Volume 10 Number 2

June 2009

Editorial 50

Recruitment difficulties associated with epidemiological surveys of the dental health of children with a Statement of Educational Special Needs in 4 PCTs in the Northwest of England in 2006/7
K Milsom, K Buchanan, J Neville and M Tickle 51

Evaluation of the impact of dental status and salivary secretion on people with dysphagia
B Bergendal, E Mörner-Serikoff, L Forsgren and J Wallquist 59

Oral hygiene education programme for intellectually impaired students attending a special school
K Kavvadia, A Polychronopoulou and K Taoufik 65

An overview of the Oral Motor Function Therapy Clinic in the Special Care Unit in Westmead Hospital, Australia
Leda Mugayar, Antonio Lee, Emma Jay, Melissa Compton and Simrit Malhi 75

An investigation of the caries experience of children with an intellectual disability living in a residential centre or at home
Zeynep Aytepe, E Bahar Tuna, Banu Ilhan, Didem Oner Ozdas and Esra Yamac 87

Oral health status amongst visually challenged children in Maharashtra: a survey
Shivlal Rawlani, Shobha Rawlani, Mukta Motwani, Shirish Degwekar, Rahul Bhowte, G Sharat and Atul Indurkar 91

EDITORIAL

It was with great delight that I said 'yes', when I was kindly asked to put some words together for this Editorial as the current President of IADH.

When a president is elected, naturally he or she has in mind goals to be achieved during the presidency. As the president of IADH, and as an individual who has had the opportunity of living overseas several times, one of my biggest goals is honouring the 'international' word in the Association's acronym. In order to do so I have been working very seriously and consistently in creating different arms to link IADH to other Associations and Societies across the Globe.

Collaboration is the word! Internationally is the adverb for it! By definition, collaboration is a recursive process where two or more people or organisations work together, an intersection of common goals. Collaboration does not require leadership and can sometimes bring better results through decentralisation. In particular, teams that work collaboratively can obtain greater resources, recognition and reward when facing competition for finite resources.

In the March 2009 Issue of the Journal, Professor Nunn pointed out the differences between equity and equality and their relation to oral health as a part of health promotion. Perhaps, we can add to it the intrinsic concept of collaboration and partnership, to which IADH has been opening its doors; IADH, as an international organisation has a lot to offer and a lot to contribute but we need to maintain the momentum initiated at congresses.

An initial partnership with Special Olympics International has been expanded to a future collaboration with the re-activated Developing Countries Working Group. This has been with a view to bringing some 'equity' for people who are marginalised and most disadvantaged.

IADH and the Special Care in Dentistry Association, from the United States of America, have started to work closer together - a significant partnership for future achievements, both at conferences and in day-to-day working. Another goal is bridging IADH to Asia and Asia to IADH. Let's allow the 'Dragon' to bring out the light of the Asian culture to our patients and colleagues.

And the bridge shall go to other countries and continents creating links and shelter to National Societies and Associations, as it should be one of the primary roles of an international organisation.

Perhaps I am a dreamer, a romantic dreamer willing to make IADH a 'small World' or maybe I am more than that … I am a believer! And if I may make my own the words of a recently elected President in his Presidential speech I will say:

"YES! WE CAN!"

Leda Mugayar
President of IADH

Recruitment difficulties associated with epidemiological surveys of the dental health of children with a Statement of Educational Special Needs in four PCTs in the Northwest of England in 2006/7

K M Milsom PhD, MSc, FDS, BDS1, K Buchanan2, J Neville BSc3 and M Tickle PhD, MSc, FDS, BDS4

1Consultant in Dental Public Health, Halton & St Helens Primary Care Trust / Honorary Senior Lecturer in Dental Public Health University of Manchester; 2Dental Public Health Projects Officer, Halton & St Helens Primary Care Trust; 3Dental Project Manager, The Dental Observatory, c/o Central Lancashire Primary Care Trust; 4Professor of Dental Public Health & Primary Care, University of Manchester.

Abstract
Aim and objectives:
To determine the dental health of children with a Statement of Special Educational Needs. To measure the dental health of children aged 5, 12, 14 years and year 6 (10-11 years) with a Statement of Special Educational Needs in four PCTs in Northwest England.
Design:
A cross sectional epidemiological survey of the dental health and socioeconomic status of children with a Statement of Educational Special Needs that were prepared to participate in the survey.
Results:
Two hundred and six schools with children in possession of a Statement of Special Educational Needs (94%) agreed to participate and 34% of parents agreed to allow their children to participate in the study. Participation was age related with 51% of 5-year-old children and 22% of 14-year-olds agreeing to participate. The mean weighted Index of Deprivation (ID) was higher amongst those parents who ignored requests to participate in the study than amongst those actively agreeing or actively refusing to participate in the study. The mean dental decay experience of the children participating in the study was similar to the wider same age population in the Northwest.
Conclusion:
The results suggest that participation in dental epidemiological studies amongst children with a Statement of Special Educational Needs is a problem and that the difficulty of recruitment is particularly acute amongst children from disadvantaged backgrounds and amongst older cohorts. Dental health among young children with a Statement of Educational Need was similar to that of the wider same age population. This study has highlighted the need to identify methodologies that will encourage wider participation in such dental studies.


Evaluation of the impact of dental status and salivary secretion on people with dysphagia

B Bergendal LDS1, E Mörner-Serikoff LDS2, L Forsgren LDS3 and J Wallquist MD4

1Head, Senior Consultant, National Oral Disability Centre, 2Hospital dentist, Department of Oral and Maxillofacial Surgery and Oral medicine, 3Senior Consultant, Department of Dentomaxillofacial Radiology: The Institute for Postgraduate Dental Education; 4Head, MD, ENT-clinic, County Hospital Ryhov, Jönköping, Sweden.

Abstract

Aim: To evaluate the impact of dental status and salivary secretion rates in individuals referred for swallowing difficulties.
Design: One hundred consecutive patients referred to an ENT-clinic for investigation of dysphagia were offered a dental examination including testing of salivary secretion rates. An evaluation was made of the impact of dental factors on the ability to swallow based on an interview on chewing capacity and choice of food, a panoramic radiograph, a clinical examination of dental status and salivary secretion rates for unstimulated and chewing stimulated whole saliva.
Results: In 90 examined individuals aged 14 to 92 years, 58 (64.4%) were 60 years or older. Many medical diagnoses known to affect swallowing were represented. Almost half of the patients had a cerebrovascular lesion or a neuromuscular disorder as their main medical diagnosis. In eight individuals a surgical intervention preceded the symptoms of dysphagia. In about half of the patients the swallowing disorder was localised to the pharyngeal phase and in one third to the oral phase of the swallow. In 61.7% of the patients decreased salivary secretion rates or a compromised dentition, or both, were judged to have a severe or moderate impact on the ability to swallow.
Conclusion: Referral for dental examination, including evaluation of dental status and salivary function, and in some cases oral rehabilitation, in patients referred for investigation of swallowing disorders is strongly advocated. Further studies are needed to evaluate the effect of dental treatment in individuals with dysphagia.

Evaluation of the impact of dental status and salivary secretion on people with dysphagia

B Bergendal LDS1, E Mörner-Serikoff LDS2, L Forsgren LDS3 and J Wallquist MD4

1Head, Senior Consultant, National Oral Disability Centre, 2Hospital dentist, Department of Oral and Maxillofacial Surgery and Oral medicine, 3Senior Consultant, Department of Dentomaxillofacial Radiology: The Institute for Postgraduate Dental Education; 4Head, MD, ENT-clinic, County Hospital Ryhov, Jönköping, Sweden.

Abstract

Aim: To evaluate the impact of dental status and salivary secretion rates in individuals referred for swallowing difficulties.
Design: One hundred consecutive patients referred to an ENT-clinic for investigation of dysphagia were offered a dental examination including testing of salivary secretion rates. An evaluation was made of the impact of dental factors on the ability to swallow based on an interview on chewing capacity and choice of food, a panoramic radiograph, a clinical examination of dental status and salivary secretion rates for unstimulated and chewing stimulated whole saliva.
Results: In 90 examined individuals aged 14 to 92 years, 58 (64.4%) were 60 years or older. Many medical diagnoses known to affect swallowing were represented. Almost half of the patients had a cerebrovascular lesion or a neuromuscular disorder as their main medical diagnosis. In eight individuals a surgical intervention preceded the symptoms of dysphagia. In about half of the patients the swallowing disorder was localised to the pharyngeal phase and in one third to the oral phase of the swallow. In 61.7% of the patients decreased salivary secretion rates or a compromised dentition, or both, were judged to have a severe or moderate impact on the ability to swallow.
Conclusion: Referral for dental examination, including evaluation of dental status and salivary function, and in some cases oral rehabilitation, in patients referred for investigation of swallowing disorders is strongly advocated. Further studies are needed to evaluate the effect of dental treatment in individuals with dysphagia.

Oral hygiene education programme for intellectually impaired students attending a special school

K Kavvadia DDS, MDentSc, PhD1 , A Polychronopoulou DDS, MS, PhD2 and K Taoufik DDS1

1Department of Pediatric Dentistry, 2Department of Community and Preventive Dentistry; University of Athens School of Dentistry, Athens, Greece

Abstract

Background: The oral health of individuals with intellectual impairment in Greece has been found to be poor, particularly their periodontal status, mainly due to lack of oral hygiene.
Aim: To test a school-based programme for young adults with intellectual impairment, by evaluating their plaque removal efficacy when trained weekly for three months and the effectiveness of this programme, two years after training.
Design: The sample consisted of 57 students with intellectual impairment, mean IQ 45 and mean age 21-years-old, who attended a special school in Athens, Greece and whom it was thought could be trained in oral hygiene practices. For three months, students watched a weekly oral health presentation, practised brushing on model teeth, had their plaque disclosed and recorded by OHI-S index and then brushed their own teeth under supervision. Plaque was re-evaluated two years after training. Results were analysed using paired t-test.
Results: The mean plaque scores before and after training were 10.9 and 9.3 respectively. This improvement was statistically significant (p<0.05). Those students who attended more than six sessions demonstrated the greatest improvement in plaque scores (p<0.05). At the end of two however, students were less efficient in plaque removal and the mean plaque scores were not statistically significantly different from the baseline.
Conclusion: This weekly, school-based oral health programme has been effective in improving the oral hygiene of students with moderate intellectual impairment. However, to be effective long-term it has to be delivered continuously.

An overview of the Oral Motor Function Therapy Clinic in the Special Care Unit in Westmead Hospital, Australia

Leda Mugayar MS DDS1, Antonio Lee BDS MSc2, Emma Jay BDS FRACDS(SND)2, Melissa Compton BAppSc (Speech Path)3 and Simrit Malhi BDS MDS FDSRCS (Eng) FRACDS4

1Head of Special Care Unit, Staff Specialist, 2Senior Dental Officer, 3Senior Speech Pathologist,4 Specialist Paediatric Dentist; Westmead Centre for Oral Health, Sydney West Area Health Service, Australia.

Abstract
Oral Motor Function Disorder (OMFD), such as feeding problems, occurs frequently in children with neurological impairment. Common parental complaints include: poor sucking, difficulty in breastfeeding, problems with the introduction of solid foods, difficulty in drinking liquids, difficulty in biting or chewing solids, and coughing and choking with meals. OMFD is a major factor in the pathogenesis of under nutrition and usually correlates with the severity of motor impairment. Children with more severe impairment who are unable to lift their heads or feed themselves have a higher risk of aspiration. The Oral Motor Function Therapy (OMFT) clinic in Special Care Unit in Westmead Centre for Oral Health looks after children with disabilities who have problems with drooling, eating and drinking. OMFT includes many home based exercises involving the carers and the children. This paper gives an overview of the running of the OMFT clinic, including the aim of the clinic, method of assessment, diagnostic criteria, different OMFT and treatment approach.

An investigation of the caries experience of children with an intellectual disability living in a residential centre or at home

Zeynep Aytepe DDS, PhD, E.Bahar Tuna DDS, PhD, Banu Ilhan DDS PhD, Didem Oner Ozdas DDS, Esra Yamac DDS

Department of Pedodontics, Istanbul, Turkey

Abstract

Aim and objectives: Behaviour and attitudes of children are influenced by their parent's and caretaker's knowledge of health and prevention of disease. The absence of family support might also influence oral health behaviour. The aim of this study was to determine and compare the caries prevalence of children with an intellectual disability (ID) who were living in a government institution with ID children who were living at home with their families.
Methods: A total of 81 children, aged between 6-13 years, and divided into three groups (Group A,B,C), were examined. The children in Group A lived in a government institution all day. Group B children lived partly in a government rehabilitation centre. Group C children lived with their parents. Tooth brushing habits, periodontal status and daily dietary schedules of the children were recorded.
Results: Mean age of groups A,B,C were 10.1, 8.5, and 9.1 years respectively. The caries status of all groups was determined using DMFT and dft indices. The mean dft in group A was 0.78±1.40 and DMFT was 1.30±1.64. In group B, the mean dft was 1.46±1.65 and DMFT was 1±1.65, and in group C the mean dft was 5.04±3.29 and DMFT was 3.4±2.17. The level of dental caries was the highest in group C.
Conclusions: From a preventive dental health perspective, special attention should be focused on subjects with ID who are not living in institutions. Increasing caretakers' and families' participation in the oral care of children with ID, and frequent follow-ups, are essential in maintaining appropriate dental health care for this special group.

Oral health status amongst visually challenged children in Maharashtra, India: a survey

Shivlal Rawlani MDS1, Shobha Rawlani MS2, Mukta Motwani MDS3, Shirish Degwekar MDS4, Rahul Bhowte5, G Sharat MDS6 and Atul Indurkar MDS7

1Senior Lecturer, Department of Oral Medicine & Radiology, Sharad Pawar Dental College; 2Professor, Department of Anatomy Mahatma Gandhi Institute Medical Sciences; 3Professor; 4Professor and Head, Department of Oral Medicine & Radiology, Sharad Pawar Dental College; 5Professor and CMS Dept. of Oral Medicine & Radiology: DMIMS, Sawangi (M), Wardha, Maharashtra, India; 6Assistant Professor, Department of Oral Medicine & Radiology, Drs S&N SIDS, Chinaoutapalli, Gannavaram, Vijayawada, Andhra Pradesh, India. 7Associate Professor, Department. Of Oral Medicine & Radiology, Sharad Pawar Dental College, DMIMS, Sawangi (M), Wardha, Maharashtra, India.

Abstract
Aims and objective: To evaluate oral health status amongst visually challenged children.
Design: The study was conducted on 202 visually challenged children during the 16th Annual Blind Welfare and Educational Week, organised by the National Federation of the Blind in Maharashtra at Wardha. For the present study, the following indices were used: OHI-S, DMFT/dmft, DMFS/dmfs and Löe & Silness Gingival index.
Results: The prevalence of dental caries was 64.9% and the prevalence of periodontal disease in male:female children was 51.9%: 62.5%. The mean DMFT (SD) Score was 2.1 (2.2), the mean DMFS Score was 4.2 (4.1). The mean OHI-Score was 2.3 and the mean Löe & Silness score was 0.9.
Conclusions: The prevalence of dental caries and periodontal disease was found to be higher in comparison to the normal population. One of the major goals of special education is the integration of the person with a disability into the society in general and enabling and maintaining oral health is part of this process.

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