Volume 8, Number 1. April 2007 DecemberContents Editorial 2 Assessment of malocclusion and orthodontic treatment need in disabled children in Nigeria An analysis of the pattern of dental treatment provided for patients with disabilities requiring treatment under general anaesthesia A longitudinal study of palatal plate therapy in children with Down syndrome. Effects on oral motor function Continuing Professional Development Programme 20 Dyslexia and errors of left-right discrimination in undergraduate dental and postgraduate orthodontic students Management of Riga-Fede disease: a case report Delayed replantation of avulsed incisors in a child with cerebral palsy and epilepsy – a case report Using large numbers can overwhelm efforts to secure care for children with special health care needs. A case study – United States A maxillary obturator for a cocaine-induced oronasal defect A report on the development of a dental service for adult survivors of childhood sexual abuse Preparing a child with autism for dental prophylaxis using structured and instructional methods: a case report Diary 48
Editorial The recent launch of A Commissioning Tool in Special Care Dentistry recognises that ‘tool kits’ for PCTs commissioning specialised services are useful in formulating specific standards of care. They are of particular use for services that span multiple settings, represent an NHS priority and may have high variability in service provision. Furthermore, the service may have an associated high volume or cost, connected with delivery of care. BSDH secured funding from the Department of Health and developed the ‘tool kit’ with a working group with wide representation. The Commissioning Tool provides clear guidance on a commissioning strategy, which has four key elements: Prevention lies at the centre of the strategy, with a focus on the development of oral care plans, early intervention and improved information about services. Effective joint planning and commissioning is at the heart of improving outcomes for the oral care of vulnerable groups. At a PCT level, commissioning of services should be person centred, with the emphasis on prevention. Dental leads at the PCT will have an important role, in conjunction with the specialist in SCD, to map the services available within the locality, identify resources and set the agenda to improve oral health through a local delivery plan. Mergers of PCTs allow for development of clinical leadership in SCD, transcending traditional boundaries and ensuring equity for vulnerable adults across primary and secondary care. A proposed hub and spoke approach will centralise specialist advice and clinical care, ensuring equity across a larger geographical area, with the provision of outreach clinics where possible. Consequently, patients should be treated by the right person, in the right place, at the right time. The important role that service users play in the planning and development of local SCD services is fundamental to this. The Dental Lead at the SHA will have responsibility for the collective commissioning of secondary and tertiary services, to secure the oral health needs of the population with the most complex needs or those requiring access to specialist facilities and multidisciplinary teams. Planning and commissioning arrangements will have to take into account cross boundary issues, by working with these partners and agreeing solutions to facilitate patient choice. Dental leads will play a key role in developing effective networks between education, social services, workforce development and clinical network support. Inter- and intra-agency working will secure optimum oral health, for example its integration into the training of carers. Identifying SCD-relevant research priorities will be central to pinpointing areas of unmet need, developing evidence-based practice and planning future services. The document can be downloaded from the BSDH website www.bsdh.org.uk. A copy will be sent to the Dental Lead at every PCT and SHA in England and all Clinical Directors of Salaried Dental Services. Furthermore, Phil Friend, Chairman of RADAR and Lord Rix Chairman of Mencap, have agreed to publicise this document through the voluntary sector. With access the main priority for PCT Commissioners, it is of paramount importance that the oral health needs of vulnerable groups are not forgotten and the document outlines all the activities necessary for the effective commissioning of SCD and the expected standards and best practice in the UK. Dr Vanita Brookes Director of Special Care Dentistry and Salaried Dental Services, Lancashire Teaching Hospitals NHS Foundation Trust.
Assessment of malocclusion and orthodontic treatment need in disabled children in Nigeria. I.L. Utomi1 and C.O. Onyeaso 2 1Department of Child Dental Health, College of Medicine, University of Lagos, Nigeria.
AbstractObjective: To compare the prevalence of malocclusion and orthodontic treatment needs of three major groups with disabilities in Lagos, Nigeria using the Dental Aesthetic Index (DAI) Methods: The study sample consisted of 428 disabled children (114 intellectually disabled, 253 with hearing impairments, 61 physically disabled) aged 6-18 years randomly selected from five special schools/centres in Lagos. Results: Dental appearance which required no orthodontic treatment or slight need accounted for 65.7% of the sample. Just over 17% had a definite malocclusion where treatment was ‘elective’; 9.3% had a severe malocclusion with treatment ‘highly desirable’ and 7.7% had a severe or handicapping malocclusion with treatment considered mandatory. The intellectually disabled group presented the highest mean DAI score (p< 0.001). In addition, there were statistically significant differences between the disabled groups in all the categories of orthodontic treatment needs according to the DAI. There was a statistically significant association between severity of malocclusion and type of disability (p< 0.001). The prevalence of severe and handicapping malocclusions was significantly higher in the intellectually disabled children. Significant differences were found in certain malocclusion traits between the groups. The intellectually disabled children had a significantly higher prevalence of missing teeth, anterior maxillary irregularity, anterior open bite and molar relationship discrepancies when compared to the other disabled groups. Conclusion: Significant differences in mean DAI scores (p < 0.001) were found between the disabled groups with the intellectually disabled group presenting the highest mean DAI score. The significantly higher differences in the intellectually disabled children could qualify them for publicly subsidised orthodontic care.An analysis of the pattern of dental treatment provided for patients with disabilities requiring treatment under general anaesthesia Fiona Graham, Martin Kinirons and Timothy Holland Department Oral Health and Development, University Dental School and Hospital, Wilton, Cork, Ireland Abstract Aim:To assess the profile of a service for comprehensive oral care of people with disabilities under general anaesthetic.Objectives:To examine the pattern of treatment provided over a period of years in terms of the number of treatment courses and procedures and to determine whether treatment levels remained the same or diminished at subsequent courses.Design:Standardised records of patients attending the Special Needs unit at the Cork University Hospital,Irelandfor treatment under general anaesthesia from 1987 to 1997 were examined for treatment patterns and timings. The profile of patients with repeated courses of treatment was analysed separately.Results:701 courses of treatment were recorded for 539 patients aged 1 to 52 years.Of these, 539 patients (77.7%) received one course of treatment during the period and 16.7% received two while only 5.5% received more than two.Restoration of permanent teeth and scaling were most common with a restoration to extraction ratio of 4 to 1 for permanent teeth and a ratio of 1.2 to 1 for primary teeth. The subset of patients who required repeated courses of treatment received them as a result of a high and sustained treatment need.Conclusion:Comprehensive oral care for the minority of patients requiring general anaesthesia results in favourable outcomes buta small subset of patients with high and sustained treatment needs require more frequent care. The latter group present the biggest challenge for preventive programmesA longitudinal study of palatal plate therapy in children with Down syndrome. Effects on oral motor function. K. Carlstedt, G. Henningsson and G. Dahllöf Karolinska Institutet, Stockholm, Sweden. Abstract Aim: The aim of the present investigation was to study the effects of palatal plate therapy on oral motor function during a 4-year treatment period. Study design: The effect of palatal plate therapy on oral motor function in children with Down syndrome (DS) was studied over a 4-year period in a prospective randomised clinical study. Subjects: Twenty children with a mean age of 24 months were randomly assigned to a palatal plate group (n=9), or to a control group (n=11). The children in the palatal plate group were treated with modified palatal plates according to Castillo Morales for a treatment period of 4 years. All children in both groups had been enrolled in the same orofacial physiotherapy programme from birth. Orofacial muscle function was documented using video registrations of the face at baseline, after 1 year, and after 4 years. The parents’ perception of the treatment method was investigated using a questionnaire. Results: After 1 year of palatal plate therapy a significant increase in the variable ‘closed mouth’ (p< 0.001) and a significant decrease in the variable ‘inactive tongue protrusion’ (p<0.01) were found. A significant decrease in the summary variables for inactive muscle function was found after 4 years of palatal plate therapy (p<0.05). The summary variables for active muscle function were increased after 4 years but not significant. Conclusion: The results indicate that palatal plate therapy in combination with orofacial physiotherapy may have beneficial long-term effects on oral motor function in DS children.
Dyslexia and errors of left-right discrimination in undergraduate dental and postgraduate orthodontic students L Al Shirawi1, F McDonald2 and J T Newton3 1Postgraduate student and 2Professor of Orthodontics, Department of Orthodontics; 3Professor of Psychology as Applied to Dentistry, Department of Oral Health Services Research & Dental Public Health, GKT Dental Institute, King’s College London, UK
Abstract Objective: To establish whether individuals who are identified as dyslexic are more prone to errors of left-right discrimination in comparison to non-dyslexic participants. Design: 155 students (84 dental undergraduates and 21 postgraduate students of orthodontics) completed a culture-fair intelligence test and a Symbol-Digit task test to assess dyslexia. The participants also undertook a task involving a series of left-right discriminations in an analogue clinical situation. Results: 35 respondents (33%) were identified as having scores suggestive of dyslexia from the psychometric tests. When respondents were asked directly if they believed they were dyslexic, eight respondents, separate from the 35 identified, indicated that they were dyslexic. Agreement between the identification of dyslexia by psychometric tests and by self-report was low (kappa=0.04). Individuals who were identified as having scores suggestive of dyslexia on the psychometric tests performed less well on the task of left-right discrimination, in comparison to those not so identified (Mean score for ‘Test dyslexic’ group 11.8, SD= 3.51; Mean score for ‘Test non-dyslexic’ group 13.9, SD=4.02; t=2.56 p<0.05). No difference in performance on the task of left-right discrimination was found between individuals who identified themselves as dyslexic and those who did not (Mean score for ‘Self report dyslexic’ group 14.8, SD= 4.76; Mean score for ‘Self report non-dyslexic’ group 13.9, SD=3.92; t=0.05 ns). Conclusions: For postgraduate students only, no significant relationship was found between identification as dyslexic and the occurrence of errors of left-right discrimination. When considering both undergraduates and postgraduates, individuals identified as having scores suggestive of dyslexia generally performed poorly on a task of left-right discrimination.Management of Riga-Fede disease: a case report Guillermo Machuca1, Sonia Rodríguez2, María-Patrocinio Vargas2, Cira Suárez2 and 1Professor, 2Assistant Professor, Department of Special Patients and Periodontics; 3Professor and Chairman, Department of Oral Medicine and Periodontics; University of Seville. School of Dentistry, Spain.
Abstract 1 Our Lady’s Hospital for Sick Children, Crumlin, 2 Dublin Dental School and Hospital
Abstract This case report describes the successful dental management of a child with cerebral palsy and epilepsy who sustained both avulsion and extrusion injuries following a fall. The teeth were stored extra orally for several hours before they could be replanted. In spite of this, the teeth remain in situ almost ten years later, the patient has complained of no symptoms to date, the aesthetic result is pleasing and the function is good.
Using large numbers can overwhelm efforts to secure care for children with special health care needs. A case study in the USA H. Barry Waldman1 and Steven P. Perlman2 1 Distinguished Teaching Professor, Department of General Dentistry, Stony Brook University, Stony Brook, NY. 2Global Clinical Director, Special Olympics, Special Smiles. Associate Clinical Professor of Pediatric Dentistry, Boston University Goldman School of Dental Medicine. Private pediatric dentistry practice – Lynn MA
AbstractThe continued use of large numbers and proportions to describe the population of children with special health care needs overwhelms comprehension and may inhibit the ability to develop programmes to provide necessary services. Similarly, the all-too-often positive emphasis in government reports masks the realities that confront individuals with special health care needs and their families. A case-report is presented of the effort in the United States, to translate larger numbers into more discrete units which would be more meaningful.
A maxillary obturator for a cocaine-induced oro-nasal defectH.S. Brand1,2, C.J. Blanksma1,2 and S. Gonggrijp3 Departments of 1 Oral-Maxillofacial Surgery and 2 Dental Basic Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.3 Centre for Special Dental Care (SBT), Amsterdam, the Netherlands Abstract
We describe the history of a 49-year-old male patient with an extensive palatal perforation caused by chronic use of cocaine. To solve his oronasal reflux and speech problems, a removable maxillary obturator was constructed. A review of similar cases and management strategies is also provided.
A report on the development of a dental service for adult survivors of childhood sexual abuse Elizabeth Williams No abstract. This paper was awarded the BSDH – Special Award, given in 2003 in The European Year of People with Disabilities. Preparing a child with autism for dental prophylaxis using structured and instructional methods: a case report Sule Yilmaz1, Meral Yurdakul2 and Yesim Fazlioglu2 1Dentist, 2 Child Development and Education Specialist; Training and Research Center for Mentally and Physically Handicapped Children, Trakya University, Edirne, Turkey Abstract Due to the nature of the autistic syndrome, children with autism are potentially difficult patients in dental settings. A period is necessary to prepare them for dental procedures. Different methods have been developed to reduce their anxiety towards unfamiliar situations and teach new skills. These strategies can be beneficial in dentistry for children with autism to make the dental settings and procedure more acceptable to them. The aim of this study was to prepare an autistic child for dental prophylaxis using structured and instructional teaching methods together. A 7-year-old girl with autism, who was very resistant to, and reactionary in, the dental setting, was prepared for prophylaxis with the aid of these methods.
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