Search

Background: Despite water fluoridation and well-established media promotion of the use of fluoride toothpaste twice a day, many adolescents are still at risk of dental caries and periodontal disease due to poor dietary and toothbrushing behaviours. However, these oral health problems can be moderated by providing individuals with preventive care and advice. In New South Wales (NSW) dental therapists and oral health therapists (Therapists) working in the public health system can help this vulnerable group by providing free dental care including advice on preventing dental caries and periodontal disease. This study used both quantitative and qualitative methodology to investigate the provision of preventive care by Therapists to adolescents who chose to attend NSW Public Oral Health Services. Methods/Methodology: The quantitative studies undertaken included: (i) obtaining clinical and preventive data from the NSW Health Information System of Oral Health database for all Therapists across all the Local Health Districts (LHDs) for interrogation and analysis; (ii) a reliability study of Therapists clinical and preventive care data as recorded in the electronic health record and paper record; and (iii) two cross-sectional postal questionnaire surveys; with one survey using three clinical vignettes to ascertain how Therapists structure their preventive care health plans for adolescents. The questionnaire survey also included items which explored Therapists’ patterns of participation in continuing professional development on clinical preventive care for adolescents. The qualitative studies included: (i) three two hour structured focus group sessions with 16 Therapists; and (ii) two separate studies using in-depth face to face interviews with clinical directors and health service managers; and Senior Therapists. The qualitative studies Page | 6 explored the participants’ perceptions and views on the influencing factors that enable or inhibit Therapists offering clinical preventive care to adolescents; and what strategies they used to enhance Therapists’ ability to facilitate preventive care in their day to day care for patients. Results: Preventive care provided for adolescents accessing NSW Public Oral Health Services across all the Local Health Districts varied considerably from approximately 32% to 55% of Therapists clinical activity over a one year period. The reliability study demonstrated that the current dual system using the electronic health record and paper records to record and account for Therapists’ clinical and preventive care activities for adolescents had deficiencies, indicating an area for infrastructure improvement. The crosssectional surveys using the clinical vignettes demonstrated that there were considerable variations noted in Therapists recommendations for stabilising and managing dental disease for their adolescent patients, suggesting a need for Clinical Directors to improve models of preventive care delivery based on scientific evidence. Therapists responded to the continuing professional development items in the survey and noted that they received most of their education from the Local Health District, suggesting opportunities for interprofessional learning from visiting dental paediatric specialists, dentists and supported by health service managers. The qualitative studies provided common themes at multiple levels of the oral health organisation, highlighting the factors that can enhance and assist Therapists operationalise scientific based preventive care into their day to day clinical practice. These include resourcing efficient clinical access pathways to preventive care; adequate workforce mix; efficient and effective administrative processes to support preventive clinical care activities; Page | 7 provision of oral health products and age appropriate information to support adolescents’ homecare regimes. Conclusion: Therapists in this study stated it was their professional clinical ethos to embed scientific based preventive care into day to day clinical practice to improve adolescents’ long term oral health outcomes. To improve preventive models of care for adolescents requires the overarching administrative authority, NSW Health to accept that the scientific evidence relating to dental care has changed, and that management monitoring information should be incorporated into health reforms; thus assisting clinical directors, Therapist clinical leaders and health service managers to collaborate more effectively with sponsored support ‘pillars’ in the redesign of sustainable, cost effective evidenced based care pathways for all adolescents. [ABSTRACT FROM AUTHOR]

Background Individuals with opioid dependence often experience poor oral health, including dental decay, periodontal disease and mucosal infection, frequently exacerbated by factors such as smoking, alcohol consumption, inadequate oral hygiene and low utilisation of oral health services. This study aimed to assess oral health status and oral health-related quality of life (OHRQoL) among opioid-dependent individuals and explore their potential associations. Methods Participants enrolled in an opioid treatment program (OTP) at three Australian urban clinics were assessed using the validated Oral Health Assessment Tool (OHAT) and Oral Health Impact Profile (OHIP-14). Results The average age of the 75 participants was 44.7years, with 45% receiving opioid treatment for over 5years. Dental decay and inadequate oral hygiene were prevalent. Mean OHAT and OHIP-14 scores were 6.93 and 20.95 respectively, indicating moderate oral health severity and poor OHRQoL. Physical pain and psychological discomfort significantly impacted participants' quality of life, with the effects being particularly pronounced for those aged 30 and above. An exploratory analysis revealed a strong correlation between OHAT and OHIP-14 severity scores, with a one-point increase in OHAT associated with 1.85times higher odds of a lower OHRQoL (odds ratio=1.85, 95% confidence interval: 1.38-2.49, P = Conclusions These findings underscore the multifaceted impact of oral health on the well-being of OTP clients. Routine dental check-ups, education on oral hygiene practices and timely treatment for oral health problems are crucial recommendations based on this study. Such measures hold the potential to enhance the quality of life for individuals attending OTPs.

Aim: Electronic health record (EHR) data have great potential for reuse in research and patient care quality improvement initiatives. However, in dual systems, where both electronic and paper health records are used, inconsistencies and errors may occur. The objective of this study was to determine the degree of agreement between EHR clinical data and paper records for reuse in clinical oral health research and quality improvement initiatives., Methods: A random sample of 200 EHRs for adolescents from eight Area Health Services was obtained from the Information System for Oral Health New South Wales database of 29 599 records, and compared with 200 paper records for adolescents that were stored at clinics. The records were analysed for data reliability. The electronic records were percentage weighted to reflect the number of adolescents treated in each of the Area Health Services., Results: The results showed an overall 95.0% agreement between the 200 individual EHRs and the 200 clinic-stored paper records. In 1.5% of cases, information contained in the paper record was not uploaded into the EHR, and in 3.5% of cases, information contained in the EHR was missing from the paper record., Conclusions: It is possible to conclude that more deficiencies occurred in paper records compared with EHRs. These deficiencies should be taken into account if EHRs are to be reused for clinical oral health research or quality improvement initiatives. Considering the missing data and the great strides in information system technology, it would be logical to adopt one system, with a focus on electronic records to replace the paper records.