Specialist Networks Influence Clinician Willingness to Treat Individuals with Special Needs.

BACKGROUND: The South Australian Dental Service's Special Needs Network was established to support oral health professionals working within their statewide government-funded dental service to treat patients with special needs. This study aimed to investigate how a structured network relationship with specialists in special needs dentistry influenced the willingness of dentists to treat this group of patients. METHODS: Semi-structured interviews were used to explore the views of specialists and dentists involved in the South Australian Dental Service's Special Needs Network. Inductive thematic analysis identified emerging themes enabling completion of a SWOT (strengths, weaknesses, opportunities, threats) analysis. RESULTS: Dentists felt that a strength of the Network was a greater sense of collegiality, particularly for those working in rural areas. Although the inability to get immediate advice was seen as a weakness, dentists felt a more structured relationship with specialists improved communication pathways and resulted in more timely care. The aging workforce, systemic barriers in the public dental system, such as productivity pressures and infrastructure, and the lack of support from other health professionals were seen as ongoing barriers and threats. Regardless, dentists identified the use of telehealth and visiting specialists as future opportunities. Specialists felt that the Network was a valuable resource but were skeptical about its effectiveness, feeling that a limitation was the ability of dentists to recognize the complexity of cases. CONCLUSIONS: Ongoing support from and communication with specialists in special needs dentistry through a structured network improved the perceived ability and willingness of dentists to treat patients with special needs. KNOWLEDGE TRANSFER STATEMENT: This research suggests that providing support to dentists through a hub-and-spoke network that facilitates additional training, professional interaction, and improved communication with specialists in special needs dentistry may help overcome some of the current barriers to access to care experienced by individuals with special needs, particularly those associated with the willingness and capability of clinicians treat them.

Oral conditions and their social impact among HIV dental patients, 18 years on.

BACKGROUND: A study undertaken in 1992-1993 identified that HIV-infected dental patients were substantially disadvantaged with regard to the social impact of their oral disease. The oral pain experienced by HIV-positive patients prior to the introduction of combination antiretroviral therapy (cART) was attributable to specific features of HIV-related periodontal disease and other oral manifestations of HIV such as candida infections and xerostomia. A repeat of this study in 2009-2010 provided additional information in the post-cART era. METHODS: Data were collected from three sources: the 2009-2010 HIV-positive sample, the National Survey of Adult Oral Health (NSAOH) and the original 1992-1993 study. Collation of data was by clinical and radiographic oral examination. Information about the social impact of oral conditions was obtained from the Oral Health Impact Profile. RESULTS: The caries experience of the 2009-2010 HIV-positive sample was improved with statistical significance for both mean DMFT and mean DT, while the presence of HIV-related periodontal disease still occurs. Statistically significant improvements were achieved for prevalence and severity of oral health related quality of life. CONCLUSIONS: The need for timely access to oral health care with a focus on prevention is essential for HIV-positive individuals whose health is impacted by chronic disease, smoking and salivary hypofunction.

Oral health in Australian HIV patients since the advent of combination antiretroviral therapy.

BACKGROUND: The introduction of combination antiretroviral therapy (cART) for the treatment of human immunodeficiency virus (HIV) has resulted in changes to the oral health of infected individuals. Little data are available describing prevalence and severity of oral manifestations in a post cART cohort of HIV positive patients. METHODS: A retrospective case note analysis was performed at the Special Needs Unit (SNU), Adelaide Dental Hospital with emphasis on identifying the prevalence of HIV related oral manifestations (OM). A total of 498 (474 males: 24 females) HIV positive individuals were identified who had attended SNU for dental care between 2001 and 2008. RESULTS: There were significant differences observed in the prevalence of oral manifestations between cART and non-cART groups, and also in comparison to a previous pilot study. Individuals taking cART therapy tended to present with more evidence of linear gingival erythema, angular cheilitis, human papilloma virus associated squamous papillomas and xerostomia. CONCLUSIONS: The widespread adoption of cART in the treatment of HIV has altered the oral health profile of these individuals. These findings provide information on the incidence of oral conditions and demonstrate the need to identify and address oral health needs for people living with HIV.

Consensus statement by hospital based dentists providing dental treatment for patients with inherited bleeding disorders.

Avoidance of dental care and neglect of oral health may occur in patients with inherited bleeding disorders because of concerns about perioperative and postoperative bleeding, but this is likely to result in the need for crisis care, and more complex and high-risk procedures. Most routine dental care in this special needs group can be safely managed in the general dental setting following consultation with the patient's haematologist and adherence to simple protocols. Many of the current protocols for dental treatment of patients with inherited bleeding disorders were devised many years ago and now need revision. There is increasing evidence that the amount of factor cover previously recommended for dental procedures can now be safely reduced or may no longer be required in many cases. There is still a need for close cooperation and discussion between the patient's haematologist and dental surgeon before any invasive treatment is performed. A group of hospital based dentists from centres where patients with inherited bleeding disorders are treated met and, after discussions, a management protocol for dental treatment was formulated.