Marc Tennant

Optic nerve regenerates but does not restore topographic projections in the lizard Ctenophorus ornatus

In adult fish and amphibians, the severed optic nerve regenerates and visual behaviour is restored. By contrast, optic axons do not regenerate in the more recently evolved birds and mammals. Here we have investigated optic nerve regeneration in a member of the class Reptilia, phylogenetically intermediate between the fish and amphibians and the birds and mammals. We assessed visual recovery anatomically and behaviourally one year after unilateral optic nerve crush in the adult ornate dragon lizard, Ctenophorus ornatus.

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.

Rural and remote oral health, problems and models for improvement: a Western Australian perspective.

Oral healthcare in rural communities shares many of the dilemmas faced by medicine in providing services to large geographical areas with dispersed populations. This study examined the population data and service provision data relevant to the geographical distribution of oral health care in Western Australia (WA). Of the 1.7 million people resident in WA, 72% were resident in the five major urban centres with only 13% in rural and remote regions. Of the 320 postcode regions, 186 had a population of less than 2500, 31 had a population from 2500 to 5000, 42 from 5000 to 10,000, 37 from 10,000 to 20,000, and 24 had a population greater that 20,000. Almost 80% of postcode regions with a population less than 2500 are in non-urban regions. Of the total of 690 dentists who were analysed in this study, it was found that the vast majority (greater than 85%) worked in practices in postcode regions within metropolitan Perth or the major urban centres. A total of 43 postcode regions did not have a dental practice within their bounds. In order to address this disparity in service availability, strategies including the development of training for medical practitioners and auxiliaries, the use of modern technology, school-based programs and the development of interdisciplinary links should be implemented. These strategies would also facilitate the development of closer links between medical and dental practitioners and the development of skills within the medical fraternity that would facilitate improved oral health in rural and remote communities.

The role of cell proliferation and migration in the development of a neo-intimal layer in veins grafted into arteries, in rats

SummaryThe development of a thickened (hyperplastic) fibro-cellular neo-intima is a significant event in the adaptation of a vein grafted into an artery. The histogenesis of tissues in vein grafts was explored in a rat model where the source of endothelial and smooth muscle cells was from the adjacent artery. Cell proliferation was assessed by the incorporation of tritiated thymidine and autoradiography, up to 18 months after grafting. Cell migration was detected by prelabelling in the first 5 days after grafting and sampling at later times. The proliferation of cells in the arterial media adjacent to the graft was elevated above control levels as early as 2 days after grafting; it was maximal at 3 days and returned to low levels by day 21. During the first week, prelabelled smooth muscle cells in the tunica media of the adjacent artery migrated to the subendothelial space, where they continued to proliferate to produce arterial intimal hyperplasia. The migration of endothelial and smooth muscle cells proceeded across the anastomosis to populate the vein graft neo-intima, where smooth muscle cells continued to proliferate until 28 days after grafting. Cell migration and proliferation were significant factors in the histogenesis of vein graft neo-intimal hyperplasia in this model. These processes were controlled, perhaps by local regulatory factors, to form a vein graft, the wall of which was similar in thickness and structure to that of the host artery.

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.

A national audit of Australian dental practice distribution: do all Australians get a fair deal?

Australia is the sixth biggest (by area) country in the world, having a total area of about 7.5 million km(2) (3 million square miles). This study located every dental practice in the country (private and public) and mapped these practices against population. The total population of Australia (21.5 million) is distributed across 8,529 suburbs. On average about one-third of the population from each State lives in suburbs without practices and 46% live in suburbs with one to five dentists. Of those living within the study frameset, 86.6% live within 5 km of a private practice and 84.4% live within 10 km of a government practice. Australias dental practices are distributed in a very uneven fashion across its vast area. Three-quarters of suburbs have no dental practice and over one-third of the population live in these suburbs. This research clearly identified that in a vast and uneven socio-geographically distributed country, service planning, if left to market forces, will end with a practice distribution that is fixed by economic drivers of scale and not that of disease burden. A more population health-driven approach to future design and construction of government safety net services is needed to address these disparities.

Networked remote area dental services: a viable, sustainable approach to oral health care in challenging environments.

OBJECTIVE This study examines the cost effectiveness of a model of remote area oral health service. DESIGN Retrospective financial analysis. SETTING Rural and remote primary health services. PARTICIPANTS Clinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centres model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study. MAIN OUTCOME MEASURED Calculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision. RESULTS AND CONCLUSION The use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australias most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care.