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.Keywords: Blood coagulation disorders ⁄ complications, dental care, haemophilia, haemostatics ⁄ therapeutic use, von Willebrand disease.Abbreviations and acronyms: HDS = hospital dental service; HTC = haemophilia treatment centre; NSAIDS = Non-steroidal anti-inflammatory drugs.

Aims: To investigate barriers experienced by clinicians treating individuals with special needs in the Australian public dental system. Methods and results: Oral health professionals working at primary care clinics in the public dental system were invited to participate in semi-structured interviews or focus groups to discuss the challenges they faced in managing patients with special needs. Qualitative methods, employing inductive thematic analysis, revealed two primary barriers: 1. clinicians lacked confidence in their ability to treat patients with special needs because of insufficient training and experience, and difficulties obtaining information about their patients, and 2. barriers within the public dental system, including inadequate funding, equipment and facilities, and productivity pressures prevented clinicians from being able to provide the care patients required. The priority and understanding of the oral health for these individuals within the public dental system and wider disability sector was also raised. Conclusion:A perceived lack of training and experience in managing individuals with special needs was a barrier to treating patients with special needs. Other significant barriers were under-resourcing of the public dental system and a lack of priority and understanding regarding oral health among carers of individuals with special needs and other health professionals. K E Y W O R D Sdental, disabled persons, general practice, health care utilization, medically underserved area INTRODUCTIONIn Australia, special needs dentistry is a recognized dental specialty that "supports the oral health care needs of people with an intellectual disability, medical, physical, or psychiatric conditions that require special methods or techniques to prevent or treat oral health problems,

BackgroundAntibiotic prophylaxis before dental treatment is routinely recommended by orthopaedic surgeons to prevent prosthetic joint infection (PJI). This recommendation is at odds with current guidelines.MethodsA postal survey of 9 checkbox or short-answer questions was completed by 633 orthopaedic surgeons.ResultsThe majority of respondents (n = 186 of 260, 72%) believe that antibiotic prophylaxis is required indefinitely for dental treatment. A small number (n = 43, 15%) seek a dentist's opinion before elective joint replacement. The surgeons reported low numbers of PJIs, although 24% (n = 68 of 280) believed that they were associated with dental treatment.ConclusionsAustralian orthopaedic surgeons continue to recommend antibiotic prophylaxis for dental treatment. The recording of PJI in relation to dental procedures into clinical registries would enable the development of consistent guidelines between professional groups responsible for the care of this patient group.

Background To explore the profile of patients and treatment delivered at specialist referral centres for individuals with special needs. Methods A cross-sectional audit was conducted of the health records of all patients with appointments at two of Australia’s largest referral centres for patients with special needs, the Integrated Special Needs Department at the Royal Dental Hospital of Melbourne and the Special Needs Unit at the Adelaide Dental Hospital, for the month of August 2015. Results The profile of patients treated at these specialist units demonstrates the diversity of individuals with additional health care needs that general dentists feel require specialised oral health care. The Adelaide-based clinic had a greater proportion of complex medical patients in comparison to those treated in Melbourne who were more likely to have a disability or psychiatric condition and were less likely to be able to self-consent for treatment. Interestingly, despite similar workforce personnel numbers, there were approximately twice as many appointments at the Special Needs Unit in Adelaide than the Integrated Special Needs Department in Melbourne during the study period which may have reflected differences in workforce composition with a greater use of dental auxiliaries at the Adelaide clinic. Conclusions The results of this study provide an initial profile of patients with special needs referred for specialist care in Australia. However, the differences in patient profiles between the two units require further investigation into the possible influence of service provision models and barriers to access of care for individuals with special needs and to ensure equitable access to health care.

This pilot study did not demonstrate a positive statistical correlation between periodontitis experience and severity of radiation-induced oral mucositis. Nonetheless, a trend towards increased bone loss, pocket depth and clinical attachment levels was noted in patients with mucositis grades 1-4. Larger studies with more stringent inclusion criteria are now required to further investigate this possible relationship between periodontitis experience and severity of radiation-induced oral mucositis.