A Cross-Sectional Survey of the Use of Clear Aligners by General Dentists in Australia

OBJECTIVES

The primary aim of the investigation was to survey clear aligner therapy (CAT) use among general dentists in Australia. A secondary aim was to evaluate the factors that influenced general dentists in Australia not to provide CAT.

MATERIAL AND METHODS

General dentists registered with the Australian Health Practitioner Regulation Agency were invited to participate in a structured cross-sectional electronic survey. The survey covered demographics, preferred CAT systems and practices, relevant treatment planning and retention protocols, patient-reported CAT issues, pertinent respondent opinions, and reasons for not providing CAT. Descriptive statistics were computed via GraphPad Prism v10 (GraphPad Software Inc., La Jolla, CA, USA).

RESULTS

Most of the 264 (n = 172; 65.2%) respondents indicated that they provided CAT. The majority (n = 82; 58.6%) reported that they treated between 1 and 20 patients with CAT annually. Invisalign was the most used system (n = 83; 61.2%), with 55 (41.7%), indicating that they used more than one system. Most (n = 124; 98.4%) were comfortable using CAT for mild crowding, whereas 73.4% (n = 94) were not comfortable in treating severe crowding with CAT. The median (IQR) number of patients per respondent treated with extraction of a permanent incisor or premolar was 0 (0). Issues regarding tooth positions were reportedly always or mostly in need of change in the initial treatment plan by 68.7%. Problems regarding patient compliance with CAT wear protocols (n = 67; 45.6%) and the predictability of treatment outcomes (n = 31; 21.1%) were the most identified themes of the free-text comments. Over 80% of those who did not provide CAT indicated that they preferred to refer to an orthodontist for management.

CONCLUSION

Almost two-thirds of the respondents provided CAT. Invisalign was the most used system. The majority use CAT combined with nonextraction treatment. Most of those who did not provide CAT preferred to refer to an orthodontist for patient management.

Australian Dentist's Knowledge and Perceptions of Factors Affecting Radiographic Interpretation

BACKGROUND

Errors of interpretation of radigraphic images, also known as interpretive errors, are a critical concern as they can have profound implications for clinical decision making. Different types of interpretive errors, including errors of omission and misdiagnosis, have been described in the literature. These errors can lead to unnecessary or harmful treat/or prolonged patient care. Understanding the nature and contributing factors of interpretive errors is important in developing solutions to minimise interpretive errors. By exploring the knowledge and perceptions of dental practitioners, this study aimed to shed light on the current understanding of interpretive errors in dentistry.

METHODS

An anonymised online questionnaire was sent to dental practitioners in New South Wales (NSW) between September 2020 and March 2022. A total of 80 valid responses were received and analysed. Descriptive statistics and bivariate analysis were used to analyse the data.

RESULTS

The study found that participants commonly reported interpretive errors as occurring 'occasionally', with errors of omission being the most frequently encountered type. Participants identified several factors that most likely contribute to interpretive errors, including reading a poor-quality image, lack of clinical experience and knowledge, and excessive workload. Additionally, general practitioners and specialists held different views regarding factors affecting interpretive errors.

CONCLUSION

The survey results indicate that dental practitioners are aware of the common factors associated with interpretive errors. Errors of omission were identified as the most common type of error to occur in clinical practice. The findings suggest that interpretive errors result from a mental overload caused by factors associated with image quality, clinician-related, and image interpretation. Managing and identifying solutions to mitigate these factors are crucial for ensuring accurate and timely radiographic diagnoses. The findings of this study can serve as a foundation for future research and the development of targeted interventions to enhance the accuracy of radiographic interpretations in dentistry.

Oral health knowledge, attitudes and practices of dietitians in Australia: A national survey

AIM

Dietitians are a well-placed profession to be providing pre-emptive oral health promotion. Despite recommendations that oral health promotion should be routinely part of dietetic practice, there is limited data informing the current practices of clinical dietitians in this area across Australia. Hence, the aim of this study was to investigate the knowledge and practices of Australian dietitians and oral health promotion.

METHODS

A cross-sectional survey was undertaken involving registered clinical dietitians in Australia using purposive and snowballing sampling (social media/dietetic organisations/public databases). Data were analysed using descriptive and inferential statistics.

RESULTS

A total of 149 dietitians participated in the national survey. Overall, dietitians were knowledgeable about oral health risk factors and preventative measures across general health domains. Majority of dietitians agreed that oral health can affect nutrition interventions (95.5%) and dietitians should be discussing oral health (88.0%). However, nearly half were not confident in providing counselling or education and felt that undergraduate training for oral health promotion was inadequate (78.2%). A small proportion (6.0%) of dietitians were already providing oral health promotion regularly. Key barriers included a lack of clear guidelines for practice, limited training opportunities and indistinct referral pathways.

CONCLUSION

Dietitians have acknowledged that oral health promotion should be incorporated into their practice. However, they are challenged by a lack of resources and training to support this in clinical practice. SO WHAT?: Capacity building dietitians to promote oral health allows opportunity for improvement in the oral health, nutritional status and quality of life of priority population groups.

Exploring the Perception and Awareness of Dental Students and Interns in Managing and Treating Pregnant Patients

Background Undergraduate dental students and interns express reluctance to deal with pregnant women in the dental office due to the fear of medical consequences on the fetus. This study aims to explore the knowledge, attitudes, and practices of dental students and interns regarding the dental considerations of pregnant women in three dental schools in Saudi Arabia. Methodology This cross-sectional study was performed between October and December 2023 and targeted the clinical academic years of dental students and interns at three dental schools in Saudi Arabia, namely, Taibah University, Umm Al-Qura University, and Qassim University. Using the convenience sampling method, 223 students were invited to respond to a questionnaire constructed from previously published studies and reviewed by experts in the field. It consisted of 15 questions divided into four sections. Descriptive analysis and chi-square test were conducted to assess the difference between the different sociodemographic groups and students' educational levels with the significance level set at p-values <0.05. Results Overall, 223 complete responses were received, with a response rate of 97%. Demographics included 99 (44.40%) males and 124 (55.60%) females, with a reasonable distribution across academic years. Knowledge assessment findings revealed that 114 (51%) participants acquired adequate knowledge. Regarding participants' attitudes, 112 (50%) found the curriculum-centered information sufficient. In addition, 173 (77.6%) participants chose lectures/books as their preferred source of information. Almost 138 (61.9%) participants did not feel confident in managing pregnant women. The chi-square test revealed that educational level significantly impacts the knowledge and practice of the participants, regardless of their gender (p < 0.05). Conclusions Both students and dental interns showed adequate-to-good levels of knowledge and attitude. Both need more exposure to clinical situations with pregnant women during their undergraduate dental training programs to boost their confidence level and enhance their readiness to practice dental procedures with such a group of patients after graduation.

Gender differences in oral health among prisoners: a cross-sectional study from Taiwan

BACKGROUND

The prevalence of oral diseases among Taiwanese prisoners has rarely been investigated. This study aimed to estimate the gender-specific prevalence of oral disease in a sample of Taiwanese prisoners.

METHODS

We included 83,048 participants from the National Health Insurance (NHI) Program. Outcomes were measured using the clinical version of the International Classification of Diseases, Ninth Revision (ICD-9-CM). For prevalence, we provide absolute values and percentages. We also performed a χ2 test to assess sex and age group differences in the percentage of disease in the oral cavity, salivary glands, and jaw.

RESULTS

The prevalence rate of oral diseases was 25.90%, which was higher than that of the general population. The prevalence of oral diseases in female prisoners was higher than that in male prisoners (p < 0.001), and the prevalence of oral diseases in prisoners aged ≤ 40 was higher than that of prisoners aged > 40. Among all cases of diagnosed oral diseases, the top three diseases were dental hard tissue diseases (13.28%), other cellulitis and abscesses (9.79%), and pruritus and related conditions (2.88%), respectively. The prevalence of various oral diseases in female prisoners was significantly higher than that in male prisoners.

CONCLUSION

Oral disease is common among Taiwanese prisoners. Female prisoners had a higher prevalence of oral, salivary gland, and jaw diseases than male prisoners. Therefore, early prevention and appropriate treatment are required and also a need for gender-specific oral disease products given the differences in the prevalence of oral disease among male and female prisoners.

Current endodontic practice and use of newer technologies in Australia and New Zealand

BACKGROUND

This study investigated endodontic clinical preferences, adoption of newer technologies and information sources among dentists and endodontists.

METHODS

Dental and endodontic society members in Australia and New Zealand were surveyed online regarding their endodontic treatment preferences, armamentarium, information sources and continuing professional education (CPE) attendance.

RESULTS

Complete responses were received from 71 endodontic specialists or postgraduates (Group E) and 139 general dentists (Group D). Most of Group E used dental operating microscopes (95.8%), endodontic cone-beam computed tomography (CBCT; 98.6%) and calcium silicate-based materials (CSBMs; 97.2%), significantly more (P < 0.001) than Group D (86.3% used loupes, <32% used CBCT for endodontics or CSBMs). Most respondents used dental dam always for endodontics (94.3%), electronic apex locators (EAL; 81.0%) and engine-driven nickel-titanium (NiTi) instruments (91.4%); Group E had more experience with engine-driven NiTi (P < 0.001). Endodontic CPE attendance was highest at dental association programs (P < 0.001) while hands-on NiTi training attendance was highest via commercial companies (P < 0.05). Online information sources were commonly used (38.8% of Group D, 59.2% of Group E).

CONCLUSION

Dental dam, EAL and engine-driven NiTi were almost universally used. The endodontic group reported high adoption of newer endodontic technologies. Endodontic CPE and information sources should be further surveyed as online engagement evolves. © 2023 Australian Dental Association.

Factors associated with knowledge about pharmacological management of pregnant women in Peruvian dental students: a logistic regression analysis

BACKGROUND

Clinical management to maintain or restore oral health through the use of drugs during pregnancy is crucial, since at this stage physiological changes significantly influence the absorption, distribution and elimination of the drug, considering also that excessive administration of drugs during this period may have adverse effects on the mother and/or fetus. Therefore, the aim of the present study was to evaluate the factors associated with knowledge of pharmacological management of pregnant women in dental students of a Peruvian university located in the capital and province.

METHODS

This analytical, cross-sectional, prospective and observational study assessed 312 Peruvian dental students from third to fifth year of study between February and April 2022. A validated questionnaire of 10 closed questions was used to measure knowledge about pharmacological management in pregnant women. A logit model was used to assess the influence of the variables: gender, age, year of study, marital status, place of origin and area of residence. A significance of p < 0.05 was considered.

RESULTS

The 25.96, 55.13 and 18.91% of the dental students showed poor, fair and good knowledge about pharmacological management in pregnant women; respectively. In addition, it was observed that students under 24 years of age and those from the capital were significantly (p < 0.05) 44% less likely to have poor knowledge of pharmacological management in pregnant women compared to those aged 24 years or older (OR = 0.56; CI: 0.34-0.92) and those from the province (OR = 0.56; CI: 0.32-0.98); respectively. Finally, those in their third and fourth year of study were significantly three times more likely to have poor knowledge (OR = 3.17; CI: 1.68-5.97 and OR = 3.88; CI: 2.07-7.31; respectively) compared to fifth year dental students.

CONCLUSION

The knowledge of dental students about pharmacological management in pregnant women was predominantly of fair level. In addition, it was observed that being under 24 years of age and being from the capital city were protective factors against poor knowledge, while being a third- and fourth-year student was a risk factor. Finally, gender, marital status and area of residence were not influential factors in the level of knowledge.

Bibliometric Analysis of the Global Scientific Production on Oral Health during Pregnancy

AIM

To analyze the bibliometric characteristics of the global scientific production indexed in Scopus on oral health during pregnancy.

MATERIALS AND METHODS

Cross-sectional study with bibliometric methodology, using scientific publications indexed in Scopus as a unit of analysis. For the search, MESH terms, Boolean operators ("AND" and "OR"), and search topics (TITLE and ABSTRACT) were used. SciVal was the tool selected for the analysis of bibliometric parameters.

RESULTS

Most of the articles were published in Q1 (30.2%) and Q2 (29.6%) quartile journals. The country with the most scientific publications was the United States (451 articles), while Spain had only 14 publications. The University of Sydney, with 16 articles, was the most productive institution and the one with the most citations per publication was Saveetha University (19.7). The author with the most articles and citations related to the topic was George Ajesh with 13 and 136, respectively. Johnson Marre had the highest impact (15.1) and expected citations with respect to the global average (FWCI: 2.49).

CONCLUSIONS

The scientific production on oral health in pregnancy has increased, with a greater preference by authors for scientific journals in the Q1 and Q2 quartile. The United States is the country with the most publications, although Australia has a greater number of institutions among the most productive.

CLINICAL SIGNIFICANCE

The clinical relevance could be addressed later in relation to oral health during pregnancy, however, analyzing the bibliometric characteristics of the global scientific production is essential to understand the dynamics of scientific publications on this topic.

Mahalli A. The knowledge, attitude and practice level of dental auxiliaries regarding oral health care for pregnant patients in the eastern province of Saudi Arabia

Background :The purpose of this research was to assess the knowledge, attitude, and practice of dental auxiliaries related to oral health care for pregnant patientsin the Eastern Province of Saudi Arabia. Methods: A cross-sectional study using a questionnaire survey was conducted. The knowledge, attitude, and practice were rated using the Likert scale out of 5. Knowledge and practice were categorized using bloom's cut off point methods (80% and above isgood, and less than 80% is bad) . Concerningattitude, (80% and above is positive, and less than 80% is negative) The questionnaires were sent to all  dental hygienists and assistants (N=358), and responses were collected from 218. Statistical Package for the Social Sciences (SPSS) software was utilised to conduct statistical analysis. Result s : Out of the 358, 218 responded (response rate = 61%).  More than half of the respondents showed relatively good knowledge (57.3%). Most respondents had a positive attitude (89.4%). Regarding practice, approximately two-thirds had a good practice (67.4%). The knowledge score of hygienists was significantly higher than dental assistants, and respondents with experience in treating pregnant patients had significantly higher knowledge scores than others who did not have experience in treating pregnant patients. There is a statistically significant positive correlation between practice scores and education. Conclusion s : The findings suggest the need to establish continuous education programs and for dental hygienists and dental assistants to adopt the best practice guidelines on perinatal oral health.

Mahalli A. The knowledge, attitude and practice level of dental auxiliaries regarding oral health care for pregnant patients in the eastern province of Saudi Arabia

Background : The purpose of this research was to assess the knowledge, attitude, and practice of dental auxiliaries related to oral health care for pregnant patients in the Eastern Province of Saudi Arabia. Methods: A cross-sectional study using a questionnaire survey was conducted. The knowledge, attitude, and practice were rated using the Likert scale out of 5. Knowledge and practice were categorized using Bloom's cut off point methods (≥80% is good, and <80% is bad) . Concerning attitude, (≥80% is positive, and <80% is negative). The questionnaires were sent to all dental hygienists and assistants (N=358), and responses were collected from 218. Statistical Package for the Social Sciences (SPSS) software was utilixed to conduct statistical analysis. Results: Out of the 358, 218 responded (response rate = 61%).  More than half of the respondents showed relatively good knowledge (57.3%). Most respondents had a positive attitude (89.4%). Regarding practice, approximately two-thirds had a good practice (67.4%). The knowledge score of hygienists was significantly higher than dental assistants, and respondents with experience in treating pregnant patients had significantly higher knowledge scores than others who did not have experience in treating pregnant patients. There is a statistically significant positive correlation between practice scores and education. Conclusions: The findings suggest the need to establish continuous education programs and for dental hygienists and dental assistants to adopt the best practice guidelines on perinatal oral health.

Mahalli A. The knowledge, attitude and practice level of dental auxiliaries regarding oral health care for pregnant patients in the eastern province of Saudi Arabia

Background :The purpose of this research was to assess the knowledge, attitude, and practice of dental auxiliaries related to oral health care for pregnant patientsin the Eastern Province of Saudi Arabia. Methods: A cross-sectional study using a questionnaire survey was conducted. The knowledge, attitude, and practice were rated using the Likert scale out of 5. Knowledge and practice were categorized using bloom's cut off point methods (80% and above isgood, and less than 80% is bad) . Concerningattitude, (80% and above is positive, and less than 80% is negative) The questionnaires were sent to all  dental hygienists and assistants (N=358), and responses were collected from 218. Statistical Package for the Social Sciences (SPSS) software was utilised to conduct statistical analysis. Result s : Out of the 358, 218 responded (response rate = 61%).  More than half of the respondents showed relatively good knowledge (57.3%). Most respondents had a positive attitude (89.4%). Regarding practice, approximately two-thirds had a good practice (67.4%). The knowledge score of hygienists was significantly higher than dental assistants, and respondents with experience in treating pregnant patients had significantly higher knowledge scores than others who did not have experience in treating pregnant patients. There is a statistically significant positive correlation between practice scores and education. Conclusion s : The findings suggest the need to establish continuous education programs and for dental hygienists and dental assistants to adopt the best practice guidelines on perinatal oral health.

Does having children affect women's oral health? A longitudinal study

BACKGROUND

Many believe women's oral health deteriorates as a result of having children. If so, such associations should exist among women but not among men. The aims of this study were to investigate whether number of children is associated with experience of dental disease and tooth loss among both men and women and to examine whether this association is affected by other variables of interest.

METHODS

This study used data from the Dunedin Multidisciplinary Health and Development study, a longitudinal study of 1037 individuals (48.4% female) born from April 1972 to March 1973 in Dunedin, New Zealand, who have been examined repeatedly from birth to age 45 years.

RESULTS

Data were available for 437 women and 431 men. Those with low educational attainment were more likely to have more children and began having children earlier in life. Having more children was associated with experiencing more dental caries and tooth loss by age 45, but this association was dependent on the age at which the children were had. Those entering parenthood earlier in life (by age 26) had poorer dental health than those entering parenthood later in life, or those without children. There was no association between number of children and periodontal attachment loss (PAL). Low educational attainment, poor plaque control, never routine dental attendance, and smoking (for PAL) were associated with PAL, caries experience, and tooth loss.

CONCLUSIONS

Social factors associated with both the timing of reproductive patterns and health behaviors influence the risk of dental disease and its management.

Predictors of periodontal and caries related perinatal oral healthcare, investigation of dentists' practices: a cross-sectional study

Background

The objectives of the study were to assess the knowledge, attitude, and practice of dentists towards providing oral health care to pregnant women and to identify barriers and predictors of periodontal and caries related perinatal oral healthcare practices.

Methods

A cross-sectional analytical survey was conducted on dentists by using a random sampling technique, and a pre-validated questionnaire was delivered to 350 dentists from May 2018 to October 2018. Data were analyzed by utilizing SPSS software. Frequencies and percentages were recorded for descriptive variables. Binary logistic regression was used to analyze the probability of predicting group membership to the dependent variable using different independent variables determined from contingency tables.

Results

Overall response rate was 41%. The mean knowledge score of respondents was 15.86 ± 3.34. The lowest correct responses were noted in the questions related to periodontal health. It was found that the advice to delay dental visits until after pregnancy was eight times more likely to be observed among dentists who lacked the knowledge of importance of oral health during pregnancy (P = 0.04, OR = 8.75). Dentists were more likely to consult obstetricians regarding dental procedures when they fear a risk of labor in the dental practice (P < 0.05, OR = 3.72). Dentists who had the knowledge of periodontal disease association with preterm delivery were about four times more likely to treat periodontal disease during pregnancy (P = 0.01, OR = 3.95). Dentists knowing the association between maternal oral health and childhood decay were more likely to counsel pregnant patients regarding caries prevention (P > 0.05, OR = 3.75).

Conclusions

Collectively the results indicated few gaps in knowledge among some dentists and a need to improve existing attitudes towards perinatal oral health. Dentists failing to recognize the importance of perinatal oral health are more likely to be hesitant in treating pregnant patients. Failing to recognize the link between periodontal disease and obstetric complications increases the possibility of hesitance to counsel pregnant patients regarding the same. The appreciation of the evidence for poor perinatal oral health and risk of early childhood caries increases the likelihood of counseling by dentists on caries prevention.

Satisfação das gestantes durante a consulta odontológica no Sistema Único de Saúde, Brasil

Objetivo O objetivo do trabalho foi verificar a taxa de gestantes satisfeitas com a consulta odontológica realizada no Sistema Único de Saúde (SUS-Brasil) e fatores associados. Metodologia O estudo foi do tipo transversal. Para coleta de dados foi elaborado um questionário abordando variáveis sociodemográficas e relacionadas a gestação. A coleta de dados foi realizada através de entrevistas face a face em um hospital maternidade da região metropolitana de Porto Alegre-RS-Brasil. O teste de qui-quadrado e a regressão de Poisson com variância robusta (p<0,05) foram utilizados nas análises bi e multivariada. Resultados Das 302 mulheres entrevistadas, 50%(n=151) realizaram consulta odon- tológica durante a gestação e destas, 86% (n=131) estavam satisfeitas com a consulta. Na análise multivariada verificou-se que a variável avaliação das consultas de pré-natal como boa aumentou em 14% [Razão de Prevalência (RP)=1,14; Intervalo de Confiança (IC) 95%:1,01-1,27] a probabilidade de as mulheres expressarem satisfação com a variável desfecho. Conclusão Conclui-se que foi alta taxa de satisfação com as consultas odontológicas realizadas no SUS pelas gestantes e avaliação das consultas de pré-natal como boa foi fator associado. Estes resultados poderiam ser considerados durante o planejamento estratégico, execução e avaliação das políticas de saúde direcionadas para este grupo operativo.

Pregnancy, oral health and dental education: an overview on the northeast of Italy

Objectives To evaluate the level of knowledge of pregnant women and puerpers about oral health and prevention during and after gestation. Methods One hundred women aged 18-49 years (mean age 33±6 years) were included in this cross-sectional study. An anonymous questionnaire with 24 items related to oral health has been administered during or just after pregnancy. Firstly, answers have been analyzed on the full population and then subdividing the sample on the base of age ranges (G1: 18-25 years, G2: 26-35 years and G3: >35 years) and number of pregnancies (FP: first pregnancy; SP: second or more pregnancies). Parametric tests have been chosen for the statistical analysis; in particular, Anova test for independent samples was used to evaluate differences of baseline demographic characteristics among subgroups G1, G2, G3 while chi-square test was used for FP and SP subgroups. Anova test was also used to intercept differences on answers given to the questionnaire among G1, G2 and G3 group; for FP and SP group was used t-test. Results Level of information and knowledge of the full sample was medium-low and no significant differences have been observed between groups regarding awareness of the own level of the oral hygiene and knowledge of oral care. Conclusions Results of this survey underline the high necessity of educational programs regarding oral care in pregnant and puerpers women. A strict collaboration between medical figures (dentist, oral hygienist, gynecologist and obstetric) is strongly encouraged to spread the concept of prevention.

Implementing and evaluating the effectiveness of an oral health module for the bachelor of midwifery program at an Australian university

OBJECTIVE

Although guidelines recommend antenatal care providers such as midwives promote oral health during pregnancy, oral health training is not routinely provided in undergraduate midwifery curricula. The aim of this study was to implement an oral health module into an Australian undergraduate midwifery program, and evaluate its effectiveness in improving the oral health knowledge and confidence of midwifery students.

DESIGN

Pre-test post-test study (2015-2017).

SETTING

An undergraduate midwifery program within an Australian university.

PARTICIPANTS

All first-year undergraduate midwifery students enrolled in two core units at the above university (N = 56).

METHODS

Oral health modules were implemented into each of the two core units within the first year of the Bachelor of Midwifery course. Changes in knowledge and confidence were measured using a standardised questionnaire, administered at baseline, immediately following module completion, and at 2 and 3 years following module completion.

RESULTS

44 students participated in the baseline survey (79% response rate), of which 41 completed the first post-module questionnaire, 21 completed the second post-questionnaire, and 24 completed the third post-questionnaire. Knowledge scores significantly increased from baseline (mean 13.12) to follow-up (mean 17.78, p < 0.001), with increases being retained through to the 3-year mark (mean 18.29, p < 0.001). Confidence scores also showed a sustained increase following the module, particularly regarding introducing oral health in the first antenatal appointment (62.1% increase, p < 0.001) and referring pregnant women to a dentist (48.2% increase, p < 0.001). However, the 48.2% increase (p < 0.001) in confidence in conducting a visual mouth check on a pregnant woman following the module was not sustained at subsequent time points, reducing to a 31.5% increase (p = 0.118) by the third year post-module.

CONCLUSIONS

The module is effective in improving and sustaining the knowledge and confidence of midwifery students to promote maternal oral health. Ongoing updates may be required to keep confidence high regarding visual mouth checks.

Endodontic Treatment in Pregnancy: Knowledge, Attitudes, and Practices of Dentists and Interns in Jeddah, Saudi Arabia

Aim:

Pregnant women require special consideration in dental treatment due to physiological changes during their pregnancy. The aim of this study is to assess the knowledge, attitudes, and practices of dentists and dental interns in Jeddah, Saudi Arabia, regarding endodontic treatment during pregnancy.

Methods:

A cross-sectional study was conducted using validated self-report questionnaires completed by 450 dental interns and dentists who treat pregnant women in governmental and private dental clinics in Jeddah, Saudi Arabia. The questionnaire measured participants’ knowledge, beliefs, and actual practices regarding behavioral counseling and the treatment of pregnant patients. Descriptive statistics were generated, and significance was set at 0.05.

Results:

A total of 86.4% of the participants acknowledged the importance of endodontic treatment for pregnant patients and responded that most endodontic procedures are considered safe during the second trimester, including periapical radiographs (67.11%), endodontic treatment (81.11%), local anesthesia with and without epinephrine (70.67%), open access (83.78%), drainage of abscesses (76.89%), prescribing acetaminophen (75.56%), and prescribing antibiotics (61.11%). In addition, 57.8% knew that Nonsteroidal Anti-inflammatory Drugs (NSAIDs) are contraindicated. However, 69.33% considered panoramic radiographs contraindicated. Knowledgeable participants were significantly more likely to practice appropriate endodontic procures. The majority (70.9%) were interested in more education about pregnant patients.

Conclusion:

Dental interns and dentists in Saudi Arabia have fair levels of knowledge about endodontic treatment of pregnant patients, and need to improve their knowledge, especially regarding radiographs and NSAIDs.

Knowledge, Attitudes and Practice Behaviour of Midwives Concerning Periodontal Health of Pregnant Patients

Maternal gum disease is associated with adverse pregnancy outcomes such as preterm birth and low birthweight. This study aims to evaluate the knowledge, attitudes and practice behaviour of Australian midwives regarding the periodontal health of pregnant women to inform interprofessional antenatal care. This was an observational, cross-sectional study. We circulated an online questionnaire to Australian midwives from August 2018 to February 2019. Key outcome variables were knowledge, attitudes, and practice behaviours related to oral health. Key predictor variables were years of practice, practice location, and dental history. We summarized responses with frequency tables and assigned tallied scores for analysis using non-parametric statistical tests. 100 responses were analysed, including from rural (n = 23) and urban (n = 77) midwives. Eighty percent of midwives agreed that maternal dental care can positively affect pregnancy outcomes. Fluoridated toothpaste use (19.1%) was incorrectly answered to prevent gum disease more often than psychological stress control (7.9%), a correct answer. Rural midwives demonstrated a significantly higher knowledge score (p = 0.001) and significantly more positive practice behaviours towards oral health (p = 0.014) than urban midwives. Australian midwives have positive attitudes towards antenatal oral health but misunderstand gum disease aetiology and prevention. This study highlights areas to improve interprofessional education for optimal oral health and pregnancy outcomes.

Factors associated with dental visit and barriers to the utilization of dental services among tribal pregnant women in Khurda district, Bhubaneswar: A cross-sectional study

Background:

There is a lack of knowledge related to the utilization of dental services by tribal pregnant women who constitute over 35% of the Indian population. The aim of the present study was to identify barriers to the utilization of the dental services and also the factors that concern the tribal mothers’ visit to the dental office.

Materials and Methods:

A total of 300 tribal mothers visiting a tertiary care unit participated in this cross-sectional, observational study. A pilot study with twenty participants was conducted before the commencement of the study. Data were collected using a modified questionnaire consisting of demographic data and questions relating to oral health knowledge, attitude, and practices, as well as barriers to the utilization of dental services and factors that concern dental visits during pregnancy. Data analysis was done using SPSS software package 21.0. Nonparametric statistical tests were done to analyze oral health knowledge and attitude of the participants. Various factors were identified using univariate and multivariate models using simple logistic regression analysis and multiple logistic regression analysis.

Results:

Among the two different tribes considered in the present study, the Saora tribe seemed to be more conscious toward oral health, and 29.7% of participants visited the dentist during pregnancy. The age and experience of the participants along with the educational level, employment status, and knowledge about oral health-related pregnancy outcomes influenced their dental visits. The most reported barrier included the lack of awareness and knowledge of the availability of the dental services. Accessibility and distance to the dental clinic were not found to be negative confounding factors among the participants for the utilization of the services.

Conclusion:

This study concludes that previous experience and consciousness of the mother to utilize the dental services played a vital role in the utilization of dental services among tribal pregnant women. However, the findings of the present study clearly indicate the need for further research to understand barriers to the utilization of dental services among underprivileged tribal groups of population.

Number of Pregnant Women at Four Dental Clinics and the Care They Received: A Dental Quality eMeasure Evaluation

Process-of-care quality measure research can be used to identify gaps in the delivery of dental services to pregnant patients. The aim of this study was to evaluate the types of dental services that pregnant patients received in four dental clinics over five years as documented in the electronic health record (EHR). To accomplish this objective, the authors modified and validated a previously published claims-based dental quality measure for EHR use. After the electronic dental quality measure specifications were defined, the number of pregnant patients was calculated at three academic dental institutions and one large accountable care organization, and the types of dental care services they received over a five-year period (2013-17) were determined. Calibrated reviewers at each institution independently reviewed a sub-sample of patient charts to validate the information obtained from EHR queries, and the concordance between manual chart reviews and EHR query reports was analyzed. Of the 335,078 women aged 15-44 years who received care at the four clinics for the five reporting years, 3.9% (n=13,026) were pregnant. Among these pregnant patients, 48.9% (n=6,366) received a periodic dental examination; 30.0% (n=3,909) received a comprehensive dental exam; and 21.5% (n=2,799) received additional dental services, irrespective of comprehensive or periodic oral evaluations. Overall, the mean proportion of pregnant patients seeking care in these academic dental and group practice clinics was low, but 78.9% of them received either a periodic or comprehensive oral evaluation. Given the importance of oral health care during pregnancy, these findings suggest a need for curriculum development to incorporate prenatal oral health education in the training of dental students.

Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of dental professionals

ISSUE ADDRESSED

All pregnant women should have a comprehensive oral health evaluation. Unfortunately, many pregnant women seldom seek dental care and some dentists are hesitant to treat during pregnancy. To address these issues, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in Australia. The aim of this study was to undertake a process evaluation and explore the perceptions of dental professionals involved in the program to determine the acceptability, feasibility and effectiveness of the program if it were to be upscaled.

METHODS

A qualitative approach using content analysis was conducted on data from two focus groups involving 12 dental professionals.

RESULTS

All participants were supportive of the MIOH-DS program. They thought pregnant women were receptive to their care, and reported markedly improved oral health. The provision of free dental care and the involvement of midwives were cited as major factors that improved the uptake of the program. Some of the challenges encountered were the prevailing misconceptions about the safety of dental treatment and pregnancy-related impairments.

CONCLUSIONS

Dental professionals found the MIOH-DS to be acceptable, feasible and effective in improving oral health of pregnant women and their uptake of dental services. However, some challenges need to be addressed as the MIOH-DS program is upscaled into a cost-effective model. SO WHAT?: Dental professionals are important stakeholders in the MIOH-DS model. The process evaluation of the successful dental intervention is necessary to understand how and why such interventions work, and is an important step in scaling up to a population-wide intervention.

Process evaluation of the midwifery initiated oral health-dental service program: perceptions of pregnant women

BACKGROUND

Pregnant women in Australia seldom seek dental care and are unaware of its importance. To address these gaps the midwifery-initiated oral health dental service (MIOH-DS) program was comprehensive trialled and found effective. The aim of this study was to undertake a process evaluation of the MIOH-DS using the perspectives of pregnant women who participated in the trial.

METHODS

A qualitative research design was utilized, whereby content analysis was undertaken on data from 11 semi-structured interviews with women who participated in the program.

RESULTS

All participants were receptive of the MIOH-DS intervention, and found it to be an acceptable intervention that met their needs, and encouraged future positive oral health practices and health-seeking behaviours. They expressed that midwives were an appropriate professional to conduct oral health assessments, education and referrals to affordable dental services. Although some participants were initially apprehensive towards receiving treatment during pregnancy, dental staff members were able to appropriately educate and reassure them during treatment.

CONCLUSIONS

The MIOH-DS represents a promising and acceptable intervention strategy for pregnant women to promote their oral health. Findings merit further investigation on whether positive outcomes achieved can be sustained when implemented in other national or international settings similar to the study setting.

Process evaluation of the midwifery initiated oral health-dental service program: Perceptions of midwives in Greater Western Sydney, Australia

BACKGROUND

Despite links between poor maternal oral health, adverse pregnancy outcomes and early childhood decay there is limited emphasis on maternal oral health in Australia. To address this, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in collaboration with the Australian College of Midwives.

AIMS

To undertake a process evaluation and explore perceptions of midwives involved in the MIOH-DS program to determine its practicability, acceptability and feasibility if it were to be up-scaled and implemented into clinical practice.

METHODS

Qualitative content analysis was undertaken on data from three focus groups with 21 midwives.

FINDINGS

Midwives generally found the MIOH-DS to be acceptable and feasible with potential for widespread scalability. The trust women had in midwives was an important factor in gaining women's attention about oral health in pregnancy. The program assisted in increasing midwives' knowledge and awareness, though some felt it was outside their scope of practice. The oral health assessment tool was acceptable to midwives but some concerns were expressed about undertaking a visual oral inspection. Most midwives stated they were now confident with referring individuals to a dentist. Significant barriers to widespread implementation included the cost of dental care and the continued lack of awareness and misconceptions pregnant women had towards oral health.

CONCLUSION

Midwives found the MIOH-DS to be acceptable and feasible which are two important barriers to potential implementation at scale. Misconceptions over the importance of oral health by women and cost of accessing dental services still need resolving.

Pregnancy, parity and periodontal disease

Many women believe that their dental condition deteriorated during pregnancy or as a result of having children. Epidemiological studies have reported an association between higher parity and tooth loss, and higher parity and periodontal attachment loss. Several possible explanations for this association exist. First, hormonal changes during pregnancy affect the immune response to bacterial plaque and drive vascular and gingival changes that may contribute to heightened gingival inflammation. These changes are transient, without irreversible loss of periodontal attachment, and post-partum resolution can be expected for most women. For women with destructive periodontal disease, the effects of pregnancy and parity are unclear. Second, it is also plausible that parity and socioeconomic position (SEP) have shared risk factors, increasing the incidence of disease or influencing its management. Education, one aspect of SEP, is an important determining factor for women's fertility rate, with a gradient of fewer children with higher educational attainment. Higher levels of education are also favourably associated with behaviours conducive to oral health, and a lower incidence of damaging health behaviours. Thus, the potential for confounding is considerable. This review examines the literature on the association between pregnancy, parity and periodontal health, and explores sociobehavioural mechanisms for the observed association.

Evaluation of a midwifery initiated oral health-dental service program to improve oral health and birth outcomes for pregnant women: A multi-centre randomised controlled trial

BACKGROUND

Oral health care during pregnancy is important for the health of the mother and child. However, pregnant women have limited knowledge about maternal oral health and seldom seek dental care. Further, due to limited training antenatal care providers like midwives rarely discuss oral health with pregnant women. The Midwifery-Initiated Oral Health Dental Service program was developed to address current gaps in oral promotional interventions during pregnancy.

OBJECTIVES

To assess the effectiveness of a Midwifery-Initiated Oral Health Dental Service program in improving uptake of dental services, oral health knowledge, quality of oral health, oral health status and birth outcomes of pregnant women.

DESIGN

Multi-centre randomised controlled trial.

SETTING

Three large metropolitan public hospitals in Sydney, Australia.

PARTICIPANTS

Pregnant women attending their first antenatal appointment who were at least 18 years old and had a single low risk pregnancy between 12 and 20 weeks gestation.

METHODS

638 pregnant women were allocated to three groups using block randomisation (n = 211) control group, intervention group 1 (n = 215), intervention group 2 (n = 212) and followed up till birth. Study investigators and data collectors were blinded to group allocation. Intervention group 1 received a midwifery intervention from trained midwives involving oral health education, screening and referrals to existing dental pathways. Intervention group 2 received the midwifery intervention and a dental intervention involving assessment/treatment from cost free local dental services. The control group received oral health information at recruitment. Primary outcome was uptake of dental services. Secondary outcomes included oral health knowledge, quality of oral health, oral health status and birth outcomes.

RESULTS

Substantial improvements in the use of dental services (20.2% Control Group; 28.3% Intervention group 1; 87.2% Intervention group 2; Odds Ratio Intervention group 2 vs Control Group = 29.72, 95% CI 15.02-58.53, p < 0.001), women's oral health knowledge (p = 0.03); quality of oral health (p < 0.001) and oral health outcomes (sulcus bleeding, dental plaque, clinical attachment loss, decayed/filled teeth- p < 0.001) were found in Intervention group 2. No difference in the rate of preterm or low-birth weight was found.

CONCLUSIONS

The Midwifery-Initiated Oral Health Dental Service program (Intervention group 2) improved the uptake of dental services and oral health of pregnant women and is recommended during antenatal care. A cause and effect relationship between this intervention and improved birth outcomes was not supported.