Con Prof Jane Taylor

The legal matrix under which forensic odontologists practice in Australia is governed by the civil and criminal framework that affects all Australian citizens and therefore healthcare providers including dentists.

Forensic odontology played a vital and historical role in an Australian homicide in 1934. Known as the Albury Pyjama Girl Case, it attracted worldwide interest for many years and illustrated the potential and the importance of dental evidence in the identification process. On the 1st of September of that year, the partly burned and battered body of a young woman clad in pajamas was found in a roadside culvert near Albury, NSW. This discovery led to one of the longest investigations in the history of Australian crime. Two simple errors by a local dentist with no previous experience in forensic odontology, who was called in by the police to examine the teeth of the victim, resulted in a delay in identification for 10 years. When identification by dental comparison was finally achieved in 1944, the crime was quickly solved and the woman's husband was brought to trial for murder. The application of dental science for identification in those days was on an ad hoc basis, and individual dentists, usually with no experience or training in forensic matters, were expected to assist as needed. The Pyjama Girl Case vividly demonstrated the serious consequences of this practice (Brown 1984).

Research supports the need for regionally and ethnically specific validated data as the reference base for age estimation techniques. This retrospective study evaluated the accuracy of three dental age estimation methods; Demirjian et al. (1973), Willems et al. (2001), and Blenkin and Evans (2010), for use in Sri Lanka for medico-legal purposes. Panoramic radiographs of 688 Sri Lankan children ranging in age from 8.00 to 16.99 years were used to determine their appropriateness to a Sri Lankan population. The mean age and standard deviations (±SD) were calculated separately for males and females of each age group. Paired t-test and mean absolute errors (MAE) were calculated to compare the calculated dental age (DA) with the chronological age (CA) across the nine age groups. The results revealed the mean CA of the entire sample was 12.38 ± 2.68 years, while the mean DA calculated using the Blenkin and Evans method was 11.83 ± 2.20 years, using the Demirjian et al. method was 12.57 ± 2.53 years, and using the Willems et al. method was 11.99 ± 2.43 years. The Demirjian et al. method consistently overestimated the age of males except in the 2 groups aged over 15 years, whereas the Blenkin and Evans method consistently underestimated the age except for the 11.00¿12.99 age range. The method of Willems et al. produced DA quite close to CA up until 12.99 years of age, and then underestimated the age for all higher age groups. In females, the Demirjian et al. method consistently overestimated the age up until 13.99 years and then underestimated the higher age groups, while the Willems et al. method underestimated the age in all age groups except 10.00¿10.99 years. The Blenkin and Evans method also consistently underestimated the age except in the 10.00¿10.99 and 12.00¿12.99-year age groups. The percentages of either overestimation or underestimation calculated for ±0.5 years of the true age were 41.0% for the Blenkin and Evans method, 42.8% for the Demirjian et al. method and 49.1% for the Willems et al. method. In conclusion, while all three methods could be applicable in the estimation of dental age for medico-legal purposes, the Willems et al. method appears to be more appropriate in overall measures for the Sri Lankan reference sample, up to the age of 12.99 years.

As part of a series of studies aimed at validating techniques in forensic odontology, this study aimed to validate the accuracy of ante-mortem (AM)/postmortem (PM) radiographic matching by dentists and forensic odontologists. This study used a web-based interface with 50 pairs of AM and PM radiographs from real casework, at varying degrees of difficulty. Participants were shown both radiographs as a pair and initially asked to decide if they represented the same individual using a yes/no binary choice forced-decision. Participants were asked to assess their level of confidence in their decision, and to make a conclusion using one of the ABFO (American Board of Forensic Odontology), INTERPOL (International Criminal Police Organisation) and DVISys¿ (DVI System International, Plass Data Software) identification scale degrees. The mean false-positive rate using the binary choice scale was 12%. Overall accuracy was 89% using this model, however, 13% of participants scored below 80%. Only 25% of participants accurately answered yes or no > 90% of the time, with no individual making the correct yes/no decision for all 50 pairs of radiographs. Non-odontologists (lay participants) scored poorly, with a mean accuracy of only 60%. Use of the graded ABFO, DVISYS and INTERPOL scales resulted in general improvements in performance, with the false-positive and false-negative rates falling to approximately 2% overall. Inter-examiner agreement in assigning scale degrees was good (ICC = 0.64), however there was little correlation between confidence and both accuracy or agreement among practitioners. These results suggest that use of a non-binary scale is supported over a match/non-match call as it reduces the frequency of false positives and negatives. The use of the terms "possible" and "insufficient information" in the same scale appears to create confusion, reducing inter-examiner agreement. The lack of agreement between higher-performing and lower-performing groups suggests that there is an inconsistency in the cognitive processes used to determine similarity between radiographs.

Greater support is required in health promotion for practitioners to adopt critical approaches to their practice. Despite recognition of the role that critical reflection can play in supporting critical practice, it is underdeveloped in health promotion. This pilot study aimed to explore the use of critical reflection with health promotion practitioners. Critical postmodernism provided the theoretical perspective and critical reflection methodology guided the study. The data collection method involved the application of a critical reflection model via in-depth semi-structured interviews with two health promotion practitioners who were recruited using purposive sampling. Critical postmodernism and critical health promotion values and principles were the thematic frameworks used to analyse the data. Four types of assumptions were identified across both participants' narratives: binary opposites and dichotomous thinking; identity and othering; professionalism; and power. Two key themes that evidenced these assumptions were conceptualising power as a commodity, and identity in the Aboriginal and Torres Strait Islander context. Both traditional and critical health promotion practice approaches were evident in participants' practice. The process of engaging in critical reflection resulted in positive outcomes for the practitioners, including the identification of new, more critical ways of practising. Critical reflection provides a process for developing critical health promotion practice. The designation of critical reflection as a core health promotion competency may enhance the development of critical health promotion. Further research is needed to develop and test a critical reflection model incorporating the values and principles of health promotion with a larger sample of practitioners.

The aim of this study was to assess the status of cultural competency education in Australian and New Zealand dental, dental hygiene, and oral health therapy programs. The study sought to explore the extent to which cultural competence is included in these programs' curricula, building on similar studies conducted in the United States and thus contributing to the international body of knowledge on this topic. A 12-item instrument was designed with questions in four areas (demographics, content of cultural competency education, organization of overall program curriculum, and educational methods used to teach cultural competence) and was sent to all Australian and New Zealand dental, dental hygiene, and oral health therapy educational programs. Of the total 24 programs, 15 responded for a response rate of 62.5%. The results showed that lectures were the most frequent teaching method used in cultural competency education; however, the variation in responses indicated inconsistencies across study participants, as discussions and self-directed learning also featured prominently in the responses. The majority of respondents reported that cultural competence was not taught as a specific course but rather integrated into their programs' existing curricula. The variations in methods may indicate the need for a standardized framework for cultural competency education in these countries. In addition, the notion of cultural competency education in academic dental institutions demands additional evaluation, and further research is required to develop a solid evidence base on which to develop cultural competency education, specifically regarding content, most effective pedagogies, and assessment of student preparedness.

This pilot study is a validation of a modified Demirjian's System developed for the Australian population by Blenkin and Evans. The study sample comprised orthopantomographs of 230 individuals aged 2.5 to 14.5¿years. Seven right mandibular teeth (excluding the wisdom tooth) were assessed and graded according to the Demirjian's stages of tooth development. Corresponding modified numeric scores for the stages were summed to form a simple maturity score from which age estimates were derived. The mean difference between the estimated and chronological age for girls was 0.02¿years, 95% CI [-0.13, 0.17]. Paired-sample t-test results found this difference not to be statistically significant p = 0.81, <0.05. For boys, the method underestimated the age with a mean difference of ¿0.24¿years 95% CI [¿0.4, ¿0.08]. Paired t-test found this to be significantly different (p = 0.003). This study found that the modified Demirjian's System of Blenkin and Evans is valid for use in the Australian population.

Objectives: Recent literature has identified a number of potential advantages in wearing loupes for dental hygienists, including improved quality of care and ergonomics. The aim of the study was to determine dental hygienists' opinions about wearing loupes. Methods: A short online survey was distributed to all dental hygienists who had recently participated in a study investigating the efficacy of loupes on musculoskeletal disorders; all had only worn loupes for a 6-month period, and prior to the study had not worn loupes. All of those invited completed the survey (n¿=¿12), achieving a 100% response rate. Results: The majority of respondents noted that the loupes were adaptable to wear; however, only one-quarter of hygienists surveyed were wearing them often following the study. Respondents identified that the biggest advantage to loupes was calculus removal (91.7%), and most indicated that they felt the quality of their work increased when wearing loupes (75%). The biggest disadvantage to wearing loupes was the adjustment period (50%), with limited depth of vision, headache, vertigo and infection control noted by at least one-third of respondents. Conclusions: This study revealed that hygienists identify both benefits and limitations to wearing loupes, and therefore, ongoing support may be required for hygienists adopting their use in clinical practice.

Background: The aim of this study was to investigate factors that influence dental therapists and oral health therapists (therapists) plan preventive oral health care for adolescents attending New South Wales public oral health services. Methods: A cross-sectional postal survey using two clinical vignettes was used to record the preventive care treatment plans offered by therapists working across 15 New South Wales local health districts. Data were tabulated and chi-square statistics used in the analysis. Results: One hundred and seventeen therapists returned questionnaires, giving a 64.6% response rate. The participants highlighted the importance of offering oral hygiene instruction (97.0%), dietary advice (95.0%) and topical fluoride applications (74.0%). Recommended home use products included fluoride toothpaste 5000 ppmF (59.0%) and casein phosphopeptide-amorphous calcium phosphate plus fluoride (CPP-ACPF) paste (57.7%). Over 50% used fissure sealants. More respondents (88%) would utilize motivational interviewing strategies for a patient with dental caries concerns; however, only 63% would use this technique for a patient in pain (p < 0.001). Conclusions: Considerable variations were noted in therapists' recommendations for stabilizing and managing dental disease, suggesting a need for clinical directors to consider providing more advice to therapists on the scientific basis of preventing dental caries.

BACKGROUND: Musculoskeletal disorders represent a significant occupational health issue in dental hygiene, with high prevalence rates documented. Despite this fact, there have been few advancements in the application of ergonomic principles in the dental hygiene profession. While the use of loupes is often promoted as an ergonomic solution, there is little published research to support this claim. OBJECTIVES: The aim of the present study, therefore, was to investigate the effect of the use of loupes on neck pain and disability in dental hygienists. METHODS: The study was conducted using an exploratory pre-test post-test design, comparing musculoskeletal measures in dental hygienists wearing loupes with final year dental hygiene students who do not wear loupes. Pre- and post-test measures included the Neck Pain and Disability Scale and a standardised physical assessment using previously validated measures. Statistical analysis was conducted as a series of mixed ANOVAs with time and treatment as the independent variables. RESULTS: While the analyses revealed no significant interactions between time and treatment (p< 0.05), there were general trends of improvement or deterioration for outcome measures. Improvements over time were noted in the treatment group for cervical range of motion and deep neck muscle endurance; however deteriorations were noted for forward head posture and cervical kinaesthetic sense. CONCLUSIONS: Overall, despite no statistically significant differences being detected, this study suggests that wearing loupes appears to have both positive and negative outcomes with regards to physical well-being. As such, further studies are required to more precisely determine the effects of loupes on MSD among dental hygienists, particularly long-term. Dental hygienists with existing neck pain exploring ergonomic equipment may reflect on the findings and consider the potential benefits and risks of wearing loupes.

PURPOSE: The aim of this retrospective, cross-sectional study was to assess the frequency of dietary advice provision by dental hygiene students.

Objectives: The aim of this study was to determine whether a qualified dental hygienist could improve oral health outcomes for residents living in residential aged care facilities on the Central Coast of New South Wales, Australia. Methods: A qualified dental hygienist undertook a 24-week oral hygiene intervention in five residential aged care facilities to test the Senior Smiles, oral health model of care. The facilities were invited to take part in the research, which was funded by a grant from NSW Medicare Local, Erina. Residents were asked to consent to having oral health risk assessments, oral healthcare plans and to receiving referrals for treatment where needed. Pre- and post-intervention plaque scores were recorded for residents and P values calculated using a paired t-test. In addition, the number of residents examined, treated and referred for more complex dental care was recorded. Results: The statistical analysis program, SPSS, was used to conduct a paired t-test to compare pre- and post-intervention plaque scores on residents from the 5 RACFs. A statistically significant result of P < 0.0001 showed the intervention of the dental hygienist was effective in reducing plaque scores in residents across the 5 RACFs. Conclusion: The Senior Smiles model of care provided residents with preventive oral hygiene care, referral pathways for complex dental treatment needs and established a formal management programme for ongoing oral health care within the RACFs. The Senior Smiles model of care is successful and transportable.

Objective The aim of this study was to record preventive oral health care planned by dental therapists and oral health therapists (therapists) for patients with poor oral hygiene undergoing orthodontic treatment. Materials and methods A cross-sectional survey, using a clinical vignette of a patient with poor oral hygiene undergoing therapy with a fixed appliance, was undertaken to record the preventive care offered to this individual by therapists working across 15 Local Health Districts (LHDs). This orthodontic vignette was inserted between two dental caries-related vignettes. Data were coded and descriptive statistics were used to report the findings. Results One-hundred and seventeen therapists returned questionnaires (giving a response rate of 64.6%), of whom 82.0% (n = 95) completed the orthodontic vignette. Adopting motivational interviewing techniques to facilitate communication with the patient and their parent was recommended by 88.4% (n = 84) respondents, 98.0% (n = 93) offered oral-hygiene instruction, 70.5% (n = 67) recorded plaque levels and used disclosing solution and 60.0% (n = 57) offered dietary advice. Products recommended for use at home included fluoride toothpaste [1,450 ppm F (80.0%; n = 76) and 5,000 ppm F (59.0%; n = 24)] and casein phosphopeptide amorphous phosphates plus fluoride (CPP-ACPF) paste (33.3%; n = 32). Less than 20% offered fissure sealants. Conclusion Preventive advice and care was offered inconsistently by therapists in this study. To ensure that all therapists adopt a scientifically based approach to prevention, LHD clinical directors should implement continuous professional education programmes for therapists to improve patient's health outcomes.

PURPOSE: Musculoskeletal disorders (MSDs) are a significant occupational health issue for the dental hygiene profession. There is increasing evidence that these problems commence during undergraduate training; however, there is a surprising lack of studies investigating how MSD develops in student groups over the course of their study. The aim of this study was to determine the longitudinal MSD trends among a cohort of undergraduate dental hygiene students at an Australian university.

Objectives: It is well established that musculoskeletal disorders (MSD) are a significant occupational health issue for dentists and hygienists. Despite this, there has been little advancement in the application of ergonomic principles in the dental profession. While the use of loupes is often promoted as an ergonomic solution, there is little published research to robustly support this claim. The aim of the present study was to investigate the effect of the use of loupes on upper extremity MSD among dental hygienists. Methods: The study was conducted using an exploratory pretest and post-test design, comparing musculoskeletal measures in practising dental hygienists wearing loupes with final-year dental hygiene students who did not wear loupes. Pre- and post-test measures included valid self-reported and objective outcome measures and were measured at baseline and 6 months following the intervention. Statistical analysis was conducted as a series of mixed anovas with time and treatment as the independent variables. Results: The analysis revealed a significant interaction between time and treatment for the Disabilities of the Shoulder, Arm and Hand (DASH) scores (P < 0.04), indicating an improvement in symptoms for the treatment group but a reversed trend for the controls. There was also a significant mean increase in scapular position measures; however, this finding was evident in both groups, indicating that these were not a result of the intervention. Conclusions: Overall, this study suggests that wearing loupes appears to have both positive and negative effects on upper extremity MSD among dental hygienists. Ongoing research is required to determine the long-term effects of loupes wear, over an extended period of time. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.