Volume 11 Number 2June 2010Editorial 50 Tributes 51 Dental care in multiple sclerosis: an overlooked and under-assessed
condition Dentistry for individuals with special needs in Saudi Arabia:
a commentary Oral health policy and access to dentistry in care homes Evaluation of objective and subjective methods for assessing
dental anxiety: a pilot study The history of childhood disabilities Continuing Professional Development Programme 89 Dental health research (1997-2007) concerning people with learning
disabilities: a systematic review addressing the extent to which
they are involved in research Diary 96 Editorial Valuing People The contents of this issue of the Journal reflects a disappointing lack of access, availability and acceptability about services for people with disabilities. Each paper documents, whether it is about the delivery of services, access to appropriate care or consideration about real involvement in research, areas where disabled people are not treated in an inclusive manner nor equitably. The Journal is now nearly ten years old and in that time, in the UK at least, there have been significant advances in making special care dentistry available to many more people; the speciality has become recognised, the availability of education and training of the dental team has become more widespread, the UK’s General Dental Council has opened up its Specialist List and 119 specialists to date have been added to that list, mostly by mediated entry and one through the academic route. A number of consultant appointments have been made around the UK and a small number of three-year training places have been funded. How has this impacted on people with disabilities? If the contents page of this issue and others is to be believed, the answer must be, some progress but a lot more to do. To an extent, lack of significant advances for vulnerable patients is due to a paucity of an evidence base around what we do; that is not to say that things do not happen for special groups but rather they do so in an uncoordinated and fragmented way and sometimes not at all; because oral health is not valued by others and there are no guidelines around what we should be doing. In part, it is a lack of suitably educated and trained dental personnel. A recent report from the Dental Schools Council in the UK highlights this ((Dental Schools Council, 2010). In the autumn of 2009, there were only 4.7 FTE (full-time equivalents) in Special Care Dentistry, across all grades, recorded as clinical academics in British universities. This compares with 41.4, 22.5 and 25.6 FTEs in three specialities traditionally close to Special Care: Paediatric Dentistry, Public Dental Health and Oral Medicine, respectively. By contrast, there are 7.7 and 169.3 FTEs in Oral Radiology and Restorative Dentistry, respectively. Of note, Special Care Dentistry is the only speciality in dental schools in the UK where the gender balance is in favour of females at 66.7%. The report makes the point that ’the dental health of the population and the teaching of future generations of dentists depends on improved levels of recruitment into and retention of dental clinical academics’. Without an academic base to support the development of education and training in Special Care Dentistry, not only of clinical academics but also the entire dental team, including their on-going continuing dental education needs, the speciality and what it hopes to achieve, will struggle. Having achieved so much in securing both specialist and consultant posts to deliver service and some education and training, this deficiency must be addressed. June Nunn, Dental Schools Council. Clinical Academic Staffing levels in the UK Dental Schools. 2010. Tributes James Neil Swallow BDS MDS James Neil Swallow, known as Neil, died on 29 April 2010 at the age of 78. Neil’s name was synonymous with paediatric dentistry for dental students of my generation. He authored the archetypal paediatric dentistry textbook that many people may remember – Child Dental Health. A practical introduction by PJ Holloway, JN Swallow and GL Slack. At a time when there was very little interest in the oral health of people with a disability, Neil established clinics for children with disabilities at the London Hospital and at Dr Barnardo’s Home, and consulted for the Bobaths at their London centre for children with cerebral palsy in the late 1950s and early 1960s In 1964, Neil was appointed as the founding senior lecturer in Children’s Dentistry at the then new Cardiff Dental School. There he established a teaching programme in Paediatric Dentistry (using role play to help students understand patients’ and parents’ experiences); he developed a dental service for both children and adults with a disability and in 1967, he published his MD thesis on the oral health of people with disability. The Wednesday morning clinics were famous in the dental school with up to 200 patients of all ages and with all types of disability and/or medical conditions booked in and as many staff and final year students as were available providing their dental treatment. In 1975, Neil became Professor of Paediatric Dentistry at the University of Amsterdam where he continued the tradition of providing oral care for children and adults with disability. He taught the undergraduates that, contrary to general belief in Holland at that time, the use of local anaesthesia assisted the delivery of children’s dentistry with the benefit that children stopped crying and were easier to treat. He established a community based clinic in the old part of Amsterdam where the dental therapists he trained provided children’s dentistry. Around 1980 he was appointed to Professor of Restorative Dentistry at Belfast Dental School, once again establishing a comprehensive dental service for people with disability. On return to England, Neil and his wife Barbara opened a dental practice in their home. Barbara ran it while Neil acted as a consultant to the practice and house husband to Barbara and their two children. Although a paediatric dentist by repute, Neil was one of the founding fathers of Special Care Dentistry and I was fortunate enough to work with him in Cardiff and Amsterdam. He influenced the career direction of many undergraduates and newly qualified dentists, and amongst them were myself and Sue Greening. Neil was a man ahead of his time and like many trailblazers his
innovative ideas were not always appreciated until much later. His
funeral service was a musical celebration of his life. The Right
Reverend Bill Ind spoke fondly of Neil. His words that ‘Neil
loved to discuss and debate but he always set out to win’ brought
back warm memories of Neil running intellectual rings round some
people, all the time with a mischievous twinkle in his eyes. Janice Fiske
Dr. Liana Zoitopoulos was born in Athens, Greece however, due to her father’s long-standing professional commitments in Liverpool, Liana received both her primary and sixth form education in the city before studying at Liverpool University, receiving her Bachelor of Dental Surgery in 1980. Following qualification, Liana embarked upon a career in the Community Dental Service, initially as a vocational trainee in the Cheshire Area Health Authority Community Dental Service and then taking up a dental officer position in Halton. Liana’s career progressed rapidly and within five years of qualification she became Assistant District Dental Officer for Halton in 1985. During her time in this position, Liana studied for and successfully completed her Master’s degree in Community Dental Health at the University of Birmingham. In 1992 Liana became the Head of Community Dental Services for the King’s Dental Institute and over the next 18 years was responsible for transforming the service from a traditional community dental service to the Department of Community Special Care Dentistry, providing comprehensive oral health care to a wide range of complex patients in a variety of clinical settings. Liana was recognised as a Specialist in Paediatric Dentistry in 2000 and was appointed as a Consultant in the Department of Community Special Care Dentistry at King’s in 2002. She then went on to complete her PhD in 2004 and became an Honorary Senior Lecturer at King’s in 2005. Well respected for her clinical leadership Liana was instrumental in introducing many service developments over the years including, amongst many others, the development of an Infant Preventive Dental Scheme for children with complex needs under 5 years of age and successfully obtaining the contracts to provide dental services for three London prisons. Liana was also an enthusiastic teacher and introduced Special Care Dentistry outreach undergraduate teaching for year 4 and 5 students at King’s and also community outreach placements for dental therapy students. Liana had a keen interest in postgraduate dental education and established a number of highly regarded training posts within her department, including vocational training, MFDS training and, more recently, one of the first specialty registrar training posts in Special Care Dentistry. Liana was heavily involved in the organisation and delivery of postgraduate courses for the British Dental Association, the Advisory Committee for Community Dentistry, the British Association for the Study of Community Dentistry and the National Association of Prison Dentistry, an association she was instrumental in founding and for which she was the inaugural President. Liana worked tirelessly on behalf of Community Dentistry, Dental Public Health and Special Care Dentistry at local, regional, national and international levels. She sat on numerous influential committees and working groups including the Central Committee for Community and Public Health Dentistry, the Advisory Committee for Community Dentistry, the Inspections and Recognition Committee for the Royal College of Surgeons of England and BASCD Council. She was also a member of the Department of Health’s Valuing People’s Oral Health Working Party and contributed to the BDA working party on the development of the BDA Case Mix Tool. In recognition of her work Liana received honorary Fellowships from the Faculty of Dental Surgery of both the Royal College of Surgeons of England and the Royal College of Surgeons of Edinburgh, a Roll of Distinction Award from the British Dental Association and had also recently been installed as the President of the British Association for the Study of Community Dentistry. Liana Zoitopoulos was a truly unique individual within the world of Community and Special Care Dentistry who will be remembered by her colleagues as an insightful clinical leader, an enthusiastic educationalist, an astute politician, and a generous and inspiring mentor whose contribution to the profession was immense. For those who knew Liana well she will also be remembered as a loyal and dear friend. Rob Hale Dental care in multiple sclerosis: an overlooked and under-assessed condition Yara Dadalti Fragoso MD, MSc, PhD1, Heloisa Helena Carvalho Alves BChD2, Letícia Carvalho Alves BChD2, Natalia Carvalho Alves BChD2, Célia Maria Siqueira de Andrade BChD2 and Alessandro Finkelsztejn MD, MSc3 1Department of Neurology, Universidade Metropolitana de Santos, SP and Multiple Sclerosis Reference Center for the Coastal Region of the State of São Paulo, DRS IV, SP,; 2Universidade Santa Cecília, Santos, SP; 3Hospital de Clinicas de Porto Alegre, RS, Brazil.
There are approximately one million residents with disabilities in Saudi Arabia. The Saudi societal view of individuals with disability is of people who are helpless, dependent, home-bound and lack productivity. There are reports of patients with disabilities who present management difficulties, are in need of increased oral hygiene and who have caries ratios comparable to the general population. However, there is little or no preparation of dental students to provide services for their special needs. Examples of dental education accreditation standards in other countries are used as models for needed educational programmes. Oral health policy and access to dentistry in care homes N Monaghan FDS RCPSGlasg, FFPH1 and M Z Morgan MPH, M Phil, FFPH2 1Consultant in Public Health, National Public Health Service Wales, Temple of Peace, Cardiff, CF10 3NW: 2Lecturer in Dental Public Health, Cardiff University School of Dentistry, Heath Park, Cardiff, Wales Aims and objectives:
Sarah L Kime BDS MFDS (RCS Edin)1, Katherine E Wilson BDS M.Sc
Ph.D DDPH (RCS Eng) MFDS (RCS Edin) and Nicholas M Girdler BDS FDS
(RCS Eng) Ph.D2 Abstract Aim and objectives: The History of childhood disabilities Clinical Professor Emeritus, University of California, School of Dentistry, San Francisco, USA
Appreciation of the uniqueness of childhood can foster awareness and recognition of the special needs for children. The aims of this article are to delineate the definitions of childhood disability and describe childhood disabilities through the ages with a chronological perspective and a focus on dental disabilities. Patients with the disabilities associated with the Ectodermal Dysplasias and Naevoid Basal Cell Carcinoma Syndrome are used to illustrate the effects on oral health.
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