ORCID Profile
0000-0002-8698-4965
Current Organisations
Perth Children's Hospital
,
University of Western Australia
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Publisher: Wiley
Date: 22-02-2023
DOI: 10.1111/CDOE.12850
Abstract: Aboriginal and Torres Strait Islander communities in remote parts of Australia are some of the most underserviced communities in regard to oral health care. These communities rely on volunteer dental programmes such as the Kimberley Dental Team to fill the gaps in care, however, there are no known continuous quality improvement (CQI) frameworks to guide such organizations to ensure that they are delivering high‐quality, community‐centred, culturally appropriate care. This study proposes a CQI framework model for voluntary dental programmes providing care to remote Aboriginal communities. Relevant CQI models wherein the (i) behaviour of interest was quality improvement, and (ii) the health context was volunteer services in Aboriginal communities were identified from the literature. The conceptual models were subsequently augmented using a ‘best fit’ framework and the existing evidence synthesized to develop a CQI framework that aims to guide volunteer dental services to develop local priorities and enhance current dental practice. A cyclical five‐phase model is proposed starting with consultation and moving through the phases of data collection, consideration, collaboration and celebration. This is the first proposed CQI framework for volunteer dental services working with Aboriginal communities. The framework enables volunteers to ensure that the quality of care provided is commensurate with the community needs and informed by community consultation. It is anticipated that future mixed methods research will enable formal evaluation of the 5C model and CQI strategies focusing on oral health among Aboriginal communities.
Publisher: Wiley
Date: 04-07-2018
DOI: 10.1111/IPD.12401
Abstract: Silver diamine fluoride (SDF) is a cariostatic agent used to adjunctively manage dental caries in high-risk groups. However, black staining is a frequently reported side effect following SDF application and influences the acceptability of this treatment. To evaluate the staining potential of SDF and the influence of the potassium Iodide (KI) application on the degree of black staining over time. Extracted carious primary molars were collected and sorted into pairs matched by tooth type, size and location of the carious lesion (n = 35). Teeth were stratified to receive either 38% SDF, KI immediately after SDF application, or 12% SDF. Standardised timelapse photography and image processing software was used to evaluate staining over a period of 7 days. Following SDF application, the onset of black staining occurred within 2 min and increased in value for up to 6 h post-application. The use of KI immediately after SDF application resulted in no noticeable staining of the carious dentine or surrounding enamel. No significant differences were evident in the staining potential between the different SDF concentrations (38% and 12%). Furthermore, root surface and cementum was found to stain darker and more readily when compared with the coronal enamel surface. SDF has the ability to visibly stain dental hard tissues and its staining potential may be modified by application of KI.
Publisher: Crimson Publishers
Date: 06-06-2019
Publisher: Springer Science and Business Media LLC
Date: 13-10-2021
DOI: 10.1186/S12903-021-01887-4
Abstract: Early childhood caries disproportionately affects vulnerable groups and remains a leading cause of preventable hospital admissions for Western Australian children. The Western Australia State Oral Health Plan seeks to improve child oral health through universal and targeted health promotion initiatives with primary caregivers. These initiatives require evidence of primary caregiver oral health knowledge and behaviours and baseline data on early childhood caries. The objective of this systematic scoping review was to understand current oral health knowledge and practices of primary caregivers of children aged 0–4 years, identify influential socioecological determinants, and identify data on early childhood caries in the Western Australian context. A systematic scoping review framework identified articles published between 2010 and 2021, using Scopus, PubMed, Medline, CINAHL, PsycINFO, selected article reference lists, and oral health websites. The lack of Western Australian specific literature prompted the inclusion of Australia-wide articles. Articles were screened via author consensus, with eight selected. Western Australia and nation-wide data on early childhood caries are limited and mostly dated. WA data from children aged 2–3 years, collected in 2006, suggests the prevalence is 2.9% in this state, with national data of children from 0 to 3 years, collected from 2006 and 2008, suggesting an early childhood caries prevalence of 3.4–8% of children aged 18 months, rising sharply by 36 months of age. Nationally, fewer than half the primary caregivers reported following evidence-based oral health recommendations for their young children. Perceptions of the role of dental services for young children tends to be focussed on treatment, rather than surveillance and prevention. Knowledge of dietary and oral hygiene practices is inconsistent and awareness of the Child Dental Benefit Schedule low. Young children’s oral health status is clearly associated with socioecological factors, including socioeconomic status. Recent early childhood caries data and evidence of primary care-givers’ oral health knowledge and behaviours are unavailable in Western Australia, a similar situation exists nationwide. To realise the Western Australian and National Oral Health Plans, research is required to address this knowledge gap.
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: Wiley
Date: 27-09-2014
DOI: 10.1111/ADJ.12219
Abstract: Indigenous populations around the world have significantly poorer oral health and inequalities in access to dental care largely attribute to the social determinants of health. Reviewing international literature offers an opportunity to better understand appropriate approaches for policy and practice in Australia. This article is a descriptive narrative review based on primary research literature discussing informative international approaches to Indigenous dental care. Approaches identified in the literature included integration of dentistry with primary health care and traditional practice, training and use of oral health professionals and approaches used at different stages of life, particularly in the management of early childhood caries. The international literature provides a range of approaches to Indigenous oral health. Tailored, culturally appropriate family and community based initiatives that address the multidisciplinary issues confronting Indigenous communities were most highly regarded.
Publisher: Mark Allen Group
Date: 02-01-2018
DOI: 10.12968/DENU.2018.45.1.64
Abstract: Hypophosphatasia has a wide clinical spectrum ranging from premature loss of primary teeth to neonatal death. The premature loss of primary teeth in a child with an otherwise unremarkable history may be the first sign of a more significant underlying disease. This report illustrates the role of the dental practitioner in facilitating the diagnosis of hypophosphatasia. CPD/Clinical Relevance: This report outlines the signs and symptoms essential to facilitate the diagnosis of hypophosphatasia by the dental practitioner.
Publisher: Scientific Scholar
Date: 19-11-2020
Abstract: Dental caries remains among the most prevalent chronic conditions in childhood and remains highly prevalent among schoolchildren in Indonesia. Globally, atraumatic restorative treatment (ART) has been used to good effect in the management of carious lesions among high-risk cohorts, particularly in challenging environments. However, in settings, where labor, time, facilities, and materials are particularly limited, strategic triaging of teeth suitable for ART restorations may be valuable to better direct public health expenditure. Therefore, this study aims to (i) describe the prevalence of dental caries among Indonesian schoolchildren and (ii) evaluate the proportion of lesions indicated for ART. A cross-sectional cohort study of elementary schoolchildren from West Java, Indonesia, was examined and categorized according to Hellman’s dental development stages (Groups 1–4 corresponding to the early mixed dentition through to complete permanent dentition). Descriptive statistics and proportional analysis were conducted with the following variables being evaluated: Teeth with early caries (EC), late/advanced caries (LC), recurrent caries (RC), and total caries experience (TC = EC+ART+LC+RC). In evaluating the suitability for ART, additional variables of ART indicated carious lesions (ART) and lower molars with lesions indicated for ART (LM) were assessed. A total of 437 children ranging from 8 to 14 years of age were examined. Out of 8882 teeth examined, 996 had active carious lesions and only 57 had received satisfactory restorative treatment. Children in Hellman’s Group 1 stage of development had the highest prevalence of EC (62%) and ART indicated caries (32%). Meanwhile, older children in Group 4 experienced the highest portion of advanced caries (15%). The proportion of lower molars indicated for ART was 87%, 76%, 70%, and 67% in Groups 1–4, respectively. Indonesian schoolchildren face a high burden of untreated dental caries from a young age. The younger the developmental stage, the higher the prevalence of early and ART-indicated lesions with the majority being found in lower permanent molars. Although ART and preventive strategies show the highest potential in the early mixed dentition, they alone cannot completely meet the dental needs of populations such as this where the severity and disease burden are extremely high.
Publisher: SAGE Publications
Date: 31-08-2016
Abstract: Contemporary approaches to child protection are dominated by in idualized forensically focused interventions that provide limited scope for more holistic preventative responses to children at risk and the provision of support to struggling families and communities. However, in many jurisdictions, it is frequently shown, often through public inquiries and program reviews, that investigatory and removal approaches are failing in critically important ways, particularly regarding reducing the inequities that underpin neglect and abuse. Consequently, there have been increasing calls for a public health model for the protection of children, although there is often a lack of clarity as to what exactly this should entail. Yet, there are opportunities to learn from public health approaches successfully used in the field of injury prevention. Specifically, we advocate for the use of Haddon's Matrix, which provides a detailed theoretical and practical framework for the application of a comprehensive and integrated public health model to guide intervention program design and responses to child protection risk factors. A broad overview of the application of Haddon's Matrix's principles and methods is provided with ex les of program and intervention design. It is argued that this framework provides the range of interventions necessary to address the complex social and structural factors contributing to inequity and the maltreatment of children. It also provides the foundation for a holistic and integrated system of prevention and intervention to contribute to system-level change and address child maltreatment.
Publisher: Mark Allen Group
Date: 02-07-2019
DOI: 10.12968/DENU.2019.46.7.626
Abstract: Over the last decade there has been a renewed interest in the use of Silver Diamine Fluoride (SDF) as an adjunctive modality in the management of caries among high-risk populations. This review presents the current evidence behind the use of SDF and recommendations for its use in caries management dental practice. CPD/Clinical Relevance: Silver diamine fluoride is an effective, evidence-based modality that can contribute towards arresting carious lesions among high-risk children and disadvantaged populations.
Publisher: Wiley
Date: 03-02-2017
DOI: 10.1111/ADJ.12495
Abstract: Aboriginal Australians experience significant disparities in oral health with even poorer outcomes reported in rural and remote areas. The high rates of preventable dental disease in Aboriginal communities are a serious concern from a social standpoint and in terms of service provision and health care expenditure. In this review, primary research literature was comprehensively reviewed. Papers were selected if they reported designing or implementing an intervention or oral health programme specific to the needs of Aboriginal communities. Twenty-one publications fulfilled the inclusion criteria with 19 different interventions being described. Interventions were categorized using a classification adapted from the work of Whitehead (2002). The review identified interventions that aimed to reduce early childhood caries, increase services to remote communities, develop the role of Aboriginal health workers, improve oral health literacy, establish water fluoridation and provide periodontal therapy. Implementing successful oral health interventions in Aboriginal communities is a challenge that is compounded by the complex interplay between psychosocial and cultural determinants. Even interventions that follow a rigorous and consultative design have a high failure rate in Aboriginal communities if upstream determinants of health are not adequately understood and addressed.
Publisher: Elsevier BV
Date: 09-2023
Publisher: Wiley
Date: 17-11-2019
DOI: 10.1111/CDOE.12503
Abstract: To describe the disease experiences and treatment provided according to a set of novel triage criteria among children in the Healthy Kids Cambodia project. The present study describes the management of caries using the Healthy Kids Cambodia (HKC) strategy at one school in Phnom Penh, Cambodia. Treatment was provided across three levels of care based on a set of simple screening criteria. All children received Level 1 (L1) care, which included application of 30% silver diammine fluoride (SDF) to arrest dental caries. Level 2 (L2) care involved use of atraumatic restorative treatment (ART) and GIC fissure sealants for children between six and eight years of age, and for older children who had one or more cavitated lesions on permanent posterior teeth. Level 3 care involved conventional dental rehabilitation for those children with cavitated lesions in permanent anterior teeth, acute infections, pulpally involved permanent teeth or carious permanent posterior teeth that were not restorable using ART. Three activities were evaluated: (i) screening of all children at the school using the HKC triage criteria (ii) a detailed re-examination of children in Grades 3 and 4 and (iii) a clinical audit of treatment provided at Level 3 (L3). 1194 children were screened using the HKC approach, and a s le of 304 8- to 12-year-old children was re-examined. Among those who were re-examined, 48 (15.7%) had been referred for L3 treatment and 88 (28.9%) referred for L2 (only). There was a significant difference in baseline caries experience by referral level, whereby those referred to higher levels of care had more severe caries experience. All children in the L3 category required advanced rehabilitative care. The application of a triage system by dental students was successful in identifying children in greatest need of complex care (L3). Further research may better validate the system for caries management.
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: Wiley
Date: 22-11-2021
DOI: 10.1111/ADJ.12890
Abstract: The delivery of effective oral health promotion strategies is essential to improving oral health outcomes among remote Aboriginal communities. This study aimed to explore the perceptions and attitudes of Aboriginal Australians living in remote Kimberley communities towards oral health education and disease prevention. Semi‐structured interviews and yarning circles were carried out following purposive s ling of Aboriginal adults living in the East Kimberley region of Western Australia. A total of 80 community members participated in the yarning process. School‐based oral health promotion and community‐driven restrictions on the sale of sugary food and drink were seen as positive strategies in improving oral health. Lifestyle changes brought about by modernity, internet availability and fixed community stores were perceived to create new challenges and shift the priorities for those living in remote communities. Community‐based yarning may better inform future oral health strategies in the Kimberley. A neoliberal approach of shifting responsibility onto the in idual ignores the complex social inequities faced by Aboriginal people living in remote communities where macro‐level determinants such as remoteness, food security and education significantly influence decisions around diet and oral health.
Publisher: CSIRO Publishing
Date: 14-07-2022
DOI: 10.1071/AH21394
Abstract: Objective The need to improve existing services to Aboriginal communities is prioritised by Australia’s National Oral Health Plan. Although only an emerging area in dentistry, continuous quality improvement (CQI) approaches have positively impacted the delivery of primary health services to Aboriginal communities. This scoping review maps the applicability of CQI strategies to Aboriginal Australian oral healthcare services. Methods A scoping review was conducted and studies that reported using CQI approaches to improve existing oral health services or quality of care deemed relevant to Aboriginal Australian communities were included. Results A total of 73 articles were retrieved and eight articles were included in the final synthesis. Several CQI tools were identified, including: plan–do–study–act cycles, dental quality alliance measures, prioritisation matrices, causal mapping and the use of collective impact methodology. Conclusion Data exploring CQI in the context of Aboriginal oral health is scarce. The plan–do–study–act cycle and its variations show potential applicability to Aboriginal oral health care. However, for CQI approaches to be adequately implemented, the prevailing model of dental care requires a paradigm shift from quality assurance to quality improvement, acknowledging the impact of structural and process elements on care.
Publisher: CSIRO Publishing
Date: 15-08-2023
DOI: 10.1071/AH23110
Publisher: Wiley
Date: 12-06-2023
DOI: 10.1111/CDOE.12885
Abstract: This study aims to conduct a process evaluation of the Kimberley Dental Team (KDT), a not‐for‐profit, volunteer organization providing care to remote Aboriginal communities in Western Australia. A logic model was constructed to detail the operational context of the KDT model. Subsequently, the fidelity (the extent to which each of the programme's elements were implemented as planned), dose (types and quantity of services provided) and reach (demographic characteristics and communities serviced) of the KDT model were evaluated using service data, deidentified clinical records and volunteer rosters maintained by KDT from 2009 to 2019. Trends and patterns of service provision were analysed using total counts and proportions over time. A Poisson regression model was used to explore changed in the rates of surgical treatment over time. The associations between volunteer activity and service provision was also investigated using correlation coefficients and linear regression. A total of 6365 patients (98% identifying as Aboriginal or Torres Strait Islander) were seen over the 10‐year period with services being provided across 35 different communities in the Kimberley. Most services were provided to school‐aged children, consistent with the programme's objectives. The peak preventive, restorative and surgical rates occurred among school‐aged children, young adults and older adults respectively. A trend was observed indicating a reducing rate of surgical procedures from 2010 to 2019 ( p .001). The volunteer profile showed significant ersity beyond the conventional dentist–nurse structure and 40% being repeat volunteers. The KDT programme maintained a strong focus on service provision to school‐aged children over the last decade with the educational and preventive components being central to the care being provided. This process evaluation found that the dose and reach of the KDT model grew with an increase in resources and was adaptive to perceived community need. The model was shown to evolve through gradual structural adaptations contributing to its overall fidelity.
Publisher: Wiley
Date: 12-03-2022
DOI: 10.1111/EDT.12747
Publisher: Wiley
Date: 06-02-2021
DOI: 10.1111/ADJ.12822
Publisher: Wiley
Date: 09-02-2021
DOI: 10.1111/ADJ.12823
Publisher: MRE Press
Date: 2018
DOI: 10.17796/1053-4625-42.6.1
Abstract: Background: Recently, there has been an increased awareness of the role of the labial and lingual frenulae on a neonate's ability to latch and breastfeed efficiently. This critical review explores the (i) oral physiology of a baby nursing (ii) factors that can decrease a baby's ability to nurse efficiently, the problems these cause and their management and the (iii) relation between poor nursing efficacy and the risk of early childhood caries (ECC) Study design: An expansive search of the literature was performed using four electronic databases. Results and conclusions: Most studies assessing the role of labial and lingual frenulae on breastfeeding were of a low quality. The relation between ECC and poor nursing efficacy was found to be largely speculative. Hence, the results of these studies should be interpreted with caution. Despite the limited quality and external validity of the current evidence, in cases where breastfeeding difficulties are identified, surgical management of labial or lingual frenulae may provide some subjective improvements in breastfeeding outcome.
Publisher: Springer Science and Business Media LLC
Date: 12-2021
DOI: 10.1186/S12903-021-02003-2
Abstract: Australian Aboriginal and Torres Strait Islander people continue to experience significant disparities in oral health and there remains an urgent need to improve services to rural and remote communities. Quantitative research has typically been used to highlight the disease burden and severity experienced by those living in remote communities, but this data does little to explore the lived reality and psychosocial nuances that impact on care. The Kimberley region of Western Australia is home to over 150 Aboriginal communities spread out across 400,000 square kilometres. The success and sustainability of oral health services to these remote communities relies on respect and reciprocity achieved through shared knowledge, decision making and involvement of Aboriginal people in discussions around oral health services and their delivery. This, study aimed to investigate the perceptions and attitudes toward dental services among Aboriginal Australian families living in remote Kimberley communities. Semi-structured interviews and yarning circles were carried out following purposive s ling of Aboriginal adults living in the East Kimberley region of Western Australia. Interviews were recorded, transcribed, and analysed guided by a constructivist grounded theory approach. In total, 80 community members participated in the yarning process. Enablers to care included: promotion of existing services, integration with primary health services, using mobile dental services and volunteers to extend care. Barriers to care included transportation, cost of treatment, the complexity of appointment systems and shame associated with health-seeking behaviours. Reassessing the prevailing operative model of dental care to remote Aboriginal communities is warranted to better address the overwhelming structural barriers that impact on oral health. Integration with existing primary health services and schools, the use of mobile units to extend care and increasing community engagement through clinical yarning are recommended in improving the current state of dental services to communities in the Kimberley.
Publisher: SAGE Publications
Date: 11-03-2019
Abstract: Dental casts are an important aspect in the treatment planning, documentation, and analysis of the dental arch forms of infants with cleft lip and palate (CLP). Impression taking in a neonate is a technique-sensitive procedure, which can result in foreign body dislodgement and carries a small risk of aspiration and airway obstruction. The advent of digital dental technologies and intraoral scanning may facilitate safer, more effective, and accurate impressions for CLP infants. A digital intraoral scan of a 3-month-old with bilateral CLP (BCLP) was compared with a conventional alginate impression taken prior to primary lip repair. Princess Margaret Hospital for Children. To test the applicability and accuracy of digital impression taking for a neonate with BCLP and palate using digital morphometrics. The average deviation of points ranged above and below the plane of superimposition from +0.78 mm to −0.42 mm with a maximum range of +2.80 mm to −2.80 mm and standard deviation of 0.88 mm. The premaxillary segment showed the greatest degree of variation. This is to our knowledge the first report that illustrates the use of a digital impression system to scan the oral structures of a neonate with BCLP. Digital scanning was found to be fast, accurate, and safe, when compared to a conventional alginate impression technique.
Publisher: Rural and Remote Health
Date: 07-07-2023
DOI: 10.22605/RRH7366
Publisher: Wiley
Date: 18-04-2021
DOI: 10.1111/ADJ.12840
Publisher: Elsevier BV
Date: 10-2023
Publisher: Wiley
Date: 13-02-2023
DOI: 10.1111/IPD.13054
Abstract: Tele‐dentistry can be useful to facilitate screening of children, especially those living in rural and remote communities, and during the COVID‐19 pandemic. This study evaluated the feasibility of tele‐dental screening for the identification of early childhood caries (ECC) in preschoolers using an app operated by their parents with remote review by oral‐health therapists. This cross‐sectional study was a sub‐project nested in ORIGINS Project, a longitudinal birth cohort study in Western Australia. Initially, children were visually examined by a paediatric dentist (gold standard). Subsequently, dental photographs were taken by parents using a smartphone camera. Two trained oral health professionals asynchronously evaluated dental photographs. The presence of dental caries was recorded as per the International Caries Detection and Assessment System‐II classification. The diagnostic accuracy and reliability of the tele‐dental screening and the gold standard dental examinations were then compared. Forty‐two children aged years were enrolled in the study. Twenty‐five per cent of examined children had dental caries (mean dmfs = 0.7). A total of 370 dental photographs were obtained. Parents were able to take good‐quality photographs, with 90% of photographs rated as good to fair quality. Tele‐dental screening demonstrated high specificity ( =95.5%) for both reviewers compared to the gold standard dental examination. However, the sensitivity scores for the two reviewers varied, ranging from 44% to 88.4%. Tele‐dental screening for ECC was shown to be a feasible approach following a brief training for primary caregivers. This approach can offer a potential low‐cost and sustainable alternative for visual dental examinations for young children, particularly in times of COVID‐19‐related restrictions.
Publisher: Wiley
Date: 29-07-2015
DOI: 10.1111/ADJ.12240
Abstract: Aboriginal Australians face significant disparities in oral health and this is particularly the case in remote communities where access to dental services can be difficult. Using volunteers to provide dental care in the remote Kimberley region of Western Australia is a novel approach. This study comprised an anonymous online survey of volunteers working with the Kimberley Dental Team (KDT). The survey had a response fraction of 66% and explored volunteer demographic characteristics, factors that motivated their involvement, perceptions of oral health among Aboriginal communities, and barriers and enablers to oral health in remote Aboriginal communities. Volunteers were more likely to be female, middle-aged and engaged in full-time employment. The two most common reasons reported for volunteering were to assist the community and visit the Kimberley region. Education and access to reliable, culturally appropriate care were perceived as enablers to good oral health for Aboriginal people in the Kimberley while limited access to services, poor nutrition and lack of government support were cited as barriers. Volunteers providing dental services to remote areas in Western Australia had a erse demographic profile. However, they share similar motivating factors and views on the current barriers and enablers to good oral health in remote Aboriginal communities.
No related grants have been discovered for Jilen Patel.