BACKGROUND:Oral health outcomes are closely linked to the completion of necessary dental treatment. HYPOTHESIS OR AIM:This study seeks to determine the socio-demographic characteristics of children and adolescents and the clinical factors contributing to the noncompletion of necessary dental treatments within a 12-month period at Monash Health Dental Services in Melbourne, Victoria. DESIGN:Data were collected from seven public health dental sites, capturing all patients younger than 18 years who visited Monash Health Dental Services within a 12-month period. RESULTS:Of the 7160 children who attended the dental clinics, 24.2% did not complete dental treatment. The majority (79.4%) were between 5 and 17 years of age, with each additional year of age increasing the probability of having an incomplete course of care (CoC). Participants receiving 'Preventive' CoCs were less likely to have incomplete treatments, while Aboriginal and Torres Strait Islander peoples, those who spoke languages other than English or Dari and patients needing interpreters were more likely to have incomplete treatments. Attendees of the different dental clinics had differing odds of noncompletion. The model explained 11.3% of the variance in predicting noncompletion. CONCLUSION:This analysis underscored the complex interplay between socio-demographic, enabling factors and clinical circumstances that contribute to incomplete CoCs.

ABSTRACT Objective This study aims to evaluate the effectiveness of a Dental Intern Program (DIP) at Monash Health, focusing on the experiences of mentors, dental interns (DI) and patients. It seeks to identify strengths and weaknesses within the programme and its impact on clinical skills, judgement and patient satisfaction. Methods Qualitative feedback was collected from mentors and DI through interviews and discussions, while quantitative data were gathered from patient surveys before and after the implementation of the DIP. The analysis focused on themes related to confidence levels, skill development, mentor support and patient satisfaction. Results Mentors emphasised the need for tailored tutorials and more practical opportunities for skill development. They noted gaps in DIs' skills in specific areas due to limitations in clinical exposure. DIs reported a positive experience, highlighting the importance of individualised learning goals and the supportive mentor‐intern relationship, which fostered confidence and clinical judgement. Patient feedback indicated high satisfaction levels, with significant improvements in care quality and staff confidence post‐programme implementation. Quantitative data revealed a statistically significant increase in DIs' confidence ( p < 0.05) and a notable rise in patient compliments and decrease in complaints after the implementation of the DIP ( p < 0.001). Conclusion This study emphasises the critical role of tailored mentoring and a structured DIP in enhancing clinical proficiency and patient care for a DI in their first year of career development. The findings contribute valuable insights into the dynamics of dental graduates' training and their implications for the recruitment of local graduates and their retention in the public sector.

AIM or PURPOSE Aim of study was to evaluate the acceptance, compliance and efficacy of Oral Appliance Therapy (OAT) intervention for patients suffering from obstructive sleep apnoea (OSA)in public dental health setting. MATERIALS and METHOD ♣ Sleep Physicians conducted the sleep study for patients using the Apnoea Hypopnoea Index (AHI), Functional Outcomes of SleepQuestionnaire (FOSQ) and Epworth Sleepiness Score (ESS).♣ Sleep Physician/Dentist conducted assessment to determine the eligibility.♣ Oral appliance had an electronic tracker to collect objective compliance data.♣ Compliance was also measured subjectively.♣ Participants were reviewed at regular intervals for effectiveness, appliance activation, and adjustments.Self-documented data and electronic tracker compliance data was compared at each appointment.Review sleep study was conducted in three months to measure efficacy. RESULTS ♣ Out of 53 participants,34 completed the sleep study with pre- and post-data recorded and all acknowledged improvements after the intervention with an acceptance rate of 97% particularly from those who had previously refused the use of CPAP.♣ ESS analysis indicated that after the intervention, participants had significantly lower EES scores compared to their baseline scores (12.7 vs.6.9;p<0.001).♣ AHI analysis showed participants had significantly lower AHI scores compared to their baseline scores (19.2 vs.3.8;p<0.001).CONCLUSION(S): Present findings indicate that the OAT is not only safe, effective and feasible but also readily acceptable treatment option for sleep apnoea patients. This project has also provided valuable insights into how the OAT can be incorporated into dental practice and be a tool to guide clinical care for patients who suffer from OSA in the public health setting.

(1) Background: Completion of the full oral health course of care (CoC) is essential to prevent further deterioration of oral and overall health. Understanding these patterns, particularly in public oral healthcare services, is crucial for improving access to and the delivery of care. This study aims to identify the socio-demographic and clinical characteristics of adult patients who did not complete required dental treatments within a 12-month period at Monash Health Dental Services (MHDS), Melbourne, Victoria. (2) Methods: Data were collected on patients' course of care (CoC), socio-demographic characteristics, and clinical information from the MHDS Titanium electronic database. This study represents a secondary data analysis from adult patients who attended MHDS between November 2022 and October 2023, excluding emergency dental care visits. Logistic regression analyzed the socio-demographic and clinical variables affecting CoC. (3) Results: Our findings identified several significant predictors of incomplete CoC; being a non-priority group, mental health clients, refugees, and identifying as Aboriginal or Torres Strait Islanders (OR = 1.41; 95% CI: 1.08-1.84). Conversely, speaking a language other than English increased the odds of completing treatment (OR = 0.85; 95% CI: 0.74-0.98). By age, patients in the 36-to-55- or the 56-to-75-year-old age groups were more likely to be in the incomplete group (OR = 1.65; 95% CI: 1.37-1.98; and OR = 1.43; 95% CI: 1.22-1.66, respectively). (4) Conclusions: This study identified predictors of discontinued care, emphasizing accessibility and equitable outcomes for users of public oral healthcare. The findings indicate that the predictors of course of care (CoC) completion differ from barriers to accessing care. This highlights key objectives in public health dentistry, focusing on improving accessibility and promoting equitable oral health outcomes for vulnerable populations.

Abstract Background Obstructive Sleep Apnoea (OSA) represents an established risk factor for several medical conditions. The evidence demonstrates that OSA can be effectively treated by an oral appliance. However, there less information about the role of an oral appliance in a clinical care model in terms of uptake and efficacy. This study aimed at examining the efficacy of an intervention in dental public health settings in Melbourne, Australia. Methods Data were collected from the 2018-2021. Participants who fitted inclusions criteria completed two instruments. The Epworth Sleepiness Score (ESS) was used to assess the Subjective daytime sleepiness, and the Apnoea Hypopnea Index (AHI) objectively evaluated the severity of OSA. Participants were further asked to self-report felt improvements post intervention. Paired t-tests were used to compare pre-test and the post-test results. Results 34 participants had complete before and after data recorded. The mean age of the final samples of 66.4 (s.d., 14.2), the majority were female (67.7%). Participants unanimously acknowledged improvements after the intervention. Findings also indicated that after the intervention, participants had significantly lower EES scores compared to their baseline scores (6.9 vs 12.7; p<0.001). Regarding the AHI, at post-test, participants had significantly lower AHI scores compared to their baseline scores (13.8 vs. 19.2; p<0.001). Conclusions Present results indicate the use of oral appliance will ultimately benefit public patients who suffer from OSA. After the intervention, there were both objective and subjective improvements in OSA. Thus, findings provide valuable inputs and guidance for the design and implementation for larger efficacy trial.

Aim or Purpose: The “Value for Visits” approach, adapted from the Value Based Oral Health Care (VBOHC) Model was introduced by Monash Health Dental Services in 2020. The VBOHC model provides better oral health outcomes for MHDS‘ clients. The aim of this study was to assess the VBOHC model by reviewing and comparing courses of care outcomes before and after the model's implementation. Materials and Methods: All general courses of care (CoC) in 2019 and 2022 were audited, and a review of courses of care was conducted. The 2019 CoCs included solely patients whose treatment had begun prior to COVID-19 restrictions being imposed.Analysis involved investigating 10 CoCs for each clinician working at an MDHS dental clinic. The review did not include new staff (less than 3 months) or staff primarily working in the School Dental program. A thorough auditing was conducted into the ways in which general oral health care was provided to public patients. Results: In 2019 the total number of clients seen was 4240 with an average patient receiving 4.05 appointments over 6.37 months, and seeing 2.61 clinicians. In 2022, under the VBOHC model, the total number of clients seen was 5644. The average number of appointments to complete a CoC was 2.70 over 5.39 months. The number of clinicians seen was 1.10. Conclusions: Data showed that after implementation of the VBOHC model there was improvement in the efficiency of oral health care provision. Full implementation of the model would provide superior continuity of care, and overall better oral health outcomes for public dental patients.

BACKGROUND:Poor oral health is known to be associated with frailty in geriatric populations. Recent exposure to anticholinergic medications is responsible for features of poor oral health. Anticholinergic medications pose a cumulative risk for frailty.METHODS:We studied 115 geriatric inpatients (aged >65 years and recruited over a 3-month period from October to December 2017). Patients who were severely agitated, cognitively impaired, from a non-English speaking background and with severe sensory impairment were excluded. Frailty and oral health were assessed using the Reported Edmonton Frailty Scale and the Oral Health Assessment Test, respectively. Exposure to anticholinergic medications was assessed using the Anticholinergic Burden Scale.RESULTS:The mean age was 80 (range from 66 to 101). Only 44 patients (38.3%) were not exposed to any anticholinergic medication. Nearly two-thirds of patients were taking anticholinergic medications, with 25% classified as having a high anticholinergic burden (ACB ≥ 4). Approximately one-third of severely frail patients were exposed to a high anticholinergic burden. Patients with a high anticholinergic burden were more than twice as likely to have severe frailty (OR 2.21; 95% confidence interval 1.05-4.6). Poor oral health was associated with frailty (OR 1.24; 95% CI 1.02-1.49).CONCLUSION:High anticholinergic burden was found to be a risk marker for severe frailty independent of its effect on oral health. Poor oral health was associated with all levels of frailty. This study highlights a need for a review of medications with anticholinergic properties in older patients. Further research should be directed at whether deprescribing could prevent poor oral health or slow the progression of frailty.

Aim or purpose An increase in number of people seeking emergency care due to inability to access dental services for general care was seen during COVID-19. This drive through model was developed to screen, educate and prioritise, based on individual risks, patients who were otherwise unable to get dental care due to COVID-19 restrictions. Methods On World Oral Health Day, 2021 dental examinations were conducted for patients while they drove through an existing COVID-19 screening clinic. The ICDAS-II index (International Caries Detection and Assessment System), score two to six, was used for caries assessment and management. Patients were categorised into three groups based on number of decayed teeth (less than three, three to six or more than six). The management criteria was based on the ICDAS score of teeth under each of the three categories. Results A total of 247 patients were screened and educated on the day. 102 patients with ICDAS score two to four were given education and preventative treatment appointment. While 118 patients with ICDAS score five or six were identified to be at risk of dental emergency in the near future and were booked in for emergency or general treatment. Another 27 patient were given clinical priority based on their periodontal or denture related needs. Patient survey revealed a high satisfaction rate of 92%. Conclusions This public health initiative was a great success in providing dental care to the patients during these unprecedented times who would not have had any care otherwise due to COVID-19 restrictions.

Background Vulnerable populations such as people with refugee backgrounds are at increased risk of poor oral health. Given that maternal characteristics play a significant role in the development of dental caries in children, antenatal care offers an opportunity to both provide information to women about the importance of maternal oral health and accessing dental care. Although pregnant women are recognised for ‘priority’ care under Victorian state-government policy, rarely do they attend. This study aims to describe Afghan and Sri Lankan women’s knowledge and beliefs surrounding maternal oral health, barriers to accessing dental care during pregnancy, and to present the perspectives of maternity and dental service providers in relation to dental care for pregnant women. Methods One agency comprising both dental and maternity services formed the setting for the study. Using participatory methods that included working with bicultural community workers, focus groups were conducted with Afghan and Sri Lankan refugee background participants. Focus groups were also completed with midwives and dental service staff. Thematic analysis was applied to analyse the qualitative data. Results Four community focus groups were conducted with a total of 14 Afghan women, eight Sri Lankan women, and three Sri Lankan men. Focus groups were also conducted with 19 dental staff including clinicians and administrative staff, and with ten midwives. Four main themes were identified: perceptions of dental care during pregnancy, navigating dental services, maternal oral health literacy and potential solutions. Key findings included women and men’s perception that dental treatment is unsafe during pregnancy, the lack of awareness amongst both the midwives and community members of the potential impact of poor maternal oral health and the overall lack of awareness and understanding of the ‘priority of access’ policy that entitles pregnant women to receive dental care cost-free. Conclusion This study highlights a significant policy-to-practice gap which if not addressed has the potential to widen oral health inequalities across the life-course. Stakeholders were keen to collaborate and support action to improve the oral health of mothers and their infants with the over-riding priority being to develop inter-service relationships to promote seamless access to oral health care.

Background: The Hall Technique (HT) is a carious primary molar treatment that does not require local analgesia, carious tissue removal or tooth preparation. The carious lesions in carefully selected teeth are sealed with a stainless steel crown (preformed metal crown). The study aims are to determine the clinical effectiveness, acceptability and cost-effectiveness of the HT for management of carious lesions in young dental patients.Methods/design: Children, aged 3-7 years, with a primary molar tooth with a carious lesion extending no further than the middle third of dentine, with no signs or symptoms of pulp inflammation or infection, and attending one of three community agencies are recruited. Target sample size is 220. A control tooth with an intra-coronal restoration is sourced from the same mouth. The primary outcome is the period of time free from further treatment. The assessments are scheduled at 6, 12 and 24 months. In addition to the clinical assessment, acceptability of the HT will be assessed via questionnaires among patients and their primary carers at baseline, 6, 12 and 24 months. Cost-outcome description and cost-effectiveness analysis from healthcare provider and societal perspective will be conducted.Discussion: The clinical effectiveness, acceptability and cost-effectiveness of the HT in the community dental setting will be evaluated. The results of this study will determine the implementation of HT in the management of dental caries in young children. (C) 2015 Elsevier Inc. All rights reserved.