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. www.foxnews.com/story/2006/11/28/tv-land-lists-100-greatest-tv-catchphrases.   Royal Hospital for Neuro-disability. https://www.rhn.org.uk/what-makes-us-special/services/dentistry     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 11 Number 4

December 2010

Editorial 154

Bisphosphonates oral implants and osteonecrosis of the jaw a review and guidelines
Abdulhadi Warreth, Najia Ibieyou and Denise MacCarthy 155

Oral health status and dental treatment needs in institutionalised versus non institutionalised psychiatric patients
Shweta Ujaoney, Mukta B Motwani, Praveen H Khairkar, Shirish S Dewgekar and Govind Bang 163

Oral health and children with an intellectual disability a focus group study of parent issues and perceptions
Linda Slack-Smith, Melissa Ree and Helen Leonard 171

Continuing Professional Development Programme 178

Emily goes to the dentist oral care for individuals with Down syndrome in the Netherlands
Elinor C M Bouvy-Berends and Wimke Reuland-Bosma 180

Special Care Dentistry Developing a highly skilled workforce
Vanita Brookes and Selina Masters 183

Oral radiological findings in a population of athletes at the III Para-Pan American Games, Rio de Janeiro, Brazil
Patricia Luise Scabell Evans, Aurelino Machado L Guedes, Rafaela De Andrade, Fabio R Guedes, Anne Luise Scabell De Almeida, Juliana De Jesus Rodrigues-Da-Silva and Eduardo Muniz Barretto Tinoco 187

The impact of dementia on the care of dental implants a case report
Lorna A Laidlaw 192

Index to Volume 11, 2010 195

Thanks to reviewers 197

Diary 200

Special Care Dentistry Developing a highly skilled workforce

Author Index 2010

Editorial

The papers in this issue addresses matters of concern for many of those involved in the care for people with disabilities: professionals, parents and carers. That is as it should be.

The societies and associations that this Journal represents have, contained in their mission statements, an important advocacy role. This has certainly been the case for the British Society for Disability and Oral Health. Members of that organisation have campaigned tirelessly for the recognition of the Specialty of Special Care Dentistry in order that the very special needs of patients will not only be recognised but also that those needs will be met, appropriately.

The Specialty was finally recognised in the UK in September of 2008 when the General Dental Council (GDC) opened the Specialist List in Special Care Dentistry. Then followed a two-year period of intense work by the Specialist Advisory Committee in Special Care Dentistry who, on behalf of the GDC, has the onerous task of reviewing all the applications to the Specialist List through the Mediated Entry process. There are 193 specialists on that List, to date. Much of this has come about through the vision and foresight of one woman. Dr Janice Fiske, who retired in September 2010 and who has led the campaign to have Special Care Dentistry recognised as a speciality. It was almost inconceivable when all this work began, firstly by the Joint Advisory Committee in Special Care Dentistry, later by the Specialist Advisory Committee (SAC) of the Royal College of Surgeons of England, both of which Janice chaired, that there would be these number of specialists on the List as well as 30 consultants in Special Care Dentistry working in the UK. Janice Fiske has steered the work of the SAC since its inception and for all her endeavours we, all those working in the speciality and patients, must be eternally grateful. Janice was recognised for her work for Special Care Dentistry by the award of an MBE in 2005.

This year also marks the retirement of another stalwart of the both the speciality and the Journal. Janet Griffiths, who was awarded an MBE in 2005 for services to Special Care Dentistry, has retired after 43 years providing mostly Special Care Dentistry in south Wales. Contrary to the belief that no-one is irreplaceable, Janet confounds that statement as no doubt her patients and colleagues will testify. Janet, like Janice will stay on the Editorial Board of the Journal for some time to come, lending huge insight and a fount of common sense.

But, change has to happen and after ten years it is time for me to hand over the baton to a new Editor. Dr Shelagh Thompson, recently promoted to Reader in Conscious Sedation and Special Care Dentistry in Cardiff will, from 2011 fully take over the Editorship of the Journal. I relinquish this post with sadness as I have enjoyed the contact with colleagues, never ceasing to be amazed by the endeavours of so many who work in impossibly difficult situations yet still manage to produce vital and relevant research. I am honoured to have been supported in this role by a cadre of mostly stunning reviewers who have lent their expertise willingly and positively on so many occasions. We list those volunteers at regular intervals in the Journal; this seems so inadequate but be assured, you are valued. Many of you will have been cajoled and persuaded into the role by the gentle persuasiveness of Norman Campbell, awarded an OBE for services to Dentistry in 2005, who on retirement has so ably communicated with referees and extricated that difficult review in the last few years. His help made my task that much easier.

With sadness but in eager anticipation of all things new, I hand over to Shelagh, her new Editorial Assistant Sue Dummer, the new Business Manager Selina Masters and the rest of her team and wish them the same pleasures that this post has given me.


June Nunn
Dublin, December 2010.

Bisphosphonates, oral implants and osteonecrosis of the jaw: a review and guidelines

Abdulhadi Warreth BDS MDent Sc PhD1, Najia Ibbayou BDS MDent Sc PhD 2, Denise MacCarthy BDS NUI FDS RCS (Edin) MA MDent Sc (TCD) FFD RCSI1

1Departement of Restorative Dentistry and Periodontology. School of Dental Science, Dublin, Ireland. 2Departement of Oral Medicine, Oral Pathology and Oral Radiology, Benghazi Dental School, Al-Arab Medical University, Benghazi, Libya

Abstract

Bisphosphonate drug groups are widely used in the treatment of bone disorders. They may be taken orally or intravenously. One complication of their use is a relatively new clinical condition known as osteonecrosis of the jaw (ONJ). This condition is reported to exclusively affect the mandible and maxilla to different degrees. Dental professionals will increasingly manage patients who are at risk of developing ONJ as the use of these drug groups is rising. Furthermore, knowledge among many healthcare professionals about bisphosphonates and their side effects is limited. Therefore, ONJ presents a challenge to the professional and requires a good understanding of how to manage the clinical situation. The purpose of this paper is to review the bisphosphonate drug groups, their effects on bone activity and how they may affect treatment outcome with oral implants. Guidelines for management of patients who are at risk of developing ONJ are also addressed.

Oral health status and dental treatment needs in institutionalised versus non-institutionalised psychiatric patients.

Shweta Ujaoney BDS1, Mukta B Motwani MDS1, Praveen H Khairkar MD2, Shirish S Dewgekar MDS and Govind Bang MD2


1 Department of Oral Medicine, Diagnosis & Radiology, Sharad Pawar Dental College;

2 Department of Psychiatry, Jawaharlal Nehru Medical College: Wardha, Maharashtra, India

Abstract

Background: Oral health is a major determinant of general health for psychiatric patients but has a low priority in the context of their mental illness. Little is known regarding the oral health status and treatment needs in and among psychiatric patients in India.

Aims and Objectives: To assess and compare the oral health status and treatment needs of the institutionalised versus non-institutionalised psychiatric patients with the general population.
Method: A total of 100 psychiatric patients from different settings 50 institutionalised and 50 non-institutionalised were recruited. An additional, separate control of 50 patients from the general population, a non-psychiatric patient group attending dental care services of SPDC hospital was enrolled. Oral health status was evaluated with respect to caries, oral hygiene, and periodontal status using DMFT, OHI-S and CPI indices. Treatment needs were evaluated and a direct comparison was made between the groups.

Results: The medical history of the patients were psychotics (42%) mood disorders (27%) and anxiety disorders (15%); 38% of institutionalised patients had <1 year of mental illness and 46% non-institutionalised patients had mental illness of 1-5 years duration. Only 6% of patients from both groups had > 10 years of long standing mental illness. Analysis in institutionalised groups showed that the mean DMFT score (5.14) increased with irregularity of oral hygiene habits, type of psychiatric disorder and age of the patient, as compared to duration of mental illness in the non-institutionalised group (mean DMFT= 4.88). Analyses in institutionalised groups for CPI showed an increase in score with an increase in age, whereas no statistically significant increase was observed amongst the non-institutionalised group. However, all the indices were statistically significant in all patients compared to those in the general population.

Conclusions: The findings of this study demonstrate high caries prevalence, poor oral hygiene and extensive unmet needs for dental treatment amongst all psychiatric patients and little opportunity for referrals to be made for further dental treatment for those in need.

Oral health and children with an intellectual disability: a focus group study of parent issues and perceptions.

Linda Slack-Smith MSc PhD1, Melissa Ree BSc (Hons) 2 and Helen Leonard MBChB MPH3

1Professor (Oral Epidemiology), 2Research Officer, School of Dentistry, The University of Western Australia; Clinical Associate Professor, Telethon Institute for Child Health Research and Centre for Child Health Research, The University of Western Australia

Abstract

Aim: Children with intellectual disability are at risk of poor oral health outcomes and it is important to understand the parental perspective to design appropriate services and resources. The aim of this study was to investigate parental issues and perceptions regarding the provision of dental care (both services and home care) for children with an intellectual disability.

Design of the study: Parents who care for children with an intellectual disability participated in focus groups and interviews. Thematic content analysis underpinned the coding and interpretation of data.

Subjects: Seven focus groups and two interviews were conducted (44 female, 3 male) with participants who were contacted through community support groups and special schools.

Results: Many parents reported difficulties (mostly related to behaviour) in providing oral care for their children. Parents related a variety of problems using dental services and obtaining relevant information for a range of reasons relating to parent, child and the service, even when specialist services were available to them. Many parents were concerned about the use of general anaesthetics for simple dental procedures. Some parents shared positive experiences.

Conclusions: The use of focus groups provided valuable insights into parent issues and perceptions. These insights are important to inform policy-makers and those health professionals involved in the care of children with intellectual disability. Discussions gave participants an opportunity to share their experiences, which will be useful for service planning for families and training of dental professionals. Many of the parents’ perceived needs should be simple and relatively inexpensive to implement.

‘Emily goes to the dentist’ - oral care for individuals with Down syndrome in the Netherlands

Elinor C M Bouvy-Berends DDS and Wimke Reuland-Bosma DDS PhD
Centre for Special Care Dentistry CBT Rijnmond, Rotterdam, the Netherlands

Summary

This article is primarily based on an Editorial in the Journal of Oral Health and Disability that describes the visits of a patient with Down syndrome named Emily. Oral health care for individuals with Down syndrome and other people with an impairment or disability in the Netherlands is discussed. Due to the syndrome-related oral aspects and specificity, the authors argue strongly in favour of multidisciplinary working within oral health care centres. The dependency of persons with Down syndrome necessitates an appeal to parents, (primary) carers and oral care professionals to work cooperatively to maintain oral health. Client-centred care is mandatory for optimal oral health in this vulnerable group.

Special Care Dentistry: Developing a highly skilled workforce

V Brookes BDS, MSc, FDSRCS(Ed) FDSRCS(Eng) MSNDRCS(Ed) DDPHRCS(Eng) and S Masters BDS MCCD MFDS FDS RCS Eng MBA

Lancashire Teaching Hospitals NHS Foundation Trust

Abstract

This paper describes the Diploma in Special Care Dentistry examination and its content and uses three individual case scenarios supplied by past registrants for this Diploma in order to provide insight into the process.


Oral radiological findings in a population of athletes at the III Para-Pan American Games, Rio de Janeiro, Brazil

Patricia Luise Scabell Evans DDS MS1, Aurelino Machado Guedes DDS PhD1, Rafaela De Andrade DDS MS1, Fabio Guedes DDS PhD1, Anne Luise Scabell De Almeida DDS1, Juliana De Jesus Rodrigues-Da-Silva DDS1 and Eduardo Muniz Barretto Tinoco DDS PhD 1,2

1Faculty of Dentistry, State University of Rio de Janeiro, Rio de Janeiro, Brazil; 2School of Health Sciences, UNIGRANRIO, Duque de Caxias, Brazil

Abstract

Objective: This cross-sectional study aimed to assess the oral health status in a population of para-athletes competing at the III-Para-Pan American Games, Rio de Janeiro, using Digital Panoramic Radiographs (DPR).

Method: The study was approved by the appropriate institutional review board. Over 1,500 contestants and medical staff received printed invitations before and during the Games. DPR were taken from 118 recruited para-athletes, mean age 32.3(sd±9.53), 92(77.97%) males. A trained practitioner assessed all DPRs, observing/registering teeth conditions as known: Erupted/Sound (S); Absent (A); Non-erupted/impacted (NE); Partly-erupted (PE); Extensive carious lesion (EC); Extensive carious lesion w/periapical lesion (EC+PL); Restored (R); Cyst (C); Residual roots (RR); Implant (I); Fracture (F); Orthodontic Band (OB); Anomalous lateral incisor (ALI); Endodontic treatment w/periapical lesion (ET+PL).

Results: Number of observations(n)/average per athlete: S:n=2451/20.77; A:n= 401/3.40; NE:n=52/0.44; PE:n=20/0.17; EC:n= 62/0.52; EC+PL:n= 50/0.42; R:n= 670/5.67; C:n=4/0.03; RR:n= 22/0.18; I:n=5/0.04; F:n=3/0.02; OB:n=11/0.09; ALI:n=12/0.10; ET+PL:n= 13/0.11.

Conclusions: Oral health preventive programmes should be encouraged within this special population. DPR is a useful method for screening large populations with special needs during major sports events.

The impact of dementia on the care of dental implants: a case report

Lorna A Laidlaw BDS (Glas) MFDS RCS (Edin)
Ayrshire & Arran Community Dental Services


Abstract

This case report highlights the implication of dementia for the care of an implant-retained denture in a patient in a nursing home. This is a situation that will become an increasingly frequent complication in the oral care of older people as implants become more common.

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