Investigating the scope and costs of dental treatment provided under general anaesthesia among children with congenital heart disease.

AIM: To identify the types of dental treatment provided under general anaesthesia for children diagnosed with congenital heart disease (CHD), quantify the costs within a publicly funded tertiary paediatric hospital setting and identify factors which affect the cost. METHODS: A retrospective analysis of dental records (July 2015 to June 2019) was conducted for children with CHD who had undergone a dental general anaesthetic procedure at The Children's Hospital at Westmead, Australia. Patient and treatment-related information were collected, and a costing analysis was performed on 89 dental general anaesthetic procedures. RESULTS: Mean age at the time of the general anaesthetic was 8.15 years. About 27% of children with CHD had a history of dental infection. Dental extractions and restorations comprised the majority of treatments provided, with extractions performed in 86% of procedures. The mean number of days in hospital was 1.43 and the mean cost was $4395.14. The cost was significantly greater when children presented with a facial swelling compared to any other reason. CONCLUSIONS: Dental extractions are performed in the majority of general anaesthetics. Not only is there an economic burden to the public health system in providing dental treatment under general anaesthesia for children with CHD, the health impacts also appear to be substantial. A considerable proportion required overnight hospitalisation and days in hospital was strongly related to the cost of the dental general anaesthetic. Systematic referral pathways for accessing dental care are an important consideration for children with CHD.

The Indigenous Adolescent Oral Health Partnership Study: A Co-Design Study Protocol.

BACKGROUND: in this protocol we outline a method of working alongside Aboriginal communities to learn about and facilitate improvement in the oral health habits in Aboriginal adolescents. By facilitating positive oral health in Aboriginal adolescents, we hope to achieve lifelong improvement in oral health and general wellbeing. METHODS: this paper outlines a co-design methodology through which researchers and Aboriginal communities will work together to create a custom oral healthcare program aimed at Aboriginal adolescents. Researchers, a youth advisory group, Aboriginal community-controlled health services and three regional NSW communities will together devise an oral health strategy focused on five components: application of topical fluoride, increasing water consumption, improving nutrition, daily toothbrushing, and enhancing social and emotional wellbeing. Capacity building is a key outcome of this program. DISCUSSION: as the gap in health status between Aboriginal and non-Aboriginal people remains wide, it is clear that new approaches and attitudes are needed in Aboriginal public health research. This protocol is representative of this shifting approach; giving power to Aboriginal communities who seek to have sovereignty and self-determination over their healthcare. TRIAL REGISTRATION: TRN: ISRCTN15496753 Date of registration: 20 October 2021.

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.

Oral health care: The experience of Australian paediatricians.

AIM: Many Australian children have dental decay in their deciduous teeth. Poor oral health can negatively impact a child's ability to eat, speak, sleep and socialise, with adverse impacts later in life. Paediatricians are well placed to examine children's teeth and to provide advice and education about oral health. Using a sample of Australian paediatricians, we aimed to determine: (i) self-reported oral health knowledge and skills, (ii) frequency of office-based oral health-related discussions, (iii) perceived role of paediatricians and (iv) barriers to oral health-related discussions. METHODS: Members of a national network of paediatricians - the Australian Paediatric Research Network - completed a multi-topic survey, which included questions designed to assess oral health knowledge, current practice and barriers to oral health-related discussions. RESULTS: Of 430 active members, 178 (41%) completed the survey. Few paediatricians reported very good/excellent ability to assess plaque build-up (8%) and dental caries (17%). Only 10% reported broaching the issue of oral health with all patients. Significant barriers included lack of professional training (52%) and other more pressing issues needing to be addressed (67%). CONCLUSIONS: The increasing (and inequitable) rates of dental decay in Australian children mean that paediatricians should play a key role in the management of children's oral health. Many paediatricians reported a lack of specific training in oral health and limited ability to assess children and educate families. Despite the traditional divide between medicine and oral health, this study highlights the opportunity for Australian paediatricians to improve oral health through early intervention in the consultation room and beyond.

A review of the hours dedicated to oral health education in medical programmes across Australia.

BACKGROUND: Oral health is an important predictor for general health, and poor oral health is interrelated with the manifestations of systemic disease. AIM: To determine the extent of oral health education in medical schools across Australia. METHODS: A survey of Australian medical schools was conducted (September 2013 to June 2014). Participants were administrators and curricula coordinators of medical programmes. The main outcome measures were teaching hours of specific areas of oral health education. Data were descriptively analysed. RESULTS: Participants from 8 of 18 universities responded to the questionnaire. The total hours dedicated to oral health in the medical programmes were: zero in one school; less than 2 h in three schools, 6-10 h in three schools and 30 h in one school. Only four schools taught the correlation between oral health and overall health, two schools taught about dental diseases (caries and periodontal disease), three schools taught dental trauma management and six schools taught oral anatomy. Only five schools taught about oral cancer: two of these taught about cancer for 10-15 min. No school reported hands-on training in an oral health setting. CONCLUSIONS: The results indicate that Australian medical school graduates have little, if any, foundational knowledge of oral health (dental caries, bidirectional relationship between diabetes and periodontal disease, oral cancer and dental emergencies). The recognition of poor oral health plays a significant part in the early detection and care of chronic diseases. The teaching of fundamental oral health to medical students is crucial and should be integrated into medical school curricula.

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.

Oral health of children with respiratory diseases.

Children with respiratory disorders are at risk of compromised oral health. It has been shown that both dental hard tissue damage (dental caries, dental erosion, mild enamel developmental defects) and soft tissue damage (gingivitis, periodontal disease and calculus formation) are more likely for such children. The aetiology of this increased risk of oral health problems is associated both with the illness itself and/or the drug therapies used. Oral health management strategies for the home and surgery are outlined.

The role of cathepsin C in Papillon-Lefèvre syndrome, prepubertal periodontitis, and aggressive periodontitis.

We have previously reported that loss-of-function mutations in the cathepsin C gene (CTSC) result in Papillon-Lefèvre syndrome, an autosomal recessive condition characterized by palmoplantar keratosis and early-onset, severe periodontitis. Others have also reported CTSC mutations in patients with severe prepubertal periodontitis, but without any skin manifestations. The possible role of CTSC variants in more common types of non-mendelian, early-onset, severe periodontitis ("aggressive periodontitis") has not been investigated. In this study, we have investigated the role of CTSC in all three conditions. We demonstrate that PLS is genetically homogeneous and the mutation spectrum that includes three novel mutations (c.386T>A/p.V129E, c.935A>G/p.Q312R, and c.1235A>G/p.Y412C) in 21 PLS families (including eight from our previous study) provides an insight into structure-function relationships of CTSC. Our data also suggest that a complete loss-of-function appears to be necessary for the manifestation of the phenotype, making it unlikely that weak CTSC mutations are a cause of aggressive periodontitis. This was confirmed by analyses of the CTSC activity in 30 subjects with aggressive periodontitis and age-sex matched controls, which demonstrated that there was no significant difference between these two groups (1,728.7 +/- SD 576.8 micro moles/mg/min vs. 1,678.7 +/- SD 527.2 micro moles/mg/min, respectively, p = 0.73). CTSC mutations were detected in only one of two families with prepubertal periodontitis; these did not form a separate functional class with respect to those observed in classical PLS. The affected individuals in the other prepubertal periodontitis family not only lacked CTSC mutations, but in addition did not share the haplotypes at the CTSC locus. These data suggest that prepubertal periodontitis is a genetically heterogeneous disease that, in some families, just represents a partially penetrant PLS.

Implications of child development on the practice of oral care.

Of all patient groups, children represent perhaps the most challenging in the preventive dental practice. While technical skills must be excellent, the interpersonal skills of the clinician are also paramount to successful pediatric dentistry and are affected by where children are in their development. This article reviews the developmental stages that children experience and how age characteristics can be predictors of the dental professional's approach to ensure successful, long-term oral health care.

A practice based evaluation of a range of children's manual toothbrushes: safety and acceptance.

Toothbrushes for children have not suited all age groups. The development of a series of children's toothbrushes (Oral-B Stages toothbrushes) targeted at four age-defined groups and designed to meet their needs offers the potential to enhance oral hygiene. To obtain information regarding the specific likes and dislikes of these four children's toothbrushes, a randomized, practice based study involving children between the ages of 4 months and 11 years was conducted. Children were recruited from 25 pediatric dental practices located in the United States, Australia, and Europe. After 1 month of using the brushes, questionnaires were completed by the parents or guardians, children, and dental professionals. Eighty percent to 90% of respondents "liked" or "liked extremely" the toothbrushes with respect to overall like or dislike, cleaning ability, ease of use, and gentleness. Ninety-five percent of the dental professionals in the study concluded that they would recommend these toothbrushes to their patients and 90% thought that the toothbrushes would improve their patients' oral health. It was concluded that the four children's toothbrushes are safe and effective. The design of the brush heads should enhance plaque removal while the ergonomic design of the handles will aid dexterity.