Oral health of individuals with cerebral palsy in Saudi Arabia: A systematic review

OBJECTIVE

This systematic review aimed to comprehensively summarize and critically assess studies conducted on oral health outcomes among individuals with cerebral palsy (CP) in Saudi Arabia.

METHODS

This study followed the Participants, Exposure, Control and Outcomes (PECO) framework to formulate a focused research question. We conducted an extensive literature search across multiple databases, including PubMed, Medline, Scopus and Embase, in addition to clinical trial registers. Inclusion criteria encompassed clinical studies conducted in either English or Arabic, focusing on CP as defined by the International Classification of Diseases 10 (ICD10), and examining various oral health conditions and parameters. Nonclinical studies, commentaries, other systematic reviews and letters to the editor were excluded. Data extraction included comprehensive information about the study characteristics, oral health outcomes (dental, oral or periodontal disease; changes in standardized indices; dental trauma and other types of oral diseases) and an assessment of the risk of bias using the Appraisal Tool for Cross-Sectional Studies (AXIS).

RESULTS

The initial search yielded a total of 879 articles, ultimately resulting seven studies that met our stringent inclusion criteria. All of these studies were conducted as cross-sectional investigations in different cities within Saudi Arabia. The sample sizes ranged from 46 to 400 participants, all falling within the age range of 2-18 years. Notably, the prevalence of dental caries among individuals with CP in these studies varied significantly, with rates ranging from 52.9% to as high as 98.6%. Additionally, a substantial portion of CP patients exhibited poor oral hygiene, with figures ranging between 34.6% and 66.2%, and dental trauma was reported in 47.5% of the cases. Moreover, these studies underscored the influence of motor function and intellectual disabilities on the oral health status of CP individuals. Furthermore, various secondary outcomes, including periodontal parameters and oral health-related quality of life, were also assessed. However, it is essential to acknowledge that several sources of bias were identified within these studies, raising questions about the generalisability of their findings.

CONCLUSION

In conclusion, the systematic review revealed a concerning pattern of high dental caries prevalence and other oral health issues among individuals with CP in Saudi Arabia. Nevertheless, the need for comparative studies between CP patients and those without CP is evident to establish a definitive understanding of the oral health status of CP individuals. Initiating early interventions such as oral hygiene education, preventive dentistry programs, and orthodontic interventions could potentially contribute to improved oral health outcomes for individuals with CP in Saudi Arabia.

Dentistry for patients with haemophilia: Trialling a safe and economical change in management

INTRODUCTION

While the dental management of patients with haemophilia has changed considerably in the last decade, haemophiliacs in Western Australia have continued to receive pre-operative factor support for dentistry regardless of the type of dental procedure.

AIM

To review the efficacy and safety of established dental protocols that reduce factor use in the dental management of patients with haemophilia and to estimate cost savings.

METHODS

Records of 11 patients with haemophilia that were seen in the pilot programme period were reviewed. These were cross-referenced with previous dental and haematology notes that stated the amount and type of pre-operative factor used. Cost savings were estimated using the Australian National Blood Authority's Product List.

RESULTS

All study participants were male, and included those with haemophilia A (n = 9), and B (n = 2). Mean age was 45 years (range 22-80). A variety of dental treatments were undertaken, and no pre-operative factor was used. Patients on prophylaxis (n = 6) received dental treatment the same day as their regular factor administration. It was estimated AUD$26,314 was saved by not using pre-operative factor. One patient had bleeding post-extraction and was seen the following day to achieve haemostasis using local measures. The remaining patients had no complaints of post-operative bleeding, and did not require any further haemostatic measures.

CONCLUSION

This pilot programme supports data that haemophiliacs can safely receive a variety of dental treatments without the need for pre-operative factor, and the significant cost savings of doing so. Further data is required to support this protocol for invasive dental procedures.

Covid lockdowns and hospitalisations for oro-facial trauma among children in Australia and the United Kingdom

BACKGROUND/AIM

This retrospective study investigated the effect of lockdowns for Covid-19 on the rates of oro-facial trauma hospitalisations in children in Australia and the United Kingdom (UK).

MATERIALS AND METHODS

Hospitalisation data for children up to 19 years old for oro-facial trauma injuries (according to ICD-10-AM principal diagnosis codes) over 5 years were collected for Australian and UK children. The age-standard rate (ASR) for each age group was calculated per 100,000 population.

RESULTS

In the younger Australian children, there was no statistically significant change in the ASR of oro-facial trauma hospitalisations during the 'Covid year', compared to the average rate over the 3 years preceding. However, there was a significant decrease in the ASR of oro-facial trauma hospitalisations during the 'Covid year' in older Australian children (aged 10-19), and for all UK children, except for infants under one-year-old.

CONCLUSIONS

Reduction of the ASR of hospitalisations due to oro-facial trauma during the 'Covid year', and the implementation of lockdown measures in the two countries provides further evidence of the impact of physical activities and travel as contributing factors to oro-facial injuries in children. In addition to its role in reducing the spread of virus infections during the pandemic, the lockdown measures also resulted in a simultaneous decrease in trauma injuries.

A Deep Learning-Based System for the Assessment of Dental Caries Using Colour Dental Photographs

D1ental caries remains the most common chronic disease in childhood, affecting almost half of all children globally. Dental care and examination of children living in remote and rural areas is an ongoing challenge that has been compounded by COVID. The development of a validated system with the capacity to screen large numbers of children with some degree of automation has the potential to facilitate remote dental screening at low costs. In this study, we aim to develop and validate a deep learning system for the assessment of dental caries using color dental photos. Three state-of-the-art deep learning networks namely VGG16, ResNet-50 and Inception-v3 were adopted in the context. A total of 1020 child dental photos were used to train and validate the system. We achieved an accuracy of 79% with precision and recall respectively 95% and 75% in classifying 'caries' versus 'sound' with inception-v3.

Experience of primary caregivers in utilising an mHealth application for remote dental screening in preschool children

Objectives This study aimed to address the acceptance of mHealth applications for a dental screening app that facilitates patient information entry and captures dental photos remotely to assist in caries diagnosis in preschool children in Australia. Methods All participants were recruited through the ORIGINS Project, a community-based interventional birth cohort study in Western Australia. Forty-two primary caregivers, who were the users of a teledental screening app, were given a questionnaire with 17 questions; these were constructed based on the theme of the Technology Acceptance Model: perceived ease of use (PE), perceived usefulness (PU), behavioural intention to adopt (BI), anxiety (ANX), attitude toward a behaviour (ATB), and self-efficacy (SE). Cronbach's alpha was estimated to determine internal consistency. Path analysis was employed to quantify the relationship between each theme. Results The mean values for most themes indicated high satisfaction with the intervention among caregivers (scores out of 5): PE (4.54 ± 0.55), PU (4.65 ± 0.49), BI (4.40 ± 0.65), ATB (4.23 ± 0.70), SE (4.36 ± 0.64). Results indicated high consistency in response in the PE, PU, ATB, and SE (α  = 0.74-0.84) and moderate consistency was observed in ANX and BI (α = 0.50-0.62). The overall intention of using the dental screening app was significantly related to both PU and ATB (P  Conclusion The perceived usefulness and attitude toward behaviours influenced the overall behavioural intention of the participants to use the telehealth model in dental screening. Recognising these relationships indicates community readiness for implementing the telehealth application in the dental program and enables identification of areas for improving its diffusion.

An assessment of the spatial distribution of bulk billing-only GP services in Australia in relation to area-based socio-economic status

BACKGROUND

The accessibility to affordable primary healthcare services contributes to population health and health equity. A key aspect to accessibility is the geographical distribution of primary healthcare services. Limited studies have assessed the nationwide spatial distribution of bulk billing-only medical practices or 'no-fee' services. The aim of this study was to provide a nationwide approximation of bulk billing-only services and evaluate the socio-demographic status and population characteristics in relation to the distribution of bulk billing-only GP services.

METHODS

The methodology in this study used Geographic Information System (GIS) technology to map the locations of all bulk bulking-only medical practices collected in mid-2020 and linked this with population data. The population data and practice locations were analysed at the level of Statistical Areas Level 2 (SA2) regions and used the most recent Census data.

RESULTS

The study sample included (n =2095) bulk billing-only medical practice locations. The nationwide average Population-to-Practice (PtP) ratio was 1 practice to 8529 people for regions with access to bulk billing-only practice, and 57.4% of the Australian population lives within an SA2 that has access to at least one bulk billing-only medical practices. No significant associations were identified between practice distribution and area socio-economic status.

CONCLUSION

The study identified areas with low access to affordable GP services, with many SA2 regions having no access to bulk billing-only practices. Findings also indicate that there was no association between area socio-economic status and the distribution of bulk billing-only services.

Special needs dentistry in multidisciplinary head and neck cancer management - characterizing scope and complexity of patient care

AIMS

To describe the involvement and need for specialists in special needs dentistry (SND) in the multidisciplinary management of patients and to characterize the complexity of patients with special health care needs.

METHODS

Referrals for SND review from the Fiona Stanley Hospital head and neck cancer (HNC) multidisciplinary team between January 1 and December 31, 2019 were screened. Data recorded included demographic information, medical history, dental status, and dental treatment provided prior to HNC management.

RESULTS

In total 127 patients were referred to the SND clinic in 2019 of which 89.0% were males and 74.8% were aged 50-79. The mean waiting time for SND review was 19.6 days. On average patients had a decayed, missing, filled tooth (DMFT) score of 20.3. During the study period 407 extractions and 30 restorations were completed. Seventeen patients (13.4%) had all their teeth removed prior to HNC management. The majority of patients (79.6%) were categorized as either moderate or severe complexity. Increasing complexity was seen in older age groups.

CONCLUSIONS

Significant oral disease is seen in patients with HNC often requiring extensive dental treatment. Complexity is seen in patients requiring multidisciplinary care however characteristics that constitute complexity are varied given the spectrum encompassing 'special needs'.

Geospatial distribution of tertiary hospitals across Australian cities

ObjectiveThis study aimed to map the geographic distribution of tertiary hospitals in Australia's most populous cities. Good access to hospital facilities improves the health and welfare of a community. The use of geographic information system (GIS) technology can assist in understanding spacial accessibility to services.MethodsUsing Quantum GIS, a geodatabase was constructed to incorporate hospital locations and demographic distribution data throughout Australia's 20 most populous cities. Data on the population's age groups were integrated into the geodatabase to investigate the distribution of age groups and their utilisation of access to emergency departments in tertiary public health care. Overall this study reported the geospatial distribution of 89 tertiary hospitals and the demographics of the population in areas around these hospitals.ResultsThe majority of hospitals were located in the three most populated cities of New South Wales (NSW), Sydney, Wollongong and Newcastle, which contain a total of 32 hospitals, with 23 (72%) of the hospitals in Sydney. There were 7.8, 24.0, 53.4 and 81.0% of the population in NSW within 1.5, 3, 6 and 50 km of the hospitals, respectively. The second-highest number of hospitals was in Victoria (n = 22), with 18 (82%) hospitals located in Melbourne. This was followed by Queensland (n = 14), with eight (57%) hospitals located in Brisbane.ConclusionsThe results indicate that 82.2% of the Australian population lives within a 50 km radius of a tertiary hospital, with NSW having higher age distribution percentages than the other states. The results of this study could be used to locate and improve areas of need with a high burden of disease and low accessibility to healthcare services.

Effects of the Child Dental Benefits Schedule on dental hospitalisation rates in Australian children

ObjectiveThe Child Dental Benefits Schedule (CDBS) was introduced in 2014, and its aim was to support access to dental care for eligible children in Australia. Dental caries, and pulp and periapical diseases were the major dental reasons for children's hospitalisations. This study investigated if the availability of the CDBS had any effects on hospitalisation rates in Australian children.MethodsThis study was a retrospective analysis of Medicare data from the Australian Government and the hospitalisation data from The Australian Institute of Health and Welfare (AIHW) from 2008 (6 years before the commencement of the CDBS) to 2020 (6 years after the commencement of the CDBS).ResultsAlthough the hospitalisation rate trend was reducing before the CDBS started (2008-14), this reduction was not statistically significant. The reduction of hospitalisation rates was higher after the commencement of the CDBS (2014-20) and was statistically significant, but the regression model analysis showed a positive correlation between the CDBS and hospitalisation rate. The analysis without 'abnormal' year data (2019-20, COVID-19 pandemic year) supported no statistically significant decrease in hospitalisation rate after the commencement of the CDBS in 2014 until 2019.ConclusionAlthough the CDBS is improving access to dental care for eligible children, any possible effects the CDBS might have on hospitalisations are not yet evident.

Distribution of dental practices in Jazan of Saudi Arabia: a GIS-based approach

BACKGROUND

Jazan region in the Kingdom of Saudi Arabia (KSA) has been extensively studied regarding access to dental care services, but there is currently no specific study on the distribution of public (primary healthcare centres (PHCs) and hospitals) and private dental healthcare facilities in the area. This study aimed to evaluate the spatial distribution of public and private dental care facilities in the Jazan region in relation to the population distribution in each governorate of the region.

METHODS

The most up-to-date, easily accessible, and anonymous data and information were used for this investigation. The Ministry of Health's (MOH) Statistical Yearbook 2020 and interactive map were used to identify the locations of healthcare facilities. These locations were plotted on a map using Google Maps, and the data was converted to longitude and latitude with 90% level building accuracy. QGIS's integrated database was used to develop buffer zones and perform attribute analysis. The data was then exported for analysis in Microsoft Excel, where healthcare facility-to-population ratios were determined.

RESULTS

In Jazan region, consisting of 17 governorates and a population of 1,726,739, there were 275 public and private dental clinics, with a ratio of one dental clinic per 6,279 people in terms of general health services. Only 12.4% of these clinics were located beyond 20 km of the city centre, serving approximately 70% of the region's population.

CONCLUSION

The uneven distribution of dental clinics in the Jazan region has hampered access to dental treatments and has led to a significant burden on dental health facilities, reducing the quality of care available in the region. Mapping the distribution of MOH, private, and other health facilities, as well as the burden of oral disease in the Jazan region, is necessary for further research.

Oral health providers' views of oral health promotion in Jazan, Saudi Arabia: a qualitative study

BACKGROUND

Oral health promotion (OHP) is a crucial aspect of dental care, as it aims to improve and protect oral health of individuals. This study aimed to qualitatively explore views of oral health providers in Jazan, Saudi Arabia, on their perceptions of their responsibilities for OHP, as well as the barriers and potential opportunities for implementing health promotion in dental practice.

METHODS

A convenience sample of 11 oral health providers from Ministry of Health (MOH) facilities were recruited and participated in virtual one-on-one semi-structured interviews, which were transcribed and analyzed using inductive thematic analysis with N-Vivo software.

RESULTS

The results showed that the providers recognized the significant role and responsibility of OHP in improving oral health. However, several barriers hindered their OHP efforts, including a lack of training, funding, time, and a lack of interest in OHP. Potential opportunities for improvement included increasing recruitment of new oral health providers and educators, developing more training programs for providers and the community, and expanding support in terms of finances and logistics.

CONCLUSION

The findings of the study suggest that oral health providers are aware of OHP, but that both patients and organizations will need to shift their behaviours and perspectives for OHP to be successfully implemented. Further research on OHP in the Kingdom of Saudi Arabia (KSA) is needed to validate these findings.

Hospitalisations due to pulp and periapical conditions in Australian children from 1998-99 to 2017-18

OBJECTIVE

To assess the demographic and time trends in hospitalisation rate for Pulp and Periapical Diseases (P&PDs) over 20-years (1998-99 to 2017-18), amongst children and adolescents (under age 19 years) in all states and territories of Australia. P&PDs are considered potentially preventable, with the possibility of them resulting in emergency presentations if timely treatment is not provided. They can result in treatment under general anaesthesia, which is costly.

DESIGN

Retrospective analysis of hospitalisation for pulp and periapical diseases.

SETTING

Public and private hospitals across Australia.

MAIN OUTCOME MEASURES

The number of hospitalisations (measured using the number of separations or cases of hospital admission) for all pulp and periapical diseases by age-group.

RESULTS

There were about 40,000 hospitalisations regarding P&PDs over the 20 years among Australian children under 19 years old. The rate of admissions ranged from means of 28.5 to 44.1 per 100,000 population. The number of admissions increased over 20 years for all children, except those younger than 4 years. Children aged 5-9 years had the highest rate of admissions and, more days in hospital per admission than other age groups. Most children only had one-day admissions.

CONCLUSION

Pulp and periapical diseases hospitalisation rates have increased over two decades. Additional approaches to improve child dental health in Australia need to be considered.

Understanding Common Rationales Adopted in Healthcare Price Setting Across the Private Healthcare Sector in Sri Lanka: A qualitative study

Background / Objectives: The Sri Lankan healthcare system consists of public and private sectors. In terms of capacity, the public sector dominates the provision of care across curative, preventive and outpatient care. The private sector, too, has grown rapidly in recent years but was mainly confined to providing curative, diagnostic and outpatient care. Since, there are little or no studies conducted in Sri Lanka thus far, the objective of this study was to understand the current approaches adopted in determining the base of healthcare payments. This study also investigated the economic and administrative processes involved in determining the level of healthcare pricing in the private sector healthcare industry in Sri Lanka. Method: This qualitative study investigated the rationales adopted in healthcare pricing by healthcare administrators in the private sector. Structured interviews were conducted and thematic analysis were applied to interview data collected and analysis. Results: Five key themes, which influenced pricing, were identified from the interviews. These themes included influence from medical practitioners/clinicians, competitor pricing, price adjustment/profit margins, consumables and staff, and economic demands. There was a consensus that competitor pricing and seniority of the practicing clinicians had an impact on pricing.  Conclusion: This study revealed that the base of payment in private sector healthcare is fee for service (FFS). Adopting popular international approaches such as Diagnostic Related Groups (DRGS) was not shown in this study. Further, it was evident that the Sri Lankan private healthcare sector administrators unilaterally fix pricing based on the identified key themes without adequately consulting the healthcare payers and users.

Australian dental students' knowledge on antibiotics prophylaxis for dental procedures

BACKGROUND

Prescribing medicine is integral to clinical dentistry. Infective endocarditis may be rare but fatal if left untreated. As a result, judicious prescribing of antibiotics should be implemented due to potential. To our knowledge, no Australian study has examined dental students' knowledge and perceptions about antibiotic prophylaxis for dental procedures.

METHODS

Australian dental students were invited to undertake the survey comprising case vignettes to investigate their medication knowledge. A total of 117 responses were received. The questions were 12 clinically relevant questions and three perception-based questions. Results were analysed using descriptive statistics as well as the chi-squared test.

RESULTS

The 117 respondents had a mean correct response of 7.34 ± 2.64 (range 3-12 out of 12). Out of 117 students, 89 (76%) answered more than half of the questions correctly. Only three students (3%) answered all the questions correctly. Nearly two-thirds felt that they knew about antibiotic prophylaxis used for dental procedures.

CONCLUSION

Most respondents answered more than half, but not all, of the clinical questions correctly. It is crucial to highlight that dental student may never receive any more training on antimicrobial stewardship (AMS) at any point in their future careers. It may be ideal that this issue is addressed at the dental school. One way to target this is to potentially nationalised teaching delivery of dental AMS across Australia.

The Use of Telehealth in Australia During the Coronavirus (COVID-19) Pandemic for Medical Practitioners: A retrospective epidemiological analysis

Introduction: New Medicare Benefits Schedule (MBS) telehealth item codes were added in 2020 to allow Australians to gain access to medical services during COVID-19 lockdown restrictions. Previous studies have been conducted on the utilisation of specific MBS item codes however none have been conducted on all medical practitioner telehealth item codes. Objective: This retrospective epidemiological analysis aims to determine the utilisation rate of newly introduced medical practitioner telehealth MBS item codes and compare them with the usage of existing in-person item codes Methods: The utilisation of 319 MBS item codes were extracted from the Medicare Statistics Database between March 2020 to March 2021. Using count and population statistics a population adjusted rate was generated and a linear regression analysis undertaken. Results: A total of 199,059,309 in-person and telehealth services (Male, n=84,007,935; 42.2%, Female, n=115,051,374; 57.8%) were utilised during the study period. 147,697,104 were in-person compared to 51,191,898 telehealth services. In-person usage decreased by 27.5% while telehealth increased by 358.8%. In-person utilisation increased by 32.4% as the year continued while the telehealth utilisation decreased by 40.7%. There was a non-significant increase in total in-person item code utilisation (p=0.76) and a non-significant decrease (p=0.32) in the total telehealth item codes used Conclusion: There was initially increased usage of telehealth especially during lockdown restrictions. However, when lockdowns eased, usage of telehealth decreased while in-person increased. Regardless, telehealth item codes continued to be used despite changes to eligibility criteria and lockdown restrictions easing. Hence, it appears that patients are accepting of telehealth as a healthcare delivery method.

Oral Health Status, Oral Health Behaviors, and Oral Health Care Utilization among Persons with Disabilities in Saudi Arabia

Various studies have indicated that persons with special needs may face several barriers to dental treatment, which increases the prevalence of oral diseases in this population. Moreover, these studies suggested that Saudis with special needs have a higher prevalence of oral diseases, such as dental caries and periodontal disease. The aim of this review is to synthesize evidence regarding the current status, trends in oral health behaviors, and oral health care utilization among these individuals, as well as to assess the quality of the literature. Furthermore, this review seeks to recommend directions for future research and oral health care policymaking. An electronic search was conducted using the following databases and registers: PubMed/Medline, Embase, ISI Web of Science, Scopus, ClinicalTrials.gov, and CENTRAL. Gray literature, which included conference proceedings and unpublished literature, was searched via the library services and Google/Google Scholar, and the quality of studies was assessed using the AXIS scale for cross-sectional studies. A total of 38 studies were included in this review, with the majority of the studies graded as 'low'. Within the limitations of this study, it can be concluded that individuals with special needs have limited access to oral health care, poor oral health status, and a general lack of awareness in regard to oral health. Therefore, nationwide surveys should be carried out to ascertain the actual extent of the oral inequities among individuals with special needs.

The evolving disparities in location and socioeconomics of an ageing Australian society

OBJECTIVES

It is well known that there are associations between overall health, age, socioeconomic status and rural residency. The objective of this study was to determine the distribution of Australia's aged population by socioeconomic status, as well as remoteness.

METHODS

The study employed the Australian Statistical Geography Standard (Statistical Area Level 1 and Remoteness Areas). The database of the geographic boundaries was integrated into the ageing population and socioeconomic data using the Geographic Information System. The socioeconomic data was analysed through the Index of Relative Socioeconomic Disadvantage.

RESULTS

Over a decade, the older population in Australia has increased noticeably. In 2016, there was a high percentage of older people (≥65 years) in Tasmania (Tas), 19%, while the lowest percentage was recorded in the Northern Territory (NT), 7%. Across the country, Tasmania had the highest percentage of older citizens living in the most disadvantaged areas since 2006, with 48% recorded in 2016. There was an association between the remoteness areas and the education and income levels of the ageing cohort. However, this association differed between the states and territories. This socioeconomic gap becomes more evident in the very remote areas of the country.

CONCLUSIONS

The ageing population in Australia is increasing rapidly; this was associated with an evolving socioeconomic disparity among this ageing society. Our results demonstrated that socioeconomic inequalities were to be found among the older people based on their distribution over the remoteness areas in Australia. This information should be used to target healthcare and ageing policies that meet the specific needs of older people.

Perceptions of service quality in Victorian public dental clinics using Google patient reviews

ObjectivesUsing Google online reviews, this study investigated why patients were satisfied or dissatisfied with their public dental clinic in Victoria, Australia.MethodsThis mixed methods study gathered Google reviews published by users pre-March, 2021. The reviews were coded and subthemes and major themes were identified. The most common reasons why patients gave reviews were tabulated and stratified according to star rating, remoteness and accessibility index classification, and socio-economic status.ResultsOf the 522 reviews included in this study, in 317 (60.7%) satisfaction was expressed. Compliments and complaints were documented. A total of 53 subthemes were identified. Major themes included Treatment, Staff, Communication and Professionalism, Patient Factors and Non-Clinical Reasons. From the reviews, more patients were satisfied with general unspecified treatment (n = 195; 14.7%) and dissatisfied with reception staff (n = 64; 4.8%). More reviews were generated by patients who visited clinics in major cities and lower socio-economic areas.ConclusionThis study found that most patients expressed satisfaction and identified reasons why patients were satisfied or dissatisfied. Consumer feedback, including compliments and complaints, is an integral aspect of monitoring and improving health service quality. It is important to continue seeking feedback and improve accordingly.

Indonesian Dentists' Perception of the Use of Teledentistry

Introduction

Teledentistry is the use of information and communication technology to provide dental services from distant locations. The use of teledentistry is highly beneficial in the COVID-19 pandemic era.

Objective

This study aimed to explore Indonesian dentists’ perceptions of the use of teledentistry in their daily practice and the benefits for patients.

Methods

This was a descriptive cross-sectional study comprising an electronic survey of Indonesian dentists. We used a cross-cultural, adapted questionnaire that consisted of 26 items and 5-point Likert scale questions that evaluated dentist perception in the following 4 domains: usefulness of teledentistry for dental practice, usefulness of teledentistry to improve practices, usefulness of teledentistry for patients, and dentists who had concerns about the use of teledentistry.

Results

A total of 652 dentists from 34 provinces in Indonesia participated in this study. The majority of respondents agreed about the usefulness of teledentistry in dental practice, especially for saving time, compared to referral letters (87%). Most respondents recognised the utility of teledentistry for improving dental practice and its benefits for patients. Nevertheless, most of the dentists had concerns about teledentistry in terms of digital forgery concern (74.2%) and technical incompatibility (71.8%).

Conclusions

Indonesian dentists reported their positive perception of the usefulness of teledentistry for improving dental practice and benefits for patients, although some concerns were still present. Further studies on the application of teledentistry in Indonesia are still needed.

Size estimation of unerupted canines and premolars using various independent variables: a systematic review

INTRODUCTION

Prediction of unerupted permanent teeth is an essential part of orthodontic diagnosis and treatment planning. This prediction is done by mixed dentition space analysis based on the estimation of mesiodistal dimensions of unerupted permanent canine and premolars from already erupted permanent teeth. Permanent mandibular incisors are most commonly used for prediction. Recent literature reveals that mandibular incisors are not accurate predictors and other independent variables have been introduced to make a more accurate and precise prediction. The objective of this paper was to evaluate the literature in light of a variety of independent variables and their predictive accuracy.

METHODS

Electronic databases such as MEDLINE, PubMed, Scopus, Embase, Web of Science, CINAHL Plus were searched to identify articles published until September 2021.

RESULTS

The search resulted in a total of 1098 articles, of which 24 papers met our inclusion criteria and were included in this review. Articles using permanent mandibular incisors only as a predictor were excluded during the eligibility assessment. The results show that various independent variables including mesiodistal and vestibulo-oral dimensions of permanent maxillary and mandibular incisors and molars, molar basal arch length, intermolar distance, maxillary and mandibular arch and gender have been used as predictors to more accurately determine mesiodistal width of unerupted canine and premolars in different populations.

CONCLUSION

Ethnic tooth size variations strongly emphasize the need to determine which independent variable gives a more accurate prediction of unerupted permanent teeth to develop a population-specific prediction model. This will play a significant role in managing space problems and developing malocclusions.

Determining The Barriers to Access Dental Services For People With A Disability: A qualitative study

Aim: To determine the perceptions of carers of people with a disability in terms of the problems they face in accessing dental care. Method: The survey was based on the modified Penchansky’s 5A classification. It focused on members of a local disability support agency and was completed as part of their ongoing quality improvement processes. Result: A total of 169 carers took part, with a quarter indicating that the person they cared for did not have a regular dentist. Nearly 25% of the participants found it extremely difficult to obtain appropriate oral health care. Amongst the participants 10% had to abandon dental treatment due to difficulties, while 13% have yet to receive any sort of dental care. Amongst school-aged children, 64.5% were unable to receive dental care from the school dental service. Conclusion: The study was conducted to obtain an insight and understanding of how people with a disability and their primary caregivers experience dental care. Several concerns were identified, with most related to the process of providing care (patient-professional interaction factors) and the structure of the dental health system and its operation (factors related to access, affordability and information systems.) Targeted strategies aimed at providing affordable and appropriate services to people with disabilities should be prioritised.So What? The study showed emerging concerns among the participants relating to providing information regarding dental care options, as well as concerns regarding the availability and accessibility of the services. Further research will be conducted using the standardized tool the Measure of Processes of Care, and findings will translate to help initiate a program with the help of Developmental Disability Western Australia to provide information.

Deep learning for automated detection and numbering of permanent teeth on panoramic images

OBJECTIVE

This study aimed to evaluate an automated detection system to detect and classify permanent teeth on orthopantomogram (OPG) images using convolutional neural networks (CNNs).

METHODS

In total, 591 digital OPGs were collected from patients older than 18 years. Three qualified dentists performed individual teeth labelling on images to generate the ground truth annotations. A three-step procedure, relying upon CNNs, was proposed for automated detection and classification of teeth. Firstly, U-Net, a type of CNN, performed preliminary segmentation of tooth regions or detecting regions of interest (ROIs) on panoramic images. Secondly, the Faster R-CNN, an advanced object detection architecture, identified each tooth within the ROI determined by the U-Net. Thirdly, VGG-16 architecture classified each tooth into 32 categories, and a tooth number was assigned. A total of 17,135 teeth cropped from 591 radiographs were used to train and validate the tooth detection and tooth numbering modules. 90% of OPG images were used for training, and the remaining 10% were used for validation. 10-folds cross-validation was performed for measuring the performance. The intersection over union (IoU), F1 score, precision, and recall (i.e. sensitivity) were used as metrics to evaluate the performance of resultant CNNs.

RESULTS

The ROI detection module had an IoU of 0.70. The tooth detection module achieved a recall of 0.99 and a precision of 0.99. The tooth numbering module had a recall, precision and F1 score of 0.98.

CONCLUSION

The resultant automated method achieved high performance for automated tooth detection and numbering from OPG images. Deep learning can be helpful in the automatic filing of dental charts in general dentistry and forensic medicine.

São Paulo urban health index: measuring and mapping health disparities

ABSTRACT: Objective: To calculate and map the health inequalities in the city of São Paulo using the Urban Health Index (UHI) methodology. Methods: Seven indicators were selected from the Brazilian census: (1) proportion of households with access to sewage systems, (2) proportion of households served by regular waste collection, (3) proportion of households with two or more toilets, (4) proportion of households receiving tap water, (5) average income per household, (6) percentage of white people, and (7) literacy rate. Based on the UHI methodology, all health indicators were standardized and aggregated into a single metric at the census tract level. The UHI scores were ranked and plotted. The disparity ratio and the graph slope were calculated. The correlation between indicators was tested. Results were geocoded to produce a map of health risks. Results: The distribution of index values showed a linear middle section and deviations at each end. The disparity ratio found was 2.95, while the slope was 0.30. All indicators were significantly correlated. The map displayed a typical pattern of health inequality between the downtown and the periphery. The tracts located in the city’s downtown had higher UHI values than those on the outskirts. Conclusions: The results of this study presented a visual distribution of health disparities in the city of São Paulo, proving to be a valuable method for identifying areas that require public health attention.

Caries prevalence and severity in association with sociodemographic characteristics of 9-to-12-year-old school children in Al-Madinah, Saudi Arabia

Aim

This study was conducted to estimate the prevalence and severity of dental caries in 9-to-12-year-old schoolchildren in Al-Madinah, Saudi Arabia (SA); to compare its expression by mean of decayed, missing and filled teeth (dmft/DMFT) and the Significant Caries Index (SiC Index); to examine the association between caries experience and sociodemographic factors; and to determine whether schoolchildren in Al-Madinah are at greater risk for high levels of dental caries.

Materials and methods

Data of 1,000 schoolchildren aged 9–12 years old from a cross-sectional oral health survey in Al-Madinah, SA was obtained and analysed. Dental caries was measured using dmft/DMFT and the SiC Index which was computed into two groups: highest 30% DMFT scores (SiC³⁰) and highest 10% DMFT scores (SiC¹⁰). Sociodemographic variables included age, gender, nationality, school type (public or private) and family income. Descriptive and inferential were calculated to estimate caries prevalence and severity and its association with sociodemographic factors.

Results

Caries prevalence in primary or permanent teeth was 85.1%, with untreated caries of 76.1%. The mean dmft was 2.66 ± 2.63 while the mean DMFT was 1.43 ± 1.73. Caries severity was significantly higher among males, Saudis, those from low-income families and those from public schools (p < 0.05). The mean values of SiC³⁰ (3.52 ± 1.57) and SiC¹⁰ (4.98 ± 1.77) were considerably higher than the overall average DMFT value.

Conclusion

Dental caries persists as a public health challenge among schoolchildren in Al-Madinah, SA, with a very high prevalence and severity among schoolchildren. The use of the SiC Index highlighted the subgroups with more severe caries experience.

Association between Western Australian children

ObjectiveThis study investigated the link between socioeconomic status and unplanned dental presentations at the Perth Children's Hospital (PCH), as well as the link between the socioeconomic status of unplanned dental patients and any previous admissions to the PCH.MethodsRecords of 351 unplanned visits to the PCH were collected, including reason for attendance (infection, trauma, other), the patient's residential location (suburb) and the history of any previous presentations at the PCH. The socioeconomic status of each patient was based on the Index of Relative Socio-Economic Disadvantage, divided into quintiles. Geographic information systems (GIS) were used to spatially map the residential locations of the patients with unplanned dental presentations. QGIS was used to map and geocode the data. Analysis of variance and Chi-squared tests were used to determine associations between subgroups and other variables.Results'Unplanned dental presentation' in this study refers to patients who present without an appointment, including by referral from the emergency department of the PCH or outside the PCH. Approximately two-thirds of unplanned dental presentation among patients from low socioeconomic groups were for dental infection, whereas the major reason for presentation among patients from higher socioeconomic groups was trauma. More than half the patients in low socioeconomic groups had at least one previous presentation at the PCH due to other medical issues.ConclusionChildren from low socioeconomic groups, or from outside of Perth, were more likely to present with dental infections, which are mostly preventable at the primary care level; these patients often presented a more significant burden to the health system. Public health interventions should aim to promote preventive oral health care, especially for children from low socioeconomic groups.What is known about the topic?In Western Australia, the most common dental problems requiring hospitalisation among children is dental caries, and children from the lowest socioeconomic backgrounds have the highest prevalence of dental hospitalisations.What does this paper add?Children from lower socioeconomic backgrounds were more likely to have an unplanned presentation at the only tertiary children's hospital in Western Australia due to dental infection.What are the implications for practitioners?Improved access to public dental services, especially in low socioeconomic areas, and the development of more strategies to reduce unplanned dental presentations at a tertiary hospital are needed.

Hospitalization for Oral Health-Related Conditions of the Australian Ageing Population: Two Decades of Analysis

The burden of oral health care increases among older people, with a profound challenge in utilising dental services in primary dental care settings. This study aimed to analyse two decades of nationwide hospital separation patterns due to oral health-related conditions among older people. Ageing population data were obtained from the Australian Bureau of Statistics, including people aged 65 years and older. All principal diagnoses of oral health conditions (ICD-10-AM) were analysed in this study. The hospitalisation data included all separations of older people for the financial years 1998–1999 to 2018–2019. A total of 205,461 hospital separations were recorded for older people over a period of twenty-one years. More than 60% of these separations were collectively attributed to dental caries, disorders of teeth and supporting structures, diseases of the jaws, diseases of the pulp and periapical tissues. However, the average rate of separations per 10,000 people due to dental caries was the highest among the dental conditions (8.68). Furthermore, the remaining oral health-related conditions predict an annual percentage increase in the rate that would compromise their oral health quality of life. Dental caries and its sequela seem to be the leading cause for oral health-related hospital admissions in Australia for people aged 65 and older. This could be an indicator of the inadequacy of disease management in the primary dental care setting.

Utilisation of Dental Services of Older People in Australia: An Economic Explanatory Model Based on Cost and Geographic Location

The increased percentage of older people retaining their natural dentition was associated with a burden of poor oral health and increased service demands. This study analyses the dental service utilisation of the ageing population in Australia and develops a modelled cost design that estimates the dental expenditure required to cover dental services for the aged population. Using the Australian Census of Population and Housing, ageing population and socioeconomic data were mapped to geographic boundaries and integrated with dental service provision data to estimate a model for the utilisation of dental services. The estimated financial cost of dental services was calculated based on the mean fees as per the Australian Dental Association's Dental Fees Survey. The utilisation of the services varied considerably across the states and also by type of service, with limited numbers using periodontic services. However, there was an increase in cost for replacement and restorative services (5020 million AUD), most evident in the socioeconomic deprivation areas. In addition, the average dental services utilisation cost increased noticeably in the lower socioeconomic deciles of all regions outside major cities. The geographic maldistribution of older people significantly affects the utilisation of dental services, especially among disadvantaged communities. A predicted cost model of 6385 million AUD would cover the oral health needs of older Australians.

Management of dental emergencies amongst Australian general medical practitioners - A case-vignette study

BACKGROUND

In Australia, because of inequity in dental service accessibility and affordability, patients can see general medical practitioners (GPs) for acute dental conditions.

METHODS

This cross-sectional study consisted of surveys distributed to the board registered GPs practising in Australia. The main outcome measures included statistical analysis of GPs managing different dental emergency scenarios and their confidence and expectations in managing dental emergencies.

RESULTS

A total of 425 GPs participated in the study. The sample primarily consisted of GPs practising in metropolitan clinics (n = 315). Most participants reported that they would refer to the dentist for mobilized tooth (n = 402). There was a negative correlation between GPs with 5-29 years of experience and traumatized tooth management (P < 0.05). GPs aged between 40 and 49 years were more inclined to treat patients with mobilized teeth [Multivariate (MV): 0.42(0.09-0.74)]. However, GPs with 0-5 years of experience were less likely to manage patients with dental abscess [MV: -0.52(-0.80 to -0.24)].

CONCLUSION

Most GPs referred dental emergencies to dentists. GP management of dental emergencies were predominantly palliative. Therefore, opportunities for collaborative practice models amongst GPs and dentists may be needed to bridge the gap in the regional and remote locations.

Investigating Perceptions of Patients on Healthcare Pricing Within The Private Healthcare Sector In Sri Lanka

Demand for private sector healthcare services in Sri Lanka is on the rise. This is very evident from the increase in the number of registered private healthcare institutions from 1990 to 2017. [1,2] With the increasing utilization of private sector healthcare services, various qualitative factors,  and service-related issues associated with the healthcare delivery system have become common debates. A major concern, patients have expressed, is about the fees charged by doctors and hospitals. Principle aim of this study was to investigate the perceptions of patients on healthcare pricing within the private healthcare sector in Sri Lanka. The target population of the study was defined as Sri Lankans who have been inpatients in private hospitals within the past year. The focus districts were Colombo, Kandy, and Galle. These 3 districts represented nearly 60% of the total private sector bed capacity. From each district, three main private hospitals were selected. Over 700 patients were invited to participate, 246 surveys were completed, and 215 were retained as 31 had excessive missing and/or unclear data. In all 3 districts the majority of patients were either dissatisfied with or remained neutral (69%) on the hospital fees,(66%) on doctor’s fees,(74%) on the overall price they ended up paying,(76%)  on whether they think the healthcare services they received are value for money. This study did not investigate the reasons or the factors that may affect the satisfaction or dissatisfaction of patients towards the fees they paid Multiple factors can affect patient’s perception on the fees they paid. With negative perception on the above it can be concluded that there is sufficient evidence to challenge private sector healthcare satisfaction level vs price/fees equilibrium in Sri Lanka.

GIS mapping of healthcare practices: do older adults have equitable access to dental and medical care in the UK?

Introduction Considering an ageing population with increasing comorbidities, access to oral and general healthcare is a growing concern. This study aimed to identify and compare access to dental and general practices. This study further aimed to ascertain if there exists a socioeconomic distribution of dental and general practices among older adults.Materials and methods A total of 13,007 dental practices and 13,759 general practices were mapped using geographic information system software, and overlaid with the UK older adult population and deprivation data by health areas. Data analysis was carried out by creating a geographical distribution map and by using descriptive statistics, Gini coefficients and Lorenz curves.Results NHS Central London Clinical Commissioning Group (CCG) held the highest dental practice-to-population ratio of 958 practices per 100,000 older adults, while NHS Manchester CCG held the highest general practice-to-population ratio of 264.4 general practices per 100,000 older adults. England had the highest Gini coefficients for general and dental practice at 0.214 and 0.195, respectively. Both dental and general practices were socioeconomically distributed among older adults in England, Wales and Northern Ireland, but not in Scotland.Conclusions An increasing proportion of older adults need access to healthcare that is based on clinical need, not the ability to pay; a founding principle of the NHS. This nation-wide study captures inequities in the spatial accessibility for older adults in the UK.

Innovative methodology to guide planning of dental workforce distribution: a GIS-based study in Nepal

OBJECTIVES

To build a predictive model based on the distribution pattern of dentists and population in selective districts of Nepal.

METHOD

Cross-sectional descriptive study conducted using secondary data from the census report and available dentist data of Nepal. Population data were obtained from the most recently available census. For dentists' data, a literature search was carried out in the databases such as PubMed, Google scholar, One Search and Medline. All data were extracted from the integrated database in the Geographic Information System (GIS), and a predictive model was built.

RESULTS

Overall, there was an uneven distribution of dentists in Nepal. When the distribution of dentists was compared with the population clusters, it was found that the slope of the population growth was below or equal to (≤) 20,000 for three provinces (2, 6, and 7), which means that lower numbers of dentists are available with respect to population density in these provinces. The slope was above 50,000 for province 3, and the number of dentists was almost half of the total nationwide. The number of dentists correlated with population clusters.

CONCLUSION

There are substantial disparities in the distribution of dentists in Nepal. Dentists were distributed relative to higher population clusters and were unevenly distributed. The Nepal government should make necessary arrangements to address the need for the human workforce in resource-limited settings. The methods used in this study could be applied globally, as the data used are available for most countries.

Systematic Literature Review of Capitation and Fee-for-Service Payment Models for Oral Health Services: An Australian Perspective

The aim of this review was to assess relevant global literature on capped-fee (CF) and fee-for-service (FFS) payment models as used by public dental services. Research data were assessed through the PRISMA check list and sourced from MEDLINE, PubMed, ProQuest, Cochrane Library, and other methods. The inclusion criteria were peer reviewed articles published between 2004 and 2020 and (i) other countries' health systems that were evaluated in contrast to Australia; (ii) care provided to individuals; (iii) payment models for private services that were the same as Australian government policy (CF and FFS); and (iv) care provided by dentists. We used a mixed methodology for data collection. A total of 262 references were reviewed with 10 references meeting the inclusion criteria with the quality rating being: three-strong, six-moderate, and one-weak. The literature included studies from Sweden (three references), Ireland (three references), United Kingdom (six references), United States of America (two references), and Norway (one reference). Four references included studies within multiple countries. The sample size varied between 20 and 106,874 participants. The two payment systems can impact on individual outcomes, such as by overtreatment in an FFS system and undertreatment in a CF system.

Oral Health Profiling for Young and Older Adults: A Descriptive Study

The purpose of this study was to trial the suitability of an oral health promotion toolkit in a chair-side setting to determine: an individual's knowledge; understanding of oral and general health behaviour and evaluate the commitment of dental practitioners to undertake an assessment of the individual's attitude and aptitude to undertake a home care preventive plan. All participants were 18 years and over and came from low socio-economic backgrounds in rural New South Wales, Australia. The study evaluated 59 case studies regarding their knowledge of oral and general health. The study included an oral health profiling questionnaire, based on validated oral health promotion outcome measures, a full course of dental care provided by a private dental practitioner or a dental student. Out of the 59 participants, 47% of participants cleaned their teeth twice per day, 69% used fluoride toothpaste and 47% applied the toothpaste over all the bristles. The questionnaire, based on Watt et al. (2004) verified oral health prevention outcome measures was a sound approach to determine an individual's knowledge, understanding of oral and general health behaviour. However, dental practitioners' commitment to assessing the individual was low.

Adult capped dental payment model applied within a university setting: an Australian reflective case study

Background

Capitation models of care in dentistry started around 1973 with varying degrees of success in meeting the needs of the individuals and expectations of the participating private practitioners. These studies mostly identified that capitation payments resulted in under treatment whilst fee-for-service models often led to over treatment. The objective of this study was to develop a new way of doing business using an outsourcing capitation model of care to meet population health needs and activity-based funding requirements of rural Local Health Districts with a local university dental school. This payment model is an alternate referral pathway for public oral health practitioners from the existing New South Wales Oral Health Fee-for-Service Scheme that focuses on urgent treatment to one that offers an all-inclusive preventive approach that concentrates on sustaining good long-term oral health for the individual.

Method

The reflective study analysed various adult age cohorts (18–24, 25–34, 35–44, 45–54, 55–64, 65–74 and 75 + years) based on 950 participants randomly selected from the Greater Southern adult public dental waiting lists. The study’s capitation formula was derived from NSW government adult treatment items (n = 447,625). Dental care was provided through the local university’s dental clinics utilising only dental students under clinical supervision. All data were sourced from NSW Oral Health Data Warehouse during 1 January 2012–30 June 2018 and analysed by using SAS 9.3 and Version 13 Microsoft Excel.

Results

There were 10,305 dental care items and 1129 capitation courses of care totalling A$599,026. This resulted in an average of 11 dental care items being provided to each participant. The capitation payment formula utilising the most provided dental care items of 100 individual patients proved to be economical and preventive focused.

Conclusion

The systematic reflection showed that this unique methodology in developing an adult capitation payment formula associated to diagnostic pathways that resulted in: (i) more efficient usage of government expenditure on public dental services, (ii) provision of person-centred courses of dental care, and (iii) utilisation of university dental education programs to best practice treatment and holistic care.

Distribution of Australian dental practices in relation to the ageing population

OBJECTIVE

The purpose of this study was to analyse and map the distribution of the ageing population, by sociodemographic profiling, in private and public dental practices in Australia.

BACKGROUND

The rapid increase in the aged population in Australia requires a comprehensive approach to ensure accessibility to geriatric dental services. However, the availability of dental services for the older people requires further investigation of the demographic distribution of need.

MATERIALS AND METHODS

Dental practices were located and mapped against the ageing population data. The address for each dental practice in Australia was compiled from online access sources. Australian socioeconomic data were integrated with dental practices, clinic locations and older populations using Geographic Information System (GIS) technology.

RESULTS

There was an uneven distribution of dental practices across Australia's States and Territories (NT and ACT). Tasmania had the highest ratio of private practices to the older population (1:1000) and the highest percentages of this ageing cohort (32%, 61%) that lived more than 5 km from private and public dental practices respectively. Higher percentages of dental practices were located in areas of lower socioeconomic status in Tasmania, Queensland and South Australia (47%, 42% and 38%) respectively, however, these areas were associated with higher ageing population densities.

CONCLUSION

There is a geographic maldistribution of dental practices in relation to the spatial distribution of Australia's older population, with the inequity most pronounced in the most disadvantaged areas. This inequality requires a National approach to match dental services to the population that they serve.

Dental specialist workforce and distribution in the United Kingdom: a specialist map

Objectives To illustrate, identify and assess a contemporary model of the geographic distribution of specialist dentists in relation to population age groups and rurality.Methods All UK dental specialists registered with the General Dental Council were extracted and paired with publicly available locations of work. Geographic information system tools were used to map specialist locations against population and rural-urban classifications of England, Wales, Scotland and Northern Ireland. The latest 2019 population estimates and health board areas were superimposed to create a specialist map. All other data were collected at the smallest geographic statistical areas and corresponding population data from the latest census.Results A total of 4,439 specialist titles were held by 3,041 individuals, linked to 3,459 unique locations of work. Specialist locations were mapped against 135 Clinical Commissioning Groups (CCGs) of England, seven Local Health Boards of Wales, 14 Health Boards of Scotland and five Health and Social Care Trusts of Northern Ireland. NHS Central London CCG had the highest specialist dentists per 100,000 people at 118.9; paediatric dentists per 20,000 children at 6.4; orthodontic dentists per 20,000 schoolchildren at 23.2; oral surgery dentists at 4.8 per 20,000 adults; and prosthodontic dentists at 7.2 per 20,000 adults. Orthodontics and oral surgery had the highest specialist-to-population ratios at 1:45,545 and 1:77,510, compared to oral and maxillofacial radiology and oral microbiology with the lowest ratios of 1:2,178,316 and 1:9,024,452, respectively. In England, Wales, Scotland and Northern Ireland, there were 79.5% (n = 42,140,039), 55.6% (n = 1,703,248), 46.9% (n = 2,481,996) and 42.9% (n = 776,295) of the respective populations that lived within 2.5 km of a specialist location. There were significant disparities in rural proximity to specialist locations across all nations. In Scotland, 40.8% of the rural population lived outside 10 km of a specialist location.Conclusions Stark inequalities exist in the geographic distribution of UK specialist dentists and high disparities were found in accessing a specialist, especially for vulnerable populations.

Factors Associated with Participation in Research Activities among Oral Health Providers in Jazan, Saudi Arabia: A Cross-sectional Study

AIMS AND OBJECTIVES

This study aimed at quantifying participation in dental research-related activities reported by the Saudi Ministry of Health-associated oral healthcare providers in Jazan and to investigate its association with sociodemographic and professional characteristics, as well as practitioners' perceptions of the Research and Development (R&D) index.

MATERIALS AND METHODS

An online cross-sectional questionnaire was sent to oral health providers in Jazan using a convenience sampling technique. The questionnaire collected data on demographic characteristics and the 16 items of the R&D index. One-way ANOVA and t-tests were used to establish factors associated with R&D index scores. Multiple regression analyses with adjusted effects were conducted to identify the significant predictors for the factors associated with participation in dental research.

RESULTS

In total, 113 study participants completed the questionnaire with a response rate of 56.5%. Just over half (53.1%) of the participants were working in primary healthcare centers, and 46.9% were working in hospitals. Most of the study samples were dentists (92.0%), while a small percentage were dental hygienists (4.4%) and assistants (3.4%). The sample's participation in dental research was low with a mean of 3.57 (standard deviation = 3.69). The R&D support (p<0.001) and intentions (p = 0.050) significantly predicted the providers' participation in dental research.

CONCLUSION

The current study found that R&D support and intention significantly predicted the providers' participation in dental research. Hence, it is recommended that comprehensive educational and training programs on dental research be developed that focus on the increase and implement it in their practice.

CLINICAL SIGNIFICANCE

This study provides insights into factors and obstacles that influence dental research, which may be useful for future investigations.

The Association Between Admission to A Tertiary Children’s Hospital and Future Unplanned Dental Presentation

Objective: Dentistry should aim to prevent rather than focus on end-stage treatment which is more costly and less effective. This study investigated the association between unplanned dental presentations and any previous admissions at a tertiary hospital for children. Design: A retrospective analysis of 351 unplanned dental presentations at PCH was performed. Setting: A tertiary children’s hospital, the Perth Children’s Hospital (PCH). Main outcome measures: Reasons for unplanned presentations (infection, trauma, others) and the history of any previous admissions at PCH were analysed. Results: Dental infection and trauma were the main reasons for the unplanned dental presentations. More than half of those who presented due to dental infection had at least once previous admission at PCH due to other reasons. Patients who presented with dental infection were more likely to have previous visits by community nurse or social worker, while those who presented due to trauma, were more likely to have had previous visits at orthopaedic or fracture wards of the same hospital. Conclusions: Community nurses and social workers can possibly play a role in informing patients about dental care options in the primary care sector.

Disparities in the geographic distribution of NHS general dental care services in England

Objectives To assess the geographic distribution of NHS dental practices in England in relation to deprivation and rurality.Methods A total of 7,851 dental practices in England were included in this study against a population of 53,004,517 from 171,349 statistical areas. The practices were mapped using geographic information systems technology and integrated with census population data, the Index of Multiple Deprivation and the rural-urban classification.Results Results showed that 92.1% of children and adolescents, 91.8% of working-age adults and 88.8% of older adults lived within 2.5 km of a practice. In general, dental practices were not socioeconomically distributed; 99.7% of people from the most deprived areas lived close to a practice compared to 92.9% of people from the least deprived areas. However, when age groups were delineated, much higher proportions of deprived children and adolescents lived within 2.5 km distance from a dental service, while the opposite was true for the older age group (high proportions of the least deprived older adults lived within 2.5 km distance from a dental service). In rural areas, 54.8%, 54.3% and 53.5% of children and adolescents, working-age adults and older adults lived outside 2.5 km of a dental practice, respectively.Conclusions Disparities exist in the distribution of NHS dental practices in England. The need to increase spatial availability of dental practices in England is evident.

Public transport access to NHS dental care in Great Britain

Objective Access to transport is a common barrier to oral health. Greater dependence on public transport has shown delayed oral healthcare, lack of usual source of care and greater unmet health needs. This study examined the spatial accessibility of the population of Great Britain to public transport in providing access to oral healthcare.Methods A total of 8,791 dental practices in Great Britain were identified and geocoded. There were 10,444 rail, metro and light rail stops and 348,961 bus and tram stops. Geographic information systems were utilised to integrate the dental practice locations and public transport points to respective census tracts of each nation containing population data, deprivation measures, and classification of rural and urban areas.Results Almost all dental clinics in Great Britain were located within 400 m of bus and tram stops or 800 m of a rail, metro or light rail stop. Similarly, in Scotland and England, 92% lived within any public transport (within 400m of bus and tram stops or 800m of a rail, metro or light rail stop), and in Wales, 84.2% lived within any public transport stop. However, only 75.1%, 79.6% and 60.4% of the population of Scotland, England and Wales had access to a high-frequency bus stop, respectively. In Scotland, England and Wales, 40.7%, 33.7% and 38.3% of rural residents did not have access to any public transport and only 4.9%, 7.5% and 14.6% of the rural residents had access to an optimal bus stop, respectively. In Wales, 19.5% of older adults do not have access to a bus stop.Conclusion Some transport-disadvantaged groups do not have adequate access to public transport services. There is a compelling need to address public transport integration with oral health facilities to ensure equality in accessing integral services.

Mesiodistal dimensions and sexual dimorphism of teeth of contemporary Western Australian adolescents

PURPOSE

Many studies of tooth dimensions have reported both diversity among populations and sexual dimorphism. This study aimed to collect data on mesiodistal dimensions and sexual dimorphism of permanent teeth of contemporary Western Australian adolescents.

METHODS

The mesiodistal dimensions of teeth from 500 adolescents (177 males, 323 females; age, 13-18 years) were obtained from pre-orthodontic treatment digital dental records of examinations using Invisalign technology. Differences between contralateral teeth and sexual dimorphism were analyzed by using SPSS.

RESULTS

Mesiodistal dimensions significantly differed between right and left teeth in both sexes. Males had larger teeth than females, and the difference was significant for most teeth. Reverse dimorphism (females had slightly larger teeth than males) was observed for the maxillary second premolar. Mandibular canines exhibited the greatest dimorphism. In addition, secular trends-specifically, a reduction in the degree of dimorphism-were observed in mesiodistal dimensions.

CONCLUSION

Mesiodistal dimensions significantly differed between teeth in contralateral quadrants, in both arches. Most teeth exhibited sexual dimorphism, which was the greatest for permanent mandibular canines. Dimorphism was less obvious in this population than in other populations.

Oral Health Behaviour and Predictors of Oral Health Behaviour Among Patients With Diabetes in the Republic of Mauritius

OBJECTIVES

To investigate the oral care habits and assess the determinants of oral care behaviour among people with diabetes in the Republic of Mauritius.

METHODS

The present study draws on data collected from 589 dentate persons with diabetes by means of a close-ended questionnaire. Multivariate logistic regression analyses were used to estimate the association of different demographic and clinical factors with recommended dental hygiene practices.

RESULTS

The majority of the participants brushed at least twice daily (84.2%), never flossed (88.6%), attended dental clinics on need only (87.1%), and did not monitor their blood glucose levels regularly (69.9%). Neither awareness about the increased risk of periodontal disease and xerostomia nor receiving advice from diabetes care providers was found to be associated with good oral hygiene or increased service utilisation. The experience of oral diseases did not encourage recommended oral health practice, with participants without experience with periodontal disease being 3 times more likely to floss (odds ratio [OR], 2.9; P = .045). Regular dental visits were strongly associated with self-reported type 1 diabetes (OR, 7.8; P = .025). Participants from urban areas were more than twice as likely to visit their dental care provider at least once annually (OR, 2.3; P = .006). Regular dental attendance (OR, 3.7; P = .011) and flossing (OR, 4.5; P = .012) were strongly associated with one another.

CONCLUSION

There is widespread noncompliance with regular flossing and dental service utilisation. Our findings highlight the need for an emphasis on preventive care through the provision of integrated medical and dental interventions to high-risk individuals suffering from both diabetes and chronic periodontitis.

Awareness About the Oral and Systemic Complications of Diabetes Among a Cohort of Diabetic Patients of the Republic of Mauritius

Background

Persistent hyperglycaemia in patients with uncontrolled or poorly controlled diabetes may cause serious oral and systemic complications. Persons with diabetes are mostly unaware of their increased risk of oral complications.

Objective

This study investigated awareness about the association of diabetes with other diseases and knowledge about the systemic and oral complications of diabetes among patients with diabetes in the Republic of Mauritius.

Methods

Data were collected from 720 patients with diabetes using an anonymous closed-end questionnaire. Descriptive statistics and multivariate logistic regression analyses were used to report the results and to identify factors associated with awareness about the link between diabetes and other diseases and knowledge about oral and systemic complications.

Results

The majority of the study participants were aware of the association between diabetes and other diseases. However, knowledge about oral complications of diabetes was limited (caries [29%], periodontal disease [37%], and xerostomia [52%]). Education and the number of years since diagnosis of diabetes were the most significant predictors of awareness about complications. The experience of xerostomia and periodontal disease were associated with knowledge about their respective increased risk. Receiving advice from diabetes care providers increased awareness about caries and periodontal disease. Age and type of diabetes were associated with knowledge about systemic complications.

Conclusion

Awareness about the oral complications of diabetes was limited and was mainly linked with the experience of disease. This indicates a need for increased health promotion with customised educational programs to inform patients with diabetes of their increased risk of developing complications.

Mobile photographic screening for dental caries in children: Diagnostic performance compared to unaided visual dental examination

OBJECTIVES

This study was conducted to compare the use of intraoral photographs with the unaided visual dental examination as a means of dental caries detection in children.

METHODS

Children aged 4- to 14-year-olds were visually examined at their schools. Following dental examinations, children had five photographs of their teeth taken using a smartphone camera. Four dental reviewers, who are different from those who visually examined the children, assessed intraoral photographs for dental caries. Sensitivity, specificity, and inter-rater reliability agreement were estimated to assess the diagnostic performance of the photographic method relative to the benchmark visual dental assessments. Caries prevalence was measured using dft/DFT (decayed and filled teeth) index.

RESULTS

One hundred thirty-eight children (67 male and 71 female) were enrolled and had a mean age of 7.8 ± 2.1 years. The caries prevalence (dft/DFT > 0) using photographic dental assessments ranged from 30 percent to 39 percent but was not significantly different from the prevalence (42 percent) estimated with the visual dental examination (P ≥ 0.07). The sensitivity and specificity of the photographic method for detection of dental caries compared to visual dental assessments were 58-80 percent and 99.7-99.9 percent, respectively. The sensitivity for the photographic assessments was high in the primary dentition (63-82 percent) and children ≤7-year-olds (67-78 percent). The inter-rater reliability for the photographic assessment versus the benchmark ranged from substantial to almost perfect agreement (Kappa = 0.72-0.87).

CONCLUSIONS

The photographic approach to dental screening, used within the framework of its limitations, yielded an acceptable diagnostic level of caries detection, particularly in younger children with primary dentition.

Retrospective case review investigating the effect of replacing oaten hay with a non-cereal hay on equine peripheral caries in 42 cases

BACKGROUND

Equine peripheral caries can cause significant morbidity and can have considerable welfare implications. Recent research suggests that diets with high water soluble carbohydrate (WSC) content are associated with high risk of peripheral caries. Previous work has indicated that the condition may be treatable if the inciting cause is removed and the damaged tooth allowed to erupt out, being replaced by the unaffected tooth previously under the gingival margin.

OBJECTIVES

To see whether the peripheral caries process can be ceased if oaten hay (typically high WSC) is removed from the diet and replaced with a non-cereal hay (typically lower WSC).

STUDY DESIGN

Retrospective blinded longitudinal study.

METHODS

Forty-two cases with peripheral caries that were on oaten hay were asked if they would change the hay type from oaten hay to a non-cereal hay or straw (meadow, Rhodes hay, lucerne hay or barley straw). Photographs were taken at the time and then again at subsequent visits. The photographs were anonymised, randomised and scored by six equine veterinary dentists using the Jackson et al. 'Peripheral Caries Grading System' grading scale.

RESULTS

At follow-up, 69.0% of cases were marked as inactive, compared with 47.6% of cases at baseline (OR: 2.45, 95%CI: 1.12-5.36, P = .02). Significantly lower grades of peripheral caries were observed in the gingival, middle and occlusive third of the molars (triadan 9-11's) at follow-up compared with baseline. However, significant improvements were not observed in the premolars (triadan 6-8's).

MAIN LIMITATIONS

This is a review of clinical records, not a prospective study. As such, other changes in the diet and management were not recorded, and there was no control group.

CONCLUSIONS

Recommending clients change their horse's diet from oaten hay (high WSC) to a typically lower WSC hay was associated with significant improvements in equine peripheral caries located in the molars.

An Indigenous cultural competence model for dentistry education

Reorientation of education for health professionals is necessary to support future health workforce in meeting population needs. Dental graduates must be competent to effectively communicate with patients, their families and other health professionals involved in their care, regardless of social or cultural background. Indigenous people in Australia experience significant oral health disparities compared to non-Indigenous Australians. Cultural competence has evolved as the leading model to equip future clinicians to deliver culturally safe care. A case study conducted at the University of Sydney School of Dentistry examined the integration of Indigenous cultural competence into dental curricula using four data sources: a systematic review identifying intervention strategies to improve cultural competence; an online survey to provide a baseline analysis of Indigenous curricula practices; and two in-depth interview studies with academics and students to determine barriers and enablers to increasing Indigenous cultural competence among dental students. As a result, an Indigenous cultural model was developed for dentistry education, recognising three major constituents being critical to achieving cultural competence among dental students. Indigenous cultural competence in dentistry education requires stringent governance, adequate faculty resources and effective educational strategies, in order to increase students' knowledge, understanding and skills to achieve a minimum cultural competence standard upon graduation.

Use of Quality-Adjusted Tooth Years as an Outcome Measure of Periodontal Treatment: A Quasi Experimental Study

Aim:

To develop a simple approach to estimate quality-adjusted tooth years of teeth (QATY) treated for periodontitis and determine gains in QATY after undergoing cause-related periodontal therapy (CRPT). Quality-adjusted life years (QALY) gained for these patients were also determined.

Materials and Methods:

Patients newly diagnosed with periodontitis ( n = 165, 58.8% females, mean age 43.3 years) were recruited from periodontal specialist clinics. They received CRPT within a period of one year. We used the EuroQoL 5 Dimension (EQ-5D) and the Malaysian Oral Health Impact Profile (OHIP-14) indexes to measure changes in quality-of-life after one year of periodontal treatment. We then used these two scores to calculate their respective utilities and subsequently calculated QALY and QATY.

Results:

Proportions of deep periodontal sites (≥ 4 mm) decreased from 32.7% to 23.2% and patients gained an average of 0.3 mm of clinical attachment level per tooth at post-treatment follow-up. Improvements in means of OHIP-14 scores from 20.30 to 12.7 were consistent with changes in EQ-5D utilities from 0.81 to 0.91. Treated teeth gained 20.4 years for longevity while patients gained 17 QATYs. This is in line with the increase of 3.8 QALYs. Both treatment outcomes and clinical parameters were statistically significant at P < .0001.

Conclusions:

The method of estimating QATY using utilities derived from OHIP-14 combined with tooth life expectancy demonstrated that it may be used to measure effective treatment outcomes and is found to be consistent with improvements in QALY scores as calculated using EQ-5D-3L.

Does socioeconomic status influence oral cancer awareness? The role of public education

Background

Public awareness on oral cancer is thought to improve prevention and early diagnosis; however, the role of socioeconomic status in this awareness is not clear.

Aims

The aim was to investigate whether an association exists between socioeconomic status and oral cancer awareness in adults.

Methods

A multi-stage random sample of adults was investigated in Tehran in 2016-2017. The outcome was awareness of oral cancer and knowledge of risk factors and signs and symptoms using a self-administered questionnaire. The main exposures were self-reported socioeconomic status of 8 indicators of family assets and economic situation. Wealth index was created using principal component analysis, and participants were classified into 5 quintiles. Regression analysis was applied to test associations.

Results

Out of 1800 adults, 1312 completed questionnaires were returned (72.8% response rate). The mean age was 37.8 (standard deviation 9.0) years; about 60% were female. Statistical analysis revealed the higher the wealth index, the higher the score for oral cancer knowledge and awareness. Awareness and knowledge were significantly lower among participants in the poorest quintile: they had a knowledge score on oral cancer risk factors 1.58 points [95% confidence interval (CI): -2.19;-0.96] lower, and a knowledge score on oral cancer signs 1.34 points (95 CI: -1.98;-0.72) lower compared with the richest quintile.

Conclusion

Socioeconomic inequalities were observed in oral cancer awareness in the Islamic Republic of Iran.

Are diabetes and dental care providers in the Republic of Mauritius advising patients about the importance of oral health in diabetes management?

Diabetes and dental care providers may greatly contribute in the early detection of oral diseases and diabetes, respectively, and in the prevention of complications of diabetes. However, there is limited collaboration and referrals between these two groups of health professionals.

OBJECTIVE

To investigate whether diabetic providers are addressing the importance of oral care in the management of diabetes and whether dental care providers are advising their patients with diabetes about the importance of glycaemic control.

METHOD

Descriptive statistics was used to report data collected from 720 patients with diabetes using a closed-end questionnaire. Logistic regression analysis revealed the factors significantly impacting whether participants received advice from healthcare providers.

RESULTS

The majority of participants did not receive advice from either diabetes (84%) or dental (75%) care providers regarding the reciprocal nature of diabetes and periodontitis. The factors significantly affecting receiving advice from diabetes care providers were place of residence (p = 0.003), self-reported type of diabetes (p = 0.000) receiving advice from dental care providers (p = 0.000); from dental care providers - education (p = 0.020), place of residence (p = 0.004), the number of years since diagnosis of diabetes (p = 0.002), frequency of dental visits (p = 0.000) and receiving advice from diabetes care providers (p = 0.000).

CONCLUSION

Diabetes and dental care providers in Mauritius are not addressing oral health care as an essential component of diabetes care. Patients with diabetes are neither being advised about the importance of regular dental visits by their treating doctor, nor about the importance of glycaemic control in the prevention of oral complications by their dentist.