The implications and management of acute odontogenic infection in association with Down and Eisenmenger syndromes and schizophrenia in a rural setting.

BACKGROUND: This report describes the case management of a 32 year old special needs patient with life-threatening odontogenic infection. The combination of schizophrenia, Down and Eisenmenger syndromes presented significant challenges to managing his oral health, particularly within the rural context. In this case, dental treatment was limited to a full dental clearance during a high risk general anaesthesia session. METHOD: A comprehensive work-up prior to general anaesthesia was an essential aspect of care. This included a full medical history and examination, communication between medical specialists, the dentist and family consultation. The anaesthetic procedure was undertaken using a careful regimen of drugs and monitoring to minimize the impact on his cardiovascular system. Techniques to minimize bleeding from extraction sites were also important. RESULTS: Three weeks postsurgically the patient was reviewed and his family reported that he was interacting positively with them after years of surliness and conflict. This was attributed to a managed psychotropic medication regimen and improved dental condition, which has led to a sustained improvement in quality of life. CONCLUSIONS: The management of acute odontogenic infection for special needs patients in the rural setting requires a local interdisciplinary team approach, careful consideration of related pathophysiology and its potential impact on general anaesthesia, and close consultation with family and carers.

Developing primary health clinical teams for public oral health services in Tasmania.

This paper reviews the problem of socio-economic health inequalities and highlights the relevance of these issues for the delivery of public oral health services in the Australian island State of Tasmania. It contends that unless there is reform of existing public oral health systems, inequities in oral health care linked to socio-economic factors and geographic location will remain. The challenge is, firstly, to understand the current situation and why it has occurred. Secondly, we need to ensure that this understanding is shared across educational and professional sectors for the development of innovative approaches to the problem. Thirdly, we must carry out preliminary research and evaluation for any reforms. Using a combination of approaches, i.e., primary health care, a 'common risk' approach and increasing workforce numbers has been identified as a method showing the most potential to improve access to equitable oral health care. An outline of a current research project evaluating the impact of the integration of primary oral health care clinical teams into public oral health services is provided. The clinical teams combine the skills of the dentist and an expanded role for dual trained dental therapists/dental hygienists. The teams focus on the development of innovative clinical practice in the management and prevention of common oral diseases that take into account the broader determinants of oral health inequality. This project will be conducted in Tasmania, where the dominance of small rural and remote communities, adverse socio-economic factors and shortage of oral health professionals are key issues to consider in planning public oral health services and programmes. The results of the evaluation of the Tasmanian pilot model will contribute to the evidence base that will support the introduction of new approaches to public oral health care.