The aim of this clinical audit is to evaluate the characteristics of dental infections requiring hospitalisations, which may help improve preventative and management policies. This study ...retrospectively evaluated the records of patients admitted to the Nepean hospital, Kingswood, New South Wales, Australia, due to dental infections between 2018 and 2019. A total of 102 patients, mostly in their thirties with equal gender distribution, were admitted with dental infections, presenting with pain (100%), swelling (99%), trismus (40.2%), dysphagia (27.4%), fever (21%) >37 °C, tachycardia (24.8%) and tachypnoea (9.3%). Most patients (68%) presented on weekends, outside regular working hours, and public holidays. A total of 52.5% of patients had taken prior antibiotics. Dental caries, smoking, mental health issues, and illicit drug use were featured strongly. The majority of patients (56.4%) underwent treatment under local anaesthesia. The total length of hospital stay was 271 days (mean 2.7, SD 1.6). Augmentin was the most prescribed antibiotic. Complications were reported in 8.8% of the patients, primarily due to airway compromise. Dental infections leading to hospitalisations continue to be a burden on the healthcare system. A notable finding was that the presentations were primarily on weekends, outside regular working hours, and public holidays, and the majority required dental interventions under local anaesthesia. The provision of on-call emergency dental services may reduce potentially preventable hospitalisations and the length of hospital stay.
: The aim of this systematic review was to analyse the published literature on dental infections leading to hospitalisations in Australia. It was hoped that understanding the patterns and trends ...would form a basis for improved preventive and management policies.
An electronic search was performed using Web of Science, Medline via Ovid and Google Scholar. Inclusion and exclusion criteria were applied. The included studies were analysed for demographics, aetiology, management, length of hospital stay and outcome of dental infections requiring hospitalisation.
Nine retrospective studies were eligible for inclusion. A total of 2196 cases of dental infections leading to hospitalisations were reported, with a male predominance (55-67%). Mental health issues, illicit substance abuse and immunosuppression were the main associated comorbidities (up to 58%). Dental caries (59-90%) and pericoronitis (10-19%) were the leading causes of dental infections. Empirical antibiotics were utilised in up to 75% of cases prior to hospital presentation. Six mortalities were reported.
The available published data show that dental infection is a significant public health problem. However, only general conclusions were possible due to the variably small sample size and data collection that was inconsistent and incomplete across studies. Improved data collection is required to develop policies for prevention and management.
ObjectivesTo critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy ...and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.Design and settingThe evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.ParticipantsData were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.Cost measuresData included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.Outcome measuresUtility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.ResultsCompared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only ‘cost-effective’ in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was ‘cost-effective’ in all scenarios except at 3 months scenario.ConclusionsThe midwives’ only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives’ and dentists’ combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.Trial registration numberACTRN12612001271897; Post-results.
Objectives
The aim of this retrospective study was to evaluate the outcome of preformed metallic crowns (PMC) utilizing the HT in carious primary molars for children treated within public dental ...clinics across the Sydney region.
Materials and Methods
A retrospective cohort study was designed, whereby two investigators evaluated 113 primary molars treated with HT PMCs involving 71 participants (aged between 5 and 11 years) after a minimum of 6 months post treatment. The mean time elapsed between crown placement (treatment) and the review was 1.42 years (17 months). The outcome of the HT was assessed by clinical and radiographic criteria.
Results
One hundred thirteen HT PMCs were reviewed from 71 participants. The overall success rate of PMCs placed utilizing the HT was 99%, with only one case presenting with confirmed failure.
Conclusions
HT PMCs have an overall high success rate as a treatment option in carious primary molars.
Issue addressed: All pregnant women should have a comprehensive oral health evaluation. Unfortunately, many pregnant women seldom seek dental care and some dentists are hesitant to treat during ...pregnancy. To address these issues, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in Australia. The aim of this study was to undertake a process evaluation and explore the perceptions of dental professionals involved in the program to determine the acceptability, feasibility and effectiveness of the program if it were to be upscaled.
Methods: A qualitative approach using content analysis was conducted on data from two focus groups involving 12 dental professionals.
Results: All participants were supportive of the MIOH-DS program. They thought pregnant women were receptive to their care, and reported markedly improved oral health. The provision of free dental care and the involvement of midwives were cited as major factors that improved the uptake of the program. Some of the challenges encountered were the prevailing misconceptions about the safety of dental treatment and pregnancy-related impairments.
Conclusions: Dental professionals found the MIOH-DS to be acceptable, feasible and effective in improving oral health of pregnant women and their uptake of dental services. However, some challenges need to be addressed as the MIOH-DS program is upscaled into a cost-effective model.
So what?: Dental professionals are important stakeholders in the MIOH-DS model. The process evaluation of the successful dental intervention is necessary to understand how and why such interventions work, and is an important step in scaling up to a population-wide intervention.
Understanding social determinants of health (SDoH) in dental patients is important for supporting population health and clinical decision making but it remains unclear how well these are recorded in ...electronic dental records (EDRs) and if SDoH can be extracted from clinical notes.
We retrospectively examined 100 clinical notes from 112,881 records of patient encounters that included an examination item in the Nepean Local Health District (LHD), with ethics approval from the LHD.
To create gold standard annotation for a rule-based natural language processing (NLP) system, we applied expert domain knowledge, WordNet and word2vec embeddings, and the Unified Modelling Language System to identify 20,168 records that were more likely to include SDoH.
Of these, we randomly sampled 100 records and 5 dental students annotated them using a schema adapted from the World Health Organization categorisation of SDoH.
The 100 records were from 100 unique patients, 44% of these clinical encounters included a comprehensive oral examination.
The most common SDoH was available for sugar (67%), tobacco (24.5%), alcohol (4.3%), housing (3.2%), and employment (1%), and 37% of clinical notes had no SDoH information available even though they included concepts that suggested SDoH.
Information was complete for 9.5% of records describing sugar consumption, and 7.9% for tobacco, but complete details were rarely described for alcohol and housing.
Clinical notes often include SDoH but it is important to understand the limits of what can be extracted to inform the feasibility of population health studies, and the design of technologies that might support improved consistency and completeness of SDoH in EDRs.
There is a limited need for antibiotics when treating oral health problems, yet they are often prescribed, increasing risk of antimicrobial resistance (AMR). With AMR a threat to public health, the ...objectives of this study were to assess the frequency, suitability, and factors associated with antibiotic prescriptions for acute dental problems across Greater Western Sydney public dental clinics.
Patients' reason for attending, details of any antibiotics use, and the treating dental practitioner's clinical examination and diagnosis were compared to current prescribing guidelines, and logistic regression was used to identify predictors of antibiotic prescription.
In all, 1,071 patients participated in the study, and 15.9% reported to using antibiotics for their dental problem. Over three-quarters obtained the antibiotics from their general medical practitioner (GMP). A high prevalence of antibiotics were not indicated for the patient's complaint (71.8%) including for those with a history of extraction, pain, or intraoral swelling, who had significantly higher odds of antibiotic prescription (OR > 9). The antibiotic type prescribed was generally suitable.
In summary, the data suggest that the majority of antibiotics were inappropriately prescribed for the patient's dental complaints and there is a need for interventions to improve compliance with antibiotic prescribing guidelines.
Objectives
A conflicting body of evidence suggests localized periodontal inflammation spreads systemically during pregnancy inducing adverse pregnancy outcomes. This systematic review and ...meta-analysis aim to specifically evaluate the relationship between periodontitis and preeclampsia.
Methods
Electronic searches were carried out in Medline, Pubmed, Embase, Lilacs, Cochrane Controlled Clinical Trial Register, CINAHL, ClinicalTrials.gov, and Google Scholar with no restrictions on the year of publication. We identified and selected observational case–control and cohort studies that analyzed the association between periodontal disease and preeclampsia. This meta-analysis was conducted following the PRISMA checklist and MOOSE checklist. Pooled odds ratios, mean difference, and 95% confidence intervals were calculated using the random effect model. Heterogeneity was tested with Cochran’s Q statistic.
Results
Thirty studies including six cohort- and twenty-four case–control studies were selected. Periodontitis was significantly associated with increased risk for preeclampsia (OR 3.18, 95% CI 2.26 – 4.48, p < 0.00001), especially in a subgroup analysis including cohort studies (OR 4.19, 95% CI 2.23 – 7.87, p < 0.00001). The association was even stronger in a subgroup analysis with lower-middle-income countries (OR 6.70, 95% CI 2.61 – 17.19, p < 0.0001).
Conclusions
Periodontitis appears as a significant risk factor for preeclampsia, which might be even more pronounced in lower-middle-income countries. Future studies to investigate if maternal amelioration of periodontitis prevents preeclampsia might be warranted.
The Midwifery Initiated Oral Health-Dental Service was developed to train midwives to promote maternal oral health, and a large trial showed it substantially improved the oral health, knowledge and ...behaviours of pregnant women.
Evaluate the long-term effectiveness of the program (post-trial) on maternal oral health knowledge, dental behaviours, and early childhood caries in offspring.
A prospective cohort study involving 204 women and children 3-4 years (followed after trial) was conducted in Sydney, Australia from 2017 to 2019.
The program did not have a significant impact on the study measures. Mothers who received the program did have comparatively better knowledge around preventative behaviours to reduce early childhood caries and significantly more mothers were engaging in a key behaviour of using a cup to feed their child. Overall maternal oral health knowledge and level of education did have a protective effect on the dental decay of children. Higher knowledge and levels of education reduced the odds of having a dmft of one or more by over half (OR 0.473), and almost 80% (OR 0.212) respectively.
Although the MIOH-DS program was not effective, there is still value in exploring other complementary interventions to improve maternal oral health, especially for disadvantaged families. Future research should focus on co-designing an antenatal and postnatal oral health intervention and exploring its long-term impact on the oral health of children.
Introduction: The early closure of the Voluntary Dental Graduate Year Program and the Oral Health Therapy Graduate Year Program by the Australian Government adversely impacted New South Wales (NSW) ...Aboriginal Community Controlled Health Services (ACCHSs). This led to the co-design of a small-scale oral health therapy graduate year program for ACCHSs known as the Dalang Project, which enabled oral health therapists to engage with local Aboriginal communities and implement culturally competent, practical and evidence-based oral health promotion activities. This article provides an overview of the Dalang Project and its evaluation.
Methods: All graduates of the Dalang Project were invited via email and social media to complete an online survey. The survey included questions about their year in the Dalang Project, why they applied, what they liked and disliked about the project, where they planned to work post-placement, and examples of the most significant changes they observed in the communities where they were placed. Host sites were also surveyed and data were collated on clinical services performed as well as oral health promotion activity.
Results: Prior to commencing the Dalang Project only 4 of the 15 respondents came from rural or regional areas. Nine of the 15 respondents were considering working in a regional, rural or remote area prior to applying for the Dalang Project. Twelve respondents were working at the time of the survey and half were working in regional, rural or remote locations in NSW and one in the Northern Territory. All reported that they would be more likely to work in an ACCHS as a result of being a part of the Dalang Project. The majority of respondents said they would recommend the program to future graduates. A total of 63 schools, 21 preschools and 15 community health services received regular dental health education through the Dalang Project. A total of 3250 toothbrushes and fluoride toothpastes were distributed to children and families through the Dalang Project. A key part of the program was the installation of refrigerated and filtered water fountains in schools where there was no free filtered or refrigerated water supply. The inclusion of this component in the program was part of the co-design process and links the program to the wider population health strategies in NSW to help prevent childhood obesity.
Conclusion: The Dalang Project is an example of a successful codesigned project that has positively impacted oral health service delivery for Aboriginal children and has provided a valuable experience for new graduate oral health therapists working in ACCHSs. Overall, the Dalang Project was found to be a positive professional experience for the oral health therapists with many remaining in rural, remote and regional locations after completing the program.
PDF
