Antimicrobial stewardship: Prescribing across the primary care health professions.

We examined the patterns of antibiotic prescribing by medical and non-medical prescribers (dentists, nurse practitioners, and midwives) in Australia. We explored trends in the dispensed use of antibiotics (scripts and defined daily dose [DDD] per 1000 population/day) by Australian prescribers over the 12-year period, 2005-2016. We obtained data on dispensed prescriptions of antibiotics from registered health professionals subsidized on the Pharmaceutical Benefits Scheme (PBS). There were 216.2 million medical and 7.1 million non-medical dispensed prescriptions for antibiotics over 12 years. The top four antibiotics for medical prescribers were doxycycline; amoxicillin, amoxicillin plus clavulanic acid, and cefalexin, constituting 80% of top 10 use in 2005 and 2016; the top three for non-medical were amoxicillin, amoxicillin plus clavulanic acid and metronidazole (84% of top 10 use in 2016). The proportional increase in antibiotic use was higher for non-medical than medical prescribers. While medical prescribers preferentially prescribed broad-spectrum and non-medical prescribers moderate-spectrum antibiotics, there was a large increase in the use of broad-spectrum antibiotics over time by all prescribers. One in four medical prescriptions were repeats. Overprescribing of broad-spectrum antibiotics conflicts with national antimicrobial stewardship initiatives and guidelines. The proportional higher increase in antibiotic use by non-medical prescribers is a concern. To reduce inappropriate use of antibiotics and antimicrobial resistance, educational strategies targeted at all medical and non-medical prescribers are needed to align prescribing with current best practice within the scope of practice of respective prescribers.

Dynamic dentin: A quantitative microscopic assessment of age and spatial changes to matrix architecture, peritubular dentin, and collagens types I and III.

To investigate age and site-related changes to human dentin collagen, sound human teeth collected from donors aged 13-29 (young) and 50-74 (aged) years (n = 9/group) were cut to shallow and deep sites. Dentin collagen orientation and fibril bundling was investigated using the Picrosirius Red (PSR) stain observed under cross-polarized light microscopy (Pol), and collagen distribution was investigated using Confocal Laser Scanning Microscopy (CLSM). Collagen types III to I distribution in peritubular dentin (PTD) was revealed using Herovici stain and brightfield microscopy. Image analysis software and linear mixed modelling quantified outcomes. In situ dentin collagen was observed using Xenon Plasma Focussed Ion Beam Scanning Electron Microscopy (Xe PFIB-SEM). The PSR-Pol analysis revealed less coherently aligned and more bundled collagen fibrils in aged dentin (P = 0.005). Deep inner dentin collagen in both groups were less coherently aligned with reduced bundling. Regardless of age, CLSM showed collagen distribution remained stable; and more collagen type III was detectable in PTD located in inner dentin (Young: P = 0.006; Aged: P = 0.008). Observations following Xe PFIB-SEM cross-sectioning showed apatite-like deposits surrounding large intratubular collagen fibers, and evidence of smaller intertubular dentin collagen fibrils in situ. In conclusion, aging changes collagen network architecture, but not distribution or content.

Coronal dentin differs between young and mature adult humans: A systematic review.

OBJECTIVE: This systematic review examines the effect of age on changes to coronal dentin properties. DESIGN: Pubmed, Cinhal, Scopus, Web of Science and the Cochrane Database were searched for publications up to 31 December 2021. All studies were uploaded and reviewed using Covidence software. At different stages of the review, study selection and the extraction of data were completed by six independent reviewers based on the eligibility criteria. The quality of the articles was judged based on JBI Critical Appraisal Checklist for quasi-experimental studies. RESULTS: Twelve studies satisfied the eligibility criteria and were included. Dentin characteristics and mechanical properties alter with age, and spatially within a tooth to depend on tubule orientation. Age-related mineral deposition within tubules, and collagen maturation in intertubular dentin compound the spatial effects on mechanical properties. Mechanical properties depend on collagen fiber orientation and apatite alignment relative to dentin tubules, characteristic differences in peritubular and intertubular dentin, and relative dentin tubule distribution within a tooth. The bulk of the research focussed on age-related apatite effects, although many reported limited understanding of changes to collagen, particularly in intertubular dentin. CONCLUSION: Investigations into the effect of age, depth, site and location on dentin collagen are warranted to minimize tooth loss in older populations by providing targeted adhesive, restorative or preventative interventions.

Does dentine mineral change with anatomical location, microscopic site and patient age?

OBJECTIVE: To determine the effect of patient age (young or mature), anatomical location (shallow/deep and central/peripheral) and microscopic site (intertubular/peritubular) on dentine mineral density, distribution and composition. METHODS: Extracted posterior teeth from young (aged 19-20 years, N = 4) and mature (aged 54-77 years, N = 4) subjects were prepared to shallow and deep slices. The dentine surface elemental composition was investigated in a SEM using Backscattered Electron (BSE) micrographs, Energy Dispersive X-ray Spectroscopy, and Integrated Mineral Analysis. Qualitative comparisons and quantitative measures using machine learning were used to analyse the BSE images. Quantitative outcomes were compared using quantile or linear regression models with bootstrapping to account for the multiple measures per sample. Subsequently, a Xenon Plasma Focussed Ion Beam Scanning Electron Microscopy (Xe PFIB-SEM) was used to mill large area (100 µm) cross-sections to investigate morphology through the dentine tubules using high resolution secondary electron micrographs. RESULTS: With age, dentine mineral composition remains stable, but density changes with anatomical location and microscopic site. Microscopically, accessory tubules spread into intertubular dentine (ITD) from the main tubule lumens. Within the lumens, mineral deposits form calcospherites in the young that eventually coalesce in mature tubules and branches. The mineral occlusion in mature dentine increases overall ITD density to reflect peritubular dentine (PTD) infiltrate. The ITD observed in micrographs remained consistent for age and observation plane to suggest tubule deposition affects overall dentine density. Mineral density depends on the relative distribution of PTD to ITD that varies with anatomical location. SIGNIFICANCE: Adhesive materials may interact differently within a tooth as well as in different age groups.

Empathetic, persistent and female: A snapshot of oral health therapy students in Australia and New Zealand.

INTRODUCTION: Dental therapists, hygienists and oral health therapists constitute up to a third of the dental workforce in Australia and New Zealand. Personality is often explored in health professions to provide insights into traits that are conducive to workforce retention and to assist in planning and training. This study aimed to investigate the current demographic and personality characteristics of oral health students in Australia and New Zealand. MATERIALS AND METHODS: Students in years one to three of all eight undergraduate Bachelor of Oral Health programs in Australia and New Zealand were invited to complete an online survey. The survey measured activities prior to entering into oral health, career intentions and included a personality questionnaire, the Temperament and Character Inventory (TCI). RESULTS: Three quarters of participants (n = 336; 30% response rate; females = 90%) were single, from an urban area and 20-29 years of age. Oral health students overall portrayed high trait levels of Persistence and Cooperativeness. Cluster analysis of TCI traits identified three groups. Groups of students with high Persistence and Cooperativeness tended to be older, were working in non-dental and dental careers prior to their degree and were interested in working in regional areas after graduation. CONCLUSIONS: Students with high levels of persistence and cooperativeness were interested in working in regional areas after graduation, highlighting the importance of industriousness and persistence in overcoming barriers to practicing in regional areas. Further research is warranted to investigate barriers and enablers in recruitment and retention of males in a primarily female dominated profession.

Understanding the well-being of dentistry students.

INTRODUCTION: The transactional model of stress is a framework describing the process for coping with stressful events as a relationship between the individual person and environment. This study aimed to investigate the associations between personality, learning environment and experiences of mental health for a cohort of Australian dentistry students. MATERIALS AND METHODS: Students were invited in 2017 to complete an online questionnaire including the Depression, Anxiety and Stress Scale (DASS-21), The Dundee Ready Education Environment Measure (DREEM) and Cloninger's Temperament and Character Inventory (TCIR-140). Students were followed-up one year later, and generalised estimating equations were used. RESULTS: A total of 219 (response 73.5%) students participated in the study. Two personality profiles of dentistry students were identified. Group 1 were significantly higher in the traits persistence, self-directedness, cooperativeness and reward dependence, whereas Group 2 were significantly higher in harm avoidance. Students with Group 2 personality had a 3.12 (CI:1.72-5.65) increased odds of depression compared to Group 1 students. Compared to students with positive perceptions of the learning environment, students with negative perceptions had increased odds of stress (3.48, CI: 1.85-6.53), depression (2.71, CI: 1.57- 4.65) and anxiety (2.59, CI: 1.56-4.28). CONCLUSION: Students with personalities high in levels of self-directedness, cooperativeness and persistence and low in harm avoidance, as found in Group 1, demonstrate high levels of general well-being. Positive perceptions of the dentistry learning environment were found to be an important influence on students stress. This study highlighted a number of factors important to student well-being and provides direction for further investigation of interventions aimed at enhancing student well-being.

Tobacco Use and Oral Health.

This review outlines the important oral implications of tobacco use. The lining of the mouth (oral mucosa), if exposed to tobacco and its products in a susceptible individual, can develop benign, potentially malignant, and malignant tumours. Treatment and prognosis depend on tumour type, how early it is detected, its size and site in the oral cavity and whether it has spread. Advanced oral squamous cell carcinoma (OSCC) has a 20% 5-year survival rate. Tobacco use also increases the risk of periodontitis, peri-implantitis, caries, alveolar osteitis and halitosis. Although less life threatening than OSCC, these tobacco related conditions create a substantial financial and health burden for individuals and society. Dental practitioners routinely examine the oral cavity for signs of mucosal and tooth changes, are experienced in recognising variations from normal and have established management and referral pathways. They are also ideally positioned to provide brief interventions to assist their patients to quit smoking.

Community pharmacy staff needs for the provision of oral health care education and advice in Australia.

BACKGROUND: In Australia, 61% of pharmacy staff (pharmacists and pharmacy assistants) state that on average they are consulted for oral health care advice 2 or more times each week. International studies recognize the potential to enhance pharmacy staff roles in oral health care, given they are regularly consulted for a variety of oral health issues. OBJECTIVES: This study explored the preparedness of pharmacy staff to provide oral health care education and advice within Australian community pharmacies. The aims of this study were (1) to assess the types of oral health education resources available for pharmacy staff and patients within Australian community pharmacies; (2) determine pharmacy staff awareness of available Australian government-funded dental services or schemes and; (3) explore pharmacy staff views regarding safety of drinking water fluoridation in Australia. METHODS: Pharmacists and pharmacy assistants from a randomly selected national sample of 5700 Australian community pharmacies were invited to complete an online or postal questionnaire. Participants were offered a A$10 incentive to enhance response rates. Descriptive and analytical statistics were used for the analysis. RESULTS: The response rate for the pharmacist cohort was 58.5% (644 of 1100) and 28% (280 of 1000) for pharmacy assistants. More than 80% of pharmacy staff did not have oral health education resources for patients and did not have access to oral health information resources for their own education. Nearly all staff (96%) were unaware of government Child Dental Benefits Schedule (CDBS) and Department of Veterans' Affairs dental funding support. Approximately one-third of pharmacy staff believed that water fluoridation in drinking water supplies was unsafe or were unsure of its safety. CONCLUSIONS: Oral health care training and education resources are needed to support pharmacy staff to deliver improved and responsive oral health care within Australian communities.

Family-Level Predictors of Australian Children's Dental Caries and Injuries.

Purpose: Fisher-Owens et al. described the diverse family-level factors influencing children's oral health, but few studies have investigated these relationships using longitudinal data. This study investigated the association between family and child oral health using the Longitudinal Study of Australian Children (LSAC), a cross-sequential dual cohort study. Methods: A total of 10,090 children were recruited at baseline, and seven waves of data are available. Children's parents or guardians reported experiences of dental caries and injury. Data were used to model family-level predictors with generalized estimating equations. Results: In the final model, predictors of dental caries over time were younger mothers (odds ratio [OR] equals 1.37, 95 percent confidence interval [95% CI] equals 1.01 to 1.87) and lower parental education (OR equals 1.24, 95% CI equals 1.10 to 1.39). Other significant factors were poor parental health, parents smoking, English as the main language, and Indigenous parents. Parents with consistent parenting styles protected against caries. Predictors of dental injury included socioeconomic status and parental age. Conclusions: This study highlighted a number of significant family-level constructs that predict dental caries and injury. Understanding the influence of family provides evidence to warrant investigation into tailored interventions targeting young mothers, common health risk factors, and parenting styles.

Consumer perspectives on pharmacy staff roles in providing oral health services in Australia.

Australian and international findings report pharmacy staff are motivated to expand and undertake new roles in public health and expressed a strong interest in providing oral healthcare services to the community. We sought to describe consumer experiences within primary oral healthcare, and views about pharmacy staff roles and boundaries in providing oral health services as perceived by a sample of consumers living within metropolitan Australia. Sampling occurred purposively to enable diverse perspectives on the topic. Socioeconomic status, as defined by the Socio-Economic Index for Areas, was used as the primary criteria to stratify focus group recruitment. Thematic, in-depth analysis of focus group discussions was carried out. In all, 34 participants took part in six focus groups, held in metropolitan settings in Queensland, Australia. Findings show that consumers supported pharmacy staff performing non-invasive oral health services including providing oral health education and advice, reviewing medications and recommending evidence-based medications. As services became more invasive (i.e., oral screening and fluoride application), questions and concerns were raised around the appropriateness of the community pharmacy setting and the level of training of pharmacy staff to provide these services. This study identifies the need to support greater integration of oral healthcare roles by community pharmacy staff. Future innovative and collaborative research involving additional stakeholder groups are necessary to explore, develop and test the feasibility and effectiveness of pharmacy-led oral healthcare models.

Depression, anxiety and stress in a cohort of Australian dentistry students.

INTRODUCTION: Dentistry students face a challenging academic and clinical curriculum that can result in depression and anxiety. While studies usually report sources of stress for dentistry students, there is less information on levels of stress. This study used the Depression, Anxiety and Stress Scale (DASS-21), to report perceived levels of depression, anxiety and stress in a cohort of Australian undergraduate dentistry students. METHODS: Students enrolled in years 1-4 of the Bachelor of Dental Science (Honours) program at The University of Queensland were invited to complete the DASS-21 using an online questionnaire. Students completed the same questionnaire 1 year later. RESULTS: At baseline, the mean DASS-21 scores for this cohort (n = 179; females = 56%) were in the normal range for depression (4.69, SD 3.87) and stress (5.50, SD 3.65), and mild range for anxiety (4.25, SD 3.21). Overall, 24% (n = 42), 44% (n = 78) and 11% (n = 20) of students had moderate or above levels of depression, anxiety and stress, respectively. At 1-year follow-up, DASS-21 scores were not significantly different. CONCLUSIONS: Dental students have higher levels of depression, anxiety or stress than the general population, indicating they may be at risk for greater psychological distress. The information from this study should guide curriculum and learning environment design, as well as interventions to support students through this challenging degree.

Exploring oral healthcare management across Australian community pharmacies using case vignettes.

OBJECTIVES: In Australia, more than 80% of pharmacists and pharmacy assistants are consulted for oral healthcare advice up to five times or more each week. This study assesses Australian community pharmacy staff's (pharmacists and pharmacy assistants) ability to recognize and manage common oral health presentations using case vignettes, and determine whether appropriate identification and management are associated with self-reported confidence. METHODS: Five oral healthcare case vignettes were developed based on previous literature by a multidisciplinary team of dental and pharmacy practitioner academics. Topics included pulpitis, gingivitis, oral hygiene advice for a toddler, a mouth ulcer and a dry mouth scenario. Pharmacies were randomly selected from each Australian State and Territory and community pharmacy staff invited to complete the case vignettes. RESULTS: A total of 312 and 932 case vignettes were completed by pharmacy assistants and pharmacists, respectively. Approximately one-third of staff appropriately identified a non-healing mouth ulcer and up to 16% recognized a pulpitis (inflamed dental pulp) presentation. Provision of best practice or evidence-based recommendations were reported in up to 28%, 19%, 57% and 31% of pharmacy staff offering appropriate advice and guidance for pulpitis, gingivitis, a non-healing mouth ulcer and oral health promotion messages, respectively. No participants provided all best practice recommendations for drug-induced xerostomia. In all five vignettes, confidence was not associated with best practice recommendations and was only modestly associated with improved rates for recognizing gingivitis symptoms. CONCLUSIONS: To allow community pharmacists and assistants to fulfil their role as important members of the oral healthcare team, additional training and support are required to facilitate improved recognition of common oral health presentations and to offer recommendations which are in line with current best practice guidelines.

Oral health in the Longitudinal Study of Australian Children: An age, period, and cohort analysis.

BACKGROUND: Oral health policy and funding must be informed by well-designed studies which monitor oral health and the factors which influence it. AIM: This study aimed to analyse the oral health of the Longitudinal Study of Australia Children (LSAC). DESIGN: The LSAC is a dual-cohort cross-sequential study run biennially since 2004. Carer-report measures for oral health were measured across six biennial waves and included frequency of tooth brushing, dental service use, and dental problems since the previous wave. RESULTS: A total of 10 090 Australian children participated at baseline (birth [B] n = 5017 and kindergarten [K] n = 4983). Most carers reported that children brushed daily and had regular access to dental care. Increasing age was a significant predictor of dental caries, whereas no differences were observed between time periods and cohorts. Dental caries was more frequently reported than dental injuries. Caries was highest at age eight for the B (n = 1234, 30.5%) and K (n = 1355, 31.5%) cohorts. CONCLUSIONS: By the age of six, caries prevalence had already begun to climb despite the majority of carers reporting good oral health behaviours for their children. Early intervention in the prevention of dental caries is essential, as children appear to attend dental services when caries is already occurring.

Evaluation of a community based dental clinic for youth experiencing homelessness in Brisbane.

The relationship between homelessness and ill health is complex, and many risk factors for homelessness such as unemployment, low income, and substance abuse are also risk factors for poor oral health. In order to overcome barriers to access dental care, previous studies have recommended integrating dental care, referral pathways, and information within the overall care provided by support services available to people at risk of homelessness. This study aimed to evaluate a dental service developed and implemented to improve access to oral health care of disadvantaged youth in Brisbane. A mobile dental clinic run by volunteer dental professionals was implemented into a community organisation for disadvantaged youth. Participants were clients of Brisbane Youth Services who were disadvantaged youth, ≤25 years and attended the dental clinic in a 1 year period. A questionnaire collected demographic information, a self-assessment of oral health and an evaluation of their experiences with the dental clinic. Clinical data including DMFT, appointment attendance and items of service provided were collected. One hundred and twelve clients participated in the four dental clinic weeks and its evaluation. Cost was the greatest reported barrier to accessing dental care among participants. More than half (57%) of participants who pre-booked an appointment failed to attend. A total of 640 services were delivered, with an estimated value of $48,000. The majority (69%, n = 444) of the services provided were preventative services. Almost all of the clients felt the service they received was suitable for them (97%, n = 98) and would use the service again (98%, n = 99). This dental clinic model is feasible and sustainable due to its integration into an existing homeless youth service, low running costs, acceptability to clients and an interest by dental practitioners to volunteer. It provides a useful model which could be scaled up and implemented in other regions.

The impact of a sugar-sweetened beverages tax on oral health and costs of dental care in Australia.

Background: Despite a clear causal link between frequent consumption of sugar-sweetened beverages (SSBs) and dental disease, little is known about the implications of a tax on SSBs in the context of oral health. The aim of our study was to estimate the impacts of a SSB tax on the Australian population in the context of oral health outcomes, dental care utilisation and associated costs. Methods: We designed a cohort model that accounted for the consequences of the tax through the mechanisms of consumer response to price increase, the effect on oral health due to change in sugar intake, and the implications for dental care use. Results: Our results indicate that in the adult population an ad valorem tax of 20% would lead to a reduction in decayed, missing and filled teeth (DMFT) by 3.9 million units over 10 years, resulting in cost savings of A$666 million. Scenario analyses show that the outcomes are sensitive to the choice of the time horizon, tax rate, price elasticity of demand for SSBs, and the definition of target population. Conclusion: We found that the total and per-person consequences of SSB tax were considerable, both in terms of dental caries (tooth decay) averted and dental care avoided. These results have to be compounded with the implications of SSB tax for other aspects of health and health care, especially in the context of chronic diseases. On the other hand, the improved outcomes have to be weighted against a welfare loss associated with introducing a tax.

Children's oral health in Australia: The past decade's research agenda.

OBJECTIVES: Research into dental diseases in children is no longer primarily focussed on biological and dietary factors, with social determinants an important influence. The aim of this study was to systematically review the focus of research on influences on children's oral health in Australia. METHODS: Relevant databases were searched for English language publications between 2008 and 2017. Included studies were original research articles with a focus on influences of oral health for Australian children. A thematic synthesis approach was adopted, and included studies were coded using the Fisher-Owens et al (2007) framework which included child-, family- and community level influences. RESULTS: A total of 252 studies were included in this review. The focus of the included studies was most frequently on child level influences (n = 200, 79.4%), followed by community level (n = 175, 69.4%) and family (n = 86, 38.1%)-level influences. Overall, the highest proportion of included studies were on the child level influences of physical attributes (n = 86, 34.1%) and child maturing (n = 83, 32.9%). The influences with the least number of studies were social environment (n = 2, 0.8%), social support (n = 3, 1.2%) and physical safety on both a family and community levels (n = 3, 1.2% and n = 1, 0.4%, respectively). DISCUSSION: Monitoring child level influences of oral health has consistently occurred in national surveys and epidemiological studies. Family level influences are comparatively underinvestigated and should be a focus of future research in Australia. This study has helped to identify area gaps in the literature and can guide future studies.

Investigating the management of potentially cancerous nonhealing mouth ulcers in Australian community pharmacies.

We sought to examine the management and referral of nonhealing mouth ulcer presentations in Australian community pharmacies in the Greater Brisbane region. Trained simulated patients visited 220 randomly selected community pharmacies within the Greater Brisbane region in 2016. Simulated patients enacted two nonhealing (>1 month) mouth ulcer scenarios: A direct product request (DPR) (n = 110) and a symptom-based request (SBR) (n = 110). Results were documented and evaluated against Australian national pharmacy practice standards. Referral rates for pharmacy staff (pharmacist, pharmacy assistant or mixed-pharmacist and assistant) were also assessed. Australian pharmacy practice standards recommend staff ask six key questions during SBR and DPR consultations to enable informed decision-making. Two questions relating to identifying the patient and their symptoms were asked in the majority of interactions (76% and 69% respectively); the remaining four questions relating to symptom duration, treatments tried, other medications, and medical conditions were enquired in only 32%, 53%, 31%, and 27% of interactions, respectively. Simulated patients were referred to the doctor/dentist in only 11.8% of all interactions (both scenarios requiring referral). Overall, staff handling of nonhealing mouth ulcer consultations was suboptimal compared to national professional standards. In particular, duration of the nonhealing mouth ulcer was enquired in less than one-third of consultations potentially resulting in low referral rates by staff. This study identifies the need for increased oral cancer awareness and education for community pharmacy staff and reinforcing the importance of practising according to professional standards to effectively screen for potentially cancerous nonhealing mouth lesions.

DREEM-ing of dentistry: Students' perception of the academic learning environment in Australia.

INTRODUCTION: Continuous evaluation and improvement of the learning environment are required to respond to the changing nature of dental practice and dental education. This study aimed to describe a cohort of undergraduate dentistry students' perceptions of their learning environment. METHODS: Students enrolled in years 1-4 of the Bachelor of Dental Science (Honours) programme at The University of Queensland were invited to complete an online survey which included demographics and the Dundee Ready Education Environment Measure (DREEM). This scale measures students' perception of the educational environment overall, and for five domains: Learning, Teaching, Academic self-perception, Atmosphere and Social self-perception. Data analysis was mostly descriptive, t tests and univariate statistics compared groups. RESULTS: Participants (N = 192; females = 57%) were generally positive about their learning environment, with a total DREEM score of 127 of 200. Overall, Academic and Social self-perception domain scores were ranked lower than others. Students in preclinical years of study and/or had dentistry as a first career preference were more positive across all domains, except Social self-perception. CONCLUSIONS: Differences between the preclinical and clinical phases of the curriculum point to the structure of teaching and learning in health professional degrees. Further research should investigate how each environmental domain more specifically correlates with other aspects of the curriculum and student progression, including well-being. This could include logistical factors such as timetabling and its effect on physical well-being, to less tangible factors that may impact on mental well-being.

A culture shock in dental hygiene: Exploring the management of oral health after head and neck cancer.

OBJECTIVES: Managing oral health after the treatment for head and neck cancer requires meticulous daily oral hygiene practices and regular professional dental care; however, the individual factors and health system structures required to achieve oral health are often not well considered. This study aimed to explore how oral health was understood and managed after head and neck cancer treatment and identify factors that influenced oral health behaviours and dental service utilization. METHODS: A qualitative, inductive approach was used for data collection and analysis. Sampling of participants was purposive, using a maximum variation approach, and data were analysed using thematic analysis. Participants were recruited from the maxillofacial clinic at a tertiary facility in Brisbane, Queensland, Australia. RESULTS: Twenty-one participants took part in the study. Findings described individual and structural factors that influenced the management of oral health post-treatment. Individual determinants of oral health behaviours included a cognitive shift towards lifelong oral health; management of unexpected barriers; and management of competing priorities. Structural factors included availability, accessibility of services, and continuity of care. The ability to fund oral health emerged as a salient theme that influenced both individual and structural factors. CONCLUSIONS: Strong self-efficacy and financial and spousal support enhanced the management of oral health, whereas difficulty managing competing issues post-treatment, such as psychological and financial stress, limited participants' capacity to prioritize and manage oral health. Policy initiatives are needed to address the structural barriers caused by a lack of timely access to general and preventive dental care post-treatment.

Quality of life of head and neck cancer patients in urban and regional areas: An Australian perspective.

OBJECTIVE: Head and neck cancer treatment affects quality of life. There are differences in quality of life outcomes and perceived supportive care needs between cancer patients living in metropolitan and regional-remote areas. This study investigated quality of life over the first 6 months following head and neck cancer diagnosis and observed differences in quality of life by geographical location. DESIGN: Prospective observational study. SETTING: Tertiary hospital in Brisbane, Australia. PARTICIPANTS: Newly diagnosed patients who were referred for the diagnosis, and/or treatment of head and neck cancer. MAIN OUTCOME MEASURE(S): Quality of life was measured by the University of Washington Quality of Life Survey, version 4 (UW-QoL). Participants completed the UW-QoL questionnaire prior to starting treatment, 1 month and 6 months post treatment. Metropolitan and regional or remote status was classified according to the Australian Standard Geographic Classification-Remoteness Area system. RESULTS: Ninety-five participants were included at baseline; 49 and 41 participants completed the 1-month and 6-month follow-ups, respectively. Scores in most UW-QoL domains decreased between baseline and 1 month post treatment and increased towards pre-treatment scores at the 6-month follow-up (except for anxiety and saliva). Pain at baseline was significantly worse in the regional-remote participants compared with metropolitan participants. No other statistically significant differences in UW-QoL score by geographical location were observed. CONCLUSION: The findings generally did not support significant differences in quality of life outcome between metropolitan and regional-remote head and neck cancer patients. The difference in pain experience between metropolitan and regional-remote groups requires further investigation.