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The Dental Prosthetist and their Future Role in Oral Health

Speaker 1: without any further  ado it gives me  great pleasure to again introduce another queens lander, Laurie Walsh or  Professor  , Lawrence  Walsh of the University of Queensland .  Laurie Walsh is a specialist in social needs dentistry. He is professor of dental society at the University of Queensland where he has been the head off the dental school of dentistry since 2004. His research interest are in preventative density, clinical microbiology and advanced dental technologies. Lawrence maintains a part time specialist practise in Bruce man he also serves as a dental advisor to the DVA and the churn of the ADA and infection control committee. It gives me great pleasure jot introduce to you professor Lawrence Walsh [applause]

LW: Thanks very much and good afternoon ladies and gentlemen. Welcome to this afternoon’s session. In honour of the spectacular weather I’m doing something that i normally do which is I’m not wearing a tie. Those who see me lecture before will know what a big change in personality that would probably cause. What I’m going to do this afternoon is take you on bit of a journey on the future? I’m not a futurist, I’m not going to throw crazy ideas at you. I’m going to share with you information and a fair bit of hard data. That data only became available publicly one week ago. So chances are you haven’t seen it but it has a lot of bearing on the profession for dental prosthetics. In fact on the whole of the dental profession industrial so i do   want to share that with you.

I am  happy to give  anyone who wants it a pdf copy of the PowerPoint because  if you want to come back and look at some  of the figures that  i will skip over a little bit  this afternoon then certainly contact me and i will have my  email on the last slide of today . Don’t feel like you have to scribble a lot of things down, I’m happy to provide the presentation to the association who can use it as they see fit.

A little bit of a road map of what i plan to talk to you this afternoon abbot out. I’m going to say a few things on demographics   and reinforce a few things I’m sure  you have already  discovered in my own practise , talk about the complexity of  patient back ground because that is what turns my switches on in the area that i work . Talk about what that means  ion terms of the demand for care and what patients   expect form us today  and some of the  applications that has down  streamed or return  to a little bit later on and talk about in terms  of continuing education for  a group of patients who are presenting to  us more challenging situations .

Hopefully this will be a nice Segway into some of the material that Gary smith will share with you tomorrow. Another string presentation from Queenslander. So that’s where we are going to go this afternoon. So to begin with a bit of stuff on some population trends. No great surprises here. We all know that people are living longer for a whole range of reasons and that has impact on the demand for care in terms of dentures. That’s largely driven by big changes that occurred post the second world award. So you have all heard the term baby burgers, the   people who are born from 1946-1964 who were not so much booming babies as booming bellies i would probably suggest to you.

What is important in that group is there has been i bog change in the gender balance with a lot more females. So just to show you some life expectancy figures here for a moment. We’ve got at birth over here if you look on the screen the- at birth in 1990 the elite expectancy was about 80 years and about 72 for males. People born today are  going to love  longer than that and people who are already 65 you can see on the other side of the slide still have a lot of life lefty and this is up a very big change from expectation that  we might have had  15 or  2oo years ago.

Probably a better way to think abbot population is to look a t these so called pyramid diagrams. I’m just going to show you 4 of these because when you are going to see is very interesting. It changes from the shape of a pyramid into a shape of a coffin. It is really quite remarkable that the numbers actually change into a particular shape. Ina population that has a pyramid distribution, this is the case from the 1960s- 1980s there is lots of young people and there is a very small number of people who are aged of 65. It is a very even distribution so it’s a pyramid distribution.

What you can see in 2000 is that the shape gas changed and there we can see this bulge emerging in the middle and buy 2045 it’s exactly the shape of a coffin. That means that the number of people who are in the age group above 65 are now a very large part of the population and in 2045 I’ll all be one of the people. This is  why the government in terms of  policies done some clever work around self-funded  retirement t and all those  sort of things because then there is an  enormous burden is going to flow  through in terms of all thee financial  situation of these retiree  age people . Of course you see a lot of these females  and that’s in fact the dominant group in my practise  and I’m sure you’ve got them in as well, patients  in their 80s , their 90s and even a number  of  patients over 100.

If you were in Japan and i asked you how many people were aged of 100 the answer is well over a million people. That amazing isn’t it. Over 100 times 10 000 people who are over 100 years old. So imagine  if you are one of  the no royals  to people who over  100 or the emperor of Japan would  be very busy literally everyday i writing out  1000 of such  letters . It’s just amazing. Now when you look at the age mix of these very old patients that changing quite a bit. Over the next 20 years there will almost be a tripling of that demographic particularly in terms of elderly females. This group is particular of interest clinically because when you go over 85 the chance of having any form of dimension, not just Alzheimer’s dementia   increases quite a bit. That hades implications for what patients will remember and what patients will lose and I’m sure you’ll all encountered this in your practise many times.

Also when these patients get osteoporosis and end up in hospital from hip fracture it has a very high impact in terms of their life expectancy because the chance of not getting out of the hospital is very, very high when you fracture you hop and that introduced a new problem which has only been recognised probably over the last 10 or 15 years and hats the problem off dirges used to pervert osteoporosis induced hip fractures in older women but they have oral complications. SO there is an o bit of an interesting cross over here about that. This group get also a lot of aspiration pneumonia when they go into hospital. It’s one reason why they don’t do so well. So do we in fact have a more compromised older grouped of patients and the answer to that is yes. I was one of those people 25 or so years ago looked at these numbers and thought gee this  would  be a really good area to get into , patients  who have got more complexed medical problems that’s  how i sort of drifted in the area  i now or in today .

We know today that oral health is being recognised as being linked to lots of things and this slide here is being taking from the National Oral Health Plan, the current version that runs out in 2013 which actually links oral disease in the middle to lots of things including food many general health impacts .So when we think about patients who are becoming more frail we are now starting to think both these two way interactions. So let’s just talk about that for a moment. Something that Michael will touch on that for presentation from the University of London what he will give you later this week is some of the important things about oral mural disease. A very common group of conditions that we’ll see in patients who are becoming increasing frailer. We know that oral cancer  ins an increasing  problems in  area that Michael  and a number of the  staff in my old school do a number  of staff in my school do a lot of  work . In dental health month which we are in at the moment it’s a big focus and so we’ve got a group of patients who are very much more likely to show abnormalities of the oral mucosa. Of course the pattern of that is changing and I’m sure Michael will talk to you about that later. I’m sure if you put all of the things of medical astute and the patients to gather what have we seen outlay? Well we’ve seen greater use of multiple medications decrivebed by the word poly pharmacy. As a result of that more mucosal disease and dry mouth. I will talk more about that in a moment.

We’ve  seen the increase in use of drugs to prevent osteoporosis and common drugs used for that and some of the near types of drugs such as polio  or  donosmab have  been  linked to osteoneuoris of the jaws , condition that fight not only  tooth extraction but also trauma form  dentures . So there’s a possibility of this very nasty problem being seen more frequently and we really don’t know enough about that problem today. We’ve got issues around nutritional state of older patient with poorer healing. We’ve got  unrecognised  diabetes where we’ll talk about some more in a moment but for every case of  type 2 diabetes that recognised  in Australia’s we have another patient who will be undiagnosed so we only see half the burden of that in terms of the clinical notifications alone .

Dementia  I will return to in a moment and  if  you think about patients who are  very frail , every dime tally complexed i can tell you now there is not enough special needs specialist  or a number of specialist  around with open appointment books waiting  to treat these patients so  we have a workforce soppy issues on the denial specially side which is another  topic for another day perhaps.

Let’s talk about the emerging epidemics and i will come back to diabetes first of all. So if you think bayou this is a population sense in Australia, it’s been estimated in 1 in 4 of the adults in Australia’s either currently has or will develop some variant of type 2 diabetes. That’s a very high prevalence. That’s has big implications  their ability to periodontitis , it has implication for mucosal disease, dry mouth and for the consequence  of dry mouth such as tooth wear  and  dental caries and particularly for  root surface  caries  . Dry mouth has big implications for the cohesiveness of saliva that may be involved in maxillary dentures or for any of the lubricating functions of saliva.  So the amount of diabetes’s in the population have big implications for oral health and that is going to be ana area to watch.


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