nan Hopcraft

Xerostomia: an update for clinicians.

Saliva plays an important protective role in the oral environment, and reductions in saliva quantity are known to increase the risk of oral diseases. Importantly, xerostomia or the perception of a dry mouth is now being recognized as an important risk factor for dental diseases. Furthermore, the subjective sensation of a dry mouth is a debilitating condition in itself that impacts on the quality of life of sufferers. With approximately 1 in 5 people reporting some form of dry mouth, and an increasing prevalence in the elderly, it is important for clinicians to have a thorough understanding of this problem. The aim of this paper is to review some of the literature relating to xerostomia in order to provide an evidence based update for clinicians.

Dental service provision in Victorian residential aged care facilities

BACKGROUND The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are at high risk of developing dental diseases, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. Traditionally, dental service provision has been problematic and sporadic for these residents. METHODS A postal survey of a random sample of Victorian general dentists and Directors of Nursing (DONs) of Victorian RACFs was undertaken in 2006 to ascertain the participation of dentists in the provision of dental care and to identify factors impacting on the organization and provision of dental care for residents. RESULTS The response rate for dentists was 57.3 per cent, and for DONs 64.4 per cent. Half of the dentists reported that they had provided care to residents of aged care facilities in the past 12 months, and they spent an average of one hour per month providing care. Overall, dentists were concerned with their level of undergraduate education and training in various aspects of dentistry for residents of aged care facilities. DONs reported significant difficulty obtaining adequate dental care for their residents. Common problems identified by both dentists and DONs included a preference for dentists to treat residents in their own practice, dentists not willing to go to RACFs and a lack of portable dental equipment for dentists to use. CONCLUSIONS There were low levels of interest and participation from Victorian dentists in providing dental care for residents of aged care facilities. Dentists had a strong preference for treating patients at their own practice, and there were a number of significant barriers that appeared to impact on the provision of dental care in RACFs.

Effect of ozone and Tooth Mousse™ on the efficacy of peroxide bleaching

BACKGROUND The aim of this in vitro study was to investigate the effect of Tooth Mousse and ozone on the bleaching effectiveness of peroxide (P). METHODS Sixty enamel specimens were stained by tea infusion. P (8% carbamide peroxide solution) and the P/TM (50:50) blend were prepared freshly as required. The specimens were divided randomly into six groups: Group A - ozone followed by P; Group B - ozone concurrently with P; Group C - P alone; Group D - ozone followed by P/TM; Group E - ozone concurrently with P/TM; and Group F - P/TM alone. Ozone exposure was of 40 seconds duration. Digital photographic images were recorded at baseline and endpoint under standardized lighting and desiccation conditions. CIELAB L*a*b* values were determined. RESULTS The addition of TM to P or the application of ozone with P did not significantly affect bleaching effectiveness compared with P alone. The application of ozone prior to P significantly decreased bleaching effectiveness as indicated by the DeltaL*, Deltaa*, DeltaE and %L* values. The addition of TM to the P did enhance the aesthetic by increasing the lustre and translucency of the treated enamel. CONCLUSIONS The results of this study suggest that Tooth Mousse may be applied concurrently with the bleach, and not reduce bleaching effectiveness.

Participation in continuing professional development by Victorian dental practitioners in 2004.

BACKGROUND Continuing professional development (CPD) has been long considered an integral component of professional practice across a range of health professions. It is believed to ensure the maintenance of practitioner clinical competence and knowledge of current concepts. This study investigated the participation in and attitudes of Victorian dental personnel to CPD activities. METHODS A self-administered cross-sectional survey of a random sample of registered dental care providers (n = 451) was conducted from March to June 2005 using an anonymous, postal, self-administered questionnaire. RESULTS The response rate was low (48.1 per cent). Nearly 90 per cent of respondents attended a CPD course in 2004, with the mean hours of attendance ranging from 8.3 to 36.9 hours, depending on registration category. Nearly half of the dentists attended more than 20 hours of CPD courses, while less than 20 per cent of prosthetists attended more than 15 hours of CPD courses. Three-quarters of respondents supported mandatory CPD as a condition of registration. CONCLUSIONS There was a high level of participation in continuing professional development activities by surveyed Victorian dental care providers in 2004, although more than half of the dentists and specialists, and nearly two-thirds of therapists, hygienists and prosthetists would fail to meet the new DPBV mandatory requirements for CPD.

Minimum intervention dentistry--a new horizon in public oral health care.

Public dental patients suffer from poorer oral health than the general population. Management of dental caries tends to focus on surgical interventions, such as restorations and extractions, rather than prevention and early intervention of the disease process. The current public dental system struggles to address the lifestyle and broader health issues affecting oral health and although an immediate dental problem can usually be alleviated, it can often be through the unnecessary removal of tooth structure, which invariably leads to other health and quality of life problems. There is widespread recognition by oral health clinicians that the restorative approach to the management of dental caries in the public sector is failing to improve oral health outcomes for many public patients. Oral health experts have recently adopted a national consensus statement on minimum intervention dentistry indicating their intention to work together to develop ways to implement this approach across the public dental sector. It is clear that, despite some significant challenges and required changes, the momentum for minimum intervention dentistry continues to grow across Australia. There is an urgent need to undertake research to assess the cost-effectiveness of this approach in the public sector.

Dentists' restorative decision‐making and implications for an ‘amalgamless’ profession. Part 3: Dentists' attitudes

BACKGROUND The Minamata Convention has agreed to a worldwide reduction in the production and use of mercury-containing products and processes. This will change the approach to use of direct restorative materials in the future. There is little research exploring the attitudes of dentists to any change. METHODS A survey relating to the use of direct restorative materials was distributed to dentists who were members of the Australian Dental Association or Members and Fellows of the Royal Australasian College of Dental Surgeons. Data were statistically analysed. RESULTS There were 408 respondents. Responses to statements concerning attitudes toward a phase-down of amalgam depended on whether the respondent used amalgam, year of primary dental qualification and association with academia. Thirty per cent of respondents indicated they do not use amalgam. The mean use of amalgam for all direct restorative procedures was 18%. CONCLUSIONS Dentists are concerned over potential implications of a phase-down of amalgam and much should be done to address these concerns. Many dentists are undecided as to what are the implications, which may reflect a lack of understanding of the issues. It is incumbent on policy-makers to produce and disseminate information relating to the issues identified by this research.

Dentists’ perceptions of a new local anaesthetic drug – articaine

BACKGROUND Articaine is a new local anaesthetic drug introduced to the Australian dental market. The aim of this study was to elicit information regarding the use of articaine in Australia, and factors that influence attitudes towards adoption of new technology. METHODS A self-administered postal questionnaire was sent to a stratified systematic sample of dentists who were members of the Australian Dental Association, with questions regarding details about articaine use and how influences such as education and scientific literature affect their adoption of new technology. RESULTS Of the sample, 53% responded and over 70% of dentists surveyed used articaine, with 95% and 97% of respondents identifying scientific literature and continuing professional development courses respectively as influencing factors in their adoption of new technology. The most common reason for not using articaine was no perceived advantage and the most influential factor that would encourage non-users to start using articaine was a scientifically proven advantage. Senior clinicians, specialists and public sector dentists were less likely to use articaine. CONCLUSIONS A majority of Australian dentists were using articaine and cited continuing professional development courses, scientific literature and anecdotal peer reports as being influential in their adoption of new technology.

Fluoride content of tank water in Australia

BACKGROUND The aims of this study were to: (1) analyse the fluoride content of tank water; (2) determine whether the method of water collection or storage influenced fluoride content; and (3) survey participant attitudes towards water fluoridation. METHODS Plastic tubes and a questionnaire were distributed through dentists to households with water tanks in Victoria. A midstream tank water sample was collected and fluoride analysed in triplicate using ion chromatography RESULTS All samples (n = 123) contained negligible amounts of fluoride, with a mean fluoride concentration of <0.01 ppm (range: <0.01-0.18 ppm). No statistically significant association was found between fluoride content and variables investigated such as tank material, tank age, roof material and gutter material. Most people did not know whether their tank water contained fluoride and 40.8% preferred to have access to fluoridated water. The majority thought fluoride was safe and more than half of the respondents supported fluoridation. Fluoride content of tank water was well below the optimal levels for caries prevention. CONCLUSIONS People who rely solely on tank water for drinking may require additional exposure to fluoride for optimal caries prevention.

Comparison of radiographic and clinical diagnosis of approximal and occlusal dental caries in a young adult population

The aims of the study were: (1) to determine if bitewing radiographs provided additional diagnostic yield for occlusal and approximal dental caries in adults aged between 17 and 30 years of age when compared with a clinical examination only, (2) how this translated into the measurement of dental caries experience, and (3) to determine the influence of water fluoridation on the diagnosis of dental caries in occlusal and approximal surfaces by clinical examination alone and by radiographic examination.