Oral Squamous Cell Carcinoma: Focus on Biomarkers for Screening.

Oral cancer is a malignant neoplasia that can originate in the oral cavity or lips. It is a serious global health problem and one of the ten most common cancers worldwide. Over the years, changes in the trends of the oral cavity and oropharyngeal cancers have been observed. The management of oral cancer is complicated due to the functional and cosmetic consequences of treating malignancies at these anatomical locations. The tumor and its treatment can affect a variety of functional activities, including smell, sight, speaking, respiration, taste, jaw function, and mastication, either temporarily or permanently. Based on the importance of this tumor, screening oral cancer for early detection and finding the best biomarkers for diagnosis is a crucial concern. In this review of literature, the etiology, risk factors, treatment, and diagnosis of oral cancer will be reviewed with a focus on the most important biomarkers.

Epidemiological Profile of Salivary Gland Tumors in Southern Iranian Population: A Retrospective Study of 405 Cases.

Aims: Salivary gland tumors (SGTs) are a rare and diverse group of tumors that account for 3 to 10% of all head and neck malignancies. We aimed to conduct a comprehensive epidemiological analysis of SGTs in the south of Iran and compare the findings with previous reports from Iran and other parts of the world. Methods: Using a retrospective study, 405 patients diagnosed with SGTs were observed over an eight-year period between April 2013 and October 2021 in Shiraz, Iran. Patients' demographic and clinicopathological features were obtained from patients' records. Quantitative and descriptive data analysis was performed using SPSS software. Results: There were 302 benign (74.5%) and 103 (25.4%) malignant SGTs. Pleomorphic adenoma and Warthin's tumors were the most common benign SGTs (70.5% and 21.5%, respectively). The most common malignant SGTs were mucoepidermoid carcinoma and adenoid cystic carcinoma (26.2% and 22.3%, respectively). There was a statistically significant association between tumor origin and its malignancy status (p < 0.001). In addition, the results indicated that benign tumors were most commonly detected in the parotid gland (p < 0.05). The benign tumors were more frequently observed among the younger population (p = 0.006). Conclusion: In summary, the findings of the current study were mainly consistent with the previous reports from Iran and the rest of the world. Benign tumors were the most prevalent type of SGTs, and the parotid gland was the most common site. While the majority of cases that developed from the major salivary glands were benign, all the minor SGTs were malignant. Older patients were more likely to develop malignant tumors compared to younger ones. This study provides insights into the prevalence, age-related incidence, gender distribution, and geographic variation of salivary gland tumors. This can be instrumental to develop a guideline for screening, diagnosis, and determining an optimal treatment.

Effects of the Child Dental Benefits Schedule on dental hospitalisation rates in Australian children.

Objective The Child Dental Benefits Schedule (CDBS) was introduced in 2014, and its aim was to support access to dental care for eligible children in Australia. Dental caries, and pulp and periapical diseases were the major dental reasons for children's hospitalisations. This study investigated if the availability of the CDBS had any effects on hospitalisation rates in Australian children. Methods This study was a retrospective analysis of Medicare data from the Australian Government and the hospitalisation data from The Australian Institute of Health and Welfare (AIHW) from 2008 (6 years before the commencement of the CDBS) to 2020 (6 years after the commencement of the CDBS). Results Although the hospitalisation rate trend was reducing before the CDBS started (2008-14), this reduction was not statistically significant. The reduction of hospitalisation rates was higher after the commencement of the CDBS (2014-20) and was statistically significant, but the regression model analysis showed a positive correlation between the CDBS and hospitalisation rate. The analysis without 'abnormal' year data (2019-20, COVID-19 pandemic year) supported no statistically significant decrease in hospitalisation rate after the commencement of the CDBS in 2014 until 2019. Conclusion Although the CDBS is improving access to dental care for eligible children, any possible effects the CDBS might have on hospitalisations are not yet evident.

Special needs dentistry in multidisciplinary head and neck cancer management - characterizing scope and complexity of patient care.

AIMS: To describe the involvement and need for specialists in special needs dentistry (SND) in the multidisciplinary management of patients and to characterize the complexity of patients with special health care needs. METHODS: Referrals for SND review from the Fiona Stanley Hospital head and neck cancer (HNC) multidisciplinary team between January 1 and December 31, 2019 were screened. Data recorded included demographic information, medical history, dental status, and dental treatment provided prior to HNC management. RESULTS: In total 127 patients were referred to the SND clinic in 2019 of which 89.0% were males and 74.8% were aged 50-79. The mean waiting time for SND review was 19.6 days. On average patients had a decayed, missing, filled tooth (DMFT) score of 20.3. During the study period 407 extractions and 30 restorations were completed. Seventeen patients (13.4%) had all their teeth removed prior to HNC management. The majority of patients (79.6%) were categorized as either moderate or severe complexity. Increasing complexity was seen in older age groups. CONCLUSIONS: Significant oral disease is seen in patients with HNC often requiring extensive dental treatment. Complexity is seen in patients requiring multidisciplinary care however characteristics that constitute complexity are varied given the spectrum encompassing 'special needs'.

São Paulo urban health index: measuring and mapping health disparities / Índice de saúde urbana de São Paulo: medindo e mapeando disparidades em saúde

ABSTRACT: Objective: To calculate and map the health inequalities in the city of São Paulo using the Urban Health Index (UHI) methodology. Methods: Seven indicators were selected from the Brazilian census: (1) proportion of households with access to sewage systems, (2) proportion of households served by regular waste collection, (3) proportion of households with two or more toilets, (4) proportion of households receiving tap water, (5) average income per household, (6) percentage of white people, and (7) literacy rate. Based on the UHI methodology, all health indicators were standardized and aggregated into a single metric at the census tract level. The UHI scores were ranked and plotted. The disparity ratio and the graph slope were calculated. The correlation between indicators was tested. Results were geocoded to produce a map of health risks. Results: The distribution of index values showed a linear middle section and deviations at each end. The disparity ratio found was 2.95, while the slope was 0.30. All indicators were significantly correlated. The map displayed a typical pattern of health inequality between the downtown and the periphery. The tracts located in the city's downtown had higher UHI values than those on the outskirts. Conclusions: The results of this study presented a visual distribution of health disparities in the city of São Paulo, proving to be a valuable method for identifying areas that require public health attention.

Resumo: Objetivo: Calcular e mapear as desigualdades em saúde na cidade de São Paulo por meio da metodologia do índice de saúde urbana (UHI). Métodos: Sete indicadores foram selecionados do censo brasileiro: (1) proporção de domicílios com acesso a esgoto, (2) proporção de domicílios com coleta regular de lixo, (3) proporção de domicílios com dois ou mais banheiros, (4) proporção de domicílios que recebem água encanada, (5) renda média por domicílio, (6) porcentagem de pessoas brancas e (7) taxa de alfabetização. Usando a metodologia UHI, todos os indicadores de saúde foram padronizados e agregados em uma única métrica para o setor censitário. Os valores de UHI foram classificados e plotados. A razão de disparidade e a inclinação do gráfico foram calculadas. A correlação entre os indicadores foi testada. Os resultados foram geocodificados, produzindo um mapa de risco à saúde. Resultados: A distribuição dos valores do índice apresentou uma seção intermediária linear e desvios nas extremidades. A taxa de disparidade encontrada foi de 2,95, enquanto o coeficiente angular foi 0,30. Todos os indicadores apresentaram correlação significativa. O mapa exibiu um arranjo característico de desigualdade em saúde entre o centro e a periferia. Os setores localizados na região central da cidade apresentaram valores de UHI mais elevados do que os da periferia. Conclusão: Os resultados deste estudo apresentaram uma distribuição visual das disparidades de saúde na cidade de São Paulo, demonstrando ser um método valioso para a identificação de áreas que requerem atenção da saúde pública.

Needs Assessment Towards Development of an Integrated Diabetes-Oral Health Nutrition Education Module: A Qualitative Study.

INTRODUCTION: The diabetes mellitus-periodontitis relationship has advocated several strategic management approaches on effective glycaemic control and oral health improvement for diabetic patients and periodontitis patients with diabetes. We aimed to identify the challenges of providing health education to patients with diabetes and/or periodontitis among healthcare professionals and needs for an integrated nutrition-oral health education module. METHODS: This study involved semi-structure in-depth interview with fifteen healthcare professionals from a training hospital focused on: (i) the existing issues and challenges encountered while managing patients for their nutrition and care and (ii) issues related to the current practice among healthcare professionals. Details pertaining to the participants' verbal and non-verbal responses were recorded, transcribed ad verbatim and analysed using themes codes. RESULTS: Patients' attitude and behaviour, language barriers and prioritising time were found as the common problems with patients, while limited knowledge on the relationship between diabetes-periodontitis, limited availability of appropriate and cultural-based health educational tools, lack of inter-professional multidisciplinary collaboration in managing patients, and constrains in time as well as costly therapy were common issues in the current practice. CONCLUSIONS: Cost-effective efforts must be focused on overcoming these issues besides emphasizing the needs on developing an integrated module to achieve better management outcomes.

Dental specialist workforce and distribution in the United Kingdom: a specialist map.

Objectives To illustrate, identify and assess a contemporary model of the geographic distribution of specialist dentists in relation to population age groups and rurality.Methods All UK dental specialists registered with the General Dental Council were extracted and paired with publicly available locations of work. Geographic information system tools were used to map specialist locations against population and rural-urban classifications of England, Wales, Scotland and Northern Ireland. The latest 2019 population estimates and health board areas were superimposed to create a specialist map. All other data were collected at the smallest geographic statistical areas and corresponding population data from the latest census.Results A total of 4,439 specialist titles were held by 3,041 individuals, linked to 3,459 unique locations of work. Specialist locations were mapped against 135 Clinical Commissioning Groups (CCGs) of England, seven Local Health Boards of Wales, 14 Health Boards of Scotland and five Health and Social Care Trusts of Northern Ireland. NHS Central London CCG had the highest specialist dentists per 100,000 people at 118.9; paediatric dentists per 20,000 children at 6.4; orthodontic dentists per 20,000 schoolchildren at 23.2; oral surgery dentists at 4.8 per 20,000 adults; and prosthodontic dentists at 7.2 per 20,000 adults. Orthodontics and oral surgery had the highest specialist-to-population ratios at 1:45,545 and 1:77,510, compared to oral and maxillofacial radiology and oral microbiology with the lowest ratios of 1:2,178,316 and 1:9,024,452, respectively. In England, Wales, Scotland and Northern Ireland, there were 79.5% (n = 42,140,039), 55.6% (n = 1,703,248), 46.9% (n = 2,481,996) and 42.9% (n = 776,295) of the respective populations that lived within 2.5 km of a specialist location. There were significant disparities in rural proximity to specialist locations across all nations. In Scotland, 40.8% of the rural population lived outside 10 km of a specialist location.Conclusions Stark inequalities exist in the geographic distribution of UK specialist dentists and high disparities were found in accessing a specialist, especially for vulnerable populations.

Does socioeconomic status influence oral cancer awareness? The role of public education.

BACKGROUND: Public awareness on oral cancer is thought to improve prevention and early diagnosis; however, the role of socioeconomic status in this awareness is not clear. AIMS: The aim was to investigate whether an association exists between socioeconomic status and oral cancer awareness in adults. METHODS: A multi-stage random sample of adults was investigated in Tehran in 2016-2017. The outcome was awareness of oral cancer and knowledge of risk factors and signs and symptoms using a self-administered questionnaire. The main exposures were self-reported socioeconomic status of 8 indicators of family assets and economic situation. Wealth index was created using principal component analysis, and participants were classified into 5 quintiles. Regression analysis was applied to test associations. RESULTS: Out of 1800 adults, 1312 completed questionnaires were returned (72.8% response rate). The mean age was 37.8 (standard deviation 9.0) years; about 60% were female. Statistical analysis revealed the higher the wealth index, the higher the score for oral cancer knowledge and awareness. Awareness and knowledge were significantly lower among participants in the poorest quintile: they had a knowledge score on oral cancer risk factors 1.58 points [95% confidence interval (CI): -2.19;-0.96] lower, and a knowledge score on oral cancer signs 1.34 points (95 CI: -1.98;-0.72) lower compared with the richest quintile. CONCLUSION: Socioeconomic inequalities were observed in oral cancer awareness in the Islamic Republic of Iran.

Dispensing patterns of emergency medicines prescribed by Australian dentists from 1992 to 2018 - a pharmacoepidemiology study.

OBJECTIVE: As the population ages, dentists are likely to encounter medical emergencies due to metabolic factors and polypharmacy. To date, there have been no documented studies in Australia that have analysed the prescription rate of Pharmaceutical Benefits Scheme (PBS)-funded emergency medicines for dentists. Therefore, this pharmacoepidemiology study aims to describe the dispensing patterns of emergency medicines as prescribed by dental practitioners, related to medicines covered by the Australian PBS system. METHODS: Data on dental medications used for emergencies, under the PBS, from 1992 to 2018, were accessed. Cumulative dispensing counts were calculated. Data on medications that were not utilised were also collected in the form of the crude cumulative count. RESULTS: Out of the 56 medications on the dental PBS schedule, eight were utilised for medical emergencies, with a total of 432 prescriptions on a national level, over 27 years. The commonly utilised lifesaving medicines of adrenaline, glucagon, as well as glyceryl trinitrate, had a total prescription count of 147, 88 and 27 respectively. Medicines used for opiate overdose; naloxone, had a total prescription count of one. Only one medicine (benztropine injection) for medical emergencies had a prescription count of 0. CONCLUSION: This study highlights the dispensing patterns of medicines prescribed by dentists for emergency scenarios. Although this study did not assess the appropriateness of use of the emergency medicines, further investigation may be required to ensure the future safety of patients when encountering emergency scenarios.

Population Survey of Knowledge about Oral Cancer and Related Factors in the Capital of Iran.

Knowledge about oral cancer risk factors and signs is thought to improve prevention and early diagnosis, and in turn, increases survival. In this population-based survey, knowledge about oral cancer was assessed in Iran. A total of 1800 self-administered questionnaires (collecting sociodemographic data and questions regarding oral cancer risk factors and signs) were distributed through random sampling. Final scores ranged between 0 and 15 for the risk factors and 0-11 for the signs. Scores below the median indicated a low level of knowledge, scores representing the third quartile of correct answers indicated a moderate level of knowledge, and scores representing the upper quartile indicated a high level of knowledge. Statistical tests were used for analysis of knowledge level in different sociodemographic categories. A total of 1312 participants completed the questionnaires. The average of knowledge scores for risk factors was 5.3 ± 3.0 and for signs was 4.5 ± 2.9. Overall, 75 and 56% respectively were able to identify major risk factors (smoking and alcohol); 23.5% could not define any related signs and symptoms. Dividing scores into quartiles indicated that three out of four people had "low" knowledge about risk factors and 58% had "low" knowledge about signs and symptoms. Females and highly educated people had more knowledge of oral cancer. Significant difference was found between job and level of knowledge (P = 0.001). This survey revealed that public knowledge of oral cancer was not satisfactory in Iran. Efforts should be done to inform and educate people with risk factors, initial clinical presentation, and symptoms, in order to improve prevention and promote early diagnosis.

Disparities in Oral Cancer Awareness: a Population Survey in Tehran, Iran.

Oral cancer is a life-threatening disease with low survival rates, especially when diagnosed in an advanced stage. Lack of awareness about this cancer among the population is proposed as a possible reason for this diagnostic delay. The aim of this study was to evaluate oral cancer awareness, as well as the association of this with sociodemographic status in Tehran. In this cross-sectional population-based survey, 1800 self-administered questionnaires (collecting sociodemographic data, questions regarding oral cancer awareness and the source of information) were distributed through multistage stratified random sampling. Scores for questions ranged from 0 to 4, and totals were summed. The outcome of question responses was also analyzed separately. In total, 1312 questionnaires were available for analysis, from 788 females and 489 males (37.8 ± 9.02 years). Only 30% of the respondents were aware of oral cancer. The average score for awareness was 1.09 ± 1.6 with no significant differences between age groups and genders. Almost 6.5% of participants had complete awareness about oral cancer. A significant difference was found between mean scores in different levels of education and occupation (p = 0.0001). From 585 responses to the "source of information" question, "public media" was the most important source (almost 50%). Only 2% mentioned "dentists" as a source of information. This study indicated an alarming lack of oral cancer awareness and literacy in Tehran, Iran. Dentists should be obliged to practice their pivotal role in informing the public about oral cancer.

A resource reallocation model for school dental screening: taking advantage of teledentistry in low-risk areas.

OBJECTIVE: To estimate the scale of resource transfer that could be achieved by screening low-risk schoolchildren using teledentistry rather than using traditional visual dental examination. METHODS: This study was based on a previous cost-minimisation study that compared the costs of two dental-screening approaches (visual and teledentistry). The data for the population of children 5-14 years of age was obtained from the Australian Bureau of Statistics and was divided across Australia according to statistical local area (SA2). The cost models (for teledentistry and visual screening) for each SA2 relative to the state, Remoteness Area (RA) and Socio-Economic Index for Area (SEIFA) indexes were estimated. The geographical information system was used to superimpose modelled cost data on the geographical map to provide a visual presentation of the data. Resource transfer scenarios, based on risk minimisation, were then developed and analysed. RESULTS: This study demonstrated a suboptimal allocation of dental-care resources, such that children living in high socio-economic areas (major cities) with low disease burdens consuming half of the estimated resources of a universal visual dental screening system. The findings suggest that utilising teledentistry screening for low-risk children has the potential to free up $40 million per annum. Such resources can be reallocated to increase care access and improve the quality of dental services for vulnerable children. CONCLUSION: To reduce inequalities in dental health within a community, scarce health-care resources should be targeted at the population at most risk. These findings can be used to inform policymakers, guide the appropriate distribution of scarce resources and target dental services to benefit high-need children.

Supportive peri-implant therapy following anti-infective surgical peri-implantitis treatment: 5-year survival and success.

OBJECTIVES: To evaluate clinical outcomes of supportive peri-implant therapy (SPIT) following surgical treatment of peri-implantitis. MATERIALS AND METHODS: Twenty-four partially dentate patients with 36 dental implants diagnosed with peri-implantitis were treated by an anti-infective surgical protocol followed by regular supportive therapy. SPIT included removal of supra- and submucosal biofilm at the treated implants using titanium or carbon fibre curettes, or ultrasonic devices. In addition, professional prophylaxis (calculus/biofilm removal) at other implants/teeth and oral hygiene reinforcement was provided. Clinical measurements and radiographs were obtained at 1, 3 and 5 years. A successful treatment outcome was defined as implant survival with the absence of peri-implant probing depths (PD) ≥ 5 mm with concomitant bleeding/suppuration and absence of progression of peri-implant bone loss. RESULTS: Twelve months after treatment, there was 100% survival of the treated implants and 79% of patients (19 of 24) had a successful treatment outcome according to the defined success criteria. At 3 years, 75% of the patients (18 of 24) had a successful treatment outcome, two patients (8%) were lost to follow-up (LTF), while 8% lost an implant, and two patients had recurrence of peri-implantitis. Between 3 and 5 years, an additional two patients were LTF, and an additional two patients each lost one implant. Thus, at 5 years 63% of patients (15 of 24) had a successful treatment outcome. Complete resolution of peri-implantitis, defined as absence of bleeding at all sites, was achieved in 42% of implants (N = 15) at 5 years. CONCLUSION: Five years following regular supportive therapy, the peri-implant conditions established following peri-implantitis surgery were maintained in the majority of patients and implants. Some patients had recurrence of peri-implantitis and some lost implants over the 5-year period.

Mortality for oral Cancer in Minas Gerais, Brazil, from 1996 to 2012 / Mortalidade por Câncer de boca em Minas Gerais, Brazil, de 1996 a 2012 / La mortalidad en Cáncer de boca en Minas Gerais, Brasil, 1996 a 2012

Aim: To investigate the spatial-temporal distribution of mortality from oral cancer in Minas Gerais between 1996 and 2012. Methods: The analysis of the growth trend rates of the series was made by Moving Average. Results: In the period there were 8.675 deaths from mouth cancer and these were identified in all the regions of the state. Being, 6,974 (80,4%) men and 1,701 (19,6%) women. Regarding the crude rate, we observed a tendency of growing of mortality from this cancer type. This phenomenon was also observed when executed the weighting by sex, especially for males and over 60 years old. Was rejected the null hypothesis of stationary of mortality series for oral cancer in Minas Gerais during the period. Conclusion: Moving Average weighted by age and gender allowed to observe an increase in the mortality rate in all age groups and for both sexes especially men and older than 60 years.

Objetivo: Investigar a distribuição espaço-temporal da taxa de mortalidade por câncer de boca do estado de Minas Gerais entre 1996 e 2012. Métodos: A Média Móvel foi utilizada para analisar a tendência de crescimento da taxa. Resultados: No período estudado ocorreram 8.675 óbitos por câncer de boca e estes foram identificados em todas as microrregiões do estado. Sendo, 6.974 (80,4%) homens e 1.701(19,6%) mulheres. Houve tendência de crescimento da taxa bruta de mortalidade por este tipo de câncer. Este fenômeno também foi observado quando executado a ponderação por sexo, principalmente para o sexo masculino e indivíduos acima dos 60 anos. Foi rejeitada hipótese de nulidade de estacionariedade da mortalidade por câncer de boca em Minas Gerais no período estudado com elevação da taxa de 2,22 em 1996 para 3,87 em 2012. Conclusão: Observou-se o crescimento da taxa nas faixas etárias estudadas, em homens e acima de 60 anos.

Objetivo: Investigar la distribución espacial y temporal de la mortalidad por cáncer oral en el estado de Minas Gerais entre 1996 y 2012. Métodos: El promedio móvil se utilizó para analizar la tendencia de la tasa de crecimiento. Resultados: En el período hubo 8.675 muertes por cáncer de boca y éstos fueron identificados en todas las regiones del estado. Y, 6.974 (80,6%) eran hombres y 1.701 (19,6%) mujeres. Con respecto a la tasa bruta, se observa una tendencia creciente en la mortalidad por este tipo de cáncer y cuando se ejecuta la ponderación por sexo, especialmente para los varones y más de 60. Rechazó la hipótesis nula de estacionariedad de la mortalidad por cáncer oral en Minas Gerais durante el período. Conclusión: Promedio ponderado por edad y sexo Mobile ha observado tasa de crecimiento en los grupos de edad y en los hombres y por encima de 60 años.

Does green tea consumption improve the salivary antioxidant status of smokers?

OBJECTIVE: Considering the higher rate of oral cancer, and reduction in salivary antioxidants in smokers as indicated in previous studies, antioxidant- containing nutrients such as green tea, seem to be beneficial in counteracting against oxidative stress in this group. This study assessed the salivary total antioxidant alteration in smokers compared to nonsmokers, after short-tem (7days) and long-term (3 weeks), green tea drinking. DESIGN: In this experimental study, 20 volunteer moderate-to-heavy male smokers, and 20 matched healthy non-smokers were selected to participate, according to the inclusion criteria. Participants were instructed to drink two cups of green tea per day, by dissolving 2g of green tea in 150ml of hot water for each cup. After saliva collection, antioxidant capacity of saliva was measured at baseline, after 7days, and after 21days. Statistical evaluation was done by SPSS 21, using paired samplet tests, one-way ANOVA and Bonferroni tests. RESULTS: At day zero nonsmokers had a higher antioxidant capacity than smokers (686.6±62.22 vs. 338.8±59.9) mM/50µl, P<0.001. There was also a significant difference between two groups in salivary total antioxidant capacity after one week and three weeks of green tea consumption (P<0.001). However, there was an upward trend in both smokers and non-smokers over the study period (after tea drinking). In addition, a significant difference was found in total antioxidant capacity alteration in smokers compared to non-smokers from baseline to day 21. CONCLUSIONS: Results support the effectiveness of green tea consumption in salivary antioxidants enhancement in smokers, in both the short- and long term.

Hospital admissions of older people for oral health-related conditions: implications for the future.

OBJECTIVE: This study analysed all hospitalisations of persons over the age of 65 years for oral health-related conditions, over a decade, and projected future hospitalisation rates. BACKGROUND: The proportion of older Australians is increasing, and their oral health is improving. At the same time, there is concern about the increasing burden that hospitalisations place on government health budgets. METHODS: Hospitalisation data of all patients older than 65 years, admitted to hospital for an oral health-related condition in Western Australia over a decade, were analysed. RESULTS: Over a ten-year period, a total of 11608 people over the age of 65 were admitted to hospital, with 10% 85 years and older, 52% were men, and 0.1% were Aboriginal patients. The highest rates of hospitalisation were for those from the most disadvantaged areas. Over ten years, there was a significant annual increase in rates of hospitalisation (4.4%). Overall, most admissions were for 'Malignant neoplasms' (16.6%), 'Dental caries' (15.4%) and 'Other disorders of the teeth and supporting structures' (14.3%). These three conditions accounted for almost half of all admissions (46.4%). Projections indicate high future burdens of hospitalisation. CONCLUSIONS: It is of concern that hospitalisations for oral health-related reasons among the oldest patients include high numbers with potentially preventable conditions such as dental caries. Projections indicate that if current trends are set to continue, hospitalisations for oral health-related conditions among Western Australians older than 65 years will place a considerable burden on the health system.

Incidence of oral cancer in Western Australia (1982-2009): Trends and regional variations.

AIM: Oral cancer remains a significant issue for many communities of the world. In Australia, there are approximately 2000 new diagnoses each year, and the rates are growing. The divide between city and rural, rich and poor, is, in many countries, found to be linked to the incidence of oral cancer. The aim of this study was to determine the trends in the incidence of oropharyngeal cancer (specifically cancer of the parotid and major salivary glands, pharynx, and tongue) in Western Australia over a 27-year period, from 1982 to 2009, and determine the geographic distribution of incidence within the state. METHODS: The de-identified data were provided by the Western Australian Cancer Registry, as oral cancer is a notifiable condition in Australia. RESULTS: There were a total of 2801 cases reported with pharynx, tongue, major salivary glands and parotid cancers over a 27-year period: 73.2 percent were male and 26.8 percent were female. The age-standardized incidence rate was 67.4 per 100 000 persons per annum for pharyngeal cancer, 54.1 for tongue cancer, 22.2 for parotid gland cancer and 5.5 for major salivary gland cancer. The age-standardized rates for pharyngeal and tongue cancer (but not parotid) were higher in country areas of Western Australia than in the metropolitan areas. The burden of some site-specific oral cancers is continuing to rise. An increasing trend with older age is also consistent throughout the study period. CONCLUSION: This study finds that the incidence of oral cancers in Western Australia is not inconsistent with other parts of Australia and fundamentally shows there is a rural-urban difference for oral cancer.

A critical discussion of the benefits of e-health in population-level dental research.

Population-level research is an essential area of health with the potential to affect quality of life and the broader economy. There are excellent epidemiological studies that have improved health services, but traditional research requires a considerable investment. Although electronic technology has changed the practice of many industries with improved efficiency, its application to health is relatively new. Termed 'e-health', this emerging area has been defined by the World Health Organization as the use of information technology to support many aspects of health such as in administration and scientific information. However, not all professionals are convinced of its use. This paper presents a novel application of this emerging area to describe the benefit in data collation and research to support one of the most pressing issues in public health: oral health and policy. Using the Chronic Disease Dental Scheme as an example, a critical discussion of its benefit to population-level research is presented. The Chronic Disease Dental Scheme method of electronic administration has been shown to enhance research and to complement existing progress in health data linkage. e-Health is an invaluable tool for population-level dental research.

Hospitalisations for removal of impacted teeth in Australia: a national geographic modeling approach.

INTRODUCTION: The aim of the study was to project hospitalisation rates for the surgical removal of impacted teeth across Australia, based on Western Australian statistics. METHODS: Population data were obtained from the Australian Bureau of Statistics and were divided across Australia by statistical local area and related to a validated socioeconomic index. Every episode of discharge from all hospitals in Western Australia for the financial years 1999/2000 to 2008/2009 indicating an impacted/embedded tooth removal as the principle oral condition, as classified by the International Classification of Disease (ICD-10AM), was included in the study. Hospitalisation data were obtained from the Western Australian Hospital Morbidity Data System. Variables of age, place of residence and health insurance status were utilised for projecting the Western Australian rates across Australia. RESULTS: The results of the study showed a definite rural-urban divide and the estimated age-adjusted rates were almost three times greater in the higher socioeconomic areas when compared to their poorer counterparts. The costs of the procedure were estimated to be approximately $60 million per annum across Australia. CONCLUSION: The findings of this study can be used to inform health policy to guide proper allocation of resources and target services for the benefit of the community especially those residing in rural and remote areas in a vast country like Australia.

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.