Matthew Hopcraft

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.

Articaine: a review of the literature

Articaine is one of the most recent local anaesthetic drugs made available to dentists worldwide. Anecdotal reports advocate its superiority over other common local anaesthetic agents and controversy exists concerning its clinical safety. This article reviews the current literature on articaine use in dentistry specifically addressing the issues of efficacy and safety.

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.

Attitudes of the Victorian oral health workforce to the employment and scope of practice of dental hygienists

BACKGROUND Increasing the number of dental hygienists and expanding their scope of practice are two policy directions that are currently being explored to increase the supply of dental services in the context of projected oral health workforce shortages in Australia. Understanding factors relating to the employment of hygienists and the attitudes of the oral health workforce to dental hygiene practice are important in this policy debate. METHODS A postal survey of a random sample of Victorian dentists, periodontists, orthodontists and hygienists was undertaken in 2006. Dentists and specialists were grouped into those whose practice employed or did not employ a hygienist. Data on the attitudes of dentists, specialists and hygienists towards various aspects of dental hygiene practice were explored. RESULTS A response rate of 65.3 per cent was achieved. Hygienists believed that their employment made dental care more affordable (53.7 per cent) and improved access to dental care (88.1 per cent), while few dentists believed hygienists made care more affordable. Most hygienists believed they were capable of diagnosing periodontal disease and dental caries and formulating a treatment plan, but there was less support from employers and non-employers. Dentists were strongly opposed to independent practice for dental hygienists, although there was qualified support from employers for increasing the scope of practice for hygienists. CONCLUSIONS Dentists who worked with hygienists acknowledged their contribution to increasing practice profitability, efficiency and accessibility of dental services to patients. Hygienists and employers supported increasing the scope of dental hygiene practice, however the majority of non-employers opposed any expansion.

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.

Dental caries experience in young Australian Army recruits 2008.

BACKGROUND Recent studies have shown a substantial decline in caries experience in Australian Army recruits between 1996 and 2002-2003, and in Australian adults between 1987-1988 and 2004-2006. However, studies in children have reported an increasing trend in caries experience between 1998 and 2002. The aim of this study was to investigate caries experience in Australian Army recruits in 2008. METHODS A cross-sectional study involving 1084 Australian Army recruits was conducted from January to May 2008. Data were obtained from a clinical dental examination with bitewing radiographs, and a questionnaire elicited socio-demographic data and history on lifetime exposure to fluoridated drinking water. RESULTS Mean DMFT scores were 3.16, 4.08, 5.16 and 7.11 for recruits aged 17-20, 21-25, 26-30 and 31-35 years, respectively. Recruits with a lifetime exposure to fluoridated drinking water had a mean DMFT of 3.02, while recruits with no exposure had a mean DMFT of 3.87. CONCLUSIONS Caries experience in Australian Army recruits aged 17-25 years increased between 2002-2003 and 2008. Recruits with lifetime exposure to fluoridated drinking water had 25 per cent less caries experience compared with recruits who had no exposure to fluoridated drinking water after adjusting for the effects of age, gender, education and socio-economic status.

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.

Provision of oral health care to adult patients by dental therapists without the prescription of a dentist.

OBJECTIVES Dental therapists are increasingly been seen as part of the solution to assist in improving access to dental care for underserved populations. The aim of this article is to report the outcomes of an educational bridging program designed to provide university-educated dental therapists with the appropriate knowledge and skills required to enable them to translate their current clinical scope of practice to adult patients aged 26+ years. METHODS Ten dental therapists completed an educational program approved by the Dental Practice Board of Victoria as a pilot. Feedback from patients and supervising and supporting dentists was provided during the project. RESULTS Supervising and supporting dentists rated the knowledge and clinical skills of participants as good to high at the completion of the education program and considered them safe to treat adults patients. Patients were very satisfied with the dental treatment provided. Eight participants successfully completed the assessment and were permitted by the Dental Practice Board of Victoria to extend their clinical scope of practice to adult patients. CONCLUSIONS Feedback from patients and dentists indicated that, following the completion of an educational bridging program, dental therapists with a university education were able to develop the knowledge and skills required to treat adult patients aged 26+ years without the prescription or supervision of a dentist. Enabling dental therapists to treat adult patients may have a role to play in improving access to dental care for underserved populations.

Dental caries in Victorian nursing homes

BACKGROUND The poor oral health of nursing home residents is the cause of substantial morbidity and has major implications relating to health care policy. The aim of this study was to measure dental caries experience in Australians living in nursing homes, and investigate associations with resident characteristics. METHODS Clinical dental examinations were conducted on 243 residents from 19 nursing homes in Melbourne. Resident characteristics were obtained from nursing home records and interviews with residents, family and nursing home staff. Two dental examiners assessed coronal and root dental caries using standard ICDAS-II criteria. RESULTS Residents were elderly, medically compromised and functionally impaired. Most required assistance with oral hygiene and professional dental care was rarely utilized. Residents had high rates of coronal and root caries, with a mean 2.8 teeth with untreated coronal caries and 5.0 root surfaces with untreated root caries. Functional impairment and irregular professional dental care were associated with higher rates of untreated tooth decay. There were no significant associations with medical conditions or the number of medications taken. CONCLUSIONS Nursing home residents have high levels of untreated coronal and root caries, particularly those with high needs due to functional impairment but poor access to professional services.

Participation in continuing professional development by dental practitioners in Victoria, Australia in 2007

BACKGROUND Mandatory continuing professional development (CPD) was introduced in 2005 in Victoria, Australia to ensure that dental practitioners maintained their skills, knowledge and kept up-to-date with current topics in dentistry. The aim of this study was to investigate the participation, impact on practice and attitudes of Victorian dentists and dental specialists to CPD activities since the commencement of mandatory CPD. METHODS A cross-sectional survey of a random sample of registered dentists and dental specialists (n = 895) was conducted from May to August 2008 using an anonymous, postal, self-administered questionnaire. RESULTS The response rate was 66%. More than three quarters of practitioners believed mandatory CPD is a reasonable requirement for continued registration. Dentists reported attending an average of 30.9 h of certifiable clinical CPD whilst specialists attended an average of 33.2 h of certifiable clinical CPD over a 12-month period. Nearly three quarters of respondents reported changing their practice as a result of CPD activities, whilst one quarter attended CPD mainly to meet the mandatory requirements. CONCLUSIONS Overall there was a positive attitude towards mandatory CPD and a high level of participation in CPD activities by Victorian dentists and specialists in 2007, although nearly half of the respondents attended <20 h of certified clinical CPD during 2007. A number of barriers exist, particularly for rural and female practitioners in accessing CPD, and further research is required to examine the benefits derived from mandatory CPD.