Volume 5, Number 1. April 2004
Contents
Letters P: 100 EditorialThere are over 6 million people registered as disabled, living in the United Kingdom (Baker et al., 1997). This does not take account of those with mental health problems, complex medical problems, social or emotional impairment. A review of the literature highlights the poorer oral health of these vulnerable groups, demonstrated by less treated dental disease and the trend to exodontia rather than restorative treatment (Nunn et al., 1987 and 1993). Furthermore, it is widely reported that there is a disparity in the access to and provision of oral care to individuals and groups with special needs (Russell et al., 1993; Griffiths et al., 1996). The barriers encountered are in direct contravention of the Disability Discrimination Act. These patients often have complex needs requiring a holistic approach to management. Furthermore, there is a requirement for a highly skilled workforce to deliver specialised care underpinning our clinical decisions with evidence based practice.The British Society of Disability and Oral Health (BSDH) is recognised as the specialist society for Special Care Dentistry. As such it has taken a lead role in the development of guidelines focusing on the provision of high quality oral health care for patients with a variety of needs ranging from mental health problems to the terminally ill. Research is a major influence in the development of new techniques in clinical dentistry (Burke et al., 2002). However, there are few evidence-based standards in Special Care Dentistry. Problems with funding, patient co-operation and lack of training compound the difficulties encountered. Many people are working individually in this field, which unfortunately results in a less than cohesive and poorly co-ordinated approach to research. BSDH encourages research in Special Care Dentistry. The society has a number of awards to support projects that improve the delivery of oral health care to individuals with a disability Dentists are not always able or willing to provide dental care for patients with special needs. The main reasons centre around the need for specialist facilities, lack of training or experience, access to the premises, challenging behaviour and cost in terms of time and expense (Oliver and Nunn, 1995). A training document in Special Care Dentistry has now been developed by the Joint Advisory Committee for Special Care Dentistry. This will be widely distributed over the next few months. BSDH have two representatives sitting on this Committee. A recognised training pathway in Special Care Dentistry is now essential. It would draw together the component parts of the discipline, thereby enhancing the quality of patient care. Such a training pathway would provide a standard approach to training, delivered through a speciality framework. This would equip dentists with the appropriate knowledge, attitudes and skills in this field. Furthermore it would provide a recognised clinical lead for Special Care Dentistry. A growing number of patients with complex medical conditions or severe learning disabilities may have care provide in both a primary care and a hospital environment. It is of paramount importance that the transition from primary to secondary to care is seamless. This ensures there is no discrimination to accessing dental care on the basis of a person’s disability. Multi-disciplinary networking as the key to identifying patients in the community, a co-ordinated approach to care through multi-organisational service provision and local services re-structured to lead to an improvement in the service provided. The development of a National Service Framework (NSF) for vulnerable people would advise on best practice in the use of existing treatment options, appraise the NHS on how they can be implemented and provide guidance as to how these best fit alongside existing treatments. In so doing, there will be greater consistency in the availability and quality of services, across the entire NHS. BSDH should now be at the fore front of the campaign for an NSF for Vulnerable Groups. Quality oral health contributes fundamentally to holistic health. It should be a right not a privilege! (Clark and Vanek, 1984) Dr Vanita Brookes President , BSDH References Baker M, Fardell J, Jones B. Disability and Rehabilitation: Survey of Educational needs of Health and Social Service Professionals. The case for Action. 1997. Disability and Rehabilitation Open Learning Project: London. Burke FJT, Crisp RJ, McCord JF Research in Dental Practice A SWOT Analysis Dent Update 2002; 29: 80-87. Clark CA, Vanek EP. Meeting the Health Care Needs of People with Limited Access to Care. J Dent Ed 48: 213-216. Griffiths JE, Trimlett HJ. Dental status and barriers to care for adults with multiple sclerosis Int Dent J 1996; 46: 445 abs. Nunn JH, Gordon PH, Carmichael CL. Dental disease and current treatment needs in a group of physically handicapped children. Comm Dent Health 1993; 10: 389-396. Nunn JH, Murray JJ. The dental health of handicapped children in Newcastle and Northumberland. Br Dent J 1987; 162: 9-14. Oliver CH, Nunn JH. The accessibility of dental treatment to adults with physical disabilities aged 16-64 in the North East of England. Spec Care Dent 1995; 15: 97-101. Russell GM, Kinirons MJ. A study of the barriers to dental care in a sample of patients with cerebral palsy. Comm Dent Health1993; 19: 57-64. AbstractsA comparison of tooth wear in children with Down syndrome, children with other intellectual mental disability and children without disabilityJ S Rees1, L Jara2, A Ondarza2, P Mistry1, E Laing1 and O Odell11Division of Restorative Dentistry, University of Bristol Dental School, Lower Maudlin Street, Bristol2Institute of Biomedical Sciences, School of Medicine, University of Chile, Santiago, Chile Aim: To examine the amount of tooth surface loss in patients with and without intellectual disability. Objectives: The objective of this study was to examine a group of patients with Down syndrome (DS), a group of patients with intellectual disability (ID) not associated with DS and a third control group for evidence of tooth wear. Design of the study: Patients were selected from a population of the South Metropolitan Area of Santiago, Chile. The Down syndrome sample consisted of 101 individuals (60 males and 41 females) ranging from 6-24 years. A second group of intellectually impaired individuals that did not have Down syndrome from the same three state schools were examined. This sample consisted of 131 individuals (78 males and 53 females) with an age range of 6-26 years. The control groups of children with no intellectual impairment were selected from two state schools in the same district of Santiago. This group consisted of 119 individuals (50 male and 69 female) with an age range of 5-18 years. Tooth wear was assessed using a modified version of the Smith and Knight Tooth Wear Index. Results: For the primary teeth, severe tooth wear was found in 3.3% of the control group, 3.5% of the ID group and 19% of the Down syndrome group. For the permanent teeth, severe tooth wear was found in 0.1% of the sample of the unaffected young people, 0.7% of the ID group and 3.3% of the DS group. Statistical analysis using the Chi squared test found that differences were statistically significant at the p<0.0001 level. Conclusion: Tooth wear was found to be more prevalent in the groups of young people with intellectual disability, compared with the control group. Key words: Down syndrome, tooth wear, Chile. Evaluation of a Chinese version of the Oral Assessment in Down Syndrome (OADS) questionnaireColman McGrath and David O’DonnellFaculty of Dentistry, University of Hong Kong, Hong Kong SAR, ChinaObjective: To develop and test the performance of a Chinese version of the Oral-Assessment-in-Down-Syndrome (OADS) questionnaire among individuals with Down syndrome (DS) in Hong Kong. Method: The OADS questionnaire underwent a forward-backwards translation process and the quality of the translation was validated. Primary caregivers (PCGs) of individuals with DS attending an outreach dental programme were recruited to participate in the study. PCGs completed a 31-item questionnaire covering seven domains related to oral health: access, function, development, signs, pain, disability and a global rating of oral health status. The OADS measure was assessed for validity and reliability. Results: Colloquial difference in the terminology emerged in the translation process for which conceptual equivalent terms were used. Sixty-one PCGs participated in the psychometric testing study. Oral health problems among the DS group were prevalent. Various OADS domain scores were associated with oral health behaviour: performance of oral hygiene (P<0.05), use of oral hygiene aids (P<0.05), and with clinical oral health status: presence of decayed teeth (P<0.05). This demonstrated the measure is discriminative validity. The mean inter-item correlation of items within the OADS domains was moderate to high (0.63-0.87), indicating good internal reliability. Conclusion: The study concludes that the Chinese version of the Oral-Assessment-in-Down-Syndrome (OADS) questionnaire is a valid and reliable assessment tool. This study has implications for all those interested in conducting user based international research in Special Care Dentistry. Down syndrome, oral care, Oral-Assessment-in-Down-Syndrome questionnaire The attitudes of dental students to natural tooth loss and how confident they feel in dealing with patients who experience itL McNally, D C Jagger, D J O’Sullivan and A HarrisonDivision of Restorative Dentistry, Bristol Dental School and Hospital, Bristol, UKThe profound impact of tooth loss on the lives of some people has been reported, together with the need to prepare the individuals for the possible effects of tooth loss. Aim: To investigate the attitudes of pre-clinical and clinical dental students to natural tooth loss and to investigate how confident clinical dental students felt in dealing with patients who may experience tooth loss. Method: A questionnaire was given to 213 dental students studying at the University of Bristol Dental School. Results: Ninety eight per cent of dental students reported that their appearance was important to them. In general very few students in any of the clinical years felt confident in giving patients emotional advice and the results demonstrated a reported reduction in confidence with progression from 3rd to 5th clinical year students. This study has highlighted that a high number of dental students reported that they did not feel confident in giving advice on the emotional effects of tooth loss and would like additional training in this area within the undergraduate dental curriculum. Key words: Tooth loss, emotional impact, dental students Special Care Dentistry: attitudes of Specialists in Restorative Dentistry practising in the United Kingdom towards the creation of a new specialtyM L Hunter1, B Hunter1, S A Thompson and W S McLaughlin21Dental Health and Biological Sciences2Adult Dental Health, UWCM Dental School, Cardiff, Wales Objectives: This study was designed to examine the attitudes of Specialists in Restorative Dentistry practising in the United Kingdom towards the creation of a specialty of Special Care Dentistry. Design: Data were collected by postal questionnaire. Sample and Methods: All dentists whose names were entered on the General Dental Council’s Specialist List in Restorative Dentistry and who were apparently resident and practising in the United Kingdom were asked to complete a questionnaire consisting of 9 closed questions. Results: Questionnaires were returned by 188 (77.37 per cent) of the eligible Specialists in Restorative Dentistry. One hundred and seventy-three respondents expressed an opinion in relation to the creation of a specialty of Special Care Dentistry. Of these, 127 (73.4 per cent) supported the proposal. However, only 119 respondents indicated a preference with regard to the nature of such a specialty. Of these, 79 (66.4 per cent) considered that it should be a ‘stand alone’ specialty. One hundred and forty-eight respondents expressed an opinion in relation to the specialty’s remit. Of these, 26 respondents (17.6 per cent) considered that this should be restricted to the provision of specialist care for adults with ‘special needs’; the remaining respondents felt that the specialty should provide care across the entire age spectrum. Conclusions: Among Specialists in Restorative Dentistry, there is substantial support for the creation of a specialty of Special Care Dentistry. However, their views as to what the nature and remit of this specialty should be are less clear. Key words: Dental specialties, special needs, disability. Cerebrospinal fluid shunts and dentistry – a short review of relevant literatureRachel Proctor1, 2, Navdeep Kumar1, Roger Davies1 and Stephen Porter11Department of Oral Medicine and Special Needs, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of London, London2Community Dental Department, Coventry NHS Primary Care Trust, Coventry, UK Abstract: It has been suggested that invasive dental treatment in individuals with cerebrospinal fluid (CSF) shunts may place them at risk of shunt infection or, in the case of ventriculo-atrial shunts, infective endocarditis. However, the recommendations regarding the need for antibiotic prophylaxis during dental treatment of such individuals remain unclear. This report reviews current knowledge regarding shunt infections and the requirement for antibiotic prophylaxis for bacteraemia-inducing dental treatment. Key words: CSF, dentistry, shunts Congenital suprabulbar paresis (Worster-Drought syndrome): a form of cerebral palsyN. Azam and L Y LowryDepartment of Child Dental Health, Dental Hospital, Newcastle upon Tyne, UKAbstract: This case report describes the dental management of a six-year-old child with a rare form of cerebral palsy known as Worster-Drought syndrome (WDS). It also contains introductory information as this is not a well-documented condition. Key words: Worster-Drought, cerebral palsy, preventive dental care.
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