Volume 1, Number 1. October 2000
Contents
Editorial Teeth and People with Learning DisabilitiesThe Lord Rix CBE DL, President of MENCAPI am delighted to have the opportunity of writing a few words to introduce this new journal - especially when I know that in November 2000 we shall be seeing the publication of new guidelines on oral health for people with learning disabilities. More information on this is contained within the Journal.Those who have grown up in families and in areas where having good teeth and all that goes with good teeth really mattered, and whose personal habits have kept them on the straight and narrow of looking after their teeth, might wonder what the problem is for people with learning disabilities. There is, after all, nothing inherent in having a learning disability that makes teeth less important. The problems are individual ones. Some people with the most severe mental and physical disabilities, and an awkwardly shaped mouth and inconvenient tongue, do have splendid teeth, even though they cannot take care of them themselves or even understand what is happening inside their mouths when someone else invades that personal and sensitive space. However, there are combinations of factors, both clinical and social, which have tended to apply to many people with more severe disabilities. These factors include the physical problems which make oral hygiene difficult for people themselves and awkward for others trying to help them; the communication problems which make it hard to follow the ideal sequence of explain - understand - co-operate; the negative effect of restricted and/or a liquidised diet and of medicines (some with high sugar content); and the attitude of those, dentists and others who think that the dental care of severely disabled people is not a matter of any great importance. Some people left the long-stay hspitals with mouths that were disaster areas. Sadly, there are still people living in the community whose mouths are disaster areas. Those who do not speak and who do not chew, do experience pain, do use their teeth, do make friends more easily if they have good breath, and do suffer the general ill health effects of poor oral hygiene. They deserve better than that, and I am pleased that determined efforts are being made to offer them something better - with this new journal playing an important part in that. Abstracts Sialorrhea: a multidisciplinary approach to the management of drooling in childrenN M Kilpatrick(1), H Johnson(2) and D Reddihough(2)(1)Department of Dentistry and (2)Department of Child Development and Rehabilitation, Royal Children’s Hospital, Parkville, Melbourne, Victoria 3052, AustraliaSummary Uncontrolled drooling of saliva from the mouth (sialorrhea) is a problem that is not uncommonly noted by parents of children with various physical or intellectual disabilities. The aetiology of sialorrhea is predominantly associated with an inability to keep saliva in the oral cavity and to coordinate the swallow mechanism. A number of strategies have been advocated for the management of sialorrhea however it remains an area of mixed success and debate. This paper reviews the aetiology and evaluation of drooling and recommends a multidisciplinary team approach to its management. Treatment of a drooling habit in Congenital Muscular Dystrophy with a palatal training plate. A case reportC J Day and R R WelburyDepartment of Child Dental Health, Dental Hospital, Richardson Road, Newcastle upon Tyne, NE7 7TE, UKSummary This case report describes the treatment of persistent drooling in a 5-year-old child with autosomal recessive Congenital Muscular Dystrophy. The drooling was successfully treated with a simple removable palatal training appliance. It is believed that this is the first reported case of the treatment of drooling in a patient with Muscular Dystrophy by this method. Further research and development is needed on the use of training plates and physiotherapy in the treatment of drooling in muscular dystrophies. Oral hygiene and periodontal conditions in special needs children and young adults in KuwaitMaddi Shyama(1), Sabiha A. Al-Mutawa(1), Sisko Honkala(2), Thattaruparambil Sugathan(3) and Eino Honkala(2)(1)Oral Health Services, Ministry of Health, Kuwait, (2)Faculty of Dentistry and (3)Faculty of Medicine, University of Kuwait, KuwaitAbstract Aim: The present study was carried out to assess the levels of oral hygiene, periodontal conditions and treatment requirements in a special needs population who are visually impaired, hearing impaired, have physical disabilities or developmental disorders, attending special schools in Kuwait. Design: An epidemiological survey was carried out according to the methods of WHO, 1997. Subjects: The sample comprised 832 subjects from 10 schools whose age ranged from 3 to 29 years, the mean being 12.1 years. Results: There were significantly poorer levels of oral hygiene and a greater prevalence of periodontal disease in the disabled young people attending special schools compared to normal children. Significant differences were found in oral cleanliness between subjects. The type of impairment had a significant association with the periodontal problems observed; those children with Down syndrome had the poorest levels of oral hygiene and the greatest periodontal treatment need. An evaluation of oral cleanliness showed poor hygiene in 38% of the children, and in 52% of Down syndrome children. For all children, 87% were brushing at least daily. Of those who brushed, 72% did not have any help with brushing. The highest proportion of pockets were found in Down syndrome children (61%), and their need for complex periodontal treatment was also highest, 21% with deep pockets. The highest risk factor for periodontal disease seemed to be poor oral hygiene (OR=8.5, 95% CI= 3.5-20.9). Conclusions: This study indicated the distinct need for strengthening organised preventive and curative programmes for special needs young people in Kuwait. Key words: Oral hygiene, periodontal disease, treatment needs, disabled people, Kuwait The expressed dental needs of patients attending a Haemophilia Reference CentreJ Fiske(1), H E Pitt Ford(2), G F Savidge(3) and M P Smith(4)(1)Senior Lecturer, Honorary Consultant in Special Care Dentistry and (2)Associate Specialist in Paediatric Dentistry, at Guy’s, King’s and St Thomas’ Dental Institute, King’s College London. (3)Professor of Coagulation Medicine, Haemophilia Reference Centre and (4)Honorary Consultant in Haematology, St Thomas’ Hospital, Guy’s and St Thomas’ Trust, LondonAbstract Aim: To assess the expressed dental needs of children and adults attending a Haemophilia Reference Centre (HRC) and to establish whether they perceive a need for a dedicated dental service connected with the HRC. Method: Postal questionnaires were sent to 92 children and 108 adults enquiring about their bleeding disorder, difficulties encountered in acquiring dental treatment, problems resulting from it and where they would prefer to receive dental care. Results: Sixty two questionnaires were returned for children and 68 for adults with response rates of 67% and 63%, respectively. More adults (30, 44%) than children (11, 18%) reported difficulty in obtaining care. The most frequent cause was concern about bleeding (14%). For adults, HIV and/or a hepatitis positive status also caused problems in accessing dental services. More adults (38%) than children (11%) had experienced problems of bleeding or bruising after dental treatment. Despite these problems, 94% of children and 71% of adults reported having a regular dentist, usually a general dental practitioner. Children were less likely than adults to put off going to the dentist (4% and 27%, respectively). The majority of children (61%) preferred to go to a family dentist whilst the majority of adults (66%) preferred to have treatment at, or linked to, the HRC. Most respondents (74%) said they would use a dental service linked to the HRC, though some, especially children, would use it as a back up to their local dental service. Conclusion: The majority of people were receiving regular dental care via the general dental service. However, there was an expressed need for a dental service related to the HRC. Most adults requested comprehensive care at the HRC while children wanted it only as a back-up to their family dentist. This probably reflected the adults greater experience of barriers to dental care. Key words: Dental needs, haemophilia, bleeding disorders Development of an attitudinal scale for dental personnel in the provision of care for people with learning disabilitiesRaman Bedi(1), Jackie Champion(1) and Rebecca Horn(2)(1) WHO Collaborating Centre for Disability, Culture and Oral Health. National Centre for Transcultural Oral Health, Eastman Dental Institute, London, UK and (2) Forensic Psychologist, Psychology Unit, HM Prison Garth, Preston, UK.Abstract Aims and objectives: To report on the development and evaluation of a new attitude scale, with special focus upon determining discriminatory views of dental personnel towards the provision of dental care for people with learning disabilities. Design of study: Self-administered questionnaires. Subjects: Ninety-two clinical dental students. Main outcome measures: Scores on an attitude scale, reliability statistics and factor analysis statistics. Results: Reliability was found to be satisfactory. Factor analysis revealed five underlying factors accounting for 58 per cent of the variance. Conclusions: The scale was found to be reliable and robust. Key words: Attitude, learning disorders, questionnaires
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