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

Measuring oral health during pregnancy: Sensitivity and specificity of a maternal oral screening (MOS) tool

Background: Being the parent of a severely injured child involves many stressors throughout the trauma journey. Internationally, little is known about the experiences or levels of emotional distress, parenting stress, quality of life, and resilience for parents of injured children. The aim of this study is to investigate the experiences, unmet needs and outcomes of parents of physically injured children 0–12 years over the 2 year period following injury. Methods/design: This is a prospective longitudinal study using an embedded mixed methods design. This design has a primary qualitative strand which incorporates supplementary quantitative data on child quality of life, and parental quality of life, parenting stress, emotional distress, and resilience at four time points; the acute hospitalisation phase, and at 6, 12 and 24 months following injury. The primary sample are parents of injured children 0–12 years hospitalised in the Australian states of New South Wales, Queensland, Victoria and South Australia. Primary data sources are child and parent demographic data; survey data; and semi-structured interview data across a 24 month period. Discussion: This study aims to address the existing gap in knowledge on the experiences and unmet support needs of parents in the 2 years following child injury to provide guidance for care provision for these families. There is a lack of evidence-based recommendations for supporting parents and families of injured children and strengthening their capacity to address the challenges they face

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

What do antenatal care providers understand and do about oral health care during pregnancy: a cross-sectional survey in New South Wales, Australia

BACKGROUND: There is mounting evidence to support the lack of awareness among pregnant women about health consequences and long term risks associated with poor oral hygiene during pregnancy. A recognised and important point of influence is their interaction with health professionals, particularly when receiving Antenatal Care. However, there is limited evidence about the perceptions of ANC providers in Australia toward the provision of perinatal oral healthcare. This study was undertaken to explore the knowledge, attitudes and practices of Antenatal Care (ANC) providers in New South Wales (NSW), Australia providing perinatal oral healthcare and to identify barriers to and predictors of their practices in this area. METHODS: A cross sectional survey was undertaken of ANC providers (general practitioners, obstetricians/gynaecologists and midwives) practising in NSW, Australia. Participants were recruited through their professional organisations via email, postal mail, and networking at conferences. The survey addressed the domains of knowledge, attitude, barriers and practices towards oral healthcare, along with demographics. Data was entered into SPSS software and analysed using descriptive and inferential statistics. RESULTS: A total of 393 surveys (17.6% response rate) were completed comprising 124 general practitioners, 74 obstetricians/gynaecologists and 195 midwives. The results showed limited knowledge among ANC providers regarding the impact of poor maternal oral health on pregnancy/infant outcomes. Most (99%) participants agreed that maternal oral health was important yet few were discussing the importance of oral health or advising women to visit a dentist (16.4–21.5%). Further, less than a third felt they had the skills to provide oral health advice during pregnancy. ANC providers who were more knowledgeable about maternal oral health, had training and information in this area and greater experience, were more likely to engage in practices addressing the oral health of pregnant women. CONCLUSION: The findings suggest that ANC providers in NSW are not focussing on oral health with pregnant women. ANC providers seem willing to discuss oral health if they have appropriate education/training and information in this area. Further research at a national level is required to confirm whether these findings are similar in all Australian states

Patient satisfaction and an international dental graduate workforce programme

Purpose: The New South Wales International Dental Graduate (N-IDG) programme was an Australian state government workforce initiative to support rural public dental services. The purpose of this paper is to evaluate patient satisfaction following dental treatment provided by an IDG workforce. Design/methodology/approach: This cross-sectional descriptive study used a validated questionnaire survey instrument to measure patient satisfaction (n=813) following treatment provided by IDGs enroled in the N-IDG programme, compared to their mentors. Domains included dentists’ professional competency, personality and the dental surgery organisation. Analysis of closed and open question responses was performed using domain grouping, frequency and χ analysis. Findings: Patient satisfaction across the IDG and mentor workforce was similar and very positively skewed with differences detected across perceived treatment quality (p=0.03), clinician efficiency (p=0.05) and answering of questions (p=0.05). These results favoured treatment provided by IDGs over mentors. This study demonstrated few differences between IDGs under limited registration and their mentors in terms of perceived patient satisfaction, suggesting patient perceived parity in care. Originality/value: Patient satisfaction was used innovatively to IDGs as an indicator of dental workforce programme effectiveness

Artificial Intelligence Supported Telehealth System for the Provision of Orthodontic Treatment to Public Patients

Background: Many children needing orthodontic treatment through public dental services miss the correct orthodontic treatment time due to long waiting time and limited resources. Remote orthodontic treatment monitoring has been shown to reduce face-to-face appointment. Aims: The aim of the study was to evaluate the feasibility of using an artificial intelligence supported telehealth system, Dental Monitoring (DM), and general dentists in providing orthodontic treatment to patients in the public system.Methods: This prospective pilot study included 23 patients from the waiting list of Sydney Dental Hospital. Patients were treatment planned by 2 orthodontists and their appliances/treatment was provided by general dentists, under the orthodontists’ remote monitoring via DM.  Before and after observation period digital dental casts were scored to check the improvement in malocclusion/bite. For the patients with a Class II malocclusion, needing growth modification, lateral cephalometric analysis was also carried out. Patient experience with DM was appraised via a questionnaire.Results: For patients compliant with aligner wear and use of DM, after a mean treatment duration of 9.2 months, there was significant improvement in the digital dental cast scores. Class II patients had significant improvement in their lower jaw position.  92% and 100% of patients indicated that DM scans were easy to do and use respectively. 1/3 of the patients preferred face-to-face appointments over DM.Conclusions: The use of aligners by general dentists under orthodontists’ remote supervision via Dental Monitoring improved the malocclusion/bite scores and lower jaw position during the observation period of this study.

Factors influencing smoking cessation brief intervention implementation among dentists

Aim or Purpose: To investigate factors influencing the low uptake of smoking cessation brief interventions (COHS, 2021), despite high prevalence of smokers amongst the patient population within the public dental system (AIHW, 2022, SLHD, 2019). Materials and Methods: It was a mixed-method low-negligible risk research of a convergent-parallel mixed method design. Data collection methods included semi-structured interviews with eight Sydney Local Health District (SLHD) Community Oral Health Clinic (COHC) dentists, and clinical record analysis of fifty patient records from SLHD COHCs. Each interview transcript was coded for thematic analysis, and data items from the clinical record analysis were analysed using descriptive statistics. The study was approved by SLHD Ethics Committee. Results: From clinical record audits, although 84% completed the ‘Ask’ step of the smoking cessation brief intervention, less than 10% undertook the ‘Advise’ and ‘Act’ steps. Factors identified as influencing smoking cessation brief intervention implementation included the characteristics of patients, the oral health status of patients, and dentist-perceived barriers. Nature of public patients, types of clinical services provided, and lack of training and time were some of the key reasons identified during dentist interviews. Conclusions: A flexible and tailored intervention approach suited to both the clinicians and intended audience is required, especially in priority populations seen in public dental clinics who experience more significant difficulty with accomplishing a sustained smoking cessation intervention

Views of pregnant women in South Western Sydney towards dental care and an oral-health program initiated by midwives

Issues addressed: Oral health during pregnancy is important, yet is often neglected by women. A program is currently being developed for midwives in Australia to promote maternal oral health. The aim of this study was to record the views of pregnant women in Australia towards dental care and midwives promoting oral health. Methods: Using convenience sampling, a cross-sectional survey was undertaken of 241 pregnant women attending a metropolitan hospital in South Western Sydney in 2010. Results: Only 10% of women received oral-health promotional material during pregnancy. More than 50% reported dental problems, yet only 17% had discussed this with their midwives and less than half (44.6%) had sought dental treatment. The main barriers to obtaining dental care were: lack of awareness, safety concerns about dental treatment and dental costs. Pregnant women were more likely (P 90%) were receptive to midwives providing oral-health education, assessments and referrals to affordable dental services. Conclusion This study has shown that pregnant women are receiving limited dental advice and are concerned about dental costs. It has also confirmed for the first time in Australia that women are very positive about receiving oral-health advice from midwives during their pregnancy. So what? Oral-health promotion programs during pregnancy should consider using midwives to increase dental awareness among women and provide pathways to affordable dental services

Clinicians’ perceptions of domestic violence routine screening in public dentistry

Aim or Purpose: To assess Sydney Dental Hospital (SDH) clinicians’ beliefs, attitudes, and experience in identification and response to domestic violence (DV) in a public dental setting prior to the implementation of Domestic Violence Routine Screening (DVRS). Materials and Methods: An anonymous cross-sectional survey was conducted amongst SDH clinicians from one general and two specialist clinics between November and December 2022 following completion of DVRS training and prior to DVRS implementation. The survey consisted of 10 questions addressing clinicians’ characteristics (demographic and educational history), their knowledge, perception, and previous experience responding to women disclosing DV. The study was approved by RPAH Ethics Committee. Results: Thirty-two clinicians participated (73% response), with 56% aged 25-34, 47% with more than 10 years of clinical experience (32% 5-10 years and 22% less 5 years) and 60% were general dentists. Most participants (75%) reported they had previously managed DV disclosures, and 63% agreed that responding to DV disclosure was part of their role, but 79% were not at all or only slightly confident in responding to DV disclosure prior to DVRS training. Nearly 60% considered that more training was needed, and their concerns included dealing with an ambiguous situation (95%), engaging with women to complete the screening (79%), responding to DV disclosures (79%) and child protection mandatory reporter requirements (63%). Conclusions: A large proportion of clinicians had previously managed DV disclosure prior to DVRS implementation and agreed that screening was part of their role but identified the need for more targeted training and support to increase their confidence in responding to DV and undertake DVRS