SmileWhat’s behind the

shocking statistics on Aussie children’s teeth?

Healthy mouths, healthy lives

Waiting

room

copy

please

do no

t

remov

e

Issue # 3, 2009 $6.95 INC GSTIssue # 8 $6.95 INC GST

Toddlers and teeth

Good deeds Using a dragon boat to raise

funds for breast cancer

The real-life CSIInside the world of forensic dentistry

Getting sensitiveHow do toothpastes for

sensitive teeth work?

The change agentThe dental researcher

who’s become an expert in indigenous

oral health

If you’re self-conscious about your smile, the last thing you

want to do is draw attention to it with braces. Thanks to Invisalign, you don’t

need to. Invisalign’s virtually invisible, comfortable and removable series of aligners

is the modern and hygienic way to straighten your teeth without anyone noticing.

Proven to be as effective as traditional methods and suitable for all ages,

Invisalign is the clear choice for your new smile.

Ask your dentist or orthodontist whether Invisalign is right for you.

WWW.INVISALIGN.COM.AU

1300 880 064

SET YOUR SMILE STRAIGHT WITHOUT ANYONE NOTICING

www

3 SMILE

03Contents

Editor Rob Johnson rob@engagemedia.com.au

Sub-Editor Kerryn Ramsey

ContributorS Marian Edmunds, Fabian Shepper, Stephanie Sword, Danielle Veldre

CrEativE dirECtor Tim Donnellan

CommErCial dirECtor Mark Brown

For all Editorial or advErtiSing EnquiriES:

PhonE (02) 9660 6995 Fax (02) 9518 5600

Smile magazine is published 4 times a year by Engage Media, ABN 50 115 977 421. Views expressed in Smile magazine are not necessarily those of publisher, editor or Engage Media. Printing by Superfine Printing

Suite 4.08, The Cooperage 56 Bowman Street Pyrmont NSW 2009

04. News and views News from here and around the globe.

08. Sensitive new-age teethThere’s been a rush of toothpastes on the market claiming to relieve the pain of sensitive teeth in a minute. But what makes them work, and why are they appearing now?

10. Doin’ it for the kidsSome recent media coverage has drawn attention to the sorry state of children’s oral health in Australia. But what can be done about it?

14. Real-life CSIWhether it’s identifying soldiers missing in action or victims of natural disaster, odontologist Russell Lain has turned a career in dentistry into highly specialised detective work

16. The change agentDr Lisa Jamieson has become one of our leading advocates for indigenous oral health. But is she researching a problem without a solution?

18. Enter the dragonDr Meng Quah-Shepherd found a great way to help breast cancer research and help survivors recover at the same time

08

10

16

18

If you’re self-conscious about your smile, the last thing you

want to do is draw attention to it with braces. Thanks to Invisalign, you don’t

need to. Invisalign’s virtually invisible, comfortable and removable series of aligners

is the modern and hygienic way to straighten your teeth without anyone noticing.

Proven to be as effective as traditional methods and suitable for all ages,

Invisalign is the clear choice for your new smile.

Ask your dentist or orthodontist whether Invisalign is right for you.

WWW.INVISALIGN.COM.AU

1300 880 064

SET YOUR SMILE STRAIGHT WITHOUT ANYONE NOTICING

D e n t a l N e w s

4 SMILE

04

We call it a gap in the teeth. Dentists call it midline diastemata, and it’s in fashion

Mind the gap! A court has ruled your dentist offers the best

whitening trreatments.

Did you know...?Advances in dental materials have led to tooth-shaded resins which are painted on and bond to your tooth. Your dentist can now repair chipped or damaged teeth with minimal drilling. The resultant filling is usually impossible to detect.

Gap-toothed women are in vogue. Gap-toothed models were all over runways at Paris Fashion Week recently. Instead of fixing their teeth, some of Hollywood’s freshest faces, like Anna Paquin and Mad Men’s Elisabeth Moss, proudly sport a midline diastema. And, last year, on America’s Next Top Model, host Tyra Banks sent a 22-year-old contestant from Boise, Idaho, to the dentist to widen her gap. Culturally, there has always been a mystique about diastematic women. In Ghana, Namibia and Nigeria, a gap in women’s teeth is a sign of beauty and fertility, said Bernice Agyekwena, an academic at UC Berkeley’s Graduate School of Journalism in California.

“Some women even go to the extent of creating an artificial gap in their teeth because they want to meet the traditional standards set for African beauty,” she said.

Some fashion and beauty commentators believe our new interest in the diastema represents a backlash against unattainable beauty standards and an obsession with perfection. “I think for so long the look was cookie-cutter beauty, and it doesn’t stand out,” said Heather Muir, beauty news editor for Allure magazine in New York.

“From a clinical standpoint, there’s no advantage to closing it,” said Tim Patel, a San Francisco dentist and assistant clinical professor at UCSF’s School of Dentistry. £

Genetic link for tooth decayNew research suggests that variations within an individual’s taste pathway genes can impact their risk of dental decay. Previous studies have considered the influence of genetics on taste preference and dietary habits. ‘Taste Genes Associated with Dental Caries’—published in the Journal of Dental Research—takes that discussion one step further, suggesting that genetic variation in taste pathway genes could be connected with an individual’s risk of suffering from tooth decay.

The study examined families’ biological samples and demographic data and clinically assessed the health of their mouth, including the amount of dental decay. There are numerous known factors that cause tooth decay, including the bacteria in the mouth, dental care routines, diet, the structure of the teeth, fluoride, salivary flow and the makeup of saliva.

Chief executive of the British Dental Health Foundation, Dr Nigel Carter said: “If we can tell in advance who is most at risk, then more preventive care can be given to protect those patients.” £

Model Jessica HartLauren HuttonMadonnaAnna PaquinCondoleezza Rice

Georgia Jagger Elisabeth MossLaura San GiacomoNatalie ColeVanessa Paradis

Famous gap-toothed women

It’s not just what you eat, but who your mum is, that decides your oral health.

Imperfection is apparently the new perfection. Or the new black.

Always read the label. Use only as directed. See your dentist if symptoms persist.

1) Taylor and Borgnakke, (2008). Oral Diseases, 14: 191-203; Khader, Albashaireh and Hammad, (2008). La Revue de Sante de la Mediterranee orientale, Vol 14, No.3: 654-661; 2) Fine, et al. (2006). Journal of the American Dental Association, 137: 1406-1413; funded by Colgate-Palmolive Co, New York. ASMI 19161-0611

Don’t brush it off – use Colgate®

Did you know that people with diabetes may be more at risk of gum disease1?

Colgate Total toothpaste reduces up to 90% of plaque germs that can cause gum disease.2

Visit your dentist and fi ght gum disease with Colgate Total.

D e n t a l N e w s

6 SMILE

06

Solar-powered oral healthStudents at the University of Saskatchewan College of Dentistry in Canada have invented a solar-powered toothbrush that apparently does away with the need for toothpaste. The brush, which works by transferring electrons from a solar panel to a titanium oxide semiconductor located at its neck—which, in turn, stimulate a reaction that facilitates the disruption of plaque and helps reduce gum inflammation—has been proven effective in clinical trials. Nonetheless, it has stimulated a strong defence of toothpaste by the British Dental Health Foundation.

A recent clinical trial U of S College of Dentistry has found the brush—called the Soladey J3X—is more effective at reducing bleeding associated with gingivitis when compared to a control brush. Canadian investigators are currently preparing their findings for publication.

However, the British Dental Health Foundation has issued a statement saying that using a fluoride toothpaste twice a day when brushing teeth is by far the best form of dental hygiene. £

US FDA cracks down on mouthwashThe United States Food & Drug Administration (FDA) has warned three companies to stop making unproven claims on mouth rinses. It has issued warning letters to Johnson & Johnson (Listerine Total Care Anticavity Mouthwash), CVS Corporation (CVS Complete Care Anticavity Mouthwash), and Walgreen Company (Walgreen Mouth Rinse Full Action). Those companies manufacture and market mouth rinse products in the United States with claims that they remove plaque above the gum line or promote healthy gums. These claims suggest the products are effective in preventing gum disease when no such benefit has been demonstrated.

These mouth rinse products contain the active ingredient sodium fluoride. The FDA has determined that sodium fluoride is effective in preventing cavities but has not found this ingredient to be effective in removing plaque or preventing gum disease. To date, the FDA is unaware of any injuries or adverse health effects related to the use of these mouth rinse products. Consumers who have these products may continue to use the products for cavity prevention without risk of injury but should be aware that the FDA has no data to show that these products can prevent gum disease. Companies that received FDA warning letters are required to take appropriate action to correct these violations within 15 days. Failure to do so may result in seizure of the product, or other civil or criminal penalties. £

Brace yourself...Orthodontic treatment to correct the position of crooked teeth can greatly improve your appearance. Mature adults as well as youngsters experience excellent results. Orthodontic bands (braces) are now small and more comfortable. Brackets and wires may also be placed on the inner surfaces of your teeth so that they are not noticeable when you smile. Some dentists offer other alternatives as well, which may involve greater costs but which may be even less visible. £

Brush your teeth with the power of the sun!

Decay runs in the familyResearchers from the University of California, San Francisco, have found that mothers with untreated tooth decay are more likely to have children with the same condition. The authors say this finding makes it important to assess family oral health in order to properly manage a child’s oral health.

Other studies have found that parents’ dental health or tooth brushing habits are linked with children’s dental health. Before reaching their conclusion, the researchers adjusted their numbers to account for other factors that can affect rates of tooth decay. These include age, child’s gender, income and education.

The study also took into account whether families had dental insurance, the age when children began brushing their teeth, how often they visited the dentist and whether they had fluoride treatments or dental sealants. Both of these treatments help to prevent tooth decay. £

Orthodontic braces aren’t just for kids anymore.

7 SMILE

Who has the right to clean these teeth?

If you thought the skills shortage in dentistry was bad, spare

a thought for the horses: a deep rift has emerged in the world of equine dentistry due to an absence of regulations and standards surrounding the profession. Melbourne University’s Dr Wayne Fitzgerald has told news outlets there is a deep divide between dentists who have veterinary qualifications and those who do not.

“They should be regulated, qualified, and they should be controlled,” he said. There are an estimated 850 horse dentists nationally and the vast majority are veterinarians. But around 50 practitioners without veterinary qualifications are providing horse dentistry nationally.

“Some research estimates that there is up to 1.2 million horses across Australia,” Sue Combridge, Australasian Association for Equine Dentistry president, told the ABC. “The equine dental industry is something that has been serviced primarily through history by the non-veterinarian.”

Both veternarians and

non-vets have been collecting photographic evidence of treatments gone wrong.

“We blame the dental technicians themselves because they do a certain degree of practice, they work in the industry, but unless you are scientifically trained it is very hard to tell if you are doing something right or wrong,” said Dr Fitzgerald.

“They aren’t capable of self-criticising and we hope that veterinarians are.”

Both vets and non-vets are working on a set of national standards that could see all practitioners re-trained.

“There are poor standards of dentistry on both sides of the fence. That is undeniable,” said Ms Combridge. “By implementing national standards for competencies and providing a way for training to become standardised across the country you are going to raise the standard of training.”

But negotiations about the national standards have been bogged down for more than a year. £

Stress and poverty cause kid’s cariesA recent study in the journal Social Science and Medicine has found that poverty and stress create chemical changes in children’s saliva which contribute to tooth decay.

In two 2004-2006 studies of 132 kindergarten children from varying socioeconomic backgrounds in the San Francisco Bay Area of California, researchers from the University of British Columbia in Canada performed detailed dental examinations to count decayed, missing or filled dental surfaces and microtomography to assess the thickness and density of microanatomic dental compartments in exfoliated, deciduous teeth. Decay was linked with three factors: high levels of decay-causing bacteria; high levels of a hormone called cortisol; and a family income below poverty level.

“We hypothesised that family stresses and stress-related changes in oral biology might explain, fully or in part, the known socioeconomic disparities in dental health,” the authors wrote.

“We found that nearly half of the five-year-old children studied had dental caries.”£

4 ways to replace missing teethWhen teeth are missing, your cheeks tend to ‘fall in’, making you look old

and tired. Talk to your dentist about it, but there are alternatives to living

with missing teeth.

1 You can have a partial denture, created with the latest lab technologies

to look as natural as possible.

2 Bridgework with modern porcelains fixed to adjoining teeth is often

difficult to detect.

3 Simple bonding of the replacement tooth to the teeth either side is

now possible—involving no drilling or further loss of tooth structure.

4 Implants made of titanium (a space-age material) can be inserted into

the jawbone to anchor the artificial crown, bridge or tooth. Implants

are especially effective where a single tooth is replaced by a lifelike

crown. It looks like a natural tooth growing out of your gum. £

Shutting the gate after the horse has bolted?

Even if you don’t have a full mouth of teeth, there’s many options for you.

At the dentist

8 SMILE

s we’re all keeping our natural teeth longer, we’re finding new problems that go along with that. One of the most talked about of recent times has been enamel-wear—where the enamel on your teeth is worn down through a combination of poor brushing techniques and poor diet. So while more people have their own teeth, a greater number have

been reporting sensitive teeth.Luckily, there are new products on the market that deal, in

different ways, with the problem, and do so more efficiently than ever before.

Colgate has recently released Colgate® Sensitive Pro-Relief™, a toothpaste clinically proven to provide instant and lasting relief from tooth sensitivity. According to dental researcher Richard Chesters, this is a leap forward in toothpaste innovation, which will offer consumers more choice in the market, and most importantly an instant solution for people who suffer from sensitive teeth.

“There are few things in life that can be achieved in a minute, but with the innovative Pro-Argin™ technology, which blocks tubules to protect against pain from sensitivity, this product offers instant relief after direct application to each sensitive tooth and massaging for just one minute,” says Chesters.

But at the same time, GlaxoSmithKline, makers of Sensodyne, has also released a toothpaste with a different active ingredient, which also claims to work in about a minute.

“We know one in three Australians suffer from sensitive teeth, and now there’s a quick and easy solution to managing their pain,” says Jane Eakins, dental expert manager at GlaxoSmith-Kline. “Sensodyne Rapid Relief gets to work instantly. It creates a mineral-like seal over the tooth to provide a protective barrier against the pain of sensitivity,” explains Eakins.

One of the common reasons why this happens is bad brush-ing, in other words, excessive and overly vigorous brushing which

can wear away enamel, exposing the underlying dentine. Dentine may also be exposed as a result of gum recession or gum dis-ease. You can also wear away enamel by grinding your teeth or through consuming acidic food and drink.

As enamel wears away and gums recede, parts of your teeth that aren’t protected by enamel become uncovered. This leads to exposed dentine with thousands of microscopic pathways leading to the tooth’s nerve centre. When teeth come in contact with air or something hot, cold or sweet, sensations are carried through these microscopic channels to the nerves, causing painful tooth sensitivity. These open tubules are the pathway to sensitive tooth pain and both tooth pastes claim to actively block the tubules and protect against the pain of sensitive teeth.

Desensitising toothpastes containing potassium nitrate have been used since the 1980s while toothpastes with potassium chloride or potassium citrate have been available since at least 2000. It is believed that potassium ions diffuse along the dentinal tubules to inactivate intra-dental nerves.

Colgate’s Sensitive Pro-Relief does it with unique Pro-Argin™ technology. Arginine is an amino acid,

which is used to deliver calcium carbonate to the tooth. Senso-dyne Rapid Relief contains stronium chloride which is an element closely grouped with calcium. Stronium can be deposited in calci-fied tissue, like teeth or bones, as a substitute for calcium.

The stronium in Sensodyne Rapid Relief replaces some of the calcium lost from the dentine, forming a barrier that blocks the exposed tubules within the dentinal tissue. This prevents the flow of the fluid within the tubules that would otherwise cause pain. ¢

08 By George Garnier

There’s been a rush of toothpastes on the market claiming to relieve the pain of sensitive teeth in a minute. But what makes them work, and why are they appearing now?

Sensitive new-age teeth

“We know one in three Australians suffer from sensitive teeth, and now there’s a quick and easy solution to managing their pain.”

Jane Eakins, GlaxoSmithKline

9 SMILE

Choosing a toothpaste in the supermarket has

never been trickier.

At the dentist

10 SMILE

hildren’s oral health has been in the media spotlight again after an Ipswich woman was jailed last year for 12 months after pleading guilty to child cruelty. Her nine-year-old

daughter had 12 teeth extracted because she had given the girl only cordial to drink and had failed to take her to a dentist for more than three years. Ipswich District Court was told the girl had had a gum abscess that was draining pus, and she found the basic act of eating painful.

Following these reports, dentists and academics around the country called for parents to take their children for oral check-ups well before they begin school to reduce the number of toddlers being placed under general anaesthetic to extract rotting teeth or fit crowns. Perth paediatric dentist Peter Gregory—one of the city’s six paediatric dentists—told a newspaper dental decay among the pre-school group was common, with the city’s paediatric dentists each operating on children under anaesthetic three times a week.

“On little pre-schoolers we do little crowns and fillings, and extract teeth,” Dr Gregory said. “I probably do about six children a week, and these are cases where children have eight to 10 cavities.”

In Brisbane, Royal Children’s Hospital oral health service director Steve Atkin said up to 10 children under the age of five were put under general anaesthetic for extensive dental work at the hospital each week.

“In my research I found only 38 per cent of children have ever seen a dental profession-al by age four,” said University of Western Australia’s School of Dentistry Professor Linda Slack-Smith. “Our research has also indicated that 60 per cent of children first see a dental professional at the School Dental Service.”

Her 2003 study into the number of pre-school children across the country who were taken for dental check-ups before they turned five put Western Australia at the bottom. The state had the lowest proportion of three- and four-year-olds who had seen a dentist, at just 29 per cent. South Australia came out on top at 48 per cent.

The study found mothers aged over 30 and parents who had private health insur-ance were more likely to get their child’s teeth checked early on.

Dr Slack-Smith said while a large number of children were getting dental attention at school, there was a worrying increasing trend in number of decayed teeth found in pre-school children.

Young children from the lowest socioeco-nomic areas have about 70 per cent more dental decay than children from the highest socioeconomic areas, according to a report released in August by the Australian Institute of Health and Welfare (AIHW). The report,

10 By Helen Mellunwellun

Some recent media coverage has drawn attention to the sorry state of children’s oral health in Australia. But what can be done about it?

“In my research I found only 38 per cent of children have ever seen a dental professional by age four.”University of Western Australia’s School of Dentistry Professor Linda Slack-Smith

11 SMILE

Unfortunately, not enough people pay proper attention to

their kids’ teeth.

At the dentist

12 SMILE

Dental decay among Austra-lian children, shows poorer oral health in disadvantaged areas across all states and territories (for which data were available) although the extent was varied.

“Of children aged 5–6 years in Western Australia, dental decay was 22 per cent higher for children in the lowest socioeconomic areas than for those in the highest

socioeconomic areas, while in the Northern Territory the difference was a much greater 139 per cent,” said AIHW spokesperson Profes-sor Kaye Roberts-Thomson. New South Wales and Victoria were not included in the report as data were unavailable. Among children aged 5–6 years, nearly half had a history of dental decay in the deciduous teeth

(also known as baby teeth) and the average number of decayed, missing and filled teeth was two. Of children aged 12 years, nearly half had a history of dental decay in the permanent teeth and the average number of decayed, missing and filled teeth was 1.1.

“More than 40 per cent of Australian children aged 5–6 years had untreated decay

and a quarter of Australian children aged 12 years had untreated decay,” Professor Roberts-Thomson said. The proportion of children aged 5–6 years with untreated de-cay varied among states and territories from 29.3 per cent in the Australian Capital Ter-ritory to 49.7 per cent in the Northern Territory. There was no difference in prevalence of decay between boys

Dental health experts

fear Australia’s

complacency

towards oral health

is reaching epidemic

proportions, according to the

recent ADA Oral-B Power

Report. The report findings

revealed some shocking

issues particularly around

the number of people who

choose not to visit the

dentist. The survey indicates

almost three quarters of

Australians (74 per cent) who

experience toothaches, and

89 per cent of people who

suffer from red and swollen

gums that bleed, both major

indicators of serious oral

health problems, fail to

bring them to the attention

of a dentist. The majority

of those suffering prefer to

simply grin and bear the pain

rather than visit a dentist.

According to peadiatric

dentist Dr Philippa Sawyer,

Australia’s indifferent

attitude towards dental

health is not only impacting

negatively on the nation’s

oral health, but is clearly

having a knock on effect

when it comes to the future

of our children’s dental

health. “What is particularly

alarming is that in the last

year, over one in three

parents with a child suffering

from a dental health issue

delayed taking their child

to the dentist, or admitted

that they didn’t take them at

all, and one in ten parents

admitted they only take their

child to the dentist if they

have a serious problem.”

Dr Sawyer concedes

the findings were alarming

but not surprising.

“Unfortunately we are seeing

a substantial increase in

the number of children

with serious dental health

problems such as chronic

tooth decay that could have

been averted if parents

were informed of preventive

measures earlier in the

child’s life.”

Dr Sawyer recommends

a child’s first visit to the

dentist should be within six

months of the eruption of the

first tooth, or by the child’s

first birthday, however Dr

Sawyer says most parents

don’t bother taking their

child for a dental check up

until around three years of

age or older. Many parents

delay taking their child until

there is a serious painful

dental problem requiring

emergency care. This is not

the ideal introduction to

dental health professionals.

“Toddlers are just as much at

risk of dental decay as an older

child or adult and what may

have started as a small cavity

can quickly turn into a serious

problem,” Dr Sawyer said.

Dr Sawyer also believes

there is a need for greater

public awareness and

education about the impact

dental health has on our long

term overall health.

Oral health shockers

Complacency towards oral health is having an effect on our children.

and girls. A second report released at the same time, Changes in child tooth-brushing over time, shows that while toothbrushing is almost universally practised in Australia, there has been a decline in toothbrushing frequency among children.

Between 1993 and 2000, the proportion of children brushing less than once a day when they began brushing their teeth almost doubled from 8 per cent to 15 per cent. The proportion brushing twice a day reduced from a high of 44 per cent in 1993 to 32 per cent in 2000.

The proportion of children brushing with low-fluoride children’s toothpaste, as is recommended for children aged 6 years or under, has increased. Most young children now use low-fluoride toothpaste. Other recent Australian Institute of

Health and Welfare reports into children, released last year using data from 2003-2004, found those aged between five and 12 years in WA had the country’s lowest levels of dental de-cay. “However we still have a serious issue that many children under five, and too many under two even, have substantial dental (decay) requiring general aesthetic,” Dr Slack-Smith said.

She cautioned against blaming parents and called for more health campaigns

and for medical profes-sionals to look at children’s teeth as part of general health checks. That system was discussed at a recent South Australian health conference.

Another solution may come from work being done in South Australia. Professor John Spencer and the team at the Aus-tralian Research Centre for Population Oral Health will lead a national study into children’s oral health, de-signed to determine why is seems to be getting worse. They have been awarded $1.3 million to find out why the system is failing kids.

“Despite a substantial level of resources ap-proximately $1 billion dollars annually being directed to dental services for children in Australia in the last de-cade, their oral health is still a major public health prob-lem,” Professor Spencer told an Adelaide newspa-per. “After several decades of improvement, child oral health has worsened and inequalities have widened.”

Prof Spencer’s team will partner with all eight State and Territory public dental authorities in the research project. The newspaper reported the partners are committing a further $1.7 million to the national study, making the total funding for the study $3 million.

“In this study we will be looking at how dental services for our children are organised and deliv-ered, comparing the use of private dentists and school dental services and the out-comes for child oral health,” Prof Spencer said.

“Public programs like the school dental services are not reaching as many children, yet private dental services may be out of the financial reach of many families.” ¢

13 SMILE

Teen dental for all?Federal Health Minister Nicola Roxon has floated the idea

of extending the Medicare Teen Dental plan to all age

groups as a way of addressing public concerns about oral

health. Her suggestion came about as a way of honouring

Labor’s commitment to the Greens to deal with dental

health in the next Budget.

The Minister’s plan involves families earning up to

$110,000 a year getting help with serious dental bills in a

voucher system very similar to Teen Dental.

“Teen Dental has been a successful program for

delivering the service,” said the Minister. “You could

extend the age, you could extend different treatments

available under it.”

Last month Minister Roxon, and Greens senator

Richard Di Natale announced the establishment of the

National Advisory Council on Dental Health as part of

the agreement between the Gillard Government and the

Australian Greens.

Headed by former senior public servant Ms Mary

Murnane, the Council will provide expert advice on dental

health issues. Ms Roxon said the Council will look at the

current mix and coverage of dental services in order to

provide advice on future needs and priorities.

NSW independent Rob Oakeshott said he was keen

to “turn around these disgraceful waiting list figures for

public oral health”.

“After several decades of improvement, child oral health has worsened and inequalities have widened.”Professor John Spencer, Australian Research Centre for Population Oral Health

At the dentist

14 SMILE

rom Victoria’s 2009 bushfires to the Bali bombings and the tsunami that rocked South-East Asia in 2004, odontologist and reserve naval officer Lieutenant-Commander Russell Lain is no stranger to disaster zones.But it wasn’t the career he originally planned. Restless with his work at his private practice, in 1994, Lain made the decision to do a one-year diploma which led him to become one of the nation’s leading dental detectives.

“Never in my wildest dreams did I imagine my career would turn out like this,” he says.

“I had been in my own practice in Swansea on Lake Macquarie [NSW] for 15 years. I was always adventurous and had been looking to stimulate my mind, but couldn’t commit to becoming a specialist.”

With a family to feed and bills to pay, Lain craved further intellec-tual stimulation but felt there were few options for career progres-sion open to him within the profession.

“You can get involved in study groups and read your journals, but to gain a qualification or do a Masters you have to stop your practice,” he says.

“Fortunately, I happened to find a Diploma of Forensic Odontol-ogy at Melbourne University which I thought was something I could do while maintaining a private practice.”

Two years on, with his diploma complete, things changed dra-matically for the man who now divides his time as a staff specialist, teacher and researcher between the Sydney Dental Hospital, the Department of Forensic Medicine and the Navy.

Having become the second specialist registered in forensic odontology in Australia, Lain soon found himself on overseas assign-ments, assisting the Australian Federal Police in the identification of bodies in disaster-ravaged areas and later, post-war historical work with the Royal Australian Navy and Australian Army. “Who would have thought? When it comes down to it, it’s teeth that are the heroes—so resistant to environmental damage after death,” he says.

“Dentistry comes into its own with its unique ability to identify deceased people where visual identification is not possible. It’s what we as dentists can do to contribute. The teeth that are so vulner-able to damage in life persist after death and are the very things that can help to bring some sort of resolution to families who have lost loved ones. It can be a great comfort to them.”

For many years, Australia’s military services have been investigat-ing the cases of servicemen killed and missing in action during the Second World War as well as the Vietnam War and the Confronta-tion Crisis. As an integral part of this military collaboration, Lain has dedicated close to 20 years as part of teams which have worked to locate and identify soldiers on Papua New Guinea’s Kokoda Track, searched for and located the Christmas Island grave of the Unknown Sailor from the loss of HMAS Sydney in 1941, which claimed the lives of 645 men, and Australian soldiers missing in action in Vietnam.

But historical odontology is just one aspect of Lain’s work. Apart

from researching and teaching odontology in Sydney, his disaster recovery work has also led him to Indonesia following the 2002 bombings, to Samoa and Thailand—both devastated by tsunami—and to Victoria after the state’s Black Saturday bushfires.

“Thailand was where I learned what disaster victim identifica-tion truly was,” he says. “It was confronting at first. There were over 4000 victims, but it was what I’d been trained for, so it was a chance to put all that training and those practise runs together.” In the end, he says, he found it “very rewarding”.

Over the years, Lain, now 56, has become an expert in the interpretation of marks including human and non-human bitemarks;

14 By Nicole Azzopardi

Whether it’s identifying soldiers missing in action or victims of natural disaster, odontologist Russell Lain has turned a career in dentistry into highly specialised detective work

Real-life CSI

“Dentistry comes into its own with its unique ability to identify deceased people where visual identification is not possible.”Lieutenant-Commander Russell Lain

15 SMILE

Real-life CSI

disaster victim and missing person identification; the management of identification operations; and age estimation.

Odontological identification is based on the location and collation of antemortem data, the generation of relevant post-mortem data, and the reconciliation of these data. Lain stresses that general prac-tice dentists have a large part to play in that process.

“The number one thing is the quality of the antemortem records or treatment records,” he says. “Forensic dental teams are largely dependent on the quality and accuracy of the patients’ treatment records. It’s paramount for the reconciliation process. We are com-promised without quality dental treatment records and that’s how the profession can help their patients and their families even after they are deceased.”

And while it’s a highly specialised area with limited employment and punctuated with gruesome realities, Lain says the training of the next generation of odontologists is paramount.

“Lots of people are interested in odontology and we always need to improve our skills in all aspects of dentistry,” he says.

“I love my job, and while I’d be quite happy never to see another deceased person, the investigation side is fascinating compared to doing scaling and cleaning! It takes a person with a slightly wacky sense of humour and it’s work you should not do by yourself. It’s challenging and stressful. Yet it’s varied and it’s interesting.

“I worked for years in the field of oral surgery and exodontia. It felt good to be able to get people out of pain. For me, forensic odontol-ogy represents another way to help people in pain, by helping to identify people who can’t be identified in the traditional way.” ¢

Russell Lain (here, and below) has

used his skill as a dental detective in disaster zones and

at war graves.

At the dentist

16 SMILE

isa Jamieson has become such a passion-ate and learned advocate for indigenous oral health. It became her mission after spending some time volunteering, following her degree, while travelling the world. That included a year and a half in Uganda and time in the Torres Straight, and being a flying dentist in Queensland.

One day, when working in the Torres Straight on some general anaesthetic sur-

gery, she found herself removing every single tooth in the mouth of a two-year-old. “Every single one had decayed to the stumps. So we were making dentures for him every six months.”

Disillusioned being “the one just pulling the teeth”, and feeling there had to be a better way of change, Jamieson returned to New Zealand to complete her Masters and a PhD, specialising in indigenous oral health studies. After that, finding her research opportunities were much better in Australia, she moved here, and now works as a Research Fellow at the Australian Research Cen-tre for Population Oral Health at the University of Adelaide.

It was this move that enabled her to change the focus of her research. While she characterises her earlier work as straightfor-ward epidemiology—describing the prevalence of certain condi-tions—she soon came to understand the limitations of this kind of research. “In terms of influencing policy, you can’t do much with just descriptive data. In Australia I’ve been doing more work look-ing at communities and families and links with substance abuse.”

It’s this research that examines the role social factors play in oral health that is paying dividends. “Up until 20 or 30 years ago there wasn’t a big difference between indigenous and non-indig-enous Australians in terms of oral health,” notes Jamieson. “That isn’t the case now.” Indeed in a recent co-authored research paper for the Medical Journal of Australia, Jamieson found the adverse clinical oral health outcomes for young Australian Ab-original adults were between two and 11 times higher than their non-indigenous counterparts.

This is of particular concern, she notes, because of the links between periodontal disease and general health, particularly cardio-vascular disease, kidney disease, diabetes and obesity—all lifestyle diseases that are also the most common cause of premature adult mortality among indigenous Australian populations. She writes, “this high prevalence of periodontal disease may contribute to a heavy burden of chronic disease in the future.” Another recent study demonstrated a clear association between substance abuse and periodontal disease among young Aboriginal Australian adults.

But it’s not just documenting the parameters of the problem that Jamieson is interested in: it’s also documenting the solutions. “Primarily we’re about prevention,” she says. “Building the fence at the top of the cliff rather than being the ambulance at the bottom.”

Here Jamieson says there are three aspects to addressing these big dental challenges.

First is changes in diet. “That’s things like making sure people are buying toothpaste with more fluoride, drinking more water and less soft drinks.” For remote communities particularly, says

16 By Sharon Aris

Dr Lisa Jamieson has become one of our leading advocates for indigenous oral health. But is she researching a problem without a solution?

The change agent

17 SMILE

Jamieson, this is all about access. Especially if there’s only the one store in the community, change needs to happen on that level and products that aren’t conducive to good oral health “shouldn’t be the easiest choice—but often now they are. We’re trying to make healthy choices the easy choice and that means getting the community stores on board. But that’s not easy—they need to make money, and they don’t make it out of promoting drinking water instead of soft drinks.”

The second area is to make oral health a priority. “A toothbrush

and toothpaste in every house”, is Jamieson’s goal. She adds strategies like an oral health week or using ‘oral health ambassa-dors’—role models—in the communities, who “happen to have a toothbrush in their back pocket” could go a long way here.

The third area is around the provision of dental services. Here, says Jamieson, there are two key issues: they’re not always in the communities and if they are there they’re not always accept-ed. “If people have had a bad dental experience they don’t go to the dentist, so as well as getting dentists out there, we also need ways of assisting the community to access them. There’s

no sense having a dentist sitting out there twiddling their thumbs.”

Jamieson is the first to acknowledge these kinds of changes will take time and will occur incrementally.

“Research indicates that it is nigh on impossible to change people’s behaviours and that change is generational,” she says. “When there has been a public health behavioural change—like getting people to wear seatbelts—it has been enforced by laws. But you can’t enforce using toothbrushes. So we need to under-stand that our work must be long-term.” Indeed, says Jamieson, it could take 20 years before you see evidence of change like being able to visit remote communities where there are fewer people missing teeth, “so that won’t be seen as normal”.

“It does boil down to education. The more people going to school, the more awareness there is.”

“I know from my years practising as a dentist that you want to say to people ‘just get your life together’ but it’s about social capi-tal—the context of the life in which they live. If they feel they’re not in charge of anything, their mouths are just part of that.”

Jamieson for her part is in it for the long haul and she intends to keep doing what she does best—maintaining the links with the many communities that participate in her research (there are 42 alone in the Top End of the Northern Territory, and others in Port Augusta, Darwin and Alice Springs) and getting out into the field when she can, now with two very young children and a supportive husband in tow. All the while building those relation-ships that will last into that next generation. ¢

When working in the Torres Straight on some general anaesthetic surgery, she found herself removing every single tooth in the mouth of a two-year-old.

Dr Lisa Jamieson has become an expert in indigenous oral health.

G o o d d e e d s

18 SMILE

I’m a member of a dragon boat club called Dragon’s Abreast that was formed for the support of breast cancer survivors. We train in Blackwattle Bay in Sydney. The fact that we are a breast cancer survivor’s club means nothing when it comes to regattas—we’re in it to win it!

“At the end of October last year, there was a big regatta in Darling Harbour to raise funds for Dragon’s Abreast Australia. This charity helps breast cancer survivors add to their health in recovery, both mentally and physi-cally. Exercise after breast cancer surgery is extremely beneficial and dragon boating is ideal as it involves the shoulders and the upper body. There’s also the camaraderie that makes it mentally supportive.

“I have never been a sporty person but after I recovered from breast cancer, I at-tended a breast cancer seminar and met the Dragon’s Abreast people during a break. I told them, ‘I wouldn’t dream of doing this. I’ve never played any sports and I’m just not

competitive in that way.’ One of the ladies looked me up and down and said, ‘Our youngest member is 28 and our oldest is 70. I don’t see that you have any excuse.’ Mind you, she failed to mention that the 70-year-old used to be an ocean swimmer! So I gave it a shot.

“In the past I have put together a team of people from the dental industry. The team was called Dragon’s Teeth. One of the worst aspects of dentistry is the constant hunching. Paddling a dragon boat makes your body move and stretch in a different way. It feels great! ¢

To find out further information, go online to www.dragonsabreastfestival.com.au.

18 H o m e a n d a w a yArticle by Kerryn Ramsey

Dr Meng Quah-Shepherd found a great way to help breast cancer research and help survivors recover at the same time

Enter the dragon

How much do you really know about teeth whitening?

Some teeth whitening procedures can leave you with unwanted side effects.

If you are considering getting your teeth whitened, make sure you get all the facts before making your decision.

Visit teethwhiteningfacts.com.au and get the full story.

For more information about teeth whitening or other dental matters visit ada.org.au or talk to your dentist.

24 hour protection*

against germs that cause plaque, gingivitis

and bad breath1,2

*When used twice daily.ALWAYS READ THE LABEL. Use only as directed. Consult your healthcare professional if symptoms persist.

References 1. Fine DH, et al. J Periodontal 2007; 78: 1935-1942. 2. Listerine label. 3.Fine DH, et al. J Periodontal 2000; 27; 157-161. 4. Pan P, et al. J ClinPeriodontal 2000; 27: 256–261. 5. Sharma N, et al. J Am Dent Assoc 2004; 135: 496-504. 6. Gordon JM, et al. J Clin Periodontal 1985; 12: 697-704.7. Overholser CD, et al. J Clin Periodontal 1990; 17: 575–579. 8. DePaola LG, et al. J Clin Periodontal 1989: 311–315. 9. Charles CH, et al. J Am DentAssoc 2001; 132: 670–675. 10. Charles CH, et al. J Clin Periodontal 2004; 31 :878-884. ® Trademark. ASMI number ASMI/19055-0611

• Effective broad spectrum antiseptic mouthwash 3

• Powered by a unique essential oil formula that kills germs in hard to reach places 4,5

• Clinically proven to significantly reduce plaque and gingivitis 5-10

• Provides a deeper, whole mouth clean 4,5