of dental profession graduates was at the required level to enter practice in Australia in a safe way. Activities involving the knowledge of clinical entrepreneurship and financial solvency were the dimensions where students and graduates felt least prepared (e.g., explaining fees, negotiating finances). In the domains involving clinical and technical competencies, students and new graduates self-assessed as less prepared around managing dental trauma and medical emergencies. On the other hand, activities around social and community orientation, and to a lesser extent professional attitudes and ethical judgements, were the dimensions where students and graduates felt the most prepared. CONCLUSIONS: Present findings indicate that there appear to be good standards of preparedness for practice for graduate dental professionals. This exploratory study provides insights into the nature of preparedness for Australian dental professionals and provides a basis for targeting education and professional development to address areas of need.

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

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

Self-Rated Oral Health as a Valid Measure of Oral Health Status in Adults Living in Rural Australia.

It is unclear how well self-rated oral health (SROH) reflects actual oral health status in the rural Australian population. Therefore, this study aimed to compare the clinically assessed oral health status and SROH of adults living in rural Australia. The data were from 574 participants who took part in the Crossroads II cross-sectional study. Three trained and calibrated dentists evaluated the oral health status of participants based on WHO criteria. SROH was assessed with the question 'Overall, how would you rate the health of your teeth and gums?', with a score ranging from excellent = 5 to poor = 1. A logistic regression analysis (LRA) was performed, allowing us to assess factors associated with SROH. The mean age of participants was 59.2 years (SD 16.3), and 55.3% were female. The key results from the LRA show poorer SROH in those with more missing teeth (OR = 1.05; 95% CI; 1.01-1.08), more decayed teeth (OR = 1.28; 95% CI: 1.11-1.46), and more significant clinical attachment loss of periodontal tissue (6mm or more) (OR = 2.63; 95% CI: 1.29-5.38). This study found an association between negative SROH and clinical indicators used to measure poor oral health status, suggesting that self-rated oral health is an indicator of oral health status. When planning dental healthcare programs, self-reported oral health should be considered a proxy measure for oral health status.

Referral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review.

With type 2 diabetes prevalence increasing in Australia, and the condition associated with significant morbidity and mortality, screening for dysglycaemia in the dental setting has been proposed to identify asymptomatic individuals. Screening commences with a risk assessment, and individuals identified at elevated risk for having diabetes are then referred to their medical practitioner for confirmation of their glycemic status. Therefore, for screening to be effective, individuals need to adhere to their oral health professionals' (OHP) advice and attend their medical follow-ups. This review aims to investigate the literature on referral compliance following a risk assessment in the dental setting and identify barriers and facilitators to screened individuals' referral compliance. A scoping review of the literature was undertaken, selecting studies of diabetes screening in a dental setting that recorded compliance to referral to follow-up, and explored any barriers and facilitators to adherence. Fourteen studies were selected. The referral compliance varied from 25 % to 90%. Six studies reported barriers and facilitators to attending medical follow-ups. Barriers identified included accessibility, cost, knowledge of the condition, and OHP characteristics.

Changes in Oral Health Policies and Guidelines During the COVID-19 Pandemic.

The aim of this study was to describe the changes in oral health policies and guidelines in response to the Coronavirus disease 2019 (COVID-19) pandemic in different countries and regions around the world. Information on oral health policies and guidelines from 9 countries (Canada, China including Hong Kong, Egypt, India, Japan, New Zealand, Nigeria, Switzerland, and Thailand) were summarized, and sources of the information were mostly the national or regional health authorities and/or dental council/associations. The changes made to the oral health guidelines depended on the severity of the COVID-19 pandemic. This included suspension of non-emergency dental care services at the peak of the COVID-19 outbreak, and easing the restrictions on non-essential and elective dental care when the pandemic became under control. The COVID-19 risk mitigation strategies include strict adherence to infection control practices (use of hand sanitizers, facemask and maintaining social distancing), reducing the amount of aerosol production in the dental setting, and managing the quality of air in the dental treatment rooms by reducing the use of air conditioners and improving air exchange. The COVID-19 pandemic has shown a major impact on dental practice. Dental professionals are trying to adapt to the new norms, while the medium to long-term impact of COVID-19 on dentistry needs further investigation.

Cost-minimization analysis of a tailored oral health intervention designed for immigrant older adults.

AIM: This paper presents an economic evaluation, from a societal viewpoint, comparing a community-based oral health promotion program aimed at improving the gingival health of immigrant older adults, with one-on-one chairside oral hygiene instructions at a public dental clinic in Melbourne, Australia. METHODS: The costs associated with implementing and operating the oral health promotion program were identified and measured using 2008 prices. The intervention was based on the Oral Health Information Seminars/Sheets model, and consisted of 10 20-min oral hygiene group seminars and four 10-min supervised individual brushing sessions carried out by a non-oral health professional educator. Health outcomes were measured as a reduction in gingival bleeding. Clinical data showed a 75% reduction in mean gingival bleeding scores among those who took part in the intervention. A population of 100 active, independent-living older adults living in Melbourne, and members of Italian social clubs, was used for modeling in this analysis. RESULTS: This analysis estimated that if an oral hygiene program using the Oral Health Information Seminars/Sheets model was available to 100 older adults, the net cost from a societal perspective would be AUD$6965.20. In comparison, a standard individual oral hygiene instruction program, at public dental clinics, given equivalent levels of case complexity and assuming the same level of effectiveness, would cost AUD$40 185.00. Per participant cost of a community-based oral health promotion program was $69.65 versus $401.85 for chairside instruction. CONCLUSIONS: Findings confirm that community-based oral health interventions are highly cost-effective and an efficient use of society's financial resources.

A community-based culturally competent oral health promotion for migrant older adults living in Melbourne, Australia.

OBJECTIVES: To evaluate the effect of a theory-based oral health promotion intervention in a community environment by a nondental peer educator on the oral hygiene and gingival health of independent-living Italian older adults. DESIGN: A quasiexperimental design with a pretest-posttest nonequivalent control group with no intervention. SETTING: Ten Melbourne-based Italian social clubs participated in this evaluation. PARTICIPANTS: One hundred forty-four active members of the social clubs. INTERVENTION: A series of oral health seminars and four supervised brushing sessions at club premises. The intervention did not involve any direct oral health professional clinical care. Clubs were allocated to the control or intervention group. MEASUREMENTS: Dental plaque levels and gingival bleeding scores were determined. A series of one-way analyses of covariance were conducted using the baseline measures as covariates. RESULTS: Controlling for pretest scores, the experimental group was significantly more likely than the control group to have improved gingival status and self-efficacy. No significant effects were found regarding dental plaque. CONCLUSION: Within the setting of Italian social clubs, the intervention was effective at increasing self-efficacy and reducing gingival bleeding. As such, it represents a useful approach for the design of oral health interventions in older migrant adults.

Stress and health-promoting attributes in Australian, New Zealand, and Chilean dental students.

This study investigated stress levels and health-promoting attributes (sense of coherence, social support, and coping strategies) in dental students using a Salutogenic approach. All dental students (n=2,049) from two Australian universities, two Chilean universities, and one New Zealand university were invited to participate in this cross-sectional study. The questionnaire covered sociodemographic and career choice questions, Perceived Stress Scale, Orientation to Life Questionnaire, Multidimensional Scale of Perceived Social Support, and Brief COPE scale. A total of 897 students participated, for a 44 percent response rate. Students' mean age was 22.1 (SD=2.7). The majority were females (59.3 percent). Students reported moderate stress, moderate sense of coherence (SOC), and high levels of social support. Significant differences in the SOC scores by country were reported. The linear regression model for stress explained 44 percent of the variance, in which SOC and social support are negatively associated with stress and the use of maladaptive coping strategies positively predicts high stress. These findings confirm that health-promoting attributes were negatively related to stress in these dental students. This is an initial approach to guide academics in the creation of Salutogenic programs that optimize students' chances to successfully cope with stress.

Transcultural dental training: addressing the oral health care needs of people from culturally diverse backgrounds.

Australia is a culturally and linguistically diverse country with a population derived from over 140 countries and including 240 language groups. Reflecting this, there has been a significant increase in cultural diversity among undergraduate dental students. It has been recognized that in order for dental students to interact and respond effectively to the diverse cultural needs of their patients, students themselves must be aware of cultural differences and respect patients' worldviews. In response to this challenge, dental students will need to have the theoretical knowledge to understand culturally-influenced health behaviours as well as the ability to communicate effectively with culturally diverse patients. Currently, the culture of dental students contrasts with the patients they treat, which may in turn affect the interaction between dental students and their patients. Given this context, new graduates need both to effectively communicate with patients from diverse communities and have an understanding of culturally influenced health behaviours. It has been proposed that dental graduates need to improve their knowledge of a variety of cultural values, beliefs, practices and attitudes. The literature in the area of cultural awareness and education for oral health professionals concentrates on both exploring health professionals' knowledge and attitudes toward transcultural care or the need for transcultural training. This paper provides an overview of the transcultural issues in oral health care which might confront dental students when treating culturally diverse patients. It will also discuss possible modifications to the dental curriculum to ensure that the future oral health workforce understands the complex health care needs of a multicultural society. This information will give planners and stakeholders an insight into the nature of the cultural issues which future dentists are likely to encounter while treating patients from diverse cultural backgrounds. This would help to establish the need to incorporate transcultural awareness modules to enhance quality of care and to respond effectively and sensitively to cultural issues.

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

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

Oral health in a convenience sample of Chinese older adults living in Melbourne, Australia.

OBJECTIVES: To present data on the dental and periodontal status of a convenience sample of 101 ambulant China-born older adults who now live in Melbourne. These older adults participated in a study to assess the prevalence of specific oral diseases. METHODS: Participants were interviewed in Cantonese using a structured questionnaire and received an oral examination to assess dental and periodontal status using the DMFS/T and CPI indices, respectively. RESULTS: This sample was largely a dentate one (94.1%); with a mean Decayed, Filled and Missing tooth surfaces (DMFS) score of 57.5 (SD 37.9). Approximately, 80% of the dentate sample had all their restorative needs met; 25% had a sound periodontium; 41% needed oral hygiene instruction plus scaling, while 6.3% required complex periodontal therapy. Compared with existing data on the oral health of older adults in Australia, Chinese immigrant older adults appear to have lower DMFS scores, a lower number of untreated decayed surfaces, a lower prevalence of gingivitis, and less need for complex periodontal treatment. CONCLUSION: These tentative findings provide an initial assessment of the risk of oral diseases among a group immigrant older adults. This study highlights the need to collect relevant information in order to identify factors that influence the oral health of older immigrants to Australia.

Socio-demographic characteristics and career choices amongst Chilean dental students / Características socio-demográficas y elección de la carrera en estudiantes de odontología en Chile

This cross-sectional study aimed to explore the socio-demographic and career choice characteristics of dental students in two publicly funded universities in Chile. A total of 601 dental students participated in the study with a 53 percent response rate. The written survey covered age, gender, type of school attended, place of residence, parental occupation, level of education, tuition fees payment methods, along with motivations and preferences towards dentistry as a career. The respondents had an average age of 22 years old. Sixty one percent of respondents were female, and the majority had completed secondary education in private and subsidized schools with only 21.5 percent having finished in public schools. Most of the students covered their tuition fees with parental money (37.1 percent), followed by any type of loan (27.9 percent). The majority of students (63.8 percent) had placed dentistry as their first career choice with self-motivation being the most important reason for their decision. This study provides a description of the socio-demographic and economic profile of Chilean dental students and provides insights about career decision issues. It also purposes areas for further research and management by academics for future program development.

El presente estudio descriptivo de corte transversal explora el perfil socio-demográfico y los factores asociados a la elección de la carrera de los estudiantes de odontología pertenecientes a dos universidades estales chilenas. Un total de 601 estudiantes participaron de esta investigación con una tasa de respuesta del 53 por ciento. La encuesta escrita incluyó, edad, género, educación secundaria, lugar de residencia, nivel educacional y ocupación de los padres, método de pago junto con las motivaciones y proyecciones de los estudiantes hacia la carrera. Los participantes reportaron una edad promedio de 22 años. Sesenta y un por ciento de los participantes fueron mujeres, y la mayoría terminó la enseñanza media en escuelas privadas o subvencionadas, con sólo un 21,5 por ciento que se graduó en escuelas públicas. Un gran número de estudiantes paga la universidad con dinero de sus padres (37,1 por ciento), seguido con créditos de diversa índole (27,9 por ciento). La mayoría de los estudiantes seleccionó odontología como primera preferencia (63,8 por ciento), y esa elección fue principalmente mediada por motivación personal. Este estudio entrega una descripción del perfil socio-demográfico y económico de los estudiantes de odontología en Chile y otorga una visión de la problemática que existe con los factores relacionados con la elección de la carrera. Además este estudio recomienda futuras áreas a investigar y el manejo por parte de los académicos para el desarrollo de programas futuros.