Recent Journals

JDOH - Volume 18 Number 3 (September 2017)

Journal of Disability and Oral Health Volume 18 Number 3 September 2017   Editorial       Conscious sedation using propofol for the treatment of patients with hypersensitive gag reflexes   C Dickinson, H M S Anwar, M Burke, E Heidari, S Koburunga, J Edwards and N Nizarali       Patient referrals to special needs dental units in Tasmania Australia   M A W T Lim and G L Borromeo       The oral health status of Special Olympics athletes in Trinidad and Tobago thirteen years later   Hema Singh, Rahul Naidu, Christina Royer and Ashley Meighan       Fibrodysplasia ossificans progressiva and its implications for dental treatment FOP: A case report   J Doughty, C Steel, P Thakrar and N Kuma   iADH Invitation Continuing Professional Development Programme Diary Dates 2017-2018    Editorial       There are times when you realise the effect education plays in people’s lives and this invited speech delivered by a recent dental graduate to the combined Dental and Medical graduation ceremony at the University of Liverpool is one of them.       The speech, written and delivered by Dominic Price, speaks for itself and truly highlights the power of belief, trust and motivation. I felt this was something to share with others.       Shelagh Thompson, Liverpool, UK            Graduation Speech to University of Liverpool Dental and Medical Graduates July 2017       Chancellor, Vice-Chancellor, distinguished guests, family, friends, and fellow graduates.   For those who don’t know me, I’m Dominic, a mature student, at least by definition anyway.  I have been asked to talk to you briefly today because there may just be one person in the room who might benefit from hearing my story. A quote I heard recently, “If you march fearlessly in the direction of your dreams, somehow the world conspires to help you”. For me, this sums up how I have ended up standing here talking to you today.       Thirteen years ago, I couldn’t see my dream through the fog of whatever it is that turns a teenager’s brain to mush. I loved learning but hated education, and those who asked me at the time what I wanted to do just got a confused mumble and a shrug in return. I dropped out of school with three AS levels at C and below and an unclassified grade. At the toss of a coin, I went to study plumbing at Further Education FE College rather than joining the Armed Forces, and four years later I was a craftsman for the gas board, a job which turned my relationship with education the right way up and strapped an engine on for good measure. Looking back, if I had resat at college and only achieved mediocre grades, I would not have been able to apply to dental school when I did. Not continuing was the right decision for me, both at the time and in the long term.       At this point three things happened in close succession involving 3 of the most influential women in my life;   • My mum had to be operated on by an Oral and Maxillofacial surgeon, which opened my eyes to the world of medicine.   • My step mum, who I had only known for a few years and who is a dentist, casually commented while talking about our jobs that, “Dentistry is just like plumbing, only smaller”!   • A friend in her final year of medical school told me about her university life, her plans to work and travel around the world, and how, “anyone can do it, you just have to work hard”.       With some help and guidance, I started using my annual leave to get work experience, which confirmed for me that if I was going to live without regret, I had to take a chance, so I handed in my notice, moved to the north west, and enrolled on an Access to Higher Education course (to mitigate my AS results (Advanced Subsidiary Level qualifications UK). At the time, there were only a handful of dental schools that would accept an Access course for entry criteria, and thankfully the University of Liverpool was one, I still remember the day I received the offer with such relief, surely the hard bit had been done.   I turned 25 in Fresher’s week. I had decided to live in halls of residence where everyone else was at least five years younger than me, but I am so pleased that I did because I had some amazing experiences and made friends for life. By the 2nd year, I was going out with that medical student, now doctor friend, who was doing exactly as she had planned and was working in Australia. It was while on holiday together that she had finished reading five books by the end of the second day and was trying to read mine over my shoulder but was getting frustrated at finishing two pages and having to wait five minutes for me to catch up, that I was harassed (she would prefer motivated) into ‘getting tested’. It wasn’t long before I was diagnosed with dyslexia, and suddenly there were tools and methods and systems in place to make life (and public speaking) easier.       Now life is not as perfect as social media makes out, and I ended up resitting the third year, but I needed to, and I don’t think I would have it any other way with hindsight. But there is always a positive and I had managed to persuade my girlfriend back from Australia and we were married a year later. During my repeat 3rd year my wife and I bought a house together, and while all this was going on I had become involved in the dental school student committee and the British Dental Student Association, so that by the time I was in 4th year I was the BDSA president and had the opportunity to work with the European Dental Student Association on a visiting programme in Stockholm.       In the 5th year, we had to go through national recruitment to Dental Foundation Training, and finals. This filled me with dread because I have a deep-seated discomfort with amateur dramatics, and both processes involve an element of performance. Thankfully, at the beginning of the year during a lecture, the Head of the Dental School Professor Callum Youngson offered to help anyone who wanted it, you just had to ask. So, I did. And in the weeks leading up to both milestone events, we discussed ways to manage my emotions and developed coping strategies to give me the best chance of performing well enough to get through. Since receiving the finals results my now four-week-old son was born and we moved home when he was a week old to be closer to family and my job starting in September.       So, from 17-year-old college dropout to married dental graduate, home owner, and new father, here are some things I’ve learned along the way:       • Throw yourself in at the deep end, take every opportunity that presents itself, you can do more than you think possible.   • Asking for help is a strength, not a weakness. Don’t be afraid of failure; use it to your advantage.   • Make as many friends as you can along the way, they are what get you through.       To end I would like to thank all the friends, staff and students alike, and family for getting us all here today, to congratulate you all for this massive achievement. Also to say that if you have a feeling that there is something you should do, no matter how sideways it is, do it, because somehow the world will conspire to help you. Thank you.       Dominic Price, BDS University of Liverpool, England UK         Conscious sedation using propofol for the treatment of patients with hypersensitive gag reflexes       C Dickinson1, H M S Anwar 2, M Burke1, E Heidari3, S Koburunga3, J Edwards4 and N Nizarali1       1. Consultant in Special Care Dentistry, 2. Specialist registrar in Periodontics; Guy’s and St Thomas’ NHS Trust; 3. Senior Specialist Clinical Teacher, King’s College London Dental Institute, 4. Consultant in Special Care Dentistry, King’s College Hospital NHS Trust           Abstract   Gagging is defined as an ejectory contraction of the muscles of the pharyngeal sphincter. This is a normal healthy physiological mechanism, preventing foreign objects from entering the pharynx, larynx or trachea. Although gagging is cited as a normal protective reflex, problems have emerged with some patients suffering from a hypersensitive response whilst undergoing basic dental treatment. This paper discusses the problem and describes six case reports in which propofol was used to help overcome patient difficulties.         Patient referrals to special needs dental units in Tasmania, Australia   M A W T Lim and G L Borromeo       Melbourne Dental School, The University of Melbourne, Australia           ABSTRACT   Even though Special Needs Dentistry has now been recognised as a dental specialty in Australia for more than a decade little is known about the nature of referrals to units dedicated to treating patients with special needs.   Aims and Objectives: To determine the types of patients referred to special needs dental units staffed by general dentists and the reason(s) for these referrals.   Methodology: Referrals for all patient appointments at Special Care Dental Units in the state of Tasmania during August 2015 were reviewed.   Results: Most referrals were from medical practitioners for the management of oral implications of medical conditions or medications. Hospital referrals originated mainly from oncology and geriatric evaluation and management units. Patients had an average of 3 medical conditions. Referrals relating to medications were generally related to the use of Bisphosphonates and Denosumab, and for chemotherapy patients.   Conclusions: This study provides details of the types of patients referred to special needs dental units. In particular, it provides insight into the awareness of the oral implications of medical conditions and medications on oral health and dental treatments amongst the medical profession and thus the importance of interactions between oral health professionals and other health professionals. Furthermore, the data stimulates discussion about the potential influence of clinic location and workforce on patient referrals.     The oral health status of Special Olympics athletes in Trinidad and Tobago: thirteen years later       Hema Singh DDS MPH, Rahul Naidu BDS PhD, Christina Royer DDS and Ashley Meighan BSc DDS       The University of the West Indies, Trinidad and Tobago           ABSTRACT   Aim and Objective: To assess the oral health status of Special Olympics athletes in Trinidad and Tobago in 2017 and compare the results of this study against the previous data collected in 2004 and with recent data from Special Olympic athletes worldwide. Methodology: A convenience sample of athletes who participated in the Special Olympics Special Smiles Healthy Athletes screening programme. The standardised Special Olympics screening form was used for the oral health assessment of each athlete. Results: 120 athletes participated. The mean age of participants was 24.1 years with a range of 5–80 years; 70.8% were male and 9.2% reported having dental pain. The prevalence of untreated decay was higher in 2017 than in 2004 (69.2% vs 43.7%), and gingival signs were present in 72.5% of the athletes in 2017 compared to 33.7% in 2014. There was an increase in participants with filled teeth (14.2% vs 9%) but a decrease in sealed teeth in 2017 (0.8% vs 2.9%). Urgent treatment need was found in 32.5% of the athletes. In comparison to Special Olympics athletes worldwide, the findings from Trinidad and Tobago were similar to those from developing countries in the Far-east and Eastern Europe.   Conclusion: The oral health status of Special Olympics athletes in Trinidad and Tobago suggests an urgent need to develop oral health promotion for people with intellectual disabilities and improve their access to oral healthcare.     Fibrodysplasia ossificans progressiva and its implications for dental treatment (FOP): A case report       J Doughty1,2, C Steel1, P Thakrar1 and N Kumar1,2       1.                  University College London Hospitals. 2.University College London       Abstract   Aims: This case report discusses the general and dental manifestations of Fibrodysplasia ossificans progressiva (FOP) and details the dental management considerations particular to this case.   Method: A case report methodology was employed to describe the clinical encounter of a patient with FOP.   Case summary: FOP is an extremely rare hereditary disorder characterised by progressive ossification of the tendons, ligaments, fasciae and striated muscles. The patient’s primary oral complaint was a complete inability to separate the upper and lower jaws, which were “locked” into position. At the age of twenty he underwent extraction of the lower right third molar, which led to progressive ossification and subsequent fixation of the jaws. The patient presented with pain and dental infection over multiple appointments. Treatment planning involved a multi-professional approach including oral and maxillofacial surgery, oral surgery and special care dentistry teams. A novel approach using cone beam CT to identify the location and extent of carious lesions was used. Risk assessment was critical as dental extractions posed a risk of uncontrolled heterotrophic bone formation; the provision of dental restorations posed the risk of inadequate visualisation / placement and trauma to the oral tissues when retracting.   Conclusions: This case poses both a clinical and ethical dilemma. After weighing the potential risks and benefits of dental treatment, there was no clear answer to this case – the plan is for the multi-disciplinary team to provide high quality preventative care and monitor the patient closely, with surgical intervention dictated by pain / infection frequency and any further dental deterioration.          

JDOH - Volume 18 Number 2 (March 2017)

JDOH - Volume 18 Number 2 (March 2017)  Editorial Audit of the use of clinical holding at Birmingham Community Healthcare Special Care Dental Service Patient and carer involvement in evaluating a toothbrushing programme for children and young people with neurological motor impairment The development of a mouthcare information leaflet for carers of older people Continuing Professional Development Programme Diary Dates 2017 2018 Some personal musings on Special Care Dentistry   In my experience a standard interview question used to be - ‘what are the most satisfying parts of your work’? Although my last experience was a number of years ago, I recall my reply following the usual acceptable responses were the immortal words of Hannibal Smith (George Peppard) at the end of the 1980’s TV series The A Team- “I love it when a plan comes together”. (Fox News, 2006).   Our realm of dentistry is principally not about the focus of dental treatment, but is considerably more about the emphasis of dealing with people. This is always interesting and often challenging. Inevitably, one of the most important qualities we need in our job, as indeed in all aspects of life, is communication. Planning, organisation and teamwork is essential and when it all comes together, it is very satisfying.   We should strive to provide a standard of treatment that is equitable to those people who do not have a disability. This is often very difficult and in the end, we simply have to do the best we can. We are not miracle workers and it is arrogant to think we can be. Clinical pragmatism can be a valuable approach; however, there is not universal agreement on its interpretation. This is particularly so in a world where the processes of commissioning and policy do not always equate with work at the coalface.   We seem to live in a time of increasing caution with the possible result that we can become more and more risk averse. Special Care Dentistry is a discipline that does not necessarily comply with standard protocols and requires flexibility and carefully managed risk. We should be prepared to accept that on occasion we have to take a step in the dark and consider taking an unpredictable risk. I used to work with a hugely experienced and skilled anaesthetist and infrequently, would discuss a case with complex medical and difficult management problems. After a pause, she would invariably say- “well Graham somebody has to treat this patient and it looks like us, so let’s get on with it.” She was definitely a good-doer.   It would be interesting to examine how and why our colleagues chose the path of Special Care Dentistry. I became interested following a move from Public Health. Initially, I experienced the joys of working in a dental caravan visiting schools for children with severe disability back in 1976. I feel it is important that the initial introduction to working with people with disability in dentistry is well supported. This was not the case in earlier years, when the approach of ‘just get on with it’ was the norm. My current position involves working with adults with profound complex neurodisability at the Royal Hospital for Neuro-disability Putney in London and in my opinion, working with this group of patients is particularly challenging (Royal Hospital for Neuro-disability). Medically, many patients have experienced a traumatic episode which resulted in severe brain injury. Additionally, they have complex medical conditions and are often very unwell. Dentally, these patients are like any other, presenting with a range of problems varying from requiring a full clearance to managing failing, complex restorative dentistry. Providing their treatment can be very tricky, due to limited oral access and difficult management. I cannot emphasise enough the value of intravenous conscious sedation in providing good dentistry. Planning for treatment is a hard one and communicating with their relatives/carers is often both humbling and difficult. Understandably, they may be in a state of shock because of the immediate nature of the event that has caused such a sudden change in their loved one. Many of the patients I treat have a very low level of consciousness with no obvious communication and very limited ability to respond. Commonly, their relatives/carers travel considerable distances every day to simply sit and be there to provide comfort. In addition, the prospect of improvement may be limited, such that the carers experience a grieving process that may go on for years and years. I find the capacity for kindness in the human creature can be overwhelming. In terms of dentistry, quite rightly patients’ loved ones want the very best treatment and may have high and unrealistic expectations for the type of care they feel is acceptable. In these circumstances empathetic, but realistic communication is so important.   Although working with young colleagues in a teaching and learning capacity can be quite demanding, it also provides great fun and much satisfaction. I do not subscribe to the older school of teaching that felt the best approach was first to break the student down and then build them up. On more than one occasion, my thoughts had been, ‘Stop, stop, stop take your forceps away from that tooth NOW it’s the wrong one’. I found, however, the ‘I wonder if I can make a slight suggestion’ approach created less panic and was more educationally creative, rather than damaging their confidence. There is however, one shortcoming in the enthusiasm of the youngsters entering our specialty and this is research; and I can understand why. Research is not an interest to everyone. It is however a very rewarding and essential pastime, as we all know progression in all aspects of clinical care needs to be supported by evidence. Research however can be challenging. Firstly, you have to hit on an idea, review the past literature, obtain ethical and institutional approval (ethics can be daunting) apply for funding, then do the work, write up and seek publication. What a lot of hurdles, with each one being very taxing.   Invariably, one of the first experiences of the research process is part of a formal academic training. This tends to be accompanied by the additional worry of exams and the research part of the training can be considered mainly as a stressful and necessary task. It’s no wonder that I have heard it said at the end of the training process ‘I never want to do any type of research ever again’. However, it is so important to have an enquiring approach to our work. This quality is common to clinicians, although taking it that step further is hard. Research is so much better coming from the angle of interested enquiry i.e. ‘I wonder what’s going on here?’ rather than a necessary exercise as part of a training programme. This can be demoralising and extinguish the spark and fire of genuine interest and enquiry. In the end, it all comes down to providing the protected time and financial support for research especially in newer specialty areas. The priority of where funding goes seems to leave some areas of research at the end of the queue, something our society needs to seriously consider.   What now of the future? Hats off and huge congratulations to our ‘grandparents’ who secured Special Care Dentistry as a specialty. Special Care Dentistry is predominantly a primary care community speciality and needs to be focused in the community; although links with academic centres and teaching hospitals are essential, as their expertise, research, and teaching provide substantial support and credibility to the specialty. This is particularly so since research, teaching and training must be the key areas of focus for the future. Academic teaching hospitals and universities need to seriously accept this responsibility and ensure that adequate provision is available in the undergraduate curriculum and opportunity for post graduate training in Special Care Dentistry. We need to fight for the continuing evolvement of Special Care Dentistry; it is a continuing and worthwhile battle -good luck to all.     Graham Manley BDS DDPH(RCS-Eng) MSc PhD FDS(RCS-Eng)     Fox News.   Royal Hospital for Neuro-disability.     The development of a mouthcare information leaflet for carers of older people   R Fitzpatrick1 and V Jones2   1Community Dental Officer, 2Consultant in Special Care Dentistry Aneurin Bevan University Health Board     Abstract   Aim: To design a written information leaflet to support carers when providing mouthcare for older people. Method: A literature search to identify existing information leaflets, recommendations on producing written healthcare information and current evidence based oral healthcare. Searches were carried out using the key words: carer, oral health, elderly, care homes, education, training and oral health promotion plus denture cleaning, tooth brushing, diet supplements and dry mouth. A draft leaflet was then produced and assessed using the Flesch Reading Ease Score, Flesch Kincaid Grade Level, Simplified Measure of Gobbledygook (SMOG) calculator, the Ensuring Quality Information for Patients tool (EQIP) and the Patient Education Materials Assessment Tool (PEMAT). The leaflet was peer reviewed by colleagues within Community Dental Service, Oral Health Promotion team and a Public Health Practitioner. It was further evaluated by carers using a structured questionnaire. Results: The leaflet scored well with regards to its readability and EQIP scores and could be easily understood by most carers. There were 33 respondents to the evaluation questionnaire, of which 85% felt that the leaflet was good to very good and 60% said it increased their knowledge and confidence when providing mouth care. Conclusion: A high quality, simple information leaflet was produced that supported carers when providing mouth care for older people.     Audit of the use of clinical holding at Birmingham Community Healthcare Special Care Dental Service   R Willis   Senior Dental Officer, Birmingham Community Health Care NHS Foundation Trust   Abstract:   Aim and objectives: To evaluate the use of clinical holding within one Special Care Dental Team against the British Society of Disability and Oral Health 2009 Clinical Holding Guidelines and the Department of Health 2014 publication, Positive and Proactive Care. Methodology: Data were collected over an eight-week period for patients where clinical holding had been used to facilitate care. Results: Forty-six patients were identified as receiving clinical holding during the audit period with 70 separate clinical holds used. Low level arm restrictions were used in 40% (n=28) of holds with medium or high level arm restrictions used in 36% (n=25). The main justification given for the use of clinical holding was the facilitation of treatment (96%, n=67). The majority of holds were used to facilitate examination (31%, n=22) or intravenous access (31%, n=22). The intervention was abandoned for 3% (n=2) of holds. The use of clinical holding was planned at a prior appointment for 60% (n=42) of holds. Non-dental staff were used in 44% (n=31) of holds. Conclusions: The use of clinical holding within the service was in line with current guidance and was effective in the facilitation of care for people whose behaviour limited their ability to receive care. The audit results suggest improvements are required in advanced planning and documentation of consent. Future work should focus on the use of non-dental staff in clinical holding, post clinical holding debriefs and post incident reviews.   Patient and carer involvement in evaluating a toothbrushing programme for children and young people with neurological motor impairment   R Emanuel1, E Ray-Chaudhuri2, J Parry3, L Borthwick4, D Sellers5 and S Dobson6   1Consultant in Special Care Dentistry, 2Specialty Registrar in Paediatric Dentistry, 3Consultant in Paediatric Dentistry, 4Senior Dental Nurse, 5Senior Specialist Speech and Language Therapist/Research Fellow, 6Lead Nurse; Chailey Clinical Services, East Sussex, UK   ABSTRACT   Background: People with cerebral palsy (CP) can have difficulty with eating and drinking safely and efficiently. A toothbrushing regime which includes routine use of suction and non-foaming toothpastes may be beneficial to reduce foam, debris and aspiration risk during brushing. This project sought to obtain feedback from children and young people with severe motor impairment, their parents or guardians and care staff of a toothbrushing programme, which introduced the use of nonfoaming paste and suction. Method: Two participant groups were invited to contribute to evaluate a toothbrushing programme based on non-foaming toothpaste and suction for children and young people with cerebral palsy who are unable to eat and drink safely. The groups were: Care staff involved in providing daily oral care to children and young people with CP, and twelve children and young people with CP who are unable to eat or drink safely and who use community dental services based at the specialist centre for children and young adults with neurological and motor impairment. Results: Lack of co-operative motor ability was identified by care staff as the greatest obstacle to thorough oral hygiene practice for children and young people with neurological motor impairment. Before the service evaluation, over 66% of staff thought that use of non-foaming toothpaste and suction would be useful. Some staff were concerned that suction use may be unpleasant for some children with sensory oral issues. A patient/carer oral hygiene education programme, using non-foaming toothpaste and suction, resulted in positive feedback from the carers or family members providing oral hygiene.    

JDOH - Volume 18 Number 1 (June 2017)

Journal of Disability and Oral Health Volume 18 Number 1 June 2017   Contents   Editorial   Deep Brain Stimulation literature review of the unseen challenges to optimal dentistry G X D Lim   Dental students attitudes towards understanding of health disability and disease in dental patients in Wales UK a foundation for special care dentistry H E Redford and P A Atkin   Oral health status and treatment needs of school children undergoing special education integrated programme in Malaysia a pilot study J John, S A Mani, V K Joshi, L Y Kuan, H W Lim, S LWan-Lin, L A Shoaib and R A Omar   Special Care Dentistry in Saudi Arabia development as a dental speciality an opinion paper Hassan Abed   Diary Dates 2017 2018 Obituary Professor Crispian Scully Research grants advisory Continuing Professional Development Programme Editorial   Looking back – the journey towards Special Care Dentistry   Today, Special Care Dentistry (SCD) sits proudly alongside other dental specialties in the UK as in other countries across the world. Whilst it is one of the newest (12th), and most ‘fresh-faced’ dental specialty in the UK, there is a long history to how it came to fruition, through the vision and efforts of many dentists, and with the engagement, input and involvement of people with a disability.   Its raison d’être is to promote good oral health and function for people with a disability, together with others who have an important role alongside the dental team. Seventeen years ago - a new millennium - the year 2000, was significant in many ways. I recall seeing-in the new century on the Malvern Hills, with crystal-clear starlit skies – joined by many others, who, like me, were thinking of what the future would bring.   For Special Care Dentistry, that year was a turning point – The Joint Advisory Committee for Special Care Dentistry (JACSCD) was established as a freestanding committee, to ‘promote and oversee the introduction of training programmes, the development of curricula and training standards and formative assessment processes’ (Woof, 2000; Fiske, 2006).   ‘A case of need – a proposal for a Specialty in Special Care Dentistry’ (JACSCD; 2003a) and, ‘Training in Special Care Dentistry’ were both published in 2003 (JACSCD; 2003b). Two years later, the General Dental Council approved in principle the establishment of a Specialty of SCD.   Yet, in reality, it was the ‘end of the beginning’; it is important to understand that the speciality grew out of a complex interaction and vision of many stakeholders, including the Royal Colleges, British Society for Disability and Oral Health, the British Dental Association, British Association for the Study of Community Dentistry, the Royal Colleges, lay people, and those with a disability. The journey towards the speciality was long and sometimes difficult, but it was vitally important for those individuals with a disability who were supported by promoting good oral health and function. It was a time of great change and a challenge for the many organisations and individuals who had shared values, but where care pathways and processes sometimes differed. The debate lasted many years, but the specialty of Special Care Dentistry is now on course providing consultant and specialist led services, training and importantly, education to future generations of dental team members at undergraduate and post-graduate level.   A future paper in the Journal of Disability and Oral Heath will provide further detail of the ‘The Journey’ to establishing the specialty both as a historical record and with the hope others will find the resilience to promote and advocate for similar developments in their countries.   References   Woof M. Specialisation in Special Care Dentistry - where from, where now, where to? J Disability Oral Health 2000; 1: 34-38.   Fiske J. Special Care Dentistry (Editorial). Br Dent J 2006 200: 61.   Joint Advisory Committee for Special Care Dentistry. A Case of Need – a proposal for a Specialty in Special Care Dentistry. London: JACSCD; 2003a.   Joint Advisory Committee for Special Care Dentistry. Training in Special Care Dentistry. London: JACSCD; 2003b.                                                                                                                 Marcus Woof Hon. Senior Lecturer, Disability Studies University of Birmingham, School of Dentistry.       Deep Brain Stimulation: literature review of the unseen challenges to optimal dentistry   G X D Lim MSc   Nanyang Polytechnic (Adjunct Lecturer), Geriatrics and Special Care Dental Centre NDCS (Visiting Clinician), Eastman Dental Institute (MSc Graduate)   Abstract   Deep brain stimulation is an implantable electrical generator increasingly used nowadays for movement or neuropsychological conditions. It was reported to cause significant morbidity and mortality when used with various dental devices. AIMS: This literature review seeks to unveil hazards, analyse current guidelines and practices, and highlight the controversies practitioners face when caring for individuals with deep brain stimulation. METHODOLOGY: Cochrane database, Ovid MEDLINE and PubMed searches were executed using MeSH terms “deep brain stimulation” AND “dentist*”. An open (basic) search for the databases was also done. Information from practice recommendations of the Parkinson’s Society UK, American Parkinson’s Disease Association, National Parkinson Foundation US, European Parkinson’s Disease Society, Parkinson’s Australia, FDA (US), and MEDSCAPE were also analysed for insights regarding deep brain stimulation and dentistry. RESULTS: A total of 1,778 articles were found and screened, of which 15 were reviewed in full text and 10 were deemed relevant for qualitative synthesis. CONCLUSIONS: Previous literature suggested diathermy use and post-treatment infections are the main concerns with deep brain stimulation. A deeper understanding of the safety concerns involving other dental procedures (including electrocautery, lasers, lithotripsy, magnetic resonance imaging, radiation therapy, and ultrasound) with deep brain stimulation use is required. In addition, antibiotic prophylaxis recommendations differ internationally. There are also concerns regarding the timing of dental interventions after deep brain stimulation and various considerations during general anaesthesia. This article arranges and summarises these concerns for the perusal of all dental practitioners.         Dental students’ attitudes towards understanding of health, disability and disease in dental patients in Wales, UK: a foundation for special care dentistry   H E Redford1 and P A Atkin2   1General Dental Practitioner, Swansea, 2Consultant/Hon. Senior Lecturer, School of Dentistry, Cardiff University     Abstract   Objectives: This cross-sectional study aimed to explore ideas relating to the wider medical knowledge and attitudes towards understanding of human health, disability and disease in dentistry amongst dental undergraduate students in different stages of the BDS programme at School of Dentistry, Cardiff University, Wales. Methods: A questionnaire relating to students’ attitudes, perceptions and knowledge concerning human health, disability and disease was distributed to first, third and final year students. The questionnaire used Likert scales to allow students to easily rate their attitudes on this topic. Results: Most students (99%) perceived human disease/clinical medical sciences for dentistry teaching to be relevant to dentistry. Students in their final year perceived themselves to be the most confident with their knowledge of human disease and their ability to use their knowledge when treating patients, compared to third and first year students. The majority of dental students surveyed perceived that dental patients would expect their dentist to have good understanding of their problems with heath, disability and disease and how these problems may impact on treatment choices (81%), but, that patients did not recognise that dental students learned about human health and disease (44%). Conclusions: The results indicate that dental students recognise that human diseases/clinical medical sciences teaching in dentistry are an essential component of undergraduate curriculum. The teaching provides students with increased knowledge of this topic area along with confidence in using this knowledge whilst treating patients. Students feel that as a dentist, they should have a good understanding of medical problems, disability and disease and how this impacts on treatment and also believe this is what patients expect. A sound understanding of patients’ medical history is key to safe practice, and identifying those patients who may need special consideration when planning dental treatments. The undergraduate human diseases/clinical medical sciences teaching in dentistry, which is later built upon with undergraduate teaching in Special Care Dentistry and sedation provides a good foundation for future safe clinical practice for all patients, whatever their special needs may be.     Oral health status and treatment needs of school children undergoing special education integrated programme in Malaysia – a pilot study   J John1, S A Mani2, V K Joshi1, L Y Kuan3, H W Lim3, S LWan-Lin3, L A Shoaib2 and R A Omar1   1Department of Restorative Dentistry, Faculty of Dentistry; 2Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry; 3Faculty of Dentistry: University of Malaya, Kuala Lumpur   AbstracT Aim and objective. This pilot study aimed to assess oral health status and treatment needs among children with special needs (CWSN) in a Special Education Integrated Programme school in Malaysia, to determine the feasibility of verifying a baseline prior to conducting an intervention programme. Methodology. A total of 82 CWSN with different types of learning disabilities aged 6-12 years old, who complied with the criteria, participated in this study. Data were collected by clinical examination and analysed using SPSS 20.0 system. Results. Among the respondents, 62% had one or more decayed teeth, 80% did not have any restorations in their oral cavity and 70% had between moderate to severe plaque index score. Almost all the CWSN required oral hygiene education while more than half required oral prophylaxis and restorative treatment. Only 21% required extraction and 12% were advised to undergo orthodontic treatment. 7.3% of CWSN presented with tooth anomalies. More than a third had either Class I or Class II incisor relationship respectively and two-thirds presented with Class I facial profile. 13% of CWSN had undesirable oral habits. Conclusion. CWSN who participated in this pilot study had satisfactory oral health status, however, they lacked adequate oral hygiene awareness and required further reinforcement.     Special Care Dentistry in Saudi Arabia: development as a dental specialty - an opinion paper   Hassan Abed BDS MSc Candidate   Department of Basic and Clinical Oral Sciences, Umm Alqura University, Faculty of Dentistry, Makkah, Saudi Arabia. Department of Sedation and Special Care Dentistry, Guy’s and St Thomas’ Hospital (GSTT) National Health Services (NHS) Trust, King’s College London, United     Abstract Special Care Dentistry (SCD) is an unrecognised speciality in the Kingdom of Saudi Arabia (KSA) and it is not currently taught as a major part of undergraduate or postgraduate dental curricular. The number of people with special needs is expected to increase based on the presence of many risk factors. For instance, the government is facing a rising burden of road traffic injuries as a result of rapid changes in behaviours. Therefore, more survivors are expected who might live using wheelchairs or with permanent physical impairments. Additionally, the elderly population of Saudi Arabia is expected to grow from 1 million in 2000 to 7.7 million in 2050. Improvements in paediatric health care in Saudi Arabia are expected to increase the number of people living with chronic or debilitating medical conditions. Thereby, dental care providers must anticipate patients with chronic medical conditions and/or wheelchair users in their daily practice. Implementation of SCD in the undergraduate and postgraduate dental programmes in Saudi dental universities will help oral health care providers to manage these patients and involve them in the health care pathway.    

JDOH - Volume 7, Number 2.

August 2006


Editorial 58

Programme 59

General Symposia 1 Oral Health and Disability a global perspective 70

Symposia 72

Oral Presentations 80

Poster Presentations 96

Index of names of authors and presenters 132

Continuing Professional Development Programme 137

18th Congress of the International Association for Disability and Oral Health


This is a significant year for the Journal. We are now six years old and will publish three issues this year. This is an important development, reflecting an enhanced submission rate and an increased interest in the Speciality of Special Care Dentistry.

In Australia, New Zealand, Brazil, the USA, and Japan the Specialty of Special Care Dentistry is recognised, with University Masters, Diploma and/or Royal College Fellowship awards. In the UK and Ireland, the Dental Councils have approved in principle the need for a speciality of Special Care Dentistry and Masters/Diploma programmes and Royal College memberships/ Diplomas for committed practitioners already exist. In Sweden, two postgraduate students are in training in Orofacial Medicine and we will hear from them at the forthcoming IADH Congress in Gothenburg.

Readers cannot fail to have noticed that this issue is entirely made up of abstracts of the proceedings of the 18 th Congress of the International Association for Disability and Oral Health, in Gothenburg. I have so enjoyed this preview of all that is going to be presented and discussed in Sweden at the end of next month. This promises to be a varied and stimulating insight into current research and clinical practice in Special Care Dentistry, as well as an opportunity to catch up with old friends and new. The biennial congresses bring together practitioners from all over the globe – experts in their field from countries with wellestablished oral health care services but increasingly, with the aid of scholarships, individuals from countries where oral health care for the able-bodied is poorly developed and that for people with disabilities almost non-existent. The IADH, along with all its member organisations, has a role to play in ensuring that global oral health gains are felt by disadvantaged people too. To that end, the collaborative partnerships with the Federation Dentaire Internationale and the World Health Organisation are vital to making our voice heard, and the very real needs of people with disabilities known, in the wider dental community. We are all in this together!

June Nunn, Editor

Dublin , July 2006

 18th Congress of the International Association for Disability and Oral Health Goteborg, Sweden – August 23-29,2006

Programme of Events

Wednesday Aug 23

Pre-Congress Symposia

1. Neuropsychiatry – aspect of patients with special needs

Christopher Gillberg, Sweden
Gunilla Klingberg, Sweden
Carin Pilebro, Sweden
Selina Master, UK
Clive Schneider-Friedman, Canada
Ichi Morisaki, Japan
Pia Dornérus, Sweden

2. Oral motor therapy

Rodolfo Castillo Morales, Argentina
Gustavo Molina, Argentina
Martine Hennequin, France
Lotta Sjögreen, Sweden
Pamela Åsten, Norway
Madeleine Wertsén, Sweden
Anita McAllister, Sweden

3. Resource centres – the Nordic models

Kari Storhaug, Norway

Anders Olausson, Sweden
Birgitta Bergendal, Sweden
Jette Daugaard-Jensen, Denmark
Hans Gjørup, Denmark
Christina Stecksén-Blicks, Sweden

Bitte Ahlborg , Sweden

Annette Carlsson, Sweden
Jan Andersson-Norinder, Sweden

 Thursday Aug 24

Opening Ceremony

General Symposia

GS1: Oral Health and Disability - a global perspective

Moderator: Allan Narvey, Canada

Co-moderator: Inger von Bültzingslöwen, Sweden

GS1:1 The WHO perspective, Poul Erik Petersen, Switzerland

GS1:2 The FDI perspective, Habib Benzian, Germany

GS1:3 The Indian perspective, Srivats Bharadwaj, India

GS1:4 The Tanzanian perspective, Tekle Asmerom, Tanzania

 Parallel sessions:


S1: Dentofacial growth disturbances and altered orofacial functions in children with neuromuscular diseases

Moderator: Stavros Kiliaridis, Switzerland, Sweden

S1:1 Orofacial dysfunctions, Lotta Sjögreen, Sweden

S1:2 Dentofacial growth disturbances, Stavros Kiliaridis, Switzerland, Sweden

S1:3 Present orthodontic treatment interventions and stability, Stefan Axelsson, Norway

S1:4 Interventions to correct dentofacial disturbances. Future aspects, Marianne Bergius, Sweden


S2: Facial disfigurement and advanced treatment

Moderator: Göran Koch, Sweden

S2:1 Overview of disabling oral conditions, Sven Kreiborg, Denmark

S2:2 Advanced restorative care-implants, Anders Ekfeldt, Sweden

S2:3 Future strategies for delivering advanced oral care, Main Sponsors

 Open symposium

Oral health care in developing countries

Moderator: Inger von Bültzingslöwen, Sweden

Co-moderator: Tom Turk, Netherlands

 Parallel Sessions:


S3: Living with facial disfigurement

Moderator: Birgitta Bergendal, Sweden

S3:1 The impact of physical difference on the growing child, Eileen Bradbury, UK

S3:2 Quality of life in young adults with cleft lip and palate, Agneta Marcusson, Sweden

S3:3 Experiences from multiprofessional network on facial disfigurement, Birgitta Bergendal, Sweden


S4: Behavioural aspects on oral health care

Moderator: Ulf Berggren, Sweden

S4:1 Overview – epidemiology and diagnoses, Ulf Berggren, Sweden

S4:2 Child perspective, Anders Broberg, Sweden

S4:3 Transition into adulthood, Erik Skaret, Norway

 Oral Presentations

O1A: Best Clinical Abstract competition, part 1

O1A:1 The Berlin Denal Health Behaviour Programme - group prophylaxis for children and teenagers with disabilities

R. Grahlen , LAG Berlin , Germany

O1A:2 The Berlin Dental Health Behaviour Programme - a practical lesson to join in

S. van Os -Fingberg , LAG Berlin , Germany

O1A:3 Gingival hyperplasia associated with hyaline fibromatosis - a report of two cases

H. Fadel , King Fahd Armed Forces Hospital, Saudi Arabia

O1A:4 Free oral care for disabled people living in Izmir, Turkey, provided voluntarily by dentists
E. Sabah, Ege university Faculty of Dentistry, Dept. of Pedodontics , Turkey

O1A:5 Oral health of patients undergoing hemodialysis in Lahore, Pakistan
M. Shoaib, Shaikh Zayed Medical Complex, Pakistan

O1A:6 Two implants treatment in cerebral palsy patients
J. Loyola, San Luis Potosi University, Mexico

 Oral Presentations

O1B: Craniofacial dysmorphology

O1B:1 Cleft lip and palate situation in Mongolia
A. Garidkhuu, Aichi-Gakuin University, School of Dentistry, Japan

O1B:2 Expansion and cleft palate patients
K. Manshaie, A ssistant Professor, Islamic Republic of Iran

O1B:3 Calvarial suture biology and dental development : lessons from craniosynostosis (CS) clinics
P. De Coster, Centre for Special Care, PaeCaMeD Research, Ghent University , Belgium

O1B:4 Short stature, characteristic facies, delayed development, and macrodontia in primary incisors: a new case of Kbg syndrome?
R. Cauwels, Dept. Paediatric Dentistry and Special Care, Paecamed Research, University Hospital Ghent , Belgium

O1B:5 Orofacial manifestations of XXXXY syndrome (a Klinefelter syndrome variant): presentation of three patients.
D. Faulks, CHU Clermont-Ferrand and EA 3847 University Clermont1, France

O1B:6 Oral manifestations and dental treatment in patients with Rubinstein-Taybi syndrome
M. Magalhães, School of Dentistry University of São Paulo , Brazil

 Oral Presentations

O1C: Medically compromised patients. Genetics & Gerodontology

O1C:1 Distribution of genotypes of Porphyromonas gingivalis in Type 2 diabetic patients with periodontitis in Mexico
J. Loyola, San Luis Potosi University, Mexico

O1C:2 Fibrodysplasia Ossificans Progressiva - morbidity and mortality study of twenty eight consecutive cases
B. Nussbaum, Thomas Jefferson University Medical School, United States

O1C:3 Langerhans cell histiocytosis. Oral manifestations.
N. Skogedal , Lovisenberg Diakonale Hospital, TAKO-centre , Norway

O1C:4 Seckel syndrome associated with oligodontia, microdontia, enamel hypoplasia, delayed eruption, and dentin dysmineralization : a new variant ?
V. Holthaus, Private Office for Oral Surgery and Dentistry for Disabled, Germany

O1C:5 Needs assessment for orthopedic dental service for disabilities and elderly people
P. Jolueva, Kyrgyz State Medical Academy, Kyrgyzstan

O1C:6 To learn how to eat by mouth - a program for children with eating difficulties
L. Gustafsson, Mun-H-Center, Sweden

 Friday Aug 25

General Symposia

GS2: Oral Health and Disability – ethical and moral issues

Moderator: June Nunn, Ireland

Co-moderator: Luc Martens, Belgium

GS2:1 Clinical perspective, Kari Storhaug, Norway

GS2:2 On the ethics of oral health and disability, Jan Helge Solbakk, Norway

GS2:3 Genetics, Irma Thesleff, Finland

GS2:4 Users perspectives, Thomas Sjödin, Sweden

Parallel Sessions:


S5: Dental care in greying societies – challenges and possibilities

Moderator: Gunilla Nordenram, Sweden

S5:1 Determinants of oral health in the elderly, Gunilla Nordenram, Sweden

S5:2 Oral health in the elderly from the patient’s perspective, Kerstin Andersson, Sweden

S5:3 Oral health care for an aging society: framing challenges through an “Ethic of Care”, Mary McNally, Canada


S6: Caries and gingival disease in children with disabilities

Moderator: Dowen Birkhed, Sweden

S6:1 Caries risk groups in children with disabilities, Jukka Meurman, Finland

S6:2 Gingival disease in children with disabilities, Göran Dahllöf, Sweden

S6:3 Preventive strategies in children with disabilities, Dowen Birkhed, Sweden

S6:4 Treatment planning and management issues in children with disabilities, Monty Duggal, UK

 Oral Presentations

O2A: Best Clinical Abstract competition, part 2

O2A:1 Procedure for evaluating gingival perfusion status using laser-doppler flowmetry in patients with diabetes mellitus and periodontal disease
J. Loyola, San Luis Potosi University, Mexico

O2A:2 The effects of two types of appliances on orofacial dysfunctions of disabled children
A. Alacam, Gazi University, Turkey

O2A:3 Clinical evaluation of minimal intervention dentistry technologies to dental care of patients with special needs
T. Ari, Turkish Disability and Oral Health Association, Turkey

O2A:4 A study of morbidity and treatment outcomes associated with day stay dental care for adults with disabilities
E. Webb, Greater Glasgow Community Dental Service, United Kingdom

O2A:5 Periodontal diseases in patients with disabilities
S. Klar, University Witten/Herdecke; Dept. Special Care in Dentistry, Germany

O2A:6 Oral self-injurious behaviour in a patient with severe mental retardation: case report
D. Emmanouil, Dept of Pediatric Dentistry, School of Dentistry, University of Athens , Greece

 Oral Presentations

O2B: Oral Health

O2B:1 : Evaluation of an oral health program for carers in institutions for adults with disabilities
I. Kaschke, Department for Conservative and Preventive Dentistry, Dental School, Charite, Germany

O2B:2 : Evaluation of oral health in institutionalized multiple-disabled young adults in Bucharest after introduction of a preventive program
R. Moraru, University Carol Davila, Bucharest, Romanian Association for Oral Health and Disability, Romania

O2B:3 : Studies on oral health condition and function of schizophrenic patients
Y. Maki, Tokyo Dental College, Japan

O2B:4 : “Baby Oral Health: Pregnancy through Childhood”: an audio-visual aid for improvement of infant oral health through primary caregiver education
L. Alsada, Saudi Aramco , Saudi Arabia

O2B:5 : An audit of a speical care assessment clinic for patients referred for treatment under a general anaesthetic
L. Zoitopoulos, Department of Community Special Care Dentistry, United Kingdom

O2B:6 : Preparedness of dental undergraduates for provision of care to individuals with special needs in Nigeria
F. Oredugba, University of Lagos, Nigeria

 Oral Presentations

O2C: Oral Health

O2C:1 : Oral health of children with special needs in Taiwan
M. Chou, Chang Gung Memorial Hospital ,Chang Gung University College of Medicine, Taiwan, Province of China

O2C:2 : Development of a system to monitor the oral health of children with special needs
A. Macpherson, NHS Lothian, United Kingdom

O2C:3 : Oral health status of Senegalese children with disabilities
M. Faye, Département d'Odontologie Faculté de Médecine de Pharmacie et d'Odontologie, Université Cheikh An, Senegal

O2C:4 : Oral health of Down syndrome children in Malaysia
H. Awang, University of Malaya, Malaysia

O2C:5 : The oral health of young people with special needs in Ireland
J. Nunn, Dublin Dental School and Hospital , Ireland

O2C:6 : Oral health and autism: epidemiologic study
E. Pozzani, University of Bologna, Italy

Parallel Sessions:


S7: Oral motor dysfunction and therapy

Moderator: Anita McAllister, Sweden

S7:1 Oral motor treatment in the Nordic countries, Anita McAllister, Sweden

S7:2 A clinical experience from Japan and Australia, Kaori Tomita, Japan

S7:3 Effects of treating children with Down syndrome with palatal plates for oral stimulation, Kerstin Carlstedt, Sweden

S7:4 Chewing function in people with neurological impairment, Martine Hennequin, France


S8: Aspects of oral care in medically complex patients

Moderator: Ulf Mattsson, Sweden

S8:1 Oral health aspects of medically compromised children, Luc Martens, Belgium

S8:2 Classification of patients with medical conditions, Michael Glick, USA

S8:3 The antibiotic prophylaxis debate, Johan Blomgren, Sweden

S8:4 Oral medicine, Mats Jontell, Sweden

 Oral Presentations

O3A: Best Research Project competition

O3A:1 : Development of the Individual Dental Anxiety Profile
J. Edwards, Pembrokeshire NHS Trust Wales UK, United Kingdom

O3A:2 : Oral health impact on quality of life among the disabled: carer perceptions
A. Pradhan, The University of Adelaide, Australia

O3A:3 : Eating and swallowing foods with various consistencies: the effect of aging and stroke
K. Matsuo, Johns Hopkins University, United States

O3A:4 : An audit of health and safety incident reporting behaviour of the staff of the Department of Community Special Care Dentistry
E. Heidari, Department of Community Special Care Dentistry, United Kingdom

O3A:5 : Hearing assessment of children with non-syndromic cleft lip/palate
M. Amaral, UNICAMP, Brazil

O3A:6 : The Prevalance of dental erosion in children with cerebral palsy
P. Karataban, Marmara University School of Dentistry, Turkey

 Oral Presentations

O3B: Oral Health, Oral motor function, Ethics & Behaviour sciences

O3B:1 : Oral and dental manifestations in adults with osteogenesis imperfecta
R. Saeves, TAKO-Centre, Lovisenberg Diakonale Hospital , Norway

O3B:2 : The correlation between oral health status and the severity level of disabled children
C. Huang, Taiwan Oral Health Association for People of Special Needs, Taiwan

O3B:3 : A screening test for orofacial function: the Nordic Orofacial Test – Screening, NOT-S
M. Bakke, Dept. of Oral Medicine, School of Dentistry, University of Copenhagen , Denmark

O3B:4 : Lip closure training in stroke patients with dysphagia
M. Hägg, Speech & Swallowing Centre, ENT Department , Sweden

O3B:5 : Ethical treatment of developmentally disabled persons: results of a Netherlands – Belgium survey
L. Marks, Dept. Paed.Dent. & Special Care - Ghent University, PaeCaMeD Research , Belgium

O3B:6 : Music therapy: mingling notes and sounds
N. Prabhu, Westmead Hospital, Australia

 Oral Presentations

O3C: Oral Prevention & Others

O3C:1 : Dental program with high preventive content using clorhexidine gel with S.A.L.F.I.O. method in patients with disabilities
G. Scagnet, Quinquela Martin Hospital of Paediatric Dentistry, Argentina

O3C:2 : Plaque removal efficacy of a titanium oxide toothbrush with solar battery
S. Akiyama, Osaka University Dental Hospital, Japan

O3C:3 : Morquio syndrome and disturbances in dental enamel. Focus on preventive measures
S. Saltnes, TAKO-Centre, Lovisenberg Diakonale Hospital , Norway

O3C:4 : Oral environment and dental problems of eating disorder patients with spontaneous vomiting
A. Suzuki, The Nippon Dental University Hospital, Japan

O3C:5 : Dental anxiety in children with cleft lip and palate: a pilot study
M. Dogan, Cukurova University,Faculty of Dentistry, Department of Pedodontics, Turkey

General Meeting IADH

Saturday Aug 26

General Symposia

GS3: Oral health and neuropsychiatric disorders – quality of life

Moderator: Jan Andersson-Norinder, Sweden

Co-moderator: Clive Schneider-Friedman, Canada

GS3:1 Epidemiology and diagnosis, Christopher Gillberg, Sweden

GS3:2 Special needs for people with autism, Rita Jordan, UK

GS3:3 Oral health needs, Gunilla Klingberg, Sweden

GS3:4 Users perspectives, Aage Sinkbaek, Denmark

 Parallel Sessions:


S9: Orofacial aids and assistive devices

Moderator: Leda Mugayar, Australia

S9:1 Multiprofessional cooperation and assistive devices in dental treatment, Bitte Ahlborg, Sweden

S9:2 Products and orofacial assistive devices for oral hygiene, Annette Carlsson, Mia Zellmer, Sweden

S9:3 Facilitating eating and drinking, Lotta Sjögreen, Sweden

S9:4 Intraoral devices for oral motor therapy, Gustavo Molina, Argentina


S10: Pre- and postgraduate education in Special Care Dentistry

Moderator: Göran Dahllöf, Sweden

S10:1 Overview of professional education, June Nunn, Ireland

S10:2 Introducing Special Care Dentistry into the undergraduate curriculum, Shelagh Thompson, UK

S10:3 Specialist’s qualifications – the Australasian experience, Jane Chalmers / Graeme Ting, Australasia

S10:4 Training in orofacial medicine in Sweden, Carl-Otto Brahm / David Öhman, Sweden

 Oral Presentations

O4A: Oral Rehabilitation & Oral Care

O4A:1 : Use and outcome of treatment with dental implants in children up to the age of 16 years in Sweden with special reference to hypohidrotic ectodermal dysplasia
B. Bergendal, National Oral Disability Centre, The Institute for Postgraduate Dental Education, Sweden

O4A:2 : Oral manifestations of Kabuki syndrome: tooth agenesis and drooling
H. Nordgarden, TAKO-Centre, Norway

O4A:3 : Case Report: long-term effect of oral motor treatment of child with AMC
M. Mahic, TAKO-Centre, Lovisenberg Diakonale Hospital , Norway

O4A:4 : Hearing assessment of children with non-syndromic cleft lip/palate
M. Amaral, UNICAMP, Brazil

O4A:5 : Oral implants and bone graft in a Down syndrome patient
J. Loyola, San Luis Potosi University, Mexico

 Oral Presentations

O4B: Oral Rehabilitation & Oral Care

O4B:1 : An understanding of medical and para medical needs of people with mental disability in India - a developing country
S. Bharadwaj, IASCD, India

O4B:2 : The promotion of dental care for people with disabilities in Taiwan
T. Cher, Graduate Institute of Clinical Dentistry, National Taiwan University, Taiwa

O4B:3 : Dental services to medically compromised children
F. Byrne, Dublin Dental Hospital, Ireland

O4B:4 : Factors contributing to behavioral management failure
B. Petrovic, Dentistry Clinic, Faculty of Medicine, Novi Sad, Serbia and Montenegro

O4B:5 : How dentists' experience affects pre-treatment reviews in special needs dentistry
E. Jay, Westmead Centre for Oral Health , Australia

O4B:6 : Defining the population requiring Special Care Dentistry using the International Classification of Functioning, disability and health
D. Faulks, CHU Clermont-Ferrand and EA 3847 University Clermont1, France

Honorary Lecture

Orofacial Regulation Therapy

Rodolfo Castillo Morales

Closing Ceremony

 Poster Programme

P01:01 : Long term effects after treatment of dental phobia, results from a multiple choice questionnaire
R. Thorman, Public Dental Service, Stockholm , Sweden

P01:02 : Oral abnormalities of a patient with Kabuki syndrome: a case report
M. Müller, Charité Humboldt-University, Department of Operative and Preventive Dentistry, Dental School, Berlin , Germany

P01:03 : Oral problems in 337 uremic patients as reported in a multiple questionnaire
R. Thorman, Public Dental Service, Stockholm , Sweden

P01:04 : Side effects on patients receiving radiotherapy, clinical consideration and oral care
R. Thorman, Public Dental Service, Stockholm , Sweden

P01:05 : A study of oral microbial flora in patients with renal disease
Y. Takeuchi, tokyo medical and dental university, Japan

P01:06 : The use of transdermal scopolamine to control drooling
J. Limeres, Special Needs Unit. School of Medicine and Dentistry. Santiago de Compostela University , Spain

P01:07 : Co-operation of the child during palatal plate application and oralmotor training
M. Koskimies, Vantaa Dental Health Care , Finland

P01:08 : Corporal and orofacial interrelation in orthodontic and speech therapies for a Down syndrome patient
R. Lowenthal, Associação Brasileira Castillo Morales e Universidade Presbiteriana Mackenzie, Brazil

P01:09 : Beckwith-Wiedemann Syndrome – dental and speech teraphy proposition according to the Castillo Morales Rabilitation Concept
R. Lowenthal, Associação Brasileira Castillo Morales e Universidade Presbiteriana Mackenzie, Brazil

P01:10 : Implant treatment on disabled patients, two case reports
R. Thorman, Public Dental Service, Stockholm , Sweden

P01:11 : Oral rehabilitation in a patient with eating disorders and severe dental erosion - a case report
P. Göthe, Department of Prosthetic Dentistry, The Institute for Postgraduate Dental Education, Sweden

P01:12 : Swallowing assessment with ultrasonography for rehabilitation effectiveness with palatal augumentation prosthesis for oral cancer patient - a case report
H. Kayanaka, The Nippon Dental University, Japan

P01:13 : Oral motor therapy was effective for a patient with Carey-Fineman-Ziter syndrome
A. Utsumi, Department of Hygiene and Oral Health, School of Dentistry, Showa University , Japan

P01:14 : Orthodontic treatment with maxillary expanders in handicapped patients
M. Abeleira, Orthodontics Department. School of Medicine and Dentistry. Santiago de Compostela University , Spain

P01:15 : To assess the referral base, waiting time and treatment required for new patients to the Special Care Dentistry Department assessment clinics of the Dublin Dental School & Hospital
L. Owens, Dublin Dental School & Hospital, Ireland

P01:16 : The use of glass ionomer surface protection material (GC Fuji VII) on permanent teeth of Special Olympics athletes
I. Tanboga, Head of Pediatric Department of Marmara University Dentistry Faculty, Turkey

P01:17 : Oral health status of Special Olympics athletes In Turkey.
I. Tanboga, Head of Pediatric Department of Marmara University Dentistry Faculty, Turkey

P01:18 : Caries experience and oral health behaviour in Turkish children with cleft lip and/or palate
N. Huroglu, PhD student, Turkey

P01:19 : Evalution of visual pedagogy for children with autism to under go dental procedures
I. Erdinc, P hD student at Marmara University Dentistry Faculty Pediatric Dentistry Department, Turkey

P01:20 : Xerostomia management for pediatric oncology patients with lactoperoxidase included oral health care products
I. Tanboga, Head of the Pediatric Dentistry Department, Turkey

P02:01 : Factors affecting dental fear in 5-12-year-old French children
P. Carrasco, University Clermont1 and CHU Clermont-Ferrand, France

P02:02 : Difficulty encountered during dental treatment related to base level of dental anxiety
V. Collado, University Clermont1 EA3847 and CHU Clermont-Ferrand, France

P02:03 : Study of prevalence of autistic spectrum disorders in children with Down syndrome
R. Lowenthal, Associação Brasileira Castillo Morales e Universidade Presbiteriana Mackenzie, Brazil

P02:04 : Intervention strategies in autistic patients
E. Falconi, ARIE Asociacion para la Rehabilitacion del Infante Excepcional, Peru

P02:05 : Among young hemophiliacs
S. Azhar, de'Montmorency Institute of Dental Sciences, Pakistan

P02:06 : Oral health perceptions, attitudes and behaviors and the oral health status of children suffering from thalasemia
A. Qureshi, Department of Oral Health Sciences and Shaikh Zayed Post Graduate Medical Institute, Pakistan

P02:07 : How do the first permanent molars play an important role in the dental health of 6-18 years old children with disabilities?
H. Liu, Graduate Institute of Dental Sciences, College of Dental Medicine, Kaohsiung Medical University , Taiwan

P02:08 : Research on the incidence of halitosis in schizophrenia patients
N. Murata, Department of Hygiene and Oral Health, School of Dentistry Showa University , Japan

P02:09 : The relationship of feeding dysfunction and gross motor development in disabled children with cerebral palsy or mental retardation
T. Ooka, Department of Hygiene and Oral Health, Showa University School of Dentistry, Japan

P02:10 : Relationship between motor development and the oral motor sistem in healthy children
M. Silva Telles, Associação Castillo Morales do Brasil , Brazil

P02:11 : Identification of Streptococcus mutans and Streptococcus sobrinus in saliva of children with and without dental caries by PCR
J. Loyola, San Luis Potosi University, Mexico

P02:12 : Self-administered oral hygiene practices as defense
S. Azhar, de' Montmorency Institute of Dental Sciences, Pakistan

P02:13 : Smear cytology for oral mucosa of dependent elderly - effect of professional oral health care
M. Endoh, Nihon University School of Dentistry at Matsudo , Japan

P02:14 : Multidimensional diagnostic model for oral health, disease, trauma & dysfunction
O. Suarez-Sanchez, Harvard School of Dental Medicine, United States

P02:15 : Static MR imaging for diagnosis of swallowing
M. Ohkubo, Department of Oral and Maxillofacial Radiology Tokyo Dental College , Japan

P02:16 : Effects of chronic administration of antiepileptic agent valproate on bone metabolism in growing rats. -histomorphometric study
A. Takahashi, Clinics of Dentistry for the Disabled, Tohoku Univ Dental Hospital , Japan

P02:17 : Status of the elderly people in the northestern of Rasht
F. Asgari, M edical University, Islamic Republic of Iran

P02:18 : Status of the elderly people in the northestern of Rasht
F. Asgari, M edical University, Islamic Republic of Iran

P02:19 : Study of the situation of elderly residents in elderly nursing home
H. Mahjoob Moadab, Medical University, Islamic Republic of Iran

P03:01 : Characteristics of patients who required the use of physical restraints during dental treatments
H. Karibe, Nippon Dental University Hospital, Japan

P03:02 : Management selection in dental treatment for exaggerated gag reflex patients
H. Yoshida, Nagasaki University Hospital/ Dept. Special Care Dentistry, Japan

P03:03 : Application of a structured visual guide for oral health examination in children with autistic disorder
O. Shinozuka, Tokyo Medical and Dental University , Japan

P04:01 : Saethre-Chotzen Syndrome using the Castillo Morales Concept: presentation of a case
L. Meirelles, Associação Brasileira Castillo Morales and Ines , Brazil

P04:02 : Oral anomalies in Shprintzen-Goldberg Syndrome : a case report
L. Marks, Dept. Paed. Dent. & Special Care - Ghent University, PaeCaMeD Research , Belgium

P05:01 : Investigation of eruptive time of permanent dentition from patients with Down syndrome
T. Takano, Kanagawa Dental College, Japan

P05:02 : Saliva preliminary study in Prader Willi Syndrome
G. Scagnet, Quinquela Martin Hospital of Paediatric Dentistry, Argentina

P06:01 : Is back to basics a solution?
E. Ion, Flora Care Homes, United States

P06:02 : Relationship between level of care needed and oral function
F. Tamura, Rehabilitation Clinic for Speech and Swallowing Disorders, The Nippon Dental University Tokyo Hospital, Japan

P06:03 : Elavation of blood glucose levels is prevented by intake of cacao liquor proanthocyanidins in diabetic models
M. Tomaru, Section of Gerodontology, Graduate School, Tokyo Medical and Dental University , Japan

P06:04 : The evaluation of the free senior denture policy in Kaohsiung City, Taiwan
Y. Lu, Department of Health Care Administration, Chung Hwa College of Medical Technology, Taiwan

P06:05 : The introduction of the free senior denture policy in Kaohsiung City, Taiwan
Y. Chen, Medical Affairs Division, Health Bureau of Kaohsiung City Government, Taiwan

P06:06 : Provision of dental care in Australian aged care facilities
B. Webb, Faculty of Dentistry, University of Sydney , Australia

P06:07 : Influence of age on cardiovascular reactivity during dental treatment
C. lassauzay, EA 3847, France

P06:08 : Video evaluation of chewing efficiency in denture wearers
E. Nicolas, EA3847, Université d'Auvergne, France

P06:09 : Supraventricular tachycardia during dental treatment of the elderly
T. Ohwatari, Tokyo Medical and Dental University , Japan

P06:10 : The factors of dry mouth only for dorsum of tongue in elderly people requiring care
T. Ogasawara, Department of Special Patient and Oral Care, Matsumoto Dental University , Japan

P06:11 : Sonic toothbrush improves the viscosity of the saliva of disabled aged person
Y. Kakinoki, Kyushu Dental College, Japan

P06:12 : The texture of the food bolus at swallowing in the young and the elderly
A. Kojo, Tokyo Medical and Dental University, Japan, Japan

P07:01 : An implant retained denture for a haemophiliac phobic man
P. Watt-Smith, Rehabilitation Hospital, United Kingdom

P07:02 : Supportive hyperbaric oxygen and dental therapy in a paediatric cancer patient - case report
K. Hallett, Royal Childrens Hospital/Griffith University School of Dentistry and Oral Health , Australia

P07:03 : An audit of the dental health, awareness and attendance patterns of cardiac inpatients in a paediatric hospital
I. Keyes, Our Lady's Hospital For Sick Children, Ireland

P07:04 : Diagnosis and treatment of cherubism: a case report
N. Lee, Pediatric Dentisty, Republic of Korea

P07:05 : Periodontal treatment in a patient with severe, chronic neutropenia. Twenty-five years of follow-up
B. Asklöw, Odontologiska Inst. Parod. Avd. , Sweden

P07:06 : Case report: a dental treatment of the Shprintzen-Goldberg syndrome patient
K. Morita, Okayama University Hospital, Japan

P07:07 : Oral cavity evaluation of leukemia patients undergoing chemotherapy
M. Inada, Tokyo Medical & Dental University, Japan

P07:08 : Clinical effectiveness of general anesthesia for children with special needs
C. Lee, Taipei Chang Gung Memerial Hospital, Taiwan

P07:09 : Oral health manifestations in phenlyketonuria
M. Olmez, Hacettepe University Faculty of Dentistry Department of Pediatric Dentistry, Turkey

P07:10 : Except extraction, whatelse we can do?
K. Chen, The Department of Oral and Maxillofacial Surgery, Tzu-Ai General Hospital and Taipei City Hospital , Taiwan

P07:11 : Williams Syndrome: a case report
I. Mariotti, Ausl Modena Italy, Italy

P07:12 : Prader-Willi And Angelman Syndromes: case reports
I. Mariotti , Ausl Modena Italy, Italy

P08:01 : Disabled children and oral health care in Poland
K. Gerreth, Department of Paediatric Dentistry Poznan University of Medical Sciences, Poland

P08:02 : Education in preventive oral health and HIV/Aids in schoolchildren in Northern Tanzania
M. Libe, Tanzania Dental Ass., United Republic of Tanzania

P08:03 : Oral care project in Estonia
T. Persson, Hospital dentistry, Sweden

P08:04 : The distribution of Actinobacillus actinomycetemcomitans and their serotypes in handicapped persons
K. Takada, Nihon University School of Dentistry at Matsudo , Japan

P08:05 : Oral health status evaluation of athletes participating in the 5th National Special Olympics Badminton Tournament
K. Gerreth, Department of Paediatric Dentistry Poznan University of Medical Sciences, Poland

P08:06 : Incidence of oral disfuctions in students between 4 to 6,11 years of age from the public school system in Cosmopolis, São Paulo, Brazil
C. Martins, Castillo Morales Brazilian Association, Brazil

P08:07 : The relationship between dry mouth and DMF teeth in mentally retarded patients and prevention countermeasure
M. Egusa, Okayama University Hospital of Dentistry, Japan

P08:08 : Clinical study on the longevity of dental restorations in patients with disabilities
T. Mori, Okayama University Hospital of Dentistry , Japan

P08:09 : Special Smiles, Special Olympics, Australia
M. Tjeuw, Special Olympics Australia, Australia

P08:10 : Caries risk by analysis of clinical variables in patients HIV+
E. Giovani, Paulista University, Brazil

P08:11 : Dental health status and treatment needs of the children with cerebral palsy under 18 years old in institutions for disabled in Taiwan
S. Hsiao, Division of Pediatric Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital , Taiwan

P08:12 : Multi-professional development of an oral assessment tool and appropriate educational resources in a critical care unit
J. Griffiths, Cardiff University School of Dentistry, United Kingdom

P08:13 : Dental caries, periodontal disease and tooth loss in patients with Type 1 and Type 2 diabetes mellitus
J. Loyola, San Luis Potosi University, Mexico

P08:14 : The national survey of oral health status of people with disabilities in Taiwan
S. Huang, Graduate Institute of Dental Sciences, College of Dental Medicine, Kaohsiung Medical University , Taiwan

P08:15 : Alternative pulp therapy for the young permanent teeth of the children with special needs
C. Huang, Chang Gung Memorial Hospital , Chang Gung University College of Medicine, Taiwan

P08:16 : Correlation of the lesions prevalence the Human Papiloma Virus (HPV) in the oral cavity and uterine col in HIV+/Aids patients
E. Giovani, Paulista University, Brazil

P08:17 : Correlation of HPV lesions in male genitalia and in month cavity
E. Giovani, Paulista University, Brazil

P08:18 : GaAIAs utilization in necrotizing ulcerative periodontitis
E. Giovani, Paulista University, Brazil

P08:19 : Effects Of low level laser therapy in HIV/Aids positive patients
E. Giovani, Paulista University, Brazil

P08:20 : Correlation of oral manifestations of lichen planus
E. Giovani, Paulista University, Brazil

P08:21 : Managing phenytoin-induced gingival enlargement and periodontitis in a patient with cerebral palsy and mental retardation: a case report
A. Miyagi, Dentistry for Special Patients, Kanagawa Dental College , Japan

P08:22 : Oral health in people with autism in Belgrade
D. Ostojic, School of Dentistry, University of Belgrade, Serbia and Montenegro

P08:23 : Profile of handicapped patients attended at the Nucleo Integrado de Atendimento ao Paciente Especial –NIAPE of the University Paulista - Brazil
M. Duarte Ferreira, University Paulista , Brazil

P08:24 : Oral health status of special athletes in 2005 Special Olympics World Games, Nagano, Japan
H. Kasahara, Department of Department of Oral Health, Matsumoto Dental University, Japan

P08:25 : “Gaining a social meeting place”: voices from people with disabilities seeking dental care
U. Hallberg, Nordiska högskolan för folkhälsovetenskap, Sweden

P08:26 : Audits carried out in the Sedation Suite in Cardiff Dental School, Wales
Department of Adult Dental Health, Cardiff and Vale NHS Trust and Cardiff University Dental School

P09:01 : A custom made oral prosthesismade to improve speech following a severe CVA
P. Watt-Smith, Rehabilitation Hospital, United Kingdom

P09:02 : Characteristics of sensing lower-jaw position in patients with cerebral palsy during laughing gas-induced sedation
M. Yoshida, Department of Pediatric Dentistry, Nihon University School of Dentistry, Japan

P09:03 : Development of swallowing function in sequential swallowing of a liquid
Y. Shimizu, Department of Communication Health Sciences, Oral Health and Preventive Dentistry Division, School of Dentistry , Japan

P09:04 : "I love my Humming Bird"
E. Lundälv, HB Meloton , Sweden

P09:05 : Proposal for the evaluation of feeding according to the Castillo Morales Concept (CCM)
S. Domingues El Hage, Associação Brasileira Castillo Moralles, Brazil

P09:06 : The rehabilitation panoramic in individuals with labial palatine fissures in Brazil
A. Sabbag, Sobrapar, Brazil

P09:07 : Orofacial rehabilitation in the peripheral facial paralyses
A. Tessitore, UNICAMP, Brazil

P09:08 : Incidence Of tongue primary movements
A. Tessitore, UNICAMP, Brazil

P09:09 : Proposal of protocol of assement of motor and motor oral skills in infants
M. Silva Telles, Associação Castillo Morales do Brasil , Brazil

P09:10 : Reaction of foot and mouth
M. Silva Telles, Associação Castillo Morales do Brasil , Brazil

P09:11 : Electropalatography - the dental technician’s part in the oral motor team
C. Nilsson, The Orthodontic Laboratory, The Institute for Postgraduate Dental Education, Jönköping , Sweden

P09:12 : Oral screen- novel use in Oral Motor Functional Therapy.
S. Malhi, Westmead Centre for Oral Health, Australia, Australia

P10:01 : Use of photos as supplementary preventive dental strategy in psychiatric patients
C. Bentsen, Vallensbæk Kommunale Tandpleje, Denmark

P10:02 : Candy sprays and- gels: the effect on salivary flow and pH
D. Gambon, Bambodino Pediatric Clinic , Netherlands

P11:01 : The role of the dental specialist in the rehabilitation of chewing and swallowing function in the individual with multiple disabilities
M. Fraschini, IADH, Italy

P11:02 : A novel burns appliance to minimise oral contractures
S. Alexander, Westmead Hospital, Australia

P11:03 : Evaluation of individualized homeopathic remedies on trigeminal neuralgia treatment
Y. Nozad Mojaver,A ssistant Prof., Islamic Republic of Iran

P11:04 : Oral care experience for nasopharyngeal carcinoma patients in southern Taiwan
W. Wang, Kaohsiung Medical University Hospital, Dept. of Oral Pathology and Diagnosis , Taiwan

P11:05 : Orthodontic treatment of a patient with hemifacial microsomia: a case report
K. Bjerklin, Department of Orthodontics, Institute of Postgraduate Dental Education, Jönköping , Sweden

P11:06 : Prosthodontic rehabilitation of a young woman with Goltz Syndrome/Inkontinentia pigmenti: a case report
K. Sondell, Department of Prosthetic Dentistry, The Institute for Postgraduate Dental Education, Jönköping , Sweden

P11:07 : Speech pathologist treatment of facial paralysis in Brazil, according to the Castillo Morales Concept
M. Quintal, UNICAMP, Brazil

P11:08 : A dental management protocol for amelogenesis imperfecta - report from a workshop
J. Norderyd, National Oral Disability Centre, the Institute for Postgraduate Dental Education, Sweden

P11:09 : Survey on speech and swallowing disorders at the rehabilitation clinic of the Nippon Dental University Hospital for 5 years
M. Kodama, The Nippon Dental University Hospital, Japan

P11:10 : Effects of different swallowing maneuvers on lingual function in healthy females. Coronal section analysis by ultrasonography
H. Okayama, The NIppon Dental University Hospital , Japan

P11:11 : Oral rehabilitation with dental implants in a patient with dystrophic epidermolysis bullosa and Alport syndrome
M. Hadjikani, Department of Prosthetic Dentistry, The Institute for Postgraduate Dental Education, Jönköping, Sweden

P11:12 : Feeding function and nutritional status of adult mental retarded people
Y. INO, The Nippon Dental University Hospital, Japan

P11:13 : Oral rehabilitation in pedodontic patients with ectodermal dysplasia – 3 case reports
E. Giovani, Paulista University, Brazil

P11:14 : Tooth eruption disturbances in patients with severe mental and skeletal disabilities
K. Staufer, Universität Witten/Herdecke, Germany

P11:15 : A case of hypophosphatasia followed from childhood to adulthood over a period of more than thirty years
C. Slotte, Dept of Periodontology,The Institute for Postgraduate Dental Education, Sweden

P11:16 : Three-dimensional evaluation of the eating and swallowing organ with cone-beam computed tomography in children. Capacity changes of the piriform fossa by Hellman’s dental age
S. Hironaka, Department of Hygiene and Oral Health, School of Dentistry Showa University , Japan

P11:17 : Special care clinic –is there a need?
A. Downey, D ublin Dental School and Hospital , Ireland

P11:18 : Clinical management of ectodermal dysplasia: a case report
A. Alomrani, King Fasial Specialist Hospital & Research Center

P11:19 : Dental treatment of children affected by hypohidrotic ectodermal dysplasia (HED)
H. Gjoerup, Centre for Rare Oral Diseases, Aarhus University Hospital, Denmark, Denmark

P11:20 : Care of train victim: a case study
L. Singh, Special Needs Unit, Westmead Hospital , Australia

P12:01 : The Development of National Guidelines for the Appointment of Dentists with a Special Interest in Special Care Dentistry
V. Brookes, Lancashire Teaching Hospitals NHS Trust, United Kingdom

P12:02 : The reduction of mineral deposition on bone nodule formed by MC3T3-E1 cells under oxidative stress
T. Sato, Shizuoka Children's Hospital, Nihon University School of Dentistry at Matsudo , Japan

P12:03 : Effective practical use of balloons and cards of cartoon characters during the dental treatment of handicapped children
N. Harano, Department of Dentistry for the Disabled, Kyusyu Dental College Hospital , Japan

P12:04 : Cardiovascular effects of two kinds of local anesthetics for handicapped patients
H. Kawaai, Ohu University School of Dentistry, Japan

P12:05 : Survey of the Gudelines produced by the British Society for Disability and Oral Health
N. Kumar, Eastman Dental Hospital, United Kingdom

P12:06 : To return to the origins of the Castillo Morales Concept in the Xingu Aboriginal Collectivities - social anthropology
A. Tessitore, Castillo Morales Association, Brazil

P12:07 : Action of foot and hand distal impulse during the emission of the syllable “te”
S. Domingues El Hage, Associação Brasileira Castillo Moralles, Brazil

P12:08 : Modifying feeding context applying Castillo Morales Concept - a case study
C. Martins, Castillo Morales Brazilian Association, Brazil

P12:09 : Oral motricity photographic registration proposal
A. Tessiotre, UNICAMP, Brazil

P12:10 : Oral-Facial-Digital Syndrome Type I: a family affair
M. Castro, Special Needs Service. School of Medicine and Dentistry. Santiago de Compostela University , Spain

P12:11 : Oral health conditions of handicapped and medically compromised individuals in Egypt- research efforts
M. El Tantawi, University of Alexandria, Egypt

P12:12 : Molecular markers in children parotid saliva. A proteomic approach
T. Ferrary, Buenos Aires National University, Argentina

P12:13 : Computer space analysis according to ideal patient arch form
K. Manshaie, A ssistant Prof., Islamic Republic of Iran

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