Westmead Center for Oral Health

Sydney, Australia

Westmead Center for Oral Health

Sydney, Australia
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PubMed | Leeds Dental Institute, Postgraduate Dental Dean, University of Pennsylvania, New York University and 6 more.
Type: Journal Article | Journal: Oral surgery, oral medicine, oral pathology and oral radiology | Year: 2015

To explore international consensus for the validation of clinical competencies for advanced training in Oral Medicine.An electronic survey of clinical competencies was designed. The survey was sent to and completed by identified international stakeholders during a 10-week period. To be validated, an individual competency had to achieve 90% or greater consensus to keep it in its current format.Stakeholders from 31 countries responded. High consensus agreement was achieved with 93 of 101 (92%) competencies exceeding the benchmark for agreement. Only 8 warranted further attention and were reviewed by a focus group. No additional competencies were suggested.This is the first international validated study of clinical competencies for advanced training in Oral Medicine. These validated clinical competencies could provide a model for countries developing an advanced training curriculum for Oral Medicine and also inform review of existing curricula.


Hsieh S.G.-S.,Childrens Hospital at Westmead | Hsieh S.G.-S.,Westmead Center for Oral Health | Hibbert S.,Childrens Hospital at Westmead | Shaw P.,Childrens Hospital at Westmead | And 2 more authors.
Cancer | Year: 2011

BACKGROUND: The aim of this study was to examine the effect of antineoplastic therapy on dental development and saliva function in recipients of childhood antineoplastic therapy. METHODS: Patients attending the long-term follow-up clinic at Children's Hospital at Westmead, NSW, Australia, were included if they had received treatment prior to 16 years of age and were in remission for more than 5 years. A dental examination and saliva test were performed for each participant. Holtta's Defect Index (HDI) was used to assess tooth aplasia, microdontia, and root-crown ratio on an orthopantomogram (OPG). Multivariable-adjusted regression analyses were used to estimate the association of patient characteristics and treatment modalities with dental outcomes. RESULTS: One hundred six participants (61% male) were recruited (response rate = 88%). The mean HDI score was 24.7 ± 17.8. A cumulative dose of cyclophosphamide >7500 mg/m2 increased the HDI score by 13.06 (P =.01). Recipients of cyclophosphamide also had significantly increased odds of exhibiting very low saliva flow (<0.7 mL/min) (odds ratio = 12.43; 95% confidence interval, 2.08-74.35; P =.006). CONCLUSIONS: Children and adolescents who received high doses of cyclophosphamide were at increased risk of dental disturbances. Cyclophosphamide recipients were also at greater risk of exhibiting very low saliva flow. This study applied the HDI to patients receiving all forms of antineoplastic treatment and highlights the dose-dependent relation between cumulative dose of cyclophosphamide and dental disturbances. © 2010 American Cancer Society.


Napenas J.J.,University of Western Ontario | Napenas J.J.,Carolinas Medical Center | Kujan O.,Al Farabi College for Dentistry and Nursing | Kujan O.,Hama University | And 8 more authors.
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology | Year: 2015

Objectives Current recommendations for safe and effective dental management are less than optimal for some medical conditions because of limited evidence, conflicting conclusions, or both. This review (1) compiled and evaluated dental management recommendations for select medical conditions; (2) summarized recommendations and their assigned levels of evidence; (3) identified areas of conflict, ambiguity, or both; and (4) identified issues that warrant future research, enhanced consensus statements, or both. Study Design Systematic literature searches were performed for guideline publications, systematic and narrative reviews, and opinion documents containing recommendations for (1) medication-related osteonecrosis of the jaw (MRONJ); (2) cardiovascular diseases (CVDs); (3) prosthetic joints (PJs); and (4) systemic steroid therapy (SST). Results The search yielded the following numbers of publications that met the inclusion criteria: MRONJ - 116; CVDs - 54; prosthetic joints - 39; and systemic steroids - 12. Conclusions Very few of the compiled recommendations were assigned or linked to levels of evidence by their authors. Key conclusions include the following: MRONJ-expert recommendations trend toward proceeding with dental treatment with little to no modification in osteoporotic patients on bisphosphonates; CVDs-current recommendations are primarily directed to general surgery and applied to dentistry; PJs-routine antibiotic prophylaxis is not indicated for dental treatment; and SST-steroid supplementation is not indicated for most patients undergoing dental procedures under local anesthesia. © 2015 Elsevier Inc.


Cashmore A.W.,University of New South Wales | Noller J.,Center for Oral Health Strategy | Ritchie J.,Griffith University | Johnson B.,Westmead Center for Oral Health | Blinkhorn A.S.,University of Sydney
Health Promotion Journal of Australia | Year: 2011

Issue addressed: Reorienting primary care dental services towards prevention is a priority for improving the oral health of Australian children with extensive dental caries. We explored the altitudes and beliefs of dental staff about the factors that helped or hindered the establishment and implementation of a hospital based parent counselling program to manage existing, and prevent new, carious lesions in children. A further aim was to explore the influence of the program on the hospital's reorientation to prevention. Methods: Eight of nine program staff participated in two focus group interviews, and two co-ordinating staff participated in semi structured interviews. Interviews were audio recorded and transcribed. Interview recordings and transcripts were analysed by qualitative thematic analysis. Results The participants identified a number of factors that they felt influenced the establishment and implementation of the program, including the dental team's support of the initiative, the advantages of building on existing clinic infrastructure and procedures, the utility of harnessing dental assistants as a resource for oral health promotion, and the confidence of dental professionals to provide parent counselling. Conclusion: Efforts to establish a preventive program in a public paediatric dental service should ensure that all members of the dental team are engaged during all phases of the program, that dental assistants are trained and supported to deliver parent counselling, and that inter professional partnerships with services such as dietetics are fostered.


Michael J.A.,Westmead Center for Oral Health | Michael J.A.,The Childrens Hospital at Westmead | Michael J.A.,University of Sydney | Hibbert S.A.,Westmead Center for Oral Health | And 2 more authors.
European Archives of Paediatric Dentistry | Year: 2014

Aim: To determine the characteristics, aetiology and management of facial swellings of odontogenic origin in the paediatric population. Study design: Prospective study of children with facial swellings of odontogenic origin. Methods: All children who presented to the Departments of Paediatric Dentistry of the Westmead Centre for Oral Health and the Children's Hospital at Westmead with a facial swelling of odontogenic origin over a 12 month period were identified and included in the study. Treating clinicians completed a standardised data collection sheet to record information relating to patient demographics, medical history, dental history, history of current episode of facial swelling of odontogenic origin, examination findings and management. Data were entered in Microsoft® Excel and statistical analysis carried out using Statistical Analysis Software® version 9.3. Results/statistics: Two hundred and fifty-three children were included in the study, with a mean age of 6.3 years. Sixteen percent of children were admitted for intravenous antibiotics, surgical management and supportive care. For the remaining children not admitted, a range of management approaches were undertaken. These included immediate surgical management with or without oral antibiotics, delayed surgical management following a course of oral antibiotics, or oral antibiotics alone, where the cause of the odontogenic infection had already been removed. For 2 % of children, a delayed surgical management approach was unsuccessful and the children were admitted. Conclusions: Management options for children presenting with facial swellings of odontogenic origin include admission to hospital for intravenous antibiotics and acute surgical management, immediate surgical management with or without a course of oral antibiotics or initial management involving a course of oral antibiotics, with definitive dental treatment being provided after resolution of the acute odontogenic infection. © 2014 European Academy of Paediatric Dentistry.


Metcalfe K.,Westmead Center for Oral Health | Heffernan M.,University of Sydney
Australian Dental Journal | Year: 2014

Background There is a high prevalence of orofacial trauma in rugby union players. Mouthguards reduce complications following dental injuries, should dental injuries occur. The aim of this study was to investigate the prevalence of oral trauma and the significance of mouthguard use in adult amateur rugby union players in New South Wales, Australia. Methods Questionnaires were distributed to players in rugby union clubs. It questioned players about their mouthguard use and orofacial trauma experience; the type of injury, complications, if a mouthguard was worn, where treatment was sought and outcome. Results The prevalence of orofacial trauma in rugby union players is 64.9%. The most common injury was laceration to intraoral and extraoral soft tissues at 44.5%. Of all orofacial injuries reported, 41.9% were to the dentition. Following dental injury, loss of the tooth was the most common complication (34.7%). 76.9% of players wore mouthguards. By wearing a mouthguard, the risk reduction for ongoing complications following dental injuries was 18.5% (p-value = 0.009). Of these, 10.4% (p-value = 0.45) represented loss of the tooth. Conclusions Rates of orofacial trauma and complications in amateur rugby union players are high in Australia. Use of mouthguards results in significant risk reduction for complications following dental injuries, including loss of tooth. © 2014 Australian Dental Association.


Dental emergencies often present to primary care providers in general practice and Emergency Departments (ED), who may be unable to manage them effectively due to limited knowledge, skills and available resources. This may impact negatively on patient outcomes. Provision of a short educational workshop intervention in the management of such emergencies, including education in supporting resources, may provide a practical strategy for assisting clinicians to provide this aspect of comprehensive primary care. This descriptive study used a validated questionnaire survey instrument to measure the effectiveness of a short multimodal educational intervention through the uptake and perceived usefulness of supporting resources at 6 months following the intervention. Between 2009 and 2010, 15 workshops, of which eight were for regional and rural hospital ED doctors, were conducted by the same presenter using the same educational materials and training techniques. A sample of 181 workshop participants, 63% of whom were in rural or remote practice and engaged in providing primary care medical services, returned responses at 6 months on the perceived usefulness of the dental emergencies resource. Thirty percent of clinicians had used the dental emergencies resource within the six-month follow-up period. Significance was demonstrated between professional category and use of the resource, with emergency registrars utilising this resource most and GPs the least. The Dental Handbook, specifically designed for ED use, and tooth-filling material contained within this resource, were deemed the most useful components. There were overall positive open-ended question responses regarding the usefulness of the resource, especially when it was made available to clinicians who had attended the education workshops. Utilisation and perceived usefulness of a supporting resource at 6 months are indicators of the effectiveness of a short workshop educational intervention in the management of dental emergencies by primary care providers. This education may have greater relevance to rural and remote practice where dental services may be limited.


Farah C.S.,University of Queensland | McIntosh L.,University of Queensland | Georgiou A.,Westmead Center for Oral Health | McCullough M.J.,University of Melbourne
Head and Neck | Year: 2012

Background Technology that highlights potentially malignant oral lesions in a highly sensitive and specific manner will aid clinicians in early diagnosis of these conditions. This study assessed the efficacy of direct tissue autofluorescence imaging Visually Enhanced Lesion Scope (VELScope) in the detection of oral mucosal lesions. Methods One hundred twelve patients referred with a potentially malignant oral mucosal lesion were examined under routine incandescent light, and then with VELScope, noting loss of autofluorescence and presence of blanching. Incisional biopsies were performed to provide definitive histopathological diagnoses. Results VELScope enhanced the visibility of 41 lesions and helped uncover 5 clinically undetected lesions. VELScope examination alone showed a sensitivity of 30% and a specificity of 63%. Its accuracy at identifying dysplasia was 55%. Conclusion VELScope examination cannot provide a definitive diagnosis regarding the presence of epithelial dysplasia. Loss of autofluorescence is not useful in diagnosing epithelial dysplasia in its own right without relevant clinical interpretation. Copyright © 2011 Wiley Periodicals, Inc.


PubMed | Westmead Center for Oral Health
Type: Journal Article | Journal: European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry | Year: 2014

To determine the characteristics, aetiology and management of facial swellings of odontogenic origin in the paediatric population.Prospective study of children with facial swellings of odontogenic origin.All children who presented to the Departments of Paediatric Dentistry of the Westmead Centre for Oral Health and the Childrens Hospital at Westmead with a facial swelling of odontogenic origin over a 12 month period were identified and included in the study. Treating clinicians completed a standardised data collection sheet to record information relating to patient demographics, medical history, dental history, history of current episode of facial swelling of odontogenic origin, examination findings and management. Data were entered in Microsoft() Excel and statistical analysis carried out using Statistical Analysis Software() version 9.3.Two hundred and fifty-three children were included in the study, with a mean age of 6.3 years. Sixteen percent of children were admitted for intravenous antibiotics, surgical management and supportive care. For the remaining children not admitted, a range of management approaches were undertaken. These included immediate surgical management with or without oral antibiotics, delayed surgical management following a course of oral antibiotics, or oral antibiotics alone, where the cause of the odontogenic infection had already been removed. For 2% of children, a delayed surgical management approach was unsuccessful and the children were admitted.Management options for children presenting with facial swellings of odontogenic origin include admission to hospital for intravenous antibiotics and acute surgical management, immediate surgical management with or without a course of oral antibiotics or initial management involving a course of oral antibiotics, with definitive dental treatment being provided after resolution of the acute odontogenic infection.


PubMed | Westmead Center for Oral Health
Type: Journal Article | Journal: Australian dental journal | Year: 2014

Bisphosphonates are inhibitors of osteoclastic bone resorption with therapeutic benefit in a variety of bone disorders in both adults and children. While these agents have been routinely used in adults for the past three decades, their more recent introduction into paediatric medicine means there is a paucity of data on long-term safety and effects on dental development. There is uncertainty regarding the dental management of children treated with bisphosphonates, particularly when invasive dental procedures, such as extractions and oral surgical procedures, are required. There are limited data with which to make recommendations about the dental management of patients treated with bisphosphonates, and there are no published recommendations that specifically address paediatric patients. This paper aims to outline paediatric uses and adverse effects of bisphosphonates and present recommendations on the dental management of children receiving bisphosphonates.

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