Volume 5, Number 2. October 2004
Contents
EditorialGood quality research and audit are vital to underpin clinical practice within the context of evidence-based care. Special Care Dentistry has been bedevilled by a lack of published research to endorse some of the clinical activity undertaken for people with disabilities, although as a clinical discipline, it is not alone in this.The British Society for Disability and Oral Health has endeavoured to address the issue of protocols for the care of people who come under the remit of Special Care Dentistry (SCD) by the development and publication of its series of Guidelines. Similarly, the Joint Advisory Committee for Special Care Dentistry has produced two very excellent documents - one on the case of need for a speciality and the other, a proposed training programme for someone intent on becoming a specialist in SCD. Both of these are available on the BSDH website: www.bsdh.org.uk. A brave person indeed you say, who is prepared to embark on a training programme in a specialty that is not officially recognised. Yet there are so many people out there providing high quality dental care for people who are impaired and disabled in some way and who have been shunned by more conventional dental care providers. Their dental team may have, as yet, no formal training pathway but they have, by dint of dedication and a sense of professional responsibility, acquired the skills and experience that has allowed them to care for such groups of people. Such is the case in the pages that follow. We read of the team of Lewis and Gilmour providing care that breaches the boundaries of the conventional primary: secondary care interface to provide consultant directed, experienced clinician-delivered care to people, close to their homes, whose only other option maybe to receive compromised, or no, care. Other teams, Tamura and Susuki, are developing novel techniques to overcome a very specific problem for the increasingly ageing members of society. Still others, Tsami et al., Terro et al. and Roman are using epidemiological tools with people with disabilities to gather data that enables them to bring political pressures to bear in order to improve services for disadvantaged groups. Whilst the dental politicians argue about the necessity for additional specialities, agonising over the recognition of Special Care Dentistry and what it might mean for their specialty, the evidence accrues on the needs and expectations of the ever-increasing number of disabled people who are excluded from accessing oral health care. Evidence that is becoming overwhelming in its support for proper education and training for those people prepared to provide clinical care, often in difficult circumstances, that their more conventionally trained peers are either unwilling or unable to provide. Or maybe we just wait for the pressure to mount from parents and carers, and eventually the legislation that follows, to force us to do what any professional should have done a long time ago; acknowledge the needs of vulnerable people in our society and if they as clinicians are not prepared to provide the dental services, ensure that, within the framework of clinical governance, there is an opportunity for others to provide high quality care backed by appropriate skills acquisition and recognition of those skills. Is this just naive -or too uncomfortable a thought? June Nunn AbstractsThe role of joint consultant restorative and special care clinics in the communityDebbie Lewis 1 and Graham Gilmour 21Canford Heath Dental Clinic, Poole, UK2Mayday Hospital, Thornton Heath, UK Abstract Access to oral health care for people with disabilities is compromised by many factors. In particular, access to advanced restorative care from a Consultant in Restorative Dentistry may be difficult due to a lack of local service provision and problems encountered by people with disabilities in relation to travel. A model of care is described in this paper that provides equity of access to advanced restorative and special care dentistry in a community setting. A number of cases are presented showing successful outcomes achieved by the use of this model. One approach to ensuring equity of access to specialist advice and care, for people with disabilities who need special care, is to provide joint restorative and special care clinics in the community. Key words: Special care, advanced restorative care, access, joint clinics Oral hygiene and periodontal treatment needs in young people with special needs attending a special school in GreeceAlexandra Tsami1, Eudoxie Pepelassi1, Sotiria Gizani2, Mando Komboli1, Liza Papagianoulis2 and Zacharias Mantzavinos11Department of Periodontics and 2Department of Pediatric Dentistry, University of Athens, Athens, GreeceAbstract Aim: To study the factors influencing the oral hygiene and the periodontal treatment needs in young individuals with special needs. Design and subjects: A group of 54 individuals attending a school with special educational services, was studied. The evaluation included consideration of detailed medical records, a dental questionnaire concerning oral hygiene conditions and dental attendance followed by a clinical examination to determine dental status and periodontal treatment needs. Results: The periodontal treatment needs of the study population were high and most individuals needed treatment for gingivitis. Very few individuals had a healthy periodontium. The periodontal treatment needs correlated with: tooth brushing frequency, oral malodour (halitosis), the gingival index, presence of calculus and dental caries. The effectiveness of the oral hygiene correlated with: the need for assistance, the frequency of oral hygiene measures, bleeding on brushing and the gingival status. Key words: Periodontal treatment needs, oral hygiene, special needs Relationship between hepatitis virus infection and dental status in an 80-year-old populationYutaka Takata1, Toshihiro Ansai2, Shuji Awano,DDS2, Kazuo Sonoki1, Masanori Wakisaka1 and Tadamichi Takehara 2 1Department of Internal Medicine, 2Department of Preventive Dentistry, Kyushu Dental College, Kitakyushu, Japan Abstract Aim: Little is known about the relationship of hepatitis virus infection to dental status, especially in very elderly individuals. We evaluated hepatitis C, G, transfusion-transmitted (TT), and B virus infection in relation to dental status in 80-year-old subjects. Design and subjects: Of 1,282 individuals who were 80-years-old and resided in the Fukuoka Prefecture, Japan, 407 (156 male, 251 female) underwent oral examination and laboratory tests. Relationships between hepatitis virus infection, tooth number and community periodontal index (CPI) were analysed by logistic regression analysis. Results: The mean tooth number was 8.4. None of 404 individuals had HBs antigen (0%), while 26 of 406 were HCV-seropositive (6.4%). Thirteen of the 405 (3.2%) and 161 of 406 (39.7%) had HGV RNA and TTV DNA, respectively. HCV infection was more prevalent in edentulous individuals (9.4% vs. 4.9%). Prevalence of HGV infection was significantly increased in edentulous individuals (6.5% vs. 1.5%). No significant differences were noted in prevalence of the TTV DNA between edentulous subjects and others. After adjustment for gender, smoking, and alcohol consumption, HGV RNA remained significantly more prevalent and HCV antibody still tended to be more prevalent, in edentulous subjects. TTV DNA tended to be more frequent in individuals with at least 20 teeth than in those with ?19 teeth. No significant relationship was found between CPI and HCV, HGV, or TTV infection. Conclusion: Very elderly Japanese people showed an association of HGV infection with tooth loss, and weak associations of HCV infection with tooth loss and TTV infection with tooth retention. Key words: Hepatitis viruses, tooth loss, dental health, elderly population, periodontal disease Root surface caries in elderly people in residential care1Kevin H-K. Yip and 2Roger J Smales 1Associate Professor, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, PR China. 2Visiting Research Fellow, Dental School, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia 5005. Abstract Aim: Ageing populations are a world-wide trend in most countries, and the quality of dental health care provided for elderly people is extremely variable. The objective of this paper is to examine the contemporary features of root surface caries and its clinical management in elderly persons in residential care. Method: A relevant dental and medical literature search was undertaken using PubMed and related search methods. Key words included special care dentistry, elderly, oral health care and institutionalised dental patients. Results: The literature searches presented an overview of the current situation in special care dentistry regarding root surface caries, with an emphasis on elderly people. The clinical treatment and management of root surface caries in this population presents many difficulties, and oral health care services may be inadequate. A standard protocol has not been satisfactorily developed for the oral health care of elderly persons in residential care. Conclusion: Root surface caries is an increasing problem in a growing number of partially dentate elderly individuals. A protocol based on existing research findings is recommended for the dental management of root surface caries in elderly persons in residential care. Key words: Elderly, special care dentistry, oral health care The oral health status of the Special Olympics Special Smiles (SOSS) athletes in the Middle East and North Africa RegionWahid M.Terro1, Stephen B. Corbin2 and Mark L. Wagner31Department of Oral and Maxillofacial Surgery, University Dental Hospital of Wales College of Medicine, Dental School, Cardiff, UK, 2Dean and 3Director, Health and Research Initiatives Special Olympics University Washington D.C. USA. Abstract Aim: The present study was carried out to assess the oral health status and treatment requirements of persons with learning disability (LD) namely, Special Olympics Special Smiles (SOSS) athletes, in the Middle East and North Africa (MENA) Region. Design: The study population consisted of a convenience sample of athletes participating in the Special Olympics events held in the Middle East and North Africa Region during 2002. Subjects: The sample comprised 204 Special Olympics athletes from 17 countries in the MENA Region whose age ranged from 11 to 54 years, mean age 19.3 years. Main outcome measures: A standardised oral health screening form and standardised oral health exam were used for the assessment of each athlete. Results: There was a high prevalence of molar decay (54.1%), and gingival signs (53.4%). Of the screened athletes, 22.4% needed urgent care, and 56.7% needed non-urgent care. The remainder needed only maintenance care. No edentulous athletes were reported. Conclusion: This study indicated the special and distinct need for creating organised education, preventive and curative oral health programmes for people with learning disability (e.g., Special Olympics athletes) in the Middle East and North Africa Region, to improve their health status. Key words: Special Olympics International (SOI), oral health status, learning disability, Special Olympics athletes Caries among a group of Romanian intellectually impaired childrenA Roman, S Tigan and O PastravUniversity of Medicine and Pharmacy, Tuliu Hatieganu, Cluj-napoca Romania Abstract Objectives: The aim of this study was to analyse the caries experience of 11- to 13-year-old children in a Romanian group of intellectually impaired children in order to determine the present dental status and to compare it with the data available for normal children in Romania, as well as with the results of similar studies in other countries. Material and methods: The study included 114 intellectually impaired children. The World Health Organisation (WHO) Oral Health assessment form and booklet were used for the assessment of dental caries. The DMFT Index was used. The information collected was entered onto a database and analysed using the EPIINFO statistical package. Results: The mean DMFT score in the permanent dentition was 8.28 with a mean of 7.93 for males and 8.73 for females. There were no statistically significant differences between males and females for DMFT (p=0.15) for decayed (p=0.55) or for the missing component (p=0.08) of the index. There was a statistically significant difference between males and females for the filled (F) component (p=0.03). The decayed component made up the largest contribution to the overall DMFT, accounting for 90.58 %, of the caries experience and 91.93% and 89%, respectively for males and females respectively. The children presented a low level of restorative care (mean FT score, 0.4). Conclusions: The results from the present study show a large difference in the DMFT values for the group of disabled children as compared with normal children. Key words: Intellectually impaired children, caries experience Effects of edentulism on lingual functions during swallowing.Fumiyo Tamura and Shiro SuzukiDepartment of Prosthodontics and Biomaterials, University of Alabama at Birmingham, Birmingham, AL, USA. Abstract Aim: To evaluate the effects of edentulism and feeding posture on swallowing function. Method: Eight, healthy edentulous individuals were chosen for the evaluation of lingual/palatal pressure during swallowing as a function of posture and edentulism. A prosthetic appliance, consisting of an acrylic base with silicone bite rims, was fabricated to restore vertical occlusal dimension. Liquid (5cc) was repeatedly given to the subjects to swallow upright, at 30?, and in the supine positions. Lingual/palatal pressure against sensors embedded in anterior and lateral portions of a denture base was evaluated by a computerised system. Results: Demonstrated that the lingual/palatal pressure was significantly higher when subjects swallowed in the edentulous condition in the 30? and supine positions. It was concluded that the effect of feeding posture was significant to swallowing function in the edentulous condition. Key words: Edentulism, feeding posture, swallowing function
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