Research Areas

Early Childhood Caries

Within Australia, dental caries is a prevalent disease affecting children. Childhood dental caries can cause acute pain and problems with eating resulting in decreased self-esteem and sleep deprivation. In severe cases a dental general anaesthetic (GA) may be required. Historically, from 2010-2012 at Barwon Health Oral Health services there were 235 events under GA. The average age at consultation was 5.5 years. Severe dental caries along with long waiting times prompted a change in dental processes.

The Wide Smiles program commenced in 2013 with the goal of utilising Minimal Intervention Dentistry (MID) to implement a positive change in the oral health of children (aged 3-7 years) by applying fluoride directly to affected tooth surfaces. MID techniques encourage non-surgical dental treatments and encourage individualised care plans with patient/ parent/ guardian management. There were 13,537 children who received dental screening at 67 kindergartens, 28 schools and 34 Early Learning Centres in the region. Of these children, 39,646 tooth surfaces had topical fluoride applied to white spot lesions. At follow up, 92% of tooth surfaces where fluoride was applied, had stabilized or improved. There were 36,474 tooth surfaces averted from further decay. The children welcomed the Oral Health therapists at their early learning centre and viewed these visits with a positive response.

In order to continue providing excellent dental care/service to the community a further evaluation of the effectiveness of the Wide Smiles program in reducing dental caries rates throughout the Geelong and Colac-Otway region from 1 January 2017 – 31 June 2021 is proceeding. Newsletters will be utilised to communicate outcomes with families involved in the Wide Smiles program.

Redesigning the forefront of emergency dental care

The Community Oral Health Service (OHS), in Victoria, Australia, is notorious for long waiting lists for dental procedures. Inherent in this issue are patients in pain requiring immediate attention. Historically emergency dental care (EDC) was provided at the next available appointment, in a system where the waiting list for general procedures was already overrun. General patient appointments were cancelled to make way for EDC leading to unhappy patients and staff. Determined to eliminate stress we put our staff at the forefront and investigated a new model of care.

A date was chosen as a cut-off point where appointments were no longer scheduled in the morning and staff discussed a new model of care. Patients presenting for EDC were advised to attend the next “open emergency session” delivered each morning at every clinic where patients were triaged and seen in order of need. General courses of care were scheduled for the afternoon and no appointments were cancelled to make way for EDC. The average number of visits for EDC was 13 (IQR 11-16) Site 1, 17 (IQR 15-20) Site 2 and 12 (IQR 11-15) at Site 3.  The initial 12 months there were 10,536 visits.  Staff agreed that the change to the model of care was good for business, employees and clients.  The patients surveyed responded with overwhelmingly positive responses.  This model of dental care could be replicated at any public OHS.  

{slider Teledentistry at Barwon Health (BH) and Colac Area Health (CAH) Oral Health Service}

This important public health project focussed on areas which are growing in population rapidly and where teledentistry approaches in the public health settling haven’t previously been investigated.  Teledentistry began at BH and CAH oral health services in 2020 to engage with patients/carers of children who had missed-out on outreach and recall visits during the COVID-19 pandemic.

Between 10 August and 30 September 2020, teledentistry consultations were offered to parents/carers of children on the dental recall list or were seen with demineralization, hypomineralisation and caries whilst being enrolled in the Wide Smiles early years dental outreach program.  Parents/carers were contacted via telephone and offered a dental teleconference consultation for their child.  An estimate of the contribution of teledentistry to activity in terms of Dental Weighted Activity Units (DWAU’s) was made.

Only 15.6% of parents/cares of children who missed their recall appointments did not respond to SMS and telephone calls, while 18.6% of parents/carers of children who missed their Wide Smiles preschool and primary school visit did not respond to SMS and telephone calls.  Only 8.9% of parents/carers of children who missed their recall appointment did not want any dietary analysis or advice or oral hygiene instruction compared with 48.4% of Wide Smiles participants who didn’t require any assistance.  Teledentistry contributed to 25% of activity in August and September in terms of DWAU’s.  Teledentistry was very well received with parents/carers of children who had missed their recall appointments.  The Oral Health Service will continue to take advantage of teledentistry when appropriate to engage with families as well as traditional face-to-face consultations.

A deliberate reduction of antimicrobials prescribed in the public community dental clinic

We undertook a quantitative audit of antimicrobials prescribed for prophylaxis or acute conditions over the time period of 2012 to 2019 with the hypothesis that there will be a reduction in use. For the January 2015 – December 2019 time period a new classification system for recording antimicrobials was introduced. 

Methods: A retrospective study of electronic dental records for patients requiring emergency and general dental treatment at Barwon Health between January 2009 – 31 December 2020 was performed.  Data was extracted from the Titanium information management system (Version 14), a Public Oral Health patient management system used within Australia. The percentage receiving antimicrobials was calculated and compared using a Chi Squared test.  In January 2015, a new recording system for item codes 927 was developed.  The following classifications for 927 item codes was developed:

• • 927 AM – Antimicrobials for acute conditions or prophylaxis
• • 927 O - Analgesics or other medications/medicaments
• • 927 NR – Antimicrobials for non-responsive infections

Improving the education of staff about antimicrobial stewardship has led to a reduction in medication/medicament prescription in the public community dental clinic. Education for dental practitioners about the safe and appropriate use of antimicrobials should be continued.