Volume 6, Number 2. October 2005
Contents
A review of screening instruments for oral health in older people - multi-agency working across health and social care The effectiveness of different toothbrushes for people with special needs A report from an investigation of abnormal oral reflexes, lip trauma and awareness levels in patients with profound brain damage Continuing Professional Development Programme 79 Teaching Undergraduates Special Care Dentistry Comprehensive dental care for special needs children under day-stay general anaesthesia – treatment outcomes and post-operative morbidity Stock fit as an alternative to custom finger guard mouth props for examination and treatment of patients with special needs Book reviews 98 Diary 100
EditorialA time to remember…Special Care Dentistry has seen great advances in recent months. Those working within the discipline were delighted that three of its members were acknowledged in the Queen’s Birthday Honours List. Norman Campbell was appointed OBE for his services to dentistry. Norman has spent the majority of his working life providing care for people with disabilities, initially with Trevor Castles, also a BSDH member, in Northern Ireland. Norman has contributed significantly to developing the service in the City Hospital in Belfast as well as in other centres around the city. Furthermore, he has provided undergraduate and postgraduate dental education in Special Care Dentistry and those working alongside him view his imminent retirement with trepidation. Janet Griffiths, working also as an Associate Specialist but in South Wales was honoured with an MBE for her services. Those who know Janet will be well aware that her devotion to people with disabilities does not stop with her professional life. It extends to the charity with which she is involved, founded by her parents, to provide significant recreational and other social benefits to adults with intellectual disabilities. Janice Fiske, also awarded an MBE is well known for her work in promoting the specialty through the Joint Advisory Committee in Special Care Dentistry and for her involvement with the postgraduate course in Sedation and Special Care Dentistry in the University of London. In the UK, 2004 saw recognition of the need for a speciality of Special Care Dentistry in the recommendation from the Department of Health’s Standing Dental Advisory Committee that the General Dental Council should consider the establishment of a speciality. This has been warmly welcomed and supported in evidence to the General Dental Council’s own review of the dental specialties, by those most important stakeholders, voluntary organisations, support groups – in other words, users of the service that we all endeavour to provide. An important landmark victory in the USA was the recognition by the Commission on Dental Accreditation of the need to reform curricula for dental care professionals so that they were inclusive of people with special needs. In the UK, competencies in SCD are established at both under- and postgraduate level with a number of dental schools incorporating elements into their new curricula. Less encouraging are the developments within primary dental care and the impact that these potentially will have on access to oral and dental care for people with disabilities. Community dental services that have fought hard to establish comprehensive and accessible services for people who require special care, face seeing those eroded, indeed even decimated in the brave new world of PCTs, PDS and Access Centres. What of those who may not be in a position to make their needs known? In the absence of a real commitment to so-called ‘special needs’ groups at governmental level in many countries, it behoves all dental special interest groups to continue to advocate for the needs of vulnerable people everywhere. A glance at our diary page will reassure the reader that that at least, is happening worldwide. June Nunn, Dublin July 2005 AbstractsA review of screening instruments for oral health in older people - Multi-agency working across health and social careE.A. Lane and J.E. GallagherOral Health Services Research & Dental Public Health, GKT Dental Institute, King’s College London, UK Abstract Aim: To present an analysis of oral screening instruments within the Single Assessment Process (SAP) for older people and make recommendations for action in light of the oral health needs of older people. Design of the study: The literature was reviewed, policy documents appraised and key personnel consulted with respect to the oral health needs of older people, screening tools, the National Service Framework (NSF) and the SAP. This resulted in the formation of the list of ideal requirements for an oral health screening instrument within the SAP. A search of the literature and contact with key individuals providing a list of screening instruments which were then compared to the list of ideal criteria. Results are presented, and recommendations for action. Inclusion: Instruments found were reviewed descriptively. Supporting evidence of effectiveness presented. Setting: Current oral health policy for England which recognises demographic change, the introduction of a single assessment process and the oral health needs of older people. Results: Ten instruments (electronic and paper) were found, of which five formed part of recently created SAP screening tools. Different versions of the same tool exist. Five were stand alone instruments reported in the dental and grey literature. Issues explored included oral/dental problems, dental visits, dental urgency and risk factors. All three studies reporting evidence of effectiveness related to one short question-based stand alone instrument, D-E-N-T-A-L, which showed high sensitivity and moderate to high specificity. Conclusions: There has been proliferation of oral health screening instruments for older people in support of health and social care policy, with limited evidence of research into their effectiveness. D-E-N-T-A-L is the only instrument with published evidence of its effectiveness; its inclusion in national and local instruments is recommended. Further research on effectiveness of screening instruments with a dental component is required, including their acceptability to older people and personnel. The effectiveness of different toothbrushes for people with special needsI Kaschke, J Klaus-Roland and A ZellerUniversitätsmedizin Berlin Charité, Berlin, Germany Aim: To investigate the type of toothbrush that enables patients with special needs and/or their carers to carry out effective tooth brushing. Study Design: Three-way cross-over with 36 subjects with physical and/or mental impairments, who used the brushes, on their own (‘Self-Brushers’) or with assistance, either in part (‘Assisted Brushers’) or total (‘Other Brushers’) from their guardian or carer. Subjects used the three-headed toothbrush Superbrush® and the Teledyne® Waterpik Sonic Speed Plaque Remover as well as a simple manual toothbrush, the Oral-B 35®. The subjects were divided into three groups according to the severity of their disability. After professional cleaning, the 14-day test phases began followed by the 14-day wash-out phase. The following indices were used by one blinded, experienced examiner for each test phase: Quigley-Hein Index (QHI), approximal plaque index according to Lange (API) as well as the papilla bleeding index according to Saxer and Muhlemann (PBI). Results: The three-headed toothbrush removed plaque more effectively from the smooth surfaces in two of the subject groups (Other Brusher and Assisted Brusher). For those able to brush for themselves, the powered toothbrush performed better in removing plaque from vestibular surfaces. Conclusion: Although the study groups are small, differences were observed in the plaque removing efficacy of the brushes with the three-headed brush performing better for those adults who required help, some or total, to brush their teeth. The Superbrush® can thus be recommended for brushing in these groups on the basis of the results from this blind, cross-over study. A report from an investigation of abnormal oral reflexes, lip trauma and awareness levels in patients with profound brain damageJoanna Millwood1, Sophie MacKenzie1, Ros Munday1 and Elaine Pierce1 |