Public Dental Clinics Research Articles

One year of COVID-19 in dental health services in Norway: psychological impact, risk perceptions and vaccination status

BackgroundIncreased psychological pressure on oral healthcare professionals (OHP) due to COVID-19 has been shown, yet little is known about the long-term psychological impacts. We aimed to study the psychological impact of COVID-19 and associated factors including perceived risk and preparedness and vaccination status among OHP in the first year after the lockdown period in Norway.MethodsA structured questionnaire sent electronically to dentists, dental hygienists and dental assistants inquired experiences and perceptions during the second year following the outbreak in Norway. The questionnaire comprised a COVID-19 fear scale and questions about risk perception, preparedness and vaccination status. Exploratory factor analysis (EFA) and Structural Equation Modeling (SEM) were used to assess psychological impact, perception of risk and preparedness according to vaccination status of the respondents.ResultsThe majority of the 708 respondents were female (92.8%), had ten or more years of work experience (67.1%), and worked in public dental clinics (95.9%). Fears and concerns related to COVID-19 were common, 72.6% feared getting infected and 85.4% feared infecting others. Of the 642 respondents who agreed that their workplaces handled the situation well, 55.6% were fully vaccinated. Three factors were retrieved from EFA: Insecurity, Instability and Infection. SEM showed that females were more concerned with Infection, and respondents with long clinical experience were less likely to express fear about Instability. Fully vaccinated individuals felt more insecure about becoming infected, and those agreeing that their workplaces handled the current situation well were concerned with Insecurity.ConclusionsDespite widespread perception of adequate preparedness and high vaccine coverage, a considerable psychological impact and high levels of fear of COVID-19 were observed among the majority of OHP. Fully vaccinated individuals had a larger psychological burden than not fully vaccinated and those with unknown vaccination status. These findings can inform means and interventions to reduce negative impacts of fear in populations with a high psychological burden.

Assessment of occupational risks of bloodborne infectious diseases for dental personnel

BACKGROUND: Awareness of dental workers about the epidemiology of blood-borne infections (HIV, hepatitis B virus [HBV], and hepatitis C virus infections) and knowledge about actions to take if accidents occur in the workplace such as contact with blood and other biological fluids are a key link in the prevention of these infections.
 AIMS: To assess awareness and adherence of dental personnel to the algorithm of postexposure prophylaxis of occupational infections with blood-borne pathogens.
 MATERIALS AND METHODS: This descriptive crosssectional study enrolled the dental staff of public and private dental clinics in Kazan, Russia. A survey of 173 dental staff was conducted in FebruaryMarch 2023. The rates of incidents caused by contact with blood and their nature among dental staff were determined, and the frequency of correctly performed algorithm of actions during an incident was calculated. The frequency of the implementation of measures for the prevention of occupational infections with blood-borne pathogens was estimated. Categorical data were described as absolute values and proportions (%).
 RESULTS: In total, 65 specialists (37.6%) had encountered incidents such as contact with blood at the workplace. These incidents were significantly more common among women than among men: 44.7% (55/123) vs. 20.0% (10/50), respectively (p=0.002). The last incident in 50 respondents was associated with skin damage (needlestick injury or cut exposure); in 17 participants, their mucous membranes were exposed to blood (including two people with a mixed characteristic of incident: skin damage + exposure of their mucous membranes to blood). After contact with blood, local treatment was carried out correctly (according to Russian recommendations) in 18.0% of the participants with skin damage and 70.5% with blood exposure to mucous membranes. After the incident, 58.5% of the participants (38/65) reported to the head of the department or clinic, and a third of the respondents (23/65, 35.4%) recorded a case of contact with blood in the incident log. Nearly all respondents always use gloves (172/173, 99.4%) when they work in the dental office. Moreover, 64.2% of the respondents (111/173) always use safety glasses or screens. Nine respondents (9/173, 5.2%) do not use personal eye protection. Others (53/173, 30.6%) wear safety glasses/screens only when performing certain procedures. In addition, 85.0% (147/173) of the respondents have been vaccinated against HBV, 18 have not been vaccinated (10.4%), and 8 (4.6%) do not know their vaccination status.
 CONCLUSIONS: The results of this study present the necessity of raising awareness among dental staff regarding the epidemiology and prevention of blood-borne infections to reduce the risk of occupational infections.

Apical incisor root resorption due to ectopic maxillary canine eruption: Association with time of diagnosis and type of intervention in a retrospective population-based cohort study.

The primary aim was to study upper incisor severe apical root resorption (RR) related to ectopic canine eruption and its association with timing of diagnosis and type of intervention conducted. The secondary aim was to correlate resorption with other dental anomalies. Digital journals and radiographic material of all ectopic maxillary canines registered in 2012 in the regional public paediatric dental clinics in the Council of Aarhus were inspected retrospectively. Data related to 10 variables were retrieved. Post-treatment radiographs were used for evaluation of incisor RR. A total of 260 ectopic maxillary canines were diagnosed in 2012. The majority were found in the 9-13-year-old age group (0.8% prevalence within the total population). In all, 244 canines were assessed for eligibility and 181 had adequate final radiographs for evaluation of RR. Among ectopic maxillary canines, 9.4% caused severe incisor RR to neighbouring teeth. Timely palpation for canine eruption significantly reduced the odds for upper incisor resorption by 80%. Multiple regression showed that when the permanent canine cannot be palpated and the deciduous has been extracted, delaying the first X-rays was associated with a 38% odds ratio increase for RR for each year of delay after the age of 10 years. No significant associations were found between incisor RR and intervention conducted or other dental anomalies. Palpation of erupting maxillary canines is crucial for timely diagnosis of ectopic eruption and initiation of treatment to avoid RR. If the canine cannot be palpated at 10 years of age, radiographic examination is highly recommendable.

Oral health literacy, knowledge and perceptions in a socially and culturally diverse population: a mixed methods study

BackgroundPoor oral health literacy has been proposed as a causal factor in disparities in oral health outcomes. This study aims to investigate oral health literacy (OHL) in a socially and culturally diverse population of Australian adults visiting a public dental clinic in Western Sydney.MethodsA mixed methods study where oral health literacy was assessed using the Health Literacy in Dentistry scale (HeLD-14) questionnaire and semi-structured interviews explored oral health related knowledge, perceptions and attitudes. Interviews were analysed using a thematic approach.ResultsA sample of 48 participants attending a public dental clinic in Western Sydney was recruited, with a mean age of 59.9 (SD16.2) years, 48% female, 50% born in Australia, 45% with high school or lower education, and 56% with low-medium OHL. A subgroup of 21 participants with a mean age of 68.1 (SD14.6) years, 40% female, 64% born in Australia, 56% with a high school or lower education, and 45% with low-medium OHL completed the interview. Three themes identified from the interviews included 1) attitudes and perceptions about oral health that highlighted a lack of agency and low prioritisation of oral health, 2) limited knowledge and education about the causes and consequences of poor oral health, including limited access to oral health education and finally 3) barriers and enablers to maintaining good oral health, with financial barriers being the main contributor to low OHL.ConclusionsStrategies aimed at redressing disparities in oral health status should include improving access to oral health information. The focus should be on the impact poor oral health has on general health with clear messages about prevention and treatment options in order to empower individuals to better manage their oral health.

What’s new for the clinician – summaries of recently published papers (April 2023)

Dental implants are a common treatment modality that is offered to many patients. There is therefore a good chance that many oral health professionals (dentists, dental therapists, oral hygienists, dental specialists) will encounter such patients in their private or public dental clinics. Barrak and colleagues (2023)1 have highlighted the mismatch between the knowledge and skill requirement of the general dental practitioner (GDP) in managing such patients and the training provided at undergraduate (UG) and general postgraduate (PG) levels. Studies in the UK among dental schools there and in Ireland have shown that most schools provided lecture-based information with no clinical trainingat undergraduate level on implant dentistry. This, despite the fact that most implants were in fact placed by dentists who had little training in their undergraduate training.

COVID-19 and smoking: Considerations after two years

COVID-19 and smoking: Considerations after two years

Positive impacts of oral health services provision by a student-led primary care clinic to an Australian rural indigenous community.

This study aimed to determine whether oral health services provision by a dental student clinical outplacement embedded within a Community Controlled Health Service positively impacted a rural Indigenous community and to explore the nature of these benefits. Aggregated and de-identified 2017, 2018 and 2019 student-led clinic services provision data were retrospectively analysed. The change in services mix over time was measured. Rural outplacement clinic operational costs to the university were estimated. Government-funded local public dental clinic waiting list and services provision data were used to identify any student clinic establishment effect. The student-led clinic services mix shifted over time from mainly acute care for toothache towards prevention of disease and tooth restoration, indicating an improvement in patient oral health and correspondingly reduced system costs. Imputed value of 2017-2019 student-led clinic services provision totalled almost AUD$1 million. Government public clinic waiting list times decreased after full establishment of the student-led clinic, indicating decreased pressure on the public system. The Community Controlled Health Service and university partnership improved community oral health care access, its timely delivery and simultaneously provided valuable human capital development from the student training experience. The student-led clinic's targeted Indigenous community showed oral health improvement over time. © 2023 Australian Dental Association.

Distribution of dental practices in Jazan of Saudi Arabia: a GIS-based approach

BackgroundJazan region in the Kingdom of Saudi Arabia (KSA) has been extensively studied regarding access to dental care services, but there is currently no specific study on the distribution of public (primary healthcare centres (PHCs) and hospitals) and private dental healthcare facilities in the area. This study aimed to evaluate the spatial distribution of public and private dental care facilities in the Jazan region in relation to the population distribution in each governorate of the region.MethodsThe most up-to-date, easily accessible, and anonymous data and information were used for this investigation. The Ministry of Health’s (MOH) Statistical Yearbook 2020 and interactive map were used to identify the locations of healthcare facilities. These locations were plotted on a map using Google Maps, and the data was converted to longitude and latitude with 90% level building accuracy. QGIS’s integrated database was used to develop buffer zones and perform attribute analysis. The data was then exported for analysis in Microsoft Excel, where healthcare facility-to-population ratios were determined.ResultsIn Jazan region, consisting of 17 governorates and a population of 1,726,739, there were 275 public and private dental clinics, with a ratio of one dental clinic per 6,279 people in terms of general health services. Only 12.4% of these clinics were located beyond 20 km of the city centre, serving approximately 70% of the region’s population.ConclusionThe uneven distribution of dental clinics in the Jazan region has hampered access to dental treatments and has led to a significant burden on dental health facilities, reducing the quality of care available in the region. Mapping the distribution of MOH, private, and other health facilities, as well as the burden of oral disease in the Jazan region, is necessary for further research.

Association between oral health knowledge, perceived oral health related quality of life, perceived oral health status and emergency department and/or urgent care visit: Results from the multi-site oral health literacy study.

To assess the link between oral health knowledge (OHK), self-perceived oral health, and emergency room (ER)/urgent care utilization for a dental problem. Data were analyzed from a convenience sample of 790 adult participants who presented to two US dental schools and completed an interviewer-administered survey. Key independent variables were OHK assessed with the Comprehensive Measure of Oral Health Knowledge (CMOHK) instrument, self-perceived oral health status and quality of life determined using the General Oral Health Assessment Index (GOHAI) scores. The dependent variable was ER and/or urgent care utilization for a dental problem. Select sociodemographic variables such as age and gender were adjusted for in logistic regression models using SAS. 15.7% of the participants had ever visited an ER and/or urgent care for a dental problem. CMOHK scores were not significantly associated with visits to the ER and/or urgent care. In adjusted analysis, participants with unfavorable GOHAI scores were about three times as likely to have had an ER and/or urgent care visit (OR=2.60, 95% CI: 1.66-4.09). Similarly, participants who were unsatisfied with their oral health were about twice as likely to have had an ER and/or urgent care visit (OR=1.91, 95% CI: 1.21-3.00) as compared to those satisfied with their oral health status. Individuals unsatisfied with their oral health and those with unfavorable perceived oral health related quality of life could benefit from a greater awareness of dental service availability and extended hours including weekend hours at public dental clinics.

Oral lesions associated with daily use of snus, a moist smokeless tobacco product. A cross-sectional study among Norwegian adolescents

Objective Use of snus, a moist, smokeless tobacco product, may lead to local changes in the oral mucous membrane in the area where the snus is placed. It can also cause irreversible gingival retraction. This cross-sectional study aimed to investigate the relationship between use of snus, oral mucosal lesions (snus induced lesions) and gingival retractions among adolescents in Norway. Material and Methods All 18–20 years olds visiting public dental health clinics in the south-eastern region of Norway between October 2015 and December 2016 were invited to participate. All participants (n = 1363) filled in an electronic questionnaire before a clinical examination. Of these, 216 used snus daily. Results Snus induced lesions were observed in 79.2% of daily snus using participants. In adjusted regression analyses, the odds of having a more severe lesion as opposed to a less severe lesion were 1.12 times greater for each additional box of snus used in a month (p < .01). Women were 46% less likely to have a severe lesion than men (p = .03). Gingival retractions were observed in 18.4% of the participants. The odds for dental retraction were significantly higher by 34% for each year of snus use. Conclusions Most of the adolescents using snus had snus induced lesions, whereas approximately one-fifth had gingival retractions. The severity of the lesion and gingival retraction increased with the amount of snus boxes used and the duration of the snus use, respectively.

Current tobacco use and COVID-19 diagnoses in a cohort of adult clients of public dental clinics in Sweden

Smoking has been linked with both increased and decreased risk of COVID-19, prompting the hypothesis of a protective role of nicotine in the pathogenesis of the disease. Studies of the association between use of smokeless tobacco and COVID-19 would help refining this hypothesis. We analysed data from 424,386 residents in the Stockholm Region, Sweden, with information on smoking and smokeless tobacco (snus) use prior to the pandemic obtained from dental records. Diagnoses of COVID-19 between February and October 2020 were obtained from health-care registers. We estimated the risk of receiving a diagnosis of COVID-19 for current smokers and for current snus users relative to non-users of tobacco, adjusting for potential confounders (aRR). The aRR of COVID -19 was elevated for current snus users (1.09 ;95%CI = 0.99–1.21 among men and 1.15; 95%CI = 1.00–1.33 among women). The risk for women consuming more than 1 can/day was twice as high as among non-users of tobacco. Current smoking was negatively associated with risk of COVID-19 (aRR = 0.68; 95% CI = 0.61–0.75); including hospital admission (aRR = 0.60; 95% CI = 0.47–0.76) and intensive care (aRR = 0.43; 95% CI = 0.21–0.89). The hypothesis of a protective effect of tobacco nicotine on COVID-19 was not supported by the findings. The negative association between smoking and COVID-19 remains unexplained.

Prevalence of malocclusion and orthodontic treatment needs among Saudi primary school male children aged 6–12 years: A cross-sectional study

Aim: To evaluate the prevalence of malocclusion and the need for early orthodontic treatment (EOT) using dental health component (DHC) of the index of orthodontic treatment need (IOTN). Materials and Methods: In this cross-sectional study, clinical examination was performed on 357 male children, aged 6–12 years who were randomly selected from five public schools and one public pediatric dental clinic, in Al-Kharj province, Saudi Arabia. The examination assessed various occlusal parameters using IOTN, across the total sample and further between two subgroups (early and late mixed dentitions). Results: For the total sample 58.8% had Angle’s Class I malocclusion, 26.7% had Angle’s Class II, 9.8% had Angle’s Class III, while crowding was present in 44.5%. Over 1/4 of the younger group and 42.8% of the older group exhibited at least one feature indicating EOT: anterior crossbite, posterior crossbite, open bite, impinging overbite, ≥7 mm overjet, and Class III malocclusion. However, no statistical differences were found between the two groups (P > 0.05). According to DHC score, 77 participants (21.6%) were in definite OTN. The DHC score demonstrates its validity in identifying evidence-based malocclusion features as significant indicators for EOT. Compared to DHC, the esthetic component significantly overestimated lack of OTN and significantly underestimated definite OTN (P < 0.05). Conclusion: The prevalence of malocclusion and EOT need is generally similar among younger and older children, but the distribution is higher among older children. Orthodontic screening at early mixed dentition stage is essential.

A Pilot Feasibility Study to Establish Full Pulpotomy in Mature Permanent Teeth with Symptomatic Irreversible Pulpitis as a Routine Treatment in Mexican Public Healthcare Services.

Symptomatic irreversible pulpitis is a common dental disease for which root canal treatment (RCT) has been the standard treatment. However, in many countries, RCT is considered a high-cost treatment that is not covered by public healthcare services; this forces patients to have dental extraction as their only option to relieve pain. In the last decade, several investigations have provided evidence that an alternative treatment known as full pulpotomy (FP) could be an alternative for patients who could not afford the cost of an RCT. Nevertheless, evidence is lacking on the success rate that could be obtained if it is performed in a public dental care clinic (PDCC). The present investigation has two main objectives. To be the first approach of a multicentric feasibility study to find out whether an FP performed by a general practice dentist (GPD) in a PDCC could be suitable and establish its success rate and patient satisfaction. Patients attending a PDCC with symptoms of irreversible pulpitis were invited to participate. FP was performed and followed up at 1, 3, 6, 9, and 12 months. The treatment success was assessed by combining three variables, patient satisfaction, clinical, and radiographic outcomes. Forty-one patients from 17 to 78 years old received the intervention. In total, 97.5% were completely satisfied with the treatment and were considered successful since none of the clinical or radiographic variables were present in any of the follow-ups. An FP performed by a GPD in a PDCC could be suitable as a routine treatment for symptomatic irreversible pulpitis due to the excellent success rate and patient satisfaction.

Knowledge, attitudes, and practices related to COVID-19 among patients attending public dental clinics in Tanzania: A cross-sectional study.

The risk of contracting COVID-19 through dental treatment is potentially high, thus several guidelines have been developed to minimize the spread of COVID-19 in the dental office worldwide. These changes have posed some relevant questions among oral health professionals regarding the understanding and attitudes of dental patients toward COVID-19. This study aimed to assess the knowledge, attitude, and practices of dental patients in Dar es Salaam, Tanzania. This cross-sectional study was carried out in 4 public hospitals in Dar es Salaam, Tanzania involving 472 adult patients. Data were collected using a questionnaire that had a set of questions regarding knowledge, attitude, and practices (KAP) related to COVID-19. Data were analyzed using the SPSS computer software version 26. For descriptive analysis means, standard error of the mean, and proportion were used. Multivariate regression analysis was utilized for the response analysis. Alpha of less than 0.05 was considered to indicate statistical significance. Good levels of knowledge, attitude, and practices related to COVID-19 were found in 76.5%, 74.8%, and 58.1% of participants respectively. On performing multivariate analysis, odds of having good knowledge regarding COVID-19 were almost 2 folds higher in participants who were females, with high education levels, those without partners, and those with stable income. Females were 1.5 folds more likely to have a good attitude toward COVID-19 and odds of good practice against COVID-19 were 3 folds higher in young adults compared to the elderly. A majority of dental patients have good knowledge and attitude related to COVID-19. Predictors of good knowledge were sex, education level, marital status, and income of the participants. Sex predicted good attitude and age predicted good practice.

The Healing Environment of Dental Clinics through the Eyes of Patients and Healthcare Professionals: A Pilot Study.

The physical environment of healthcare settings can promote both the healing process and patient feelings of well-being, as well as instill positive emotions in employees. The present study aimed to evaluate the dental work environment of a typical private and public dental clinic to identify key parameters that determine the perception of health facilities by patients and employees. The study was carried out from 1 to 20 December 2021, in two dental clinics in Ekaterinburg (Russian Federation) using ‘ASPECT’. The participants were 58 staff and 94 patients. The results showed that, compared with patients, staff reported higher views scores, nature and outdoors scores, and comfort and control scores. The common criterion that distinguishes private clinics from public ones was comfort and control. Compared with patients in state clinics, patients in private clinics reported higher privacy, company and dignity scores, comfort and control scores, interior appearance scores, and facility scores. In general, while views scores and nature parameters can be singled out as a universal absolute value for everyone in a particular environment, staff pay more attention to factors that contribute to long-term comfortable stay and performance of their duties.

Attitudes, techniques and trends in endodontic treatment by general dental practitioners in Benghazi- Libya

Introduction: The success of the root canal treatment depends on the attitudes, techniques and different approaches that carried out by the dental practitioners who made major impact on performing a high standard level of dental treatment to get a great quality of work. Aim: The objective of this research was to investigate the current trends and attitudes in endodontic treatment exhibited by general dental practitioners worked in private and public dental clinics in Benghazi- Libya.&#x0D; Materials and Methods: This study was accomplished in March 2017 included 170 general dental practitioners worked in private and public dental clinics in Benghazi Libya. Each participant received structured questionnaires to assist the attitudes, techniques, current trends, materials and new technology used in a daily endodontic practice. All returned forms were evaluated by a single operator. Descriptive statistics and frequency distribution were analyzed using SPSS version 21 and Chi-square test.&#x0D; Results: The respond of participants was 150 represent 88.23% response rates. The results showed that 78% (117) of the respondents they did not build up the tooth before starting RCT and the majority preferred multiple visits per endodontic treatment. The main isolation method was cotton roll with saliva suction (77.3%). About (43.3%) of the practitioners used step-back technique for canal preparation and the most common used hand instruments was a K-files in conjunction with hedstrom files (50%). The finding of this study indicated that (52.7%) of the practitioners took 0.5 mm working distance from the apex. Sodium hypochloride was the common irrigant (55.3%) and (38%) of respondents used calcium hydroxide as intracanal medicament. Lateral condensation was more common among the respondents (64%) and the zinc oxide-eugenol was the common type of sealer used among them (45.3%). The most common restorations were composite materials (34.7%). Conclusion: It was concluded that the general participant dentists in Benghazi city did not keep up with the newly introduced techniques in endodontic as they were used more conventional methods in their work which could be attributed to lack in expertise and recognition of new technology in a daily endodontic work.

Reasons for Delay in Seeking Treatment for Dental Caries in Tanzania

IntroductionThe delay in seeking dental treatment is a universal health problem, with a reported prevalence as high as 98%. It is a critical feature not only in planning management but also in the final treatment outcome. AimThis study aimed to determine the reasons for the delay in seeking treatment for dental caries amongst patients attending public dental clinics in Dar es Salaam, Tanzania. MethodologyThis was a cross-sectional study carried out in 5 public hospitals in Dar es Salaam, Tanzania. It included 315 adult patients who had dental caries. Data were collected using a questionnaire that included questions regarding reasons for the delay in seeking care for dental caries. Data were analysed using the SPSS computer software version 26. A one-way analysis of variance was used to assess the association between variables, and the significance level was set at P < .05. ResultsA majority (n = 244, 77.5%) of the participants delayed seeking dental care upon noting a problem in their teeth. However, the association between the sociodemographic characteristics of the participants and delay in seeking dental care was statistically insignificant (P > .05). The most common reason given by the participants who delayed seeking dental care for their decayed teeth included self-negligence (n = 184, 75.4%), the practice of self-medication (n = 164, 67.2%), and ignorance (n = 110, 45.1%). ConclusionsThe majority of patients experiencing dental caries seek dental care very late. Delay in seeking dental care is not dependent on sociodemographic characteristics of individuals. Self-negligence, the practice of self‑medication, and ignorance are the major reasons for the delay.

Dental unit water content and antibiotic resistance of Pseudomonas aeruginosa and Pseudomonas species: a case study

ABSTRACT Background Many studies consider the contamination of dental unit waterlines (DUWLs), but few of them have studied the possible presence of antibiotic resistant Pseudomonas aeruginosa in the DUWLs. Aims Investigation of the presence of P. aeruginosa and Pseudomonas spp. strains in DUWLs and evaluation of their resistance to six antibiotics (ceftazidime, netilmicin, piperacillin/tazobactam, meropenem, levofloxacin, colistin sulfate) at a public dental clinic in Milan, Italy. Results Dental units were contaminated by P. aeruginosa with loads of 2–1,000 CFU/L and were mainly located on the mezzanine floor, with a range of 46–54%, while Pseudomonas spp. were primarily found on the first and second floors, ranging from 50 to 91%. P. aeruginosa was antibiotic resistant in 30% of the strains tested, andPseudomonas spp. in 31.8% . Cold water from controls was also contaminated by these microorganisms. Conclusion Monitoring antibiotic resistance in the water and adopting disinfection procedures on DUs are suggested within the Water Safety Plan.

Leadership, work environment and caries prevention – what is good for the staff, is also good for the patients

Objectives Dental caries is a health problem that can be prevented. The aim of this study is to analyse if the quality of leadership, in Swedish Public Dental Health clinics, influences the extent to which patients with caries receive preventive care, and if any such effect is mediated through a collaborative work climate, clear role expectations and a low average level of burnout among staff. Methods The multilevel cross-sectional design includes work environment data from surveys of 75 general public dental clinics, register-based data on preventive measures provided to 5398 patients who received a dental filling due to a caries diagnosis, and patient demographics. Using a multilevel path analysis with logistic regression, we tested a model with one direct and three indirect pathways, controlling for the potential confounding effect of patient demographic factors. Results Leadership quality, as assessed by the staff at the clinic, was associated with increased odds of patients with caries receiving prevention, controlling for patient demographic factors. Leadership quality was also positively related to a collaborative work climate, clear role expectations and a low average level of burnout among staff. Against expectations, however, no indirect effect from leadership quality on prevention through the other work environment factors was found. Conclusions In conclusion, the quality of leadership in Swedish Public Dental Health clinics was positively related to a good work environment for staff and to delivery of preventive care to patients experiencing caries.

Oral healthcare attendance and the effectiveness of referrals for rural antenatal women.

To analyse the effectiveness of targeted stakeholder engagement strategies and the impact they have on antenatal referrals, oral health admission, attendance and education of pregnant women in a rural public dental clinic. Key stakeholders (obstetric trained general practitioners [GPs] and midwives) were educated and motivated to refer pregnant women to the rural public dental clinic via priority referral pathways. A 10-month pre- and post-intervention period of oral health assessments and treatments was compared and contrasted. Quasi-experimental study. A rural health service in the Loddon Mallee region, Victoria. Local pregnant women, 18 years of age or older, eligible for public dental care. Increased oral health admission, attendance and education of pregnant women. Active engagement with key stakeholders significantly increased the oral health referral, admission and attendance of eligible antenatal women. Prior to the intervention, only 15.04% of eligible antenatal women sought oral health treatment, in comparison with 40.37% post-intervention. Of the 62 women referred, 44 actively received dental care. Active engagement with key stakeholders has demonstrated a clinically effective method of increasing antenatal referrals of socially disadvantaged women to a rural public dental clinic. Further collaboration between healthcare professionals can improve the oral health admission rates, attendance and education of antenatal women and their children.