Oral Health

Our Research

The oral health research at SDH and SLHD Oral Health Service is committed to advancing scientific knowledge and improving oral health of our patients. We strongly believe that oral health is an integral aspect of general health. Poor oral health is likely to exist when general health is poor, and vice versa (AHMAC 2001). Our focus moving forward is to be part of multidisciplinary health research to improve health and well being of our population.

Our Goals are:

• To position Sydney Dental Hospital as a high-quality, multidisciplinary research institute in addition to its community service provider role.
• To encourage research and promote a culture of evidence based clinical practice within OHS.
• To strengthen and improve the integration of basic, translational, and clinical research.

Key research themes, by department, include:

Orthodontics
The Orthodontics department is a leader in the management of Obstructive Sleep Apnoea in Adults and Growing Patients. There is evidence that certain jaw discrepancies are closely related with breathing and sleep problems. However, there are very few studies on the short and long-term effects of the correction of jaw discrepancies on the treatment of sleep apnoea and potential cardiovascular diseases.

Our actual and future studies aim to investigate how significant early treatment of jaw discrepancies in growing patients and the use of oral appliances and jaw surgery in adults can help in treating OSA, and also its short and long-term side effects, particularly in cardiovascular diseases. Other areas of research include Orthodontic Tooth Movement and Root Resorption, Orthopaedic Functional Appliances in the treatment of Jaw Discrepancies, Effects of Mechanical Vibration on Tooth Movement, Root Resorption, Bone and Condylar Growth and Accelerated Tooth Movement.

Periodontology
The Periodontics department is currently investigating the responses to a number of treatment protocols for periodontal disease and implants, changes to the periodontal complex which occur around both natural teeth and implants in response to different treatments in both human and animal models and inter-relationship between periodontal disease and atherosclerosis-induced diseases, such as coronary heart disease (CHD), stroke and peripheral artery disease, as evidenced by multiple studies and meta-analyses. In Australia, moderate to severe periodontal disease currently occurs in approximately 23% of the adult population and its prevalence increases with age and will continue to do so as more older adults retain their teeth. If the successful treatment of periodontal diseases and maintenance of periodontal health has a positive effect on the systemic diseases mentioned above, this would have a beneficial effect on both the well being of the patients as well as on the financial burden of the health care system.

Other areas of research include investigating:

• The efficacy of different mouthwashes on plaque formation and gingival inflammation
• The use of piezocision to promote orthodontic treatment Histological changes initiated by piezocision
• Efficacy of an air polishing device with a new powder in maintenance patients (SPT)
• Changes to the health practices of both non-dental clinicians and patients with systemic disease such as HIV infection.

Oral Surgery and Diagnostic Imaging
The Department of Oral Surgery and Diagnostic Imaging has taken the lead role in training Oral Health staff in the management of medical emergencies, including developing the skills required to recognise, assess and provide treatment for someone who is deteriorating. The Department is also conducting research into how staff learn about medical emergency management, how well they retain the knowledge (given that it is not used often), and how the program be developed to best suit the needs of an outpatient health service. Other ongoing projects include looking at the role of bisphosphonates on dental treatment and B-cell Isotype Dysregulation in Pemphigus Vulgaris. The Diagnostic imaging is involved in research related to oral care for people with disabilities, the use of panoramic images as a potential indicator of undiagnosed thyroid disorder in symptomatic patients, pathology missed on panoramic radiographs and radiographic errors and quality of radiographs taken.

Forensic Odontology
We are addressing the challenge to the identification sciences within forensic science raised by the National Academy of Science Report of 2009. This challenges some of the underpinnings of identification sciences (bite marks, fingerprints, document examination, firearms examination). Among other recommendations was a call for validation studies. Two validation studies have been initiated in the field of forensic odontology. One involves skills in dental anatomy, with teeth collected in the Sydney Dental Hospital and The Canterbury Hospital used to make reproductions of teeth to assess skills in dental anatomy among students, practitioners and registered specialist odontologists. The second study is aimed at assessing skills in a core activity - matching antemortem and postmortem radiographs. This involves an online study which has been sent to all odontology organizations internationally. This study is still in the data collection phase. A third validation study aimed at assessing the skills of odontologists at age estimation using dental radiographs is planned.

Endodontics
Ongoing projects include an investigation into the amount of apical debris extruding in three rotary/reciprocating techniques of root canal preparation, a study into why tooth fail and are extracted within 12 months of the completion of the root canal treatment, a meta-analysis of treatment modalities employed in treating the endodontic emergency, an analysis of the effect of smoking on endodontic success and the uptake and utilization of endodontic treatment in metropolitan and regional AMS clinics. Recently completed research has involved surveys into the techniques and material used by Australian Endodontists, a survey into the endodontic techniques used by general practitioners in the state of Queensland, a meta-analysis of irrigant modalities used by dentists and endodontic specialists throughout Australia, the overall success rate of endodontic treatment carried out in a large teaching hospital, the long term success of various treatment modalities utilized in the pulp-capping of permanent teeth, procedural errors in endodontic procedures carried out by final year dental students and frequency of the presence of the MB2 canal in upper maxillary molars in private and specialist dental practice.

Population Oral Health
Midwifery Initiated Oral Health Program
Women during pregnancy are prone to dental problems which can contribute to adverse pregnancy and infant outcomes. Unfortunately only a third of Australian women consult a dentist during pregnancy with the main barriers being lack of dental awareness, high dental costs and limited emphasis on oral health during antenatal care. To address this issue a unique midwifery initiated oral health dental service (MIOH-DS) program is being developed to promote maternal oral health in Australia. This is a collaborative project between Centre for Applied Nursing Research (CANR) and Oral Health Service and an Australian first. The program involves training midwives to provide oral health education/assessment and referrals during early pregnancy and offering priority dental referral pathways. It is a randomised controlled trial of 641 pregnant women recruited from three metropolitan hospitals in Western and South-western Sydney.

The low uptake of dental services has been attributed to various barriers facing pregnant women such as cost, lack of awareness and misconceptions. However, recent research reveals that there are significant provider barriers that can further exacerbate the problem. A review has shown there is no clear consensus among dentists and prenatal care providers regarding oral health care during pregnancy. There is also limited emphasis being placed on oral health within maternity care in Australia. All these issues can further deter pregnant women from seeking dental care. To address these issues researchers from the Centre for Applied Nursing Research, Sydney & South Western Sydney Local Health District and University of Western Sydney are gathering information about the current knowledge, attitude and practices of dentists and prenatal care providers (general medical practitioners, midwives and obstetricians & gynaecologists) in NSW towards oral health care during pregnancy. The information gained will inform the development of practice guidelines in perinatal oral health for all health professionals in Australia.

Preventive / Interceptive Orthodontic Research (PrIOR)
Orthodontic problems (abnormal positioning of the teeth and jaws) may affect individual-s quality of life. Some minor orthodontic problems if intercepted in childhood or adolescence can be prevented from becoming severe in adulthood. Currently only severe conditions are eligible for treatment in Public Specialist Service and there is a lack of early treatment strategies. An innovative tool is being developed as part of PrIOR Project which will be a cost-effective strategy for delivering orthodontic care by public dentists who are not qualified in orthodontics. It will provide dentists- competence to monitor, diagnose, treat or refer the disadvantaged children in a timely manner.

Key Achievements

• Orthodontics Periodontics collaborative research showcased on the cover page of the American Journal of Orthodontics and Dentofacial Orthopaedics with the paper tittled 'Effect of piezocision on root resorption associated with orthodontic force: A microcomputed tomography study. ' published in the journal.
• Elston Storey Award to graduate student Dr Braydon Patterson for the above study.
• 2nd Place Winner (Clinical Research) Charley Schultz Resident Scholar Award to DClinDent student Dr Doreen Ng for the study 'Ng D, Chan A, Dalci O, Papadopoulou AK, Darendeliler MA. The effect of low-level laser therapy compared to sham laser on orthodontically induced root resorption: A pilot double-blinded split-mouth randomized controlled trial.' In the annual congress of the American Association of Orthodontists.

Awards/Medals

• Elston Storey Award from the Australian Society of orthodontists to the graduate student Dr Braydon Patterson for the study 'Patterson BM, Dalci O, Papadopoulou AK, Madukuri S, Mahon J, Petocz P, Spahr A, Darendeliler MA. Effect of piezocision on root resorption associated with orthodontic force: A microcomputed tomography study. Am J Orthod Dentofacial Orthop. 2017 Jan;151(1):53-62. '.
• 2nd Place Winner (Clinical Research) Charley Schultz Resident Scholar Award to DClinDent student Dr Doreen Ng for the study 'Ng D, Chan A, Dalci O, Papadopoulou AK, Darendeliler MA. The effect of low-level laser therapy compared to sham laser on orthodontically induced root resorption: A pilot double-blinded split-mouth randomized controlled trial.' In the annual congress of the American Association of Orthodontists.

Research Staff

DClinDent students involved in research.

• Dr Vanessa Hawkins
• Dr Jessica Li 
• Dr Chun Ang Kaw
• Dr John Sambevski
• Dr Gordon Cheung
• Dr Laura Leask
• Dr Simone Mustac
• Dr Shanya Hammond
• Dr Dipika Mistry
• Dr Chelsea Mann
• Dr Jeddica Yeo
• Dr Morgan Wishney
• Dr Meredith Owen
• Dr Nima Kianoush
• Dr Olivia Nova
• Dr Harold Pradhan
• Dr Suman Madukuri
• Dr Hugh Lenehan
• Dr Sal Sahidi

Academic Staff

• Professor M. Ali Darendeliler
• Dr Oyku Dalci
• Dr Alexandra Papadopoulou
• Prof Axel Sphar
• Dr Jessica O'Neill
• Dr Tihana Divnic-Resnik
• Dr Helen Carey
• Dr Nikeeta Naren
• Dr Russell Lain
• Dr Alan Reid
• Dr Amelita Simpson
• Dr Peter Duckmantion
• Dr Shilpi Ajwani
• A/Prof Dr Sameer Bhole

Higher Degree Students:

PhD:

• Dr Nour Eldin Tarraf
• Dr Lam Cheng
• Dr Lucyna Michalewska
• Dr Fabian Obregon Miano

Masters:

• Dr Lamis Ahmed
• Dr Adrian Lok
• Dr Antonia Scott
• Dr Amelita Simpson

Publications and Presentations

Publication Details:

1. Patterson BM, Dalci O, Papadopoulou AK, Madukuri S, Mahon J, Petocz P, Spahr A, Darendeliler MA. Effect of piezocision on root resorption associated with orthodontic force: A microcomputed tomography study. Am J Orthod Dentofacial Orthop. 2017 Jan;151(1):53-62.
2. Katyal V, Wilmes B, Nienkemper M, Darendeliler MA, Sampson W, Drescher D. The efficacy of Hybrid Hyrax-Mentoplate combination in early Class III treatment: a novel approach and pilot study. Aust Orthod J. 2016 May;32(1):88-96.
3. Buck LM, Dalci O, Darendeliler MA, Papageorgiou SN, Papadopoulou AK. Volumetric upper airway changes after rapid maxillary expansion: a systematic review and meta-analysis. Eur J Orthod. 2016 Jul 20. pii: cjw048. [Epub ahead of print] Review.
4. Liao Z, Chen J, Li W, Darendeliler MA, Swain M, Li Q. Biomechanical investigation into the role of the periodontal ligament in optimising orthodontic force: a finite element case study. Arch Oral Biol. 2016 Jun;66:98-107.
5. Arita K, Hotokezaka H, Hashimoto M, Nakano-Tajima T, Kurohama T, Kondo T, Darendeliler MA, Yoshida N. Effects of diabetes on tooth movement and root resorption after orthodontic force application in rats. Orthod Craniofac Res. 2016 May;19(2):83-92.
6. Buck LM, Dalci O, Darendeliler MA, Papadopoulou AK. Effect of Surgically Assisted Rapid Maxillary Expansion on Upper Airway Volume: A Systematic Review. J Oral Maxillofac Surg. 2016 May;74(5):1025-43.
7. Patterson BM, Dalci O, Darendeliler MA, Papadopoulou AK. Corticotomies and Orthodontic Tooth Movement: A Systematic Review. J Oral Maxillofac Surg. 2016 Mar;74(3):453-73.
8. George, A., Dahlen, H Reath, J. Ajwani, S, Bhole, S., Korda, A., Ng Chok, H., Miranda, M., Villarosa, A., Johnson, M., (2016) What do antenatal care providers understand and do about oral health care during pregnancy: A cross-sectional survey in New South Wales, Australia. BMC Pregnancy and Childbirth. 2016; 16:382. DOI 10.1186/s12884-016-1163-x
9. George, A., Dahlen, H., Blinkhorn, A., Ajwani, S., Bhole, S., Elli, S., Yeo, A., Elcomb, E., Sardozai, A., Johnson, M. Measuring oral health during pregnancy: Sensitivity and Specificity of a Maternal Oral Screening (MOS) Tool. BMC Pregnancy and Childbirth. 2016; 16:347 DOI: 10.1186/s12884-016-1140-4
10. Ajwani, S., Jayanti, S., Burkolter, N., Anderson, C, Bhole, S., Itaoui, R., and George, A. Integrated Oral Health Care for Stroke Patients-A Scoping Review. Journal of Clinical Nursing. 2016; DOI: 10.1111/jocn.13520.
11. Veale, M., Ajwani, S., Johnson, M., Nash, L., Patterson, T., George, A. The Early Childhood Oral Health program- perceptions of child and family health nurses in South-western Sydney. BMC Oral Health. 2016; DOI 10.1186/s12903-016-0213-0.
12. George, A., Lang, G., Johnson, M. Ridge, A., De Silva, A., Ajwani, S., Bhole, S., Blinkhorn, A., Dahlen, H., Ellis, S., Yeo, A., Langdon, R., Carpenter, L., Heilbrunn, A. The evaluation of an Oral Health Education Program for Midwives in Australia. Women and Birth. 2016; 29(3): 208-213. doi:10.1016/j.wombi.2015.10.004.
13. Lain, R and Ajwani, S. Minor post extraction complications other than BRONJ in older patients on oral bisphosphonates - a retrospective study. Gerodontology 2016 Jul 19. doi: 10.1111/ger.12239.

Accepted for publication

1. Chan E, Dalci O, Papdopoulou AK, Petocz P, darendeliler MA. The Effects of Micro-Osteoperforations on Orthodontic Root Resorption - A Micro-CT study. (Am J Orthod Dentofacial Orthop.)
2. Ng D, Chan A, Dalci O, Papadopoulou AK, Darendeliler MA. The effect of low-level laser therapy compared to sham laser on orthodontically induced root resorption: A pilot double-blinded split-mouth randomized controlled trial. (Eur J Orthod)
3. Papadopoulou AK, Dalci O, Petcoz P, Darendeliler MA. Effects of hubrid-Hyrax, alt-RAMEC and mini-screw reinforced heavy Class III elastics in maxillary retrusive growing patients. A 4-year follow-up pilot study. (Australian Orthodontic Journal)

Book Chapters:

1. Alexandra K. Papadopoulou, Oyku Dalci, M. Ali Darendeliler. Orthodontic specialty education in Oceania. In: Orthodotic Postgraduate Education: A global Perspective. Theodore Eliades, Athanasios E. Athanasiou eds. Thieme Publications

Presentations:

Professor M. Ali Darendeliler:

1. Annual Congress of the American Association of Orthodontics. Orlando, Florida.
2. Annual Congress of the European Orthodontic Society. Stockholm, Sweden.
3. Annual Congress of the Australian Orthodontic Society. Melbourne, Australia.

Dr Doreen Ng (Final year DClinDent Student)

1. International Australian Orthodontic Conference in Melbourne DClinDent Oral Presentation representing University of Sydney.

International and National:

1. American Association of Orthodontists international conference in Orlando, USA. Oral Presentation during the Research Oral Presentations Session (selected from the submitted abstract from around the World)
2. American Association of Orthodontists international conference in Orlando, USA. 2nd Place Winner (Clinical Research) Charley Schultz Resident Scholar Award with her Poster presentation
3. European Orthodontic Society annual conference in Stockholm, Sweden. Oral Presentation during the Research Oral Presentations Session
4. George, A., Farley., J., Bhole, S., Ajwani, S., Srinivas, R., Blinkhorn, A., Yaacoub, A., Dahlen, H., Ellis, S., Johnson, M. (2016). A process Evaluation of the Midwifery Initiated Oral Health Dental Service program: Perceptions of Dentists. Beyond Research and Teaching showcase 18-19 Oct 2016, Liverpool Catholic Club, Sydney.
5. Sanchez P, George A, Everett B, Salamonson Y, Ajwani S, Bhole S, Lintern K, Rajaratnam R, Redfern J, Sheehan M, Skarligos F, Spencer L, Srinivas R. (2016-) Promoting Oral Health in the Cardiac Setting: Perception of Cardiovascular patients. The Australian Cardiovascular Health and Rehabilitation Association Conference, 1-3 Aug 2016, Adelaide, Australia.
6. Ajwani, S, Jayanti, S, Burkolter, N, Anderson, C, Bhole, S, Itaoui, R, George, A. (2016) Integrated Oral Care for Stroke Patients. Asia Pacific Stroke Conference, Brisbane, Australia 15-17 July 2016.
7. George, A., Bhole, S., Farley, J., Ajwani, S., Dahlen, H., Srinivas, R., Blinkhorn, A., Yaacoub, A., Ellis E., Johnson, M. (2016) Midwifery-Dental intervention to improve oral health: A Process Evaluation. FDI Annual World Dental Congress, Pozman, Poland, Sept 7-10 2016.
8. Annual Conference International Association of Dental Research (IADR) 2016 Seoul: A. Spahr: Adjunctive Effect of Photodynamic Therapy in Residual Pockets during SPT?
9. Annual Conference International Association of Dental Research (IADR) 2016 Seoul: H. Carey: Oral health promotion for HIV patients
10. Poudel P, George A, Griffiths R, Wong V, Arora A. Oral health care for people with Diabetes: A scoping review. Ingham Institute Research and Innovation Showcase 2016 18-19 October 2016, Liverpool, Australia.
11. Poudel P, George A, Griffiths R, Wong V, Arora A. Diabetes and Oral Health Care: A Scoping Review. Australian Diabetes Society and Australian Diabetes Educators Association Annual Scientific Meeting, 24-26 August 2016, Gold Coast, Australia.
12. Bhole S, Hua D, You S, Bedros D, Ajwani S, Eastwood J, Arora A. Lessons Learnt from Recruiting Disadvantaged Families to a Dental Cohort Study. Sydney Research and Innovation Symposium, Sydney Local Health District, NSW Health. Redfern, Australia, June 2016.
13. Arora A, Doan J, Martinez J, Phan C, Bhole S. Content Analysis of Nuritional Information in Paediatric Oral Health Education Leaflets. The 94th General Session and Exhibition of the IADR, 22-25 June 2016, Seoul, South Korea.
14. Prihaswan, P., Knox, D., Haque, A., Coutelas, J., Ajwani, S., Carey, H., Houtzager, L. Open your mouth: a practical oral health resources for people living with HIV and health care professionals in NSW. 23rd National Conference of the Australian Health Promotion Association, Perth, 19 - 22 June 2016
15. From Sick to Fit. Utilizing non dental professionals to promote oral health of patients in hospital. A review. NSW Public Oral Health Conference, Fairmont Resort Blue Mountains, Leura NSW 2016
16. Chairside Advice Program. Oral Health Promotion Conference, Primus Hotel Sydney, 2 November 2016

Research Grants

GRANTING BODY	AWARDEES	PROJECT TITLE	YEARS total $$	Years
Australian Society of Orthodontics Foundations for Research and Education	DClinDent projects	3 projects each year	$    4,500	2016 - 2017
The Financial Markets Foundation for Children	George, A., Johnson, M., Dahlen, H and MIOH investigators	Reducing dental decay in young children through an antenatal intervention: A prospective cohort study	$117,310	2016 - 2018
APRF	Suman Madukuri & Axel Spahr	The effect of piezocision on periodontal parameters	$    3,876	2016 - 2017
NHMRC	Arora A, Bhole S, Curtis BH, Hector D, Sivaneswaran S, Moody G	Early Childhood Feeding (including breastfeeding) and food and beverage intake: Relationships with Early Childhood Caries and Childhood Obesity	$240,000	2012 - 2016
NHMRC	Arora A	The common risk factor approach to assess relationships between dental caries and adiposity in disadvantaged preschool children	$335,000	2014 - 2018
Western Sydney University	Arora A, Bhole S (Associate Investigator)	Healthy Smiles Healthy Kids Cohort – Relationships between Child Oral Health and Adiposity	$  20,000	2015 - 2016
Western Sydney University and Sydney LHD	Arora A, Bhole S , Eastwood J	Healthy Smiles Healthy Kids – Oral Health Literacy in CALD communities	$  10,024	2016

Contact details for department

Head of Department: A/Prof Sameer Bhole

Department/Unit: Oral Health
Address:
Sydney Dental Hospital
2 Chalmers St
Surry Hills NSW 2010
Telephone: (02) 9293 3466
Facsimile: (02) 9293 3488
Web: www.slhd.nsw.gov.au/oralhealth/
Email: shilpi.ajwani@health.nsw.gov.au