A comparison of two models of dental care for Aboriginal communities in New South Wales.

BACKGROUND: Aboriginal people, and particularly those in rural areas, continue to suffer very high levels of dental disease despite significant reductions in the wider Australian population in the past 30 years. Until recently, there has been a shortage of oral health clinicians and the majority have provided care in major cities. The NSW Government funded various models of care for rural and regional areas and vulnerable population groups including Aboriginal people. This study utilizes a comparative retrospective analysis to compare two models of oral health care for Aboriginal people including those living in rural NSW to inform future policy decisions. METHODS: Two models (Model A - Fly in Fly out and Model B - Collective impact) of public oral health care for Aboriginal patients in NSW were examined using publicly available descriptive information. Two years of funding and Dental Weighted Activity Units (DWAUs) data were analysed for the two different models and regression analysis was used to compare the trends of monthly time series of DWAUs. CONCLUSIONS: Based on the standardized national weighted pricing for public dentistry, model B offers significantly more services for less financial resources.

Clinical performance of reinforced glass ionomer restorations placed in UK dental practices.

AIM: To retrospectively evaluate the performance of reinforced glass ionomer restorations placed in load-bearing surfaces of posterior teeth in three UK general dental practices. METHODS: Inclusion criteria for the participating practitioners were that they would be able to find, in their regularly attending patients' mouths, a minimum of 30 Fuji IX restorations placed in load-bearing cavities in posterior teeth. The three practitioners who agreed to participate were given training in the methods of assessment of restorations. Presence/absence of the restoration, presence of secondary caries, anatomic form, margin adaptation, margin discolouration, surface roughness and colour match were recorded. RESULTS: Three general dental practitioners and 169 restorations in 116 patients were included in the study. Seventy-eight percent of restorations were placed in molar teeth, the remainder in premolar teeth, with 67 being Class I and 102 Class II. The mean age of restorations at examination was 25 months, ranging from five months to 56 months. Of the restorations examined, 98% (n = 166) were found to be present and intact. No secondary caries was detected clinically. Three restorations were found to have fractured. CONCLUSION: Reinforced glass ionomer restorations placed in load-bearing situations in patients attending three dental practices in the UK were found to be performing satisfactorily at two years. Further investigations, of improved rigour, may now be indicated to more fully assess the performance of such restorations in the long term.

Prenatal diagnosis of apparently isolated unilateral multicystic kidney: implications for counselling and management.

Cases where initial prenatal diagnosis was made of isolated unilateral multicystic kidney (UMCK) were reviewed to determine appropriate counselling and management strategies. For the 73 cases, chromosome abnormalities, pregnancy complications and family histories were reviewed. In addition, subsequently diagnosed birth defects, and pediatric medical and surgical outcomes were available for 54 cases. Of those with outcome information available renal/genital-urinary tract abnormalities were diagnosed subsequently in 33% and non-renal abnormalities in 16% of cases. Of the non-renal abnormalities, congenital heart defects were most frequent (7%). One chromosome abnormality, a trisomy 21, was present among 32 cases where karyotypes were known (3%). Amniotic fluid volume abnormalities were present in 11 cases but not predictive of associated anomalies, with the exception of one case where polyhydramnios accompanied multiple malformations consistent with VATER association. A family history of structural renal anomalies was reported in 11 cases (20%). There were 14 cases of partial or complete involution (25%), including two cases of complete prenatal involution of the cystic kidneys. No long-term associated morbidity such as hypertension or malignancy was present in our cohort. Based on our study and corroborating literature, amniocentesis should be offered to women when a seemingly isolated UMCK is detected on routine prenatal ultrasound. Furthermore, a detailed ultrasound with careful assessment of the fetal heart and contralateral kidney is indicated at diagnosis and during the third trimester to assess for further evidence of structural abnormalities, as well as amniotic fluid volume abnormalities. Careful assessment of the newborn is indicated with appropriate speciality referral as required.

An assessment of the use of intravesical potassium in the diagnosis of interstitial cystitis.

PURPOSE: We evaluated the use of intravesical potassium in the diagnosis of interstitial cystitis. MATERIALS AND METHODS: A blinded test assessment on 39 consecutive subjects attending our urology clinic for the evaluation of symptoms consistent with interstitial cystitis was performed. The pain response to intravesical potassium and water as a control was measured. The response rate was compared to the results of cystoscopy using standard outcome measures associated with diagnostic test assessment. RESULTS: The probability of having interstitial cystitis given a positive intravesical potassium test was 66%. This finding added no new useful information and would not be helpful with clinical decisions as the probability of having interstitial cystitis in this population was already 56% before the test. Similarly, if the test was negative then 46% or nearly half of the subjects were still likely to have interstitial cystitis. Therefore, a negative test would have no ability to rule out disease nor would it be useful in making clinical decisions about how to proceed with evaluation or therapy. Test characteristics were considered poor with a sensitivity of 69.5% and a specificity of 50%. Likelihood ratios (positive 1.39, negative 0.61) also indicated poor inclusion and exclusion capabilities. CONCLUSIONS: The general use of intravesical potassium as a diagnostic test for interstitial cystitis is not validated. The diagnosis of interstitial cystitis must depend on the clinical presentation and endoscopic findings based on National Institutes of Health criteria.