Volume 4, Number 2. October 2003
Contents
Abstracts Do health care professionals refer housebound people to dental services? Referral behaviours and characteristic factorsMartin Smith1,2and Ruth Freeman21Homefirst Community Trust, 2Queen's University, Belfast, Northern Ireland, UKObjectives: The objectives were to investigate the referral behaviours of three of the health and social care professions and to identify their characteristics, using a predictive model, of those who had and had not referred their housebound clients for dental care. Design: A cross-sectional survey Subjects: A convenience sample of all community nurses (CNs), social workers (SWs) and occupational therapists (OTs) in a large community trust that were in regular contact with housebound people. Setting: Homefirst Community Trust, Northern Irelan Results: The response rate was 61 per cent. The sample rarely referred housebound clients. The OTs were significantly less likely, than the CNs or SWs, to have made dental health referrals. A Professional Dental Assessment Scale (PDAS) was developed. Logistic regression analysis identified four factors characteristic of respondents who had referred clients to a community dentist. These were: feeling confident to refer to (P<0.001), knowing the name of the nearest community dentist (P=0.01), encountering the Community Dental Service through work (P<0.05) and assessing new clients' dental health (PDAS) (P<0.001). A canonical discriminant analysis characterised the CNs by their higher PDAS scores, the SWs by greater confidence to refer and the OTs by lower PDAS scores and lesser confidence to refer. Conclusions: These three health care professionals differ in their referral behaviours, and characteristics suggesting the need for tailored in-service training. Key words: Referral, housebound, oral care, primary care. Incidence of dental caries in children and young adults with Down syndrome in KuwaitSabiha A. Al-Mutawa1, Maddi Shyama2, Sisko Honkala3, Eino Honkala41Oral Health Superintendent, 2Pedodontist,, Oral Health Services, Ministry of Health, Kuwait3Assistant Professor, 4Professor, Faculty of Dentistry, University of Kuwait, Kuwait Aim: To determine the incidence and the increment of dental caries in subjects with Down syndrome with moderate mental retardation in Kuwait from 1999 to 2001. Method: The target population included subjects with Down syndrome (n=102) attending the special needs schools in 1999 (9-19 years; mean age 12.6 years) and in 2001 (11-21 years; mean age 14.9 years). Dental caries was scored by surface on all erupted teeth in accordance with the WHO criteria. Results: The increase in incidence of caries was 10.3 per cent from 1999 to 2001, and the caries increment (DMFT) was 3.0 during the same period. The mean DMFS increased from 10.2 to 16.5. Conclusions: The two-year caries incidence and the increment of these subjects were clearly higher than in the recent national survey of children without developmental disabilities, despite fewer erupted teeth due to congenital absence. These results indicate that subjects with Down syndrome should be targeted for increased preventive dental care. Key words: Incidence, dental caries, Down syndrome, Kuwait Perceived dental needs and experiences of preventive dental care of patients attending a paediatric cardiology clinic.H E Pitt Ford1 and S A Qureshi21Associate Specialist in Paediatric Dentistry, at Guy's, King's and St Thomas' Dental Institute, King's College London2Consultant in Paediatric Cardiology, Guy's and St. Thomas', N.H.S. Trust, London Aim: This study aimed to assess the need for dental services expressed by the patients attending a Paediatric Cardiology Outpatient Clinic and the level of preventive care reported. Design of the study: A questionnaire evaluated the expressed dental needs of these patients and the level of preventive dental care received. The questionnaire was distributed to 100 randomly chosen patients. Main outcome measures: To assess patients' access to dental care, invasive treatment and preventive care reported and parents' knowledge of antibiotic cover. Results: Eighty-five questionnaires were analysed; 77 families reported no difficulty in obtaining dental care; 51% received care in the general dental services. A total of 37% reported receiving fillings, 31% extractions, 12% fissure sealants and 11% fluoride treatment. In all 60% reported receiving advice about prevention of dental disease. More patients who recalled receiving preventive advice reported receiving invasive treatment, compared with those who did not. (p < 0.05, c2 test). More patients who recalled receiving preventive treatment, reported receiving invasive treatment, compared with those who did not recall receiving preventive treatment (p < 0.001, c2 test). Forty-nine families recalled being given advice about antibiotic cover prior to invasive dental care. Conclusions: Most patients had access to dental care. Although these patients should be given priority for preventive dental care, relatively few reported receiving it, and many reported receiving invasive treatments. It appears that young patients with cardiac disorders are not being given adequate preventive dental care at a sufficiently young age. A smaller percentage of patients than expected was aware of the need for antibiotic cover. Key words: Dentistry; preventive dentistry; congenital heart defects The oral and dental health of children in special national schools in the Eastern Regional Health Authority Area, Ireland 1999/2000Triona McAlister1 and Conac Bradley21South West Area Health Board2East Coast Area Health Board and Lecturer in Special Care Dentistry, Dublin Dental School and Hospital Aim: An investigation of the oral health of children attending special national schools in the Eastern Regional Health authority (ERHA) of Ireland. Sample: An opportunistic sample of 704 children from 12 special national schools. Outcome measures: Caries experience, fissure sealants, periodontal and restorative treatment needs, dental attendance patterns and tooth brushing habits. Results: Children attending special national schools (SNS) had a lower prevalence of decay than children attending mainstream schools. They had more teeth filled compared with other surveys of children at SNS and comparable levels to their mainstream counterparts. Younger children at SNS tended to have had more teeth extracted than children at mainstream schools, however fewer teeth were untreated. In the older age groups, fewer teeth had been extracted but more had been filled than has been found in other surveys of children at special schools. Thirty-eight per cent of 12-year-olds and 45% of 15-year-olds had fissure sealants. This is a high value compared with other surveys of children in special schools. Plaque scores and CPITN scores were high with only 4.7% of 15-year-olds and 8.6% of 12-year-olds having healthy gums. Many of the children scored CPITN scores that require treatment at a low level. The findings for the group as a whole mask differences between the types of schools in this survey. Children at special national schools mainly attend health board dental services for their treatment and most parents and children find this an acceptable service. The dental screening programmes appear to be a good way of reviewing the delivery of dental care to these groups. Key words: Special needs, epidemiology, oral health status. The impact of childhood disability and chronic illness upon siblingsAnnette Hames PhDConsultant Clinical Psychologist, Community Team Learning Disabilities, Gosforth, Newcastle upon Tyne, UKAbstract: Work with the siblings of children with various disabling conditions indicates that knowledge about the condition is important for their own adjustment. However parents are not always able to provide this information and there is not much appropriate material available. This report describes the development of materials and invites expressions of interest from readers. Key words: Disability, siblings An investigation into the dental health of children attending two special day schools in South WarwickshireEileen R. Gunn1, Deborah A. White2 and Janine A. Brooks31Senior Community Dental Officer, South Warwickshire Primary Care Trust, UK2Lecturer in Oral Health and Behavioural Sciences, School of Dentistry, Birmingham, UK 3Clinical Director, South Warwickshire Primary Care Trust, UK Abstract: Although information is collected by the British Association for the Study of Community Dentistry (BASCD) to ascertain children's dental health status, children attending special schools are specifically excluded due to the difficulty of examining them using the criteria constructed in the strict examination protocol Aims and objectives: The aim of this study was to investigate the dental health of children attending special day schools. The objectives were to record the dental health of children attending two special day schools in Warwickshire and assess the dental health of these children with reference to their socio-economic group. Material and methods: An epidemiological survey, using the protocol for BASCD co-ordinated studies, was conducted in the only two Moderate Learning Difficulties schools within South Warwickshire. This area has a fluoridated water supply. Results: 128 children were surveyed. The DMFT for the total sample was 0.99. More than 40% of children in ACORN categories D, E and F had some untreated decay compared with less than 30% of children in categories A, B or C. The conclusion is that social factors may be influencing some of the outcomes for dental health. The dental health of children at special schools should be monitored regularly which could be achieved by their inclusion into the present national monitoring system or by regular, separate surveys. Key words: Dental health, children, special needs, special day schools. Atypical facial pain in a patient with Moebius syndromeNavdeep Kumar and Stephen PorterDepartment of Oral Medicine and Special Needs, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of London, 256, Gray's Inn Road London WC1X 8LD.Abstract: Moebius syndrome is a rare congenital anomaly characterised by complete or partial facial and abducens nerve palsies, often associated with other cranial nerve defects and limb anomalies. This case report highlights the unusual presentation of atypical facial pain in a patient with Moebius syndrome. Key words: Moebius syndrome, atypical facial pain, chronic facial pain
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