Transcript

Dental Health with Professor Peter Wilson

23 June 2008

peter-wilsonProfessor Peter Wilson
Email: p.wilson@latrobe.edu.au

You can also listen to the interview [MP3 13.2 MB].

Matt:

This is the La Trobe University podcast, I'm you're host Matt Smith, good morning, good afternoon, and good evening, it all depends on where you’re standing! And joining me today is Professor Peter Wilson, he's the head of the La Trobe University dentist school. Welcome aboard, Peter.

Peter:

Thankyou

Matt:

Nice to have you here. So you've opened up the new dental school in Bendigo, it was the first year of it.

Peter:

That's correct.

Matt:

What sort of challenges have you faced in opening up that dental school?

Peter:

Significant challenges. Recruitment of staff, preparation of curriculum, insuring that the students received teaching in their first year. I only started in this position at the end of January, so as you can imagine it's been a bit of a rush.

Matt:

The end of January this year?

Peter:

That's correct.

Matt:

Wow. Is it you that's been spearheading this the entire time?

Peter:

No, the vast part of the initial work was by Professor Mark Tennant from Western Australia. He's been instrumental in setting up the Dental School in Bendigo and he was instrumental in setting up the dental school in Griffith, South Queensland. He's gone on to work with the Charles Sturt University, with their regional and rural university, and he's now also involved with James Cook in the far north of Queensland. So he's leaving us but he's done an amazing job of helping us get this set up. However, I arrived in January to try and get the thing working.

Matt:

So you got a bit of a trial by fire really.

Peter:

Well it was a bit of a surprise, I even ended up teaching myself for the first four weeks, which I wasn't planning to do, but it meant the course got running.

Matt:

So have you done a lot of teaching in the past?

Peter:

I was at the University of Melbourne for seventeen years teaching undergraduates to do crowns and bridges. I was responsible for looking after the final year of the undergraduate course, and I ran the speciality program in prosthodontics, which is the speciality of replacing teeth.

Matt:

Why Bendigo? Why was Bendigo chosen as a place to open up the dental school?

Peter:

Bendigo was chosen as the place to open up the dental school because La Trobe has a significant presence in Bendigo, and La Trobe put a proposal forward to the state government to create a dental program. It follows on from an already commenced Bachelor of Health Science program which teaches dental hygienists and dental therapists and Bendigo is a very thriving regional city and it's an excellent base to have as our home base for the dental program. We will be sending our students out clinics in Mildura, Wodonga, and Melton for clinical experience.

Matt:

Will they be third year students I assume?

Peter:

Third year students will largely be taught in Bendigo. We will be sending out fourth year students and fifth year students to the distant clinics. We will also send out some final year or third year students in the Bachelor of Health Science program to the distant clinics too.

Matt:

So will that hopefully lessen the waiting period in regional areas?

Peter:

The clinical capacity isn't being increased. The students are in training, and they're not as productive as a normal dentist. But there are advantages not just in having students in place and providing some treatment provision, it will also provide some census for professional development for the local dental community to be involved. There'll be a whole raft of things that come along with dental students being present.

Matt:

So why aren't there more dental schools in Australia. This is the first one to open up in sixty years, is that right?

Peter:

That's not quite correct. Griffith have opened up on the Gold Coast a couple of years ago, but we're the second in a whole set of expansions that have happened in the last two or three years. We are the first rural and regional school and as I mentioned before Charles Sturt is setting up a similar exercise which will start next year for rural and regional New South Wales.

Matt:

But why is it only now that that sort of thing has started?

Peter:

That's a difficult question that I can't answer completely. I think La Trobe particularly was very well positioned with the skills and expertise in it's senior staff to make a good bid to the government and it was an appropriate time to do it. Waiting lists are high in public clinics and it's well recognised as a dental workforce shortage. This was probably recognised ten or fifteen years ago but I think it's only recently that it's actually been decided to do something about it. I would say there's a long lag time between the production of dentists from dental students. It must be something like eight years from the first idea to producing a dentist. So there's a lot in process, but eventually we will be producing fifty dentists a year.

Matt:

Is that just from Bendigo?

Peter:

No that's from our intake. Sorry, when you say from Bendigo… they will come out of the La Trobe dental school which has several sites.

Matt:

Oh okay, yes. The big draw of having the dental school in Bendigo is that it's a regional site. How far have students been coming to go to Bendigo to attend this dentistry school?

Peter:

We have a few from interstate, I know there's certainly one from Sydney. Our major objective is to have largely rural students from a rural background to train in a rural and regional area and then end up practising in a rural and regional site. We've had a lot of competition to get into our course and for our first year we've ended up with about a third rural students and two thirds metro students. We will be addressing this in future with special regional and rural loadings, so there's some attempt to equalise the opportunities for rural students compared to metro students.

Matt:

You were educated in the UK, is that right, and you've taught over there?

Peter:

My initial degree was from the University of Newcastle upon Tyne and then I did a master's degree at the University of Newcastle upon Tyne, then I went to America for a couple of years, to Minnesota to do specialist training and then I went to the University of Melbourne where I did a PhD, I actually then did a graduate diploma in health administration at La Trobe in the mid nineties and then the position came up here.

Matt:

So how does how we do dental care here, how it's taught here as well, how does it compare around the world?

Peter:

The dental care system in Australia is almost completely private. There's a minor public component for people of limited means. But the system is essentially a free market by the privately driven system. About five sixths of dentists work in private practise compared to the sixth that are in other bits and pieces like public service and universities.

Matt:

Can you tell us more about fluoridation in Australia?

Peter:

Certainly! When I trained in Newcastle upon Tyne I was taught by one of the world figures in fluoridation, Professor John Murray. He was instrumental in really teaching me some of the major issues in fluoridation, with water fluoridation and the effects of fluorides. So I haven't had much chance to use this for the past twenty years because I've really been in an area where I treat people at the end of a dental path with replacements and repair on badly damaged teeth. But I've had an interest in this and since my appointment as head of school I feel I've got a public duty to try and take part in the fluoridation debate. And I have been on the expert panel for DHS, I've visited Colac and I've just been to Castlemaine to provide an expert panel for members of the general public to discuss fluoridation and how it might effect them. It's certain that it's a very important public health initiative, it's easily proven that it's a very effective at reducing decay in both children and adults. It's, as far as we can tell, completely safe. The initial interest in fluoridation came from naturally fluoridated areas in America where there was low rates of decay and people wanted to try and explain it. And it's been conclusively proven that natural fluoride is effective and the fluoride ion that's added at water treatment plants is just the same fluoride ion that gets added by nature. So it's an interesting story of man mimicking nature and trying to optimise some of the levels of minerals in the water.

Matt:

Is there fluoride added to Victorian waters?

Peter:

Melbourne has been fluoridated for thirty years, that was in the mid-seventies, the technology for fluoridation has improved and come down in cost, so now communities of smaller and smaller size can have their water supplies fluoridated. The reduction of treatment needed because of fluoride is actually easily in excess of the cost of adding fluoride to water. That doesn't include all the social benefits of not having toothache, not having treatment, it's generally a good thing.

Matt:

Is it something that needs to be done though considering fluorides in toothpaste? It's a general ingredient of all toothpaste nowadays.

Peter:

It is now, it's quite difficult to buy a toothpaste without fluoride in.

Matt:

So is it something that we need in the water?

Peter:

That's an interesting question, because for the people who clean their teeth excellently with toothpaste, and have a good diet, the effect of water fluoridation is probably small. But for the worst off people who don't clean their teeth well, have a bad diet, and generally have higher levels of dental disease, water fluoridation is still effective. So water fluoridation has the benefit of affecting having the biggest benefit where there's the most disease. The most disease is with the people of low socio-economic status, so really fluoride’s remarkable in helping people who need the most. When it's supplied in the water system.

Matt:

Can I just ask you a few general dental questions?

Peter:

Yes

Matt:

How often a day should you brush your teeth?

Peter:

As often as you need to.

Matt:

As often as you need to… so there's no minimum number that you should be…

Peter:

I think that one of the classical experiments that were done many years ago is with dental students. Now dental students are often chosen for experiments because they're available and they're co-operative. Dental students either brush their teeth once a day, once every two days, or once every three days.

Matt:

Oh no, that's horrid.

Peter:

It was only at the once every three days that it was actually a problem, with inflammation developing in their guns. But that was for gum disease. I think practically most people are not superb at cleaning their teeth, and the more times they try and do it the better. So I'd say a couple of times a day are a sensible time, before you go to bed and when you get up.

Matt:

How often do you brush yours, can I ask that?

Peter:

Oh, a couple of times a day.

Matt:

Does an apple a day make a difference?

Peter:

A difference to what?

Matt:

A difference to the quality of your teeth.

Peter:

I don't think so.

Matt:

Oh, it's an apple a day keeps the doctor away, isn't it?

Peter:

That's correct, but it would be good in terms of getting your nutritional input correct.

Matt:

I suppose so.

Peter:

And dentistry and nutrition input are actually quite closely linked, because the major cause of dental care is probably diet. So a poor diet in terms of easily accessible sugars and high frequency of use of sugars is a very powerful agent in destroying your teeth.

Matt:

What about chewing chewing gum and Listerine?

Peter:

Chewing chewing gum is an interesting concept because the chewing gum may contain some agents that are useful. So for instance contains fluoride or an antibacterial agent, or even an agent that helps mineralise teeth again, for example there's a material called amorphous calcium phosphate that can help remineralise. So having the agent in there is one thing, but actually the mechanism of chewing stimulates saliva flow, so the saliva flow that is created is actually good for naturalising the acid that ends up damaging your teeth. So there's a couple of ways that chewing chewing gum is quite good. I'm not a great favour of people chewing chewing gum because they leave it all over the place and I don't find it particularly socially appealing.

Matt:

Listerine… I looked it up, it was originally a surgical antiseptic, a floor cleaner, and a cure for gonorrhoea. How do we get oral health from that?

Peter:

Well it depends if you're a floor cleaner with gonorrhoea.

Matt:

He'd have good oral health if he did!

Peter:

Possibly! The issue is that it actually kills some of the bacteria that is in your mouth. That's a reasonable thing. There are other agents as well called Chlorhexidine in some of the tooth agencies are well proven anti-bacterial agent that can help reduce bacteria loads in your mouth. Mouth wash is more probably towards the cosmetic and pleasant sides to use, they have a nice taste and leave your teeth feeling clean. The main part of your cleaning regiment should be mechanical cleaning with your toothbrush. And use some fluoride toothpaste and the toothpaste helps loosen the plaque from the teeth and the fluoride helps with making the teeth less soluble.

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