Volume 6, Number 1. April 2005
Contents
EditorialEmily is Emily.My youngest daughter Emily is nearly 4 years old, she, like many other little girls of her age attends nursery, has swimming lessons and enjoys weekly ballet classes. She, like her older sister Katie, enjoys playing with a range of toys and participates in a range of family activities such as trips to the zoo, the park and to the leisure centre. Just like all other children she has a totally individual personality. Emily, however, is different to many little girls her age in that she has Down syndrome. Emily was diagnosed as having Down syndrome when she was six days old and one of my initial reactions to this news was of concern for Emily, was her life going to be difficult? How would she manage when I was no longer around? I didn't have many pre-conceived ideas about what her life would be like but at only a few days old I was already worrying about whether she would be safe and whether she would be able to have children. I assumed that, even though she may well live independently, she would need support from me. When I sat down and thought more clearly about these worries they probably weren't much different to those I could have had about my other daughter, Katie. The difference was, when Katie was six days old I wasn't thinking that far into the future. What I wasn't prepared for were the low expectations of some other people and the way they would refer to Emily. I have been horrified by people who refer to Emily, or to others who have Down syndrome, as "a Downs" or, "a little Downs syndrome" and shocked to find that many people, professionals included, are of the opinion that those who have Down syndrome are capable of very little. Emily having Down syndrome does not lead me to the assumption "she can't", it leads me to the question, "how can she?" and I have been helped to answer these questions by the vast amounts of research available. Whilst Emily has similar needs to other children who have Down syndrome she also has similar needs to other children who don't. Quite simply Emily is Emily and her needs are individual. Ensuring equal opportunities for Emily is not necessarily about providing the same for her as for others. Her needs are different and so, very often, the support required is also different. This usually is a case of breaking down a task, looking at where her strengths lie, adding a bit of creativity and being willing to go about things in a different way! With a positive attitude, high expectations and the right mix of specialist intervention and ordinary experiences I am confident that Emily's achievements will continue. Until recently Emily saw the community dentist on a regular basis. The dentist she saw was superb and had specialist knowledge of dentistry in people with learning difficulties. She knew about the dental issues that often arose in the case of patients who had Down syndrome and explained them to me. She was aware of what she was looking out for. However, not only did she have this specialist knowledge, she treated Emily as Emily and was prepared to give her time. Most of our visits resulted in Emily opening her mouth, but certainly not on every occasion. Many resulted in using the chair as a slide but one thing that always happened was that we sang a few songs. Singing is something that Emily enjoys, some songs have actions that involve her opening her mouth, others result in tickling and giggling giving a well prepared dentist the chance to do her job! Emily has poor auditory memory, and very little spoken language but she learns well visually so on one visit I took photographs and made Emily a book about going to the dentist. The book* gave us a chance to recall our visits and to prepare for the next one. Emily took the book with her to each appointment to remind her where she was going and what she was expected to do when she got there. This is a perfect example of providing the individual support needed and of parent and professional working together, something which is absolutely paramount. I hope I have briefly conveyed to you the need for individualised support. I have taken heed of the typical learning profile for people who have Down syndrome, and applied it to what I know about Emily to provide support tailored for her. I am not trying to say the job is easy, at times the term 'far from it' springs to mind, but Emily works hard to achieve what she does and she deserves the same from those supporting her. I feel privileged to be Emily's mum and to have the opportunity to help her flourish. I know that some of the professionals who work with Emily feel a little of that too; they are those who have understood that Emily is Emily! Helen Long AbstractsStudy of the value of the panoramic radiographic examination in special risk patients with a history of infective endocarditisDavid Townsend 1, Navdeep Kumar1, Jackie Brown2, Kalpesh Patel3, Roger Davies1 and Stephen Porter 11Department of Oral Medicine and Special Needs, 1 Department of Radiology, 1 Department of Periodontology, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of London, 256, Gray's Inn Road, London WC1X 8LD. Abstract Individuals with a history of infective endocarditis (IE) may be at increased risk of further episodes of endocarditis arising from a bacteraemia associated with invasive dental treatment or oral infections. Detailed oral assessment to exclude oral pathology is thus important to identify potential sources of bacteraemia, however the selection criteria for radiographic views when examining patients at risk of IE are not clear. Objective: To determine the frequency and nature of oral and dental lesions detected by dental panoramic tomograms (DPTs) which would not have been detected by clinical history, examination and bite-wing radiographs, in a group of patients with a history of known IE. Methods: DPTs of patients with a history of IE were examined retrospectively by three observers for oral and dental disease likely to be a source of bacteraemia. The patients' clinical notes were then reviewed to determine whether the findings from the DPTs affected the treatment the patients received. Results: Twenty of 30 (66%) DPTs revealed additional pathology which would not have been detected by routine history and clinical examination even when augmented with bitewing radiographs. Nine out of twenty (45%) of the detected pathologies demonstrated suspected periapical inflammatory pathology and hence a potential source of bacteraemia. Of these, four of the patients did not undergo any further investigation or treatment, although the involved teeth were closely reviewed, while periapical radiographs were taken for the remaining seven patients. Three occult periapical lesions, which would not otherwise have been detected, were confirmed and these teeth were subsequently extracted. Three of the patients (10%) had treatment modified as a result of the panoramic radiograph. Conclusions: The clinical history with examination and bitewing radiographs alone may not be sufficient to detect all potentially bacteraemic pathology in patients with a history of infective endocarditis. In view of the substantial morbidity and mortality associated with a further episode of IE, the dental assessment of these patients should include a more extensive radiographic survey such as DPT supplemented with selected intraoral radiographs, rather than the reliance on bitewing radiographs alone. Dental care for children (and the not so young) with intellectual disabilitiesH. Barry Waldman1 and Steven P. Perlman21Department of General Dentistry, SUNY at Stony Brook, New York, USA, <2The Boston University Goldman School of Dental Medicine Abstract It is estimated that there are 156 million people with intellectual disabilities in the world. Despite the fact that many of these individuals no longer reside in large government run facilities and are dependent upon local practitioners for dental and medical services, many countries have rudimentary information on the numbers of these people in their communities. In addition, there is the question of the adequacy of preparation and competency of dental school graduates to provide needed services. Limited educational opportunities perpetuate stereotypic perceptions and inadequate preparation to deal with the complexities of care. Efforts for change are considered, together with the challenge to the profession to consider the need to provide the necessary services. A prospective study of complications and outcomes associated with conscious sedation for the anxious dental patientN M Girdler1, K E Wilson2 and E J Booth31Consultant & Senior Lecturer, 3 Clinical Assistant, Department of Sedation, Newcastle Dental Hospital and School of Dental Sciences, Newcastle upon Tyne. 2 Senior Dental Officer/Honorary Staff Grade, South Tyneside Primary Care Trust, South Tyneside & Newcastle Dental Hospital, Newcastle upon Tyne Abstract Aim: To establish baseline standards for the prevalence of complications and success rates for dental treatment under intravenous and inhalation sedation. Objective: To establish the nature and frequency of complications and the outcome of treatment in patients undergoing conscious sedation with intravenous midazolam or inhalational nitrous oxide/oxygen. Design: Prospective prevalence study. Setting: Dental Hospital & Community Dental Service in north east England. Methodology:All patients undergoing adult intravenous midazolam sedation and paediatric inhalational nitrous oxide/oxygen sedation for dental care over a specified period of time were audited. Data on demographics, sedative drug and dose, complications and outcome were collected. Results: Intravenous Sedation. At Newcastle Dental Hospital (NDH) the records for 89 patients were audited. Eighty-three patients (92%) experienced no complications and 7 (8%) patients experienced only minor complications. At South Tyneside Community Dental Service (STCDS), the records of 59 patients were audited. Fifty-eight (98%) experienced no complications and 1 (2%) patient experienced a minor complication. Dental treatment was successfully completed in 88 patients (98.8%) at Newcastle Dental Hospital and 59 patients (100%) at South Tyneside. Inhalational Sedation. At NDH 160 patients were audited. 138 patients (86%) had no complications. At STCDS 107 patients were audited and 96 (90%) had no complications. At NDH dental treatment was successfully completed in 141 patients (88%), with 7 patients (4%) requiring referral for GA. At STCDS dental treatment was successfully completed in 94 patients (88%), with 9 patients (8%) requiring referral for GA. Conclusion: This audit has established baseline standards for the prevalence of complications and outcome of dental treatment with two established sedation techniques. Recovering drug users and oral health: a qualitative study1Kevin H-K. Yip and 2Roger J Smales Barry Gibson1, Sam Acquah 2, and Peter G. Robinson1~ 1School of Clinical Dentistry, Sheffield, UK, 2Unit of Oral Health Services Research and Dental Public Health, Guy's King's and St Thomas' Dental Institute, King's College London, London, UK Abstract Aim and objectives: Sociological literature on recovery from drug use has highlighted the importance of identity and the definition and understanding of 'addiction'. This literature it seems might have much to add to the relatively underdeveloped explanations that have been provided for the oral health experiences of these groups in the dental literature. The consequences of both these concerns are explored in a secondary analysis of qualitative data concerning the range of experiences and concerns of recovering drug users with respect to their oral health. The aim of this study is to document to a professional audience the problems associated with 'entangled identities' and how they can explain the relevance of oral health to drug users both during times of problematic drug use and when they are recovering. Design: The analytical techniques of grounded theory focussed on the core concerns of participants as opposed to describing themes which appear important to the researcher in the primary analysis. Results: Forty of forty-two people invited to take part in the study did so. Twenty-five participated in focus group discussions and fifteen took part in-depth interviews. Participants were aged between 21 and 52 years and 26 were men. Participants indicated their main concern was with becoming someone who they had not been. This was described as having an 'entangled identity'. Subsequently their main concerns when recovering from drug use was with 'disentangling' themselves from the entangled drug using self. Within this context the recovery process involved a reconstitution of their oral health by seeking dental care. Oral health therefore became an important part of the recovery of control and becoming the person they were before. Conclusion: A sociological understanding of drug addiction can add to existing explanations of this phenomenon in the dental literature by extending the current understanding of lifestyle to include structural factors that surround the entangled identity. Further work might adopt a more psychosocial perspective alongside a perspective from the sociology of the emotions. Oral findings and 18-month follow-up care in two siblings with autistic disorderFolakemi A. Oredugba and Mark L. WagnerDepartment of Child Dental Health, College of Medicine, University of Lagos, Nigeria Abstract Autism is marked by extreme abnormal emotional, social and speech development. Parents and caregivers may often have difficulty providing home care for affected children. Their dental management can therefore be most challenging for the paediatric dentist. This paper highlights some significant oral findings and management challenges in two autistic siblings. Case Report - Treatment of localised, moderately deep periodontal pockets in an HIV- positive patient with minimal intervention.R J EmanuelPrincess Royal Hospital, Haywards Heath, Sussex, UK Abstract This case report describes a case of periodontal treatment provided to a positive HIV woman over a number of months. It highlights the increased susceptibility towards periodontal disease experienced by HIV positive patients but also mentions the importance of local anatomical factors as being important in disease susceptibility. Simple treatment can be effective in such cases, even in the immune-compromised person. The importance of disruption or removal of the biofilm, along with prevention of re-colonisation of the root surface by bacterial plaque, is a key element of successful periodontal therapy. If these treatments are carried out thoroughly, the effects of a poor host response as seen in HIV infection, will have less of an impact. Types of specific periodontal disease pathology, which are unique to patients with HIV infection, exist and can include disease where the causative organisms are thought to include Candida and Herpes viruses.
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