Volume 3, Number 1. April 2002
Contents
Editorial The Year of Special Care Dentistry?Whatever your views on the true start to the Millennium, this is an auspicious year for Special Care Dentistry.January saw a joint meeting, on Clinical Advances in Special Care Dentistry, between the Faculty of Dental Surgery of the Royal College of Surgeons of England, the Advisory Committee for Community Dentistry, the British Society for Disability and Oral Health and the BDA Community Dental Services Group. In the following month there was another meeting, in a series hosted by the Royal Society of Medicine’s Forum on Learning Disability, at which dental care was very much in evidence supported by many members of BSDH as speakers. This is a year of educational initiatives too; the Membership examination in Special Needs Dentistry of the Royal College of Surgeons of Edinburgh continues with its diet of examinations, both in the UK and in North America. We are hopeful too that the Diploma in Special Care Dentistry of the Royal College of Surgeons of England will, this Spring,. receive final approval from both the Education Committee of the General Dental Council and the Board of the Faculty. Continuing the theme of education and training, Professor Raman Bedi, as the President of BSDH, will have most of the spring meeting of BSDH devoted to Special Dental Care Education. It was a particular honour to have the Chief Dental Officer, Dame Margaret Seward open the December meeting of the Society in London. Commenting on the day that marked the Jubilee celebrations for the Society, Dame Margaret looked forward to significant achievements in our next 25 years. We are fortunate too that the Minister of Health will open the BSDH meeting in May, in Birmingham, so keeping Special Care Dentistry on the health agenda. More details of this meeting are published in the calendar in this issue of the Journal. Further afield, May is also the date of a European consensus meeting on Ectodermal Dysplasia to be held in Malmo, Sweden. As with the format of many BSDH meetings, this two-day symposium has a big representation from patient and user groups as speakers. Join us too in Dublin for the Special Olympics in June; Cardiff set the ball rolling for the oral screening as part of the healthy athletes programme in these islands and we will be delighted to welcome as many volunteers as are able to help out, both this year and in June 2003 when the World Games of the Special Olympics comes to Ireland. Staying in Europe, we look forward to meeting long-standing friends at the biennial Congress of the International Association for Disability and Oral Health in Athens in September. This meeting has a number of themes the details of which also appear in the Calendar within this Journal. Interestingly, in addition to many new areas, we will have the opportunity to continue the debate started in Madrid in 2000 on ethical issues, a topic not entirely unrelated to a new Guidelines that BSDH will produce in 2002 on Consent and Restraint. More topical issues will be aired at the Annual Presidential and Scientific meeting of the Community Dental Services Group when Carolyn Taylor will hold her presidential meeting on the topic of Special Care Dentistry- a Practical Approach. It is good for the specialty too that the FDI have also devoted a session on disability and oral health at its Annual meeting in Vienna in October. 2002. The year is well rounded off by our Winter Scientific meeting in London addressing the theme of the oral health needs of sensory impaired people. An altogether eventful year! June NunnEditorAbstracts The use of oral midazolam and metoclopramide as premedication prior to day stay general anaesthesia: an audit of premedication for adult patients with severe learning disabilitiesC J Butterworth1, K Llewellyn2, J Watt3 and M J Shaw11Department of Restorative Dentistry, 2Department of Oral Surgery, 3Department of Anaesthesia, Birmingham Dental Hospital, Birmingham, UKAim: To audit the use of oral midazolam and metoclopramide as a premedicant prior to the induction of general anaesthesia for uncooperative adult patients with special needs. Objectives: To demonstrate that such a premedicant regimen is effective, safe and carries no significant post-operative effects. Design: A hospital based clinical audit. Subjects: 40 subjects with special needs who were referred to the Birmingham Dental Hospital for dental treatment under general anaesthesia participated in the audit. Subjects were allocated to the test group (n=20) if it was felt that they would benefit from premedication prior to induction. Patients deemed not to require premedication (n=20) comprised the control group. Main Outcome measures: Successful induction of general anaesthesia, uneventful discharge, and minimal/no post-operative problems. Results: All subjects successfully underwent dental treatment as day-case patients and were discharged later the same day. In the test group, the mean dose of premedicant was 16mg midazolam and 10mg metoclopramide. The mean time from sedation to induction of general anaesthesia was 33 minutes. The mean operation time was 58 minutes as compared to 60 minutes for the control group. The incidence of postoperative complications in the test group was low and at a similar level to the control group. Conclusions: Premedication of adult special needs patients with oral midazolam and metoclopramide to facilitate a smoother induction of general anaesthesia for dental treatment is safe and effective. This audit suggested that the premedicant does not prevent same-day discharge or have unwanted postoperative effects. Key words: Midazolam, metoclopramide, sedation, special needs, premedication Attention Deficit Hyperactivity Disorder: A review and guide for dental professionalsD Efron and N M KilpatrickRoyal Children’s Hospital, Parkville, Melbourne, AustraliaChildren with Attention Deficit Hyperactivity Disorder (ADHD) are presenting to the dental surgery in increasing numbers. The diagnosis of ADHD is often associated with confusion and misunderstanding. This paper summarises current knowledge on the aetiology, epidemiology, diagnosis and management of this common behavioural condition. It then goes on to make suggestions that may assist the dental practitioner in successfully treating such clients. Key words: ADHD, Attention Deficit Hyperactivity Disorder, behaviour Electrocardiographic findings and history of medical diseases in hospitalised dental patientsY Takata1, J Fukuda2, H Kurokawa3 and O Nakanishi41Department of Internal Medicine, 2First Department of Oral Surgery, 3Second Department of Oral Surgery, 4Department of Dental Anesthesiology, Kyushu Dental College, Kitakyushu, JapanAim: To study the prevalence of electrocardiographic (ECG) findings and associated history of medical diseases in hospitalised dental patients. Design and Subjects: Medical histories (hypertension, diabetes, hyperlipidaemia, heart disease, stroke), blood pressure (BP), serum cholesterol and glucose concentrations were assessed in relation to ECG findings (ST segment depression, T wave abnormalities, abnormal Q waves, ventricular premature contractions (VPC)) in 1,597 dental patients. Results: Patients with a history of heart disease had a higher prevalence of ST depression, T wave abnormalities and VPC. Patients with hypertension had a higher prevalence of T wave abnormalities. Diabetic patients had a higher prevalence of abnormal Q-waves. In patients with a high systolic BP, ST depression and T wave abnormalities were found in a higher prevalence. Patients with a high serum cholesterol concentration had a higher prevalence of T-wave abnormalities. Conclusions: Histories of heart disease, hypertension, and diabetes are independent predictors of ST depression, T wave changes, or abnormal Q waves. Patients with these factors are at risk of sudden death during dental procedures. Key words: Dental, ECG, heart disease, hypertension, diabetes Prion disease: implications for Special Care DentistryStephen R. PorterOral Medicine, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of LondonPrion diseases are a group of rare fatal neurodegenerative disorders of humans and animals histopathologically characterised by spongiform change of the central nervous system. Sporadic Creutzfeldt-Jakob disease (CJD) is the most common of the acquired human prion disorders, giving rise to rapid onset illness in elderly persons worldwide. In contrast the recently described variant CJD (vCJD) has affected young adults from Western Europe, giving rise to a slow onset disorder comprising both psychiatric and neurological upset. The present article reviews aspects of prion disease relevant to special needs dentistry in the UK. Key words: Prion diseases, neurodegenerative disorders, Special Needs Dentistry Case Report- Delayed deciduous teeth exfoliation in a Down syndrome patientR EmanuelSenior Dental Officer for Special Needs, West Sussex Community Personal Dental Services, Central Clinic, Stoke Abbott Road, WorthingThis report describes a case where a Down syndrome lady was still shedding her deciduous teeth well into her fourth decade. It also highlights why regular reference needs to be made to past notes so that the longitudinal nature of the patient’s dental history is taken into account. Certificate in Special Care Dental NursingM WanlessDental Office, The Health Centre, Geoffrey Street, Preston, UKThis paper describes the development of the qualification in Special Care Dental Nursing, from its innovation under the auspices of the British Society of Dentistry for Disability and Oral Health to its adoption by the NEBDN. The outline of the course as well as the assessment process is described. Keywords: Special care, dentistry, nursing Guidelines for the oral care of patients who are dependent, dysphagic or critically illJanet Griffiths1, Debbie Lewis21Department of Adult Dental Health, University of Wales College of Medicine, Cardiff, UK. 2Senior Dental Officer, Dorset Healthcare Community Dental Service, Poole, Dorset, UKThese guidelines are adapted from the report of a BSDH Working Group: J. Griffiths, V. Jones, I. Leeman, D. Lewis, K. Patel and K. Wilson
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