Volume 7, Number 1.       April 2006

Contents


Editorial 2

Oral health findings in a group of Greek schoolchildren with mild intellectual impairment
Sotiria Gizani, William Papaioannou and Lisa Papagiannoulis 3

A comparison of the effectiveness of chlorhexidine varnish, fluoride varnish and fluoride gel in children with intellectual disability
Nazan Kocatas Ersin, Özant Önçağ 10

Feeding habits of children with Down syndrome living in Riyadh, Saudi Arabia
Maha Al-Sarheed 17

Continuing Professional Development Programme 22

An approach to the restoration of fractured anterior teeth in adolescents with intellectual impairment
Alexandra Roman and Ovidiu Păstrăv 25

The use of hypnosis and systematic desensitisation in the management of dental phobia: a case report
K E Wilson 29

Mortality after full mouth rehabilitation under general anaesthesia for a child with Tetralogy of Fallot: report of a case
C.C. Liao, Y.H. Chen and C. Y. Yang 35

Oral hygiene status and behaviour of the special needs children in Lahore, Pakistan
Muhammad Shoaib, Nazia Yazdanie, Ayyaz Ali Khan, Omer Hafeez Kaleem, Noorya Ibrahim and Bushra Azad 43

The oral health status of Special Olympics athletes in Trinidad and Tobago
Rahul S Naidu, Tricia Percival, Visha Ramroop, Soorebettu R Prabhu and

Steven Perlman 48

The dental management of a patient with erythromelalgia: a case report
L. Zoitopoulos and H. Ghoddousi 53

BSDH News 55

Addendum 56

Editorial

Special Care Dentistry –a reality

The year 2005 will be recalled as a landmark year for Special Care Dentistry.

Three members - Norman Campbell, Janice Fiske and Janet Griffiths - were honoured in the Queen’s Birthday Honours List in the summer for their contributions to the speciality and in December, the General Dental Council (GDC) approved in principle, the need for a speciality of Special Care Dentistry (SCD).

It had to come; countless patients, parents, support groups and dental teams could not have all been wrong. The submissions received by the GDC in its call for views were testimony to the need and demand out there for formal recognition of what selfless, dedicated oral health care teams had been doing for years. Now comes the really hard work.

It was a year too which saw much activity in related areas. The Department of Health had commissioned the British Society for Disability and Oral Health to set up a working group to explore a way forward in establishing dentists with a special interest – DwSI – in SCD and that group is now ready to present its finished document on competencies for such a group of dentists in the UK health service.

The Society also launched its competencies for undergraduate education in this journal in the spring of 2005 and in the closing stages of the year we welcomed the incoming president of BSDH, Peter Holland, our first non-dentist to take the helm for what will surely be an important year.

There is of course much hard work to do; the task now of making the case amongst relevant bodies in the different jurisdictions to ring fence money and posts for education and training, as well as ensuring a good case is made to commissioners for the resources to provide high quality care for the vulnerable groups that SCD is all about.

It is however, a time for reflection also. To think back to all those people, some of them sadly no longer with us, and be grateful for all their dedication, often working in isolation, facing much more suspicion and hostility than we can ever imagine, for what they saw as, and we know is, important, Special Care Dentistry

June Nunn

Dublin , April 2006

O ral health findings in a group of Greek schoolchildren with mild intellectual impairment

Sotiria Gizani, William Papaioannou and Lisa Papagiannoulis

University of Athens , Greece

Abstract

Aim: To describe the oral health condition and the need for dental and periodontal treatment in children with mild mental impairment. Information was gathered concerning family characteristics and the oral hygiene and dietary habits of the children. The influence of these factors on the oral health condition of the children was evaluated using a statistical model.
Material and methods: The sample was a convenience sample selected from eight special schools in the greater Athens area. The children were clinically examined in a mobile dental unit and the following parameters were assessed: periodontal condition, caries experience and past dental treatment.
Results: The participants comprised 171 students (114 boys and 57 girls) with mild mental impairment and a mean age of 11.46 years (SD: 1.92). The results for the provision of dental treatment index showed that only 8.39% (SD: 24.76%) of carious permanent tooth surfaces were treated. The picture was similar for the primary dentition. The multiple linear regression analysis showed that lack of tooth brushing and frequent daily sugar consumption influence negatively the periodontal and dental condition of the children, respectively. The index for periodontal treatment need showed that scaling and root planning was necessary for 41.44% of the children examined while only one child had a healthy periodontium.
Conclusions: It seems that the absence of motor impairment in the children made parents and teachers believe that their children could be trusted to perform oral hygiene, which was shown clinically not to be the case. Programmes of oral health education addressed to parents, teachers and children are necessary.

A comparison of the effectiveness of chlorhexidine varnish, fluoride varnish and fluoride gel in children with intellectual disability

Nazan Kocatas Ersin and Özant Önçağ

Ege University, Faculty of Dentistry, Department of Pedodontics, Bornova-Izmir, Turkey

Abstract

Objective: To compare the effectiveness of chlorhexidine and fluoride varnishes and fluoride gel within a group of intellectually disabled patients.
Design: A randomised controlled trial.
Methods: Ninety young people aged between 12-15 years, who had previously received full-mouth rehabilitation under general anaesthesia, participated in this study. Subjects were randomly allocated to one of three groups for treatment with Cervitec â , a chlorhexidine-containing varnish or a fluoride gel or Bifluorid 12 â , a fluoride containing varnish. The Cervitec â varnish was re-applied every three months and the fluoride treatments semi-annually. The outcomes were the caries increment (DMFS index), dental plaque, mutans streptococci (MS) and lactobacilli counts by comparison at baseline and after one year.
Results: Thirty-seven subjects showed poor compliance to the follow-ups and were excluded from the study. The Cervitec â varnish group showed a statistically significant reduction in MS counts after one year in comparison to the fluoride gel and fluoride varnish groups (p<0.05), but no inhibitory effect was found in the lactobacilli counts in all groups. There were also no statistically significant differences in the pre- and post-treatment plaque scores between the groups. The caries increments were 0.74±1.5, 1.06±2.26, 1.38±2.03 in the Cervitec â , fluoride gel and Bifluorid 12 â groups, respectively. The differences between the groups in mean caries increment were not significant.
Conclusion: The preventive agents tested showed equal efficiency in one-year caries increment within a group of children with intellectual disabilities.

Feeding habits of children with Down syndrome living in Riyadh, Saudi Arabia

Maha Al-Sarheed

Consultant Pedodontist, Assistant Professor, Division of Pediatric Dentistry, Department of Preventive Dental Science, King Saud University,

Riyadh , Saudi Arabia

Abstract

Aim: The aim of the study was to investigate the duration of breastfeeding and the timing of introduction of solid food among children with Down syndrome living in Riyadh, Saudi Arabia.
Subjects and Method: Mothers of 225 children attending three institutes providing education for children with Down syndrome were asked to complete a questionnaire. Data were collected on knowledge of feeding procedures, pattern of feeding, and the introduction of solid food.
Results: Although 66.7% of mothers breastfed initially, 30% of them discontinued breastfeeding at 3-6 months of the child’s age. Overall, mothers of children with Down syndrome introduced solid food to their children between 6-9 months of age and the most frequently used formula was Similac “yellow”. Just over 15% of the mothers gave their children sweet food every day as part of weaning. Most mothers believe that chocolate is bad for their children teeth.
Conclusion: In Saudi Arabia, mothers with Down syndrome children are more likely to breastfeed. The introduction of solid food was relatively late.

An approach to the restoration of fractured anterior teeth in adolescents with intellectual impairment.

Alexandra Roman 1 and Ovidiu Păstrăv 2

1 Associate Professor, 2 Assistant Lecturer, Department of Odontology–Periodontics, The “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Abstract

Aim: T o restore traumatic lesions of the anterior teeth, in a group of adolescents (age range 13-16 years) while conscious, with mild and moderate mental impairment.
Study design: The study group consisted of 10 teenagers selected from an orphanage, with good oral hygiene, motivated and cooperative, in which 14 traumatic fractures were diagnosed. For the aesthetic restoration a microhybrid composite Herculite ® and a fifth generation adhesive system Optibond Solo ® were used in conjunction with t he stratification technique suggested by Vanini (1996), utilising a silicone palatal guide produced in the laboratory. In the case of fractured but non-vital teeth, endodontic treatment was carried out.
Results: Nine central maxillary incisor fractures and five lateral maxillary incisor fractures were treated. Immediately postoperative, one-week, six months and 12 months later, results were considered satisfactory.
Conclusions: We believe that the value of this report is in the illustration of relatively complex dental treatments in adolescents with intellectual impairment, whilst conscious; improving function, aesthetics and self esteem.

The use of hypnosis and systematic desensitisation in the management of dental phobia: a case report

Katherine Wilson

South Tyneside Primary Care Trust, Community Dental Service

Abstract

This case report presents a patient with dental phobia, which reportedly developed at the age of 9 years of age, following a traumatic dental experience. It describes the use of hypnosis and a programme of systematic desensitisation in the management of dental and needle phobia.

Mortality after full mouth rehabilitation under general anesthesia for a child with Tetralogy of Fallot: report of a case

C C Liao, Y H Chen, C Y Yang

Division of Pedodontics and Orthodontics, School of Dentistry, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.

Abstract

This paper presents the case of a 9-year-old boy with uncorrected Tetralogy of Fallot (ToF) who was admitted to our hospital for comprehensive treatment of his dental problems under general anaesthesia. Treatment included three amalgam restorations, four sealants, eight resin-based composite restorations, two preformed metal crowns (SSC), eight primary tooth or residual root extractions, two supernumerary tooth extractions, and a lower arch impression for the fabrication of a lower lingual holding arch (LLHA). Immediately after the operation, the patient was sent to the paediatric intensive care unit and after he was stabilised, his nasotracheal tube was removed. Unfortunately, the patient then developed severe breathing difficulty and lost consciousness but was resuscitated after reintubation and cardiopulmonary resuscitation. The patient died two months postoperatively from spontaneous, massive bleeding from the pharyngoesophageal region. The poor outcome in this case, after full mouth rehabilitation under general anaesthesia, indicates the risk associated with these special patients, the need to work with a well trained paediatric anaesthetist and the importance of cautiously embarking upon this form of dental care.

Oral hygiene status and behaviour of the special needs children in Lahore, Pakistan.

Muhammad Shoaib 1, Nazia Yazdanie 2, Ayyaz Ali Khan 1, Omer Hafeez Kaleem 2,

Noorya Ibrahim 2 and Bushra Azad 2

1 Department of Oral Health Sciences, Sheikh Zayed Federal Postgraduate Medical Institute, Lahore, Pakistan

2 de’Montmorency College of Dentistry, Lahore, Pakistan

Abstract

Aim: To investigate the oral health status of individuals with mental and medical disabilities in Lahore and compare the results with an age and gender matched healthy control group.
Material and methods: A cross-sectional study conducted on 424 individuals with a mean age of 10.7 years (age range: 6-17years) at two day schools for individuals with intellectual impairment and Down syndrome. Medically compromised subjects were recruited from the paediatric ward of a local hospital. Age and gender matched controls were selected from one school.
Outcome measures: Oral hygiene status and tooth brushing practices.
Results: Medically compromised individuals reported highest mean OHI(S) values (poorest oral hygiene) among the three groups. The mean difference was significant between the groups (p< 0.05). Among the compromised individuals, those with insulin dependent diabetes mellitus (IDDM) had poor oral hygiene, followed by persons with mild intellectual impairment. The oral hygiene status of sub-classes of intellectually disabled and medically compromised groups was significantly poorer when compared to normal individuals (p < 0.05). However, the mean difference was not significant among the individual disability groups (p > 0.05). Individuals with special needs had irregular tooth brushing practices when compared with their normal counterparts. The difference between the groups was statistically significant at (p < 0.05). The two main disability groups (intellectual impairment and medically compromised) did not differ significantly in their brushing practices (p=0.602). Conclusions: Individuals with special health care needs had poor oral hygiene and irregular tooth brushing practices as compared to their normal counterparts. There is an essential need to improve the oral health status of this neglected group in society.

The oral health status of Special Olympics athletes in Trinidad and Tobago

Rahul S Naidu 1, Tricia Percival 1, Visha Ramroop 1, Soorebettu R Prabhu 1 and Steven Perlman 2

1 School of Dentistry, Faculty of Medical Sciences, The University of the West Indies, Trinidad and Tobago

2 The Boston University Goldman School of Dentistry, Boston, Massachusetts, USA

Abstract

Aim: To assess the oral health status of Special Olympics athletes in Trinidad and Tobago (a developing country in the English-speaking Caribbean).
Design: A convenience sample of athletes competing in the Trinidad and Tobago Special Olympics Spring Games in 2004.
Subjects: A sample of 410 athletes who participated in the Special Olympics Special Smiles Healthy Athletes screening programme.
Main outcome measures: A standardised oral exam and screening form were used for the assessment of each athlete.
Results: The mean age of the athletes was 18.8 years with a range of 5-58 years; 57% were male and 13% reported having pain in their teeth. The prevalence of untreated molar decay among those who completed the oral exam was high (43.7%). Few participants had filled (9.3%) or sealed teeth (2.9%). Gingival signs were present in 34.6%. Urgent treatment need was found in 27.6%. Compared to Special Olympics athletes in the United States of America (USA), those in Trinidad and Tobago had generally worse oral health.
Conclusion: The oral health status of Special Olympics athletes in Trinidad and Tobago suggests the need to develop oral health promotion for people with intellectual disabilities and improve their access to oral healthcare.

The dental management of a patient with erythromelalgia: a case report

L. Zoitopoulos and H. Ghoddousi

Department of Community Special Care Dentistry, Guy’s, King’s & St. Thomas’ Dental Institute, London, UK.

Abstract

Erythromelalgia is a painful paroxysmal dilatation of the blood vessels of the skin, usually affecting the feet and extremities. We present details of a 50-year-old female who required simple dental treatment, the delivery of which was made difficult by erythromelalgia. This was due to vasodilatation which rendered local anaesthetic ineffective. She attended a series of appointments during which dental treatment was carried out with articaine as the local anaesthesia. It is important not to dismiss the patient’s perception of pain and to take a good medical and social history to establish a reason for this.

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