Knowledge, Attitudes, and Practices of Dental Practitioners in Providing Care to Children in Out-of-Home Care: A Scoping Review.

A scoping review was conducted to synthesize available evidence of knowledge, attitudes, and practices of dental practitioners in providing care to children in out-of-home care (OOHC). Scientific databases and the grey literature were searched: 855 studies were screened after removing duplicates; 800 studies were excluded based on the title and/or abstract, and the full text of 55 studies was reviewed, with 7 included in the analysis. These included three peer-reviewed articles regarding the knowledge, attitudes, and practices of dental practitioners in providing care to children in OOHC, as well as four guidelines. Dental practitioners had some knowledge of the high health care needs of OOHC children, but knowledge regarding when children entering care received dental assessment and about OOHC dental care pathways was low. Practices of dental practitioners were varied, most gave oral hygiene instructions, but there was inconsistency in practices regarding continuity of care following placement changes and failure to attend policies. There was more consensus with dental practitioner attitudes, with practitioners in private settings seeming to prefer not to treat children in OOHC. Three of the identified guidelines provided logistical information about OOHC and consent. The final guideline gave practical information on treating children with a background of adverse childhood events (ACEs), including children in OOHC. Further research and education is warranted to aid dental practitioners in providing care to children in OOHC.

Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management.

OBJECTIVES: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. METHODS: Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. RESULTS: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. DISCUSSION: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care.

Retrospective analysis of the outcomes of pulpotomies in traumatised permanent anterior teeth.

BACKGROUND/AIM: Complicated crown fractures are frequently encountered in the paediatric population and pulpotomy procedures (either partial or coronal) are recommended to maintain the pulp. The aim of this study was to determine the pulp outcomes of permanent teeth with complicated crown fractures treated with pulpotomy in a hospital-setting and to identify potential factors which may influence the outcomes. MATERIAL AND METHODS: Data for this retrospective study were extracted from dental records of patients with complicated crown fractures and treated with pulpotomies at a single centre between 1 January 2015 and 30 August 2019. Pulp outcomes were determined, and the associations between the outcome and independent variables were assessed using the Chi-Square test of independence and the Point-Biserial Correlation Test. Predictors of outcome were identified using the binary logistic regression model. RESULTS: The overall success of pulpotomy in managing traumatised permanent teeth was 61%, which was lower than those previously reported. Pulp healing was seen in 54.1% and 73.7% of teeth treated with partial pulpotomies and coronal pulpotomies, respectively. The presence of a radiographically detectable dentine bridge (p < .01) and longer clinical experience of the clinician (p < .04) was significantly associated with successful outcomes. The history of pain and the stage of root development were identified as significant predictors of the outcome. CONCLUSION: Pulpotomy is a viable treatment modality for complicated crown fractures in the paediatric population. However, appropriate case selection and further training may be required to ensure improved pulp healing outcomes. A longer follow-up period should be considered to identify late-stage complications.

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.

Oral cancer risk behaviours of Indian immigrants in Australia: a qualitative study.

OBJECTIVE: Oral cancer is widespread in South Asia, particularly India. In Australia, Indians are one of the fastest-growing communities. This study aimed to explore the oral cancer-related knowledge, attitudes and practices of Indian immigrants in Australia. METHODS: Fourteen semi-structured interviews were conducted with Indian immigrants residing across New South Wales and Victoria. Purposive and snowball sampling were used for recruitment. Data were analysed through a directed content analysis approach. RESULTS: All participants were knowledgeable of oral cancer risks associated with tobacco and alcohol, but few were familiar with the harmful effects of areca nut preparations. Varied attitudes were evident with most participants acknowledging the importance of oral cancer check-ups, yet very few followed this practice. All participants admitted engaging in oral cancer risk practices including areca nut use at least once or more in their lifetime. CONCLUSION: Oral cancer risk practices are common among Indian immigrants in Australia who possess limited knowledge with varying attitudes in this area. Implications for public health: Preventative strategies are needed to limit the use of oral cancer risk products among Indian immigrants. General practitioners and community organisations can play a key role in raising awareness in this area.

Congenital nephrotic syndrome: Oral manifestations and dental implications.

Children with congenital nephrotic syndrome (CNS) can present with oro-dental complications secondary to the disease or from the treatment of the condition. This case report describes the multidisciplinary management of a 12-year-old male patient with CNS. It highlights the importance for pediatricians and nephrologists to be aware of the dentists' role in the general health and well-being of children with chronic renal disease.

Perceptions and Practices of General Practitioners towards Oral Cancer and Emerging Risk Factors among Indian Immigrants in Australia: A Qualitative Study.

BACKGROUND: In Australia, Indian immigrants are one of the fastest-growing communities. Since oral cancer is widespread in India, the indulgence of Indians in customs of areca (betel) nut use in Australia may be linked to the recent rise in oral cancer cases. Since GPs (general practitioners) are primary healthcare providers, it is pivotal to ensure the oral cancer awareness of GPs. This study aimed to explore oral cancer risk-related knowledge, beliefs, and clinical practices of GPs in Australia. METHODS: Fourteen semi-structured interviews were conducted with GPs practicing across New South Wales and Victoria. Purposive and snowball sampling were used for recruitment. Data were analysed through a directed content analysis approach. RESULTS: All GPs were knowledgeable of major oral cancer causative factors including tobacco and alcohol, but some had limited understanding about the risks associated with areca nut preparations. Positive attitudes were evident, with all participants acknowledging the importance of oral cancer risk assessment. Most GPs recalled not performing oral cancer routine check-ups. CONCLUSION: GPs presented good oral cancer knowledge except for emerging risk factors such as areca nut use. Varied beliefs and inconsistent clinical practices relating to oral cancer screening is concerning. Accessible oral cancer training around emerging risk factors may benefit GPs.

Ingrowth of Mineralized Tissue into the Root Canal of Immature Permanent Teeth after a Traumatic Injury: A Report of 3 Cases.

The aim of this case series was to describe the endodontic management of 3 immature permanent teeth that sustained traumatic injuries and subsequently presented with complete ingrowth of mineralized tissue into the canal space. Ingrowth of bone/mineralized tissue into the canal has been considered a poor long-term outcome with an inherent risk of ankylosis. In cases 1 and 2, no endodontic treatment was undertaken, except for emergency management requiring splinting. The cases were followed for 36 and 23 months, respectively. No ankylosis was evident over the review period, and normal teeth eruption was apparent. In case 1, the tooth was treated orthodontically and was responsive to pulp sensibility testing. In both cases, there was an appearance of an internal periodontal ligament-like space on the inner root wall of the canal. In case 3, 2 years postinjury, pulp necrosis and apical periodontitis occurred, and the tooth was managed with regenerative endodontic treatment consistent with the European Society of Endodontology and the American Association of Endodontists guidelines/recommendations for a regenerative procedure. The case was followed for 8 years after regenerative endodontic treatment. No ankylosis was noted with normal eruption of the teeth. The tooth was responsive to pulp sensibility testing despite the ingrowth of mineralized tissue, which was confirmed clinically.

Knowledge, attitudes and practices of general medical practitioners in developed countries regarding oral cancer: an integrative review.

BACKGROUND: Oral cancer is a public health concern and is widespread in developing countries, particularly in South Asia. However, oral cancer cases are also rising in developed nations due to various factors, including smoking, viruses and increased migration from South Asia. In this context, the role of general medical practitioners (GPs) in identifying oral cancer is becoming increasingly important and, while some studies have explored their perspective about oral cancer, a synthesis of these results has not been undertaken. OBJECTIVE: The objective of this integrative review is to synthesize existing evidence regarding oral cancer-related knowledge, attitudes and practices of GPs in developed countries. METHODS: Four electronic databases were searched to identify studies focussing on the objective of this review. The inclusion criteria were: peer-reviewed English language publications; studies conducted in developed countries involving GPs; explored at least one study outcome (knowledge/attitudes/practices). No restrictions were placed on the publication date. RESULTS: A total of 21 studies involving 3409 GPs were reviewed. Most studies revealed limited knowledge of GPs about emerging risk factors, such as betel nut chewing (0.8-50%). Significant variation (7-70%) was evident in routine oral examination practices of GPs. Most GPs felt unsure about diagnosing oral cancer and many (38-94%) raised the need for further education. No study explored the specific relevance of GPs' practices concerning South Asian immigrants. CONCLUSION: This review suggests the need for educational programs to enhance GPs' knowledge regarding oral cancer. Further research exploring oral cancer-related practices of GPs caring for South Asian immigrants is warranted.

Preliminary study of the oral mycobiome of children with and without dental caries.

Children's oral health is in a dire state, with dental decay (caries) being one of the most common chronic diseases. While the role of bacteria in the oral microbiome and dental caries is established, the contribution of fungi is relatively unknown. We assessed the oral mycobiome in childhood (n = 17), to determine if the composition of fungi varies between children with and without caries. Oral mycobiome composition was assessed by using Illumina MiSeq to sequence the ITS2 region, which was amplified from dental plaque. This revealed that the oral mycobiome in the investigated children contained 46 fungal species. Candida albicans was the most abundant species and was ubiquitous in all samples, indicating this species may not be involved in caries development as previously suggested. While the overall diversity of fungi was similar, independent of caries status (p > 0.05), we found caries influenced the abundance of specific fungi. Children without caries had a significantly higher abundance of 17 species compared to children with caries, which had three enriched species (p < 0.001). While the differentially abundant species between health and caries may be specific to an Australian population, our findings indicate the mycobiome plays a role in oral health.

Multifocal Epithelial Hyperplasia.

Multifocal epithelial hyperplasia is a rare disease associated with human papilloma virus types 13 and 32. Diagnosis is based on clinical and histopathological findings, and most lesions are asymptomatic and regress spontaneously with time. The purpose of this paper is to describe a five-year-old girl who presented with multiple intraoral lesions on the buccal mucosa and tongue, which regressed spontaneously in 15 months.

Erythromelalgia presenting with premature exfoliation of primary teeth: a diagnostic dilemma.

Erythromelalgia is an extremely rare neurovascular disorder, characterized by symptoms of red, hot, and painful extremities. There is considerable confusion regarding the etiology and pathogenesis of this condition, and the diagnosis is essentially a clinical one. This condition may occur in isolation or in association with other myeloproliferative disorders. Unfortunately, no therapy is effective consistently in managing the symptoms, although early diagnosis can aid in psychological counseling and minimizing the frequency and severity of the attacks. The purpose of this report was to describe the case of a child presenting with premature loss of primary teeth and the difficulties in determining the final diagnosis of erythromelalgia, which responded positively to low-grade aspirin therapy.

Access to dental care-parents' and caregivers' views on dental treatment services for people with disabilities.

The goal of this study was to elicit the views of patients or parents/caregivers of patients with disabilities regarding access to dental care. A questionnaire was generated both from interviews with patients/parents/caregivers already treated under sedation or general anesthesia as well as by use of the Delphi technique with other stakeholders. One hundred thirteen patients from across six community dental clinics and one dental hospital were included. Approximately, 38% of the subjects used a general dental practitioner and 35% used the community dental service for their dental care, with only 27% using the hospital dental services. Overall waiting time for an appointment at the secondary care setting was longer than for the primary care clinics. There was a high rate of parent/caregiver satisfaction with dental services and only five patients reported any difficulty with travel and access to clinics. This study highlights the need for a greater investment in education and training to improve skills in the primary dental care sector.

KBG syndrome: review of the literature and findings of 5 affected patients.

KBG syndrome is a rare, multiple congenital anomaly/mental retardation (MCA/MR) syndrome characterized by neurological disturbance, short stature, a distinct craniofacial appearance, and skeletal anomalies. It is likely to be autosomal dominant in nature with a wide range of expressivity in its clinical features. Dentally, macrodontia, particularly of the maxillary permanent central incisors is a common finding. The aim of this article was to review the familiar clinical presentations of this syndrome and to highlight previously unreported findings of generalized macrodontia and shovel-shaped incisors. Dental and clinical findings of 2 affected brothers with a 3-year follow-up of their dental progress following orthodontic treatment are outlined. Additionally, dental and clinical findings of an affected mother and her daughter, and another sporadic case are also presented.

Dental Age Assessment: a comparison of 4- to 24-year-olds in the United Kingdom and an Australian population.

BACKGROUND: The physiological age of a person is determined by the degree of maturation of the different tissue systems. Children of the same chronological age (CA) can demonstrate different degrees of maturation. Dental age (DA) is based on the maturation of teeth. Tooth formation is a continuous process, where the developmental stages of the tooth can be sequenced and defined depending on the degree of mineralization. These stages can be visualized on a dental panoramic tomograph (DPT). AIM: The aim of this study was to use a new method of Dental Age Assessment (DAA) to compare a United Kingdom (UK) and an Australian (AUS) population. DESIGN: The DPTs used are from the archives of the Westmead Centre for Oral Health (Westmead, Australia) and the King's College London Dental Institute. From the preliminary sample of 89 DPTs from each population, 77 were suitable for use as matched pairs. The radiographic technique used was developed by Demirjian and describes eight stages of tooth development. This was used in combination with numerical data derived from a meta-analysis of a single UK subject. RESULTS: A significant difference was shown between the CA and DA of the AUS patients. The AUS patients were also shown to have a significant 0.82 years delay in their DA compared to the UK patients. The findings indicate a difference in AUS compared to UK patients. These results indicate the need to develop a reference data set for the AUS population for DAA. CONCLUSIONS: This research is of significance in a number of clinical disciplines and can also be used to assist in age determination of subjects of unknown birth date to assist in forensic dentistry or social deliberations.

Development of a screening tool to assess the suitability of people with a disability for oral care under sedation or general anesthesia.

The aim of this study was to develop a screening tool to assess the suitability of people with disabilities for oral care in different settings. The objectives were to investigate retrospectively the uptake of general anesthetic (GA) services and use this information to develop a composite tool. One hundred cases referred for GA were reviewed to generate data for a Delphi Panel. Patients with disabilities were the subject of a tool, devised by the Delphi Panel, to appropriately allocate patients to the most suitable care, including the patients' medical, behavioral, and social status as well as planned dental treatment complexity. A total of 124 patients, between the ages of 4 and 75 years, in seven centers were treated under sedation or GA, according to the tool. Agreement on behavior assessment between dentists and anesthesiologists was poor. The tool has the potential to identify which people with disabilities can be effectively allocated for treatment under sedation or GA.

The placement of osseointegrated dental implants in a patient with type IV B osteogenesis imperfecta: a 9-year follow-up.

Osteogenesis imperfecta (OI) is a rare autosomal dominant connective tissue and metabolic disorder. Typically, patients with OI exhibit bone fragility, with the sclera, joints, skin, and tooth dentin being affected to varying degrees. Despite existing classifications, there is an extreme phenotypic variation within this population, and at times the mild forms of OI may be difficult to diagnose. Comprehensive management of the severe types of OI involves aggressive physical and surgical orthopaedic treatment to improve muscle structure and joint mobility. For those patients with associated dentinogenesis imperfecta (DI), early and definitive management can help prevent excessive tooth wear and sensitivity. A case of a late diagnosis of type IV OI with DI successfully treated with implant-supported dentures is reported. To date, 9 years after implant surgery and prosthetic loading, the patient continues to be clinically and radiographically normal.

A comparison of costs in providing dental care for special needs patients under sedation or general anaesthesia in the North East of England.

OBJECTIVE: To compare the costs of providing dental treatment under general anaesthesia or sedation for special needs patients. METHODS: After a Delphi exercise, a questionnaire was designed, piloted and then sent to nine NHS Trust dental service managers, within the Salaried Dental Services in the North East of England, to obtain information on the costs incurred during the treatment of special needs patients using sedation or general anaesthesia. The questionnaire related to the average number of such patients treated per session, staff costs, depreciation cost for buildings and equipment, and overhead costs including consumables and drugs. RESULTS: All nine dental service managers returned completed questionnaires. The all-inclusive cost for treatment per patient under general anaesthesia ranged from 203.65-479.50 pounds (mean cost: 285.79 pounds) and for sedation from 57.60-153.50 pounds (mean cost: 90.81 pounds). On average three special needs patients were treated per session. The greatest variation in the costs for general anaesthesia was due to staffing costs, which ranged from 1064.10 to 350.00 pounds per session across the Trusts. CONCLUSIONS: In the small number of centres sampled, the cost of delivering dental care under sedation or general anaesthesia was shown to vary widely. Overall, the mean cost of sedation was one-third that of general anaesthesia. However, the cost of both was substantial and cognisance needs to be taken of the costs of such services.

The impact of dental appearance on the appraisal of personal characteristics.

PURPOSE: The purpose of this study was to ascertain the influence of dental appearance upon subjective ratings of personal characteristics, specifically social competence, intellectual ability, and psychologic adjustment. MATERIALS AND METHODS: A cross-sectional analytic interview study was conducted with 201 undergraduates. Each participant was asked to make judgments about the personal characteristics of the subject of a single color photograph. Eight photographs of four different men were used, each with one of two degrees of dental status (visible disease, no visible disease). Outcome measures were participants' judgments of the social competence, intellectual ability, and psychologic adjustment of the subjects of the photographs. RESULTS: Participants judged subjects with less dental disease to be more socially competent, to show greater intellectual achievement, and to have better psychologic adjustment. CONCLUSION: In the absence of other information, the judgments an individual makes concerning the personal characteristics of others are influenced by dental appearance.