Provision of dental care for medically compromised children in the UK by General Dental Practitioners

Dental Students' Perceptions before and after Attending a Centre for Children with Special Needs: A Qualitative Study on Situated Learning

Objectives: To develop an in-depth understanding of the perceptions and experiences of senior dental students before and after fieldwork visits to a centre for children with special needs. Methods: A qualitative study utilised open-ended questions and involved 39 fifth-year dental students. A thematic analysis of the collected responses was undertaken, and a hierarchy of themes and subthemes were developed. Results: Analysis of the pre-visit responses revealed three main themes and a number of subthemes: 'negative expectations', 'positive expectations', and 'pain expectations'. Similarly, four main themes with a number of subthemes emerged from the post-visit responses: 'positive perceptions', 'negative perceptions', 'oral problems observed', and 'recommendations'. Conclusions: Within the study limits, different perspectives were extracted. Prior to the fieldwork visit, students expressed their lack of self-confidence and inadequate preparation. Following the situated learning visit experience, students' perceptions of managing special needs children was positively influenced. Students were happy to be exposed to such an experience, but hoped for better organisation and specialised supervision in the future.

Oral Health Status of Kuwaiti Children with a History of Chronic Liver Disease

OBJECTIVE

To investigate the oral health status and dental manifestations of children with a history of chronic liver disease (CLD) compared to healthy children.

SUBJECTS AND METHODS

Twenty children (15 boys and 5 girls) with a history of CLD were compared to 20 healthy controls matched for age and gender. The clinical examination was carried out by the same dentist. Caries prevalence, using the decayed, missing, and filled primary and permanent teeth indices (dmft/DMFT), was recorded. Developmental enamel defects, plaque scores, and gingival overgrowth were also investigated.

RESULTS

No statistically significant differences were found in mean dmft scores for children with a history of CLD (4.9 ± 5.4) and for healthy individuals (3.9 ± 4.5). However, the mean DMFT score was significantly higher (p =0.025) in children with CLD (4.2 ± 4.6) compared to controls (1.7 ± 1.6). The mean decayed teeth parameter (DT) was also significantly higher in children with CLD (p =0.004). All patients with CLD exhibited enamel defects compared to only 33% in the control group (p< 0.05). A higher mean plaque index was observed in children with a history of CLD (p< 0.001). Also, a positive correlation for gingival overgrowth was noted in patients with a history of CLD (p< 0.05). Green staining was evident only in the permanent dentition of 1 child with CLD.

CONCLUSION

Children with a history of CLD exhibited a high caries prevalence, high plaque scores, and more enamel defects compared to healthy subjects. Gingival overgrowth is less prevalent among pediatric liver transplant patients on tacrolimus therapy.

Dental prevention and disease awareness in children with congenital heart disease

OBJECTIVES

The importance of excellent oral health is known to be crucial in children with congenital heart diseases (CHD). Data about dental health and disease awareness is limited. This study aims to assess preventive measures taken to improve dental health in children with CHD and to gain insight into disease awareness and knowledge about the importance of oral health in children with CHD and to propose measures that could be taken.

MATERIAL AND METHODS

Parents of 150 children with CHD were asked to complete a questionnaire containing specific questions about the preventive measures taken by the parents and dental and medical practitioners and their knowledge about underlying disease and the importance of oral health.

RESULTS

Our results show an absence of information in parents concerning preventive measures and oral hygiene. Knowledge of the indications for antibiotic prophylaxis and for actually given medications was lacking. Preventive dental measures were not performed according to current guidelines.

CONCLUSIONS

Knowledge of parents about the importance of oral health in children with CHD could be improved. However, specialized centers involving pediatric cardiologists and pediatric dentists could coordinate the education of parents at an early stage. Moreover, general dentists should be trained more frequently concerning the indications for antibiotic prophylaxis, in particular, and the dental care of children with chronic diseases, in general. Warning cards such as the heart pass should be issued to parents of children with CHD.

CLINICAL RELEVANCE

The current study reveals the need for the structured training of medical and dental practitioners to support parents of children with CHD.

Oral health assessment practices and perceptions of North American paediatric cardiologists

OBJECTIVE

Children with cardiac defects should have good oral health, particularly prior to cardiac surgery to minimize risks of infective endocarditis. The aim of the study was to examine the oral health assessment practices of North American cardiologists.

METHODS

Online surveys were e-mailed to 1409 cardiologists. Cardiologists without paediatric patients or practicing in centres without cardiac surgical care were excluded. Surveys addressed oral health assessment practices for paediatric cardiac patients, and perceptions of the impact of oral health on cardiac care.

RESULTS

The centre response rate was 69%, individual response rate 20%. Most cardiologists (96%) reported oral health was assessed as part of cardiac care. The most common time for assessment was prior to cardiac surgery (44%), with a quarter assessing by age 1 (28%). While most oral assessments involved a dentist (59%), 17% of cardiologists performed the oral assessment without the aid of a dentist. Four-fifths of cardiologists (83%) reported cancellation of cardiac surgery due to oral disease. Cardiologists who deferred assessment until prior to surgery had the highest experience of cancellation (96%). Assessments were delayed despite the common belief (89%) that children on pre-surgical high-calorie diets are at increased risk of oral disease.

CONCLUSION

Assessments of oral health status were often deferred until immediately prior to cardiac surgery despite the cardiologist's perception that children with cardiac defects were at increased risk of oral disease and prior experience of surgical cancellation due to oral disease. Paediatricians may need to facilitate early oral assessment for these children.

Endocarditis prophylaxis and congenital heart defects in the Norwegian Public Dental Service

AIMS

The aims of this study are (i) to assess how dental health workers of the Public Dental Service, PDS, carry out endocarditis prophylaxis related to dental treatment for children and adolescents with congenital heart defects (CHD) and to identify factors influencing their appropriate use of guidelines and (ii) to assess how dental health workers perceive any characteristics of patients with CHD.

METHODS

This cross-sectional study was based on self-administered questionnaires mailed to all dentists and hygienists in the PDS in three Norwegian counties.

RESULTS

The response rates among dentists (n = 130) and dental hygienists (n = 54) were, respectively, 63% and 68%. The findings revealed an over-prescription of endocarditis antibiotics to patients with CHD. Most of the background variables investigated did not influence the responders' prescription decision for appropriate use of the current guidelines on the topic. The only significant factor was whether or not the respondent considered that the endocarditis prophylaxis guidelines were consistent and easy to follow. Compared with healthy children, dental healthcare workers felt less confident when providing dental treatment to children with CHD.

CONCLUSION

There is room for improved education about children with CHD in dentistry and dental education.

The oral health of children considered very high risk for infective endocarditis

BACKGROUND

Children with previous experience of infective endocarditis or with prosthetic heart valve are considered at very high risk for infective endocarditis.

AIM

The aim of this study was to compare the dental health of a group of these children with a group of healthy controls and to determine parental awareness of the importance of good oral health.

DESIGN

Oral examination was carried out in 28 children with previous infective endocarditis or a prosthetic heart valve to assess oral health. Findings were compared to a healthy control group of 28. Questionnaires were distributed to the parents to assess awareness of oral health.

RESULTS

There was no significant difference in DMFT scores of study and control group (2.43 +/- 3.72 and 1.36 +/- 2.5 respectively) or in DMFT scores of study and control group (1.5 +/- 1.73 and 1.15 +/- 1.42 respectively), 36% of the study group had untreated caries. Parental knowledge of the link between oral health and infective endocarditis was excellent.

CONCLUSIONS

There were no significant differences between the oral health of cardiac children and healthy children although the dmft and DMFT scores of the study group were high. Of concern was the proportion of children with untreated caries in spite of good dental awareness and attendance.

Dental health and management for children with congenital heart disease

Congenital heart disease (CHD) is one of the most common developmental anomalies. Children with CHD are at increased risk of developing oral disease, and are at increased risk from the systemic effects of oral disease. Recent changes in guidelines related to prophylaxis against infective endocarditis have highlighted the importance of establishing and maintaining oral health for this group of patients. The management of children with CHD can be complex and, unfortunately, many of these children do not receive the care they require. The challenges that these children pose are discussed, and suggestions are made for the appropriate management of these patients and the key role that all those working in primary dental care have to play.

Use of oral health care services and oral findings in children with special needs in Lagos, Nigeria

This study was carried out to determine the use of oral healthcare services by children with special needs in Lagos, Nigeria. In this study, 125 structured questionnaires were sent to parents of children in two public day schools for CSN in Lagos. Once the questionnaires were returned, oral examinations were scheduled. The findings were compared to a control group of healthy children from two public schools in the same environment. One hundred and nine CSN and 134 controls, aged 5 to 19 years, participated in the study. The majority of the children had parents who had a low educational level. Fewer than 5% of the children had ever been to the dentist, and had only attended because of some symptoms. Non-attendance in 59.6% and 58% of CSN and controls respectively was reported to be due to absence of dental problem, 28% and 33.5% expressed ignorance about dentists and 8% of the parents of CSN identified finance and transportation as a problem. There were no significant differences between the two groups (p>0.05). It was found that 54% of CSN and 9% of controls had poor oral hygiene (p<0.05); dmft/DMFT was 0.25 in the controls and 0.12 in CSN (p>0.05). Untreated fractured teeth and missing teeth were more prevalent in CSN (p<0.05), while enamel hypoplasia was more prevalent in the controls (p<0.05). This study concluded that CSN and children from lower socioeconomic levels did not adequately utilize dental facilities in Lagos. Preventive programs in schools and the development of dental clinics in or near their schools could help.

Attitudes about dental care among parents whose children suffer from severe congenital heart disease: a case-control study

OBJECTIVES

To examine attitudes and experiences of parents whose children have complex congenital heart disease (CHD) with respect to dental health information and advice, dental care, and service and to compare the results with data from an age- and gender-matched control group without any medical problems.

SETTING

Faculty of Medicine (Paediatric Cardiology and Paediatric Dentistry), Umeå University, Umeå, Sweden.

SAMPLE AND METHOD

Each group comprised parents of 33 children; the children's mean age was 9.4 years. All the cases and the controls resided in the county of Västerbotten, northern Sweden. Data were collected with a questionnaire with 20 joint questions to both groups and four additional questions to the CHD group.

RESULTS

Of the 20 joint questions, significant differences were displayed in the following areas: the professional group that provided the parents with dental health information and advice (P < 0.01), attitudes to reception at the dental clinic, and experience of sedation before operative dental treatment (P < 0.05). Parents to 11 children with CHD who were patients at a specialist clinic for paediatric dentistry scored the reception at the dental clinic as excellent in nine cases and satisfactory in two, compared to excellent (3), satisfactory (11), decent (4), and poor (4) among those who were patients in general dental practice (P < 0.01). No statistically significant differences in educational level or in parental experience of dental health were noted between the two groups (P > 0.05).

CONCLUSION

Children with CHD in northern Sweden mainly receive their dental health information from a physician or a dentist, and healthy children mainly receive information from a dental hygienist indicating that children with CHD are given priority in the dental care system. Parental attitudes to reception in the dental service differed, and parents of healthy children scored the reception at the dental clinic better than parents of children with CHD. It is suggested that children with severe CHD should receive dental care in clinics for paediatric dentistry, particularly at early ages.

Hypodontia in an adolescent with the HbSC genotype: a case report

The haemoglobin SC (HbSC) genotype is a variant form of haemoglobin disorder that often presents less frequent clinical symptoms of sickle cell disease (SCD) than the homozygous state (HbSS). Various dental abnormalities, such as enamel hypoplasia, hypomineralization, midline diastema and delayed eruption of the teeth, have been associated with SCD. This report presents the case of an adolescent patient with HbSC who had hypodontia, transposition of a permanent canine, retained primary teeth, multiple carious lesions and poor oral hygiene complicated by sickle cell crisis. This report focuses on the need for preventive care in such patients to reduce functional and aesthetic complications.