Oral midazolam for adults with learning disabilities

This paper demonstrates how oral midazolam can be employed as an alternative method of behaviour management to general anaesthesia for the dental treatment of people with learning disabilities. A range of treatments, from scaling to root canal therapy, can be carried out successfully using the sedation technique outlined. The advantages of sedation include reduced morbidity and mortality. Treatment outcomes are also likely to be improved as root canal therapy and periodontal care can be carried out over a number of visits rather than a single treatment session under general anaesthesia. Oral sedation with midazolam should improve the scope of dental treatment available to patients with disabilities.

Dental treatment for people with challenging behaviour: general anaesthesia or sedation?

The dental care of people with severe learning disability and challenging behaviour presents many problems. The maintenance of oral health by regular examination, prevention and treatment may be difficult because of the limitations in patient cooperation. In many cases the diagnosis of orofacial pain may need to be discounted as a cause of uncharacteristic and sometimes aggressive behaviour. In such cases the use of general anaesthesia for examination and treatment would seem to be the obvious option but this strategy has limitations. This paper undertakes a focused review of sedation techniques as an alternative to general anaesthesia in the treatment of people with challenging behaviour. The use of novel techniques of sedation combining intravenous with oral or intranasal routes is described with patients treated in a community dental health centre. All patients had previously received treatment using general anaesthesia. The techniques described proved effective and safe for use in the primary care setting.

An instrument for the non-invasive objective assessment of velar function during speech

This paper describes the development of a non-invasive, computer-based, clinical instrument that infers velar function by way of the measurement of nasal and oral airflow. The design criteria of the instrument were based upon a wide ranging review of current practice and available techniques. The instrument measures and displays both nasal and oral airflow, along with the envelope of the speech sound waveform. This allows the clinician to determine whether airflow is associated with oral or nasal airflow and, hence, to infer the position of the velum. Preliminary clinical trials suggest that the instrument provides valuable objective information about the movement of the soft palate, particularly within the time domain. Hence, it is believed that the device provides additional information for the assessment of velar function, complementing those techniques currently employed.

Assessment in the treatment of hypernasal speech with motor neuron disease: a clinical report

The application of nasal anemometry in this patient's treatment proved to be of value in obtaining an objective assessment of this intervention. Nasal anemometry may be of use in other situations, for example, (1) in preassessment and postassessment of cleft palate surgery and surgical interventions to improve the velopharyngeal seal (such as pharyngoplasty), (2) in the evaluation of nasalized speech with conventional speech therapy, (3) in the evaluation of nasalized speech by use of a palatal training appliance, and (4) in the investigation of snoring.

A spoonful of sugar helps the medicine go down? Perspectives on the use of sugar in children's medicines

This analysis examines the policy issues involved in the removal of sugar from paediatric medicines. It reports a study which investigates the perspectives of professionals, consumers, and the pharmaceutical industry. Interviews were conducted with: parents of children receiving long term medication, dental professionals involved in influencing policy or caring for such children, and drug companies who produce medication for long term use by children. Results showed that the parent group preferred the tablet over the liquid form of medication; this was also considered acceptable by the key dental professionals interviewed. The removal of sugar from liquid medicine (rather than the alternative use of smaller tablets) was not therefore a policy generally preferred by the groups involved in the issue. It was concluded that the singular concern of the dentist, doctors and pharmacists to remove sugar from liquid paediatric medicines was a reflection of their altruistic intentions. The limited biomedical perspective of clinically trained occupations prevented them from exploring the wider issues of the various needs of consumers. Thus, the analysis highlights the problems which have been introduced by professional dominance in the issue of medication caries.

Nasal airflow measurement using a compensated thermistor anemometer. Part 2. Computer signal processing and quantitative analysis

A nasal anemometer is a useful tool for speech therapists in their assessment of treatment effectiveness. This work is the second part of a research scheme which describes how the system is compatible with the use of an IBM PC-AT microcomputer using a suitable analogue-to-digital convertor. This enables the system to perform signal processing and to display, draw, and calculate a numerical 'figure of merit' using Kendall's tau nonparametric correlation.

Dental services for children with mental handicaps: policy changes and parental choices

Dental services for children with mental handicaps are subject to conflicting policies. On the one hand, the community dental service is being asked to move towards a more specialised role and to focus on disadvantaged groups such as people with mental handicaps. On the other hand, policies for community care have stressed that handicapped people are stigmatised by specialised provision and should have access to all the services used by non-handicapped people. A longitudinal study of 162 mentally handicapped children provided an opportunity to assess parents' opinions on this issue. The results showed high levels of contact with the dental services. Most parents were satisfied with the care their children had received, although there was some suggestion of a preference for receiving care from the general dental practitioner service. However, parents whose children were hard to manage tended to prefer the more specialised care provided by the community dental service. The results of the study suggested that there is a continuing role for the community dental service and that general dental practitioners may need support from the community dental service to help them meet the demands of parents whose children have a mental handicap.