Children’s HEalthy Weight guideline Implementation in the dental setting : a multi-phase sequential mixed methods project : the CHEWI project

There has been an increasing prevalence of childhood overweight and obesity worldwide and locally, with a quarter of Australian children now considered overweight or obese. This is of concern as obesity in childhood is associated with obesity in adulthood and increased risk of chronic diseases. In response to this, in 2015 the New South Wales (NSW) government released a Premier’s Priority titled “Tackling Childhood Obesity”, which called for all public health services to identify children above a healthy weight and refer them to appropriate services. This priority encompassed public dental services, due to the shared risk factors between childhood obesity and oral health including consumption of sugar-sweetened beverages, and the opportunities they have to recall and monitor child patients at regular intervals. In light of this, in 2018 the NSW Ministry of Health released guidelines titled ‘Growth Assessment and Dietary Advice in Public Oral Health Services’ for dental staff (DS) such as dental and/or oral health therapists and dental assistants across the state. However, to ensure these guidelines are incorporated into practice, it is anticipated that implementation strategies will be required to support dental practitioners. This study aimed to develop and pilot implementation strategies to facilitate the translation of the ‘Growth Assessment and Dietary Advice in Public Oral Health Services’ guidelines into dental staff’s practice. Specific objectives included: 1. Summarise the existing evidence on the most effective guideline implementation strategies for the dental setting. 2. Codesign implementation strategies with dental staff and parents to facilitate implementation of children’s healthy weight guidelines into the dental setting. 3. Design and psychometrically evaluate an instrument that measures dental staff behavioural intention. 4. Refine and pilot test the implementation strategies using the developed instrument and service data. This project has provided valuable insight into the systematic development of implementation strategies for the dental setting by drawing upon the principles of codesign as well as involving a range of stakeholders. It was clear that dental staff can play a key role in addressing overweight and obesity in childhood, although this can be a challenging role expansion. A systematic approach where dental staff and parents could codesign their own strategies, and in ensuring involvement of other stakeholders in the refinement of these strategies produced strategies that were acceptable, feasible, and sustainable for all involved parties. Initial findings from this project showed promising improvements to behavioural determinants and self-reported behaviours following the introduction of the strategies for one district

A retrospective study of the Hall technique for the treatment of carious primary teeth in Sydney, Australia

Objectives: The aim of this retrospective study was to evaluate the outcome of preformed metallic crowns (PMC) utilizing the HT in carious primary molars for children treated within public dental clinics across the Sydney region. Materials and Methods: A retrospective cohort study was designed, whereby two investigators evaluated 113 primary molars treated with HT PMCs involving 71 participants (aged between 5 and 11 years) after a minimum of 6 months post treatment. The mean time elapsed between crown placement (treatment) and the review was 1.42 years (17 months). The outcome of the HT was assessed by clinical and radiographic criteria. Results: One hundred thirteen HT PMCs were reviewed from 71 participants. The overall success rate of PMCs placed utilizing the HT was 99%, with only one case presenting with confirmed failure. Conclusions: HT PMCs have an overall high success rate as a treatment option in carious primary molars

Patient perceptions of oral health care following stroke : a qualitative study

Background: Stroke is a serious cerebrovascular disease and is one of the world’s leading causes of disability. Maintaining good oral health is a challenge among those hospitalised after stroke. A multidisciplinary approach to oral care involving non-dental professionals can be beneficial in improving oral health outcomes for patients. The aim of this study was to understand the perceptions of stroke survivors regarding oral healthcare across acute and rehabilitation settings. Methods: A descriptive qualitative approach was used. Face-to-face semi-structured interviews were conducted. A framework analysis was employed to analyse the data. Patients who had recently experienced a stroke were purposively recruited across both acute and rehabilitation settings, at two metropolitan hospitals in Sydney, Australia. In total, 11 patients were interviewed. Results: Although participants recognised the importance of oral health, few understood the link between oral and general health. Regular oral hygiene practices varied since having stroke, with a few receiving oral care assistance from nurses. Time, cost and lack of information were some barriers to accessing dental services, while supportive measures such as coordination of oral care, financial subsidy and nurse assistance were strategies proposed to support oral care practices amongst stroke survivors. Conclusions: There is scope to improve current models of oral care in stroke. While stroke survivors understand the importance of oral care, an integrated oral health model with a multidisciplinary approach could improve health outcomes

Knowledge, attitudes and practices of Indian immigrants in Australia towards oral cancer and their perceived role of general practitioners : a cross-sectional study

Oral cancer is highly prevalent in the Indian subcontinent. With the increasing immigration of Indians to Australia, a potential rise in oral cancer cases can be expected if they continue engaging in oral cancer risk practices. Unfortunately, little is known on this topic in the Australian context. This study aimed to generate new insights into this area by examining Indian immigrants’ knowledge, attitudes and practices regarding oral cancer in Australia and their perceived role of general practitioners in raising oral cancer awareness. Exploring these aspects could determine the oral cancer risk behaviours of Indians in Australia along with any contributing factors which could help identify potential preventative strategies. A cross-sectional survey was undertaken of 164 Indians across Australia. Data were analysed using SPSS software with descriptive statistics. Respondents had varying levels of knowledge about oral cancer (mean total score 61%), particularly around risk factors such as alcohol and areca nut use as well as oral cancer-related signs/symptoms. The majority (87.7%) had not received any information about oral cancer in a health care setting but were receptive (71–90%) to general practitioners playing a more active role in this area. Respondents were engaging in positive preventative oral health care though few were currently (6.7%) or previously (14.7%) chewing tobacco preparations. Further research is needed through larger studies to confirm the study findings and inform the development of culturally tailored strategies particularly involving general practitioners, to raise oral cancer awareness and provide early screening for Indian immigrants

The codesign of implementation strategies for children's growth assessment guidelines in the dental setting

Background: Considering the interdisciplinary role dental staff can play in addressing overweight and obesity in childhood, this study aimed to codesign guideline implementation strategies for children’s growth assessment and dietary advice guidelines in the dental setting. Methods: This qualitative study utilised principles of codesign and appreciative inquiry through a series of four, two hour focus groups with dental staff and parents. Focus groups were analysed using content analysis. Results: Discussion fell into two main themes, engaging patients throughout their care journey and supporting staff to engage with the guidelines. Six strategies were developed within these themes: (1) providing growth assessment information to patients and families before appointments, (2) providing refresher training to staff, (3) involving dental assistants in the growth assessment, (4) keeping dental staff updated regarding referral outcomes, (5) culturally appropriate information resources for patients and families, and (6) enabling longitudinal growth tracking in patient information systems. Conclusions: This study successfully designed six implementation strategies for children’s growth assessment guidelines in the dental setting. Further research is required to determine their impact on guideline adherence

The effectiveness of guideline implementation strategies in the dental setting : a systematic review

Background: Guideline implementation has been an ongoing challenge in the dental practice setting. Despite this, there are no reviews summarising the existing evidence regarding effective guideline implementation strategies in this setting. In order to address this, this systematic review examines the effectiveness of guideline implementation strategies in the dental practice setting. Methods: A systematic search was undertaken according to the PRISMA statement across nine electronic databases, targeting randomised controlled trials and quasi-experimental studies which evaluated the effectiveness of guideline implementation strategies in improving guideline adherence in the dental setting. All records were independently examined for relevance and appraised for study quality by two authors, with consensus achieved by a third author. Data were extracted from included studies using a standardised data extraction pro forma. Results: A total of 15 records were eligible for inclusion in this review, which focused on the effects of audit and feedback, reminders, education, patient-mediated interventions, pay for performance and multifaceted interventions. Although there were some conflicting evidence, studies within each category of implementation strategy indicated a positive effect on guideline adherence. Conclusions: This study has identified education, reminders and multifaceted interventions as effective implementation strategies for the dental practice setting. Although this is similar to research findings from other health sectors, there is some evidence to suggest patient-mediated interventions may be less effective and pay for performance may be more effective in the dental setting. These findings can inform policy makers, professional associations, colleges and organisations in the future adoption of clinical guidelines in the dental practice setting

Countering the poor oral health of people with intellectual and develoopmental disability : a scoping literature review

Background: People with intellectual and developmental disability (IDD) have poor oral health and need support to maintain optimal oral health outcomes. Little is known about how, when and where to intervene for this population. Thus the aim of this review was to summarise the existing evidence surrounding improving oral health outcomes for people with IDD. Methods: A scoping literature review was conducted focusing on ‘oral health’ and ‘intellectual disability’. Systematic searches of five electronic databases were conducted in line with the study aims and two authors independently examined all records for relevance, with consensus achieved by a third author. Results: A small number of approaches and interventions were identified to support people with IDD to independently maintain optimal oral hygiene. Identified studies highlighted that caregivers play a vital role in the provision of oral health support, emphasising the effectiveness of educational interventions for caregivers. However, there was uncertainty regarding the efficacy of specific tooth brushing interventions for people with IDD. In cases of more severe IDD and/or dental-related behavioural problems, dental treatment under general anaesthesia was often both a necessary and effective method of oral health care provision. The findings also identified outreach and exclusive oral health services as successful strategies for increasing the limited access of people with IDD to oral care services. Conclusions: A uniform approach to supporting oral health for people with IDD is unlikely to succeed. A system based approach is needed to address the diverse needs of the population of people with IDD, their caregivers and service context. Further high quality evidence is required to confirm these findings

Long-term effectiveness of the midwifery initiated oral health-dental service program on maternal oral health knowledge, preventative dental behaviours and the oral health status of children in Australia

Background The Midwifery Initiated Oral Health-Dental Service was developed to train midwives to promote maternal oral health, and a large trial showed it substantially improved the oral health, knowledge and behaviours of pregnant women. Aim Evaluate the long-term effectiveness of the program (post-trial) on maternal oral health knowledge, dental behaviours, and early childhood caries in offspring. Methods A prospective cohort study involving 204 women and children 3–4 years (followed after trial) was conducted in Sydney, Australia from 2017 to 2019. Results The program did not have a significant impact on the study measures. Mothers who received the program did have comparatively better knowledge around preventative behaviours to reduce early childhood caries and significantly more mothers were engaging in a key behaviour of using a cup to feed their child. Overall maternal oral health knowledge and level of education did have a protective effect on the dental decay of children. Higher knowledge and levels of education reduced the odds of having a dmft of one or more by over half (OR 0.473), and almost 80% (OR 0.212) respectively. Conclusions Although the MIOH-DS program was not effective, there is still value in exploring other complementary interventions to improve maternal oral health, especially for disadvantaged families. Future research should focus on co-designing an antenatal and postnatal oral health intervention and exploring its long-term impact on the oral health of children

Oral health in residential aged care : perceptions of nurses and management staff

Aim: This study aimed to explore the perceptions of residential aged care nursing and management staff regarding oral care, to develop strategies to improve the oral health of aged care residents. Design: A qualitative approach was used. Methods: Two focus groups were conducted with nursing and management staff at two residential aged care facilities and transcripts were thematically analysed. Results: All staff had an awareness of the importance of oral health; however, they highlighted the significant challenges in the current system that affect implementation of oral health training and practice guidelines in the residential aged care facility. High staff turnover, time constraints, difficulties in accessing dental services and working together with residents, their families and external staff were barriers to providing oral health care. Staff highlighted the need for formalized clinical guidelines and processes and efficient dental referral pathways to create a more cohesive system of care

Evaluation of Smiles for Life : a caregiver focused oral health education programme

Background: People with an intellectual and/or developmental disability are at increased risk of adverse oral health outcomes and often require support from caregivers to assist in maintaining or seeking treatment for their oral health needs. However, caregivers and support workers are often family members with limited formal oral health training. Hence, the aim of this pilot study was to review the outcomes of the ‘Smiles for Life’ oral health education workshop with reference to their knowledge, attitudes, and practices of caregivers of people with an intellectual or developmental disability. Methods: A single group pre-test post-test intervention design was used to explore the preliminary effectiveness and appropriateness of the Smiles for Life oral health education workshop. Results: A total of 244 participants completed both the pre and post knowledge test. Oral health literacy scores decreased following the post test. Those with higher levels of education achieved higher post-training knowledge scores. Overall, caregivers reported satisfaction on the material presented however, it could be improved with more practical demonstrations. Conclusion: Providing an oral health education tool that caters to the diverse caregiver audience presents a unique set of challenges, despite oral health education in this professional group being vital. Future studies may benefit from reviewing the efficacy of a more tailored educational intervention