Volume 4, Number 1. April 2003
Contents
Abstracts A comparison of factors in pre-anaesthetic dental assessment and post-operative outcomes following dental care under general anaesthesia in a group of disabled and anxious patients.N. Prabhu1, J H Nunn2 and G R Enever31Research Associate, Department of Child Dental Health, Dental School, Newcastle upon Tyne2Professor, Head of Department of Public and Child Dental Health, Dental School and Hospital, Dublin, Ireland 3Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne, UK Aim: To review the pre-anaesthetic dental assessment and post-operative outcomes in a group of 100 disabled and/or anxious patients who had comprehensive dental care in an outpatient general anaesthetic (GA) unit during the year 1999-2001. Design: A questionnaire-based study. All parents or carers were asked to identify the post-operative problems experienced by the patient and to comment on the hospital services provided. Clinical data for the patients (3- 31 years) were examined for pre-existing disability or medical condition, type and duration of the GA and the nature of the recovery period. Where possible, senior staff examined the patients prior to the GA, recording estimated treatment time and treatment plan. Main outcome measures: Comparisons between the predicted and actual length of treatment time. Results: Average anaesthesia time was 60-90 minutes, with a similar time for recovery, although the anxious group required a significantly longer duration of general anaesthesia than the disabled group. Most post-operative symptoms were mild and of only a few days, with no significant differences between groups. Low rates of reported pain were observed in both the groups. Treatment time was significantly less than the predicted time for both the groups. Similarly, a larger number of restorative procedures, extractions and pit and fissure sealants were carried out than was actually predicted for both groups. Conclusion: Post-operative morbidity was negligible. All respondents were very satisfied with the services offered, except one complaint about long waiting lists. Key words: Disabled, anxiety, pre-anaesthetic assessment, day-stay anaesthesia, post-operative outcomes The dental prosthetic status of psychiatric in-patients in South WalesSusan Lewis1, Robert G Jagger1 and Elizabeth Treasure 21Departments of Adult Dental Health2Dental Health and Development, Dental School, University of Wales College of Medicine, Cardiff Aim: To assess the dental prosthetic status of a sample of psychiatric in-patients in South Wales; the objectives were to evaluate the conditions of the dentures and to assess the patients’ satisfaction with the dentures. Design: Examination of patients was carried out in seven psychiatric hospitals in South Wales, and included the prosthetic status and presence of oral pathology. Patients were also questioned regarding satisfaction with their dentures. Subjects: The total patient population of the hospitals involved in the study was 429, and 326 subjects (70%) took part. The mean age of the subjects was 71.1 years, with 265 long stay and 61 short stay patients. Forty-seven per cent of patients had a psychiatric diagnosis of dementia, 23% of schizophrenia and 19% of depressive illness. Results: Of the 326 subjects, 63% were edentulous, and of these, 32% of subjects were wearing dentures. Forty-two per cent of the dentures were judged to be clean, and 66% of dentures did not have identification marks. Soft tissue lesions were identified in 17% of the edentulous subjects. Eighty-four per cent of the patients were happy with their dentures and did not want any treatment. Conclusions: A high proportion of the study population was edentulous, and approximately one third of these were wearing dentures. A large majority of patients were happy with their dentures and did not want treatment of any kind. A moderate number of soft tissue lesions were found in the edentulous subjects. Key words: Psychiatric patients, treatment needs, oral health, dentures, and residential care Atraumatic restorative treatment (ART) with CarisolvTM in intellectually disabled patientsG F Molina1 and C Kultje21Department of Dental Materials, The Dental Faculty, Universidad Nacional de Córdoba, Argentina2MediTeam Dental AB, Sävedalen, Sweden Aim: To investigate the use of ART in carious cavities in intellectually impaired individuals with and without the use of CarisolvTM. Materials and methods: To apply these treatment approaches for dentinal caries without pulpal compromise, in a residential centre for intellectually disabled people in the city of Córdoba, Argentina. Results: 25 patients were treated from a total population of 98 individuals, ranging from 4 to 65 years of age. At the 1-year follow-up, clinical performance of 28 ART restorations was compared to 47 ART+CarisolvTM restorations in the same patients using the same material (Fuji IX, GC Corporation). A significant difference was found in treatment outcome in relation to caries-free cavities after excavation (p<0.001 Fisher’s Exact test) and loss of restoration at follow-up (p<0.05 Fisher’s Exact test). Conclusions: CarisolvTM seems to enhance clinical performance of ART restorations in this population of intellectually disabled patients. However, long-term follow-up is needed to justify this approach. Key words: Chemomechanical removal, disabled patients, atraumatic treatment, ART Evaluation of the outcome of different management approaches to reduce drooling in children with cerebral palsyJ F Tahmassebi and M E J CurzonDepartment of Paediatric Dentistry, Leeds Dental Institute, Leeds, UKAim: To compare and evaluate the different methods which have been used commonly to reduce drooling in cerebral palsy children. Method: Five centres in the UK that carried out some form of treatment to control drooling took part in this study. Using a detailed questionnaire, data were collected on 37 cerebral palsy subjects aged between 3 and 18 years. Results: It was found that the two most common management approaches to control drooling used in these five centres in the UK, were surgery and drug therapy, but both appeared to have limitations. The majority of the children in this study had undergone surgery to reduce their drooling without any attempt of trying a less invasive approach prior to surgery. Conclusions: It is apparent that there are a number of different strategies used to manage drooling. However, the small numbers involved in each centre, coupled with difficulties in assessment, make it hard to evaluate effectiveness. Multi-centre studies are required to establish an evidence base for the management of drooling. Key words: Drooling, cerebral palsy, management Acquisition of tooth brushing skills by intellectually impaired children with the aid of plaque disclosing agents: a case report.Sule Yilmaz1, Yesim Fazlioglu1 and Galip Ekuklu21Trakya University Training and Research Centre for Mentally and Physically Disabled Children, Edirne, Turkey2Department of Public Health, Faculty of Medicine, Trakya University, Edirne, Turkey Aim: To investigate whether plaque disclosing tablets could be used by intellectually impaired children in the acquisition of effective tooth brushing skills. Subjects: The three subjects, aged between 12 and 16 years, were moderately intellectually impaired. Results: At the end of the study, it was seen that there were positive effects on the acquisition of tooth brushing skills with the use of plaque disclosing tablets by these young people. Key words: Tooth brushing, plaque, disclosing tablets
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