Aim: To describe the existing usage of oral health care protocols and of oral health care routines carried out in New Zealand Rest Homes and Long Term Care (RH/LTC) facilities. Methods: A two-part structured questionnaire was sent to 425 randomly selected facilities. It recorded the number of residents, staff and location of the facilities. It then examined whether the facility had written Oral Health Care (OHC) policies, whether they were drafted with the assistance of a dental professional, and whether the staff had problems with adhering to the policies. Results: Written policies for oral care were in place in 139 facilities (35.9%). Of those with policies, 15.4% had had a dental professional assist in drafting it (5.5% overall). Only 14.0% of facilities had ever had a dental professional in to give a demonstration in oral care, and 90.2% of facilities felt that a demonstration in oral care would be beneficial. Most facility management teams were satisfied with the way in which they dealt with basic oral care for their residents, and the way in which they manage dental emergencies (72.6% and 77.9% respectively). Baseline oral examinations were a low priority for facilities; only one in nine reported providing them for residents on entry. Conclusions: Written oral health policies are not used extensively in New Zealand LTC facilities. The provision of baseline oral examinations to document the oral health of residents at admission is uncommon. The sector recognised a need for improvement, but they were generally satisfied with the level of care they were able to provide for residents, given existing economic and time constraints.
OBJECTIVE:The aim of this study was to explore changes in dentists' promotion and use of implants in New Zealand over the past 10 years.METHODS:A postal survey was conducted of a random sample of 807 New Zealand registered dentists, using a 23-item questionnaire adapted from one used in a similar survey in 2004.RESULTS:The participation rate was 54.3%. In the past 10 years, the percentage of dentists providing an implant service has increased from 49.4% to 68.0%, with an equal proportion of females now providing this service. Single missing teeth (56.9%) and trauma (51.5%) are the most common clinical situations in which implants are provided. Patient enquiries about implants have slightly increased. A need for continuing education, particularly in the area of implant prosthetic procedures, was noted by 76.5%. Despite more proprietary implant systems now being available, the most commonly used system has remained unchanged. Cost is still the primary barrier to implementing implant treatment.CONCLUSIONS:Although dental implant use in New Zealand has increased, it appears that a need exists for continuing education, particularly for implant prosthetic procedures. The perceived expense of treatment continues to hinder optimal utilisation.
© 2016 New Zealand Dental Association. All rights reserved. Background and objectives: Health services should be targeted toward those most in need of health care. Poor oral health disproportionately affects Māori, Pacific Island, and socioeconomically deprived New Zealanders of all ages, and oral health care services should be prioritised to such groups. In New Zealand, free oral health care is available for all children up to the age of 17. On the other hand, adult dental services are provided on a user-pays basis, except for a limited range of basic services for some adults, access to which varies regionally. This study investigated the extent of dental treatment inequalities among patients at New Zealand's only School of Dentistry. Methods: Data were audited for all treatments provided at the University of Otago Faculty of Dentistry from 2006 to 2011 for patients born prior to 1990. Ethnic and socioeconomic inequalities in the provision of dental extractions, endodontic treatment, crowns, and preventive care were investigated. Differences were expressed as the odds of having received one or more treatments of that type during the six-year period 2006 to 2011. Results: Data were analysed for 23,799 individuals, of whom 11,945 (50.2%) were female, 1,285 (5.4%) were Māori and 479 (2.0%) were Pacific, 4,040 (17.0%) were of low socioeconomic status (SES), and 2,681 (11.3%) were beneficiaries or unemployed. After controlling for SES, age, and sex, Māori had 1.8 times greater odds of having had a tooth extracted than NZ European patients, while Pacific Islanders had 2.1 times the odds. Furthermore, after controlling for ethnicity, age, and sex, low-SES patients had 2.4 times greater odds of having had a tooth extracted than high-SES patients, and beneficiaries had 2.9 times the odds. Conversely, these groups were less likely to have had a tooth treated with a crown or endodontics or receive preventive care. Conclusions: Existing policies call for the reduction of inequalities. There is a need for a strategy to monitor changes in treatment inequality over time which includes improving equity in service care provision. The observed treatment inequalities are likely to be an underestimate of those occurring in private dental practice in New Zealand.
BACKGROUND AND OBJECTIVES:Suicide rates among dentists and a perceived elevated risk for suicide have been debated in the academic literature. It has filtered into the public psyche that dentists have the highest suicide rate of any occupation. The present review seeks support for both protagonist and antagonist positions from multidisciplinary perspectives. Contemporary risk factors and strategies for intervention and the prevention of suicide in dentistry are explored.METHODS:An online database search for articles and reports, with selected target words, was conducted for peer reviewed publications on suicide in the dental profession, and for factors contributing to dentist suicide. Review guidelines from the American Psychological Association were used to clarify concepts, identify where most work was focussed, and to explore the superiority of any approach to the emotive topic over another.RESULTS:Findings suggest the dominant belief that dentists have an elevated risk of suicide may be historically, but not currently, accurate. Although dentists' suicide is trending down, diversity in methodology means no current consensus is possible. Factors found to be influencing dentists' suicide ranged from known occupational stressors, to toxins and substance abuse, and untreated mental health problems.CONCLUSION:The contemporary position in New Zealand shows dentists per sé are not more likely than other health professionals to commit suicide although they may have been in the past. Dentists should be aware of individual susceptibility to burnout and mental health problems. Future directions are outlined to address this including peer intervention, and programmes available for dentists to cope better with risks leading to suicide.
BACKGROUND AND OBJECTIVES:Sugar, a known aetiological factor in dental decay, has been used in paediatric medications as a bulking agent, preservative and to improve taste. Although artificial sweeteners have largely replaced sugar, some prescribed and over-the-counter (OTC) paediatric medications and supplements containing sugar are still available in New Zealand. Little is currently known about the knowledge, opinions and practices of staff in NZ pharmacies regarding sugar-containing paediatric medications. This study was carried out to investigate these factors.METHODS:After ethical approval was obtained, questionnaires were delivered to all staff members at pharmacies in the greater Dunedin area. Quantitative statistical analysis was carried out using SPSS version 22.0 with the alpha value set at 0.05. Qualitative data were analysed using a general inductive technique.RESULTS:A total of 58 questionnaires were returned giving a pharmacy response rate of 63.0%. Some 29.9% of respondents thought the inclusion of sugar in medications necessary and 77.6% agreed that sugar in paediatric medications can contribute to dental decay. Most of the 67.2% who reported that they do not give advice to customers regarding sugar in medications and oral health, felt it was not a priority. Parental request was the main factor determining provision or recommendations regarding sugar-free options (87.9%).CONCLUSION:Although choice of a sugar-free medication can be limited by many factors, inter-professional collaboration and knowledge sharing on this topic would be advantageous. In addition, the provision of more formalised education, either as part of undergraduate pharmacy curricula or as part of continuing education, should be considered.
BACKGROUND AND OBJECTIVES:It is expected that the graduating dental student will have acquired the skills and knowledge to confidently treat most circumstances that they may encounter in private practice. The aims of this study were to evaluate final year dental students' self-reported levels of confidence in expected core skills just prior to graduation and to explore their career intentions both directly after graduating as well as in the longer term.METHODS:After ethical approval was obtained, a survey and participant information sheet was distributed to all final year undergraduate dental students in 2014. Statistical analysis was carried out using SPSS version 22.0 with the alpha value set at 0.05.RESULTS:The response rate was 69% (58/84). Most (44.8%) were going to be working in New Zealand private practices with 34.5% definitely considering specializing. The majority reported high self-confidence levels for sealant restorations (96.6%) and radiography (94.8%), while very few were confident in carrying out soft tissue biopsies (1 .8%) or restoring dental implants and treating medical emergencies (10.5%). Some gender differences were found.CONCLUSIONS:The general finding was that most NZ graduates perceived themselves to be confident in managing the most fundamental aspects of general practice. Similar to their counterparts around the world, they will benefit from further mentoring and additional exposure to the more complex clinical tasks such as the restoration of implants and soft tissue biopsies.
BACKGROUND AND OBJECTIVES:Prior to the introduction of the Southern District Health Board's reconfigured Community Oral Health Service in Otago, a project was undertaken with parents to investigate their knowledge, understanding and views of the historical School Dental Service and of the Community Oral Health Service that was being introduced.METHODS:Focus groups were run during 2011 in ten selected schools (parents with children in years 1-8) across two areas in Otago to represent ur ban and rural settings and to represent parents who were already travelling to dental services.RESULTS:Parents valued the traditional School Dental Service in Otago highly, generally agreeing that the service based in schools was accessible and convenient for parents and children. Rural parents who had always taken their children to dental appointments viewed it as a normal process, accepting that there could not be a service located in every school. Parents were aware that facilities were out-of-date. They highlighted the challenges of locating therapists since they started moving from school to school in the later 1990s and felt it was difficult for children seeing different therapists at each recall. There were diverse views on the proposed new system. Some parents felt that school-aged children should go to dental clinics on their own or with peers, while other parents welcomed the opportunity to attend when their child was having health care.CONCLUSION:It appears that the Community Oral Health Services should have an ongoing process to seek the views of parents and children about the service.
A 55-year-old woman presented to Whangarei Base Hospital Emergency Department with a mandibular swelling adjacent to her unerupted tooth 48. She had never had dental radiographs taken, having had a dental clearance 20 years earlier. She wore full dentures. A panoramic dental radiograph revealed 44 unerupted teeth. Based on the clinical, oral and radiographic examinations a diagnosis of cleidocranial dysplasia (CCD) was confirmed. The patient had not been diagnosed with CCD prior to her hospital visit. Treatment included staged extractions of superficial mandibular supernumeraries and enucleation of the mandibular cyst, attempting to avoid pathological fracture. This would be followed by a six-month review and then annually as required. The case outlines the value of dental radiography in dental practice. Little is known about the prevalence of CCD in New Zealand and this is an area where future research could be conducted.
OBJECTIVE:To describe the knowledge and practices of New Zealand (NZ) General Dental Practitioners (GDPs) concerning the use of steroid prophylaxis.METHODS:An online survey was conducted in 2013 involving a sample of 500 NZ GDPs who met inclusion criteria and had email addresses on the Dental Council register.RESULTS:A total of 214 dentists responded, giving a 44.5% response rate after accounting for undelivered questionnaires. Nearly two-thirds (61 .7%) did not currently recommend corticosteroid prophylaxis, although nearly three-quarters (74.8%) believed that dental treatment posed a potential risk to patients with adrenal suppression. Over half (53.4%) believed that oral corticosteroids could cause adrenocortical suppression, and a similar proportion (58.3%) believed that a specific dose of oral prednisolone of 7.5 mg per day could do so. Most practitioners (79.6%) supported the formulation of steroid prophylaxis guidelines.CONCLUSION:Despite most NZ GDPs believing the dental setting to pose a risk of adrenal crisis for patients taking corticosteroids, there is some confusion among dentists identifying at-risk patients and their ability to manage if such an event was to occur in their practices. There is further confusion over whether steroid prophylaxis is warranted for perceived at-risk patients, and which regime to follow when it is. There is an associated tendency to be over-cautious when determining the need for steroid prophylaxis, and to rely on their undergraduate steroid prophylaxis guidelines when doing so. There is a need for evidence-based guidelines to be formulated by an expert panel.
BACKGROUND AND OBJECTIVES:Among other restorative strategies, the Accident Compensation Corporation (ACC) provides benefits for dental implant treatment to replace teeth lost as a result of trauma. While ACC has funded over 15,000 dental implants since 2002, the outcomes of this treatment and patient perceptions of this treatment have not been investigated. The aim of this study was to investigate the perceptions of the dental implant treatment outcomes and reasons for failure to complete restorative treatment in patients who had undergone trauma-related implant surgery funded by ACC between February 2006 and September 2009, but had not completed the prosthetic component of the treatment.METHODS:A randomly selected sample of 399 patients, who had undergone dental implant surgery but not completed the crown restoration, was identified from the ACC database. These individuals were contacted by mail for expressions of interest and 181 clients were interviewed by telephone. Responses to open-ended questions were entered into an Excel spreadsheet and analysed using a general inductive technique.RESULTS:A common emergent theme was the high level of satisfaction expressed by participants with the implant process, however just under half of those responding felt they had been pushed into having implants and were given the impression that this was the only treatment ACC paid for. The cost of the prosthetic phase of the treatment and surgical complications were identified as the primary reasons why participants failed to complete the restorative phase of treatment, after completing the surgical phase.CONCLUSIONS:The results highlighted the need to better inform patients of their treatment options and to allow time for them to process this information before progressing with care. A patient decision tool may help to give greater ownership of the treatment options. Newly implemented protocols to assist dentists to better assess treatment needs may also assist in achieving improvements in perceived treatment outcomes for patients.
BACKGROUND AND OBJECTIVES:During the First World War, 10% of New Zealand's population served in the armed forces, and around one in five of those were killed. In commemoration of 100 years since WW1, this study uses retrospective data to report on the oral health of NZ service personnel. METHODS:325 Pākehā, 165 Māori and 150 Samoan male recruits who served in the NZ Expeditionary Force between 1914 and 1918 were randomly selected and their personnel files accessed through Archives New Zealand. RESULTS:The oral health of recruits was described as 'good' for 44%, 'pass' for 38%, 'pass with false teeth' for 5% and 'poor' for 13%. Dental health was documented at enlistment for a decreasing proportion of soldiers as the war progressed, dropping from 96% during 1914-15, to 54% in 1916 and 22% in 1917-18 (p < 0.001). Significantly more soldiers who enlisted in 1917-18 had poor dental health (44%) than those who enlisted during 1916 (20%) and 1914-15 (8%) (p < 0.001). By ethnicity, Māori had the best dental health, followed by Samoan and Pākehā recruits (p < 0.001). On average, dental health was poorer among the lower ranks and among recruits of low socio-economic status; and soldiers from major cities had better oral health than those from rural areas; however, these differences were not statistically significant in this sample. CONCLUSIONS:Enlistment criteria appear to have been loosened as the war progressed, perhaps to accept more soldiers into service. Poor oral health was reported for approximately 1 in 7 accepted recruits. Māori appear to have had better oral health.
BACKGROUND:A 71-year-old female presented with a left submandibular space abscess. This was found to be due to large accumulations of calculus on the lingual flanges of her lower denture ulcerating the floor of the mouth. She had not taken the prosthesis out since it was provided as an immediate denture after extractions 54 years previously. At presentation she could not take her denture out as the calculus locked the denture under lingual undercuts. The denture was sectioned in the midline to remove it and the submandibular abscess was drained via a neck incision.FINDINGS:Prior to removal the denture was remarkably stable and she had enjoyed a long period of problem free denture wearing and had had exceptional value from it. There was also surprisingly little mandibular alveolar bone resorption.CONCLUSION:The case demonstrates what may happen if a lower denture is not taken out for over half a century. The calculus on the lingual flanges provided both stability and retention for the denture, and it appeared to have protected the ridge from resorption. While the calculus may have provided some surprising benefits to her lower denture it ultimately led to a serious infection.
