Melbourne Dental School - Research Publications
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ItemRisk factors for periodontitis & peri-implantitis.(Wiley, 2022-10)Risk is part of all health professions and generally indicates the chance of getting some form of illness. For dental practitioners this includes periodontitis or peri-implantitis, the focus of this issue. Many risk factors are involved in the development of disease and most likely interact or overlap. Most patients will probably have multiple risk factors, some of which will be the same for both periodontitis and peri-implantitis. The most recent classification of periodontal disease recognises the importance of risk factors and contemporary dental practice requires that clinicians be aware of and manage them. Broadly speaking risk factors can be patient, environment or practitioner related. Patient risk factors would include socio-economic status, smoking, substance use disorders, diabetes, diet and dietary supplements, mental health disorders, old age, poor home dental care or understanding of the need for good home care and use of medications. Environmental modification of the host response through gene function is an emerging risk factor. Lastly, practitioner-related factors in implant dentistry are now known to affect risk. These would include the use of digital technology, but patient related factors such implant location and the body's reaction to an implant itself add to the risk of developing disease. This edition of Periodontology provides an uptodate review of many of these risk factors and their impact summarising current knowledge.
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ItemMental health and periodontal and peri-implant diseases(WILEY, 2022-10)Mental health disorders, particularly depression and anxiety, affect a significant number of the global population. Several pathophysiological pathways for these disorders have been identified, including the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and the immune system. In addition, life events, environmental factors, and lifestyle affect the onset, progression, and recurrence of mental health disorders. These may all overlap with periodontal and/or peri-implant disease. Mental health disorders are associated with more severe periodontal disease and, in some cases, poorer healing outcomes to nonsurgical periodontal therapy. They can result in behavior modification, such as poor oral hygiene practices, tobacco smoking, and alcohol abuse, which are also risk factors for periodontal disease and, therefore, may have a contributory effect. Stress has immunomodulatory effects regulating immune cell numbers and function, as well as proinflammatory cytokine production. Stress markers such as cortisol and catecholamines may modulate periodontal bacterial growth and the expression of virulence factors. Stress and some mental health disorders are accompanied by a low-grade chronic inflammation that may be involved in their relationship with periodontal disease and vice versa. Although the gut microbiome interacting with the central nervous system (gut-brain axis) is thought to play a significant role in mental illness, less is understood about the role of the oral microbiome. The evidence for mental health disorders on implant outcomes is lacking, but may mainly be through behaviourial changes. Through lack of compliance withoral hygiene and maintenance visits, peri-implant health can be affected. Increased smoking and risk of periodontal disease may also affect implant outcomes. Selective serotonin reuptake inhibitors have been linked with higher implant failure. They have an anabolic effect on bone, reducing turnover, which could account for the increased loss.
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ItemReferral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review(MDPI, 2022-10)With type 2 diabetes prevalence increasing in Australia, and the condition associated with significant morbidity and mortality, screening for dysglycaemia in the dental setting has been proposed to identify asymptomatic individuals. Screening commences with a risk assessment, and individuals identified at elevated risk for having diabetes are then referred to their medical practitioner for confirmation of their glycemic status. Therefore, for screening to be effective, individuals need to adhere to their oral health professionals' (OHP) advice and attend their medical follow-ups. This review aims to investigate the literature on referral compliance following a risk assessment in the dental setting and identify barriers and facilitators to screened individuals' referral compliance. A scoping review of the literature was undertaken, selecting studies of diabetes screening in a dental setting that recorded compliance to referral to follow-up, and explored any barriers and facilitators to adherence. Fourteen studies were selected. The referral compliance varied from 25 % to 90%. Six studies reported barriers and facilitators to attending medical follow-ups. Barriers identified included accessibility, cost, knowledge of the condition, and OHP characteristics.
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ItemDiabetes and Oral Health (DiabOH): The Perspectives of Primary Healthcare Providers in the Management of Diabetes and Periodontitis in China and Comparison with Those in Australia(MDPI, 2022-06)Diabetes and periodontal disease are highly prevalent conditions around the world with a bilateral causative relationship. Research suggests that interprofessional collaboration can improve care delivery and treatment outcomes. However, there continues to be little interprofessional management of these diseases. DiabOH research aims to develop an interprofessional diabetes and oral health care model for primary health care that would be globally applicable. Community medical practitioners (CMPs), community health nurses (CNs), and dentists in Shanghai were recruited to participate in online quantitative surveys. Response data of 76 CMPs, CNs, and dentists was analysed for descriptive statistics and compared with Australian data. Health professionals in China reported that, while screening for diabetes and periodontitis, increasing patient referral and improving interprofessional collaboration would be feasible, these were not within their scope of practice. Oral health screening was rarely conducted by CMPs or CNs, while dentists were not comfortable discussing diabetes with patients. Most participants believed that better collaboration would benefit patients. Chinese professionals concurred that interprofessional collaboration is vital for the improved management of diabetes and periodontitis. These views were similar in Melbourne, except that Shanghai health professionals held increased confidence in managing patients with diabetes and were more welcoming to increased oral health training.
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Item"Say Ahhh": Experience and Views on Halitosis Management in the General Public in Victoria, Australia(ELSEVIER, 2021-08)INTRODUCTION: Halitosis is common and can have a significant impact on quality of life. It is attributed to both intraoral and extraoral causes. Although halitosis treatment depends on the aetiology, little is known about consumers' perception of halitosis causes and the types of assistance sought. The Say Ahhh Study aimed to explore the interprofessional care for halitosis and improve understanding by the general public. Phase 1 explored the perceptions of health care providers. This article reports the findings of Phase 2, which explored the general public's knowledge of halitosis, its management, and help-seeking behaviour. METHODS: Patients and clients at 2 medical clinics, 3 dental clinics, and 2 pharmacies in Melbourne and rural Victoria were approached and invited to participate in a short semistructured interview. Qualitative data was thematically analysed. RESULTS: A total of 122 participants (54 males, 66 females, 2 missing) were interviewed. Participants' past experience with halitosis influences their understanding of the cause. Halitosis was attributed mostly to poor oral hygiene and diet and less commonly to systemic disease. Their perception of the condition's severity influenced whether they seek professional help. Their perceived roles of health professionals and ease of access influenced their choice of health professionals to seek help from. CONCLUSION: The Victorian general public is aware of the causes of halitosis and the available treatment options. Choice of treatment and help-seeking behaviour are influenced by experience, perceived severity of the condition, and perceived role of health professionals and their accessibility.
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ItemMicrobiome profiles of non-responding and responding paired periodontitis sites within the same participants following non-surgical treatment(TAYLOR & FRANCIS LTD, 2022-12-31)AIM: Periodontitis is a site-specific, chronic disease treated by non-surgical debridement of subgingival plaque. We aimed to determine the microbiome of sites that did not respond to this treatment (NR) compared with paired good responding (GR) sites before and after treatment. MATERIALS AND METHODS: In a longitudinal cohort study, clinical parameters of disease and biological samples were taken prior to and 3 months after treatment. Twelve NR sites from six participants were paired with GR sites within the same participant. Subgingival plaque samples were subjected to bacterial community analysis using 16S rRNA gene sequencing. RESULTS: There were no significant differences in clinical parameters and microbial communities at baseline between GR and NR sites. Bacterial communities in deep pockets were dominated by a small number of species, notably Porphyromonas gingivalis and Treponema denticola. In NR sites three months after treatment there was no significant change in bacterial composition whilst there was a collapse in the abundance of pathobionts in GR sites. CONCLUSION: NR sites were not identifiable prior to treatment by clinical or microbiological parameters. Treatment failed to disrupt pathogenic bacterial community in NR sites. Targeted suppression of particular species should be considered to initiate community collapse and aid disease resolution.
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ItemDentists' preferences in implant maintenance and hygiene instruction(WILEY, 2021-09)BACKGROUND: This study investigated the preferences of dentists in Australia in providing professional implant maintenance and implant-specific oral hygiene instructions (OHI). METHODS: General dentists were surveyed online about their preferences in peri-implant diagnostics, maintenance provision, armamentarium used, and implant OHI techniques and frequency. RESULTS: Most of the 303 respondents (96%) provided maintenance services; 87.6% reviewed implants regularly while 10.7% only performed diagnostics after detecting clinical signs/symptoms. Supragingival prosthesis cleaning was performed by 77.9% of respondents, 35.0% performed subgingival debridement, 41.9% treated peri-implant mucositis and 18.2% treated peri-implantitis. About 15% did not treat nor refer peri-implant disease, including significantly more non-implant providers and dentists without implant training. Maintenance armamentarium commonly included floss (76.3%), prophylaxis (73.9%), plastic curettes (43.3%) and stainless-steel ultrasonics (38.0%). Brushing (86.5%), flossing (73.9%) and interdental brush use (68.3%) were most commonly recommended. Implant OHI was repeated routinely by 57.4% of dentists who provided it. Dentists with greater implant training and experience were more likely to perform reviews and complex maintenance procedures. CONCLUSIONS: Peri-implant diagnostics performed, treatments provided and armamentarium varied among dentists. Implant providers and those with higher levels of training had more preventative approaches to implant OHI. Possible shortcomings in disease management and OHI reinforcement were identified.
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ItemA comparative study of encode protocol versus conventional protocol for restoring single implants: One-year prospective randomized controlled clinical trial(WILEY, 2017-12)BACKGROUND: The Encode protocol (Biomet 3i, Palm Beach Gardens, Fla) has been proposed as a simplified implant restoration protocol. PURPOSE: To compare the 1-year clinical outcome of the Encode and conventional protocols for restoring single implants. MATERIALS AND METHODS: Forty-seven implants were inserted in 44 patients. After randomizing the implants, 24 implants were allocated to the Encode protocol and 23 implants were allocated to the conventional protocol. After 1 year, changes in esthetics, patient satisfaction, proximal contacts quality, occlusal contacts quality, marginal bone level (MBL), and probing pocket depth (PPD) were evaluated. Further, the prosthesis cleansability, mucosal health, bleeding on probing (BoP), metallic discoloration, and all forms complications were recorded. RESULTS: Forty patients with 41 implants (22 Encode and 19 conventional) were recalled. One conventional crown failed due to excessive looseness. Esthetics, patient satisfaction, and prosthesis cleansability were favorable for the two protocols. One Encode crown (4.5%) and six conventional crowns (33.3%) had slight mucosal redness. BoP was present around 8 Encode crowns (36.4%) and eight conventional crowns (45.4%). Only two conventional crowns showed metallic discoloration of the mucosa. The two protocols had similar PPD alteration (Encode = 0.04 mm, conventional = 0.13 mm), and MBL loss (Encode = 0.71 mm, conventional = 0.78 mm). Similar proximal contacts and occlusal contacts were observed for the two protocols. CONCLUSIONS: After 1 year, the Encode protocol for restoring single implants appears to be comparable to the conventional protocol from the biological, prosthetic, and esthetic perspectives.
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ItemPeriodontal treatment in private dental practice: a case-based survey(WILEY, 2017-12)BACKGROUND: This study aimed to assess the management and referral patterns of Victorian general dental practitioners based on periodontal diagnosis. METHODS: Following ethics approval, Victorian general dental practitioners were invited to complete five randomized text-based periodontitis scenario questionnaires. Based on their diagnosis, respondents were asked for their management options and asked to specify who would perform these treatments. Respondents were also asked about referral procedures. RESULTS: One hundred and thirty-five dentists attempted the survey. Most were in group practice and based in Melbourne. Of the total respondents, 22.5% worked in a practice employing a hygienist. The management of periodontal disease was appropriate, and treatment options increased with severity. As severity increased, patients were more likely to be referred to a periodontist. Periodontal services referred by general dentists to dental hygienists increased with the number of days the hygienists worked within a practice. Over- and underdiagnosis did not markedly affect management. The recommendation of antibiotics, mouthwashes and periodontal surgery varied depending on year and school of graduation. CONCLUSIONS: The general dentists that completed the survey are managing periodontal conditions appropriately and according to current guidelines.
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ItemInterdisciplinary periodontics: the multidisciplinary approach to the planning and treatment of complex cases(WILEY, 2017-06)Periodontics cannot be practiced in isolation as frequently many patients have multiple dental needs or medical health issues requiring management. In addition, pathology may manifest in the periodontal tissues, and the onset and progression of periodontitis can be affected by systemic conditions, such as diabetes, and vice versa. The focus of this volume of Periodontology 2000 is interdisciplinary periodontics, and the articles included discuss the interactions and the interrelationshipbetween periodontal tissues/periodontal diseases and endodontics, fixed prosthodontics, implant dentistry, esthetics, gerodontology, radiology, orthodontics, pediatric dentistry, oral and maxillofacial surgery, oral pathology, special needs dentistry and general medicine. Previous volumes of Periodontology 2000 have covered some of the interactions between periodontal diseases and other dental disciplines, especially implant dentistry, 'and the interaction between periodontal disease and systemic disease', but there has not been a volume on interdisciplinary periodontics. The intention therefore is to show how and why periodontics should be interdisciplinary, as well as the benefits of an interdisciplinary approach; in addition, the potential consequences of using a discipline in isolation are discussed.