Stephen Cox

Background: Medication related osteonecrosis of the jaw (MRONJ) is a debilitating condition associated with antiresorptive and antiangiogenic therapies. As the use of these medications continues to increase, dental practitioners play a critical role in prevention and management of at‐risk patients. This survey evaluated the awareness, knowledge and practice patterns of Australian dental practitioners regarding MRONJ. Materials and Methods: A cross‐sectional online survey of registered Australian dental practitioners was conducted. The 26‐item questionnaire assessed knowledge of MRONJ diagnosis, clinical features, risk factors and practice patterns. Responses were analysed descriptively. Results: A total of 343 dental practitioners participated. Overall MRONJ awareness was high, with 88.6% correctly identifying the principal diagnostic criteria. Knowledge of antiresorptive medications was strong, but familiarity with antiangiogenic agents was limited, with 25% unable to identify any associated medication. Only 62.4% were comfortable assessing MRONJ risk before extraction and just 37.9% comfort in performing extractions in at‐risk patients. Public practitioners reported greater MRONJ‐related education and clinical confidence than private practitioners. Conclusion: Australian dental practitioners demonstrated strong awareness of MRONJ. However, confidence in providing invasive treatment for at‐risk patients remained limited, particularly among private dental practitioners. These findings highlight the need for targeted education and clinical support as the use of MRONJ associated medications continues to increase. Clinical Relevance: Although overall awareness of MRONJ is high among Australian dental practitioners, ongoing knowledge and confidence gaps may contribute to variation in clinical practice. Addressing these gaps through continuing professional education, evidence‐based guidance, and structured risk assessment may enhance patient safety and optimise the prevention and management of MRONJ.

Background/Objectives: One of the most common oral surgery procedures performed in dentistry is the removal of third molar teeth (3M). Complications of both retention and removal of third molars are associated with potentially preventable hospitalisations (PPH). This study aims to systematically review the published literature to identify demographics, aetiology, incidence, associated factors, length of hospital stay (LOS) and variables influencing the outcomes of PPH arising from 3M. Methods: An electronic literature search was performed using Medline and Embase via Ovid in May 2024, and relevant studies were analysed for demographics, aetiology, incidence, related factors and LOS associated with PPH resulting from 3M. Results: Nineteen publications with sample sizes ranging from 37 to 3549 patients per study were identified. Two studies reported 101 patients described PPH specifically related to 3M. The remaining 17 studies described 6153 oral health-related PPH, predominantly arising from broader odontogenic infection cohorts, of which 1654 (26.9%) PPH were associated with 3M. The mandibular 3M was implicated in 98.5% of 3M-related PPH. Pericoronitis and postoperative infections following 3M removal were reported as the leading causes of hospitalisation, whereas data on dental caries were not reported. Similarly, most studies did not report detailed information on demographics, aetiology, or outcomes specific to third molars. Conclusions: Available indirect data shows that 3M-related dental infections, including post operative infections, contribute to oral health-related PPH. There are significant evidence gaps in third molar-specific PPH data. Further studies with standardised reporting focusing on third molar-related hospitalisations are required to identify factors influencing clinical outcomes and to inform evidence-based clinical decision-making regarding the removal or retention of third molars.

Objectives: This study aimed to investigate the cost of hospitalization and length of stay (LOS) associated with dental infections and their impact on healthcare resources. Materials and Methods: Web of Science, Medline via Ovid, and Google Scholar were searched for articles published from 2013 to 2023 using relevant MeSH terms. A descriptive summary was produced to describe study characteristics, and selected studies were analyzed to evaluate financial implications and hospitalization outcomes. Results: After removing duplicates, 125 articles were screened, with 25 read in full and 9 excluded. Sixteen retrospective studies were included, encompassing 156,487 patients. Hospital length of stay ranged from 1.15 to 10 days, and hospitalization costs ranged from AUD 2402 to USD 47,836.60. Variability in outcomes appeared to be influenced by infection severity, healthcare infrastructure, and geographic setting. Conclusions: Dental infections impose a substantial and variable burden on healthcare systems. These findings emphasize the need for timely intervention, preventive strategies, and standardized management protocols to reduce clinical complications and financial strain on healthcare services.

Background: This study compared the reasons for dental presentations between Indigenous and non-Indigenous Australian adults at the Nepean Centre for Oral Health, NSW, Australia. Methods: A retrospective cohort study was conducted on adult patients presenting between 1 July and 31 December 2019. Clinical notes were audited and categorized as either ‘emergency’ (pain, dental infection, dental trauma, loose teeth or dental implants, bleeding) or ‘conservative’ (dental check-ups, examinations, prosthodontic, restorative, periodontal, or non-emergency endodontic therapy). Results: A total of 4663 patients met the inclusion criteria; 61.6% were female, and 6.4% were identified as Indigenous Australians. Overall, 41.3% of presentations were for emergency dental care. Indigenous Australians were significantly more likely to present for dental emergencies compared with non-Indigenous (58.2% vs. 40.2%; χ²(1, N = 4663) = 53.4, p < 0.00001; OR = 2.07, 95% CI: 1.64–2.63), and were also more likely to undergo emergency tooth extractions (p < 0.05). Conclusions: Indigenous Australians demonstrated a higher proportion of emergency and oral surgery-related presentations and underwent tooth extractions as the primary treatment compared to their non-Indigenous counterparts. These findings suggest a higher burden of oral disease and delayed access to general dental services among Indigenous Australians, highlighting the need for targeted and culturally appropriate public health interventions.

The aim of this clinical audit is to evaluate the characteristics of dental infections requiring hospitalisations, which may help improve preventative and management policies. This study retrospectively evaluated the records of patients admitted to the Nepean hospital, Kingswood, New South Wales, Australia, due to dental infections between 2018 and 2019. A total of 102 patients, mostly in their thirties with equal gender distribution, were admitted with dental infections, presenting with pain (100%), swelling (99%), trismus (40.2%), dysphagia (27.4%), fever (21%) [>37 °C], tachycardia (24.8%) and tachypnoea (9.3%). Most patients (68%) presented on weekends, outside regular working hours, and public holidays. A total of 52.5% of patients had taken prior antibiotics. Dental caries, smoking, mental health issues, and illicit drug use were featured strongly. The majority of patients (56.4%) underwent treatment under local anaesthesia. The total length of hospital stay was 271 days (mean 2.7, SD 1.6). Augmentin was the most prescribed antibiotic. Complications were reported in 8.8% of the patients, primarily due to airway compromise. Dental infections leading to hospitalisations continue to be a burden on the healthcare system. A notable finding was that the presentations were primarily on weekends, outside regular working hours, and public holidays, and the majority required dental interventions under local anaesthesia. The provision of on-call emergency dental services may reduce potentially preventable hospitalisations and the length of hospital stay.

Background: The aim of this audit is to evaluate the characteristics of dental infections requiring hospitalisations, which may help improve preventative and management policies. Methods: This study retrospectively evaluated the patients’ records admitted to a public hospital due to dental infections between 2018 and 2019. Results: A total of 102 patients, mostly in thirties with equal gender distribution were admitted with dental infections, presenting with pain (100%), swelling (99%), Trismus (40.2%), dysphagia (27.4%), fever (21%) >37°C, Tachycardia (24.75%) and Tachypnoea (9.3%). Most patients presented (68%) on weekends, outside regular working hours and public holidays. 54 (52.5%) patients had taken prior antibiotics. Dental Caries, smoking, mental health issues and illicit drug use were featured strongly. The majority of patients (56.4%) underwent treatment under local anaesthesia. The total length of hospital stay was 271 days (mean 2.66). Augmentin was the most prescribed antibiotics. Complications were reported in 8.8% patients, primarily related to airway compromise. Conclusion: Dental infections leading to hospitalizations continue to be a burden on the healthcare system. A notable finding was the presentations primarily on weekends, outside regular hours and public holidays and the majority requiring dental intervention under local anaesthesia. Provision of on call emergency dental services may reduce length of hospital stay and admissions.

Background: The aim of this systematic review was to analyse the published literature on dental infections leading to hospitalisations in Australia. It was hoped that understanding the patterns and trends would form a basis for improved preventive and management policies. Methods: An electronic search was performed using Web of Science, Medline via Ovid and Google Scholar. Inclusion and exclusion criteria were applied. The included studies were analysed for demographics, aetiology, management, length of hospital stay and outcome of dental infections requiring hospitalisation. Results: Nine retrospective studies were eligible for inclusion. A total of 2196 cases of dental infections leading to hospitalisations were reported, with a male predominance (55–67%). Mental health issues, illicit substance abuse and immunosuppression were the main associated comorbidities (up to 58%). Dental caries (59–90%) and pericoronitis (10–19%) were the leading causes of dental infections. Empirical antibiotics were utilised in up to 75% of cases prior to hospital presentation. Six mortalities were reported. Conclusions: The available published data show that dental infection is a significant public health problem. However, only general conclusions were possible due to the variably small sample size and data collection that was inconsistent and incomplete across studies. Improved data collection is required to develop policies for prevention and management.

Objectives: To identify the factors influencing errors in the interpretation of dental radiographs. Methods: A protocol was registered on Prospero. All studies published until May 2022 were included in this review. The search of the electronic databases spanned Ovid Medline, PubMed, EMBASE, Web of Science and Scopus. The quality of the studies was assessed using the MMAT tool. Due to the heterogeneity of the included studies, a meta-analysis was not conducted. Results: The search yielded 858 articles, of which eight papers met the inclusion and exclusion criteria and were included in the systematic review. These studies assessed the factors influencing the accuracy of the interpretation of dental radiographs. Six factors were identified as being significant that affected the occurrence of interpretation errors. These include clinical experience, clinical knowledge, and technical ability, case complexity, time pressure, location and duration of dental education and training and cognitive load. Conclusions: The occurrence of interpretation errors has not been widely investigated in dentistry. The factors identified in this review are interlinked. Further studies are needed to better understand the extent of the occurrence of interpretive errors and their impact on the practice of dentistry.