Volume 8, Number 3. December 2007Contents A prospective audit of a day stay hospital service for the dental management of adults with disabilities The oral health of Romanian young adults with multiple disabilities, in Bucharest, Sector 2 Intranasal and intravenous sedation with midazolam in a child with special needs - a case report Continuing Professional Development Programme 115 The importance of follow-up dental findings to diagnose Sauk syndrome: a case report in a child Mastocytosis – oral and dental manifestations and medical considerations for dental treatment: a case report Allgrove’s syndrome and oral health care A case study report on the use of a turntable transfer Evaluation of oral health knowledge among personnel in an institution for the rehabilitation of disabled young adults Thanks to reviewers Editorial It is an honour and a pleasure to have the opportunity to write the Editorial for this issue of the Journal of Disability and Oral Health. Not being a clinician, but a disability equality consultant, the focus of this piece is very much around the social and environmental aspects of disabled people accessing dentistry and oral health services, and the role the profession has to play in promoting disability equality. Well over ten million people in the UK have a disability and one in five patients is likely to be covered by the Disability Discrimination Act (DDA). It is, however, interesting to note that recent research by the Disability Rights Commission indicates that over 40% of disabled people covered by the DDA do not consider themselves as disabled. The reasons for the increase in the number of disabled people in the UK are numerous, and include advances in medical treatment, increasing survival rates and an older population. It is also the case that the ever evolving legal definition of disability has meant an increase in the number of disabled people covered. It should also be remembered that seven out of ten disabled people become disabled during their working lives. Treating disabled people is, in fact, becoming less of a speciality and more of a norm. The skills and knowledge needed may sometimes be different and require subject matter expertise but, as a competency, the ability (and the expected ability) to treat disabled people needs to become part and parcel of a dentist’s skills portfolio.
What do we mean by disability equality in oral health? Achieving disability equality means going far beyond providing physical access - although it is still important to recognise the very real barrier this still presents. What is even more important is to recognise some of the attitudinal barriers that disabled people can still encounter when trying to access oral health services. These are, by no means, always explicit or deliberate but can, sometimes, be borne out of low levels of disability awareness, which can result in anxiety and, at worst, a lack of enthusiasm and or willingness to treat disabled people. The social model of disability places less emphasis on the impairment and more on the environmental barriers that can prevent disabled people accessing good oral-health services. The impairment will always be important when deciding on a clinical treatment, but a patient centred approach is essential when ensuring that disabled service users have the same level of access, informed choice and customer service than anyone else. It seems fair to say that, in a minority but real number of cases, treatment plans are still decided on the basis of easing the burden on the practitioner, rather than as a result of the informed choice of the disabled person (or their advocate). Disability awareness training, based on the social model of disability, must, therefore, be seen as an essential ingredient to achieving disability equality. Another key ingredient to disability equality is the active engagement of disabled people in the way non-clinical services for disabled people are devised and delivered. A patient centred approach again is something familiar to treatment planning, what is also needed is to develop the concept further when developing service delivery. Dentistry has already demonstrated its willingness to be receptive to the needs of disabled people and it is also likely that it will also be a sector to lead the way in promoting disability equality in the health provision. A prospective audit of a Day Stay Hospital service for the dental management of adults with disabilities E Webb BDS, MFDS (RCS RCPS)1, K E Wilson PhD, MSc, BDS, MFDS (RCS Edin), DDPH (RCS Eng), Dip Con Sed2 and J Haq BSc., BDS, MFDS (RCS Edin)3 1Salaried Paediatric GDP, Drumchapel Health Centre, Glasgow. 2Senior Dental Clinician/Honorary Associate Specialist, South Tyneside Primary Care Trust, South Tyneside & Newcastle Dental Hospital, Newcastle upon Tyne. 3MFDS Community Dental Service Trainee, South Tyneside Primary Care Trust, South Tyneside, UK Abstract Aim: To carry out an audit of a day stay general anaesthetic/sedation service, for the provision of dental care to adults with physical and or intellectual impairments and/or who are medically compromised. Objectives: To investigate current waiting times for care, establish the nature and frequency of medical complications, determine outcomes of dental treatment and obtain patient views relating to dental treatment on the Day Stay Unit. Design: Prospective clinical audit. Setting: A district general hospital in the north east of England. Methodology: All adult patients attending for dental treatment under day stay general anaesthesia or conscious sedation at South Tyneside District General Hospital over a period of 24 months (December 2002 to November 2004) were audited. Using questionnaires, data on demographics, waiting times, dental and anaesthetic care provided, post-operative morbidity and patient satisfaction were collected. Results: The average waiting time for care was 36 weeks. Dental treatment carried out differed greatly from that predicted at assessment. Minor post-operative complications only were reported in 35% of patients and the majority of patients were very satisfied with the treatment they received. Conclusion: The standard for waiting times was not met and was exceeded by 12 weeks. More invasive treatment was required than had been anticipated resulting in an extended operative period, however peri and postoperative morbidity was found to be low. It is clear from the audit that waiting times are unacceptably high and as a result it would appear that the oral health of those with disabilities is being compromised. A business case has been submitted to the Primary Care Trust for increased resources to address the situation and if the bid is successful a further audit of the service will be carried out.
The oral health of institutionalised Romanian young adults with multiple disabilities, in Bucharest, Sector 2 Ruxandra Moraru1, Pantea Ghannad2, Mihaela Ghinoiu3, Claudia Brătan3 and Jörgen G Norén2 1Department of Oral Health and Behavioural Sciences, Faculty of Dental Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania; 2Department of Pedodontics, Faculty of Odontology, Göteborg University, Göteborg, Sweden; 3Recuperation and Rehabilitee Centre for Persons with Handicap, Sector 2, Bucharest, Romania Abstract Intranasal and intravenous sedation with midazolam in a child with special needs -a case report M C G Manley BDS DDPH(RCS) MSc PhD East Kent Primary Dental Care Service, Dental Department, 26 Old Dover Road, Abstract
The importance of follow-up dental findings to diagnose Sauk syndrome: a case report in a child Márcia Pereira Alves dos Santos, DDS1, Áurea Simone Barroso Vieira, DDS1, Márcia Gonçalves Ribeiro, MS, DDS, PhD2 and Lucianne Cople Maia, MS, DDS, PhD3 1Postgraduate student, Department of Pediatric Dentistry and Orthodontics, School of Dentistry; 2 Adjunct Professor, Department of Pediatrics, Clinical Genetics, IPPMG Hospital; 3 Department of Pediatric Dentistry and Orthodontics, School of Dentistry: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Abstract This case report presents a rare case of a 10-year-old Brazilian boy who was referred to a dental clinic of a Public Institution when he was 7-years-old because of early loss of teeth and delayed teeth eruption. Clinical features included delay in cognitive development and growth, under-weight, short stature, microcephaly, hypertelorism, small but prominent ears, depressed nasal bridge, hypoplastic maxilla and prognathism. He had no nail, skin or hair abnormalities. Radiographic examination demonstrated delayed bone age, microcephaly, minimal scoliosis of the spine, taurodont mandibular and maxillary first permanent molars, diminished root formation in other mandibular and maxillary teeth, microdontia and hypodontia. Based on these dental findings after a follow up of two years, the medical history and complementary examinations, the condition of this patient was diagnosed as Sauk syndrome.
Mastocytosis – oral and dental manifestations and medical considerations for dental treatment: a case report Esti Davidovich DMD, MSc 1, Lev Ronin MD2 and Diana Ram Dr. Odont3 1Clinical Instructor, 3Senior Clinical Lecturer, Department of Paediatric Dentistry, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel. 2Department of Anaesthesiology and Critical Care Medicine, Hadassah Medical Centre Jerusalem, Israel
Abstract The present case emphasises the importance of a multidisciplinary approach in treating a 6-year old boy suffering from systemic mastocytosis. Mastocytosis is characterised by mast cell proliferation and accumulation within various organs, the most commonly affected of which is skin. The patient was scheduled for treatment under general anaesthesia. The medical, dental and anaesthetic considerations and treatment are presented. Allgrove’s syndrome and oral health care Katie Parfitt BDS1 and Chris Dickinson BDS, MSc, MFDS, DDPH LDS RCS (Eng), DipDSed2 1Elmpt Dental Centre, Javelin Barracks, BFPO 35. 2Associate Specialist, King’s College London Dental Institute, Department of Sedation and Special Care Dentistry, Guy’s Hospital, London, UK. Abstract Allgrove’s syndrome is an uncommon inherited condition. It consists of a triad of congenital defects each of which has a dental relevance in its own right but together can produce major oral health problems for the patient and treating clinician alike. Knowledge of the main aspects of Allgrove’s syndrome will assist the dental team in the provision of oral health care to patients with this condition. A case study report about the use of a turntable for transferring patients from a wheelchair to the dental chair in order to facilitate treatment PA Watt-Smith BDS, LDSRCS, MGDP, MSc, MSND Ed and Gill Walton RDN
Abstract This report describes the use of a simple yet safe and effective way of transferring patients from certain groups from their wheelchairs to the dental chair for treatment. A turntable was investigated to ascertain if this would safely and easily transfer wheelchair users, who still retained upper body strength, to the dental chair. The requirements were that it should be ergonomically designed to make it comfortable for carer and patient alike to use, to be height adjustable with padded knee and hand support for patient comfort yet be sturdy, easy to clean and space efficient, maintain dignity and overall be safe and user friendly. Evaluation of oral health knowledge among personnel in an institution for the rehabilitation of disabled young adults Ruxandra Moraru1, Pantea Ghannad2, Evin Ulusoy2, Mihaela Ghinoiu3, Kristian Dahlén4, Emanuel-Gabriel Botnariu3 and Jörgen G. Norén2 1Department of Oral Health and Behavioural Sciences, Faculty of Dental Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania; 2Department of Pedodontics, Faculty of Odontology, Göteborg University, Göteborg, Sweden; 3Recuperation and rehabilitee centre for persons with handicap, Sector 2, Bucharest, Rumania; 4School of Public Administration, Göteborg University, Göteborg, Sweden Abstract
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