Stress levels of dental students at the Fiji School of Medicine

INTRODUCTION

The Fiji School of Medicine is the primary health care educational institution in Fiji and possesses the only dental school in the Pacific. The oral health programme is a multi-entry/exit programme. The aim of this study was to determine the perceived sources or stress and at risk groups within the undergraduate oral health care programmes.

METHODS

A modified version of the Dental Environment Stress questionnaire was used to assess levels of stress for 41 items.

RESULTS

A total of 115 undergraduate students participated (response rate = 84%). Of the respondents, 54% were male and 46% were female; 55% were Indo-Fijians, 18% Indigenous-Fijians, 8% Polynesians, 7% Micronesians, whilst Melanesians and others were each 6%. Moderate to severe stressful items were: full loaded day, followed by criticism from clinical supervisors in front of patients, amount of assigned work, fear of failing a course or year, examination and grades, financial resources, fear of employment after graduation and fear of facing parents after failure. Of the questionnaire items, 24% had significant differences across year groups. Overall, third years were most stressed followed by fourth years, fifth years, first years and second years. Indo-Fijians were the most stressed, followed by Indigenous-Fijians, Polynesians, others and Melanesians. Females were significantly more stressed than males for 27% of items. Private fee-paying students were more stressed than sponsored students.

CONCLUSION

Overall stress levels were slight to moderate and were higher in senior years, Indo-Fijians, females and private fee-paying students.

Ibuprofen as a pre-emptive analgesic is as effective as rofecoxib for mandibular third molar surgery

The objective of this study was to compare the pre-emptive analgesic effect of rofecoxib, a cyclooxygenase (COX)-2 inhibitor, with a more traditional and commonly used analgesic, ibuprofen, for mandibular third molar surgery, utilizing a prospective, randomized, double-blind, placebo-controlled clinical trial. Fifty-five healthy patients who were scheduled to undergo surgical removal of an impacted mandibular third molar as outpatients at one of two government dental clinics in Fiji were enrolled. The patients were divided randomly into three groups to receive 50 mg rofecoxib or 400 mg ibuprofen, or a placebo 1 h prior to surgery. A dose of 1000 mg paracetamol was offered as rescue medication. Participants recorded their pain intensity on a 10-cm visual analogue scale 1 h before and just prior to surgery and every 30 min for 6 h following surgery. There were no significant analgesic differences between rofecoxib and ibuprofen at any time intervals postoperatively. Ibuprofen was significantly better at reducing pain at all time intervals by comparison with the placebo. Rofecoxib provided significantly better pain relief compared with the placebo, except at 60, 180, and 240 min postoperatively. Rescue medication use was significantly lower in the rofecoxib and ibuprofen groups by comparison with the placebo group; however, there was no significant difference between the two therapeutic groups. Rescue medication was used by 50%, 25%, and 94% of patients receiving rofecoxib, ibuprofen, and placebo, respectively. Ibuprofen, a commonly used over-the-counter analgesic, is as effective as rofecoxib for the relief of acute postoperative pain following third molar surgery when used pre-emptively.

BIS monitoring during midazolam and midazolam-ketamine conscious intravenous sedation for oral surgery

OBJECTIVE

The purpose of this study was to determine whether the bispectral index scale (BIS) would provide added benefit to established methods of monitoring conscious sedation with midazolam (M group) or midazolam supplemented with ketamine (MK group).

STUDY DESIGN

BIS was prospectively and blindly examined in 22 patients receiving outpatient oral surgery with conscious sedation supplemented with local anesthesia.

RESULTS

The average midazolam dose in the midazolam group over the treatment period was 0.01 mg/kg/h, and the average midazolam plus ketamine dose was 0.01 and 0.05 mg/kg/h, respectively. Mean BIS values throughout the sedation study period were 90 for the midazolam group and 94 for the midazolam plus ketamine group. The addition of ketamine did not lower BIS. BIS values did not alter significantly over time except for an expected transient drop after the midazolam bolus induction.

CONCLUSION

BIS levels remained close to baseline levels, suggesting that BIS would not provided any additional benefit to currently established methods of monitoring patient consciousness during conscious sedation for oral surgery.

Dental antibiotic prescription in Fijian adults

AIM

To identify and evaluate dentists' knowledge of and prescription patterns of antimicrobial drugs.

PARTICIPANTS

All 80 registered general dental practitioners in the Republic of The Fiji Islands, excluding academic staff at Fiji School of Medicine. Sixty five (81%) usable replies were received and analysed.

RESULTS

Daily prescription of antibiotics increased with years in practice. There was a moderate level of knowledge regarding specific indications for antibiotic prescription both therapeutically and prophylactically. There was a tendency towards over-prescription with lower dosage, broad spectrum antibiotics with amoxycillin being the overwhelming choice. Some under prescription was noted in certain surgical scenarios. There was a lack of knowledge of the incidence of adverse reactions and very poor medical history record taking. Approximately one third of respondents felt antibacterial resistance is a problem in Fiji and 40% reported experiencing some form of antibiotic resistance in clinical practice.

CONCLUSION

Overall there was a moderate level of correct knowledge for antibiotic prescribing of dentists in Fiji. An improved section on oral and dental infections including guidelines for children should be included in the Fiji Antibiotic Guidelines which could be distributed to all dentists.

Preterm low birth weights associated with periodontal disease in the Fiji Islands

AIM

To determine any association between pre-term low birth weight (PTLBW) neonates and periodontal disease during the mother's pregnancy.

DESIGN

A multi-centered prospective case cohort study.

SETTING

Ante-natal clinics at the Colonial War Memorial and Lautoka Hospitals, Fiji from 1st January to 30th June 2004.

PARTICIPANTS

670 multiethnic pregnant women.

METHODS

Participants were interviewed to identify confounding variables--medical conditions, smoking, alcohol consumption, maternal age and history of preterm birth. Oral examination was conducted and included the Community Periodontal Index of Treatment Needs (CPITN). Delivery outcome was recorded for each woman.

RESULTS

The mean age of participants was 25.80 +/- 5.56 years. 1.9% (n=13) women delivered preterm babies. More than 50% of this group displayed moderate to severe periodontitis compared with 13% of women who had a normal delivery. Preterm birth was also associated with the mother having had a previous preterm birth and who was more likely to be Indo-Fijian (p < 0.01). There was no significant association with where the mother lived; however, rural women with PTLBW babies had more severe periodontal disease (p = 0.0001).

CONCLUSION

There is a highly significant association between pre-term birth and moderate to severe periodontal disease (p = 0.0001).

English language education in Japanese dental schools

English is the common language of international scientific and cultural exchange. As the world becomes more globalized and with increasing dependence on the Internet, English becomes increasingly important as a second language. English is the official language for all international associations, societies, organizations etc and their meetings and publications. High quality international collaboration usually requires a high standard of English language proficiency. There is very little information regarding English language education in dentistry on a global basis, particularly in Japan. In 1999 we undertook a comprehensive survey of English education in all 29 Japanese dental schools in the form of a questionnaire. Few schools had native-speaking educators or those at native speaker level and most did not have a background in dentistry or the health sciences. There are no ideal textbooks for dental students studying English. Most disciplines within dentistry have a professional society or an association with meetings and publications. Currently there is no such group for English-language education in dentistry. Closer collaboration amongst those concerned may help improve the quality of education. The level of English-language ability of current dental students will affect the quality of future dental educators and researchers.

Decreased intraoral secretions during sedation-analgesia with propofol-ketamine and midazolam-ketamine combinations

PURPOSE

To investigate salivary flow over time with a balanced sedation-analgesia technique using a propofol-ketamine (PK) or a midazolam-ketamine (MK) combination in human volunteers.

METHODS

In the PK group, boluses of 1 mg.kg(-1) of propofol and 0.7 mg.kg(-1) of ketamine were initially administered. This was followed by an infusion, given over a 1-h period, of propofol (5 mg.kg(-1)) admixed with ketamine (0.7 mg.kg(-1)). In the MK group, 0.07 mg.kg(-1) of midazolam and 0.7 mg.kg(-1) of ketamine was followed by the infusion of a midazolam (0.07 mg.kg(-1)) and ketamine (0.7 mg.kg(-1)) admixture, also given over a period of 1 h. Salivary flow was measured prior to and at 10-min intervals during the sedation-analgesia, as well as for 30 minutes after its termination.

RESULTS

Mixed intraoral secretions were significantly reduced, by 43% and 47%, on average, in the PK and MK groups, respectively, when compared with presedation levels, and had not returned to baseline levels 30 min after discontinuation of the infusion.

CONCLUSION

Sedation-analgesia with PK and MK combinations controls intraoral secretions by reducing salivary flow.

Work-related musculoskeletal disorders in oral health professionals: an umbrella review protocol

OBJECTIVE

The objective of this review is to synthesize the evidence on the prevalence, incidence, risk factors, and preventive and management interventions for work-related musculoskeletal disorders (MSD) in oral health professionals.

INTRODUCTION

Oral health professionals face a considerable risk of developing work-related MSD due to the nature of their work. These disorders can lead to loss of employment, reduced job quality, increased occupational injuries, and early retirement. They can also lead to significant financial burdens for employers and society.

INCLUSION CRITERIA

This umbrella review will include systematic reviews and meta-analyses that have oral health professionals as a population group and address at least one of the following topics: the prevalence or incidence, risk factors, and the efficiency or effectiveness of interventions for the prevention or management of work-related MSD.

METHODS

A systematic search will be conducted across CINAHL Complete (EBSCOhost), Dentistry and Oral Sciences Source (EBSCOhost), MEDLINE (EBSCOhost), Cochrane Library (Ovid), Scopus, PsycINFO (Ovid), AMED Allied and Complementary Medicine (Ovid), Epistemonikos, Ergonomics Abstracts Online (EBSCOhost), and Google Scholar (first 200 articles). The search will be limited to articles published in English, with no restrictions on geographical location. Two independent reviewers will screen the titles and abstracts against the inclusion criteria. The reviews will be assessed using the JBI critical appraisal instrument for systematic reviews and research syntheses, and data will be extracted from each review using a modified version of the JBI data extraction tool. A narrative summary and tables will be used to describe the review characteristics and findings. Results will be presented in a table using visual indicators (traffic light system) to represent beneficial, neutral, and negative effects with each risk factor and intervention. The GRADE approach will be used to rate the overall quality and strength of the evidence.

REVIEW REGISTRATION

PROSPERO CRD42023388779.

Attitudes regarding a warranty and the expected longevity of dental treatment amongst New Zealand dentists, dental students, and patients: a mixed methods survey

OBJECTIVES

To investigate and compare estimates of the longevity of dental treatment, expectations for free remedial treatment, and attitudes about formal dental warranties among dentists, students, and patients.

MATERIALS AND METHODS

This is a mixed-method cross-sectional questionnaire survey with convenience sampling from dentists, dental students, and patients in New Zealand. A questionnaire was distributed to New Zealand dentists (n = 28) and final-year dental students (n = 27). A separate questionnaire was provided to patients in a university dental clinic (n = 43). Mann-Whitney U, Chi-square and Pearson Correlation, and Binary logistic regression tests were used to test for differences between groups and correlations amongst variables. Qualitative data were analysed thematically.

RESULTS

Dentists believed that their posterior composite resin restorations would last longer (p = 0.014), would remediate failed crowns for longer (p = 0.002) and would provide longer crown warranties (p = 0.003) compared to students. Patients had higher expectations for restoration longevity and free remediation for failed treatment. Students were generally more willing to provide warranties. Crowns were perceived to be the most warrantable, while endodontic treatment was the least warrantable. Recall attendance, mechanical failure, and adequate oral hygiene were commonly proposed as warranty conditions for restorations and crowns. There was little consensus about complete dentures and endodontic treatment.

CONCLUSIONS

There are significant disparities between the expectations of patients and clinicians regarding treatment longevity and free remediation times. Clinicians, in general, are willing to provide free remediation within a specified time frame, except for endodontic treatment, but are hesitant to provide formal dental warranties.

Novel dental anesthetic and associated devices: a scoping review

The efficient management of pain and discomfort is essential for successful dental treatment and patient compliance. Dental professionals are commonly evaluated for their ability to perform treatment with minimal patient discomfort. Despite advancements in traditional local dental anesthesia techniques, the pain and discomfort associated with injections remain a concern. This scoping review aims to provide a comprehensive overview of the literature on novel dental anesthetics and associated devices designed to alleviate pain and discomfort during dental procedures. The Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews guidelines were used to prepare the review. Six databases and two sources of gray literature were searched. This review analyzed 107 sources from 1994 to 2023. Local anesthesia devices were grouped into computer-controlled local anesthetic delivery (CCLAD) systems, intraosseous anesthesia (IOA), vibratory stimulation devices, and electronic dental anesthesia (EDA). CCLAD systems, particularly the Wand and Single-Tooth Anesthesia, have been the most researched, with mixed results regarding their effectiveness in reducing pain during needle insertion compared to traditional syringes. However, CCLAD systems often demonstrated efficacy in reducing pain during anesthetic deposition, especially during palatal injections. Limited studies on IOA devices have reported effective pain alleviation. Vibrating devices have shown inconsistent results in terms of pain reduction, with some studies suggesting their primary benefit is during needle insertion rather than during the administration phase. EDA devices are effective in reducing discomfort but have found limited applicability. These findings suggest that the CCLAD systems reduce injection pain and discomfort. However, the evidence for other devices is limited and inconsistent. The development and research of innovative technologies for reducing dental pain and anxiety provides opportunities for interdisciplinary collaboration and improved patient care in dental practice.

Effects of a propofol--ketamine admixture in human volunteers

As the ideal sedative does not exist for all situations, particularly in settings with limited resources, the effect of a propofol-ketamine combination in human volunteers was examined. Eleven American Society of Anesthesiologists (ASA) physical status I volunteers were administered propofol at a loading dose of 1 mg/kg and two minutes later by 0.7 mg/kg of ketamine. This was followed by a propofol-ketamine combination of 5 mg/kg of propofol admixed with 0.7 mg/kg of ketamine that was infused over one hour via a 60 gtts/ml intravenous. Infusion set. Cardiorespiratory parameters were recorded and blood samples taken to measure plasma catecholamine levels prior to, during and for thirty minutes following the termination of the infusion. Rate of respiration and oxygen saturation levels did not alter significantly from baseline levels. When there was a cardiovascular decrease from base line levels it was on average 11% for systolic, 15% diastolic blood pressure and 14% for heart rate. Only plasma adrenaline and noradrenaline increased by 28 and 20%, 10 minutes following the bolus injectons. No dysphoria was experienced. This combined sedoanalgesic technique in nonstimulated human volunteers maintains spontaneous ventilation and may be considered as abalanced alternative to traditional conscious sedation or general anesthesia.

The relationship of placement accuracy and insertion times for the laryngeal mask airway to the training of inexperienced dental students

Any health care professional can be faced with a medical emergency in which the patient needs ventilatory support. Bag-valve-mask ventilation with the assistance of an oropharyngeal airway that uses 100% oxygen is currently the preferred method for artificial ventilation. This procedure is generally performed ineffectively by most dentists inexperienced in airway management. We examined whether a short and simple period of training by dental students inexperienced in airway management would increase the speed and accuracy of the placement of the laryngeal mask airway (LMA), which may be a superior airway device to the bag-valve-mask and oropharyngeal airway. Thirty-five dental students inexperienced in airway management were divided into 3 groups. The first group received only a demonstration on how to use the LMA. The second and third groups received the demonstration plus practiced inserting the LMA 5 and 10 times, respectively. A dental anesthesiologist graded the placement of the LMA with a tracheobroncho-fiberscope (fiberoptic bronchoscope). Those who practiced inserting the LMA 5 times faired better than those who received no training; however, those who practiced 10 times did not do any better than the second group. The LMA can be inserted rapidly and effectively by dentists inexperienced in airway management after a short period of simple training that may be critical when personnel experienced in intubation are not readily available.

Attitude/practices of oral healthcare provider to management of HIV/AIDS patients in the Pacific

This paper expands a quantitative study which measured dentists attitudes, practices, knowledge, education, policies towards HIV positive patients in the Pacific region in order to identify potential barriers to the provision of adequate dental treatment. 300 questionnaires were sent out to all the 14 countries in the region. However, only the following six countries responded Fiji, Solomons, Vanuatu, Samoa, FSM, and Cook Islands of which 91.6% worked for the government sector, 4.2% respondents for academic and 4.2% were private oral health care providers (OHCP). These were 32.6% of dentists and 67.4% Paradentals. Results of the research showed that the major reasons for the unwillingness among oral health care providers mainly described fear of HIV transmission in dental clinics, inadequate infection control procedures in the clinics to prevent cross transmission or lacked knowledge about HIV patient management in dental clinics. There is a need for continuing education on management of HIV/AIDS positive dental patients covering such areas as management, infection control, policies, education and ethical issues concerning HIV positive patients for oral health care providers in the South Pacific region. Limitations of study: Since this is an incomplete (six countries responded out of fourteen countries) survey, generalization on attitudes and practices of OHCP in the Pacific can not be made yet. Also, larger sample is required to make definite conclusion about oral health care practices in the Pacific.

Oral Irrigation Devices: A Scoping Review

OBJECTIVES

Self-performed oral hygiene is essential for preventing dental caries, periodontal, and peri-implant diseases. Oral irrigators are adjunctive oral home care aids that may benefit oral health. However, the effects of oral irrigation on oral health, its role in oral home care, and its mechanism of action are not fully understood. A comprehensive search of the literature revealed no existing broad scoping reviews on oral irrigators. Therefore, this study aimed to provide a comprehensive systematic review of the literature on oral irrigation devices and identify evidence gaps.

METHODS

The Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were utilized to prepare the review. Four databases and eight gray literature sources were searched for English publications across any geographical location or setting.

RESULTS

Two hundred and seventy-five sources were included, predominantly from scientific journals and academic settings. Most studies originated from North America. Research primarily involved adults, with limited studies in children and adolescents. Oral irrigation was safe and well-accepted when used appropriately. It reduced periodontal inflammation, potentially by modulating the oral microbiota, but further research needs to clarify its mechanism of action. Promising results were reported in populations with dental implants and special needs. Patient acceptance appeared high, but standardized patient-reported outcome measures were rarely used. Anti-inflammatory benefits occurred consistently across populations and irrigant solutions. Plaque reduction findings were mixed, potentially reflecting differences in study designs and devices.

CONCLUSIONS

Oral irrigators reduce periodontal inflammation, but their impact on plaque removal remains unclear. Well-designed, sufficiently powered trials of appropriate duration need to assess the clinical, microbiological, and inflammatory responses of the periodontium to oral irrigation, particularly those with periodontitis, dental implants, and special needs. Patient-reported outcome measures, costs, caries prevention, and environmental impact of oral irrigation need to be compared to other oral hygiene aids.

Migration of oral health professionals: a scoping review protocol

INTRODUCTION

Each year, many dental professionals are trained; however, many low-income and middle-income countries face a scarcity of dental professionals. This trend has been observed because of the migration of oral health professionals from developing to developed countries for various reasons such as professional, economic or personal. This negatively impacts the healthcare system by causing critical shortages of trained personnel to support the oral healthcare needs of the countries where the oral health professionals migrate from (source countries). The key objectives of this scoping review are to assess the intentions behind the migrations, identify the countries the graduates migrate to and from, examine the barriers to and facilitators of integrating oral health professionals, as well as the challenges they face post migration.

METHODS AND ANALYSIS

A scoping review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR) and the Joanna Briggs Institute guidelines. Scientific databases such as Dentistry and Oral Sciences Source, Cumulative Index to Nursing and Allied Health Literature, MEDLINE and Scopus will be systematically searched to identify potential articles. In addition, grey literature will be searched to identify unpublished materials relevant to the topic using Google Scholar and Google. The reviewers will assess the retrieved sources in a three-step search strategy, and a PRISMA-ScR flowchart will document the numbers of identified, screened and excluded sources. The scoping review will collate and present the findings as a descriptive analysis. Finally, the narrative descriptions will be presented in a thematic form based on the findings of the scoping review.

ETHICS AND DISSEMINATION

This scoping review is based on a secondary analysis of published data; hence, ethical approval is not required. The findings of this study will be disseminated through publication in a peer-reviewed journal, professional networks and conferences.

Identification and Management of Dental Anxiety by New Zealand Dentists

Objective

More than 1 in 8 New Zealand (NZ) adults are dentally anxious, which can lead to avoiding dental care and a higher risk of poor oral health. However, little is known about how dentally anxious patients are identified and managed by NZ general dentists. This survey aimed to investigate how NZ dentists identify and manage dentally anxious patients.

Methods

We conducted an email survey of NZ dentists in 2022, obtaining 212 responses. Along with demographic information, respondents were queried about whether they ask patients about past/current dental fears and their likely origin, how they assessed those fears, their usual management of dentally anxious patients, and how the management of dentally anxious patients could be improved.

Results

Almost three-quarters reported personally asking patients about past and/or current dental fears, and half enquired about bad life experiences that had led to those fears. Only 6 respondents (2.8%) reported using a formal dental anxiety/phobia assessment tool prior to treatment. For managing severely anxious adult dental patients, all dentists used at least 1 pharmacologic or psychological technique or referral to a colleague.

Conclusion

The study identified several weaknesses among NZ dentists in identifying and managing dental anxiety patients. The use of formal dental anxiety/phobia assessment tools prior to treatment needs improvement. Addressing dental anxiety is a complex issue that requires a multipronged approach involving improved education, the development and implementation of better assessment tools, and a greater understanding of how dentists' current assessment and management of dental anxiety can be improved.

Pacific oral health: a scoping review

Introduction

A growing body of literature reports on the oral health of Pacific peoples but a synthesis of the existing knowledge on Pacific oral health epidemiology is absent. This scoping review aims to summarise the evidence on Pacific oral health epidemiology. The findings of this review may help identify knowledge gaps and issues requiring health policy prioritisation.

Methods

The review followed the PRISMA-ScR guidelines for scoping reviews and included reports published prior to July 2023 on Pacific oral health, regardless of design. Searches were conducted across four databases, and the grey literature.

Results

An analysis of 95 sources, primarily from 2000 to 2023 and predominantly New Zealand-based, found that a high proportion of Pacific peoples (including children) were affected by poor oral health and challenges in accessing dental care services. Numerous studies have reported oral health disparities, with poorer oral health among Pacific peoples than other population groups. Epidemiological and health services data from Pacific Island nations show a high prevalence of dental conditions, along with limited healthcare resources and workforce shortages. Studies on the broader social determinants shaping these issues and health promotion strategies to address them were limited.

Conclusion

This review revealed significant unmet oral health needs, ethnic disparities in oral health, and barriers preventing care in Pacific populations. The findings emphasise the need for more research to address these gaps to help develop effective, culturally-informed oral health strategies for Pacific communities.

Medical emergencies in dental practice in the Fiji Islands

Medical emergencies in dental clinics are atypical however they do occur with potentially serious consequences. A postal questionnaire survey of all seventy-seven dentists in Fiji regarding occurrence of medical emergencies, their possession of emergency drugs and equipment and whether further training was required in the management of medical emergencies was conducted in 2004. The response rate was 85.7%. The most common medical emergencies were fainting (27.9%), postural hypotension (23.5%), hypoglycaemia (19.5%), epileptic fits and seizures (11.1%) and asthma (8%). The most commonly kept emergency drugs and equipment were disposable needles, oral glucose, disposable syringes, sphygmomanometer adrenaline, first aid kit, tourniquet and oxygen. Additionally, the vast majority of the dentists (98.5%) expressed a need for some form of further training or refresher course in this area. It is hoped that the respective stakeholders in Fiji islands and that it forms baseline information and guidelines in addition to stimulating future prospective studies.