Estie Kruger

Dental trauma in an Australian rural centre

BACKGROUND/AIM There is little epidemiological research regarding dental trauma in Australia. Previous research has largely focused on specific sub-populations with data not necessarily applicable to a general rural Australian population. Studies from other countries have presented variable data and the relevance of their findings to the Australian setting is questionable. The aim of this study was to investigate the prevalence, causes and presentation of dental trauma in a large rural centre in Australia. MATERIALS AND METHODS A retrospective analysis was performed of the dental records of 323 consecutive patients who had attended a private general dental practice in Bunbury, Western Australia following an injury to their teeth and/or mouths during the period from May 2000 to December 2005 (inclusive). Injuries were classified using the Andreasen system (1994). Data analysis was carried out using spss software and Chi-Square tests were performed with the level of significance set at 5%. RESULTS There were 528 teeth injured and eight patients had only soft tissue injuries. Males (68.1%) significantly outnumbered females (31.9%) and the ages ranged from 10 months to 78 years. The highest number of injuries occurred in children and adolescents, specifically the 0- to 4-year age group followed by the 5- to 9-year age and 10- to 14-year age groups. Trauma was most frequently the result of falls, accidents while playing and participating in sports activities. CONCLUSIONS The maxillary central incisors were the most commonly injured teeth in both the primary and permanent dentitions. Uncomplicated crown fractures were the most common injury followed by luxations and subluxations. No significant differences in frequency were reported for the different days of the week, the different months or seasons of the year. Only one-third of the patients presented for dental treatment within 24 h of the injury while the remainder delayed seeking treatment for varying times up to 1 year.

Oral hygiene care status of elderly with dementia and in residential aged care facilities

OBJECTIVE To explore the effectiveness of oral hygiene care on plaque and gingival status of residents with dementia. BACKGROUND Oral hygiene and oral hygiene care has been reported to be poor among the institutionalised elderly with dementia. The severity of oral diseases has been shown to increase with the severity of physical and cognitive impairment related with dementia. Little research has been carried out on plaque and gingival status of elderly with dementia and the impact of disability related with dementia on oral health in residential aged care facilities (RACF). MATERIALS AND METHODS A cross-sectional study of 205 elderly residing in RACF in Perth. RESULTS Forty-one percent of the residents in RACF had dementia. Sixty percent of the residents with dementia and 75% of the residents with an Activities of Daily Living Oral Health score of D were assisted with oral care. Mean plaques scores and extent of gingival inflammation were higher for residents in the DD and D subgroups and resident with dementia. Residents assisted with brushing had higher mean plaque score and more moderate gingival inflammation. CONCLUSION Oral hygiene care status in residents with dementia was poor despite the fact that oral care assistance was being provided.

Lip cancer in Western Australia, 1982–2006: a 25-year retrospective epidemiological study

BACKGROUND The aim of this study was to report on the epidemiological trends in incidence and mortality rates of lip cancer in Western Australia from 1982-2006. METHODS Incidence and mortality data were provided by the Western Australian Cancer Registry. Analysis of demographic distribution by gender, age, metro-rural residence and Indigenous status and by sub-site of lip cancer was undertaken. Percentages, crude, age-specific and direct age-standardized rates were computed with 95% confidence intervals. RESULTS In Western Australia, lip cancer represents 49 per cent of all oral cancer cases. A total of 2,152 new cases and 31 deaths due to lip cancer were reported. Eighty-one per cent of new cases occurred on the lower lip. The incidence rate ratio of males to females was 2.5-3:1, with non-Indigenous people suffering 98 per cent of lip cancer. Rural dwellers have higher standardized incidence rates when compared to people living in metropolitan areas. An increasing trend with older age is consistent throughout the study period. CONCLUSIONS Over the 25 years, on average 90-100 people are diagnosed with lip cancer but only 1-2 people die each year. These mortality rates are very low indeed and are the reason for its good prognosis.

The oral health status and treatment needs of Indigenous adults in the Kimberley region of Western Australia

OBJECTIVE The oral health of Indigenous Australians, whether urban or rural, is significantly poorer than their non-Indigenous counterparts, and it would be expected that the oral health of rural and remote Indigenous Australians would be particularly poor, although the extent of this extra disadvantage has not been thoroughly documented. The aim of this study was to assess the oral health status and oral health needs in a sample of adult residents of selected towns and remote communities in the Kimberley region of North-west Australia. DESIGN A cross-sectional survey (dental examinations and oral health questionnaires) was carried out. SETTING Rural and remote communities in the Kimberley region of Western Australia. PARTICIPANTS Adults in four selected communities. RESULTS The mean Decayed, Missing and Filled Teeth (DMFT) score for all participants was 9.8 (SD 8.3). The mean DMFT increased with increasing age. Only 7.3% of people were caries-free. A total of 13% of participants had periodontal pockets of 6 mm or more, and only 3% had no periodontal disease. More than a third (37%) of all participants had advanced periodontal disease. Only 21% of participants did not need any dental treatment. CONCLUSIONS The oral health of Aboriginal and Torres Strait Islander people are listed as one of the priority areas of Australias National Oral Health Plan. Based on the above results, oral health is clearly an important priority in the Kimberley.

Short‐stay rural and remote placements in dental education, an effective model for rural exposure: A review of eight‐year experience in Western Australia

OBJECTIVES The increase in demand for dental care over the next 10 years is expected to outstrip the supply of dental visits in Australia, resulting in an ongoing shortage of dental practitioners. As trends in medicine have shown, the greatest effect will be felt in rural and remote regions, where an undersupply of dentists already exists. It is clearly evident that it is important to provide strategies that will increase the recruitment and retention of practitioners in rural and remote areas. Previous research suggested an increased likelihood for health graduates to choose rural practice if they have a rural background, or were exposed to rural practice during their education. Short-stay (three to four weeks) placements for final-year dental students has been part of dental education in Western Australia for near on a decade. METHODS This paper reflects on the experiences gained from managing this placement program. CONCLUSIONS Short-stay placements are a quality learning initiative but need a high level of planning and a clear vision to be effective. IMPLICATIONS The key factors in ensuring sustainable, student centred learning is driven through a small core group of staff who have strong direct links with rural and remote communities, students and support providers. The integration of service, education and research goals have played a critical role in sustaining placements. The philosophy underpinning the rural placements needs to be clearly articulated and applied effectively in each step of their implementation and a highly focused customer-service driven implementation is required to make short-stay rural and remote placements effective.

Oral cancer in Western Australia, 1982–2006: a retrospective epidemiological study

OBJECTIVE To report differences and trends in oral cancer incidence by gender, age, indigenous status and area of residence and on mortality in Western Australia. METHODS Data were provided by Western Australian Cancer Registry. Oral cancer definition included ICD-O-3 codes C00C08. Age-specific, direct age-standardized rates and mortality:incidence ratios were computed with 95% confidence intervals. RESULTS The incidence and death rates of oral cancer accounted for 2.3% and 1.3% of all cancers respectively. Over 25 years, the male:female incidence ratio was 2.4:1. Eighty-eight percent of new cases were over the age of 40, peaking in the sixth decade of life. The incidence rates were 14.6 and 6.2 per 100,000 per annum in men and women respectively. Over 17 years, standardized mortality rates were less than 1 per 100,000 per year, with double the deaths in men. Mortality:incidence ratios for oral cancer were between 0.4 and 0.6 with the exception of lip. CONCLUSIONS Cancer registries are the only reliable source of data for epidemiologic surveillance of cancer incidence and mortality. Results from this study are comparable with studies on oral cancer in Australia and globally.

Condylar position assessed by magnetic resonance imaging after various bite position registrations

INTRODUCTION In this study, we evaluated the reliability and validity of 3 bite registrations in relation to condylar position in the glenoid fossae using magnetic resonance imaging in a symptom-free population. METHODS Nineteen subjects, 14 men and 5 women (ages, 20-39 years) without temporomandibular disorders were examined. Three bite registrations were taken and evaluated on each subject: centric occlusion, centric relation, and Roth power centric relation. The differences in condyle position among the 3 bite registrations were determined for the left and right condyles: centric occlusion-centric relation, centric occlusion-Roth power centric relation, and centric relation-Roth power centric relation for each plane of space. RESULTS The results indicated that (1) all measurements collected had large standard deviations and ranges with no statistical significance, and (2) of the 19 subjects and 38 condyles assessed, 33 condyles (87%) were concentric in an anteroposterior plane. In the transverse anatomic plane, all condyles were concentric. CONCLUSIONS The clinical concept of positioning the condyles in specific positions in the fossae with various bite registrations as a preventive measure for temporomandibular disorders and as a diagnosis and treatment planning tool is not supported by this study.

High-acuity GIS mapping of private practice dental services in New Zealand: does service match need?

OBJECTIVES New Zealand is a country with a relatively small population (4 million people) distributed unevenly over a relatively large land area. Adult oral health services in New Zealand are almost all delivered through a market-driven, private practice model and are funded directly by patient payments. Little attention has been given to the distribution of these services. This study reports the findings of a high-acuity examination of the distribution of private dental practices in New Zealand, using modern geographic information system (GIS) tools. METHODS A total of 1,045 private dental practices in New Zealand were geocoded. These dental practices overlaid 1,909 area units. RESULTS The highest practice: adult population ratios found in this study reflected the areas with the highest population densities of Maori and Pacific Islander people. CONCLUSIONS Oral health has a substantial impact on health-related quality of life and the utilisation of dental care services can contribute to its improvement. As such, it is expected that access to care should be focused on the population groups with the highest degree of need. However, in a market-driven, mostly private practice model, such as that in New Zealand, available care is concentrated largely in areas of high socioeconomic status and in populations with lower levels of oral disease.

Primary oral health service provision in Aboriginal Medical Services-based dental clinics in Western Australia

Australians living in rural and remote areas have poorer access to dental care. This situation is attributed to workforce shortages, limited facilities and large distances to care centres. Against this backdrop, rural and remote Indigenous (Aboriginal) communities in Western Australia seem to be more disadvantaged because evidence suggests they have poorer oral health than non-Indigenous people. Hence, provision of dental care for Aboriginal populations in culturally appropriate settings in rural and remote Western Australia is an important public health issue. The aim of this research was to compare services between the Aboriginal Medical Services (AMS)-based clinics and a typical rural community clinic. A retrospective analysis of patient demographics and clinical treatment data was undertaken among patients who attended the dental clinics over a period of 6 years from 1999 to 2004. The majority of patients who received dental care at AMS dental clinics were Aboriginal (95.3%), compared with 8% at the non-AMS clinic. The rate of emergency at the non-AMS clinic was 33.5%, compared with 79.2% at the AMS clinics. The present study confirmed that more Indigenous patients were treated in AMS dental clinics and the mix of dental care provided was dominated by emergency care and oral surgery. This indicated a higher burden of oral disease and late utilisation of dental care services (more focus on tooth extraction) among rural and remote Indigenous people in Western Australia.

A proof-of-concept evaluation of a cloud-based store-and-forward telemedicine app for screening for oral diseases

Objective It is widely considered that telemedicine can make positive contributions to dental practice. This study aimed to evaluate a cloud-based telemedicine application for screening for oral diseases. Methods A telemedicine system, based on a store-and-forward method, was developed to work as a platform for data storage. An Android application was developed to facilitate entering demographic details and capturing oral photos. As a proof-of-concept, six volunteers were enrolled in a trial to obtain oral images using smartphone cameras. Following an onsite oral examination, images of participants’ teeth were obtained by a trained dental assistant. Oral images were directly uploaded from the smartphone to a cloud-based server via broadband network. The assessments of oral images by offsite dentists were compared with those carried out via face-to-face oral examinations. Results A complete set of 30 oral images was obtained from all six participants. Out of 192 teeth reviewed, the proportion of ungradable teeth was 8%. Sensitivity and specificity of teledental screening were 57% and 100% respectively. The inter-grader agreement estimated for two examination modalities and between two teledental graders was 70% and 62% respectively. Findings indicate that the proposed system for screening of oral diseases can be implemented to provide a valid and reliable alternative to traditional oral screening. Conclusion This study provided evidence that a robust system for store-and-forward screening for dental problems can be developed, and leads to the need for further testing of its robustness to confirm the accuracy and reliability of the teledentistry system.