Volume 10 Number 3

September 2009

Editorial 98

Provision of oral healthcare and support in care homes in Scotland
Valerie A A White, Maura Edwards, M Petrina Sweeney and Lorna M D Macpherson 99

The placement of implants in patients who are medically or intellectually compromised.
A review of the literature and case reports
L Owens, N Claffey, M O'Sullivan, F Houston and J Nunn 107

Proposals for a dental care professional qualification in special care dentistry: results of a UK survey
Gillian Jones, Janet Griffiths, Neil McCusker, Colleen Rooney, Sue Hilton and Lindsay Hunter 115

Continuing Professional Development Programme 122

Oral health status and oral impact on daily performance in an adult population with leprosy living in rural Tanzania
Katherine E Wilson and Rachel Opie 124

Cowden's syndrome impacting on oral health: considerations for the oral healthcare worker
Karwan A Moutasim, Penelope J Shirlaw and Stephen J Challacombe 131

Cognitive behavioural therapy and severe needle phobia - a case study
Phidelma Lisowska and Liana Zoitopoulos 135

Hajdu Cheney syndrome: a case report
Mubeen, Ridhima Sharma and Rupa Chandramala 139

Diary 144

Editorial

Time for vision

This time last year I wrote about the rapidly approaching establishment of a Specialist List in Special Care Dentistry, held by the General Dental Council in the UK. A landmark then, after many years, when on 3 September 2008 Special Care Dentistry was formally recognised as a speciality in the UK, alongside other, long established specialties such as Orthodontics and Restorative Dentistry. For those who have not undergone formal training programmes, of which there have been few, the period of mediated entry onto the Specialist List will cease at the end of September 2010.

The Specialist List in the UK contains, at the time of writing, 63 names. All these have undergone a rigorous application process and review by a number of peers who are well-established within the speciality, on behalf of the General Dental Council who have the ultimate responsibility to decide on an applicant's suitability to enter a Specialist List.

Much of the energies of specialist organisations in Special Care Dentistry have been channelled, and continue to be so in many countries, towards recognition of what special care dentists do. Never has this been more important in this time of financial exigencies when funding for public services and the vulnerable patients whom Special Care Dentistry encompasses, is under real threat.

That notwithstanding, the formal establishment, in the UK at least, of a speciality throws the spotlight on the need for well founded training programmes. In the UK, these will be training programmes starting in September 2009 that will provide the range of education and skills training to ensure that future specialists will be able to demonstrate successful completion of three-year, full time courses in order to gain entry to the Specialist List. Many countries have well developed masters and diploma courses such that the skill base should be expanding. The potential for flexibility in training, particularly for Special Care Dentistry will be an important element to build into such programmes. Although fraught with difficulties, it is timely to revisit workforce planning in this area, especially with the interest expressed by dental care professions in joining special care teams. The article by Jones and colleagues in this issue points to the need for health services to fund training, especially for those committed at the postgraduate level to team care within Special Care Dentistry.

The need for team training at the undergraduate level needs to be further embedded in dental school curricula; there is enormous scope for not only engendering and maintaining an empathetic attitude amongst undergraduates of all types to special care patients but an eagerness amongst such students to be more clinically involved in the direct care of these patients. By these means, dental schools can also demonstrate their commitment to the wider community, with service that extends beyond providing for the conventional training needs of their students and sophisticated secondary and tertiary care.

Whilst many are goaded into entrenchment and parsimony as the impact of the global downturn is felt, others argue that this is a time for development, entrepreneurship and vision. Although it could be reasoned that Special Care Dentistry is in its infancy - and in many areas this is so - it could also be said that we have accumulated considerable evidence on the oral health issues of people with special healthcare needs. A glance at the titles in this issue will confirm this. Now is the time for many beleaguered public dental services, on which such patients depend, to take a fresh look at how we might imaginatively address the issues that these authors so eloquently outline.

June Nunn, Editor.
Dublin, August 2009

Provision of oral healthcare and support in care homes in Scotland

Valerie A A White BDS, MFDS RCS Ed, MPH, DDPH, Maura Edwards BDS, MPH, PhD, FDS(DPH) RCPS, M Petrina Sweeney BDS, MSc (MedSci), DDS, FDS RCPS, Professor Lorna M D Macpherson BDS, MPH, PhD, FDS RCPS, FRCD(C), FFPH

Department of Public Health, Fife, Scotland

Abstract

Aim: To describe the reported oral healthcare and support provided in care homes for older people in Scotland.
Design: A cross-sectional, descriptive study was undertaken using postal questionnaires. A stratified random sample of 327 Scottish care homes was selected for inclusion in the study. The questionnaire was sent to the managers of the selected care homes for completion.
Results: The response rate to the study was 72% (N=234). The vast majority of managers reported that their home had a provider of urgent dental treatment, although many managers raised concerns over the accessibility and responsiveness of the service. Only half the managers reported that oral assessments of residents were undertaken within one week of a resident's arrival at the care home; of those who reported that such assessments were undertaken, only 27% of managers reported that staff performing such assessments were trained to do so. All care home managers reported that staff provided oral healthcare assistance to residents if it was required; however less than half of managers reported that their staff received any training in this area. Care home managers were also less likely to rate oral health as a high priority, compared to other healthcare areas.
Conclusions: The results of this study show that, in a large proportion of care homes for older people in Scotland, the provision of oral healthcare and support for oral health care assistance falls below that of currently published guidance specific to the oral health of older people in care homes.

The placement of implants in patients who are medically or intellectually compromised. A review of the literature and case reports

L Owens BDS MFD RCSI1, N Claffey BDS (NUI) MA M Dent Sc FDSRCPS (Glas) FFDRCSI FFD2, M O'Sullivan BA, B Dent Sc MSc(Lond) PhD FDSRCSI FDSRCS (Ed)3, F Houston BDS (NUI) MA FDSRCPS (Glas) FFDRCS1, J Nunn MA BDS PhD DDPH RCS (Eng,) FDS RCS (Edin) FDSRCS FFDRCSI FRCPCH FTCD4

1Acting Senior Dental Surgeon in Special Needs, Dental Section, Health Service Executive Dublin North, Ireland; 2Professor of Periodontology and Implant Dentistry, 3Senior Lecturer/Consultant, Division of Restorative Dentistry and Periodontology, Dublin Dental School and Hospital; 4Professor of Special Care Dentistry, Division of Public and Child Dental Health, Dublin Dental School and Hospital, Lincoln Place, Dublin 2, Ireland.

Abstract
Recent legislative changes now insist on equal access to care for all patients. Those with medical or intellectual conditions are entitled to high quality dental treatment and this case series aims to show how this can be achieved. Important aspects for successful provision of this care include the use of adjuncts to deliver treatment, the inclusion of carers/family and a team approach for all those involved in these cases.

Proposals for a dental care professional qualification in special care dentistry: results of a UK survey

Gillian Jones BDS, DDPHRCS (England), MCDH, FFPH1, Janet Griffiths LDS (Bristol), BA (OU)2, Neil McCusker BDS, MFDS2, Colleen Rooney BDS, MFDS3, Sue Hilton Dip Dent Hygiene, Dip Dental Therapy4, Lindsay Hunter BDS, MScD, PhD, FDS(Paed)RCS (Edinburgh), FHEA5

1Peninsula Dental School, University of Plymouth, UK, 2University Dental Hospital, Cardiff, UK, 3Bristol Dental Hospital, Bristol, UK, 4Community Dental Service, North Wales NHS Trust, 5School of Dentistry, Cardiff University,UK

Abstract
Aim and objectives: To investigate demographic details, scope of practice, mandatory training, opportunities for Continuing Professional Development (CPD) and interest in a post-qualification course in Special Care Dentistry (SCD) amongst dental hygienists and dental therapists working in the United Kingdom.
Design: There were 5,224 dental hygienists and 461 dental therapists identified as registered with the General Dental Council (GDC) for 2006 and permitted to practise within the United Kingdom. A self-administered questionnaire was designed for data collection. A copy of the questionnaire was sent to all dental hygienists and dental therapists with registered addresses in Wales and one in ten of those with registered addresses in England, Scotland and Northern Ireland, giving a sample of 630.
Results: A total of 262 completed questionnaires were returned after one mailing, a response rate of 41.6%. The results reveal some interesting trends that may be relevant to the development and implementation of a dental hygienist /therapist qualification in SCD.
Conclusions: This study has shown that training courses in SCD for dental hygienists and dental therapists are likely to be highly valued and well-attended provided that funding issues are resolved. The authors suggest that such courses should, ideally, be overseen by one group and that closer links between dental hygiene/therapy and dental undergraduate training should be developed.

Oral health status and oral impact on daily performance in an adult population with leprosy living in rural Tanzania

Katherine E Wilson BDS MSc PhD DDPH (RCS Eng) MFDS (RCS Edin)1 and Rachel Opie2

1Newcastle upon Tyne School of Dental Sciences, 2Undergraduate Dental Student, Newcastle upon Tyne School of Dental Sciences, England

Abstract

Aim: To assess levels of oral health and their impact on daily performance (OIDP) in an adult population with leprosy living in a rural village in Tanzania.
Objectives: The objectives were three fold: to carry out an oral examination; to undertake a questionnaire survey; to make recommendations for provision of oral health care services.
Design: The study was an opportunistic population survey: carried out over four days. Adults with leprosy living at Bukumbi Care Centre (BCC) were recruited. An oral screening and an OIDP questionnaire were carried out for each subject after obtaining consent.
Results: Thirty three people were recruited, 15 men and 18 women, with an age range of 27-88 years (mean = 60 years). The mean DMFT was 10.48 (D=3.45, M=7.03, F=0.0) and 18 subjects (54.5%) presented with tooth mobility. Twenty people (60.6%) required treatment, but access to care was reported to be limited. The prevalence of oral impacts was 75.7%. The most common activities affected were eating, sleeping and cleaning teeth, with toothache being the main reason for reported problems arising.
Conclusion: The impact of dental disease on this population is significant and access to dental care is very limited. It is recommended that local government and the charity Bridge2Aid, work together to improve access to oral health education and emergency dental care for the residents of Bukumbi Care Centre.

Cowden's syndrome impacting on oral health: considerations for the oral healthcare worker

Karwan A Moutasim BDS, MFD RCSI, MSc1, Penelope J Shirlaw BDS, FDS RCS2, Stephen J Challacombe BDS, FDS RCS, FMedSci, FRCPath, PhD3

1Clinical Research Assistant, Centre for Clinical and Diagnostic Oral Sciences, Barts & The London School of Medicine and Dentistry, Queen Mary University of London; 2Consultant in Oral Medicine, 3Professor of Oral Medicine, Department of Oral Medicine, Guy's and St. Thomas' NHS Foundation Trust, Floor 18, Guy's Tower, London SE1 9RT.

Abstract

Cowden's syndrome is a rare autosomal dominant genodermatosis characterised by multiple hamartomas affecting all three germ layers coupled with an increased risk of developing cancer, most commonly of the breast, thyroid and endometrium. Here, we present a case of Cowden syndrome in an adult male where the chief complaint is the inability to maintain adequate oral health as a direct result of the oral manifestations of the condition. We also highlight the role of the oral healthcare worker in recognising and, when appropriate, referring such cases for specialist opinion and management.

Cognitive behavioural therapy and severe needle phobia - a case study
Phidelma Lisowska BDS FDS RCPS ILTM1, Liana Zoitopoulos BDS MCDH MHSM PhD ILTM FDSRCS Ed2

1Senior Dental Officer and Specialist in Paediatric Dentistry; 2Consultant in Special Care Dentistry/Honorary Senior Lecturer and Head: King's College London Dental Institute, London, UK

Abstract

Aim: To establish the aetiology of severe needle phobia in a 13 year old patient, investigate its effect and use a range of anxiety management techniques to overcome this, in order to achieve medical and dental treatment.
Method: The patient's history was explored in liaison with the anxiety team at the Maudsley Hospital, South London. Clinical examination was carried out using three steps: establishing the problem, identifying the effect on the patient and rectifying the problem. The latter was achieved through collaboration between the dentist and the patient to undergo cognitive behavioural therapy, to resolve the needle phobia.
Results: The three steps above led to cognitive behavioural therapy which resulted in overcoming the needle phobia.
Conclusions: Cognitive behavioural therapy can be used to support children and adolescents to overcome their fears of needles and injections in order to obtain treatment.

Hajdu Cheney syndrome: a case report

M Mubeen1, Ridhima Sharma2 and Rupa Chandramala2

1Professor and Head of Department, 2Postgraduate student, Oral Medicine & Radiology, Government Dental College & Research Institute, Bangalore, India

Abstract

Hajdu-Cheney Syndrome is a rare, autosomal dominant disorder of bone metabolism. Only one case has been reported describing abnormalities involving the tooth structure in this syndrome. This paper presents a plethora of dental findings of interest and highlights the structural changes in the dentine and cementum. Unexplained loss of teeth is a not infrequent occurrence in people with disabilities, who often have no aetiology identified for their impairment. In such cases, consideration ought to be given to the possibility of such syndromes as this particularly when radiographs of the orofacial region may be available as an additional aid to diagnosis.

JDOH home

BSDH home