Research at Dental Health Services Victoria
DHSV recognises evidence-informed clinical practice and policy development is essential to improve oral health outcomes. We partner with academics, consumers, professional associations, policy-makers and health service providers to undertake research and provide thought leadership to improve the oral health of Victorians and Australians. Our focus is to promote prevention and early intervention, the integration of oral health with general health, value-based health care and oral health equity. DHSV has collaborated with the following:
- The University of Melbourne
- La Trobe University
- Deakin University
- Victorian Department of Health
- Community dental agencies
Check out our latest research work:
A policy option towards improving efficiencies in Victorian public oral healthcare
Nguyen TM, Hall M. A policy option towards improving efficiencies in Victorian public oral healthcare. Int J Health Plann Mgmt. 2024;1‐14
This study evaluated the potential financial impact of optimising the oral health workforce skill-mix of dentists and oral health therapists in Victoria. A more efficient oral health workforce has the potential to generate cost-savings of AUD$1,425,037 which could be reinvested to treat more Victorians from the eligible population.
Singh, A., Hegde, S., Silva, M., Whelan, M., Karahalios, A., Manton, D. J., Goldfeld, S., English, D. R., & Dashper, S. International Journal of Paediatric Dentistry
The study explores inequities in early childhood caries among children accessing the public dental system in Victoria. Social disadvantage is assessed by Aboriginal and Torres Strait Islander status, the main language spoken at home as a proxy for culturally and linguistically diverse status, concession card holder status and area deprivation determined by the Index for Relative Socioeconomic Disadvantage. The results found that not only are children from socially disadvantaged backgrounds more likely to develop decay than their counterparts, but they also experience decay earlier.
Han C, Lin CE, Raichur A, Hall M, Nguyen TM. Leadership, regulatory approaches and policy to re-orientate health services towards health promotion, Health Promotion International, Volume 39, Issue 3, June 2024
This paper calls out three specific actions to improve population oral health: (i) population oral health reform through leadership, (ii) innovative oral health workforce models, (iii) universal health coverage that includes oral health. The aim of the paper is to outline how leadership, regulatory approaches and policy in Australia can strengthen health promotion practice. Examples in Australia shows that effective leadership, regulatory approaches and well-designed policies can address the complex problems associated with improving population oral health, and are made possible through public health advocacy, collaboration and research.
A refresh on oral health messages for Australia to enable effective oral health promotion
Nguyen TM, Lin C. A refresh on oral health messages for Australia to enable effective oral health promotion. The Australia and New Zealand Journal of Dental and Oral Health Therapy. 2023;11(2):1-6
Improving health literacy, including oral health literacy, can significantly influence overall health at a population and individual level. Effective health promotion to prevent oral diseases relies on available evidence to improve health literacy and promote healthy behaviours. Our paper discusses the implications of the 2023 revised oral health messages for Australia for oral health promotion efforts, identifies potential gaps for health promotion with a focus on oral health, and outlines an approach for developing consistent, evidence-based communications.
Dental Health Services Victoria value-based health care principles for oral health models of care
Lin CE, Nguyen TM, McGrath R, Patterson A, Hall M. Dental Health Services Victoria value‐based health care principles for oral health models of care. Journal of Public Health Dentistry. 2023
Value-based health care is being rapidly adopted to promote a focus on patient outcomes and value. Dental Health Services Victoria recognises the potential for value-based health care to improve population oral health and drive healthcare efficiencies. However, the concept of value-based health care and its translation into practice can be challenging to understand. To support translation to practice, Dental Health Services Victoria developed three key principles that can underpin oral health models of care and support front-line staff in implementing value-driven care. These include:
- Care is co-designed with the person or population
- Prevention and early intervention are prioritised
- Consistent measurement of health outcomes and costs is embedded.
Nguyen TM, Rogers H, Taylor GD, Tonmukayakul U, Lin C, Hall M, Calache H, Vernazza C. Fit for Purpose? The Suitability of Oral Health Outcome Measures to Inform Policy. JDR Clinical & Translational Research. 2023
The decayed, missing, and filled teeth index is commonly used to measure oral health and disease burden. It focuses on dental problems due to tooth decay but does not consider how they affect people’s lives. This paper proposes that we should consider using tools that measure the outcomes that patients care about. These tools, including patient-reported outcome measures and patient-reported experience measures, can help shape policies that better address the needs and preferences of patients in oral healthcare.
Prioritising population oral health through public policy: the Victorian experience
Nguyen TM, Lin C, Raichur A, Patterson A, Hall M, Aldrich R, Robinson S. Prioritizing population oral health through public policy in Australia: the Victorian experience. Health Promotion International. 2023.
This paper explores the pivotal role Victoria's local councils can play to advance oral health. It examines the influence Victorian Public Health and Wellbeing Plans can have on local councils’ Municipal Health and Wellbeing plans. The results show that the inclusion of specific oral health priorities mostly decreased over time but that common risk factors for oral and chronic diseases were frequently prioritised. The study suggests that a multi-sectoral approach, that includes oral health, is crucial to address the rising burden of non-communicable diseases.
Nguyen TM, Bridge G, Hall M, Theodore K, Lin C, Scully B, Heredia R, Le LK, Mihalopoulos C, Calache H. Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study. Journal of Public Health Policy. 2023 May 4:1-5.
Value-based healthcare is a strategy that focuses on healthcare outcomes relative to cost. Dental Health Services Victoria began implementing value-based healthcare in 2016 to reform public oral healthcare. This paper explores a value-based healthcare case study for the oral health context and demonstrates that it is a potential strategy to achieve universal health coverage that includes oral health. The flexibility of value-based healthcare is helpful because it considers a diverse health workforce and alternative funding models beyond fee-for-service.
Supporting oral health in Timor Leste and the Western Pacific Region
Nguyen T, Han C, Hall M, The Health Advocate, Supporting oral health in Timor Leste and the Western Pacific Region, Issue 72/August 2023, page 15
Dental Health Services Victoria has spent over six years building international partnerships to improve oral health in the region, from Timor Leste to the Western Pacific. These partnerships aim to build local oral health capacity while also providing an opportunity for Dental Health Services Victoria staff to learn from other nations. In 2023, Dental Health Services Victoria initiated the Colin Riley Scholarship for Victorian public oral health professionals to participate in clinical placements and support training in the Western Pacific region. Additionally, three dental vans were donated to further support oral health services in these areas.
Nguyen TM, Arora A, Sethi S, Gavanescu DJ, Heredia R, Scully B, Lin C, Hall M. Is Australia's lack of national clinical leadership hampering efforts with the oral health policy agenda? Aust Health Rev. 2023
This paper outlines the case for national clinical leadership, including the appointment of Australia’s first Chief Dental Officer, to drive national oral health reform and address oral health inequities. The World Health Organisation Global Strategy on Oral Health 2030 recognised the need to include oral health in universal health coverage and the role of national clinical leadership in driving this forward. This article discusses the oral health issues in Australia, its healthcare system, and past challenges of Australian funded dental programs. It emphasises the importance of expertise in dental public health to guide national policies that focus on prevention and early intervention.
Lessons learned from a Victorian public dental model of care focusing on periodontitis: A case study
Nguyen TM, Tonmukayakul U, Lin C, Scully B, Heredia R, Bischof W, Hall M, Calache H. Lessons learned from a Victorian public dental model of care focusing on periodontitis: A case study. Australian & New Zealand Journal of Dental & Oral Health Therapy. 2022;10(2).
This paper describes a preventive care model for severe gum disease, centred around the role of oral health educators, at a community health service. Evaluation showed the model increased dental service rates, particularly for preventive services and self-reported outcomes due to severe gum disease.
Nguyen TM, Tonmukayakul U, Hall M, Calache H. Cost‐effectiveness analysis of silver diamine fluoride to divert dental general anaesthesia compared to standard care. Australian Dental Journal. 2022;67(4):352-61.
Silver diamine fluoride is medicine used to stop tooth decay from getting worse and can help prevent the need for dental treatment under general anaesthetics, particularly among children. This study is a health economic evaluation of a trial using silver diamine fluoride for children aged 2-10 in Victoria. Over 12 months, silver diamine fluoride was found to be cost-effective, save costs to the healthcare system and significantly reduce the number of children requiring dental treatment under general anaesthesia. Silver diamine fluoride is a good option for managing dental caries in children and should be promoted more broadly into routine clinical dental practice.
Lin C, Goncalves N, Scully B, Heredia R, Hegde S. A Teledentistry Pilot Study on Patient-Initiated Care. International Journal of Environmental Research and Public Health. 2022;19(15):9403.
This paper outlines Dental Health Services Victoria's patient-initiated teledentistry model of care and its strengths in reaching vulnerable populations. From May 2020 to April 2021, 2,492 patients accessed telehealth services, with positive patient-reported experience measures demonstrating that teledentistry was able to provide safe and critical access to dental services during the COVID-19 pandemic.
Trends in social inequalities in early childhood caries using population-based clinical data
Lopez, D. J., Hegde, S., Whelan, M., Dashper, S., Tsakos, G., & Singh, A. (2022). Trends in social inequalities in early childhood caries using population‐based clinical data. Community Dentistry and Oral Epidemiology. 51;(4);627-35.
The study assessed the trend in social inequalities in early childhood caries in Victoria from 2008 to 2019, analysing prevalence and severity across various sociodemographic measures. The results showed increasing inequalities for children from culturally and linguistically diverse background and holders of concession cards. This paper highlights the need for oral health policies and interventions to reduce oral disease and oral health inequalities between population groups.
Yawary, R., & Hegde, S. (2022). Silver diamine fluoride protocol for reducing preventable dental hospitalisations in Victorian children. International Dental Journal, 72(3), 322-330.
This study was designed to assess the effectiveness of a dental caries management protocol using silver diamine fluoride and oral health education for children aged 2-10 years. The results showed that using silver diamine fluoride intervention protocol resulted in substantial reduction in proportion of active caries and preventable dental hospitalisations. Following the intervention, most primary carers opted against referral for dental general anaesthesia, and significant improvements were observed in child oral health-related quality of life scores.
Early childhood caries in Victorian preschoolers: a cross-sectional study
Graesser, HJ., Sore, R., Rogers, J., Cole, D., & Hegde, S. (2022). Early Childhood Caries in Victorian Preschoolers: A Cross-Sectional Study, International Dental Journal, 72(3), 381-391.
Early childhood caries can significantly impact a child’s quality of life, growth and development and is entirely preventable. This study aimed to determine the prevalence of early childhood caries and any associated sociodemographic variables in Victorian preschool children enrolled in Dental Health Service Victoria’s Smiles 4 Miles program. Results showed statistically significant associations between sociodemographic factors and early childhood caries. The early childhood years provide a valuable opportunity to provide oral health information and prevention-focused interventions for improved population oral health among children.
Chattopadhyay, A., Christian, B., Gussy, M., Masood, M., Hegde, S., Raichur, A., Martin, R., & Kenny A. (2021). Oral health surveillance in Australia: the need for ongoing data to inform public health decision-making. Australian Journal of Primary Health. 28(1):18-22.
Health surveillance is important in public health, enabling the monitoring of diseases and prompt response to population health changes. An effective public health system relies on population-level data for informed policy and program development. This perspective paper presents the need for real-time oral health surveillance in Australia, which can be used to inform health decision-making in a timely manner.
Lang, AY., Carpenter, LM., de Silva, AM., Kearney, SL., & Hegde, S. (2021). Health promotion competencies for promoting child-oral health: Victorian multidisciplinary workforce perspectives. Health promotion journal of Australia, 32 Suppl 2, 126–138.
Improving oral health requires a multidisciplinary and co-ordinated approach by both oral health and non-oral health professionals. This study aimed to identify the oral health promotion competencies required for the successful implementation of Dental Health Service Victoria’s community-based oral health program ‘Smiles 4 Smiles’. Core competencies identified for best-practice oral health promotion are consistent with the key domains identified by both oral and general health promotion frameworks and can be developed through education, training and collaborative intersectoral partnerships.
Riordain, R.N., Glick, M., Al Mashhadani, S.S.A., Aravamudhan, K., Barrow, J., Cole, D., Crall, J.J., Gallagher, J.E., Gibson, J., Hegde, S. & Kaberry, R. (2021). Developing a standard set of patient-centred outcomes for adult oral health–an international, cross-disciplinary consensus. International Dental Journal, 71(1), pp.40-52.
Traditionally measuring the impact of oral diseases has only focused on a biomedical model, that does not provide a holistic understanding of the disease burden. This study aimed to develop a minimum adult oral health standard set (AOHSS). An international oral health working group of patient advocates, researchers, clinicians, and public health experts through a rigorous selection process developed the final AOHSS which included 17 outcome concepts and 14 case-mix conceptual models. The development of the AOHSS is intended to be used by clinicians and patients within a decision-making environment to plan and track the progress and oral health outcomes overtime.
Hegde, S. (2021). Settings-based interventions at primary, secondary and tertiary prevention levels may significantly improve the oral health of older people. Journal of Evidence Based Dental Practice, 21(2), p.101537.
Oral health is often neglected as part of healthy ageing in older people. This review provides a summary of existing evidence on interventions to improve the oral health of older people over 65 years of age. The identified interventions were from a range of settings and were mapped into three levels of prevention (primary/secondary/tertiary prevention) as well as their role in the care process (caregiver/patient, dentist, or system/policy-maker level). It was found that there are many resources available to guide older people in improving their oral health, especially at the primary prevention level. However, it was difficult to compare and form a strong conclusion on what factors influence the effectiveness of these interventions in improving the oral health of older people.
Gussy, M., Mnatzaganian, G., Dashper, S., Carpenter, L., Calache, H., Mitchell, H., Reynolds, E., Gibbs, L., Hegde, S., Adams, G. and Johnson, S., (2020). Identifying predictors of early childhood caries among Australian children using sequential modelling: Findings from the VicGen birth cohort study. Journal of Dentistry, 93, p.103276.
This study aimed to identify concurrent associations between early childhood caries and risk factors such as biological, environmental and socio-behavioural factors. The study findings inform oral health promotion efforts and clinical decision-making for the management of early childhood caries at both the individual and population levels.
Family-centred oral health promotion through Victorian child-health services: a pilot
Heilbrunn-Lang AY, Carpenter LM, de Silva AM, Meyenn LK, Lang G, Ridge A, Perry A, Cole D, Hegde S. (2020). Family-centred oral health promotion through Victorian child-health services: a pilot. Health Promotion International, 35(2), 279–289.
Early childhood caries is one of the most preventable chronic diseases in Australian children. The aim of this study was to investigate the impacts of a piloted oral disease prevention intervention called Tooth-Packs. The intervention involved Maternal Child Health Nurses’ (MCHN) from four high-needs Victorian local government areas providing oral health promotion resources, toothbrushes, toothpaste, and examine MCHN referral practices to dental services. Overall improvements were observed in children’s tooth brushing behaviour, access to preventive care, toothbrushing twice a day and use of fluoridated toothpaste.
Dental Health Services Victoria: Journey to Value Based Healthcare
Raymond, K, Hegde, S. (2020) Dental Health Services Victoria: Journey to Value Based Healthcare. Deeble Perspectives Brief No 7. Deeble Institute, Australian Healthcare & Hospitals Association.
Australia's public dental model is primarily driven by a fee for service model which encourages volume of service delivery over patient outcomes. This paper explores Dental Health Services Victoria’s shift to a value-based health care (VBHC) journey. The need to implement VBHC at DHSV (Dental Health Services Victoria) emerged from the need to improve health outcomes that matter to patients, particularly for people accessing public dental care, who tend to be more disadvantaged compared to the general population. The paper explores various barriers and enablers to VBHC implementation. including the need to address health inequalities, improve outcomes, and drive systematic reforms.
Is there an association between body weight and early childhood caries experience?
Hegde, S., (2020). Is there an association between body weight and early childhood caries experience? Evidence-Based Dentistry, 21(3), pp.114-115.
Dental caries and obesity are two of the most common chronic health issues amongst preschool children. Previous evidence has indicated that the presence of dental caries and obesity is associated with dental hospitalisations, dental emergency presentations and treatment under general anaesthesia. This paper reviews existing literature on the relationship between body weight and early childhood caries experience. It was found that preschool children who were overweight and obese had a greater risk of developing dental caries. Public health prevention programmes can target both conditions together through a common risk factor approach.
Hegde, S., 2020. Which type of personal protective equipment (PPE) and which method of donning or doffing PPE carries the least risk of infection for healthcare workers? Evidence-based dentistry, 21(2), pp.74-76.
The Covid-19 pandemic was a public health emergency during which the compulsory use of personal protective equipment for healthcare workers was enforced to reduce the risk of transmission and infection of this disease. This review outlines the most appropriate type of personal protective equipment for dental settings, taking into consideration the method of donning or doffing of personal protective equipment that will result in the least risk of infection for healthcare workers.
Re-orienting funding from volume to value in public dental health services
Hegde, S. and Haddock, R., 2019. Re-orienting funding from volume to value in public dental health services. Deeble Issues Brief No. 32. Deeble Institute, Australian Healthcare & Hospitals Association.
This Issues Brief explores the funding reforms for public dental health services that will be required to achieve value-based health care in Australia. Using Dental Health Service Victoria’s learnings from implementation of value-based health care implementation, this brief draws on local and international examples on funding model reforms. The report provides the rationale and evidence for funding reforms that maximise value and outcomes for patients, government and the health system and provides recommendations for adoption by policy-decision makers.