Melbourne Dental School - Research Publications
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ItemPerceptions of oral health education and practice among nursing students in Malaysia and Australia(WILEY, 2021-05)OBJECTIVE: Representing the largest proportion of healthcare workers, nurses play a significant role in oral health (OH) maintenance as part of a larger effort to promote holistic patient care. The study aims to determine nursing students' perceptions of OH education and practice in Malaysian and Australian nursing schools. MATERIALS AND METHODS: A self-administered questionnaire (content- and face-validated) survey was undertaken, classroom style, amongst final-year nursing students from selected Malaysian (n = 122, Response rate=97.6%) and Australian (n = 299, Response rate=54.7%) institutions. Quantitative data were analysed via Statistical Package for Social Science software (Chi-square and Fisher's exact tests, p ≤ 0.01). RESULTS: Significantly more Malaysian nursing students, compared to those in Australia, reported having encountered patients with OH issues (98.4% vs. 82.9%), namely halitosis (87.7% vs. 62.2%), oral ulcers (63.1% vs. 41.1%), oral/dental trauma (36.9% vs. 21.1%) and caries in children (28.7% vs. 7.7%). Less than half of Malaysian and Australian nursing students reported that they received adequate OH training (48.4% vs. 36.6%, p ≤ 0.01), especially in detecting oral cancer (18.0.0% vs. 22.6%, p ≤ 0.01) and preventing oral diseases (46.7% vs. 41.7%, p ≤ 0.01). Students in both countries demonstrated positive attitudes and believed in their role in OH care. Most students agreed that they should receive training in OH, especially in smoking cessation and providing OH care for patients with special needs. They also opined that a standardized evidence-based oral hygiene protocol is needed. CONCLUSION: Support for education and practice in this area of patient care suggested positive implications for further development of nurses' roles in OH promotion and management.
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ItemMentoring of oral health professionals is crucial to improving access to care for people with special needs.(Public Library of Science (PLoS), 2022)INTRODUCTION: Individuals with special health care needs continue to experience difficulties with accessing regular dental care. This has largely been due to clinicians feeling they lack the training and experience to manage their needs. The aim of this study was to determine whether working closely with specialists in special need dentistry influenced the willingness of clinicians to treat patients with special needs. MATERIALS AND METHODS: Semi-structured interviews were conducted with specialists and clinicians involved in these mentoring initiatives. Qualitative thematic analysis was used to determine perspectives towards how this additional support influenced their willingness to treat individuals with special needs. RESULTS: The views of all participants towards these supports were positive with clinicians feeling it not only offered them opportunities to learn from the specialists, but also increased their willingness to treat individuals with special needs and the timeliness and quality of care they were able to provide. Likewise, despite some concerns about the inappropriate use of specialist support, the specialists felt these mentoring relationships offered many benefits including improving timely access to care and ensuring individuals were able to receive appropriate care. CONCLUSIONS: Mentoring provided by specialists in special needs dentistry improved the willingness of clinicians to provide care for individuals with special health care needs. Supports such as these are likely to be crucial to overcoming concerns of clinicians about their ability to manage the needs of these individuals and begin to address a significant barrier to access of care for individuals with special health care needs.
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ItemPerceived barriers encountered by oral health professionals in the Australian public dental system providing dental treatment to individuals with special needs(WILEY, 2021-05)AIMS: To investigate barriers experienced by clinicians treating individuals with special needs in the Australian public dental system. METHODS AND RESULTS: Oral health professionals working at primary care clinics in the public dental system were invited to participate in semi-structured interviews or focus groups to discuss the challenges they faced in managing patients with special needs. Qualitative methods, employing inductive thematic analysis, revealed two primary barriers: 1. clinicians lacked confidence in their ability to treat patients with special needs because of insufficient training and experience, and difficulties obtaining information about their patients, and 2. barriers within the public dental system, including inadequate funding, equipment and facilities, and productivity pressures prevented clinicians from being able to provide the care patients required. The priority and understanding of the oral health for these individuals within the public dental system and wider disability sector was also raised. CONCLUSION: A perceived lack of training and experience in managing individuals with special needs was a barrier to treating patients with special needs. Other significant barriers were under-resourcing of the public dental system and a lack of priority and understanding regarding oral health among carers of individuals with special needs and other health professionals.
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ItemPerception of Special Needs Dentistry education and practice amongst Australian dental auxiliary students(WILEY, 2018-08)INTRODUCTION: The role of dental auxiliaries in collaborative care of patients with special needs is compelling. This study was undertaken to investigate the perceptions of Special Needs Dentistry (SND) education and practice amongst students enrolled in Australian programmes in dental auxiliary, namely dental hygiene, dental therapy and oral health therapy (DH/DT/OHT). MATERIALS AND METHODS: All Australian institutions offering DH/DT/OHT programmes (n = 14) were invited to participate in a self-administered questionnaire survey, conducted online, involving students across all academic years. Twelve institutions agreed to participate, but only five institutions were included in the final analysis, with a student response rate of 31.1%. Answers to open-ended questions were coded and grouped for measurement of frequencies. Quantitative data were analysed via chi-squared and Fisher's exact tests (significance taken as P < .05). RESULTS: The majority of students could not define SND (87.0%) were not aware of the existence of this specialty (53.5%) and did not have clinical experience treating patients with special needs (68.9%). Nevertheless, they felt comfortable and positive about treating these patients independently. Most agreed that they should receive clinical and didactic education in SND, with many of them expressing interest in pursuing a specialty training in this field. CONCLUSION: DH/DT/OHT students' comfort levels, positive attitudes and supportiveness for SND suggested positive implications for these practitioners to partake in multidisciplinary management of patients with special needs, thus indicating the need for standardised training requirements and practice guidelines in this area of care.
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ItemReferral patterns of special needs patients at the Royal Dental Hospital of Melbourne, Victoria, Australia(WILEY, 2017-06)BACKGROUND: Special Needs Dentistry (SND) has been recognized as a dental specialty in Australia since 2003 but there have been no studies addressing the profile of patients for specialist care. The purpose of this study is to identify, via referrals received, the profile of patients and quality of referrals at the largest public SND unit in Victoria, Australia. METHODS: All referrals received over a 6-month period (1 January-30 June 2013) by the integrated SND unit (ISNU) were reviewed prior to allocation to the outpatient clinic (OP), domiciliary (DOM) or general anaesthetic (GA) services. RESULTS: Six-hundred and eighty-eight referrals were received with the majority for the OP clinic (68.3%), followed by DOM (22.4%) and GA services (9.3%) (χ2 = 360.2, P < 0.001). A referral may have specified more than one special needs condition with the most common category being those who were medically compromised (81.7%). The reasons for referral included lack of compliance (27.2%), further management due to multiple medical conditions or GA services required (9.9%), or for multiple other reasons (62.9%). CONCLUSIONS: A diverse pattern of SND patients was referred to the ISNU with a majority of referrals having no specific referral reason cited, suggesting poor quality of referrals.
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ItemOral health education in the undergraduate nursing curriculum of Australian and Malaysian institutions(WILEY, 2021-05)INTRODUCTION: A high degree of training is necessary to prepare student nurses for their roles as oral healthcare partners that can promote a holistic approach to health in the community. This study aims to determine the extent of oral health education in Australian and Malaysian nursing institutions, as well as investigate educators' perceptions of education and practice in this area of care. METHODOLOGY: An audio-recorded, semi-structured qualitative phone interview was conducted with the heads of 42 nursing schools across Australia (n = 35) and Malaysia (n = 7) during the 2015 academic year. Qualitative data were analysed via thematic analysis. Quantitative data, wherever appropriate, were measured for frequencies. RESULTS: The response rate was 34.2% (n = 12) and 71.4% (n = 5) for the Australian and Malaysian subjects, respectively. Findings revealed that although all the nursing schools measured provided didactic and clinical training in oral health, curriculum content, expected learning outcomes, amount of clinical exposure and assessment approach lacked consistency. Most nursing educators across both countries perceived an overloaded curriculum as a barrier to providing oral health education. Whilst educators demonstrated their support for training in this area of care, they expressed the need for an established national guideline that highlights the educational requirement for future nurses in oral health maintenance and their scope of practice. CONCLUSION: This study provides valuable information for further developing oral health education for nurses, to improve their competency and ultimately the health of the communities that they will serve.
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ItemAssociation between disability status and dental attendance in Australia-A population-based study(WILEY, 2021-02)AIMS: Disability is a key social determinant of health. The objective of this study was to test the association between disability status and irregular dental attendance among the Australian population, and to examine whether the observed association varied among adolescents. METHODS: Data on 17 501 participants from The Household, Income and Labour Dynamics in Australia (HILDA) were analysed. The main outcome examined was irregular dental attendance (two or more years since last dental visit) with disability as the primary exposure. Multivariable logistic regression models were fitted to test the associations between disability and dental attendance pattern. Models were adjusted for age, gender, country of birth, region of residence, education and income. Analysis was repeated among adolescents (15- to 24-year-old) to examine for variations in observed association. RESULTS: One in four participants reported having a disability. Unadjusted model showed that the odds for irregular dental attendance were 1.40 times greater (95%; CI, 1.30-1.51) in those with disability than those without disability. After adjusting for all covariates, participants with disability had 1.20 times higher odds (95%; CI 1.10-1.30) of irregular dental attendance than those without disability. Irregular dental attendance was 1.41 times greater (95%; CI 1.10-1.80) in those with disability aged 15-24 years than those without disability. CONCLUSIONS: Australian individuals with disability are more likely to have irregular dental attendance than those without.
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ItemUtilisation of dental services for people with special health care needs in Australia(BMC, 2020-12-11)BACKGROUND: To explore the profile of patients and treatment delivered at specialist referral centres for individuals with special needs. METHODS: A cross-sectional audit was conducted of the health records of all patients with appointments at two of Australia's largest referral centres for patients with special needs, the Integrated Special Needs Department at the Royal Dental Hospital of Melbourne and the Special Needs Unit at the Adelaide Dental Hospital, for the month of August 2015. RESULTS: The profile of patients treated at these specialist units demonstrates the diversity of individuals with additional health care needs that general dentists feel require specialised oral health care. The Adelaide-based clinic had a greater proportion of complex medical patients in comparison to those treated in Melbourne who were more likely to have a disability or psychiatric condition and were less likely to be able to self-consent for treatment. Interestingly, despite similar workforce personnel numbers, there were approximately twice as many appointments at the Special Needs Unit in Adelaide than the Integrated Special Needs Department in Melbourne during the study period which may have reflected differences in workforce composition with a greater use of dental auxiliaries at the Adelaide clinic. CONCLUSIONS: The results of this study provide an initial profile of patients with special needs referred for specialist care in Australia. However, the differences in patient profiles between the two units require further investigation into the possible influence of service provision models and barriers to access of care for individuals with special needs and to ensure equitable access to health care.
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ItemNo Preview AvailableOral health care for the elderly population in Malaysia: A review of current status and future direction(SEAMEO TROPMED Network, 2018-05-01)Poor oral health status among the elderly population in Malaysia could be associated with various limitations in accessing oral health care services experienced by these individuals. This review discusses government policies and services available to support oral health needs of the elderly population in Malaysia. It also discusses the current status of oral health and dental treatment needs of this patient cohort, as well as the level of utilization of oral health care services. Recommendations to address the various issues are provided to serve as guidance to policy makers in formulating an effective plan aimed at improving the status of oral health and the services available for elderly individuals in the country.
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ItemIs bisphosphonate therapy for benign bone disease associated with impaired dental healing? A case-controlled study(BMC, 2011-04-10)BACKGROUND: Bisphosphonates are common first line medications used for the management of benign bone disease. One of the most devastating complications associated with bisphosphonate use is osteonecrosis of the jaws which may be related to duration of exposure and hence cumulative dose, dental interventions, medical co-morbidities or in some circumstances with no identifiable aggravating factor. While jaw osteonecrosis is a devastating outcome which is currently difficult to manage, various forms of delayed dental healing may be a less dramatic and, therefore, poorly-recognised complications of bisphosphonate use for the treatment of osteoporosis. It is hypothesised that long-term (more than 1 year's duration) bisphosphonate use for the treatment of post-menopausal osteoporosis or other benign bone disease is associated with impaired dental healing. METHODS/DESIGN: A case-control study has been chosen to test the hypothesis as the outcome event rate is likely to be very low. A total of 54 cases will be recruited into the study following review of all dental files from oral and maxillofacial surgeons and special needs dentists in Victoria where potential cases of delayed dental healing will be identified. Potential cases will be presented to an independent case adjudication panel to determine if they are definitive delayed dental healing cases. Two hundred and fifteen controls (1:4 cases:controls), matched for age and visit window period, will be selected from those who have attended local community based referring dental practices. The primary outcome will be the incidence of delayed dental healing that occurs either spontaneously or following dental treatment such as extractions, implant placement, or denture use. DISCUSSION: This study is the largest case-controlled study assessing the link between bisphosphonate use and delayed dental healing in Australia. It will provide invaluable data on the potential link between bisphosphonate use and osteonecrosis of the jaws.