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JDOH - Volume 17 Number 4 (December 2016)

Journal of Disability and Oral Health Volume 17 Number 4 December 2016     Editorial   Oral health interventions for children and adolescents with disabilities: a scoping review C Waldron, C MacGiolla Phadraig, C Comiskey and J Nunn                         An evaluation of a blended intravenous cannulation teaching method in dentistry E Heidari, B Kerr, S Rana and J T Newton   The use of lateral oblique radiographs in dental treatment planning for patients with special needs A Pradhan and M Gryst   A case of status epilepticus in the dental surgery: learning through significant event audit Z Khan and N Ransford   Editorial   Back to the future   Looking back recently at the archives of Journal of Disability and Oral Health (JDOH), I wondered if the aims of the journal were being met, since its inception in 2000. The JDOH was established by Professor June Nunn, the inaugural editor and our current, supportive publisher, Stephen Hancocks and a small and active editorial team. The opening editorial by The Lord Rix, President of MENCAP entitled ‘Teeth and People with Learning Disability’ stated ‘They deserve something better than that, and I am pleased that determined efforts are being made to offer something better—with this new journal playing an important part in that’.   Today, the aims of JDOH resonate with those sixteen years ago, ‘the Journal seeks to publish original work relating to all aspects relevant to the comprehensive oral care of people with disabilities. It is dedicated to the advancement of knowledge and expertise in the area of special care dentistry and aims to give the reader, clinical and scientifically based papers, practical management techniques and case reports’.   Interestingly in the first Special Care Dentistry journal, Special Care in Dentistry, the opening editorial by Roger Scholle, Editor-in Chief in 1981 expressed a similar mission ‘to enhance and facilitate communication among those participating in this initiative to elevate the quality of life of patients with needs requiring special attention’. Furthermore ‘Special Care’s mission holds the promise of better oral health for all by expanding the area of competence of the dental profession. This mission will be accomplished when the concept of “special” patients becomes meaningless because they are being cared for as a matter of usual and accepted dental practice’.   All academic journals should have a clear vision and in 2015, the British Society of Disability and Oral Health refined the mission statement for the JDOH ‘to provide an international forum for exchange of knowledge and expertise in Special Care Dentistry through publication of peer-reviewed scientific papers, review articles, editorials and case reports.   The Journal of Disability and Oral Health aims to promote wider understanding within dentistry, medicine, nursing, social care, public health, government policy makers, disability organisations and educators; opening avenues to inclusiveness, and to contribute to the evidence base to improve the oral healthcare of people with medical, intellectual and physical and psychological impairments’.   Questions arise from taking a historical perspective of Special Care Dentistry (SCD) and there is a benefit to look back to look forward. Have the aims of the two English-language journals in SCD been achieved over the last 35 years? Do we understand what is best practice for the diverse patient populations that we serve; how robust is the evidence we have and where does it fit within the hierarchy of evidence? How do we evaluate the outcomes of our preventative and treatment strategies, with increasing treatment options available, yet often with budgetary constraints? Is what we do consistent between clinicians within one country, far less across SCD communities across the world? Have we engaged with colleagues in social care, public health, government policy makers, disability organisations and educators? Lastly, what challenges face us in the future?   Answers cannot be achieved in isolation and despite publications relating to SCD appearing in general and the other specialist SCD journal (Journal for the Japanese Society for Disability and Oral Health), many questions remain. Increasingly information is available in different languages and formats; however, there still remains a need for scientific journals to be the repositories for peer-reviewed publications to inform the evidence base.   Supporting publication Although, the issue of obtaining Medline listing for JDOH has yet to be obtained, there is much to commend carrying on the challenge. The adage ‘We may encounter defeats but we must not be defeated’ by Maya Angelou is apt.   It is a matter of time for the building blocks put in place by those instrumental in advocating and developing SCD, albeit as a specialty in some countries and as an integral part of dentistry in others, to provide the solid academic foundation required to develop educational and research opportunities for undergraduates, postgraduates and the wider teams, to provide evidence-informed care for the increasingly complex and diverse needs of populations with disabilities within primary dental services. Unfortunately, this is not yet, the ‘usual and accepted dental practice’ advocated by Scholle in 1981.   Engagement For the last 16 years, the JDOH has endeavoured to be part of the future in SCD. The journal remains a valuable resource for the readership of the supporting national and international societies, including educators and students in various spheres of interest globally to access peer-reviewed papers contributing to the scientific literature in SCD. One unsung achievement of JDOH is the contribution to the development of young authors, educators and researchers across the world; some of whom have limited academic support. The assistance afforded to them by our reviewers, who devote their time to drive up the academic standards is important, as these individuals and groups of authors have the vitality and belief their work will improve outcomes for patients.   Challenges and real-life issues face us in our day to day activities with our patients and the desire of dental teams to work collaboratively and creatively make a difference to the lives of patients. Research networks in SCD between academics, clinicians and other health and social care teams should continue to develop to investigate measure and record these issues using best practice in scientific enquiry, to form part of the historical, scientific record. In this way, we can learn from shared knowledge, experience and solutions found to improve better oral health and lead to change in ‘accepted dental practice’ (Scholle, 1981).   In essence, the aim of the Journal of Disability and Oral Health is to be here for the long haul, it is gaining momentum; the reward is being engaged in making a difference. Be part of it.                                                                                                                                            Shelagh Thompson, Liverpool 2016 References   The Lord Rix. Teeth and People with Learning Disability. J Disability Oral Health 2000; 1: 2.   Sackett et al. Evidence based medicine: what it is and what it isn’t. BMJ 1996; 312: 71-72. Scholle R. Special Care in Dentistry What it’s all about. Spec Care Dent 1981; 1: 3.   Oral health interventions for children and adolescents with disabilities: a scoping review   C Waldron1 RDH MSc MA (Health Promotion), C MacGiolla Phadraig2, C Comiskey3 and J Nunn4   1PhD Student in Special Care Dentistry School of Dental Science; 2Assistant Professor in Dental Public Health (Disability Issues), Division of Special Care Dentistry; 3Professor, Head of School, School of Nursing and Midwifery; 4Professor Emeritus, Division of Special Care Dentistry: Trinity College Dublin, University of Dublin   ABSTRACT Background: The existing literature on improving the oral health and oral health related outcomes of children and adolescents with disabilities, reports on interventions targeting a range of groups, in very prescribed settings and using varying methods. This variability of measure, population and intervention makes synthesising this knowledge difficult. This scoping review aimed to provide an overview of the types of oral health interventions implemented for children and adolescents with disabilities (CAWD), prior to a more focused Cochrane supported Systematic Review. A scoping review is a practical methodological approach to finding relevant literature in a previously un-searched subject area. Methodology: A search strategy of five databases was developed and carried out. A screening protocol for the articles was piloted and implemented and inter-rater (n =2) agreement measured. The bibliographic software Endnote was used to record and manage the articles. Results: A total of 3,909 articles was identified. Duplicate, non-English language and articles not meeting the inclusion criteria following screening were excluded. 112 studies were finally included. The number of interventions has increase dramatically in the last 15 years. The usual disability targeted was intellectual. The most usual type of intervention was therapy based and all were very diverse. Skills-based interventions, which predominantly focused on tooth brushing skills, were the next most usual. Conclusion: The use of a scoping review, to identify the range and type of oral health interventions for CAWD, has proved efficient and effective and has helped to focus the objectives of a Systematic Review of the topic.     An evaluation of a blended intravenous cannulation teaching method in dentistry   E Heidari1 BDS MSc MFDS RCS (Eng) MA, B Kerr2 BDS, MSc Mscd, S Rana3 BDS, MFJDP RCS (Eng) and J T Newton4 BA PhD
   1Senior Specialist Clinical Teacher; 2Consultant in Special Care Dentistry; 4 Professor in Psychology Applied to Dentistry: Department of Sedation and Special Care Dentistry King’s College London Dental Institute
Floor 26, Tower Wing. Guy’s Hospital.
Great Maze Pond. London. SE1 9RT. 3Dental Core Trainee 2 in Restorative Dentistry, King's College Hospital NHS Foundation Trust, Dental Institute,
Bessemer Road,
Denmark Hill, London SE5 9RS     Abstract Introduction: Traditional teaching consists of face-to-face interaction whilst online uses digital media allowing learner control over the location, time and pace of their learning. Literature in intravenous (IV) cannulation training suggests blended teaching, essentially a combination of traditional and online teaching, may be effective. Using both teaching methods avoids the social isolation of online learning and an opportunity to clarify any ambiguity while still retaining the ability for the learner to revisit their knowledge and to assess it, to become a self-paced learner and have easy access to the learning material. Aim: To evaluate a newly introduced teaching method (blended learning) in intravenous cannulation subject for final year dental undergraduate students (BDS 5) studying at King’s College London Dental Institute (KCLDI). Method: Longitudinal cohort study. Participants completed traditional venepuncture training followed by e-learning. Upon completion of each type of learning the students rated their confidence in the technique and their felt need for assistance using a 100mm Visual Analogue scale. Results: Ninety-two BDS 5 dental students (87% of all students in the cohort) participated. There were more female (55, 60%) students than male. Students reported increased self-confidence and decreased perceived need for assistance after having the blended learning in intravenous cannulation training in comparison to the traditional training alone (p≤0.05). There were no statistically differences between the genders. Conclusion: Blended learning in IV cannulation among final year dental undergraduate students significantly increased self-confidence and decreased felt need for assistance.   The use of lateral oblique radiographs in dental treatment planning for patients with special needs   A Pradhan1 and M Gryst2   1Senior Lecturer, Oral Health Centre, The University of Queensland, 2Senior Consultant, Special Needs Unit, Adelaide Dental Hospital, Australia     Abstract   This case series describes four cases on the use of oblique lateral radiographs as an alternative technique where intra-oral radiographs or an orthopantomogram (OPG) are not possible due to the patients’ physical and/or intellectual disabilities. The cases represent patients across different age-groups (25-83 years), medical conditions (autism, dementia, intellectual disability) and varying clinical situations (assessment of third molars, decision to restore or extract teeth). The oblique lateral radiographs provided adequate radiographic information to confirm diagnosis and treatment. Due to the very short time exposure needed, oblique lateral radiographs are good alternatives to OPGs and still have a significant role in the diagnosis, treatment planning and therefore treatment outcomes for patients with special needs.   A case of status epilepticus in the dental surgery: learning through significant event audit   Z Khan1 and N Ransford2   1Community Dental Officer, 2Consultant in Special Care Dentistry, Birmingham Community Healthcare NHS Trust   Abstract This report is of a 40-year-old patient with tuberous sclerosis who experienced an episode of status epilepticus associated with an urgent dental extraction. It highlights the lessons learned from this scenario and provides recommendations for the practice of those dentists who are more likely to have to manage such an event.    

JDOH - Volume 17 Number 3 (September 2016)

Journal of Disability and Oral Health Volume 17 Number 3 September 2016     Editorial   Is there an association between oral health and the incidence of pneumonia in adults with a neuro-disability who are Percutaneous Endoscopic Gastrostomy (PEG) fed? R Prasad, G Manley, M Andiappan and B Daly                                  Wrong site surgery in a special care setting: case report and literature review S Master and Y Allen                                                                           Correspondence between dentists and medical practitioners: a pilot audit C L Castle-Burrows, J Parekh and N Ransford                                   Decayed, Missing and Filled Teeth among Jordanian nursing home residents A A Hamasha                                                                                       Editorial   The Arts and empathy in Special Needs (Care) Dentistry. “What on earth are dental students doing in an art gallery?” “What does the gallery have to do with empathy?” These are questions I am often asked as I meet dental students at the doors of the Ian Potter Museum of Art. I wonder if I should tell them outright or rather just let them experience the moment. As I walked around the Art Gallery here in Barcelona after attending the annual conference of the Association of Dental Education in Europe (ADEE) 2016, I feel that the student questions are somewhat self-explanatory. Dental students and in fact all students in health disciplines can learn an enormous amount by spending time in galleries. Apart from the obvious beauty and time for self-reflection that a gallery affords one, it allows thinking and moulding of thoughts, and development of relationships with the inner self and humanity at large. But back to the teaching space - artworks are invaluable teaching tools in at least three different ways. Firstly, cultivation of empathy, secondly, enhancement of observational skills and finally, enhancement of subjective analysis and handling of many contradictory thoughts and ideas all of which can take place in a safe space removed from dental schools. Empathy, both cognitive and affective1, is an important aspect of the doctor-patient relationship and underpins good patient-centered clinical practice. It involves understanding of the inner experiences and perspectives of the patient, combined with the capability to communicate this to that patient (Hojat, 2002). Empathy is central to both interpersonal relationships and communication competency. Allowing students to engage with artworks in a facilitated environment may also have benefits in an emotional context (Braverman, 2011). Empathy improves interpersonal relationships, provides a positive role in clinical outcomes and is beneficial to patient care. Unfortunately, it has been shown to decline as medical and dental students progress through their training especially as the demand on clinical time increases (Hojat, 2002; Sherman and Cramer, 2005; Hemmerdinger, 2007; Yarascavitch, 2009). Observational skills are the cornerstone of good clinical practice. They are not only important in determining what is abnormal when it comes to clinical observation, but also in routinely seeing what is normal (Braverman, 2011). However, with the advent of improved technologies in clinical practice such skills are thought to have declined (Hemmerdinger, 2007). Recent literature indicates techniques such as arts-based interventions in health education, traditionally referred to as ‘medical humanities’, have a significant impact on diagnostic observational skills as well as improvements in other facets such as empathy (Bardes et al., 2001; Dolev et al., 2001; Naghshineh et al., 2008; Pellico et al., 2009). Despite this, the use of health humanities in observational and empathic training is not well understood. There is always the risk in a significantly hands-on profession such as dentistry that one focuses on the technical aspects of the discipline perhaps at the expense of the context of the patient. As the demands for perfection, preparation of a perfect crown, the need to pass exams, graduate, or run a successful dental practice with all its associated expenses and complexities increases, there is a real risk of losing sight of the patient as an individual. Understanding the patient, talking to them, observing body language, evaluating affect and nuances all take time and are essential to good clinical practice. However, a paradigm shift is needed to bring one back to the core principle that dentistry is a health profession – at the end of each clinical procedure there is an individual, the patient. Teaching students observational skills – both objective and subjective as part of their curriculum together with enhancing empathy, allows for the development of caring clinicians and a health discipline involved in improving an individual’s quality of life (Borromeo et al., 2013). But how does one justify bringing students into an art space in a heavily flooded dental curriculum where time is precious and there is constant battle for both clinical and didactic space? Methodological approaches for medical humanities can include single or combination formats involving artworks, theatre and narrative (Perry, 2011). Frequency of format has also been assessed with both single and multiple arts-based sessions shown to be of benefit (Dolev et al., 2001; Shapiro et al., 2006; Naghshineh et al., 2008; Schaff, et al., 2011). The latter format affords the advantage of repetition and practice, which is not possible in a one-off session but this may be more difficult to implement in time poor clinical disciplines such as dentistry. The location of delivery of these programs is also important (Schaff, et al., 2011). In the dental context, removal from the traditional pedagogic environment of the lecture theatre, or clinical setting and using the construct of the gallery should not be underestimated. Projection of artworks in a lecture theatre creates a sense of inappropriateness for the work as well as to the process. Allowing students to gain an appreciation of the artwork in its natural environment brings vividness and immediacy, as well as, providing a new and potentially exciting surrounding, something students may not otherwise experience. In 2012, the first arts-based intervention was introduced into the dental curriculum at the University of Melbourne (Naghshineh et al., 2008) The programme involved a single 2-hour session with 2nd year dental students as a component of teaching into special needs dentistry. Sessions consisted of 14 students who worked in pairs observing one of seven artworks. By observing carefully selected artworks, students gained a snapshot understanding of observational skills (both objective and subjective) and the role that empathy played as part of clinical practice. The sessions allowed for interpretation, reflection and discussion of artworks followed by explicit and facilitated application to relevant clinical scenarios with both a specialist in Special Needs Dentistry and an art curator. Student engagement throughout the sessions was striking. The opportunities to interpret, debate visual clues, engage in in-depth discussions and touch on relevance to real world practice beyond simple dental aspects of clinical relevance was evident (Alvarez, 2011). Overall, students found these sessions valuable because they were able to explore aspects of their role in managing complex special needs patients through the observation of artworks. This brings me back to the original questions asked by students when they met me at the door of the gallery – questions they were able to answer for themselves. Perhaps the most striking comment was “Well, I really had no idea why I was here but this has taught me that I should look at every patient as a blank canvas. I should not have preconceived notions of individuals before I actually take the time to talk to them and understand what they are about.” What more can I say other than integrating the arts into teaching, especially in the context of the special needs patient has benefits that outweigh potential issues that may arise from crowded or tradition dental curricula. It is certainly something all dental schools should explore as a means of improving who dental students are and what the profession as a whole can offer to its patients. Associate Professor Mina Borromeo BDSc, MScMed, MBioethics, PhD, FFPMANZCA, FRACDS(SND). Convener Special Needs Dentistry, University of Melbourne, Australia. References Alvarez SE. A beautiful friendship. Art museums and medical schools. J Museum Ed 2011; 36: 57-68. Bardes CL, Gillers D, Herman AE. Learning to look: developing clinical observation skills at an art museum. Med Educ 2001; 35: 1157-1161. Borromeo GL, Gaunt H, Chiavaroli N. The arts and visual thinking in education at the Melbourne Dental School. In: CL McLead ed “Creative Arts in Humane Medicine”, 2013 Brush Publishing, Calgary, Canada. Braverman IM. To see or not to see: How visual training can improve observational skills. Clin Dermatol 2011; 29: 343-346. Dolev JC, Friedlaender LK, Braverman IM. Using fine art to enhance visual diagnostic skills. JAMA 2001; 286: 1020-1021. Hemmerdinger JM, Stoddart S, Lilford R. A systematic review of tests of empathy in medicine. BMC Med Ed 2007; 7: 24. Hojat M. Physician empathy: definition, components, measurement, and relationship to gender and specialty. Am J Psych 2002 159: 1563-1569. Naghshineh S, Hafler JP, Miller AR et al. Formal Art Observation Training Improves Medical Students’ Visual Diagnostic Skills. J General Internal Med 2008.; 23: 991-997. Pellico LH, Friedlaender L, Fennis KP. Looking is not seeing: using art to improve observational skills. J Nursing Ed 2009; 48: 648-653. Perry M, Maffulli N, Willson S, Morrissey D. The effectiveness of arts-based interventions in medical education: a literature review. Med Educ 2011; 45: 141-148. Schaff P, Isken S, Tager RM. From contemporary art to core clinical skills: observation, interpretation and meaning-making in a complex environment, Acad Med 2011; 86: 1272-1276. Shapiro J, Ruckner L, Beck J. Training the clinical eye and mind: using the arts to develop medical students’ observation and pattern recognition skills. Med Educ 2006; 40: 263-268. Sherman JJ, Cramer A. Measurement of changes in empathy during dental school. J Dent Educ 2005; 69: 338-345. Yarascavitch C, Regehr G, Hodges B, Haas DA. Changes in dental student empathy during training. J Dent Educ 2009; 73: 509-517.     Is there an association between oral health and the incidence of pneumonia in adults with a neuro-disability who are Percutaneous Endoscopic Gastrostomy (PEG) fed?   R Prasad,1 G Manley,2 M Andiappan3 and B Daly4 1Senior Dental Officer, Kent Community Health NHS Foundation Trust; 2Consultant Special Care Dentistry, Royal Hospital for Neuro-disability; 3Biostatistician and 4Senior Clinical Lecturer/Discipline Lead in Special Care Dentistry, Kings College London Dental Institute   Abstract Aspiration pneumonia is an acute inflammatory condition that affects the distal airways and the lung alveoli. Adults with a neuro-disability are pre-disposed to developing aspiration pneumonia due to their increased risk of pulmonary aspiration. Our aim was to assess whether there was an association between poor oral health and the incidence of pneumonia in dentate adults with a neuro-disability, who are PEG fed. The study showed that oral health, in particular periodontal pocketing, may have an impact on the prevalence of pneumonia in adults with a neuro-disability. However, the magnitude of that impact remains unclear, especially when taking into account the other factors implicated in the onset of aspiration pneumonia.   Wrong site surgery in a special care setting: case report and literature review   S Master1, and Y Allen2 1Specialist in Paediatric Dentistry and Special Care Dentistry, 2 Clinical Fellow, Health Education England   Abstract Aim: To investigate the incidence and causes of wrong site extraction and to consider effective preventive procedures to reduce the risks in Special Care Dentistry (SCD). Method: A root cause analysis was conducted following an error within the SCD team, which resulted in the wrong extraction of a tooth on a 74-year-old male who was medically compromised and had a physical disability. A review of the literature was conducted to ascertain the incidence and common risk factors for wrong site extraction and surgery. Consideration was also given to effective measures to reduce the risks in future.   Correspondence between dentists and medical practitioners: a pilot audit   C L Castle-Burrows1, J Parekh2 and N Ransford3   1Specialist in Special Care Dentistry, Coventry and Warwickshire Partnership NHS Trust; 2Specialty Trainee in Orthodontics, Royal London Hospital; 3Consultant in Special Care Dentistry, Birmingham Community Healthcare NHS Foundation Trust Dental Services   Abstract Objectives: To: establish the reasons why dentists write to medical practitioners, assess the clinical usefulness of responses, consider how the process can be improved and the implications for training dentists in the dental management of patients with complex medical conditions. Methodology: 102 letters to medical practitioners were submitted for retrospective analysis over a 6-month period in 2012. Data were collected on: information requested from and received from the medical practitioner, the level of the patient’s medical complexity using the American Society of Anaesthesiologists (ASA) scale, the management implications for dental treatment. Results: 44 letters requested advice on dental management issues, such as suitability for treatment in primary dental care or for the use of sedation; 40 requested information regarding the patient’s medical history. There were also requests for test results, assessment of disease severity, lists of current medications, and assessment of bleeding risk. Additionally, there were 14 letters written providing information to medical practitioners. A number of letters requested more than one piece of information. Eighteen (17.6%) letters written received no reply, and a further 9 (8.8%) replies were assessed as being of no clinical use as they either were unable to give the information requested or gave advice which conflicted with existing guidelines. Only 46 (45.1%) letters received a reply which fully addressed the questions raised by the dentist.  Conclusions: Letters written between dentists and medical practitioners often fail to provide the information required, either because no reply is received, or the reply fails to address the concerns of the dentist. The authors suggest a need to improve the questions that are asked within dentists’ letters to medical practitioners by making them more appropriate and specific. The use of existing tools and guidelines may also support dentists in assessing medical risk and knowing when to seek the advice of a specialist in SCD rather than deferring the decision to the medical practitioner.     Decayed, Missing and Filled Teeth among Jordanian nursing home residents A A Hamasha BDS MS ABDPH Professor of Preventive and Geriatric Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. On Sabbatical leave to College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Abstract Aim: To report on Decayed, Missing, Filled Teeth (DMFT) among Jordanian nursing home residents and to analyse the differences of these conditions among different socio-demographic, personal and dental characteristics. Methodology: A convenience sample of 221 Jordanian nursing home residents with a mean age of 62.4 years (121 males and 100 females) from all nursing home residents in Jordan (297 subjects) were recruited to participate in this study. Subjects were interviewed and clinically examined for DMFT by a single trained and calibrated examiner. Data were processed and analysed using SPSS software. Statistics included frequency distributions and non-parametric tests. Kruskal Wallis and Mann-Whitney tests were used to analyse the differences in the mean DMFT among different independent variables. Results: The mean number of missing teeth was 21.13 (32.6% of residents were totally edentulous). The mean numbers of DMFT were 4.0, 21.13, and 0.57, respectively (DMFT=25.72). DMFT among dentate residents was significantly higher in older age group, smokers and those with irregular tooth brushing and dental visits. Conclusion: This study provided useful information on the DMFT status of Jordanian nursing home residents. Attention should be given by the general dental practitioner to the poor oral health status and the treatment needs that nursing home residents might exhibit.      

JDOH - Volume 17 Number 2 (June 2016)

Volume 17 Number 2  June 2016 Ethical approval considerations for patients who lack capacity R Prasad and B Daly   Raising the Body Mass Index (BMI) limit for day procedure units: results of an audit in Belfast K McKenna and A Stevens   Introduction of a Nomad Pro hand held dental x-ray unit for radiography in a special care setting U Jogezai, T Riches, D Townsend and C Abercrombie   The influence of a postgraduate qualification (Diploma/Master) in Sedation or Special Care Dentistry on work practices and career progression E Heidari, C Dickinson and J T Newton   X-linked hypophosphatasia, a battle to save the dentition: a review and case report of a patient`s journey highlighting the effects of x-linked hypophosphatasia on the dentition and possible dental treatments A D Truman, L D Addy, L A Blackburn

The Journal of Disability and Oral Health is the official publication of the British Society for Disability and Oral Health and the official journal of the International Association of Disability and Oral Health. It is published quarterly by Stephen Hancocks Limited (

Manuscripts prepared in accordance with the instructions for authors should be submitted to the Editor,

Mission Statement

The vision of the Journal of Disability and Oral Health is to provide an international forum for exchange of knowledge and expertise in Special Care Dentistry through publication of peer-reviewed scientific papers, review articles, editorials and case reports. The Journal of Disability and Oral Health aims to promote wider understanding within dentistry, medicine, nursing, social care, public health, government policy makers, disability organisations and educators; opening avenues to inclusiveness, and to contribute to the evidence base to improve the oral healthcare of people with medical, intellectual and physical and psychological impairments.

Dr Shelagh Thompson, Editor
Journal of Disability and Oral Health
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University of Liverpool
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