Melbourne Dental School - Research Publications
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ItemCultural competence skills in a dental curriculum: A review(WILEY, 2018-02)UNLABELLED: This study aimed to analyse and evaluate the extent of transcultural content in the current curricula of the Doctor of Dental Surgery (DDS), Bachelor of Oral Health (BOH) and Master of Nursing Science (MNSc) courses at the University of Melbourne. METHODS: The study was conducted in two phases: a quantitative review and assessment of the current DDS, BOH and MNSc curricula at the University of Melbourne, and interviews with various staff from the University of Melbourne who were responsible for curriculum development for these courses. RESULTS: Staff from the DDS, BOH and MNSc courses concurred on the importance of transcultural skills, the necessity of covering cultural issues relevant to the main ethnic groups in Australia, obstacles faced and the lack of evaluation methods for cultural competency. The nursing curriculum had the most extensive coverage of transcultural content throughout both years of the course (total 71 formal contact hours; mean 36 formal contact hours per year). In contrast, modules on transcultural skills were limited to the first two of the 3-year BOH course (54 hours; 18 hours) and only the first of the 4-year dental curriculum (40 hours; 10 hours). CONCLUSION: The DDS course showed less time devoted to formal teaching of these concepts compared to the nursing and BOH courses despite showing a noticeable improvement from a previous assessment conducted in 2006. It is hoped that the DDS course continues to further increase the transcultural content and find ways to incorporate more transcultural education.
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ItemCultural competency and communication skills of dental students: clinical supervisors' perceptions(WILEY, 2017-11)OBJECTIVES: This study explored clinical supervisor's (CS) views and experiences of dental students' cultural competence (CC) at the Melbourne Dental School, The University of Melbourne, Australia. Additionally, this study explored CS insights into how CC could be taught. METHODS: Semi-structured one-to-one interviews were organised with consenting CS. Interview topics included the following: the importance of CC, communication and rapport, the role of culture in oral health and the need for curriculum enhancement. Interviews were recorded, transcribed and thematically analysed to identify key areas using NVivo software. RESULTS: A total of 12 CS participated in this study. CS acknowledged the importance of CC and felt that it was important for good patient management. CS's definition of CC focused primarily on language and communication skills. CS felt that dental students were generally able to manage culturally diverse patients. However, CS indicated that additional training in this area would be beneficial. Concerns were raised about the students' ability to establish good rapport and communication, with CS highlighting areas such as misuse of interpreters and use of jargon. CS felt that clinical experience, confidence and a positive attitude are effective tools for overcoming cultural barriers. Furthermore, some CS also felt that cultural competency was a skill that is learnt through experience. CONCLUSIONS: For most CS, cultural competence was an important part of the clinician-patient exchange which would benefit from enhanced curriculum. They also highlighted areas where transcultural education could be improved. The majority of CS believed dental students managed culturally diverse patients well.
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ItemPsychological and behavioral acculturation in a social network of Mexican Americans in the United States and use of dental services(WILEY, 2016-12)OBJECTIVES: We used data from the TalaSurvey study to examine associations between dental health experiences, social network characteristics, and levels of behavioral and psychological acculturation in one location in the American Midwest. METHODS: Starting in parishes and community organizations, we identified adults of Mexican origin living in Indianapolis, who were 1st- or 2nd-generation immigrants from Tala, Mexico. Using a social networks methodology and following extensive formative research, we created an egocentric social network survey and administered it via face-to-face interviews. We identified the peers (alters) in interviewees' (egos) personal networks. We asked egos about multiple oral health and dental care variables for self and for alters. Acculturation (psychological and behavioral) was measured with a validated tool. Through logistic and negative binomial regression, we examined the effects of acculturation and network composition on ego's dental insurance status, dental office visits, and the reason for most recent dental office visit. RESULTS: A total of 332 egos (mean age 36; 63% female) were interviewed: 90% were born in Mexico; 45% had completed elementary school or lower; and most had low income. Each ego named 3.9 (SD±1.9) alters in his/her personal network, for a total of 1299 alters (mean age 39; 61% female). Both behavioral acculturation and psychological acculturation were moderately associated with dental insurance coverage, and greater behavioral acculturation predicted more frequent dental care. More psychologically acculturated egos were more likely to seek preventive care. Further, egos with more highly educated networks sought care more frequently and for preventive purposes, net of ego's own education and acculturation. CONCLUSIONS: This study contextualizes acculturation of Mexican Americans within the personal networks in which oral health discussion takes place. The findings underscore the critical importance of acculturation and social network factors in shaping a subgroup of Latinos' orientation toward dental care.
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ItemPerceptions, attitudes and factors that influence prescribing by general dentists in Australia: A qualitative study(WILEY, 2019-08)BACKGROUND: Longitudinal studies of dental prescribing in Australia show that dentists make some inappropriate prescribing choices; literature has shown that dentists tend to overprescribe antibiotics and prescribe for incorrect indications. The unnecessary use of antibiotics is a contributing factor towards the development of antibiotic resistance. The aims of the study were to obtain a greater understanding of the perceptions, attitudes and factors that influence dental prescribing for all major relevant drug classes. METHOD: Semi-structured interviews of 15 purposively sampled dentists practising in Victoria, Australia were conducted from June-September 2018. Two dentists practised in rural areas and the remainder in urban locations. The range of clinical experience varied from 2.5 to 37 years, with a mean of 13 years. The transcripts were analysed thematically. RESULTS: Dentists generally preferred amoxicillin as first-line therapy for odontogenic infections, with some confusion about the spectrum and uses of antibiotics. Overprescribing was evident, mostly due to basing judgement for use of antibiotics on symptoms rather than clinical signs. Other factors, such as time pressure, patient expectations, pressure from assistant staff, concern about online criticism and medico-legal considerations, influenced prescribing. Of the dentists who prescribed anxiolytics, most did not have a care protocol for their sedated patients. CONCLUSION: A variety of prescribing practices were described, and future interventions should target misconceptions around the appropriate use and choice of antibiotics, resources to address the shortfall in knowledge of therapeutics, patient education and staff training, as well as appropriate care and monitoring of sedated patients.
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ItemDevelopmental regulation of lifelong dental experiences and beliefs in Guangzhou and Hong Kong(WILEY, 2019-03)AIMS: The aim of this study was to explain through the life-course and life-span perspectives of developmental regulation theory the controls on dental experiences and beliefs throughout the lives of older people in Guangzhou and Hong Kong. BACKGROUND: Dental diseases and disabilities among older people are serious public health concerns in China. METHODS: A facilitator conducted eight focus groups, three in Hong Kong and five in Guangzhou, involving a total of 51 participants. She encouraged discussions about lifetime events to explain dental experiences and beliefs. Transcripts were coded and analysed using a constant comparative approach to identify themes that explained the regulators of dental experiences throughout the participants' lives. RESULTS: Participants explained the influence of culture and history through critical events, and how external and internal factors regulated their current oral health status and beliefs. They emphasised the role of Traditional Chinese Medicine and family, and the stress of social upheaval compounded by a scarcity of dental services. They revealed also how current choice of dental services and health promotional programs, helped by personal food choice, self-reliance, and scepticism, helped them to adjust and cope with dental diseases and disabilities and the commercialisation of dental services. CONCLUSIONS: Dental experiences and beliefs of older people living in Guangzhou and Hong Kong were regulated strongly during personal development by culture and history during critical events, and by various controlling factors, such as health promotion and choice of services supplemented by food choice, nutritional balance, self-reliance, scepticism and social adjustments.
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ItemCost-effectiveness of professional oral health care in Australian residential aged care facilities(WILEY, 2019-06)OBJECTIVE: To conduct a model-based cost-effectiveness analysis, from a health care system perspective, of using oral health professionals to provide oral hygiene services at residential aged care facilities (RACFs) in Victoria, Australia, compared to current practice (CP). BACKGROUND: Increasingly dentate cohorts of older adults are entering RACFs, making urgent the need of further development and provision of oral health programmes in ageing dentitions. MATERIALS AND METHODS: The model was based on 47 624 RACFs' places in Victoria over one year. The main outcome measured was "cost per pneumonia case averted." Four different scenarios of oral hygiene provision were compared to CP. Costs included were RACF staff training, professional salaries, programme coordinator office expenses, dental equipment and hospitalisation costs. Effectiveness assumptions for each scenario were based on systematic reviews and randomised control trials. RESULTS: All four scenarios were dominant strategies. The magnitude of negative incremental cost-effectiveness ratio was not informative; therefore, incremental costs and incremental effectiveness were used to present results. "Professional oral health care (POHC) provision once every two weeks and current provision of oral health care the other days" was the most cost-saving alternative (AU $896 per resident saved). The most effective alternative was "POHC provision once a week and non-POHC provision by trained Nurse aids twice per day the other days" (6779 pneumonia cases averted). One-way sensitivity analyses confirmed the robustness of results. CONCLUSION: The four scenarios were highly cost-effective compared to CP. These results could be a strong basis to implement new oral health programmes in Australian RACFs.
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ItemValidity and reproducibility testing of the Molar Incisor Hypomineralisation (MIH) Index(WILEY, 2019-01)BACKGROUND: To address challenges presented to clinicians to diagnose and treat molar incisor hypomineralisation (MIH), a new assessment tool was created. AIM: To explore the reproducibility and validity of a new instrument developed to assess MIH. METHODS: Inter-rater and test-retest reliabilities were examined using Cronbach's alpha. Thirty-five oral health professionals scored clinical photographs for the presence/absence of MIH and other enamel defects using the new index. Face, content, and construct validities were assessed. A panel of six experienced researchers assessed face validity. Construct validity was determined by examining hypothesised associations with clinical variables reported to change concurrently or as modifiers of the MIH outcome. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were also assessed. RESULTS: The index reflected the hypothesised associations regarding the presence, prevalence, and severity of MIH, demonstrating construct validity. Researchers indicated that codes and definitions were clear and suitable for international use. The index showed satisfactory scores of sensitivity/specificity and PPV/NPV. Examiners achieved "Substantial" to "Almost perfect" levels of agreement in clinical presentation and lesion extension. CONCLUSIONS: The tested MIH index had reasonably solid properties providing confidence that it is a reliable and valid instrument for use in population-based and clinical screenings for diagnosis of MIH and other enamel defects.
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ItemValidation and usability of a mobile phone application for epidemiological surveillance of traumatic dental injuries(WILEY, 2019-02)BACKGROUND/AIM: Traumatic dental injuries (TDI) are a public health problem, given their prevalence and consequences. However, their epidemiology is uncertain due to a general lack of quality data capture. The aim of this study was to evaluate the validity and usability of a mobile phone-based application for community-based surveillance of traumatic dental injuries. MATERIALS AND METHODS: A mobile phone-based application, Dental Trauma Tracker (DTT), was developed. This system involves a mobile application for general users to report TDIs and a Web application for researchers to generate epidemiological data. The DTT evaluation used mixed methods and was conducted in three phases: (a) validation of a trauma identification system using preselected TDI images; (b) design evaluation by experts; and (c) usability evaluation measured by the reporting of three fictitious TDI cases and using the System Usability Scale (SUS). RESULTS: In the first phase, 182 participants participated. Most images showed over 95% accuracy, indicating that they adequately represented the type of dentoalveolar trauma being evaluated (κ = 0.75). The design evaluation identified nine usability problems-four of them with a "High priority" to be fixed, four with "Low priority," and one "No fix necessary." A total of 29 volunteers participated in the usability evaluation. The mean time for users to complete all of the reports was 7.8 ± 3.0 minutes. Mean SUS score was 67.4 ± 21.9 (Range: 0-100; worst to best). The global agreement between cases registered with the gold standard was also "Substantial" (κ = 0.71). CONCLUSIONS: This preliminary evaluation confirmed the App's usability, using a sample of potential users, as well as reporting on the results of an expert panel review of the DTT. These are the minimum requirements necessary before further expansion and widespread implementation occurs to confirm these results.
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ItemCarious lesion severity and demarcated hypomineralized lesions of tooth enamel in schoolchildren from Melbourne, Australia(WILEY, 2018-09)BACKGROUND: Developmental hypomineralized lesions of enamel (DHL) may represent a significant caries-risk factor. The aim of this study was to determine the association between carious lesion severity and DHL in 6- to 12-year-old schoolchildren from Melbourne, Australia. METHODS: The sample was derived from randomly selected schools in inner Melbourne. A full dental examination was performed at the school. Socio-demographic data, caries experience (DMFT/dmft/ICDAS II) and the consequences of untreated carious lesions (PUFA/pufa) were measured. DHL, molar incisor hypomineralization (MIH) and hypomineralized second primary molar (HSPM) presence were assessed using the European Academy of Paediatric Dentistry (EAPD) criteria. RESULTS: Of the children examined (n = 327), 26.9% had DHL. The prevalence of MIH and HSPM was 14.7% and 8%, respectively. Almost 20% of children had severe carious lesions (ICDAS 5 & 6) in at least one permanent or primary tooth. Ordinal regression analyses indicated that DHL (OR = 2.17; 95% CI: 1.35-3.49) and being born overseas (OR = 2.59, 95% CI: 1.66-4.06) increased the likelihood of severe carious lesions. CONCLUSIONS: One of four children had DHL. DHL-affected children had an increased likelihood of presenting untreated severe carious lesions compared with DHL-free children.
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ItemAntibiotic resistance and relevance to general dental practice in Australia(WILEY, 2018-12)Antibiotic resistance is a well-established global public health crisis, with the use and misuse of antibiotics being the principal cause of bacterial resistance. Studies in both Australia and overseas have demonstrated that the dental prescribing of antibiotics is increasing and that dentists tend to prescribe antibiotics unnecessarily and for incorrect clinical indications. Dental practitioners in Australia also prefer to prescribe moderate to broad-spectrum antibacterial agents and make some inappropriate antibiotic prescribing choices. This review aims to inform dentists about the overall scope and development of bacterial resistance, approaches and challenges to reducing resistance and, ultimately, the role of dental prescribers in practising with optimal antibiotic stewardship.