Work-related musculoskeletal disorders in oral health professionals: an umbrella review protocol.

OBJECTIVE: The objective of this review is to synthesize the evidence on the prevalence, incidence, risk factors, and preventive and management interventions for work-related musculoskeletal disorders (MSD) in oral health professionals. INTRODUCTION: Oral health professionals face a considerable risk of developing work-related MSD due to the nature of their work. These disorders can lead to loss of employment, reduced job quality, increased occupational injuries, and early retirement. They can also lead to significant financial burdens for employers and society. INCLUSION CRITERIA: This umbrella review will include systematic reviews and meta-analyses that have oral health professionals as a population group and address at least one of the following topics: the prevalence or incidence, risk factors, and the efficiency or effectiveness of interventions for the prevention or management of work-related MSD. METHODS: A systematic search will be conducted across CINAHL Complete (EBSCOhost), Dentistry and Oral Sciences Source (EBSCOhost), MEDLINE (EBSCOhost), Cochrane Library (OVID), Scopus, PsycINFO (Ovid), AMED Allied and Complementary Medicine (Ovid), Epistemonikos, Ergonomics Abstracts Online (EBSCOhost), and Google Scholar (first 200 articles). The search will be limited to articles published in English, with no restrictions on geographical location. Two independent reviewers will screen the titles and abstracts against the inclusion criteria. The studies will be assessed using the JBI critical appraisal instrument for systematic reviews and research syntheses, and data will be extracted from each study using a modified version of the JBI data extraction tool. The GRADE approach will be used to rate the overall quality and strength of the evidence. REVIEW REGISTRATION: PROSPERO CRD42023388779.

Current approaches addressing oral health practitioners' responsiveness to child abuse and neglect: A scoping review protocol.

INTRODUCTION: Child abuse and neglect (CAN) poses significant risks, causing severe and long-lasting effects on a child's well-being, including physical and mental health and learning and socializing capabilities. Oral health practitioners (OHPs) uniquely position themselves to identify signs of maltreatment in the orofacial area, offer appropriate support, and collaborate with a multidisciplinary team. The literature has shown that OHPs under-report child protection concerns to a statutory child protection agency. Responding to CAN is often hindered by various factors, such as the fear of making false accusations and insufficient knowledge to detect and report potential cases. However, the literature lacks a comprehensive understanding of the strategies and interventions that can address the responsiveness of OHPs and other professionals to child protection issues. This scoping review aims to provide a broad overview and map the literature on the existing approaches to enhance the responsiveness of OHPs in child protection. MATERIALS AND METHODS: The proposed scoping review will be conducted following the JBI methodology for scoping reviews guideline and reported using the PRISMA-ScR guideline. The first exploratory search is conducted to refine the search strategy and inclusion and exclusion criteria. The second search will include MEDLINE (EBSCO), CINAHL (EBSCO), Dentistry & Oral Science Source (EBSCO), Cochrane Library, and Scopus, with a date range from January 2000 to March 2023. The third search will involve reference list searching and gray literature searching in Google and Google Scholar. Government and international health organizations' websites will be searched for policies and guidelines. The review will consider studies that report the current approaches to address OHPs' responsiveness to CAN in any setting. Two reviewers will independently select sources and extract data. Any disagreements will be resolved by consensus of the research team. The extracted data will be presented in a tabulated chart with a narrative summary.

Attitudes regarding a warranty and the expected longevity of dental treatment amongst New Zealand dentists, dental students, and patients: a mixed methods survey.

OBJECTIVES: To investigate and compare estimates of the longevity of dental treatment, expectations for free remedial treatment, and attitudes about formal dental warranties among dentists, students, and patients. MATERIALS AND METHODS: This is a mixed-method cross-sectional questionnaire survey with convenience sampling from dentists, dental students, and patients in New Zealand. A questionnaire was distributed to New Zealand dentists (n = 28) and final-year dental students (n = 27). A separate questionnaire was provided to patients in a university dental clinic (n = 43). Mann-Whitney U, Chi-square and Pearson Correlation, and Binary logistic regression tests were used to test for differences between groups and correlations amongst variables. Qualitative data were analysed thematically. RESULTS: Dentists believed that their posterior composite resin restorations would last longer (p = 0.014), would remediate failed crowns for longer (p = 0.002) and would provide longer crown warranties (p = 0.003) compared to students. Patients had higher expectations for restoration longevity and free remediation for failed treatment. Students were generally more willing to provide warranties. Crowns were perceived to be the most warrantable, while endodontic treatment was the least warrantable. Recall attendance, mechanical failure, and adequate oral hygiene were commonly proposed as warranty conditions for restorations and crowns. There was little consensus about complete dentures and endodontic treatment. CONCLUSIONS: There are significant disparities between the expectations of patients and clinicians regarding treatment longevity and free remediation times. Clinicians, in general, are willing to provide free remediation within a specified time frame, except for endodontic treatment, but are hesitant to provide formal dental warranties.

Migration of oral health professionals: a scoping review protocol.

INTRODUCTION: Each year, many dental professionals are trained; however, many low-income and middle-income countries face a scarcity of dental professionals. This trend has been observed because of the migration of oral health professionals from developing to developed countries for various reasons such as professional, economic or personal. This negatively impacts the healthcare system by causing critical shortages of trained personnel to support the oral healthcare needs of the countries where the oral health professionals migrate from (source countries). The key objectives of this scoping review are to assess the intentions behind the migrations, identify the countries the graduates migrate to and from, examine the barriers to and facilitators of integrating oral health professionals, as well as the challenges they face post migration. METHODS AND ANALYSIS: A scoping review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR) and the Joanna Briggs Institute guidelines. Scientific databases such as Dentistry and Oral Sciences Source, Cumulative Index to Nursing and Allied Health Literature, MEDLINE and Scopus will be systematically searched to identify potential articles. In addition, grey literature will be searched to identify unpublished materials relevant to the topic using Google Scholar and Google. The reviewers will assess the retrieved sources in a three-step search strategy, and a PRISMA-ScR flowchart will document the numbers of identified, screened and excluded sources. The scoping review will collate and present the findings as a descriptive analysis. Finally, the narrative descriptions will be presented in a thematic form based on the findings of the scoping review. ETHICS AND DISSEMINATION: This scoping review is based on a secondary analysis of published data; hence, ethical approval is not required. The findings of this study will be disseminated through publication in a peer-reviewed journal, professional networks and conferences.

Child abuse knowledge and attitudes among dental and oral health therapists in Aotearoa New Zealand: a cross-sectional study.

BACKGROUND: Child abuse and neglect are significant social and health issues in New Zealand. As the government provides free oral care to children and adolescents, oral health practitioners are positioned to respond to child protection concerns. However, research on the knowledge and attitudes of oral health practitioners is limited. This study aimed to understand the knowledge and attitudes of New Zealand dental and oral health therapists in detecting and reporting child abuse and neglect. METHODS: In this descriptive exploratory cross-sectional study, we invited registered New Zealand dental and oral health therapists treating children and adolescents to the anonymous online survey. RESULTS: Among the 92 dental and oral health therapists, 72% agreed that they could recognise the signs and symptoms of child abuse and neglect. Yet, only 48% agreed they were familiar with the reporting process. During their professional careers, 62% had at least 1 suspected case; and only 21% had ever reported their concerns. Fear of false reporting (70%) was the most significant barrier. CONCLUSIONS: Participants understood child abuse and neglect as significant social issues; however, the knowledge and attitudes to respond were limited. Efforts to enhance the knowledge and attitudes will be necessary to promote child safety and wellbeing.

For Indirect Orthodontic Attachment Placement, Adding a Custom Composite Resin Base Is Not Beneficial: A Split-Mouth Randomized Clinical Trial.

Aim: The aim of this study was to compare the chairside time, bond failure rate, and accuracy of bonding between two orthodontic attachment indirect bonding techniques. Methods and Materials: Two indirect bonding techniques were studied: unaltered base attachment (UA) and custom base attachment (CBA) methods. Eighty-four orthodontic attachments were bonded on six patient stone models. Preoperative models were digitally scanned, and subsequently, attachments were transferred with the aid of a single but sectioned vacuum-formed tray to their corresponding patients. Finally, participants were scanned after attachment bonding to make the postoperative digital replicas. Chairside time and immediate bond failure rates were measured and compared between both techniques. Postoperative and preoperative digital models were then superimposed in order to measure the accuracy of bonding in the three dimensions of space. Results: No differences existed between the two techniques regarding chairside time (P=0.87) and bond failure rates (P=0.37). There were also no differences found for the total attachment movement (P=0.73), mesiodistal (P=0.10), occlusogingival (P=0.31), torquing (P=0.21), and rotational measurements (P=0.18). The UA technique, however, proved to be more accurate for buccopalatal linear directions (P=0.04), whilst the CBA technique showed more accuracy for tipping angular deviations (P < 0.01). There was a statistically significant directional bias for the UA towards the occlusal (P < 0.01) and palatal (P=0.02) directions with mesial-out angular deviation (P=0.02). Conclusion: The two indirect bonding techniques were comparable for chairside time, bond failure rates, and most linear and angular measurements. The UA technique was, however, superior in buccopalatal directions, while the CBA method showed more tipping accuracy. Both techniques were efficient and reliable for indirect bonding.

Preterm low birth weights associated with periodontal disease in the Fiji Islands.

AIM: To determine any association between pre-term low birth weight (PTLBW) neonates and periodontal disease during the mother's pregnancy. DESIGN: A multi-centered prospective case cohort study. SETTING: Ante-natal clinics at the Colonial War Memorial and Lautoka Hospitals, Fiji from 1st January to 30th June 2004. PARTICIPANTS: 670 multiethnic pregnant women. METHODS: Participants were interviewed to identify confounding variables--medical conditions, smoking, alcohol consumption, maternal age and history of preterm birth. Oral examination was conducted and included the Community Periodontal Index of Treatment Needs (CPITN). Delivery outcome was recorded for each woman. RESULTS: The mean age of participants was 25.80 +/- 5.56 years. 1.9% (n=13) women delivered preterm babies. More than 50% of this group displayed moderate to severe periodontitis compared with 13% of women who had a normal delivery. Preterm birth was also associated with the mother having had a previous preterm birth and who was more likely to be Indo-Fijian (p < 0.01). There was no significant association with where the mother lived; however, rural women with PTLBW babies had more severe periodontal disease (p = 0.0001). CONCLUSION: There is a highly significant association between pre-term birth and moderate to severe periodontal disease (p = 0.0001).

Dental antibiotic prescription in Fijian adults.

AIM: To identify and evaluate dentists' knowledge of and prescription patterns of antimicrobial drugs. PARTICIPANTS: All 80 registered general dental practitioners in the Republic of The Fiji Islands, excluding academic staff at Fiji School of Medicine. Sixty five (81%) usable replies were received and analysed. RESULTS: Daily prescription of antibiotics increased with years in practice. There was a moderate level of knowledge regarding specific indications for antibiotic prescription both therapeutically and prophylactically. There was a tendency towards over-prescription with lower dosage, broad spectrum antibiotics with amoxycillin being the overwhelming choice. Some under prescription was noted in certain surgical scenarios. There was a lack of knowledge of the incidence of adverse reactions and very poor medical history record taking. Approximately one third of respondents felt antibacterial resistance is a problem in Fiji and 40% reported experiencing some form of antibiotic resistance in clinical practice. CONCLUSION: Overall there was a moderate level of correct knowledge for antibiotic prescribing of dentists in Fiji. An improved section on oral and dental infections including guidelines for children should be included in the Fiji Antibiotic Guidelines which could be distributed to all dentists.

Stress levels of dental students at the Fiji School of Medicine.

INTRODUCTION: The Fiji School of Medicine is the primary health care educational institution in Fiji and possesses the only dental school in the Pacific. The oral health programme is a multi-entry/exit programme. The aim of this study was to determine the perceived sources or stress and at risk groups within the undergraduate oral health care programmes. METHODS: A modified version of the Dental Environment Stress questionnaire was used to assess levels of stress for 41 items. RESULTS: A total of 115 undergraduate students participated (response rate = 84%). Of the respondents, 54% were male and 46% were female; 55% were Indo-Fijians, 18% Indigenous-Fijians, 8% Polynesians, 7% Micronesians, whilst Melanesians and others were each 6%. Moderate to severe stressful items were: full loaded day, followed by criticism from clinical supervisors in front of patients, amount of assigned work, fear of failing a course or year, examination and grades, financial resources, fear of employment after graduation and fear of facing parents after failure. Of the questionnaire items, 24% had significant differences across year groups. Overall, third years were most stressed followed by fourth years, fifth years, first years and second years. Indo-Fijians were the most stressed, followed by Indigenous-Fijians, Polynesians, others and Melanesians. Females were significantly more stressed than males for 27% of items. Private fee-paying students were more stressed than sponsored students. CONCLUSION: Overall stress levels were slight to moderate and were higher in senior years, Indo-Fijians, females and private fee-paying students.

Ibuprofen as a pre-emptive analgesic is as effective as rofecoxib for mandibular third molar surgery.

The objective of this study was to compare the pre-emptive analgesic effect of rofecoxib, a cyclooxygenase (COX)-2 inhibitor, with a more traditional and commonly used analgesic, ibuprofen, for mandibular third molar surgery, utilizing a prospective, randomized, double-blind, placebo-controlled clinical trial. Fifty-five healthy patients who were scheduled to undergo surgical removal of an impacted mandibular third molar as outpatients at one of two government dental clinics in Fiji were enrolled. The patients were divided randomly into three groups to receive 50 mg rofecoxib or 400 mg ibuprofen, or a placebo 1 h prior to surgery. A dose of 1000 mg paracetamol was offered as rescue medication. Participants recorded their pain intensity on a 10-cm visual analogue scale 1 h before and just prior to surgery and every 30 min for 6 h following surgery. There were no significant analgesic differences between rofecoxib and ibuprofen at any time intervals postoperatively. Ibuprofen was significantly better at reducing pain at all time intervals by comparison with the placebo. Rofecoxib provided significantly better pain relief compared with the placebo, except at 60, 180, and 240 min postoperatively. Rescue medication use was significantly lower in the rofecoxib and ibuprofen groups by comparison with the placebo group; however, there was no significant difference between the two therapeutic groups. Rescue medication was used by 50%, 25%, and 94% of patients receiving rofecoxib, ibuprofen, and placebo, respectively. Ibuprofen, a commonly used over-the-counter analgesic, is as effective as rofecoxib for the relief of acute postoperative pain following third molar surgery when used pre-emptively.

Effects of a midazolam-ketamine admixture in human volunteers.

As the ideal sedative does not exist for all situations, we examined the effect of a midazolam-ketamine sedoanalgesic admixture in human volunteers. Ten ASA physical status I volunteers were administered loading doses of 0.07 mg/kg of midazolam followed by 0.7 mg/kg of ketamine. The same amount of midazolam and ketamine was then infused constantly over 1 hour via a 60 drops (gtts)/mL i.v. infusion set. Blood samples were analyzed for plasma catecholamine levels. Respiration rate and oxygen saturation did not alter significantly from baseline levels. Heart rate and systolic blood pressure remained stable with an increase of 15% in heart rate and 6% in systolic blood pressure only at 10 minutes following the bolus loading. Diastolic blood pressure did not alter significantly from baseline levels (P < .05). Plasma catecholamines levels remained stable except for an increase in epinephrine (38%) and norepinephrine (19%) 10 minutes following the bolus injections. Plasma dopamine levels remained unchanged. There were no cases of unpleasant dreaming, dysphoria, or emergence-type reactions. This combined nonnarcotic sedoanalgesic technique maintains spontaneous ventilation and stable cardiorespiratory parameters and may be considered as an alternative to traditional conscious sedation or general anesthesia.

Sedation in Japanese dental schools.

There is very little information about the practice of sedation in Japan. Despite the remarkable advances in dentistry, fear and anxiety continue to be significant deterrents for seeking dental services. Most dental procedures can fortunately be undertaken with the aid of sedation. A comprehensive survey of all the dental schools in Japan was carried out to determine what sedation practices were used in Japan. All 29 dental schools in Japan possessed a dedicated department of anesthesiology at the time of this survey. The survey attempted to determine the specific sedation methods (techniques, routes of administration, and agents used in sedation) as well as practices (monitoring, fasting, location, education, and fees involved in sedation). The results indicate that there was a broad range in sedation practices. The Japanese Dental Society of Anesthesiology may wish to examine the findings of this study and may wish to formulate guidelines appropriate for the practice of sedation in Japan. Others may also wish to compare their own practices with those of Japan.

Dental anxiety in Fiji.

Despite the technological advances in dentistry, anxiety about dental treatment and the fear of pain associated with dentistry remains globally widespread and is considered a major barrier to dental treatment. This can have detrimental consequences to people's oral health and pose a serious epidemiological challenge to oral health care professionals. Dental anxiety is well described in the Western world however there is little literature on the situation in the developing world. The purpose of the study was to evaluate the levels of dental anxiety in Fijians using Corah's DentalAnxiety Scale (DAS). 120 adults, aged 18-45 years were randomly selected from the capital city of Suva until there were 60 Indigenous and 60 IndoFijians, with 30 males and 30 females from each group responding to questions from Corah's Dental Anxiety Scale. The average DAS for all the participants was 8.8. The average DAS for IndoFijians was 9.8 and was significantly higher than for Indigenous Fijians ie 78. IndoFijians only reported less anxiety with increasing age as the Indigenous Fijians generally displayed low levels of anxiety. There was no significant difference in DAS between the genders. A considerable proportion of IndoFijians (28%) were anxious with 13% being highly anxious. Young IndoFijian adults are more likely to possess dental anxiety and should be managed appropriately which may include behavioural and/or pharmacological therapy. This may require referral to dental specialists or involve a multidisciplinary approach to the management of these people.

Attitude/practices of oral healthcare provider to management of HIV/AIDS patients in the Pacific.

This paper expands a quantitative study which measured dentists attitudes, practices, knowledge, education, policies towards HIV positive patients in the Pacific region in order to identify potential barriers to the provision of adequate dental treatment. 300 questionnaires were sent out to all the 14 countries in the region. However, only the following six countries responded Fiji, Solomons, Vanuatu, Samoa, FSM, and Cook Islands of which 91.6% worked for the government sector, 4.2% respondents for academic and 4.2% were private oral health care providers (OHCP). These were 32.6% of dentists and 67.4% Paradentals. Results of the research showed that the major reasons for the unwillingness among oral health care providers mainly described fear of HIV transmission in dental clinics, inadequate infection control procedures in the clinics to prevent cross transmission or lacked knowledge about HIV patient management in dental clinics. There is a need for continuing education on management of HIV/AIDS positive dental patients covering such areas as management, infection control, policies, education and ethical issues concerning HIV positive patients for oral health care providers in the South Pacific region. Limitations of study: Since this is an incomplete (six countries responded out of fourteen countries) survey, generalization on attitudes and practices of OHCP in the Pacific can not be made yet. Also, larger sample is required to make definite conclusion about oral health care practices in the Pacific.

Blood pressure monitoring amongst Fijian general dental practitioners.

This study was designed to gauge the attitude and practice towards monitoring of blood pressure among dentists in Fiji and to assess whether they were willing to participate in a national health campaign to screen blood pressure of dental patient without remuneration. Sixty-two questionnaires were mailed out to all General Dental Practitioners in the Republic of the Fiji Islands. Responses were obtained from 49 (79 %) dentists following a second reminder letter. The majority of the practitioners (85 %) had been taught to measure blood pressure as undergraduates and approximately two-third of them stated that blood pressure screening in dental office was very important. Only about one-third of the respondents reported measuring blood pressure routinely, however this figure rose dramatically to 92 % when assessing patients with known high blood pressure. Approximately two-thirds of the practitioners were willing to participate in a national health campaign to screen blood pressure of dental patients without remuneration. Most of the dental practitioners in Fiji acknowledged that blood pressure monitoring in dental office was very important. They also stated that additional training in blood pressure monitoring was of necessary. Therefore, it is essential for stakeholders such as the Fiji Dental Association and the Ministry of Health to assist in providing guidelines and training in blood pressure monitoring for dental professionals in Fiji as well as to assist in conducting national health campaigns to screen for blood pressure.

Medical emergencies in dental practice in the Fiji Islands.

Medical emergencies in dental clinics are atypical however they do occur with potentially serious consequences. A postal questionnaire survey of all seventy-seven dentists in Fiji regarding occurrence of medical emergencies, their possession of emergency drugs and equipment and whether further training was required in the management of medical emergencies was conducted in 2004. The response rate was 85.7%. The most common medical emergencies were fainting (27.9%), postural hypotension (23.5%), hypoglycaemia (19.5%), epileptic fits and seizures (11.1%) and asthma (8%). The most commonly kept emergency drugs and equipment were disposable needles, oral glucose, disposable syringes, sphygmomanometer adrenaline, first aid kit, tourniquet and oxygen. Additionally, the vast majority of the dentists (98.5%) expressed a need for some form of further training or refresher course in this area. It is hoped that the respective stakeholders in Fiji islands and that it forms baseline information and guidelines in addition to stimulating future prospective studies.

Usefulness of measuring plasma cytokines in oral and maxillofacial surgery.

We determined the intra- and postoperative plasma concentrations of cytokines (tumor necrosis factor [TNF]-Alpha, interleukin [IL]-1Beta, IL-6, and IL-8) in oral surgery patients with procedures ranging in duration from 20 to 375 min and investigated their relationship to the intensity of the surgical stress over time. No significant differences from baseline levels were observed in the levels of TNF-Alpha, IL-1Beta, and IL-8. By contrast, increased IL-6 levels were noted only on the first postoperative day, when they reached 1500% of the baseline level, after which they decreased to preoperative levels by the third postoperative day and tended to reflect the intensity of surgical stress.

Effects of a propofol--ketamine admixture in human volunteers.

As the ideal sedative does not exist for all situations, particularly in settings with limited resources, the effect of a propofol-ketamine combination in human volunteers was examined. Eleven American Society of Anesthesiologists (ASA) physical status I volunteers were administered propofol at a loading dose of 1 mg/kg and two minutes later by 0.7 mg/kg of ketamine. This was followed by a propofol-ketamine combination of 5 mg/kg of propofol admixed with 0.7 mg/kg of ketamine that was infused over one hour via a 60 gtts/ml intravenous. Infusion set. Cardiorespiratory parameters were recorded and blood samples taken to measure plasma catecholamine levels prior to, during and for thirty minutes following the termination of the infusion. Rate of respiration and oxygen saturation levels did not alter significantly from baseline levels. When there was a cardiovascular decrease from base line levels it was on average 11% for systolic, 15% diastolic blood pressure and 14% for heart rate. Only plasma adrenaline and noradrenaline increased by 28 and 20%, 10 minutes following the bolus injectons. No dysphoria was experienced. This combined sedoanalgesic technique in nonstimulated human volunteers maintains spontaneous ventilation and may be considered as abalanced alternative to traditional conscious sedation or general anesthesia.