The role of a bus network in access to primary health care in Metropolitan Auckland, New Zealand.

UNLABELLED: Background: This study examined the spatial accessibility of the population of metropolitan Auckland, New Zealand to the bus network, to connect them to primary health providers, in this case doctors (GP) and dentists. Analysis of accessibility by ethnic identity and socio-economic status were also carried out, because of existing health inequalities along these dimensions. The underlying hypothesis was that most people would live within easy reach of primary health providers, or easy bus transport to such providers. METHODS: An integrated geographic model of bus transport routes and stops, with population and primary health providers (medical. and dental practices) was developed and analysed. RESULTS: Although the network of buses in metropolitan Auckland is substantial and robust it was evident that many people live more than 150 metres from a stop. CONCLUSION: Improving the access to bus stops, particularly in areas of high primary health care need (doctors and dentists), would certainly be an opportunity to enhance spatial access in a growing metropolitan area.

Predicting geographically distributed adult dental decay in the greater Auckland region of New Zealand.

OBJECTIVE: To model the geographic distribution of current (and treated) dental decay on a high-resolution geographic basis for the Auckland region of New Zealand. BASIC RESEARCH DESIGN: The application of matrix-based mathematics to modelling adult dental disease-based on known population risk profiles to provide a detailed map of the dental caries distribution for the greater Auckland region. RESULTS: Of the 29 million teeth in adults in the region some 1.2 million (4%) are suffering decay whilst 7.2 million (25%) have previously suffered decay and are now restored. CONCLUSIONS: The model provides a high-resolution picture of where the disease burden lies geographically and presents to health planners a method for developing future service plans.

High acuity GIS comparison of dentist and doctor surgery locations in Auckland, New Zealand.

OBJECTIVES: New Zealanders are one of the healthiest populations in the world, but significant inequalities in health and oral health remain. New Zealand suffers a possible shortage of medical and dental practitioners and an agreed mal-distribution of both. This study examines the distribution of dental and medical practices in New Zealand's largest city Auckland, using modem Geographic Information System tools. The aim of the study is to determine if medical and dental practices are similarly distributed across the city. DESIGN AND METHODS: The address for each dental and medical practice in Auckland was obtained and mapped over the census population data. A total of 442 medical and 256 dental practices were geo-coded in the study area. These practices overlaid the Auckland region, with a total population of 0.8 million, and an adult population (>9 years old) of 0.69 million. Auckland city was deemed, for this study, to be a region included in a 15km radius circle from a central reference point that was the General Post Office (GPO). RESULTS: The medical practice to total population ratio ranged from 1:1,500 for people 121/2-15km from the GPO, to 1:1,200 for those within 21/2km. Dental practice to population ratio ranged from 1:2,700 for people living 121/2-15km from the GPO to 1:1,300 for those within 21/2km. Medical practices were relatively evenly distributed, regardless of distance from the GPO, but the fairly dense distribution of dental practices in the city's inner 21/2km circle rapidly decreased in density as distance from the GPO increased. CONCLUSION: These results refute the hypothesis of this study in that there is a similar distribution of primary health practices (medical and dental) across the Auckland region.

Informed consent for people with diminished capacity to consent.

This paper discusses the rights and responsibilities of patients and providers in New Zealand when a patient has diminished capacity to understand and provide consent for dental care. The Code of Health and Disability Services Consumers' Rights 1996, the Protection of Personal and Property Rights Act 1988, and the New Zealand Bill of Rights Act 1990 all affect decisions that relate to the provision of dental care for patients with diminished capacity to consent. A person's capacity to understand medical or dental procedures will vary with differing procedures and may vary at different points in time. Capacity to consent must be assessed by the dentist responsible for the proposed dental care in the first instance. Welfare guardians and power of attorney may exist for some patients with diminished capacity to consent, but the documentation of appointment to those roles should be read by the dentist to verify the extent of the appointment. When a patient is not competent to make an informed choice and give informed consent, treatment providers may provide care under Right 7.4 of the Code of Health and Disability Services Consumers' Rights 1996 if the appropriate provisions within the Code are satisfied.

Dental care for children under general anaesthesia by private dental practitioners in New Zealand.

An overall reduction of approximately one-third in the availability of private dental care under general anaesthesia in New Zealand has occurred in the past 5 years. Private dentists providing dental care under general anaesthesia are disproportionately located in Auckland. Specialist anaesthetists or general medical practitioners are used to provide almost all the general anaesthetics; approximately half the dentists providing this service continue to use their dental surgeries for the procedure. Private dentists provide approximately one-third of the dental care under general anaesthesia for children each month in New Zealand, but utilise a greater number of sessions per month than the public-sector hospitals. Fees associated with dental care under general anaesthesia for children provided by private dentists are predominantly privately funded. Barriers to dental care for children provided by private dentists are primarily cost, difficulties for the dentists and anaesthetists to fit a general anaesthetic session into the practising day, and difficulties providing care for children under 3 years of age and for those with medical problems and disabilities.

Dental management of people with renal disease and renal transplants.

Chronic renal failure is the result of progressive loss of functioning nephrons leading to loss of renal function and accumulation of excretory products. Loss of the regulatory and excretory functions of the kidneys causes oral manifestations and multiple complications which have implications for dental care. Dental management of patients with renal failure and renal transplants involves consideration of specific haematological and cardiovascular effects, and implications for the prescribing and use of pharmaceuticals. It also requires the dentist to appreciate the potential for involvement of multiple organ systems in the disease process and the implications this has for dental care. The orofacial manifestations of chronic renal failure are secondary to systemic manifestations and are not specific to the diagnosis of end-stage renal disease.

Dental disease levels and reasons for emergency clinic attendance in patients seeking relief of pain in Auckland.

This study examined the reasons for attendance, duration of the problem, treatment expectations and oral health of patients seeking relief of pain at Auckland hospital dental departments and a private accident and emergency clinic. One-third of hospital-clinic participants and 15 percent of private-clinic participants had delayed treatment for more than 1 month. Sixty-three percent of hospital-clinic and 30 percent of private-clinic participants expected to receive an extraction. The hospital-clinic group had a mean of 5.0 (SD 3.9) decayed teeth, and the private clinic group a mean of 2.3 (SD 2.8) decayed teeth. Periodontal treatment needs were also significantly higher among participants attending the hospital clinics. Twenty-five percent of hospital-clinic participants had complex periodontal treatment needs. Further research is required to estimate the size of the population these groups represent and to investigate the reasons for these differences.

The oral health of long-term residents of a hospital for the intellectually handicapped and psychiatrically ill.

The oral health of 207 intellectually handicapped and psychiatrically ill people resident in a long-term hospital was examined. Almost three-quarters of the population were mentally retarded, a similar proportion had secondary medical problems in addition to their main reason for admission, and almost all were taking at least one medication. Half of the population was edentulous and one-quarter of the edentulous wore a denture or were considered capable of wearing a denture. The dentate population had a mean of 22.8 (SD, 7.6) teeth, but their condition was poor with a mean of 3.2 (SD, 4.4) decayed teeth. There were fewer filled teeth than in the national population of similar age, and more teeth were decayed and missing. Although root caries was not a significant problem, oral hygiene and periodontal disease were--83.5 percent of subjects required scaling and cleaning and 17.7 percent complex periodontal therapy. Two-thirds of the population were amenable to treatment in the dental surgery, and one-third required a general anaesthetic for most dental treatment. A greater proportion of people who were mentally retarded or had Down's Syndrome required special facilities or an escort nurse to facilitate dental treatment than those who were psychiatrically ill. The findings have implications for those seeking to provide care for these groups of people living in the community.

Changing patterns of dental disease and the implications for dental practice.

Changing disease patterns is one of the effects on dental practice. Although the amount of simple treatment is declining, the amount of complex treatment required is increasing. Important social changes influencing dental practice include the gross inequalities in oral health that are seen in New Zealand. Regional health authorities are the bodies which will have to assess the need for treatment and allocate funding, but private practitioners will have the opportunity to enter into contracts with purchasing bodies to provide care. In comparison with other countries, the number of dentists in New Zealand is correct provided fluoridation and the School Dental Service continue.

Dens in dente associated with infective endocarditis.

This article describes an 11-year-old patient in whom infective endocarditis developed after the occurrence of a dental abscess associated with a dens in dente affecting the maxillary left lateral incisor. Dens in dente has not been reported in the literature previously as a source of infection associated with infective endocarditis. A prolonged period of hospitalization was required to control the infective endocarditis, which was caused by a strain of nutritionally deficient streptococci.

An unusual case of hemifacial atrophy.

A case of hemifacial atrophy in a 10-year-old boy is described. The presentation in this patient is unusual because the lesion is extremely localized, and the abnormalities of teeth in the affected region are more severe than previously recorded. Alternative diagnoses are considered, and the results of a computed tomographic scan with three-dimensional reformatting are presented.

Determination of vertical dimension by hydraulic intraoral jack.

This paper describes the application of a hydraulic intraoral jig to the establishment of the vertical dimension of occlusion for full denture construction. The device enables the patient to establish an occlusal height which is most comfortable without the intervention or guidance of the dentist. Six patients for whom new dentures were to be constructed in the University of Otago School of Dentistry were invited to participate in the study. A conventional technique of denture construction was employed, but an additional stage was introduced after the jaw records had been taken and the casts mounted. Each patient was instructed in the use of the hydraulic jig and was asked to find a comfortable bite height in his own time. The results were compared with occlusal heights determined by conventional subjective methods. The former results proved to be more repeatable than those utilizing rest position and an average free-way space. The results are discussed and the implications outlined. Suggestions for further research using the hydraulic jig are made and the authors conclude that the hydraulic jig may be used to determine vertical dimension for full denture construction.