Volume 9, Number 2.       June 2008

Editorial          50

How dentists’ experience affects pre-treatment reviews in special needs dentistry
51
E E Jay, P J Dennison, P King and L Mugayar

Electromyographic evaluation of anterior temporalis and masseter muscles in patients with cerebral palsy before and after postural stabilisation          59
Maria Teresa Botti Rodrigues dos Santos, Fabíola Grammatico Carmagnani and
César F Amorim

Oral health status of teenagers and young adults with intellectual impairment in Athens, Greece                      63
K Kavvadia, S Gizani, S Mamali and M Nassika

An investigation of the association between gingival bleeding and consultations for cardiac, ENT and immunological problems in people with Down syndrome     73
Karen Fung, Herenia P. Lawrence and Paul J. Allison

Preparedness of dental undergraduates for provision of care to individuals with special health care needs in Nigeria            81
F A Oredugba and J A Akinwande

Conscious sedation- the only tool in the box?          87
Stephen M. Woolley

2008 will be another significant year for Special Care Dentistry. We are very optimistic that the regulatory body for dentistry in the UK, the General Dental Council, will finally recognise the existence of the specialty by opening a Specialist List, any day now. Whilst all in the discipline will be delighted with this significant milestone, which gives due recognition to Special Care Dentistry in the UK at last, many dentists will be wondering about their eligibility for inclusion on that Specialist List. Whilst the mediation criteria for entry to the List are as yet unknown, the predecessor of the Specialist Advisory Committee, the Joint Advisory Committee for Special Care Dentistry, developed draft criteria and it is hoped that these will be helpful in the deliberations over eligibility, as was the case with other specialities. Dentists interested in viewing these draft criteria can access them via the website of the British Society for Disability and Oral Health  (www.bsdh.org.uk).

Apart from the regular meetings of special care dentistry organisations in individual countries, which are showcased in the International Association for Disability and Oral Health (IADH) magazine, 2008 will see the 19th biennial congress of the IADH in Santos, Brazil (www.iadh.org). This is an important forum –to update our knowledge, to give exposure to new research findings, to enable young researchers to present their work in a relevant context and above all, a time for meeting up with old friends and making new ones. So much of what is significant for many is what happens outside the lecture hall, in the discussions and sharing of problems and solutions to the daily challenges we all face.

In an increasingly competitive world, if we are serious about the specialty and its distinct place amongst other disciplines, we need as individuals and groups to enhance our research efforts. A systematic review of the older literature pertaining to special care dentistry is at best at the level of ‘good practice guidelines’ and at worst, case reports of rare conditions that do not always include much other than novelty value as well as a relatively easy way to accumulate publications for the successful author.
We must now publicise the increasing evidence-base for what we do - that means robust science and high quality papers. Potential authors need to read carefully the Journal’s Instructions to Authors (www.bsdh.org) since the criteria for inclusion are now much stricter in terms of adherence to international guidelines: on consent, ethical approval and conflict of interest, for example.  As an editorial team, we do our very best to facilitate publication of your work but we are reliant on you to provide good quality material in the first place. Our referees make huge efforts to help authors in the review process but they need to be presented with the results of high calibre. Worthy publications do not happen overnight; good research takes years in the planning and execution with many drafts before it is ready for publication. As well as general career support from those well established in the field of special care dentistry, aspiring young researchers need focussed mentoring from those with experience in research. Many organisations now offer such support – the IADH website is one, the BSDH Teachers Group has such a forum – the rest is up to you!

June Nunn, Editor
Dublin, May 2008

E E Jay BDS, FRACDS (SND) Fellow of the Royal Australiasian College of Dental Surgeons (Special Needs Dentistry) , P J Dennison BDS (Otago) DPHDent (Syd) MComDent (Otago) FICD , P King BDS MDS (University of Sydney) FICD and L Mugayar, DDS MSc4

1Westmead Centre for Oral Health; 2Staff Specialist, Special Care Dentistry, Westmead Centre for Oral Health, Director - Bachelor of Oral Health, Faculty of Dentistry, University of Sydney, Australia; 3 Clinical Associate University of Newcastle, 62 Curry St, Merewether 2287, NSW, Australia; 4 Staff Specialist, Head of Special Care Unit, Westmead Centre for Oral Health, Westmead, Australia
 
Abstract
Junior staff are rotated through the Special Care Unit of the Westmead Centre for Oral Health for periods of between one and three months. As a result there were concerns about the appropriateness of dental care plans for patients referred for a dental procedure under general anaesthesia (GA) or intravenous sedation (IVS).
Aim: This prospective audit was designed to compare changes at the Pre-treatment review meetings (PRM) to the treatment plans of junior and senior staff referring Special Needs patients to GA or IVS.
Hypothesis: That significantly more treatment plans of dentists with a limited knowledge in special care would need modification in the PRM.
Methods: Using pre-agreed criteria the care plans of all 153 patients referred within the Special Care Unit (SCU) were audited prospectively. All PRM involved at least one senior staff member, and 94% involved 2 or more senior staff members.
Results: The junior dentists had almost 4 times the odds of needing a change in the mode of sedation OR 3.81 (95%CI: 1.27<OR<12.26) p = 0.01 and more than twice the odds of more experienced staff of needing a change to the treatment provided OR 2.39 (95%CI: 1.18<OR<4.95) p = 0.01.
Discussion: A PRM prior to IVS or GA is an important step in optimising dental care for Special Needs patients in this context.

Electromyographic evaluation of anterior temporalis and masseter muscles in patients with cerebral palsy before and after postural stabilisation

Maria Teresa Botti Rodrigues dos Santos, DDS, MS, PhD1, Fabíola Grammatico Carmagnani, DDS, MS2 and César F Amorim, MS3

1Professor of the Discipline of Dentistry, 2Pediatric Dentistry; Persons with Disabilities Division, Universidade Cruzeiro do Sul, Sao Paulo, Brazil. 3Biomedical Engineering, Universidade do Vale do Paraíba - UNIVAP, Sao Jose dos Campos - SP, Brazil

 Abstract

Aim: To evaluate the electromyographic activity of right and left anterior temporalis and masseter muscles in the physiological rest position of the mandible in patients with cerebral palsy in a dental chair, before and after postural stabilisation.
Method: A group of 28 non-residential individuals with quadriplegic spastic cerebral palsy of both genders aged 7 to 13 years were evaluated. The electromyographic signals of electrical activity of the muscles were stored and analysed as root-mean-square (RMS) with values expressed in microvolts (mV). The nonparametric Wilcoxon Signed-Rank test was used to compare the EMG activity of the muscles.
Results: The right and left anterior temporalis muscles showed a statistically significant reduction in electrical activity (p<0.001, and p<0.001, respectively) after postural stabilisation, and the same was observed for the right and left masseter (p<0.001 and p<0.001, respectively).
Conclusion: Postural stabilisation influences not only the activity of masticatory muscles but also inhibits pathological postural reflexes, facilitating dental treatment of individuals with cerebral palsy.

K Kavvadia DDS, M Dent Sc, PhD1, S Gizani DDS, MScD, PhD2, S Mamali DDS3 and M Nassika DDS PhD4

1Assistant Professor; 2Lecturer; 3Postgraduate Student, Department of Paediatric Dentistry; 4Clinical Instructor, Department of Orthodontics: Dental School, University of Athens, Greece

Abstract

Aim and objectives: To assess the oral health status in Greek teenagers and young adults with intellectual impairment. The objectives were to: evaluate their oral hygiene level, caries experience, restorative care, need for periodontal treatment and frequency of orthodontic anomalies; collect, through questionnaires, information regarding their family characteristics, medical profile, oral hygiene and dietary habits; and evaluate the influence of these factors on their oral health status.
Design: 87 students (53 males, 34 females) with intellectual impairment and mean age of 21.08 years (±4.17) attending a special school in Athens participated in the study. Periodontal condition, caries incidence, dental treatment needs and malocclusion were evaluated by clinical examination in the special school’s dental office.
Results: The periodontal treatment need index revealed that 60.56% of the students were in need of periodontal treatment. The mean DMFT index was 8.9 (±7.2) and caries represented the largest part of the score (mean DT: 5.4, ±5.1). Results for the restorative index showed that only 24% (±30.3) of the carious teeth surfaces were treated. Orthodontic anomalies were found in 58% of the students with a greater prevalence of crossbites and open bite. Furthermore from regression analysis, there was an association between intellectual impairment, dental status and paternal educational level.
Conclusions: Teenagers and young adults with intellectual impairment attending a special school in Athens, Greece had poor oral hygiene and increased needs for dental and periodontal treatment. Students with more severe intellectual impairment had lower caries prevalence but worse periodontal condition.

An investigation of the association between gingival bleeding and consultations for cardiac, ENT and immunological problems in people with Down syndrome

Karen Fung1, Herenia P Lawrence2 and Paul J Allison1

1Faculty of Dentistry, McGill University, Montreal, Canada; 2Faculty of Dentistry, University of Toronto, Canada

 Abstract

Objectives: To investigate the hypothesis that gingival bleeding is associated with markers of cardiac, immunologic and ear, nose and throat (ENT) problems in people with Down syndrome (DS).
Methods: A population-based, cross-sectional study design was used. Data were collected using a validated self-complete questionnaire via members of the Canadian Down Syndrome Society. Parental reports of regular (≥ once/year) consultations with relevant medical specialists were used as indicators of cardiac, immunologic and ENT problems. Similarly, gingival bleeding was based on parental evaluation. Multiple logistic regression analysis was used to investigate the hypothesised associations while controlling for co-variables.
Results: Of 2,327 questionnaires distributed 1,221 (52.5%) were returned. Controlling for co-variables, subjects consulting for immunological problems were more likely to also have bleeding gums compared to those not consulting regularly for these problems. However those consulting for cardiac and ENT problems were at the same risk for bleeding gums as those with no health problems.
Conclusion: The results of this study support previous work indicating that gingival bleeding is associated with immunological problems in people with DS, but do not provide any evidence for an association between gingival bleeding and either ENT and/or cardiac problems in people with DS.

Preparedness of dental undergraduates for provision of care to individuals with special health care needs in Nigeria

F A Oredugba BDS, FWACS, MPH, MSND, RCS (Ed)1 and J A Akinwande BDS, FMCDS, FWACS2

1Department of Child Dental Health; 2Department of Oral and Maxillofacial Surgery
College of Medicine, University of Lagos, Nigeria

Abstract

Objectives: To determine the preparedness of dental undergraduates in Nigeria to provide care to individuals with SHCN, to identify the area of need concerning their education and to provide recommendations for improvement of the curriculum in the areas of deficiency.
Design: Three survey questionnaires were used: Deans of the four dental schools in Nigeria, lecturers teaching the course and final year dental students. Information requested include name and year of establishment of the Dental School, average number of students in the final year, the department responsible for teaching ‘Dental care of patients with special health care needs’, course content, method of teaching and rating of preparedness of the students. The students were asked if they were willing to treat such patients in their future practices, the rating of their course and their preparedness to treat such patients.
Result:  100% response. Teaching is provided by different departments in the four schools; Child Dental Health, Preventive Dentistry and jointly with Oral and Maxillofacial Surgery in one school. The course contents were dissimilar with a variation in hours of lectures. One school did not give the students any hands-on training. Only one Dean and two lecturers felt their students were adequately prepared to provide care to patients with SHCN. One hundred (76.9%) of the students were willing to treat the patients in their future practices while 55 (42.3%) felt they were adequately prepared to treat such patients.
Conclusion: Few dental undergraduates in Nigeria are adequately prepared to provide care for individuals with SHCN. Improvement and harmonisation of the curriculum is suggested to increase student interest.

Stephen M Woolley BDS (Wales), MFDS RCS(Ed)

Division of Adult Dental Health, School of Dentistry, The Wales College of Medicine, Biology, Life and Health Sciences, Cardiff University, UK

In 1990, the Standing Dental Advisory Committee published its influential report, known as the Poswillo Report, on General Anaesthesia, Sedation and Resuscitation in Dentistry, to reduce the risk of fatalities and adverse events within primary care facilities (Poswillo, 1990). The report’s recommendations, and subsequently published guidelines (General Dental Council, 1998), aimed at placing general anaesthesia (GA) for dental procedures within a safer framework. In consequence, the treatment option of choice for dental anxiety and phobia that did not respond to basic behavioural management techniques, is conscious sedation. This paper looks at some underlying assumptions made about the management of dental phobia and the ramifications of this modality as being the preferred method employed with anxious patients.

JDOH home

BSDH home