ORCID Profile
0000-0002-2052-558X
Current Organisations
University of Tasmania
,
University of Otago
,
University of Western Australia
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Publisher: Wiley
Date: 10-2020
DOI: 10.1002/JPPR.1695
Publisher: Elsevier BV
Date: 10-2023
Publisher: Elsevier BV
Date: 10-2023
Publisher: Elsevier BV
Date: 04-2021
DOI: 10.1111/IDJ.12605
Publisher: European Alliance for Innovation n.o.
Date: 13-07-2022
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.JEBDP.2019.01.005
Abstract: This systematic review and meta-analysis aimed to evaluate the overall, clinical, and radiographical success rates of alternative pulpotomy medicaments in primary teeth. A systematic search of five databases was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Prospective clinical trials using alternative pulpotomy medicaments in children were included. The outcome measures were overall, clinical, and radiographic success, expressed in percentages and converted to odds ratios. Fifteen articles were included in the meta-analysis. Combined odds ratios for overall, clinical, and radiographic success was 0.55 (95% confidence interval [CI]: 0.12-2.41 P = .42 I There is insufficient evidence to support the efficacy of alternative pulpotomy medicaments for use in primary teeth. Further robust studies are required before such alternative medicaments should be used in clinical practice.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Wiley
Date: 13-08-2018
DOI: 10.1111/ADJ.12616
Publisher: Wiley
Date: 19-10-2022
DOI: 10.1111/ADJ.12878
Abstract: In Australia, because of inequity in dental service accessibility and affordability, patients can see general medical practitioners (GPs) for acute dental conditions. This cross‐sectional study consisted of surveys distributed to the board registered GPs practising in Australia. The main outcome measures included statistical analysis of GPs managing different dental emergency scenarios and their confidence and expectations in managing dental emergencies. A total of 425 GPs participated in the study. The s le primarily consisted of GPs practising in metropolitan clinics (n = 315). Most participants reported that they would refer to the dentist for mobilized tooth (n = 402). There was a negative correlation between GPs with 5–29 years of experience and traumatized tooth management ( P 0.05). GPs aged between 40 and 49 years were more inclined to treat patients with mobilized teeth [Multivariate (MV): 0.42(0.09–0.74)]. However, GPs with 0–5 years of experience were less likely to manage patients with dental abscess [MV: −0.52(−0.80 to −0.24)]. Most GPs referred dental emergencies to dentists. GP management of dental emergencies were predominantly palliative. Therefore, opportunities for collaborative practice models amongst GPs and dentists may be needed to bridge the gap in the regional and remote locations.
Publisher: CSIRO Publishing
Date: 23-06-2021
DOI: 10.1071/AH20318
Abstract: Objective To date, there has been little research that has comprehensively analysed dental treatment under general anaesthesia (DGA) at Perth Children’s Hospital (PCH) for dental emergencies (dental pain and sepsis). This cross-sectional descriptive analysis of the PCH dental department analysed the demographic of children admitted and the type of treatment used, and assessed the cost. Methods This was a retrospective descriptive study analysing the dental records of patients ranging from 2 to 16 years of age at PCH in Western Australia. Of the 310 cases randomly selected from the 2018–19 study period, 202 were admitted for DGA. Two outcome measures were derived: cumulative count of treatment mix and cost analysis. Results The mean (±s.d.) age at the time of admission was 6.2 ± 2.6 years and the mean (±s.d.) decayed (d/D), missing, (m/M) and filled (f/F) teeth (dmft/DMFT) was 2.1 ± 0.8. Of the 429 teeth affected, 282 were molars. Treatments were grouped therapeutically of the 856 treatments performed, 465 were extractions (54%). The total cost, consisting of direct and indirect costs, was A$313 823, and equated to an approximate mean (±s.d.) of A$1554 ± 109 per case. Conclusion Untreated dental caries was the most common cause for hospital admission. Most cases presenting at the emergency department were young children ( years old) who underwent extractions under DGA. What is known about the topic? The Child Dental Benefits Schedule (CDBS) was introduced to improve access and affordability to oral health care for children without private dental insurance. However, a significant number of children are still being admitted to hospital for emergency dental treatment. What does this paper add? Despite the availability of the CDBS, untreated dental caries remains one of the most common reasons for dental emergency in the PCH. What are the implications for practitioners? Not only are direct costs a burden on the health budget, but indirect and intangible costs also affect children and their families.
Publisher: Elsevier BV
Date: 08-2020
DOI: 10.1111/IDJ.12562
Publisher: Springer Nature Switzerland
Date: 2022
Publisher: Wiley
Date: 23-12-2021
DOI: 10.1111/ADJ.12893
Abstract: Rates of online reviews are continually increasing. Coinciding with this, is the beneficial abundance of subjective information that is now available to patients. Such information can be persuasive in selecting a healthcare provider. This analysis of one‐and‐two‐star Google reviews received by dental practices within the Perth metropolitan region aims to identify common themes within dental practice complaints. This mixed‐methods study was conducted by gathering reviews from the ‘Google review’ feature, which have been published by users between 2013 and 2020. These data were then coded into recognised themes, and crucial quotes were selected and de‐identified creating a narrative about the themes present which formed the qualitative component of this research. A total of 413 negative reviews were included in this study. From these, 1071 specific complaints were identified. Major themes identified included treatment issues, staffing, communication and professionalism, finance, and premise. Spread across these five themes were an additional thirty‐eight subthemes. Overall, treatment was a primary concern for patients, making up 37.1% of the results. Within the subthemes ‘treatment dissatisfaction (unspecified)’ was also high, at 23.1%. This study identified the most common complaints received by dental clinics on Google review within the Perth metropolitan area. Further investigation is required to provide supplementary data regarding factors that may influence complaint rates and types, such as the socio‐economic status of areas and geographical factors such as distance from the Perth metropolitan.
Publisher: Wiley
Date: 25-07-2017
DOI: 10.1111/ADJ.12535
Abstract: This systematic review aimed to determine whether there is consensus for antibiotic prescription in healthy patients undergoing implant placement. A search of PubMed, Embase and Medline databases was conducted in January 2016 to find published journal articles on the use of antibiotics in implant placement, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were prospective human clinical trials investigating antibiotic usage during implant placement. Fifteen studies were deemed suitable. In 13 studies, no statistical difference was found between antibiotic use and the incidence of prosthetic failure, implant failure and early postoperative infections. These were rated as having low to high risk bias. Contrary results were reported in two studies, both of which were rated as having a high potential for bias. In conclusion, antibiotic use in healthy patients for the prophylaxis of surgical infection associated with dental implant placement does not appear to improve clinical outcomes. Practitioners should apply principles of antimicrobial stewardship and not use antibiotics as a routine measure in healthy patients.
Publisher: Oxford University Press (OUP)
Date: 24-06-2023
DOI: 10.1093/IJPP/RIAD039
Publisher: Wiley
Date: 14-12-2019
DOI: 10.1111/IPD.12452
Abstract: The health and well-being of children are intimately linked to their parents' physical, emotional, and social health and social circumstances. To conduct a meta-analysis of studies that have used the Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) instruments, to evaluate the family impact scale (FIS) changes following their children's dental treatment under general anaesthesia (DGA). A systematic search was undertaken using the PRISMA guidelines. The inclusion criteria consisted of patients below 16 years of age, DGA, pre- and post-operative assessments, and the use of ECOHIS and COHRQoL. FIS changes were the primary outcome measure, where the mean difference (MD) was calculated. After initial search of 105 studies in the database, twenty-one articles were included in the analysis. A positive outcome in the FIS changes was identified in all studies. The combined MD for FIS using ECOHIS and COHRQoL was 1.52 [95% CI: 1.15-1.89 P < 0.00001 I Dental treatment with general anaesthesia for children had a significant positive impact on parental emotions, activity, and conflict. Following DGA, there was significant improvement in the FIS, with large MD.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Wiley
Date: 21-09-2019
DOI: 10.1111/JICD.12466
Abstract: To outline the current literature surrounding natal teeth, and then, in a pilot study, to evaluate natal teeth using micro-computed tomography (micro-CT) to determine their anatomical profile, and compare and contrast different analytical methods to assess natal teeth. 2 extracted natal teeth (mandibular central incisors) and 1 exfoliated mandibular primary central incisor were subjected to micro-CT analysis. Within natal teeth, there were no statistical differences in tooth mineral density (TMD) of both enamel and dentine (P > .05), whereas mandibular primary central incisors had a significantly higher TMD of both enamel and dentine in comparison with both natal tooth 1 and natal tooth 2 (P < .05). Mandibular primary central incisors had a greater thickness and volume of both enamel and dentine, but exhibited lower pulpal space volume. Micro-CT is an alternative and non-invasive method to anatomically assess natal teeth. According to the pilot study, natal teeth exhibited lower TMD, decreased enamel and dentine thickness, and smaller pulpal space volume in comparison with mandibular primary incisor teeth. This pilot study creates a foundation to establish the collection and analysis of natal teeth on a larger scale over time using micro-CT.
Publisher: Springer Science and Business Media LLC
Date: 09-10-2018
DOI: 10.1007/S00784-018-2700-Y
Abstract: To determine the detectability of the intra-oral photographic method in comparison to the baseline, comprehensive dental examination (CDE), in children when performed by different levels of dental practitioners. As part of a quality assurance program, intra-oral photographs were obtained from 77 patients (2-18 years) as part of a CDE before undertaking dental treatment under general anaesthesia. A DSLR camera was utilised to acquire images which were subsequently uploaded to a cloud-based server. The baseline for each participant was established during the CDE, utilising both visual and radiographic examination, which was then compared to the assessment made by a mid-level dental practitioners (MLDP). The evaluation was based on utilising an odontogram where the teeth were charted either as decayed or filled. Specificity (95%) was higher than sensitivity (61.5%) when comparing the photographic assessment with the benchmark CDE assessment. The inter-rater reliability between the two methods of assessment was substantial, with a kappa score of 0.62. The photographic assessment method underestimated the decayed and filled teeth, as observed by the caries experience (dft/DFT scores) (CDE = 7.01 vs. photographic assessment = 5.22). There were lower levels of diagnostic detection in the posterior teeth as compared to the anterior teeth assessments. Although the CDE is still considered to be the gold-standard, this study found that the photographic caries assessment by MLDP produced an acceptable diagnostic level of detection particularly for the anterior teeth. The photographic method could offer a potential cost-saving and user-friendly screening.
Publisher: Wiley
Date: 22-04-2023
DOI: 10.1111/EJE.12802
Abstract: Dentists can prescribe medications for prophylactic and therapeutic purposes. In Australia, dental graduates can autonomously practise within the scope of their qualifications without needing to undertake an internship post‐graduation. Although previous research has identified knowledge gaps amongst dental students in Australia on pharmacology and pharmacotherapeutic knowledge, there has been no published research that qualitatively highlights dental students' knowledge of medication prescribing in Australia. This study aimed to undertake a qualitative analysis of Western Australian dental students' attitudes towards and knowledge of medication prescribing. This qualitative case study design employed semi‐structured interviews as means of collecting data. It utilised a purposive s ling in penultimate and final year dental students at the University of Western Australia. Twenty dental students participated in the study. Five key themes were identified in the data: current and previous education, application when delivering pharmacology and pharmacotherapeutics, teaching to ensure patient‐centred care, supervision and referral to relevant resources. Participants agreed that having previous knowledge in the area provides students with confidence regarding medication prescribing. Furthermore, students in this study valued having guidance when prescribing medications. This study highlights the complexity of medication prescribing for dental students. It also highlights their experience with the current pharmacology and pharmacotherapeutics curriculum. All students interviewed valued application‐based teaching, making it specific to dentistry. If curriculum were to be redeveloped, considering their perceptions may be a valuable tool.
Publisher: CSIRO Publishing
Date: 12-11-2020
DOI: 10.1071/AH20140
Abstract: Objective This cost-analysis study explored Pharmaceutical Benefits Scheme (PBS) data to determine the financial patient contribution (PC) towards dispensed medications prescribed by dentists and temporal trends in cost contributions. Methods For this study we used the PBS online dataset and only included concessional data in the analysis. Data on dental medications dispensed under the PBS from 2006 to 2018 were accessed. For all medicines aggregated to different pharmacological categories (antibiotics, analgesics and opiates, anti-inflammatories, antifungals, benzodiazepines, anticonvulsants and anti-emetics, and emergency medications), a temporal trend was generated using annual PC data. Cumulative patient and mean annual PC data were also generated in a similar manner. Results Cumulative PC over the study period for dental PBS prescriptions was A$28 783 361 (A$5.55 per dispensing). The mean annual PC for dental PBS was A$2 214 105 (for the entire concessional population from 2006 to 2018), with a statistically significant and strong correlation between year and PC (Dental PBS, A$59 756 per year r = 0.98: P 0.0001). Antibiotics represented the highest proportion of PC (87.8%), whereas the lowest proportion of PC was for emergency medications (e.g. adrenaline, atropine, glucagon, naloxone), which amounted to 0.003%. Conclusions This study highlights the increasing contributions made by patients towards antibiotic prescriptions. What is known about the topic? Australian dentists can independently prescribe subsidised medications as per a set scope for general and specialist dentists, regulated under the PBS with requisite adherence to specific legal requirements. What does this paper add? This is the first study highlighting the increased level of patient financial contributions towards dental medicines, according to different pharmacological categories, dispensed by pharmacists in Australia. What are the implications for practitioners? This study creates a base for future research assessing the appropriateness of the PBS subsidy and the PBS Safety Net threshold, possibly reassessing the out-of-pocket pricing on brand substitution and appropriately reassessing the current dental PBS schedule.
Publisher: Springer Science and Business Media LLC
Date: 09-02-2018
DOI: 10.1007/S00784-018-2367-4
Abstract: To conduct a meta-analysis of studies that have employed the Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Health-Related Quality of Life (COHRQoL) instruments, to evaluate the oral health-related quality of life (OHRQoL) changes in children following dental treatment under general anaesthesia (DGA). A systematic search of 5 databases was conducted in accordance with the PRISMA guidelines. The inclusion criteria were use of ECOHIS and COHRQoL, pre-and post-operative assessments, patients aged between 0 and 16 years, no restrictions on the follow-up period and DGA. The primary outcome measure was changes in quality of life for both the children, which was based on mean difference (MD). Twenty-two articles were included in the meta-analysis. A favourable outcome in OHRQoL was identified in all studies. The combined MD for ECOHIS and COHRQoL were 1.62 [95% CI 1.52-1.71 P < 0.00001 I2 = 0%] and 0.86 [95% CI 0.74-0.99 P < 0.00001 I2 = 0%], respectively, both with no evidence of heterogeneity. There is evidence to support that the OHRQoL of children was improved, with large effect size, in the short-term following DGA. Dental treatment under GA significantly improved the OHRQoL of children.
Publisher: CSIRO Publishing
Date: 23-06-2022
DOI: 10.1071/AH21393
Abstract: Objectives Using Google online reviews, this study investigated why patients were satisfied or dissatisfied with their public dental clinic in Victoria, Australia. Methods This mixed methods study gathered Google reviews published by users pre-March, 2021. The reviews were coded and subthemes and major themes were identified. The most common reasons why patients gave reviews were tabulated and stratified according to star rating, remoteness and accessibility index classification, and socio-economic status. Results Of the 522 reviews included in this study, in 317 (60.7%) satisfaction was expressed. Compliments and complaints were documented. A total of 53 subthemes were identified. Major themes included Treatment, Staff, Communication and Professionalism, Patient Factors and Non-Clinical Reasons. From the reviews, more patients were satisfied with general unspecified treatment (n = 195 14.7%) and dissatisfied with reception staff (n = 64 4.8%). More reviews were generated by patients who visited clinics in major cities and lower socio-economic areas. Conclusion This study found that most patients expressed satisfaction and identified reasons why patients were satisfied or dissatisfied. Consumer feedback, including compliments and complaints, is an integral aspect of monitoring and improving health service quality. It is important to continue seeking feedback and improve accordingly.
Publisher: Australasian College of Health Service Management
Date: 20-12-2022
DOI: 10.24083/APJHM.V17I3.1433
Abstract: Introduction: New Medicare Benefits Schedule (MBS) telehealth item codes were added in 2020 to allow Australians to gain access to medical services during COVID-19 lockdown restrictions. Previous studies have been conducted on the utilisation of specific MBS item codes however none have been conducted on all medical practitioner telehealth item codes. Objective: This retrospective epidemiological analysis aims to determine the utilisation rate of newly introduced medical practitioner telehealth MBS item codes and compare them with the usage of existing in-person item codes Methods: The utilisation of 319 MBS item codes were extracted from the Medicare Statistics Database between March 2020 to March 2021. Using count and population statistics a population adjusted rate was generated and a linear regression analysis undertaken. Results: A total of 199,059,309 in-person and telehealth services (Male, n=84,007,935 42.2%, Female, n=115,051,374 57.8%) were utilised during the study period. 147,697,104 were in-person compared to 51,191,898 telehealth services. In-person usage decreased by 27.5% while telehealth increased by 358.8%. In-person utilisation increased by 32.4% as the year continued while the telehealth utilisation decreased by 40.7%. There was a non-significant increase in total in-person item code utilisation (p=0.76) and a non-significant decrease (p=0.32) in the total telehealth item codes used Conclusion: There was initially increased usage of telehealth especially during lockdown restrictions. However, when lockdowns eased, usage of telehealth decreased while in-person increased. Regardless, telehealth item codes continued to be used despite changes to eligibility criteria and lockdown restrictions easing. Hence, it appears that patients are accepting of telehealth as a healthcare delivery method.
Publisher: Oxford University Press (OUP)
Date: 06-2022
DOI: 10.1093/IJPP/RIAC050
Publisher: Elsevier BV
Date: 08-2021
Publisher: Springer Science and Business Media LLC
Date: 23-12-2022
DOI: 10.1186/S12903-022-02660-X
Abstract: Prescribing medicine is integral to clinical dentistry. Infective endocarditis may be rare but fatal if left untreated. As a result, judicious prescribing of antibiotics should be implemented due to potential. To our knowledge, no Australian study has examined dental students' knowledge and perceptions about antibiotic prophylaxis for dental procedures. Australian dental students were invited to undertake the survey comprising case vignettes to investigate their medication knowledge. A total of 117 responses were received. The questions were 12 clinically relevant questions and three perception-based questions. Results were analysed using descriptive statistics as well as the chi-squared test. The 117 respondents had a mean correct response of 7.34 ± 2.64 (range 3–12 out of 12). Out of 117 students, 89 (76%) answered more than half of the questions correctly. Only three students (3%) answered all the questions correctly. Nearly two-thirds felt that they knew about antibiotic prophylaxis used for dental procedures. Most respondents answered more than half, but not all, of the clinical questions correctly. It is crucial to highlight that dental student may never receive any more training on antimicrobial stewardship (AMS) at any point in their future careers. It may be ideal that this issue is addressed at the dental school. One way to target this is to potentially nationalised teaching delivery of dental AMS across Australia.
Publisher: MDPI AG
Date: 09-2023
Publisher: Australasian College of Health Service Management
Date: 26-12-2022
DOI: 10.24083/APJHM.V17I3.1635
Abstract: Background / Objectives: The Sri Lankan healthcare system consists of public and private sectors. In terms of capacity, the public sector dominates the provision of care across curative, preventive and outpatient care. The private sector, too, has grown rapidly in recent years but was mainly confined to providing curative, diagnostic and outpatient care. Since, there are little or no studies conducted in Sri Lanka thus far, the objective of this study was to understand the current approaches adopted in determining the base of healthcare payments. This study also investigated the economic and administrative processes involved in determining the level of healthcare pricing in the private sector healthcare industry in Sri Lanka. Method: This qualitative study investigated the rationales adopted in healthcare pricing by healthcare administrators in the private sector. Structured interviews were conducted and thematic analysis were applied to interview data collected and analysis. Results: Five key themes, which influenced pricing, were identified from the interviews. These themes included influence from medical practitioners/clinicians, competitor pricing, price adjustment rofit margins, consumables and staff, and economic demands. There was a consensus that competitor pricing and seniority of the practicing clinicians had an impact on pricing. Conclusion: This study revealed that the base of payment in private sector healthcare is fee for service (FFS). Adopting popular international approaches such as Diagnostic Related Groups (DRGS) was not shown in this study. Further, it was evident that the Sri Lankan private healthcare sector administrators unilaterally fix pricing based on the identified key themes without adequately consulting the healthcare payers and users.
Publisher: Public Library of Science (PLoS)
Date: 27-02-2023
DOI: 10.1371/JOURNAL.PONE.0282185
Abstract: This systematic review and meta-analysis aimed to examine more recent data to determine the extent of lingual nerve injury (LNI) following the surgical extraction of mandibular third molars (M3M). A systematic search of three databases [PubMed, Web of Science and OVID] was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria encompassed studies on patients who underwent surgical M3M extraction using the buccal approach without lingual flap retraction (BA-), buccal approach with lingual flap retraction (BA+), and lingual split technique (LS). The outcome measures expressed in LNI count were converted to risk ratios (RR). Twenty-seven studies were included in the systematic review, nine were eligible for meta-analysis. Combined RR for LNI (BA+ versus BA-) was 4.80 [95% Confidence Interval:3.28–7.02 P .00001]. The prevalence of permanent LNI following BA-, BA+ and LS (mean%±SD%) was 0.18±0.38, 0.07±0.21, and 0.28±0.48 respectively. This study concluded that there was an increased risk of temporary LNI following M3M surgical extractions using BA+ and LS. There was insufficient evidence to determine whether there is a significant advantage of BA+ or LS in reducing permanent LNI risk. Operators should use lingual retraction with caution due to the increased temporary LNI risk.
Publisher: Elsevier BV
Date: 05-2020
Publisher: Oxford University Press (OUP)
Date: 09-05-2022
DOI: 10.1093/IJPP/RIAC033
Abstract: Pharmacists are known as medicine experts. Dentists can independently prescribe and administer medications related to dental conditions such as antimicrobials, anti-inflammatories and analgesics. However, little is known about pharmacists’ knowledge and perceptions of medicines prescribed for dentistry. Therefore, this study aimed to assess community pharmacists’ ability to identify the indications for dental prescriptions using hypothetical vignettes. Australian community pharmacists were invited through email and social media to undertake a web-based questionnaire consisting of nine case vignettes of dental prescriptions and their indicated uses in dental settings and two perception-based questions. The results were provided as a percentage of the correct answers to the case vignettes. In addition, Pearson chi-square tests were performed to examine associations between categorical variables. Of the 202 pharmacists who completed the questionnaire, the mean number of correct responses was 5 ± 2 (out of 9). More than three-quarters (78.5%) of pharmacists believed that thorough knowledge of prescriptions for dental ailments was necessary for safe and effective community pharmacy practice. In addition, nearly two-thirds (64.1%) felt confident that they could dispense medicines indicated for dental conditions safely and effectively. The knowledge demonstrated by participants through correct identification of the indications for dental prescription was less than optimal. Professional development courses for pharmacists in dental ailments could prove beneficial.
No related grants have been discovered for Alex Park.