Julie Satur

Models for individual oral health promotion and their effectiveness: a systematic review.

BACKGROUND There is a recognized need to deliver oral health information to people during clinical encounters to enable them to develop personal skills in managing their own oral health. Traditional approaches to individual oral health education have been shown to be largely ineffective and new approaches are required to address personal motivations for preventive behaviour. This systematic review aims to identify and assess the effectiveness of behaviour models as a basis for individual oral health promotion. METHODS Electronic databases were searched for articles evaluating the effectiveness of health behaviour models in oral and general health between 2000 and 2007. Eighty-nine studies were retrieved and data were extracted from the 32 studies that met the inclusion criteria. RESULTS Thirty-two studies were identified in the fields of clinical prevention and health education, motivational interviewing (MI), counselling, and models based interventions. MI interventions were found to be the most effective method for altering health behaviours in a clinical setting. CONCLUSIONS There is a need to develop an effective model for chairside oral health promotion that incorporates this evidence and allows oral health professionals to focus more on the underlying social determinants of oral disease during the clinical encounter. There is potential to further develop the MI approach within the oral health field.

Body mass index and dental caries in children and adolescents: a systematic review of literature published 2004 to 2011

The objectiveThe authors undertook an updated systematic review of the relationship between body mass index and dental caries in children and adolescents.MethodThe authors searched Medline, ISI, Cochrane, Scopus, Global Health and CINAHL databases and conducted lateral searches from reference lists for papers published from 2004 to 2011, inclusive. All empirical papers that tested associations between body mass index and dental caries in child and adolescent populations (aged 0 to 18 years) were included.ResultsDental caries is associated with both high and low body mass index.ConclusionA non-linear association between body mass index and dental caries may account for inconsistent findings in previous research. We recommend future research investigate the nature of the association between body mass index and dental caries in samples that include a full range of body mass index scores, and explore how factors such as socioeconomic status mediate the association between body mass index and dental caries.

Dental service provision in Victorian residential aged care facilities

BACKGROUND The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are at high risk of developing dental diseases, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. Traditionally, dental service provision has been problematic and sporadic for these residents. METHODS A postal survey of a random sample of Victorian general dentists and Directors of Nursing (DONs) of Victorian RACFs was undertaken in 2006 to ascertain the participation of dentists in the provision of dental care and to identify factors impacting on the organization and provision of dental care for residents. RESULTS The response rate for dentists was 57.3 per cent, and for DONs 64.4 per cent. Half of the dentists reported that they had provided care to residents of aged care facilities in the past 12 months, and they spent an average of one hour per month providing care. Overall, dentists were concerned with their level of undergraduate education and training in various aspects of dentistry for residents of aged care facilities. DONs reported significant difficulty obtaining adequate dental care for their residents. Common problems identified by both dentists and DONs included a preference for dentists to treat residents in their own practice, dentists not willing to go to RACFs and a lack of portable dental equipment for dentists to use. CONCLUSIONS There were low levels of interest and participation from Victorian dentists in providing dental care for residents of aged care facilities. Dentists had a strong preference for treating patients at their own practice, and there were a number of significant barriers that appeared to impact on the provision of dental care in RACFs.

Oral hygiene and periodontal disease in Victorian nursing homes

OBJECTIVE To investigate oral hygiene and periodontal disease in residents of Victoria nursing homes. BACKGROUND   The Australian population is ageing with a growing proportion of elderly Australians living in nursing homes. With declining edentulism rates, periodontal disease is becoming more prevalent in this population. MATERIALS AND METHODS A total of 275 dentate residents from 31 Victorian nursing homes had a questionnaire and clinical examination using the Visual Plaque Index and a modified Community Periodontal Index. RESULTS Self-reported oral hygiene habits of residents were poor, with less than one-third of residents cleaning their teeth twice daily or more. Periodontal health was found to be extremely poor, and the prevalence of 4 mm+ periodontal pockets was 35.6%, with 10.2% having 6 mm+ pockets. Logistic regression found that age, gender, number of teeth present and oral hygiene were all strongly associated with the prevalence of 4 mm+ periodontal pockets. CONCLUSION Poor oral hygiene and the presence of significant plaque and calculus were common findings in this study. Periodontal diseases are a significant problem for residents in nursing homes. Addressing this health issue will require improved training for carers and better access to appropriate dental services.

Utilizing dental hygienists to undertake dental examination and referral in residential aged care facilities

OBJECTIVE The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are commonly dependent on others for their daily oral hygiene care and often display high levels of plaque and calculus. With declining edentulism rates, periodontal disease is becoming more prevalent in this population. The aim of this study was to investigate the ability of a dental hygienist to undertake a dental examination for residents of aged care facilities, devise a periodontal and preventive treatment plan and refer patients appropriately to a dentist. METHODS A total of 510 residents from 31 Victorian RACFs were examined, with 275 dentate residents included in this study. Between May 2005 and June 2006, residents were examined by a single experienced dental epidemiologist and one of four dental hygienists using a plane mouth mirror and periodontal probe. RESULTS A total of 510 residents from 31 RACFs had a dental examination from a dentist and one of four dental hygienists. The treatment needs of residents examined were high, with nearly all of the 275 dentate residents requiring preventive and periodontal treatment, and three-quarters requiring referral to a dentist for treatment. There was excellent agreement between the dentist and hygienists regarding the decision to refer residents to a dentist for treatment, with high sensitivity (99.6%) and specificity (82.9%). Only 8.0% of residents were referred by a hygienist to a dentist when the dentist considered that no referral was required. CONCLUSIONS Dental hygienists have the skills and knowledge necessary for undertaking a dental examination for residents, correctly identifying the majority of residents who require a referral to a dentist. They are capable of formulating appropriate dental hygiene treatment plans for residents of aged care facilities. It is recommended that there should be greater utilization of hygienists in the provision of dental care to residents of aged care facilities, as a safe, efficient and effective use of health resources.

The capacity of dental therapists to provide direct restorative care to adults

Introduction: In Victoria, dental therapists are restricted to treating patients under the age of 26 years. Removing this age restriction from dental therapists’ scope of practice may assist significantly in addressing workforce shortages, particularly in rural Victoria.

Review of the evidence for oral health promotion effectiveness

Dental caries, periodontal diseases, tooth loss and oral cancers have significant burden of disease effects *, quality of life and cost implications for the Australian community. Oral health promotion is a key approach to addressing these conditions endorsed as part of the National Oral Health Plan. Understanding the evidence for effectiveness of oral health promotion is integral to strategic planning for both oral and general health settings. Objective: The objective of this article is to report the key findings of a systematic review of the evidence for oral health promotion commissioned by the Victorian Department of Human Services in 2006. Methods: Evidence was collected and evaluated using a combined approach incorporating the Cochrane Public Health and Health Promotion Field Handbook and the Health Gains Notation in order to a develop a synthesis approach to reporting, framed around the Ottawa Charter. Findings: Findings included evidence supporting the continued fluoridation of water supplies, interventions aimed at early childhood and aged care settings, smoking cessation and capacity building with non-oral health care providers. Emerging evidence supporting multi-strategy community based approaches is also reported along with gaps in the evidence. General Conclusions: The authors conclude that, while there is good support for the incorporation of oral health into general health promotion, it will be important to monitor the outcomes in oral health terms.

Edentulism and dental caries in Victorian nursing homes

OBJECTIVES The aim of this project was to investigate edentulism and dental caries in nursing home residents in Victoria, Australia. BACKGROUND The Australian population is ageing with a growing number of people living in nursing homes. These residents are at increased risk for dental caries, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. MATERIALS AND METHODS Clinical dental examinations were conducted at 31 nursing homes in Melbourne and regional Victoria between May 2005 and June 2006. A total of 510 residents were examined out of 1345 eligible participants. Socio-demographic and medical history was collected via questionnaire. RESULTS Just over half of the residents were dentate (53.9%), and dentate residents had a mean of 14.4 teeth present and 2.66 untreated decayed teeth. Residents who required total assistance with oral hygiene had more decayed teeth and fewer filled teeth than residents who did not require assistance. CONCLUSIONS Nursing home residents in Victoria are retaining an increasing number of natural teeth and have more tooth surfaces at risk for dental caries. Untreated dental caries was a significant problem for residents, particularly for those who are dependent on others for their daily oral hygiene care.

How to Select a Career in Oral Health

Oral health care offers a wide variety of roles for those considering a career in the oral health professions. Although the titles and definitions of these professions vary between countries, they are generally described as dental surgeons or dentists, specialist dentists, dental therapists/oral health therapists, dental hygienists, dental technicians, dental prosthetists, and dental assistants. Students considering a career in oral health should note the various different professions and understand that each one is defined by the education and training required. The educational pathway for each profession also varies considerably between countries. For example, in many countries, dental surgeons or dentists are required to complete a 5 or 6 year full-time university degree. In the USA and some European countries, students must undertake a two-part or graduate degree structure, completing a Bachelor degree (e.g., Bachelor in Biomedical Sciences) before progressing to a 4-year professional degree with a more specialized focus, which usually culminates in a professional doctorate. Oral health professionals may work in the private or public sector, and prospective students should take every opportunity to familiarize themselves with potential career paths through programs such as internships.

Career Paths in Organised Dentistry and International Organisations

Involvement in oral health organisations and professional bodies (e.g. professional associations, specialists’ organisations, etc.) can end up influencing population oral health, law and health policies. Along with their advocacy roles, this can be seen as part of oral health professionals’ responsibility beyond their clinics and dental offices. Oral health professionals need to use any available opportunity to work to ensure that oral health programmes and oral health care services can achieve the expected effect. This chapter provides a description of the options and discusses the many opportunities offered by local, state, national and international dental associations and specialist organisations. We also discuss the activities of international organisations (e.g. WHO, Med Sans Frontieres, etc.) that play an active and important role in improving health and well-being. An oral health professional can contribute to these efforts by providing specialised knowledge on this subject, for example, as an elected Board member, employee, intern or an oral health advisor at an international oral health programme. The chapter will also provide a description and reflection on how oral health professionals can be involved in these associations and organisations and include the authors’ insights gained from personal experience working in these areas.