Hospitalisations due to pulp and periapical conditions in Australian children from 1998-99 to 2017-18.

OBJECTIVE: To assess the demographic and time trends in hospitalisation rate for Pulp and Periapical Diseases (P&PDs) over 20-years (1998-99 to 2017-18), amongst children and adolescents (under age 19 years) in all states and territories of Australia. P&PDs are considered potentially preventable, with the possibility of them resulting in emergency presentations if timely treatment is not provided. They can result in treatment under general anaesthesia, which is costly. DESIGN: Retrospective analysis of hospitalisation for pulp and periapical diseases. SETTING: Public and private hospitals across Australia. MAIN OUTCOME MEASURES: The number of hospitalisations (measured using the number of separations or cases of hospital admission) for all pulp and periapical diseases by age-group. RESULTS: There were about 40,000 hospitalisations regarding P&PDs over the 20 years among Australian children under 19 years old. The rate of admissions ranged from means of 28.5 to 44.1 per 100,000 population. The number of admissions increased over 20 years for all children, except those younger than 4 years. Children aged 5-9 years had the highest rate of admissions and, more days in hospital per admission than other age groups. Most children only had one-day admissions. CONCLUSION: Pulp and periapical diseases hospitalisation rates have increased over two decades. Additional approaches to improve child dental health in Australia need to be considered.

Innovative methodology to guide planning of dental workforce distribution: a GIS-based study in Nepal.

OBJECTIVES: To build a predictive model based on the distribution pattern of dentists and population in selective districts of Nepal. METHOD: Cross-sectional descriptive study conducted using secondary data from the census report and available dentist data of Nepal. Population data were obtained from the most recently available census. For dentists' data, a literature search was carried out in the databases such as PubMed, Google scholar, One Search and Medline. All data were extracted from the integrated database in the Geographic Information System (GIS), and a predictive model was built. RESULTS: Overall, there was an uneven distribution of dentists in Nepal. When the distribution of dentists was compared with the population clusters, it was found that the slope of the population growth was below or equal to (≤) 20,000 for three provinces (2, 6, and 7), which means that lower numbers of dentists are available with respect to population density in these provinces. The slope was above 50,000 for province 3, and the number of dentists was almost half of the total nationwide. The number of dentists correlated with population clusters. CONCLUSION: There are substantial disparities in the distribution of dentists in Nepal. Dentists were distributed relative to higher population clusters and were unevenly distributed. The Nepal government should make necessary arrangements to address the need for the human workforce in resource-limited settings. The methods used in this study could be applied globally, as the data used are available for most countries.

Improving Iraqi school dental services: A GIS-based study of service location optimisation.

BACKGROUND: The United Nations (UN) estimated the population of Iraq in 2005 at almost 29 million, of which nearly 14 million were children aged 0-14 years. Iraq is aiming to improve child oral health, and subsequent child general health, through school dental services, offered by primary health care centres. OBJECTIVE: To develop and test a GIS-based planning approach for the Hillah district of Iraq as a model for the rest of the country. All data were gathered from open sources. SETTING: The city has 98 neighbourhoods, with a total child population of 368 274, occupying 161 Sq. km2, with 14 fixed primary health care dental clinics. DESIGN: Accessibility zones were created using GIS, based on the ability of dentists to make their way to schools. OUTCOME MEASURES: A total of 23 307 of 0-4 year-olds (14%) and 74 384 (45%) of 0-15 year-olds lived outside the accessibility zones. RESULT: Areas where services are not available to the child population were identified, whether or not they attended primary schools. CONCLUSION: Reforming the existing dental health services in Iraq can be achieved by careful planning and appropriate utilisation of health resources.

The distribution of dentists in Australia Socio-economic profile as an indicator of access to services.

OBJECTIVES: Analyse the dentist to population ratio relative to socio-economic profile to identify areas of workforce shortages and inform the policy direction of workforce recruitment strategies and public dental service planning. METHODS: The suburb, state and postcode of dentists listed on the public access register of the Australian Health Practitioner Regulation Agency were geocoded by latitude and longitude and added to a map of Australia built on Australian Bureau of Statistics (ABS) Statistical Area 2 (SA2) census districts. Population data detailing the relative socio-economic disadvantage of each Statistical Area 1 (SA1) within each SA2 was superimposed on the map and used to calculate the number of dentists per 100 000 population relative to level of socio-economic disadvantage as defined by the ABS Socio-Economic Index for Areas, (SEIFA) Index of Relative Socio-economic Disadvantage (IRSD). The results were reported according to state and territory, and the Accessibility and Remoteness Index of Australia (ARIA+). RESULTS: The dentist to population ratio was lower in areas of disadvantage within major cities. All regions outside major cities had population cohorts with dentist to population ratios below the 65 dentists per 100 000 benchmark, conservatively estimated to be the minimum required for reasonable access to services. CONCLUSION: There is an inequity in the distribution of dentists relative to the socio-economic profile and geographic location of the Australian population. Shortages of dentists persist across many IRSD deciles in regional and rural areas. Within major cities there are fewer dentists per capita in the lower socio-economic districts.

The Distribution of Dental Health Specialist Locations in Sri Lanka.

AIM: To investigate the distribution of dental health specialist locations staffed by Oral and Maxillo-Facial Surgeons (OMF), Restorative dentists, and Orthodontists in Sri Lanka in relation to population distribution and socio-economic status. METHODS: Specialist dental locations were mapped using GIS (Geographic Information System) and overlayed with census population data and socio-economic quintiles. RESULTS: Overall, there was an uneven geographic distribution of the total 55 specialist dental locations and 74 attributed specialist work force within the country. Access to specialist care is remarkably high in Western and Central provinces, compared to the Northern, Eastern and North Central provinces. When the geographic distribution was compared to population socio-economics, it was found that in Sri Lanka only 22.3%, 44.4%, and 25.4% of the most disadvantaged lived within 20 kms from an Orthodontic, OMF and Restorative clinic respectively, compared to 66.3%, 82.8% and 44.7% of the least disadvantaged. CONCLUSION: The findings of this study can contribute to the decision-making process when determining future locations of dental specialist clinics and identifying subgroups in the population who are geographically and socio-economically isolated from accessing care.

Indigenous cultural competence: A dental faculty curriculum review.

BACKGROUND: Indigenous Australians have more than double the rate of poor oral health than their non-Indigenous counterparts. Cultural competence of dental and oral health practitioners is fundamental to health care and quality of life in addressing health disparities in minority cultural groups in Australia. Higher education curricula reviews have identified the need for institutions to incorporate Indigenous culture and knowledge more widely into the curricula to improve educational outcomes for Indigenous Australians and to increase cultural competence for all students. AIM: The aim of this research was to provide a baseline analysis of Indigenous cultural competence curricula practices to ascertain changes required within Faculty of Dentistry programmes at the University of Sydney to enable students to become more culturally competent upon graduation. METHODS: Staff and students of the Doctor of Dental Medicine and Bachelor of Oral Health programmes at the Faculty of Dentistry, University of Sydney participated in an online survey. Quantitative analysis of the survey data was conducted using integrated research electronic data capture survey tools, with open-ended questions being coded to common responses for those questions. RESULTS: A total of 69 staff (71%) and 191 students (51%) participated in the online survey. The majority of participants perceived there was limited Indigenous content in the curriculum. Most participants reported that Indigenous curriculum was integrated into several units of study. The main pedagogical method for curriculum delivery was lectures, followed by case studies and group discussions. CONCLUSION: Although some Indigenous content exists in dental faculty curriculum, in-depth investigation is required to develop a comprehensive, evidenced-based Indigenous cultural competence teaching framework, for integration into Doctor of Dental Medicine and Bachelor of Oral Health curricula.

Groundwater fluoride in Sri Lanka: opportunities to mitigate the risk at maximum contaminant level

Introduction: High groundwater fluoride (F) is one of the major environmental hazards in the dry zone of Sri Lanka. The prolonged exposure to F at maximum contaminant levels can give rise to lifelong debility and disability among its inhabitants. Objectives: This study investigated the F contamination in groundwater resources in Sri Lanka above recommended Maximum Contaminant Levels (MCL) and possibilities to mitigate the health risk. Methods: Groundwater samples (6107) were randomly collected from different geographic areas of the country, and categorised as hazardous, if it exceeded the maximum contaminant level of 4 mg/L (the level at which bone health is compromised). The minimum distances from a hazardous to a relatively safe F groundwater source (below 1.0 mg/L and 1.5 mg/L) were determined using geospatial analysis. Results: Only 2.3% (142) of the total sample was found to be hazardous to skeletal health. Optimal F sources were identified in close proximity to highly contaminated sources (>4.0 mg/L), some even within a walking distance of 500 metres. Conclusions: The identification and elimination of maximally contaminated sources, possibly by dilution with widely available low F sources in close proximity, would be a more feasible and cost effective approach to ensure long term public health benefits.

Public health intervention over four decades for the children in the Australian Capital Territory: Have we reached the point of diminishing returns?

BACKGROUND: Most of the developed world has seen some substantial improvements in the dental health of children over the past four decades owing to advances in service access, fluoride exposure, socio-economic development and improved diets, with the DMFT score of 12 year-olds dropping from well over 10 down to around one. AIM: To examine the question of advancing dental health for children even further using the same set of tools as we have to date by asking the question: Have we come to a point of diminishing returns? The study examines the long-term, near optimum settings of the known public dental health variables in the Australian Capital Territory. RESULTS: Despite having the most ideal and persistent dental health optimised situation, there remains underlying dental caries at a severity level of just below 1 DMFT (12 year olds), and over the last decade the rate of diminishing incidence and prevalence of decay has slowed and arguably stopped. CONCLUSION: This suggests that rather than toiling to eliminate dental decay completely, the focus might usefully be reoriented towards those small known pockets of society with persistent higher levels of disease and looking for new ways to address these difficult clusters, while simultaneously advancing the understanding that a small residual level of decay will always exist in society.

Identifying and prioritising areas of child dental service need: a GIS-based approach.

AIM: To identify and prioritise areas of high need for dental services among the child population in metropolitan Western Australia. DESIGN: All children hospitalised due to an oral-condition from 2000 to 2009, at metropolitan areas of Perth were included in the analysis of a 10-year data set. QGIS tools mapped the residential location of each child and socioeconomic data in relation to existing services (School Dental Service clinics). RESULTS: The tables and maps provide a clear indication of specific geographical areas, where no services are located, but where high hospital-admission rates are occurring, especially among school-age children. The least-disadvantaged areas and areas of high rates of school-age child hospital-admissions were more likely to be within 2km of the clinics than not. More of high-risk-areas (socio-economically deprived areas combined with high oral-related hospital admissions rates), were found within 2km of the clinics than elsewhere. CONCLUSION: The application of GIS methodology has identified a community's current service access needs, and assisted evidence based decision making for planning and implementing changes to increase access based on risk.

A retrospective audit of population service access trends for cleft lip and cleft palate patients.

UNLABELLED: Population prevalence of orofacial clefts (OFCs) is well documented but the service utilisation patterns of these patients have received limited consideration. OBJECTIVE: To analyse 10-year trends in the utilisation of subsidised OFC related services in Australia. DESIGN: Retrospective audit of service utilisation and claims datasets. METHODS: Using state-wide hospital admission data, all persons treated for Cleft Palate Only (CPO) and Cleft Lip Only (CLO) as their primary diagnosis from 1999 to 2009 in Western Australia were included in the data frameset. Additionally, National Medicare out-of-hospital claims from 2003 to 2013 were added to the data frameset. The socioeconomic status and accessibility to services were analysed as effectors of service-mix such as age group, gender and geographic location. RESULTS: Of 721 in-hospital care episodes in Western Australia, 69% had CPO and 31% CLO as their principal diagnosis. Hospitalisations occurred from 0-69 years of age, but three quarters of all episodes occurred from 0-4 years of age (averaging one to two episodes per child). Whilst total hospitalisations were about four times higher for patients resident in high access areas, adjustment for population found the poorest 20% of the population having substantially lower hospital admission rates than the rest of the population. In Australia, claims for out-of-hospital cleft-related services varied between States. The overall pattern of out-of-hospital Medicare claims nationwide showed orthodontic services having the highest number of claims, followed by prosthodontic then oral surgical services. CONCLUSION: These data provide a picture of diverse service utilisation and leads to some interesting conclusions about geographic and economic access as well as cost-shifts between State and Commonwealth.

The role of a bus network in access to primary health care in Metropolitan Auckland, New Zealand.

UNLABELLED: Background: This study examined the spatial accessibility of the population of metropolitan Auckland, New Zealand to the bus network, to connect them to primary health providers, in this case doctors (GP) and dentists. Analysis of accessibility by ethnic identity and socio-economic status were also carried out, because of existing health inequalities along these dimensions. The underlying hypothesis was that most people would live within easy reach of primary health providers, or easy bus transport to such providers. METHODS: An integrated geographic model of bus transport routes and stops, with population and primary health providers (medical. and dental practices) was developed and analysed. RESULTS: Although the network of buses in metropolitan Auckland is substantial and robust it was evident that many people live more than 150 metres from a stop. CONCLUSION: Improving the access to bus stops, particularly in areas of high primary health care need (doctors and dentists), would certainly be an opportunity to enhance spatial access in a growing metropolitan area.

Predicting geographically distributed adult dental decay in the greater Auckland region of New Zealand.

OBJECTIVE: To model the geographic distribution of current (and treated) dental decay on a high-resolution geographic basis for the Auckland region of New Zealand. BASIC RESEARCH DESIGN: The application of matrix-based mathematics to modelling adult dental disease-based on known population risk profiles to provide a detailed map of the dental caries distribution for the greater Auckland region. RESULTS: Of the 29 million teeth in adults in the region some 1.2 million (4%) are suffering decay whilst 7.2 million (25%) have previously suffered decay and are now restored. CONCLUSIONS: The model provides a high-resolution picture of where the disease burden lies geographically and presents to health planners a method for developing future service plans.

Building a stronger child dental health system in Australia: statistical sampling masks the burden of dental disease distribution in Australian children.

INTRODUCTION: In Australia, over the past 30 years, the prevalence of dental decay in children has reduced significantly, where today 60-70% of all 12-year-olds are caries free, and only 10% of children have more than two decayed teeth. However, many studies continue to report a small but significant subset of children suffering severe levels of decay. METHODS: The present study applies Monte Carlo simulation to examine, at the national level, 12-year-old decayed, missing or filled teeth and shed light on both the statistical limitation of Australia's reporting to date as well as the problem of targeting high-risk children. RESULTS: A simulation for 273 000 Australian 12-year-old children found that moving from different levels of geographic clustering produced different statistical influences that drive different conclusions. At the high scale (ie state level) the gross averaging of the non-normally distributed disease burden masks the small subset of disease bearing children. At the much higher acuity of analysis (ie local government area) the risk of low numbers in the sample becomes a significant issue. CONCLUSIONS: The results clearly highlight the importance of care when examining the existing data, and, second, opportunities for far greater levels of targeting of services to children in need. The sustainability (and fairness) of universal coverage systems needs to be examined to ensure they remain highly targeted at disease burden, and not just focused on the children that are easy to reach (and suffer the least disease).

High acuity GIS comparison of dentist and doctor surgery locations in Auckland, New Zealand.

OBJECTIVES: New Zealanders are one of the healthiest populations in the world, but significant inequalities in health and oral health remain. New Zealand suffers a possible shortage of medical and dental practitioners and an agreed mal-distribution of both. This study examines the distribution of dental and medical practices in New Zealand's largest city Auckland, using modem Geographic Information System tools. The aim of the study is to determine if medical and dental practices are similarly distributed across the city. DESIGN AND METHODS: The address for each dental and medical practice in Auckland was obtained and mapped over the census population data. A total of 442 medical and 256 dental practices were geo-coded in the study area. These practices overlaid the Auckland region, with a total population of 0.8 million, and an adult population (>9 years old) of 0.69 million. Auckland city was deemed, for this study, to be a region included in a 15km radius circle from a central reference point that was the General Post Office (GPO). RESULTS: The medical practice to total population ratio ranged from 1:1,500 for people 121/2-15km from the GPO, to 1:1,200 for those within 21/2km. Dental practice to population ratio ranged from 1:2,700 for people living 121/2-15km from the GPO to 1:1,300 for those within 21/2km. Medical practices were relatively evenly distributed, regardless of distance from the GPO, but the fairly dense distribution of dental practices in the city's inner 21/2km circle rapidly decreased in density as distance from the GPO increased. CONCLUSION: These results refute the hypothesis of this study in that there is a similar distribution of primary health practices (medical and dental) across the Auckland region.

Using GIS to analyse dental practice distribution in Indiana, USA.

OBJECTIVE: Dentistry across the globe faces significant workforce issues with mal-distribution at most levels of analysis being a substantial issue. This study was the first to apply high resolution Geographic Information Systems (GIS) tools to map every private dental practice in the State of Indiana against a backdrop of population demographics. The hypothesis tested in the study is that there is an even density distribution of dental practices across Indiana. METHOD: Adult population data were obtained from the United States Census of Population and divided by census tracts. The physical address for each dental practice in Indiana was collated from a comprehensive web-based search and the two datasets were integrated using GIS tools. RESULT: The whole adult population of Indiana (5 million) was distributed across 1,511 census tracts. Across these tracts a total of 2,096 separate private general dental practices were distributed. There were a total of 679 tracts (45%) without a dental practice while 2.5% of tracts had 8 or more practices. CONCLUSION: The practice to population ratio (1:2,384) for the whole State was not significantly different for those living within 50km (31 miles) or 25km (15 miles) of the seven major city centers, and mean personal income (by residency location) did not appear to significantly influence practice location.

The geographic distribution of patients seeking emergency dental care at the Royal Dental Hospital of Melbourne, Australia.

BACKGROUND: Little detail is known about the geographical catchment areas covered by dental hospitals, with no previous Australian studies of this kind. The aim of this study was to assess the geographical distribution of public dental emergency patients and their socioeconomic status to define catchment zones for a dental hospital. METHODS: All patients requesting emergency dental care at the Royal Dental Hospital Melbourne, meeting the inclusion criteria, in calendar years 2006 and 2010 were included in the sample. Geographic information systems tools were used to locate and link each patient address to the socioeconomic data. RESULTS: For both 2006 and 2010 95% of the patients were living within 50km of the hospital. In 2006, most of the patients seeking care lived within a 15km radius of the dental hospital whilst in 2010 that distance increased somewhat. Patients from areas with similar socioeconomic status living more than 10km away from the hospital had poorer access to dental emergency treatment. CONCLUSIONS: The hospital had a surprisingly large catchment zone that overlapped those of smaller community-based clinics.

Lateral occlusion schemes in natural and minimally restored permanent dentition: a systematic review.

Clinicians commonly encounter the dilemma of which lateral occlusion schemes is most suitable for a specific patient. The aim of this review is to evaluate the prevalence of the lateral occlusion schemes that exist naturally. An electronic search was completed through PubMed (MEDLINE), Google Scholar and Cochrane Library. The search was confined to peer-reviewed studies published in English, up to April 2013. The literature search was supplemented by manual searching through the bibliography lists of the selected studies. The initial search retrieved a total of 575 studies. After applying the selection criteria, only 12 studies were suitable for inclusion. The Critical Appraisal Skills Programme (CASP) tools were utilised to appraise the quality of the studies. The prevalence of canine-guided, group function and balanced occlusions was reported. Overall, there was a clear variability between the studies. The prevalence of the lateral occlusion schemes appears to be influenced by the following factors: (i) the magnitude of excursion, (ii) an individual's age and (iii) the static occlusal relationship. During complete excursion, the canine-guided occlusion tends to be more frequently observed. After partial excursion, the most prevalent lateral occlusion schemes was group function occlusion. With ageing, the prevalence of canine-guided occlusion tends to be reduced and the prevalence of group function occlusion is increased. Dentition that is closer to Class II occlusion exhibits mainly canine-guided occlusion, while for Class III occlusion, group function occlusion is more prevalent. The studies revealed no relationship between the lateral occlusion schemes and TMD development.

Three year retrospective analysis of computer-assisted emergency dental triage in Tasmania, Australia.

INTRODUCTION: Tasmania is Australia's smallest state measuring approximately 68,000 km2 and separated (by approximately 240 km of ocean) from the mainland of Australia, at the south-east corner of the continent. The total resident population of Tasmania is approximately 500,000 people with the greatest population density in the capital city, Hobart. Adult dental care is subsidised for socioeconomically disadvantaged people and are provided through the State government dental clinics. Emergency demand for adult dental care is rationed through a triage system (mainly by telephone contact with trained receptionists), applied across the State based on universal clinically agreed criteria. The aim of this study was to analyse the outcomes of this triage system in delivering effective public emergency dental care services in Tasmania. METHODS: The study population consisted of all patients who approached the dental services in Tasmania for emergency care over a period of 3 years. The data were collected from all four major fixed public dental clinics for the calendar years 2009, 2010 and 2011. RESULTS: A total of 56,298 triage events were analysed over the 3 years (2009-2011) of the study. The proportion of each triage outcome category (ie speed to needing to be seen) was stable. Regarding month-to-month variation, December had the lowest overall number of events (n=3921) and August had the greatest (n=5237). There was a tendency mid-year (winter in the southern hemisphere) for triage events to be above the baseline, while in summer (December to February) there were fewer events. Most triage events occurred on the first day of the working week (Monday), and the least occurred on Fridays. Over half the events were driven from two patient symptom sets: (1) pain that woke patients at night; and (2) pain that required analgesics. CONCLUSION: In order to deal with the current workforce shortage and funding constraints in the public health sector, the peri-operative workforce such as receptionists can be utilized in innovative ways such as triage, and in particular clinical-based systematic telephone-based assistance.

Size estimation of unerupted canines and premolars using various independent variables: a systematic review.

INTRODUCTION: Prediction of unerupted permanent teeth is an essential part of orthodontic diagnosis and treatment planning. This prediction is done by mixed dentition space analysis based on the estimation of mesiodistal dimensions of unerupted permanent canine and premolars from already erupted permanent teeth. Permanent mandibular incisors are most commonly used for prediction. Recent literature reveals that mandibular incisors are not accurate predictors and other independent variables have been introduced to make a more accurate and precise prediction. The objective of this paper was to evaluate the literature in light of a variety of independent variables and their predictive accuracy. METHODS: Electronic databases such as MEDLINE, PubMed, Scopus, Embase, Web of Science, CINAHL Plus were searched to identify articles published until September 2021. RESULTS: The search resulted in a total of 1098 articles, of which 24 papers met our inclusion criteria and were included in this review. Articles using permanent mandibular incisors only as a predictor were excluded during the eligibility assessment. The results show that various independent variables including mesiodistal and vestibulo-oral dimensions of permanent maxillary and mandibular incisors and molars, molar basal arch length, intermolar distance, maxillary and mandibular arch and gender have been used as predictors to more accurately determine mesiodistal width of unerupted canine and premolars in different populations. CONCLUSION: Ethnic tooth size variations strongly emphasize the need to determine which independent variable gives a more accurate prediction of unerupted permanent teeth to develop a population-specific prediction model. This will play a significant role in managing space problems and developing malocclusions.

Prediction of mesio-distal dimensions of the unerupted permanent canines and premolars using measurements of different groups of erupted teeth: retrospective cross-sectional analysis of digital records in Western Australians.

PURPOSE: Recently, other combinations of teeth are claimed to be better predictors for size estimation of permanent canine and premolars. The present study aimed to determine which combinations of teeth presented an appropriate predictor in Western Australians using digital technology. METHODS: A total of 500 (323 females, 177 males) participants meeting the inclusion criteria were randomly selected from private orthodontic clinics. Mesiodistal dimensions of selected teeth obtained from pre-orthodontic treatment digital records were analyzed using SPSS 20. Fifteen possible combinations of teeth were used to determine the best prediction capability. RESULTS: Different combinations of teeth showed a higher correlation with the sum of permanent canine and premolars. In females, group 13 (Mandibular incisors and maxillary first molars) and in males, group 15 (mandibular incisors, maxillary central incisors, and first molars) and group 14 (mandibular incisors and first molars) showed a higher correlation in maxilla and mandible respectively. Linear regression equations were developed based on the best predictor for each arch and gender. CONCLUSION: Permanent mandibular incisors may not be better predictors when used alone. Newly developed equations, based on different combinations of teeth, more accurately predicted the sum of mesiodistal dimensions of permanent canine and premolars in the Western Australian population.