Volume 9, Number 3.       September 2008

Editorial          99

An audit of the Restorative Dentistry Index of Treatment Need Complexity Assessment
David Townsend 100

Health issues in persons with Down syndrome
V P Prasher and M Shaffulia 113

The dental health of adults with learning disabilities - results of a pilot study
Gill Davies, Darren Chadwick, David J Cunningham, Samantha Starling, Jackie Duxbury and Mark Burton 121

Behaviour guidance in dentistry for patients with autism spectrum disorder using a structured visual guide
Ichijiro Morisaki, Tomoko T Ochiai, Shigehisa Akiyama, Jumpei Murakami and Clive S Friedman 136

Unusual behavioural response of a patient with learning disabilities: A case study
Navida Hanif, Victoria Kewley and V Brookes 141

Editorial
Tribute:
Michael John Prendergast

The sudden death of Mike Prendergast on 19th June 2008 resulted from a heart attack whilst on holiday in Turkey.

Born on 8th January 1945, Mike was raised in Wombwell near Barnsley in Yorkshire and went on to study dentistry at the Turner Dental School in Manchester from 1964 to 1968. He returned to Yorkshire to work for the School Dental Service for the West Riding County Council, in his home town. This service was integrated into the NHS as part of Barnsley Area Health Authority in 1974. Mike was promoted to Senior Dental Officer (Special Needs Services) with Kirklees Health Authority and spent many years working with patients with a wide range of disabilities and those from a variety of deprived communities. During this time he greatly valued the friendship and peer support provided by his colleagues in the British Society for Disability and Oral Health (BSDH).
He returned to his studies in 1984 undertaking a Master of Community Dental Health degree at Leeds University under the supervision of Professor Martin Curzon and presented a successful dissertation on the health of Asian children attending schools in Batley. His interest in the plight of children from the Indian sub-continent introduced him to the work of Professor Sonia Williams with whom he was to develop a fruitful and close working relationship in the years to follow.

Shortly after gaining his Masters degree Mike made a transformational career change when he took up the post of Senior Dental Officer in Public Health for Leeds Health Authority. This post included an honorary academic appointment at Leeds Dental School. Mike was unfailing in his support for student researchers including many from overseas arising from his links with IADH. He provided much support for his colleagues in Community Dental Services in Yorkshire by acting as the regional coordinator for the BASCD school surveys programme.

Mike continued to support the work of BSDH, taking on the role of Honorary Treasurer from 1992 to 1997. In this role he also acted as the Finance Officer for the organising committee for the 1996 IADH Congress in Edinburgh. The resounding success of this congress financially allowed the establishment of a travel bursary for members of BSDH seeking to attend future IADH meetings. The organizing committee was also able to provide funds towards a project particularly dear to Mike, the IADH journal fund. Mike became President of BSDH in 1999 and used the opportunity to pursue his interest in developing a scientific journal for Special Care Dentistry, the Journal of Disability and Oral Health, working with June Nunn and a dedicated team.

The successful development of Mike's career in Dental Public Health was confirmed in 2000 when he was appointed as Consultant in Dental Public Health by Shropshire Health Authority. In this post Mike was able to guide services through the troubled times of the new NHS contract and oversee the development of a range of innovative services. This was achieved as a result of Mike's good-humoured enthusiasm coupled with a steely determination to get the job done despite being affected by personal ill health.
Mike retired in 2006 and spent two happy years with his wife Mandy pursuing those leisure interests that sustained him throughout his life. His love of opera and his involvement with amateur dramatics was reflected in the memorial service at Shrewsbury Crematorium on July 11th 2008, which was a fitting celebration in remembrance of his life. He will be greatly missed. He will be missed by those colleagues who were touched by his work and benefited from his support. He will be missed by his friends including those in the amateur dramatic society who have lost a fine leading man, pantomime dame and their best 'tortoise fun runner'. He will be missed most of all by Mandy to whom we send our deepest sympathy.

John Hinchliffe. July 2008.

An audit of the Restorative Dentistry Index of Treatment Need Complexity Assessment
David Townsend BDS, MSc

Assistant Clinical Director Salaried Primary Care Dental Service Hampshire Primary Care Trust, Havant, U.K.

Abstract

Objectives: To audit the complexity of dental care provided by the Salaried Primary Care Dental Service using the Restorative Dentistry Index of Treatment Need Complexity Assessment (RDITN), as a measure of the complexity of treatment carried out and to present the index as a potential candidate for inclusion in a 'basket of indicators' for contracting Special Care Dentistry in the UK.
Design: The audit was carried out in three dental clinics in Hampshire over the period of 2005-2006; data were collected over two representative periods for 327 treatment episodes. Following clinical examination, each patient had the complexity of his or her treatment plan recorded according to the Complexity Assessment of the RDITN.
Results: Nearly three quarters of treatments involved fixed or removable prosthodontics (>70%); 27% of treatments were for periodontal problems. Very few root canal treatments were carried out. The majority (over 70%) of treatments fell into Complexity Code 2. Fixed and removable prosthodontics was nearly all Code 2. Periodontal treatment involved a more even mix between Code 2 and Code 3. The distribution of Complexity Assessment scores was very similar in both years.
Conclusion: The Restorative Dentistry Index of Treatment Need Complexity Assessment was used to provide a quick and easy assessment of the complexity of treatment for patients needing special care. The results showed very little change over a two-year period.

Health issues in persons with Down syndrome

VP Prasher MBChB, MRCPsych, MMedSc, MD, PhD, F.IAASID1 and M Shaffulia MBBS2

1Liverpool John Moore University and South Birmingham PCT; 2South Birmingham PCT

No Abstract as this is Review Paper

Introduction

The health of the learning disability (LD) population as a whole has, until recently, been of low priority. With the closure of large institutions virtually all persons with LD now live in the community, either in supported community units or with family carers. Persons with Down syndrome (DS), who are the most identifiable individuals with LD, are now regularly accessing all aspects of community health services. Virtually all dentists will, at some time in their career, treat a child or adult with DS. Optimum treatment will only be possible with some awareness of the wider physical and psychiatric problems with which a person with DS may present. This review will highlight some of the commonest forms of physical disorders seen in persons with DS (including obesity, cardiac conditions, ophthalmic and auditory conditions, endocrine dysfunction and musculoskeletal issues) and give a general over-view of associated psychiatric disorders (e.g. dementia, depression and obsessional behaviours). It is good clinical practice that all professionals coming into contact with persons with DS are aware of such health issues.

This review will not focus on the phenotypic characteristics of DS (physical or psychological) as these are often an inherent part of the syndrome and not an 'illness' as such. Only those problems with clinical implications for dentists will be considered. Readers are referred to several recently published books (Prasher and Smith, 2002; Pueschel and Pueschel, 1992) for more detailed information.

The dental health of adults with learning disabilities - results of a pilot study

Gill Davies PhD, MSC, BDS, DDPH RCS1, Darren Chadwick PhD, BA2, David J. Cunningham BDS1, Samantha Starling BSc3, Jackie Duxbury BDS, MSc FDS RCPS1, and Mark Burton PhD, BSc, MSc, MSc3

1Manchester PCT, 2The Manchester Metropolitan University, 3Manchester Learning Disability Partnership

Abstract
Aim: To establish a methodology to determine the levels of dental health and dental treatment service use among adults with learning disability (ALD).
Objectives: To design data collection methods and identify, contact and survey ALD in the Manchester Learning Disability Partnership area.
Design: Cross sectional descriptive study, involving data collection via a questionnaire and dental examination.
Subjects: 440 adults in Manchester, from a variety of living circumstances, all drawn from the Learning Disability Partnership database of ADL. Contacted and surveyed in day centres, community care and family homes.
Results: 92% of participants were partially or fully examined. Three quarters of volunteer ALDs regularly visited a dentist, although a significant proportion of those residing in family homes (37%) and living independently (50%) had not accessed dental treatment services in the past year. Levels of untreated disease or other conditions were low among volunteer ALDs, levels of tooth loss were high (22% edentulous) compared with those from a wider adult population (14% edentulous).
Conclusions: The methodology was feasible for collection of data about dental health, self care and service use among Manchester ALDs. There was a sufficient level of co-operation to allow this survey. Edentulousness is at a higher level among these ALD than in a comparable group of adults who do not have learning disability. People living independently and in family homes may require differential kinds and levels of support to increase access.

Behaviour guidance in dentistry for patients with autism spectrum disorder using a structured visual guide

Ichijiro Morisaki DDS, PhD1, Tomoko T. Ochiai DDS2, Shigehisa Akiyama DDS, PhD3, Jumpei Murakami DDS, PhD4 and Clive S. Friedman DDS, Cert Pediatric Dentistry5

1Professor, Instructor, 2Associate Professor, 3Assistant Professor, 4Division of Special Care Dentistry; Osaka University Faculty of Dentistry, Suita-Osaka, Japan; 5Associate Clinical Professor, Schulich School of Dentistry, Western Ontario, Canada

Abstract

The non-pharmacological approach is integral to management in paediatric and special care dentistry. A structured visual guide has become popular as a technique and has been applied effectively in education and daily life for children with autism and learning disability. Recently, the visual guide system has been applied to patients with autistic spectrum disorder, using a series of pictures or drawing cards and boxes to explain the treatment procedures. The practical application of the visual guide in dentistry and its prospective view of the pedagogy are discussed.

Unusual behavioural response of a patient with learning disabilities: A case study

Navida Hanif BDS(Hons), MFGDP(UK), MFDS(Lon)1, Victoria Kewley BDS, MDSc FDS.RCS (Edin), Dip.Con.Sed (Nwcl), MSND.RCS(Edin)2, V Brookes BDS, MSc, FDSRCS(Ed), FDSRCS(Eng), DDPHRCS(Eng), MSNDRCS(Ed)2

1Dental Officer; 2Specialist in Paediatric Dentistry, Lancashire Teaching Hospitals NHS Trust

Abstract

Pain and anxiety management techniques are now widely used to supplement local anaesthesia for dental procedures. In particular, patients with learning disabilities are benefiting from the advancements in conscious sedation techniques. A review of the literature shows that this group of patients can receive oral care in a safe manner, thus avoiding the need for general anaesthesia. There is, however, little documented evidence of any adverse responses or reactions to sedation in patients with learning disabilities. This case study describes an unusual behavioural response by a patient with mild learning disability during dental treatment with intravenous sedation. The authors wish to share their experiences and to raise awareness of the importance of a thorough patient assessment and management of emergencies that may arise.

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