Australian dental policy reform and the use of dental therapists and hygienists

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

Edentulous patients' knowledge of dental hygiene and care of prostheses

Objective: The aim of this study was to analyse denture users' oral care habits with regard to the use of their prostheses. Background: Rehabilitative treatment is only successful when patients are motivated and aware of correct prosthesis use and hygiene. Materials and methods: Questionnaires were distributed to 150 complete denture users at the Federal University of Bahia School of Dentistry, the Esmeralda Natividade Health Center, the Bahian Science Development Foundation and a Salvador nursing home. The questionnaire included information on gender, age, length of prosthesis use, cleaning methods and materials, etc. The data were analysed using EpiInfo version 6 software. The chi-squared test was used for statistical analysis, with a significance level of 5%. Results: Questionnaire results showed that 78% of the subjects, with an average age of 67.3 years, had used the same complete denture for over 5 years. 64% slept with their prostheses and 44% removed them from the mouth only for cleaning. None of the patients interviewed knew anything about brushes designed specifically for complete dentures. 37.3% had a restricted diet and 44% believed that a complete denture would last for more than 10 years. Conclusion: Within the limitations of this study, it was concluded that the edentulous patients surveyed had limited awareness of prosthetic hygiene and long-term oral care despite extended periods of denture use. © 2008 The Authors.

Prevention of dental trauma during childhood: An overview

The aim of the present study was to evaluate the prevention of dental trauma in children aged 0 to 3 years, as it is studied in the literature. Since these traumatic injuries can cause damage and complications to the deciduous teeth, and even to the permanent teeth, the development of actions to reduce their occurrence is necessary because these injuries represent a considerable problem in dentistry. Although prevention is difficult in this age group, efforts should be directed at education, especially the development of educational programs involving qualified professional directly engaged in the routine of traumatic dental injuries. The actions to be adopted should be based on the understanding of etiological factors, on the different patterns of the mechanism of injury, and on the characteristics of each community. © 2009 Bentham Science Publishers Ltd.

Dentistry for babies: Caries experience vs. Assiduity in clinical care

Aim: This study analyzed and compared the experience of dental caries in 300 children aged 0 to 48 months, who were participants and non-participants of a preventive program 'Dentistry for babies', as well as the correlation between assiduity of dental visits and experience of dental caries. Methods: The subjects were randomly selected and divided into two groups: G1 'Non participant children of the Program' (n=100) and G2 'Participant Children of the Program' (n=200). Each group was subdivided in two subgroups: 0-24 months and 25-48 months. The collected data from G2 were analyzed, relating the variation of the dmft index (dmft refers to primary teeth: d = decayed, m = missing/extracted due to caries, f = filled, t = teeth) (C) and dental caries prevalence (P) with the influence of assiduity factor in each subgroup. To collect data, clinical examinations were performed using tactile and visual criteria by a single calibrated examiner. The data were statistically analyzed using the 'paired t-test', 'Mann-Whitney' and 'Chi-Squared' tests (p<0.05). Results: It was found that prevalence and dmft index were statistically significant (P=0.0001) with the greatest values observed in G1 (p=0.0001). The values were: PG1 (73%), PG2 (22%), CG1 (3.45±3.84), CG2 (0.66±1.57). Assiduity was significant in G2 (p=0.0001). The values observed were: P-Assiduous (2%), P-Non-assiduous (42%), C-Assiduous (0.04±0.31), and C-Non-assiduous (1.29±2.01). Conclusions: The participation in the program had a positive influence on the oral health of babies. Complete assiduity to the program resulted in the lowest rates and prevalence of dental caries.

Dentinogenesis imperfecta type II: approach for dental treatment

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A dental caries preventive program applied to children aged 5 to 8 years attending since the first year of age at the Baby Clinic of the Araçatuba Dental School, Brazil

Objective: Tooth decay is one of the more common diseases of childhood. Several studies recommend that early preventive measures must be implemented since the first years of life and continue throughout childhood and adolescence. The aim of the this study was to present results of a preventive dental program considering oral health maintenance, dental caries experience and the prevalence of dental caries relation with follow-up compliance visits. Material end method: Intraoral and interproximal radiographic exams were performed on 171 patients participants of a preventive dental program. Data regarding age, gender, previous caries experience and the frequency at which the patients attended return visits were obtained from the records. The data were analyzed statistically by the McNemar test, with the level of significance set at 1%. Result: Clinical and radiographic examination revealed that most children participating in the program had sound teeth (77.2 and 84.8%, respectively). The past dental history of the dental caries from patients included in this study showed statistical relevance when associated with the present dental caries experience and a statistical relationship was found from the absence of compliance to clinical visits and the dental caries presence. Conclusion: The preventive strategy had a positive influence on oral health maintenance in the children examined. Previous caries experience and the lack of compliance with return visits influenced the clinical oral condition of the children during participation in the preventive program.

Socioeconomic and psychosocial predictors of dental healthcare use among Brazilian preschool children

Abstract Background Disparities in utilization of oral healthcare services have been attributed to socioeconomic and individual behavioral factors. Parents’ socioeconomic status, demographics, schooling, and perceptions of oral health may influence their children’s use of dental services. This cross-sectional study assessed the relationships between socioeconomic and psychosocial factors and the utilization of dental health services by children aged 1–5 years. Methods Data were collected through clinical exams and a structured questionnaire administered during the National Day of Children’s Vaccination. A Poisson regression model was used to estimate prevalence ratios and 95% confidence intervals. Results Data were collected from a total of 478 children. Only 112 (23.68%) were found to have visited a dentist; 67.77% of those had seen the dentist for preventive care. Most (63.11%) used public rather than private services. The use of dental services varied according to parental socioeconomic status; children from low socioeconomic backgrounds and those whose parents rated their oral health as “poor” used dental services less frequently. The reason for visiting the dentist also varied with socioeconomic status, in that children of parents with poor socioeconomic status and who reported their child’s oral health as “fair/poor” were less likely to have visited the dentist for preventive care. Conclusion This study demonstrated that psychosocial and socioeconomic factors are important predictors of the utilization of dental care services.

O efeito da implantação do programa saúde da família (PSF) nas taxas de procedimentos odontológicos em municípios do Estado do Rio de Janeiro

O objetivo deste estudo foi comparar as taxas de implantação das Equipes de Saúde Bucal, dos 92 municípios do estado do Rio de Janeiro, com as taxas dos procedimentos odontológicos de primeira consulta, procedimentos preventivos e procedimentos básicos dos mesmos municípios, verificando o período de 1998 a 2010. Os resultados, obtidos através de dados secundários fornecidos pelas fontes de dados do Ministério da Saúde, mostraram que o crescimento nas taxas dos procedimentos odontológicos foi muito mais modesto do que o crescimento verificado nas taxas de cobertura das Equipes de Saúde Bucal no período estudado e que, após a implantação dessas equipes, também não se observou impacto do aumento dessa implantação nas taxas de procedimentos odontológicos. Os únicos procedimentos que parecem ter alguma relação com a implantação dessas equipes são os procedimentos preventivos. Concluiu-se que, pelo menos no estado do Rio de Janeiro, não se pode afirmar que as Equipes de Saúde Bucal tenham melhorado significativamente o acesso aos serviços odontológicos da população em anos recentes e que isso serve de alerta para que, antes de mais investimentos no aumento do número de Equipes de Saúde Bucal, haja esforços no sentido de avaliar por que esse programa não tem proporcionado o aumento no acesso esperado.

A contribuição dos cirurgiões-dentistas para a prevenção e tratamento da cárie em adolescentes nas capitais brasileiras.

Esta tese é composta por três estudos ecológicos que incluíram as 27 capitais brasileiras. Esses três estudos foram os seguintes: 1- A associação entre a disponibilidade de cirurgiões-dentistas e a quantidade de procedimentos odontológicos nos serviços públicos de odontologia; 2- A associação entre a disponibilidade de cirurgiões-dentistas e a proporção de dentes restaurados (em relação ao total de dentes atacados pela cárie) em indivíduos de 15 a 19 anos ; 3- A associação da disponibilidade de cirurgiões-dentistas com a prevalência e severidade da cárie em indivíduos de 15 a 19 anos. As três investigações são apresentadas sob forma de artigos. Foram utilizados diversos bancos de dados secundários, disponíveis gratuitamente na internet. No primeiro estudo foi identificada associação do número de Equipes de Saúde Bucal do programa Saúde da Família (ESB) e de cirurgiões-dentistas no SUS de uma forma geral com o número de procedimentos odontológicos no serviço público; quanto mais ESB e cirurgiões-dentistas mais procedimentos odontológicos, tanto preventivos quanto restauradores. Mais dentistas no serviço público de odontologia significaram mais procedimentos preventivos e coletivos, porém um número relativamente pequeno a mais de restaurações. É preocupante a quantidade relativamente pequena de restaurações realizadas pelos dentistas do serviço público no Brasil diante do grande número de dentes com cárie não tratada, identificado pela pesquisa nacional de saúde bucal. O segundo estudo revelou que a quantidade de dentistas nas capitais brasileiras é muito grande e que, portanto, há capacidade instalada para atender todas as necessidades de tratamentos restauradores. Entretanto, o índice de cuidado odontológico em jovens de 15 a 19 anos revelou que menos da metade dos dentes atacados pela cárie tinham recebido o cuidado adequado, i.e., estavam restaurados. Este estudo concluiu que, o grande investimento da sociedade brasileira em odontologia, seja no setor público ou privado, não está tendo o retorno esperado, pelo menos para jovens de 15 a 19 anos. O terceiro estudo concluiu que fatores socioeconômicos amplos e flúor na água foram os principais determinantes da variação na prevalência e severidade da cárie em jovens de 15 a 19 anos e que a contribuição do dentista foi relativamente pequena. Diante do papel relativamente pequeno do dentista na prevenção da cárie, o esforço clínico do mesmo deveria, portanto, enfatizar tratamentos de maior complexidade, visando a restauração e reabilitação de danos relevantes para a função e bem estar (Serviço Pessoal de Saúde). Esforços efetivos para evitar a cárie dentária ocorrem principalmente no âmbito de estratégias preventivas populacionais (Serviço não Pessoal de Saúde), com uma contribuição relativamente pequena do trabalho clínico.

Atitudes dos médicos dentistas no tratamento médico-dentário de pacientes com deficiência mental

Monografia apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Medicina Dentária

Educating the dental team:exploring perceptions of roles and identities

Interprofessional education (IPE) should help to promote a team-based approach to professional practice but there are barriers to its implementation including professional identity. The aim of this study was to use a qualitative research methodology to explore dental and dental care professional (DCP) students' perceptions of professional roles and identities in the dental team. Data were collected by means of focus groups from a purposive sample of dental and DCP students and were audio recorded, transcribed and analysed using an explanatory framework. Five common themes emerged around the issue of professional roles and identity in the dental team. The results indicate that professional identity was an important factor in team development and was determined by direct responsibility for patient care and by the amount of clinical experience acquired. Professional identity within a team context was perceived as different from professional identity per se. Dental students were found to lack confidence in their role as team leaders which was related to their lack of knowledge of team roles, responsibilities and experience. The role of the dental technician was perceived as 'outside' the dental team due to lack of patient interaction.

Two-year survival of ART restorations placed in elderly patients: A randomised controlled clinical trial

OBJECTIVES: Older dentate adults are a high caries risk group who could potentially benefit from the use of the atraumatic restorative treatment (ART). This study aimed to compare the survival of ART and a conventional restorative technique (CT) using rotary instruments and a resin-modified glass-ionomer for restoring carious lesions as part of a preventive and restorative programme for older adults after 2 years.

METHODS: In this randomised controlled clinical trial, 99 independently living adults (65-90 years) with carious lesions were randomly allocated to receive either ART or conventional restorations. The survival of restorations was assessed by an independent and blinded examiner 6 months, 1 year and 2 years after restoration placement.

RESULTS: Ninety-six (67.6%) and 121 (76.6%) restorations were assessed in the ART and CT groups, respectively, after 2 years. The cumulative restoration survival percentages after 2 years were 85.4% in the ART and 90.9% in the CT group. No statistically significant between group differences were detected (p=0.2050, logistic regression analysis).

CONCLUSIONS: In terms of restoration survival, ART was as effective as a conventional restorative approach to treat older adults after 2 years. This technique could be a useful tool to provide dental care for older adults particularly in the non-clinical setting. (Trial Registration number: ISRCTN 76299321).

CLINICAL SIGNIFICANCE: The results of this study show that ART presented survival rates similar to conventional restorations in older adults. ART appears to be a cost-effective way to provide dental care to elderly patients, particularly in out of surgery facilities, such as nursing homes.