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The Dental Prosthetist and their Future Role in Oral Health P3

Putting that all together where does that get us? Well I’m going to give you some good news  this afternoon but so at    the news has all been couched in guarded terms. So tot this point we’ve found out that the situation of the patients medically is becoming more complex. We we i narrow down and look at their dentition that’s becoming more complex because of the burden off past treatment. The soft tissues are becoming more difficult and again Gary and Michael will return to tack with you some more about the soft tissue problems in these patients. Then we have the underline changes that are happening and some of the are much linked to the patients’ medical therapy and that’s   why i touched on the topic of bisphostinex with you.

If you then turn that into what doe that means in terms of problems with providing removable partial dentures of these patients and you can generate pretty quickly this sort of list. well there is a smelly area, there’s less muscle  to control , there’s less muscle  for coordination , there’s less healing capacity , the patties  don’t adapt to change so  well .All the things that we are seeing in this  patient group that are making them so ever so much becoming just  little built to trickier to treat as time comes on . I won’t preach to the converted  but i’ sure you’ve all got your answer to mental  algorithms for how you approach patients in elms of their  ad ability to change  and wither  you use a copy technique or whether  you don’t  and where the patient  needs some work up  in term so pre prosthetic surgical or other  procedures as well . Today we need to have some discussion about algorithms because h the patients is becoming more complex. I think most of you would have certainly seen that  trend if you look back  and think about what  you were  doing 5 years ago or  10 years ago and you project that forward  in other 5 or 10 years i think you will see that trend  emerging .

Gary will talk about this more with you tomorrow but as patients age we’ve got more desorption. We’re not going to see so many parliament with beautifully full bridges. In fact we have  deckle  this eon finding these  so called ideal cases for our students to treat  oddity  and make relatively  straight forward  full over full dentures  folds. We actually tend to dose patients who are more complexes who got flabby ridges and very shallow and mobile tissue which all of which makes it difficult to treat. Gary will take you through tomorrow in some of the aeayys you can actually systematically work through examining this patients but it is fair to say as people live longer we are seeing   the cumulative effect of absorption over many, many years and that’s why the move towards implants stabilise prosthesis is becoming so much stronger across the profession at alarm. If you sort of take a  very tradition text book approach and you  drag a classification like those very  long range  from the American Academy of Prosthetics and you start to tick off boxes  of complexity and you start to see patients who got these highly mobile tissues particular in the  mandible and very  , very  shallow silica then you realise what we are actually trying to construct  something on a moving base . It’s like trying to land a fighter aircraft on the deck of an aircraft cart in the middle of a Gail at sea.

It’s actually becoming more difficult to treat such patients and for that reason the move towards implant stabilization with to fixtures or to even go some way toward support, those things are becoming much more common place. In the US , a survey which was  done only a coupled  of weeks ago indicated that one in eight practises was doing  this kind of dentistry  for their patients now as a matter of  routine using  to start to stabilise  these increasingly difficulty lower denture cases. i you think about l projecting that in terms  of workforce if you look at the workforce of  dental;  specialist in Australia  this is one  figures from  work force [Inaudible] involved with us a couple  of years ago , in Australia about  10% of the dentist are specialist which is about  a half  of the proportioned the US  and the prostendotis presents about 12.4% of the specialist . You can see the orthodontist there in large number and you probably all be hereof that if you had children who o required orthodontist. Recently there is certainly no shortage on orthodontist at the moment but when you look at prostidontist that number is actually small when you think about the projected needs of the population. So don’t imagine for a moment that every patient who needs an implant to stabilise a denture is going to end up landing in the lap of specialty care because the number of specialist is actually fairly low in Australia in real terms.

What we do know is that patients do tend to expect more and they certainly have gotten much attuned to aesthetic and cosmetic requirements in denturist. Not  only for removal of prosthesis  but also for  fixed  prosthetics  and merchandise and  orthodontia and every  other thing that you can think of in the  gambit of cosmetic  dens try  today . This has prompted guess a much greater demand for   dentures that are much more realistic and life like looking. So as well as people becoming more complexed they are also becoming become in a little but it more demanding and a bit more discerning.  I think you would have noticed that trend as well in your practise and that’s why it’s every good to see people talking about techniques that can improve the final quality of the procedures that is provided to the patients…

Let’s sort of think about the things that  drive decentralism .So let’s sort of look at the things that drive tooth loss and look at actual head count of actual people with missing teeth and from  that hen  project the need  for  denture into the future. I guess this is the leading up to the big finale part of the presentation which is   really to say is the current workforce really going to meet the demand for the future? Let’s sort of lay down some of the facts and furfures to   support and argument with you.

If you think about what the federal  government expects , the  federal government expects , this is for the national aural health plain that the number of adults  who have lost all their teeth will  be reduced and the target should be down by 2010 , more clearly we’ve gone a  bit past 2010 but that  intention will certainly carry word  into the future. That’s an expectation of the federal government. If you they look at how does the profession as a  whole measure up  against that   and you take the Australia’s  dental generation as  good set of  data  on which to make a  prediction you find that we’re to doing as well  in terms OECD comparisons persons with tooth loss and carries in particular where  we actually doing quite  badly. In terms of children we are doing morbidly well although not as well as we certainly could. We’re actually not doing come basic things very well either.  A couple of weeks ago i have a radio interview on the ABC about this exact problem .Twice daily tooth brushing, the actual ABC interview was bout children but this is the figures for adult Australian. So the proportion who brush twice per day as you can see floats between 40 % and 60 % that’s not very good. When we did the large survey in South East Queensland that number was 95%. So it’s actually dropped. I think that’s alarming because that’s if one of the bench mark indication of people’s interests in preventative dentistry that would have me quit e worried. Some other unpleasant home truths for you. While we kowtow have across moist parts of Australia and now with Queensland finally having got community fluoridation in many parts of it there’s been a belief in the community that somehow dental carries will disappear overnight and that certainly not true for a whole range of reason. We have sub groups in Australia which show 1950s- 1960 very, very high prevalence in sever dental caries and those groups are not going away.

One of our University research cents is actually based in the highest carries community in an all of Australia by post code and there we have thousands of people on GA waiting list for full clearances. It’s just spectacular bad. So Carries has to gone away and it won’t go away but with all the people retaining more teeth we have more risk sides. Particularly for root surface carries and some research that we do did show that for every clinical region that spotted a root surface carries there is a mother legion which will only be found on a berth wing radio graph. So it’s a lot of missed root carries around in Australia as well.

We see a lot of sever carries in young adult and as often the belief in the community only older people need dentures while this young lady over here is only 22 and as you can see she is going to have immediate dentures made and you can see the final results which we archived for her. We see large numbers of these patients they are not going away. The high risk tale of the community are not people who are going to be large of fluoridated  water or attending for lot of dental care. We have some very deep pockets of disease in all parts of the Australian community to day.  we have a lit more teeth retained so  we have a lot  more  root surface  carries and that has implications for denture design because if patients aren’t very festive about how they clan these denture they are  going to be reinserting that plaque biofilm  back against that oopt surface and  continuing on a very long slow process. We know from all ears that root surface carries in austral is airs in increasing in real terms quite a bit and has been doing so for the last decade.

If we think about the mouths that are being treated today those mouths carry the burden of a lot of treatment. For the people who are adults today who behave heavily filled teeth , they have cuss that are breaking , they have crowns that are  getting recurrent decay , they have roots that re  braking . We know all these things so there is still a lot of the burden of that disease yet to be experessinged in terms of tooth loses today.

Just though it would show you a couple example of patents with heavily restored dentition and over dentures who are going downhill every quickly. This chip over here has got some nicely restored top teeth and pretty woeful perrodnitis conditions and all over denture that is in some pretty significant strife. He’s in his nineties but the s guy his 14 years old and he’s joint an over dentate and his supporting teeth are not doing very well wither. Smoking 9 bongs of marijuana per day probably has something to do with that. I would do suggest to you if you ever seen a patient who has that much marijuana then you will certainly see a dry mouth. This is a perfect example i can actually show you.

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