Dentistry for patients with haemophilia: Trialling a safe and economical change in management.

INTRODUCTION: While the dental management of patients with haemophilia has changed considerably in the last decade, haemophiliacs in Western Australia have continued to receive pre-operative factor support for dentistry regardless of the type of dental procedure. AIM: To review the efficacy and safety of established dental protocols that reduce factor use in the dental management of patients with haemophilia and to estimate cost savings. METHODS: Records of 11 patients with haemophilia that were seen in the pilot programme period were reviewed. These were cross-referenced with previous dental and haematology notes that stated the amount and type of pre-operative factor used. Cost savings were estimated using the Australian National Blood Authority's Product List. RESULTS: All study participants were male, and included those with haemophilia A (n = 9), and B (n = 2). Mean age was 45 years (range 22-80). A variety of dental treatments were undertaken, and no pre-operative factor was used. Patients on prophylaxis (n = 6) received dental treatment the same day as their regular factor administration. It was estimated AUD$26,314 was saved by not using pre-operative factor. One patient had bleeding post-extraction and was seen the following day to achieve haemostasis using local measures. The remaining patients had no complaints of post-operative bleeding, and did not require any further haemostatic measures. CONCLUSION: This pilot programme supports data that haemophiliacs can safely receive a variety of dental treatments without the need for pre-operative factor, and the significant cost savings of doing so. Further data is required to support this protocol for invasive dental procedures.

Distribution of Australian dental practices in relation to the ageing population.

OBJECTIVE: The purpose of this study was to analyse and map the distribution of the ageing population, by sociodemographic profiling, in private and public dental practices in Australia. BACKGROUND: The rapid increase in the aged population in Australia requires a comprehensive approach to ensure accessibility to geriatric dental services. However, the availability of dental services for the older people requires further investigation of the demographic distribution of need. MATERIALS AND METHODS: Dental practices were located and mapped against the ageing population data. The address for each dental practice in Australia was compiled from online access sources. Australian socioeconomic data were integrated with dental practices, clinic locations and older populations using Geographic Information System (GIS) technology. RESULTS: There was an uneven distribution of dental practices across Australia's States and Territories (NT and ACT). Tasmania had the highest ratio of private practices to the older population (1:1000) and the highest percentages of this ageing cohort (32%, 61%) that lived more than 5 km from private and public dental practices respectively. Higher percentages of dental practices were located in areas of lower socioeconomic status in Tasmania, Queensland and South Australia (47%, 42% and 38%) respectively, however, these areas were associated with higher ageing population densities. CONCLUSION: There is a geographic maldistribution of dental practices in relation to the spatial distribution of Australia's older population, with the inequity most pronounced in the most disadvantaged areas. This inequality requires a National approach to match dental services to the population that they serve.

A comparison of Demirjian's four dental development methods for forensic age assessment.

The aim of this study was to determine the comparative accuracy of Demirjian's four dental development methods for forensic age estimation in the Western Australian population. A sample comprising 143 individuals aged 4.6 to 14.5 years were assessed using Demirjian's four methods for dental development (original 7-tooth: M(2), M(1), PM(2), PM(1), C, I(2), and I(1); revised 7-tooth: M(2), M(1), PM(2), PM(1), C, I(2), and I(1); 4-tooth: M(2), M(1), PM(2), and PM(1); and an alternate 4-tooth: M(2), PM(2), PM(1), and I(1)). When comparing all four methods, the 4-tooth method overestimated age in both males and females by 0.04 and 0.25 years, respectively. The original 7-tooth was least accurate for males, while the original 7-tooth, the revised 7-tooth, and the alternate 4-tooth were unsuitable for females. Therefore, we recommend the 4-tooth method to be used for forensic age estimation in Western Australian males and females, as it has the lowest overall mean deviation and the highest accuracy.