Volume 2, Number 2. October 2001
Contents
Editorial On the occasion of the 25th Anniversary of the original foundation of the British Society for Disability and Oral Health it is a privilege to be able to congratulate those who have nurtured the organisation to its present influential position. The opportunity has arisen also to reflect on the origins of the Society and the progress in its aims which have accrued in the intervening years. In 1968 a small Study Group was set up in Birmingham by the writer under the heading "Principles and Practice of Dental Care for Patients with Chronic Disease and Disability". It met annually until 1971. The purpose was to bring together a compact multi-disciplinary group of specialists representing dentistry, medicine, associated professions and social welfare whose common purpose was to improve the health care of disadvantaged patients and who had demonstrated a practical commitment. Of course dentistry has a place in these concerns for the impact of an oral disorder, the way it is approached and rectified has to be judged on the type of patient who needs help. These matters are well known to readers of this Journal. However 30 years ago it was still necessary to make the case, for example, that oral rehabilitation is not simply a technical reconstruction of the occlusal table. It is a concept which embraces a concern with the quality of life of the individual. Unfortunately dental health service provision for adults by tradition has been geared to elective needs and has tended not to be aware of the quiet problems of many patients with chronic disability. From a historical viewpoint it is worth recalling that in the early 1970s the Community Dental Service was limited to the priority care of children and pregnant women. Hospital based Regional Dental Units, which in theory covered all hospitals in each area, were essentially Oral and Maxillofacial Surgery Departments with a very heavy work load. Long stay hospitals nationwide were privileged if they had a visiting general dental practitioner for a session or so. However amongst their number were some beacons of outstanding service who worked principally in a form of professional isolation. With regard to training there was little available for postgraduates other than that provided by teachers of paediatric dentistry. They had a long established and honoured tradition of didactic and practical concern with the child who had special needs. From the Birmingham Study Group there emerged a Working Party of dental colleagues who prepared a report which was submitted to the then Secretary of State for Health, Sir Keith Joseph (Franks et al, 1971 ). It contained specific recommendations for improvement in meeting the needs of what were then termed ‘handicapped’ patients. It highlighted also concerns in the educational gaps in professional training. The fate of the Report remains unknown as, apart from the usual acknowledgement from the Minister’s Private Secretary no other official response was evident either by word or deed. Unofficial comment on the views expressed however was forthcoming. The criticism made to the present writer was based on the well rehearsed mantra, "There is no need to make special provision for the disabled person as by Statute the NHS Dental Service covers all members of the community". It was evident that some form of more formal organisation was necessary in order to promote the aims of the original Study Group. Colleagues overseas, particularly in the Nordic countries and the United States, had shown already the value of a specialist society with a specific agenda to help improve the dental care for patients with disability. So, following a letter of intent published in the British Dental Journal on 2 March 1976 the Foundation Meeting of what was originally called ‘The British Society of Dentistry for the Handicapped’ was held at the Eastman Dental Hospital on 23 June 1976. Over 120 colleagues attended, drawn from all branches of dentistry. A comment expressed by many there was the feeling of an end to a sense of professional isolation in pursuing a commitment to their disadvantaged clients. To the original founders of the Society the advances made by our successors have provided much satisfaction. The original necessary evangelism has been solidified into practical contributions and the needs of special care patients codified in clear uncompromising terms. Instruction in the welfare of these patients of all ages is established within dental education. The Community Dental Service plays the significant and now extended role in providing care through designated specialists in ‘Special Needs’. Postgraduate degrees and diplomas are now widely offered by both Universities and the Royal Colleges. The achievements of the past 25 years have been considerable. On behalf of those who launched the Society we acclaim the influence it has achieved so far and wish good fortune to the ongoing campaign to provide still further improvements in the dental welfare of patients with special needs. Arnold FranksBirminghamAbstracts The effect of topical metronidazole therapy and controlled oral hygiene procedures on periodontal disease in patients with Down syndrome – a clinical interventional studyP Cichon, S Klar and W-D GrimmDepartment of Periodontology, University Witten/Herdecke, GermanyAim: The purpose of the present study was to assess the effect of topical application of a metronidazole 25 per cent dental gel (Elyzol) with supragingival plaque control on the gingival condition and the subgingival microflora in patients with Down syndrome. Method: Nine patients in the test group and 10 patients in the control group with Down syndrome were examined to assess their clinical health status and the composition of the subgingival flora. Following the initial examination supragingival plaque was professionally removed in both groups, and in the test group metronidazole gel was applied twice into the periodontal pockets. Clinical and microbiological examinations were repeated after 1, 4 and 12 weeks. Results: The findings of the baseline examinations showed that the inflammation of the gingiva was associated with the amount of plaque in both groups. The composition of the subgingival flora was heterogeneous in both groups. During the course of the clinical trial, oral hygiene status and gingival inflammation improved markedly in the test group. The number of sites with bleeding on probing was reduced (60 per cent), whereas the composition and the mean number of putative pathogens remained unchanged in the test group. Conclusions: The results of the clinical trial show that professional removal of supragingival plaque with topical application of a metronidazole 25 per cent dental gel significantly improves the clinical situation in patients with Down syndrome. Key words: Down syndrome, periodontitis, interventional study, metronidazole treatment, supragingival plaque control Day stay service for special needs patients requiring restorative dentistry - an audit of non attendanceM J Shaw and J M WattBirmingham Dental Hospital, St. Chad’s Queensway, Birmingham, B4 6NNThe aim of this audit was to assess the size of the non-attendance rate for a group of patients with learning difficulties attending for day-stay general anaesthesia, with the objectives of introducing a procedure to reduce non-attendance and to establish the value of the new procedure. The audit was conducted initially as a retrospective review of 164 patient records followed by introduction of a new patient, parent or carer contact procedure with a subsequent prospective re-audit of 54 patient records. Prior to the introduction of the new procedure the non-attendance rate was 19 per cent and subsequently at re-audit this reduced to 9 per cent reflecting an encouraging improvement. Key words: General anaesthesia, disability, audit, attendance An assessment of appropriate mode of treatment for children with special needsC Taylor, L Zoitopoulos, K Barnard, M Ahluwalia, H Bembridge, P LisowskaGKT Dental Institute, King’s College, London, UKAim: To determine the most appropriate mode of treatment (chairside, sedation or general anaesthesia) for children with special needs. Objectives: To undertake a behavioural assessment based on mouth opening on request, to ascertain the child’s initial compliance; to assess oral health status and treatment need using standardised criteria. Design: Cross-sectional study of children with varying degrees of disability in special schools in Lambeth, Southwark and Lewisham. Subjects: A stratified random sample of 300 children was selected giving 210 children (127 female, 83 male, age range 5-18 years) available for examination. Main outcome measures: To utilise the behavioural assessment in determining the most appropriate mode of treatment. Results: Eleven children refused or were unable to co-operate on the day of the examination. 28% of the children examined had untreated caries; 20% had sustained dental trauma; 25% had experienced erosion, 72% had plaque present (the average plaque score per child was 10.1) and 17% had calculus. Sixty seven per cent of the children required treatment and of those requiring treatment 52% needed a combination of treatment procedures; 34% needed oral hygiene instruction only and 14% oral hygiene instruction and scaling and polishing only. The behavioural assessment of all the children (210) suggested that 38% would co-operate with chairside treatment, 23% would require sedation and 39% general anaesthesia if they needed treatment in the future. Conclusions: Of those children (52%) who required a combination of treatment procedures, 64% could be treated in the primary care setting without sedation and the remaining 36% would require sedation (27%) or a general anaesthetic (9%) because of inability to comply. Keywords: Special needs, treatment needs, oral health, disabled Development of an undergraduate curriculum in special care dentistryS Thompson1, J Griffiths1, L Hunter2 , R Jagger1, A Korszun1 and W McLaughlin11Department of Adult Dental Health , 2Department of Dental Health and Development University of Wales College of Medicine, Cardiff, UKAims and objectives: To report on the development of a sub-theme of Special Care Dentistry within a new undergraduate dental curriculum. Keywords: Special Care Dentistry, curriculum, competency The oral health and treatment needs of adults with a learning disability living in private households in Lambeth, Southwark and Lewisham, LondonR S Naidu, P Pratelli, P G Robinson and S GelbierDivision of Dental Public Health, Oral Health Services Research and the Schools of Dental Nursing, Guy’s, King’s and St. Thomas’ Dental Institute, King’s College LondonAim: To describe the oral and dental health and treatment need of adults with a learning disability living in private households in Lambeth, Southwark and Lewisham Health Authority, London. Objective: To describe levels of oral hygiene, periodontal health, caries experience and normative need for restorative, prosthetic and exodontia treatment. Design: Clinical survey. Setting: Private households in Lambeth, Southwark and Lewisham Health Authority. Subjects: Adults with a learning disability registered with Social Services in these districts and living in private households. Main outcome measures: Caries and treatment experience (DMFT index), proportion of adults with 18 or more sound untreated teeth, proportion edentulous, periodontal health, denture wearing and restorative, exodontia and prosthetic need. Results: Two hundred and seventeen participants were examined. Mean DMFT was 11.2. Fifty six participants (27 per cent of dentate subjects) had one or more teeth with active decay. The prevalence of plaque, calculus and gingivitis was high. Participants had better oral health than the general population in terms of caries experience and presence of sound untreated teeth but showed a trend towards greater edentulousness in the older age groups. Beyond the need for improved oral hygiene, the greatest need was for simple restorations and prosthetic treatment. Conclusion: Adults with a learning disability who live in private households appear to have better dental clinical status than the general population but have fewer teeth. The main treatment needs identified were for simple restorative or prosthetic care. Key words: Learning disability, epidemiology, treatment need
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