Fiona Blinkhorn

A phase II clinical trial of a dental health education program delivered by aboriginal health workers to prevent early childhood caries

BackgroundEarly Childhood Caries (ECC) is a widespread problem in Australian Aboriginal communities causing severe pain and sepsis. In addition dental services are difficult to access for many Aboriginal children and trying to obtain care can be stressful for the parents. The control of dental caries has been identified as a key indictor in the reduction of Indigenous disadvantage. Thus, there is a need for new approaches to prevent ECC, which reflect the cultural norms of Aboriginal communities.Methods/DesignThis is a Phase II single arm trial designed to gather information on the effectiveness of a dental health education program for Aboriginal children aged 6 months, followed over 2 years. The program will deliver advice from Aboriginal Health Workers on tooth brushing, diet and the use of fluoride toothpaste to Aboriginal families. Six waves of data collection will be conducted to enable estimates of change in parental knowledge and their views on the acceptability of the program. The Aboriginal Health Workers will also be interviewed to record their views on the acceptability and program feasibility. Clinical data on the child participants will be recorded when they are 30 months old and compared with a reference population of similar children when the study began. Latent variable modeling will be used to interpret the intervention effects on disease outcome.DiscussionThe research project will identify barriers to the implementation of a family centered Aboriginal oral health strategy, as well as the development of evidence to assist in the planning of a Phase III cluster randomized study.Trial registrationACTRN12612000712808

An intervention to improve the oral health of residents in an aged care facility led by nurses

Introduction: The growing population of elderly people is impacting on overstretched dental services in many countries, as many individuals are retaining natural teeth and may have dentures or implants, all of which influence the way in which the oral cavity must be cared for. A major difficulty for older residents is their decreasing level of motor and cognitive functioning to adequately self-care for their mouths. Hence, the role of the nurse is crucial. However, staff shortages, time factors and lack of awareness can lead to neglect of the mouth in this population. The loss of function is often exacerbated in individuals with mental health problems. Objectives: To improve the oral health of residents in an aged care mental health unit through the introduction of an innovative nursing intervention. Methods: Firstly, utilizing focus groups, nursing staff identified the main barriers to delivery of oral hygiene to residents as follows: lack of proper equipment; no protocol in place; lack of knowledge. Staff knowledge of oral health and hygiene was measured using a structured questionnaire before and after the intervention. A training program was devised by a dentist, dietician and nurse working in the unit. A multidisciplinary team met on several occasions to design a suitable vehicle and process to deliver oral hygiene. Oral health examinations were conducted at baseline, three months and 12 months. Interventions: Design and production of oral hygiene trolley; development of protocol for oral hygiene; staff education in oral health. Results: The program was successful in improving the oral health of residents with reductions in plaque scores, gingivitis and pocket depths. The oral hygiene protocol was positively accepted into a daily routine and the knowledge of staff in matters relating to oral health increased. Conclusions: A simple oral health intervention utilizing qualified nurses and a purpose-built oral hygiene trolley made significant improvements to the oral health of aged care residents.

An assessment of the educational value of service‐learning community placements in residential aged care facilities

AIMS The aim of this study was to determine whether dental hygiene students attending residential aged care facilities (RACFs) during a placement programme gained any knowledge about the oral care of elderly patients and the RACF environment. LOCATION Aged Care Facilities on the Central Coast of New South Wales, Australia. METHODOLOGY Final year dental hygiene students undertook a 12-week placement, one day per week, in one of 17 residential aged care facilities on the NSW Central Coast. They were asked to complete pre-placement and post-placement questionnaires, which recorded their knowledge of medical, dental and environmental issues related to older people. The placement questionnaires used five point Likert scales, ranging from strongly agree to strongly disagree, pre- and post-mean scores were produced for each question and P values calculated using a paired t-test. RESULTS Thirty-three students attended the placement, 26 (79%) completed both the pre- and post-placement questionnaires. Post-placement mean scores as compared to pre-placement mean scores showed significant improvement in student knowledge of medical (P < 0.05) and dental (P < 0.05) conditions specific to the older person and improvement in knowledge (P < 0.05) about the residential aged care facility environment. CONCLUSION The placement programme enhanced student knowledge across three subject categories; medical and dental conditions of the older person and the structure and services of the residential aged care environment.

User assessment of an early childhood oral health education training course for Aboriginal Health Workers

Introduction: Dental caries has a severe impact on young Australian Aboriginal children. With appropriate advice, dental caries is preventable; however, many Aboriginal children cannot access dental services. Aboriginal health workers (AHWs) are a valued member of Aboriginal communities and have regular contact with Aboriginal families. Once trained about dental health, AHWs have the ability to teach families with young children about preventing dental caries. This article reports on an oral health training course for AHWs. Objectives: To evaluate the training course in terms of its components, cultural appropriateness, course content and whether the participants felt competent to offer oral health advice. Methods: Sixty-one AHWs from twelve Aboriginal Controlled Community Health Services (ACCHS) participated in the training programme across New South Wales, Australia. Anonymous self-completed questionnaires were collected after the training to determine whether the participants felt prepared to offer oral health advice to Aboriginal families with young children and to evaluate the course. Results: Most AHWs thought the components of the training were very good to good including the PowerPoint presentation (59, 97%), graphics (60, 98%) and materials (60, 98%). All (59, 100%) thought the training and materials were culturally appropriate. The course was informative, the material was relevant (61, 100%), and the training increased the AHW’s oral health knowledge (61, 100%). Most (59, 98%) reported increased confidence to deliver dental advice to families with young children. All believed the course appeared easy to use and would recommend it to others (61, 100%).

Factors that influence the preventive care offered to adolescents accessing Public Oral Health Services, NSW, Australia.

Background Many adolescents are at risk of dental caries and periodontal disease, which may be controlled through health education and clinical preventive interventions provided by oral health and dental therapists (therapists). Senior clinicians (SCs) can influence the focus of dental care in the New South Wales (NSW) Public Oral Health Services as their role is to provide clinical support and advice to therapists, advocate for their communities, and inform Local Health District (LHD) managers of areas for clinical quality improvement. The objective of this study was to record facilitating factors and strategies that are used by SCs to encourage therapists to provide preventive care and advice to adolescent patients. Methods In-depth, semistructured interviews were undertaken with 16 SCs from all of the 15 NSW LHDs (nine rural and six metropolitan). A framework matrix was used to systematically code data and enable key themes to be identified for analysis. Results All SCs from the 15 NSW Health LHDs participated in the study. Factors influencing SCs’ ability to integrate preventive care into clinical practice were: 1) clinical leadership and administrative support, 2) professional support network, 3) clinical and educational resources, 4) the clinician’s patient management aptitude, and 5) clinical governance processes. Clinical quality improvement and continuing professional development strategies equipped clinicians to manage and enhance adolescents’ confidence toward self-care. Conclusion This study shows that SCs have a clear understanding of strategies to enhance the therapist’s offer of scientific-based preventive care to adolescents. The problem they face is that currently, success is measured in terms of relief of pain activities, restorations placed, and extraction of teeth, which is an outdated concept. However, to improve clinical models of care will require the overarching administrative authority, NSW Health, to accept that the scientific evidence relating to dental care has changed and that management monitoring information should be incorporated into NSW Health reforms.

Assessment of the management factors that influence the development of preventive care in the New South Wales public dental service

Background Oral diseases, particularly dental caries, remain one of the most common chronic health problems for adolescents, and are a major public health concern. Public dental services in New South Wales, Australia offer free clinical care and preventive advice to all adolescents under 18 years of age, particularly those from disadvantaged backgrounds. This care is provided by dental therapists and oral health therapists (therapists). It is incumbent upon clinical directors (CDs) and health service managers (HSMs) to ensure that the appropriate clinical preventive care is offered by clinicians to all their patients. The aims of this study were to 1) explore CDs’ and HSMs’ perceptions of the factors that could support the delivery of preventive care to adolescents, and to 2) record the strategies they have utilized to help therapists provide preventive care to adolescents. Subjects and methods In-depth, semistructured interviews were undertaken with 19 CDs and HSMs from across NSW local health districts. A framework matrix was used to systematically code data and enable key themes to be identified for analysis. Results The 19 CDs and HSMs reported that fiscal accountability and meeting performance targets impacted on the levels and types of preventive care provided by therapists. Participants suggested that professional clinical structures for continuous quality improvement should be implemented and monitored, and that an adequate workforce mix and more resources for preventive dental care activities would enhance therapists’ ability to provide appropriate levels of preventive care. CDs and HSMs stated that capitalizing on the strengths of visiting pediatric dental specialists and working with local health district clinical leaders would be a practical way to improve models of preventive oral health care for adolescents. Conclusion The main issue raised in this study is that preventive dentistry per se lacks strong support from the central funding agency, and that increasing prevention activities is not a simple task of changing regulations or increasing professional education.

Preventing dental decay in young children requires all primary health care professionals to work together

Untreated dental caries causes pain and suffering to children, as well as stress to the family. Young children with dental pain are difficult to treat and may require a general anaesthetic in hospital to receive dental care. This is expensive, carries a risk of death, can cause postoperative pain and treatment usually entails multiple dental extractions. Long wait lists for treatment of this type often means that young children can suffer pain and loss of sleep for over 12 months. Child and family nurses working in Western Sydney, New South Wales considered dental caries in young children to be one of the most significant issues in their daily working lives, especially in areas with large multicultural populations. Unlike many childhood health problems, dental caries is preventable with simple behavioural changes. The important health messages for families with pre-school children are: 1 Do not put a child to bed with a night time bottle once the baby teeth have begun to erupt. 2 Do not allow a child to have sugar-containing drinks from a feeding bottle. 3 Restrict sugary foods and drinks to meal times, and drink fluoridated water. 4 Brush the teeth gently twice a day with a smear of fluoride toothpaste. If these behaviours are implemented, then all young children should have healthy teeth. Unfortunately, in many socially disadvantaged areas of the city of Sydney, there is a tendency to: • Provide sweetened milk in night time bottles • Use sugar containing drinks as comforters for long periods of time during the day • Brush their child’s teeth infrequently As a result, their children may suffer an aggressive form of tooth decay termed early childhood caries, which destroys the primary dentition over a relatively short period of time. An education programme to help families improve the dental health of their young children is offered in the Paediatric Dental Department at Westmead Centre for Oral Health. The target group was those families with a child under 5 years of age waiting for dental treatment under general anaesthesia. Many of them were from non-English speaking backgrounds and had limited contact with dental care professionals. The programme emphasised the following key messages: 1 Parents/carer’s should supervise and help their children brush their teeth twice daily with a fluoride toothpaste. 2 Sugary drinks should only be given at meal times and never in a feeding bottle. 3 Children should not use a bottle at night as a comforter. In order to encourage the appropriate behaviour, free toothpaste, toothbrushes, diet advice leaflets and ‘sippy’ training cups were supplied. The programme proved very popular with dental staff as they were pleased to be focusing on preventive care, and the children enjoyed the experience and wanted to return for more visits. As part of the evaluation process, parents were asked to comment on the programme through a semi-structured interview. Three main themes were identified from the collected data: • Value of the setting • Difficulties in controlling diet • Overall assessment of the programme

Developing leaflets to give dental health advice to Aboriginal families with young children

OBJECTIVES Dental caries (decay) is a serious problem for young Aboriginal children, causing pain and stress. Treatment often involves extraction of teeth under a general anaesthetic. However, dental caries can be prevented by reducing the frequency of sugar consumption and brushing teeth twice a day with fluoride toothpaste. Such straightforward advice could be given to families by Aboriginal Health Workers who are trusted by their communities and have an existing advisory role. This paper reports on the development of dental health advice leaflets for use in Aboriginal communities. METHODS An Aboriginal reference panel was recruited to comment on dental health advice leaflets prepared by an Aboriginal graphic designer. The panel was asked to consider the design, cultural appropriateness and practicality of the leaflets. Comments were collected through email and face-to-face discussions, which were collated and the leaflets altered accordingly. RESULTS The advice from the panel resulted in greater use of pictures. For example large green ticks and red crosses highlighted healthy and unhealthy behaviours, respectively. The tooth brushing leaflet was amended to emphasise the safe storage of toothpaste in order to keep it out of reach of young children. The panel stated that all leaflets should incorporate the Aboriginal flag, and proposed that fridge magnets might be beneficial as all family members would benefit from seeing the messages every day. CONCLUSION The consultation process refined dental advice leaflets to reflect the views of an Aboriginal Reference Panel, in terms of design, cultural competence and practicality.

Periodontal disease is not associated with poor pregnancy outcome

Abstract This study investigates the relationship between maternal periodontal disease and intrauterine growth restriction and preterm labour. Periodontal disease was assessed by bleeding on probing indices. Periodontal bleeding did not correlate with either preterm labour or intrauterine growth restriction (using a corrected birth weight of <5th percentile).

Prevention of dental caries in Indigenous children from World Health Organization–listed high-income countries: A systematic review:

Objective: To systematically review evidence for interventions to prevent early childhood caries (ECC) in Indigenous children in high-income countries. Search strategy: In November 2016, we searched Medline (from 1946), Embase (from 1980), the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed (from 1996) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (from 1982) for randomised and quasi-randomised controlled trials including children aged 0–5 years. Outcomes included the decayed, missing and filled teeth (dmft) index or similar index; the number of children with reported pain or emergency dental visits because of pain; the number of children referred for dental care; plaque scores; the amount of oral debris present; change in parent/carer attitude or knowledge towards baby teeth; reported regular dental visits and adverse outcomes. Two authors independently screened for inclusion and assessed the risk of bias. Main results: Four trials reported in five papers with 2,311 participants were included. Interventions were fluoride varnish with counselling/health promotion, chlorhexidine varnish, and motivational interviewing techniques plus oral hygiene materials and a dental examination. Two trials showed fluoride varnish applied biannually over a 2-year period reduced caries prevalence (mean difference [MD]: –3.00; 95% confidence interval [CI]: –4.94 to −1.06; MD: –2.47; 95% CI: –2.57 to −2.37). Motivational interviewing with oral hygiene materials and a dental examination can reduce the number of carious lesions in children aged 30 months (d2–4efs > 0 MD: –5.10; 95% CI: –8.74 to −1.46; d3–4efs > 0; MD: –4.40; 95% CI: –7.55 to −1.25). Conclusion: Fluoride varnish applied biannually over 2 years is effective at reducing ECC in Indigenous children. Motivational interviewing has some benefit in caries prevention. Further research is required to test other preventive programmes.