Volume 12 Number 3September 2011Editorial 98 Evaluation of noncavitated and cavitated carious lesions using
the International Caries Detection Assessment System (ICDAS II)
and oral hygiene in Thai students with disabilities Reliability of the BDA case mix tool for use in special care
dentistry A pilot audit of oral health in mechanically ventilated critically
ill patients The use of applied tension to manage orthodontic extractions
in Blood-Injury-Injection Phobia: a case report Dental treatment for a patient with motor neurone disease completed
under total intravenous anaesthesia: a case report A case report of the dental management of a patient with Sotos
syndrome Solitary median maxillary central incisor in two healthy siblings:
case report Case report: management of unerupted incisors in a patient with
Angelman Syndrome
A paradigm is a set of assumptions, concepts, values and practices that constitutes a way of viewing reality. The dominant paradigm in health has undergone a massive shift in the last 20 years. The ubiquitous medical model that revolved around disease management was revolutionised by concepts of quality of life and the behavioural aspects of health. Further evolution has reached beyond the realm of the individual into the domain of the social determinants of health (Marmot & Wilkinson, 1999) and the concept of universal human functioning (Bickenbach et al., 1999). In the domain of disability, this change has been particularly palpable in the WHO system of classification (Stucki & Grimby, 2004). The original International Classification of Impairment, Disability
and Handicap (WHO, 1980) described a linear model with a disease
or disorder leading directly to impairment then disability and handicap.
The current International Classification of Functioning (ICF: WHO,
2001) abandons the negative connotations of impairment and handicap.
It is a complete classification of human functioning in terms of
body function and structure, individual activity, and participation
in society. These dimensions are modified by environmental and personal
factors. Disability is thus not considered an illness but is defined
according to how a person fulfils his/her normal social role within
a given environment. It is universally applicable to all persons,
with or without a declared disability, and critically, recognises
the major influence of environment on human function. So how can special care dentists help to reduce inequalities through paradigm shift? The ICF is an enlightening gift to those wishing to improve oral health for all disenfranchised groups in society. ICF Core Sets are already well recognised as practical tools used widely in other disciplines (Stucki & Grimby, 2004). The future development of ICF Core Sets for Oral Health could enable: Collection of reliable, reproducible epidemiological data, comparable
between local and international communities It is my belief that the International Association for Disability and Oral Health (iADH) is facilitating this paradigm shift by endorsing the ICF model. Paradigm shifts are discreet, implicit and intangible but they can rapidly and radically revolutionise thinking and thus action, particularly in terms of attitude, policy, legislation and service provision. Education and dissemination of knowledge hold the key to this process and the iADH have recognised this priority. The association’s action to develop core curricula in special care dentistry based on the ICF is an important step in encouraging change. For further information regarding the development of core curricula for special care dentistry visit www.iadh.org or contact: scipe@iadh.org For further information regarding the project to develop ICF Core Sets in Oral Health contact denise.faulks@u-clermont1.fr References Dr Denise Faulks, BDS, PhD Evaluation of noncavitated and cavitated carious lesions using the International Caries Detection Assessment System (ICDAS II) and oral hygiene in Thai students with disabilities Supatra Oranbundid BDH MPH1,2, Nusara Poomat DDS3, Somkiat Luengpailin DDS PhD4, Araya Pisek DDS3, Anwar T Merchant DMD ScD5 and Waranuch Pitiphat DDS MPHM MS ScD3 1Faculty of Graduate Studies, Khon Kaen University; 2Sirindhorn College of Public Health Khon Kaen; 3Department of Community Dentistry, Faculty of Dentistry, Khon Kaen University; 4Department of Oral Biology, Faculty of Dentistry, Khon Kaen University: Khon Kaen, Thailand. 5Department of Epidemiology and Biostatistics, University of South Carolina, SC, USA Abstract Aim and objectives: Epidemiological data concerning oral health
status of individuals with disabilities is sparse and most studies
do not include the assessment of noncavitated lesions. This study
aimed to evaluate noncavitated and cavitated carious lesions and
oral hygiene status of students with disabilities in Khon Kaen,
Thailand. Reliability of the BDA case mix tool for use in special care dentistry M Burgess1, N Monaghan2, M Z Morgan3, R Playle3 and S Thompson4 1Learning and Scholarship Group, Cardiff University School of Dentistry; 2Public Health Wales, Temple of Peace and Health, Cathays Park; 3Applied Clinical Research and Public Health, Cardiff University School of Dentistry; 4Learning and Scholarship Group, Cardiff University School of Dentistry, Heath Park, Cardiff, UK Abstract Introduction: The British Dental Association (BDA) have developed
a case mix tool for measuring patient complexity to aid commissioning
and evaluation of special care services. The aim of this study was
to explore examiner agreement when using the case mix tool. A pilot audit of oral health in mechanically ventilated critically ill patients T E Lloyd1, P J Frost2, M P Wise2 and J S Rees3 1Locum Registrar in Maxillofacial Surgery and 2Consultants in Critical Care Medicine, University Hospital of Wales: 3Professor of Restorative Dentistry, Cardiff University Dental School, Cardiff, UK
Aim and objectives: There is increasing awareness among Intensivists
that poor oral hygiene may be associated with ventilator associated
pneumonia in intubated patients. The aim of this pilot audit was
to assess the oral health status of mechanically ventilated, critically
ill patients. The adherence of intensive care nursing staff to local
guidelines for the delivery of oral care was also assessed. The use of Applied Tension to manage orthodontic extractions in Blood-Injury-Injection Phobia: a case report Shannu Bhatia BDS MDS MFDS RCS (Eng) M Paed Dent RCS (Eng)1, Caroline Roberts2 and Barbara Chadwick BDS, MScD PhD FDS RCS (Ed)3 1Paediatric Dentistry Unit, University Dental Hospital; 2Paediatric Psychology, University Hospital of Wales; 3Applied Clinical Research & Public Health, School of Dentistry, Cardiff University; Cardiff, Wales Abstract Blood-injury-injection phobia (BIIP) is characterised by a strong tendency to faint when exposed to phobic stimuli. Patients with BIIP often exhibit dental anxiety and may deliberately avoid dental treatment. The dental anxiety in BIIP does not respond to conventional techniques as just relaxation increases the likelihood of fainting. It is important for dentists to be aware of this condition since it requires specific management.
1Specialty Trainee in Orthodontics, Newcastle Dental Hospital; 2Specialist Registrar, Birmingham School of Anaesthesia; 3Consultant in Restorative Dentistry and Special Care Dentistry, Birmingham Dental Hospital; 4Consultant in Anaesthesia, Royal Orthopaedic Hospital Foundation Trust, Birmingham; 5Senior Dental Officer, Heart of Birmingham PCT
A 78-year-old male patient presented to the Birmingham Dental Hospital
for dental treatment. His management was complicated by amyotrophic
lateral sclerosis (ALS) a form of motor neurone disease, with associated
inability to protect his airway due to bulbar involvement in the
disease process. His dental treatment was managed successfully as
a day case with total intravenous anaesthesia (TIVA) by target control
infusion of propofol and remifentanil, aided by monitoring with
bispectral index monitoring (BIS). No non-depolarising muscular
blocking drug was used. Intubation was performed solely under propofol
and remifentanil. The procedure lasted 150 minutes due to the extent
of dental treatment required and the patient was discharged home
120 minutes after the completion of the procedure. A discharge this
early has not previously been reported. No complications resulted.
A case report of the dental management of a patient with Sotos syndrome Shaik Mohammed Asif1 and Shefali Waghray2 1Assistant Professor,Department of Oral Medicine and Radiology;
2Post Graduate,
Sotos syndrome, a rare disease of cerebral gigantism, is characterised
by overgrowth, advanced bone age and a typical facial appearance
with mild to severe learning disability. This paper reports a case
of an 18-year-old male patient with Sotos syndrome and rare association
of optic nerve atrophy who, unaware of his underlying condition,
reported to our dental clinics with a complaint of spacing between
his lower front teeth. The purpose of this case report is to review
the diagnostic characteristics of Sotos syndrome, emphasising the
importance of a multi professional dental intervention in combination
with active family participation. Solitary median maxillary central incisor in two healthy siblings: case report Roberta Barcelos DDS MSD PhD1, Patricia Nivoloni Tannure DDS MSD2, João Alfredo Farinhas DDS MSD2, Evelyn Kahn MD MS3 and Rogerio Gleiser DDS MSD PhD2 1Department of Specific Formation, Federal Fluminense University,
Nova Friburgo, Brazil;
A solitary median maxillary central incisor is an unusual dental finding and may be associated with short stature, growth hormone deficiencies, syndromes and chromosomal abnormalities. This paper describes two cases of the absence of a maxillary central incisor affecting both dentitions in two healthy siblings. No reports were found in the literature similar to this rare situation. This anomaly can be considered a predictor of holoprosencephaly in the next generation and affected individuals may require a long term evaluation by a multidisciplinary team. Case report: management of unerupted incisors in a patient with Angelman Syndrome M Storey BDS (Hons) MFDS RCS (Edin)1, JV Kewley BDS, FDS.RCS(Ed)
M Dent Sci (Paed) (Lvpl) Dip Con Sed (Nwcl) MSND RCS(Ed) Specialist
in Paediatric Dentistry1 and V Brookes BDS MSC FDS RCS (Ed) FDS.RCS
(Eng) DDPH RCS (Eng) MSND RCS (Ed)2 Abstract This paper describes the dental care provided for a 9-year-old patient with Angelman Syndrome, who presented with delayed eruption of the maxillary permanent left central and lateral incisors, and dental caries. The importance of effective communication with colleagues and parents of the patient is highlighted, along with the benefits of taking a holistic approach to patient management. Patients with learning disabilities present the dental practitioner with a wide range of management issues. An understanding of a patient’s disability and how this impacts on treatment planning and provision is fundamental in providing quality care for patients.
|