Factors associated with suicidal ideation and suicide attempts by Australian dental practitioners.

INTRODUCTION: To investigate factors associated with suicidal ideation and suicide attempts amongst Australian dental practitioners. METHODS: A self-reported online survey of 1474 registered dental practitioners in Australia was conducted from October to December 2021. Participants reported thoughts of suicide in the preceding 12 months, prior to the preceding 12 months and prior suicide attempts. RESULTS: Overall, 17.6% reported thoughts of suicide in the preceding 12 months, 31.4% prior to the preceding 12 months, and 5.6% reported ever having made a suicide attempt. In multivariate models, the odds of suicidal ideation in the preceding 12 months were higher in dental practitioners who were male (OR = 2.01), had a current diagnosis of depression (OR = 1.62), were experiencing moderate (OR = 2.76) or severe psychological distress (OR = 3.58), had self-reported illicit substance use (OR = 2.06) or had previous self-reported suicide attempts (OR = 3.02). Younger dental practitioners had more than twice the odds of recent suicidal ideation than those aged 61+ years, with higher resilience having decreasing odds of suicidal ideation. LIMITATIONS: This study did not address help seeking behaviours directly related to suicidal ideation, so it is not clear how many participants were actively seeking mental health support. The response rate was low and results may be subject to responder biases, with practitioners experiencing depression, stress and burnout being more willing to participate. CONCLUSION: These finding highlight a high prevalence of suicidal ideation amongst Australian dental practitioners. It is important to continue to monitor their mental health and develop tailored programs to provide essential interventions and supports.

Dental Implant Hygiene and Maintenance Protocols: A survey of oral health practitioners in Australia.

Purpose: Dental implant care and maintenance is of critical importance as implants grow in popularity as a tooth replacement option. The purpose of this study was to investigate the implant-related training and clinical practices of oral health practitioners (OHPs) in Australia regarding oral hygiene instructions (OHI) and maintenance protocols, and to better understand their role in providing peri-implant services.Methods: A 42-item web-based survey was forwarded to the members of the Dental Hygienists Association of Australia and the Australian Dental and Oral Health Therapists' Association. Survey items included participant's demographics, types of peri-implant services provided in the workplace, implant-related information sources, peri-implant diagnostic preferences, implant maintenance protocols and oral hygiene instructions (OHI) for dental implants. Descriptive statistics were used to analyse the data. Comparisons were made with a similar survey of the implant maintenance preferences of general dentists in Australia.Results: One hundred fifty-four Australian OHPs completed the electronic survey (n=154). Nearly all respondents (96.7%) considered implant home hygiene and peri-implant health to be strongly associated. Dental qualification (64.9%) and association-sponsored professional development courses (50.6%) were the most common sources of implant assessment/management information. Brushing (88.7%) and the use of an interdental brush (78.1%) were the most popular implant-specific OHI provided. All of the respondents reported performing oral hygiene assessments around dental implants; 94.0% performed supragingival cleaning, 67.5% subgingival cleaning, 55.0% treated peri-implant mucositis and 38.4% peri-implantitis. Dental floss (80.9%), rubber-cup prophylaxis (59.6%), plastic/carbon curettes (52.5%) and plastic-tipped ultrasonics (43.3%) were the most common devices used for implant maintenance.Conclusion: Australian OHPs reported providing peri-implant services generally in agreement with the current literature and demonstrated a greater focus on prevention as compared with Australian dentists. Oral health practitioners in Australia expect to be highly involved in dental implant maintenance care and provide the majority of preventive, periodontal and OHI services in their workplaces.

Patient-reported oral hygiene and implant outcomes in general dental practice.

BACKGROUND: This study investigated the possible correlations between patient-performed implant hygiene and peri-implant success and disease, as well as patient-reported outcomes, in a community-based cohort. METHODS: Fifty-one patients (78 implants) from two private general practices were surveyed on their dental implant treatment history, oral hygiene instructions (OHI) received, home hygiene habits and current implant concerns. Their dentition, plaque/calculus scores and clinical implant parameters were examined. Correlations between hygiene habits, risk factors, implant success and peri-implant disease rates were assessed. RESULTS: Implants had a patient-reported mean time in function of 6.7 years. Floss (74.4%), interdental brushes (IDB) (44.9%) and mouthwash (39.7%) were commonly used, while 7.7% of implants were only cleaned by brushing. Over half (56.4%) of implants fulfilled the success criteria, 61.5% had peri-implant health, 24.4% had mucositis and 7.7% had peri-implantitis. Only brushing (P < 0.001) and detectable plaque/calculus (P < 0.001) were significantly associated with more peri-implant disease. Local prosthetic factors affecting cleaning accessibility significantly reduced implant success (P < 0.001). Patients reported mixed recall of implant OHI, 7.7% of implants were aesthetically unsatisfactory and 9.0% had peri-implant symptoms. CONCLUSIONS: Lack of interproximal cleaning and the presence of plaque/calculus were significantly associated with peri-implant disease in a community-based general practice setting, and patients reported mixed recall of OHI.

Dental implant maintenance teaching in Australia-A survey of education providers.

INTRODUCTION: Implant treatments and peri-implant maintenance continue apace, while the evidence for implant maintenance and home hygiene continues to be developed. Information sources for dental practitioners and patients in peri-implant health maintenance and disease management are generally not known. This study investigated the implant maintenance topics taught, the discipline backgrounds of convenors and presenters and information delivery methods within implant dentistry teaching in Australia. MATERIALS AND METHODS: An online survey was distributed to 56 convenors of implant dentistry and maintenance education programmes in Australia, garnering responses from 24 individuals which outlined 43 different education programmes. RESULTS: Lectures were the main delivery method for implant maintenance information across the different course types. Peri-implant diagnostics were generally taught according to current literature recommendations, but coverage varied in topics where the evidence is yet to be established (eg home hygiene, professional maintenance and implant review). Some educators reported awareness of limitations in their programmes. CONCLUSION: Implant dentistry education programmes in Australia vary widely in teaching implant maintenance, coverage of which should be current and evidence-based at all education levels. The structure of implant dentistry teaching at the continuing professional development level requires further development.

Dental educators' attitudes towards the teaching of dental amalgam.

OBJECTIVE: To ascertain dental educators' attitudes towards the teaching of dental amalgam at dental schools in Australia and identify preferred curricular approaches in a potentially "amalgamless" profession. METHODS: A mixed methods analysis was employed based on an open-ended response survey followed by a closed-ended questionnaire. Identification of key issues from the survey helped frame the questionnaire. Participants included those with expertise in operative and restorative dentistry, with direct involvement in curriculum development or delivery, at Australian dental schools. RESULTS: Participants numbered fifteen and represented seven of the nine dental schools in Australia. Key themes identified and explored included the following: (in)consistency of approach to teaching restorative dentistry; a perceived disconnect between undergraduate study and the "real world"; a need for a focus on teaching of alternatives to dental amalgam (80 per cent (strongly) agreeing); the contradictory nature of the evidence base and literature that is not readily understood; the need for more post-graduate education relating to adhesive restorative materials (86 per cent (strongly) agreeing); the need for dental amalgam to continue to be available; formal understandings (guidelines) as to the use of dental amalgam; dental schools in Australia being heard on these issues; and the relevance of this issue (100 per cent (strongly) agreeing the issue is topical and important). CONCLUSION: There is a broad consensus of dental educators at Australian dental schools as how best to approach the teaching of amalgam if a phase-down is to occur and the issues any such approach may face.

A survey of cariology teaching in Australia and New Zealand.

BACKGROUND: The Australian and New Zealand chapter of the Alliance for a Cavity Free Future was launched in 2013 and one of its primary aims was to conduct a survey of the local learning and teaching of cariology in dentistry and oral health therapy programs. METHODS: A questionnaire was developed using the framework of the European Organisation for Caries Research (ORCA)/Association of Dental Education in Europe (ADEE) cariology survey conducted in Europe in 2009. The questionnaire was comprised of multiple choice and open-ended questions exploring many aspects of the cariology teaching. The survey was distributed to the cariology curriculum coordinator of each of the 21 programs across Australia and New Zealand via Survey Monkey in January 2015. Simple analysis of results was carried out with frequencies and average numbers of hours collated and open-ended responses collected and compiled into tables. RESULTS: Seventeen responses from a total of 21 programs had been received including 7 Dentistry and 10 Oral Health programs. Key findings from the survey were - one quarter of respondents indicated that cariology was identified as a specific discipline with their course and 41% had a cariology curriculum in written format. With regard to lesion detection and caries diagnosis, all of the program coordinators who responded indicated that visual/tactile methods and radiographic interpretation were recommended with ICDAS also being used by over half them. Despite all respondents teaching early caries lesion management centred on prevention and remineralisation, many taught operative intervention at an earlier stage of lesion depth than current evidence supports. Findings showed over 40% of respondents still teach operative intervention for lesions confined to enamel. CONCLUSION: Despite modern theoretical concepts of cariology being taught in Australia and New Zealand, they do not appear to be fully translated into clinical teaching at the present time.

Provision of oral health care to adult patients by dental therapists without the prescription of a dentist.

OBJECTIVES: Dental therapists are increasingly been seen as part of the solution to assist in improving access to dental care for underserved populations. The aim of this article is to report the outcomes of an educational bridging program designed to provide university-educated dental therapists with the appropriate knowledge and skills required to enable them to translate their current clinical scope of practice to adult patients aged 26+ years. METHODS: Ten dental therapists completed an educational program approved by the Dental Practice Board of Victoria as a pilot. Feedback from patients and supervising and supporting dentists was provided during the project. RESULTS: Supervising and supporting dentists rated the knowledge and clinical skills of participants as good to high at the completion of the education program and considered them safe to treat adults patients. Patients were very satisfied with the dental treatment provided. Eight participants successfully completed the assessment and were permitted by the Dental Practice Board of Victoria to extend their clinical scope of practice to adult patients. CONCLUSIONS: Feedback from patients and dentists indicated that, following the completion of an educational bridging program, dental therapists with a university education were able to develop the knowledge and skills required to treat adult patients aged 26+ years without the prescription or supervision of a dentist. Enabling dental therapists to treat adult patients may have a role to play in improving access to dental care for underserved populations.

Oral hygiene and periodontal disease in Victorian nursing homes.

OBJECTIVE: To investigate oral hygiene and periodontal disease in residents of Victoria nursing homes. BACKGROUND: The Australian population is ageing with a growing proportion of elderly Australians living in nursing homes. With declining edentulism rates, periodontal disease is becoming more prevalent in this population. MATERIALS AND METHODS: A total of 275 dentate residents from 31 Victorian nursing homes had a questionnaire and clinical examination using the Visual Plaque Index and a modified Community Periodontal Index. RESULTS: Self-reported oral hygiene habits of residents were poor, with less than one-third of residents cleaning their teeth twice daily or more. Periodontal health was found to be extremely poor, and the prevalence of 4 mm+ periodontal pockets was 35.6%, with 10.2% having 6 mm+ pockets. Logistic regression found that age, gender, number of teeth present and oral hygiene were all strongly associated with the prevalence of 4 mm+ periodontal pockets. CONCLUSION: Poor oral hygiene and the presence of significant plaque and calculus were common findings in this study. Periodontal diseases are a significant problem for residents in nursing homes. Addressing this health issue will require improved training for carers and better access to appropriate dental services.

Edentulism and dental caries in Victorian nursing homes.

OBJECTIVES: The aim of this project was to investigate edentulism and dental caries in nursing home residents in Victoria, Australia. BACKGROUND: The Australian population is ageing with a growing number of people living in nursing homes. These residents are at increased risk for dental caries, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. MATERIALS AND METHODS: Clinical dental examinations were conducted at 31 nursing homes in Melbourne and regional Victoria between May 2005 and June 2006. A total of 510 residents were examined out of 1345 eligible participants. Socio-demographic and medical history was collected via questionnaire. RESULTS: Just over half of the residents were dentate (53.9%), and dentate residents had a mean of 14.4 teeth present and 2.66 untreated decayed teeth. Residents who required total assistance with oral hygiene had more decayed teeth and fewer filled teeth than residents who did not require assistance. CONCLUSIONS: Nursing home residents in Victoria are retaining an increasing number of natural teeth and have more tooth surfaces at risk for dental caries. Untreated dental caries was a significant problem for residents, particularly for those who are dependent on others for their daily oral hygiene care.

Evaluation of a pilot bridging program to enable Australian dental therapists to treat adult patients.

This study evaluated a pilot educational bridging program designed to provide dental therapists in Australia with the appropriate knowledge and skills required to enable them to translate their current clinical scope of practice to adult patients. Ten dental therapists completed a bridging program consisting of forty-two hours of didactic content, fourteen hours of clinical observation, forty-two hours of clinical practicum under direct supervision, and 105 hours of clinical experience with supervision by mentoring dentists. Process and impact evaluation was undertaken at various stages of the program by participants and supervising dentists. Self-reported confidence and knowledge for dental therapists had increased at the completion of the course. Supervising dentists reported high levels of knowledge for dental therapists after completing the course and said that the course adequately prepared the dental therapists to translate their current clinical scope of practice to treat adult patients. Eight of the ten participants successfully completed the assessment at the completion of the course and were permitted by the Dental Practice Board of Victoria to extend their clinical scope of practice to adult patients aged twenty-six years of age or more. The dental therapists thought that the educational model was relevant in developing their clinical skills. The evaluation indicates that this model is an effective method of extending the scope of practice for dental therapists and has important implications in enhancing the flexibility of the dental team.

Shortening the xerostomia inventory.

OBJECTIVES: The aim of this study was to determine the validity and properties of the Summated Xerostomia Inventory-Dutch Version in samples from Australia, The Netherlands, Japan, and New Zealand. STUDY DESIGN: Six cross-sectional samples of older people from The Netherlands (n = 50), Australia (n = 637; n = 245), Japan (n = 401), and New Zealand (n = 167; n = 86) were enrolled. Data were analyzed by using the Summated Xerostomia Inventory-Dutch Version. RESULTS: All datasets revealed a single extracted factor which explained about one-half of the variance, with Cronbach alpha values ≥0.70. When mean scale scores were plotted against a "gold-standard" xerostomia question, statistically significant gradients were observed, with the highest score seen in those who always had dry mouth, and the lowest in those who never had it. CONCLUSIONS: The Summated Xerostomia Inventory-Dutch Version is valid for measuring xerostomia symptoms in clinical and epidemiologic research.

Comparison of radiographic and clinical diagnosis of approximal and occlusal dental caries in a young adult population.

OBJECTIVES: The aims of the study were: (1) to determine if bitewing radiographs provided additional diagnostic yield for occlusal and approximal dental caries in adults aged between 17 and 30 years of age when compared with a clinical examination only, (2) how this translated into the measurement of dental caries experience, and (3) to determine the influence of water fluoridation on the diagnosis of dental caries in occlusal and approximal surfaces by clinical examination alone and by radiographic examination. METHODS: Between November 2002 and March 2003 a total of 879 subjects aged 17-30 years had a clinical examination using visual and tactile criteria. Subsequent to this examination, bitewing radiographs were taken and viewed separately and blind. Approximal and occlusal surfaces of molars and premolars were examined on the radiographs. RESULTS: Between 22.9-32.9% of approximal caries and 75.9-82.9% of occlusal caries was detected by clinical examination, while 93.1-97.1% of approximal caries and 33.1-42.6% of occlusal caries was detected by radiographic examination. In addition, while only 0.97% of clinically sound approximal surfaces and 0.83% of clinically sound occlusal surfaces were diagnosed with dentine caries on the radiographs, 67.1-77.1% of approximal caries was detected by radiographs alone, an additional diagnostic yield of 204-336%. The DS score increased 45-46% and the DMFS score increased 6-11% from the clinical examination with the addition of the radiographic information (P<0.001). CONCLUSIONS: The prevalence of approximal and occlusal caries was underestimated when clinical means only were employed. There was a significant increase in DS and DMFS scores from the clinical examination only when radiographic information was added across all age groups (P<0.001). This study confirms the value of bitewing radiographs in caries diagnosis.