FDIWDC23: exploring dentistry and oral health on the cutting edge
With all of the glamour of its Sydney backdrop, located at the International Convention Centre Sydney (ICC Sydney), and accompanied by a busy and exciting social programme, featuring some of the profession’s most prominent names, plus the four-day exhibition, FDIWDC23 is still, at its heart, a collegial coming together of delegates ready to advance the dental profession as a whole.
We do this by enthusiastically sharing our work with each other, drawing our greatest lessons and ideas from the research labs and training facilities of the world’s universities and dental schools, through to those of us in practice who have honed our skills to the point we have new innovation to share.
Over the course of the year, we have met some of the speakers on FDIWDC23’s impressive programme, who cover the full gamut of dental practice and research. This month, we meet three presenters who are planning to provide delegates with particularly fresh and inspiring content in their chosen fields.
Dr Felix Sim
Dr Sim is a specialist oral, maxillofacial and head and neck reconstructive surgeon. He practises in Melbourne at Royal Melbourne Hospital, Geelong University Hospital and in private practice. His areas of expertise include management of oral cancer, microvascular reconstructive surgery of the jaws, and complex implant dental rehabilitation.
Following his oral and maxillofacial surgery training, Dr Sim underwent further subspecialty training in Portland, Oregon focusing on head and neck oncology and microvascular reconstructive surgery. He had the opportunity to be able to work and learn from the pioneers who implemented the digital workflow of reconstructive surgery of the maxilla and mandible with virtual surgical planning and 3D printed biomodels.
His presentations at FDI will include updates and information on potentially malignant disorders of the oral cavity and the advances of reconstructive surgery and dental rehabilitation of the jaws following tumour ablative surgery.
Oral and maxillofacial surgery has evolved tremendously in Australia over the past 15 years, with more and more oral and maxillofacial surgeons becoming involved in reconstructive surgery with microvascular free flaps. The involvement of a dentally trained reconstructive surgeon has played a crucial role in bridging the gap between reconstructive surgery and implant-based dental rehabilitation advancing the field by improving jaw reconstruction leading to a more ideal position of the bone to enable implant placement. The advances of digital technology has led to the ability to provide immediate reconstruction and dental rehabilitation of the jaws, a concept termed ‘Jaw in a Day’.
As Co-convenor of the symposium, I can say there are several sessions during Congress focusing on oral cancer which includes a symposium on Tuesday at 10.45am. The delegates in their day-to-day practice play a crucial role in the early detection, referral, and post-treatment care of patients with maxillomandibular reconstruction and oral cancer. Some important points that dentists should be aware of and communicate to their patients are:
(1) EARLY DETECTION AND SCREENING
Dentists should emphasise the importance of regular oral cancer screenings and examinations. They should educate patients about the signs and symptoms of oral cancer, which can include persistent mouth sores, lumps, white or red patches, difficulty swallowing, and changes in speech.
(2) RISK FACTORS
Dentists should inform patients about the risk factors associated with oral cancer, such as tobacco and alcohol use, HPV infection, sun exposure, and a history of oral cancer. Patients with these risk factors may need more frequent screenings and vigilant monitoring.
(3) IMPORTANCE OF TIMELY DIAGNOSIS
Dentists should stress that early diagnosis is crucial for improved outcomes following the treatment of oral cancer.
(4) REFERRAL TO SPECIALISTS
Dentists should have a network of oral and maxillofacial surgeons, oncologists, and other specialists they can refer patients to if they suspect oral cancer or the need for maxillomandibular reconstruction. Collaboration with a multidisciplinary team is essential for comprehensive patient care.
(5) MAXILLOMANDIBULAR RECONSTRUCTION OPTIONS
Dentists should be knowledgeable about the various options for maxillomandibular reconstruction after cancer treatment. These options may include bone grafts, tissue flaps, dental implants, and prosthetic rehabilitation.
(6) PREVENTIVE ORAL HEALTH
Dentists should emphasise the importance of maintaining good oral hygiene and overall oral health, especially for patients undergoing cancer treatment. Addressing dental issues before treatment can minimise complications and improve the patient’s quality of life during and after treatment.
(7) NUTRITIONAL SUPPORT
Patients undergoing maxillomandibular reconstruction or oral cancer treatment may experience difficulty with eating and maintaining proper nutrition. Dentists can provide guidance on soft food diets and nutritional supplements to support
the patient’s wellbeing.
(8) PHYSICAL AND EMOTIONAL RECOVERY
Dentists should be aware of the potential physical and emotional challenges patients may face during the recovery process. Providing resources and support for coping with speech changes, facial appearance alterations, and emotional wellbeing is important.
(9) PATIENT EDUCATION
Dentists should educate patients about the treatment process, potential side effects, and the expected timeline for recovery. Empowering patients with information helps them make informed decisions and actively participate in their treatment journey.
Overall, effective communication between dentists and patients is crucial for raising awareness about oral cancer, ensuring early detection, providing appropriate referrals, and supporting patients through their treatment and recovery phases.
There are many unmet needs for head and neck cancer patients and one of them is the universal access to dental care. Dental care following treatment of oral cancer is crucial for several reasons. The treatments used to combat oral cancer, such as surgery, radiation therapy, and chemotherapy, can have significant impacts on oral health. Proper dental care plays a vital role in minimising complications, promoting healing, and maintaining a good quality of life for patients post-treatment.
Outside of tertiary cancer centres, many patients do not have access to dental care pre and post treatment. This gap often could lead to head and neck cancer survivors having to deal with complications of their treatment such as radiation caries and/or osteoradionecrosis. I hope that there will be increased awareness amongst the dental community that would provide advocacy and support for campaigns to promote increased funding for access to dental care for head and neck cancer patients and survivors.
I would encourage delegates to attend the Symposium on oral cancer on Tuesday, 26 September where there will be a multidisciplinary panel of specialists outlining the updates on Diagnosis, Treatment and Rehabilitation/Recovery.
Dr Wendy Thompson
Dr Thompson is an academic general dentist. Her academic research and teaching are at University of Manchester, while her clinical practice is in a rural part of northern England. In addition to various national policy committees on AMR she is a member of the FDI Science Committee and Chairs its AMR working group.
Following her first degree in microbiology, she fast streamed as a scientist in Whitehall, at the heart of UK Government. After relocating back to her roots in northern England, and with few jobs for science policymakers outside of London, she realised the need to retrain. A new dentistry course was starting locally aiming to get dentists into the high needs remote and rural areas, and she got a place. Since graduating in 2012, she has used the range of her knowledge and skills to deliver research and policy input nationally and internationally about ways to tackle the global problem of antibiotic resistance from a dentistry perspective.
Dentistry has been responsible for around 10% of antibiotic prescribing for years. This figure increased significantly during COVID-19 due to restricted access to dental procedures for people with dental infection or pain. My presentations at FDIWDC23 will look at how this pattern was consistent in general and in detail around the world.
Many things are implicated in the development and spread of antimicrobial resistance, including using antibiotics. Guidelines about appropriate use don’t matter to the bacteria which are (or are not) resistant to antibiotics. Using antibiotics kills the susceptible bacteria and leaves the resistant ones to do their thing. Dental guidelines aim to focus the use of antibiotics on cases where procedures alone could leave the patient at risk from the condition being treated. Guidelines aim to balance risk to the patients from other adverse outcomes such as anaphylaxis and C diff. High rates of dental antibiotic prescribing not in accordance with guidance takes place around the world. My talks will also explore this issue in both high income and low/middle-income countries – including how long is long enough for delivering guideline-congruent care during urgent appointments.
I will also talk about the UN’s sustainability agenda, which is about ensuring future generations have access to the things we take for granted in our everyday life. Keeping antibiotics working is clearly an important element of this agenda. Teams delivering dentistry and oral care in Australia (and all other countries of the world) need to be aware of the impact that antibiotic resistance will have on them, their friends, families and patients. Within 30 years it is expected that more people will die from bacterial infections than from cancer. This is a stark statistic. Treating patients in accordance with national guidance and using antibiotics only when strictly necessary is the best way to keep us all safe.
Congress presents the opportunity to meet colleagues from around the world and to share stories about what works. Since 2020, I’ve been ‘Zooming’ around the world at strange times of day. It’ll be great to be able to meet in the same time zone and share a bottle of something cold and fizzy, especially with colleagues from the Universities of Melbourne and Sydney who I feel that I know so well.
Finally, I’ll be taking the opportunity to encourage National Dental Associations to sign the FDI Pledge on tackling AMR and encouraging them to complete the survey (which will have been circulated by the time of Congress) about how they have been delivering it in practice. Interested delegates can visit fdiworlddental.org/antibiotic-resistance-needstackling- immediately-across-dentistry
Dr Mark Wotherspoon
Dr Wotherspoon is a self-described oral health activist; he is a general dental practitioner who wears a number of hats. Mark has had many years in private practice as Principal and practice owner as well as experience in the public service, military service and even corrective services. He firmly believes in establishing best practice oral hygiene routines for his patients and educating other health professionals and the public as to the close link between oral health and general health. Mark is an Adjunct Senior Lecturer and Clinical Team Leader (Portable Dentistry) at Charles Sturt University.
Two experiences, one professional and the other personal, drew me to developing a portable dental service. Firstly, I started to look more deeply into why many of my older patients simply stopped coming in for their long-standing preventive care visits. It turned out the answer was quite simple – it was just too difficult for them to physically make the trip along with other multiple medical commitments. Then when my mother’s health deteriorated, I could see firsthand the strain this put on my father and brother and sister, all chipping in to support mum. Clearly any home support was valued and greatly appreciated.
Certainly, denture hygiene is at a very poor standard for our aged care residents, and this directly impacts on the quality of life and health. I’ll let Hygenie and my other denture hygiene products speak for themselves in my presentations when they are included in patient care video demonstrations and oral health education packages for Aged Care nursing staff.
COVID-19 has sadly put a halt to a couple of planned research projects; however, I have participated in a number of proof-of-concept pilot projects. The use of digital scanners and CAD Cam technology to 3D print duplicate or new dentures in dementia wards without the need for traditional impressions has been very exciting along with demonstrating the enormous potential for very simple Tele-Dentistry systems. Also, the use of dental mannequins to assist in the delivery of hands on practical oral health skills to health workers has been another very exciting project new in development.
As a profession, we have known for many years now the diabolical state of oral health for our elderly in nursing homes and how this directly impacts their quality of life and health. We also know this is only getting steadily worse with our patients living longer and retaining more of their natural teeth and now arriving in nursing homes with implants and other forms of complex dentistry.
Over three presentations at FDIWDC23, I will cover how we, as a profession, can better prepare and then support our patients for healthy ageing, how we can simply add a part-time portable dental service to our fixed practices to support our patients when they need us the most and finally how we can help improve the standard of oral health and plaque control for our patients by educating and upskilling the aged care support workers.
I think as a profession we understand oral disease and its impact on our patients very well, but we also understand the unique challenges to changing our patients’ behaviours and motivating them to change – for the better. I hope my work will shine a light on the new technologies and dental products that make real and sustainable change very achievable and which all of us, private and public, have an important role to play.
The ADA wishes to thank ICC Sydney for the use of their image.