Prevalence of Dental Caries among Visually Impaired Institutionalized Adolescents in Lagos State

OBJECTIVES

To assess and compare caries prevalence among institutionalized visually impaired and sighted 10dash;19 year old children in Lagos State, Nigeria.

METHODS

A cross sectional study of institutionalized visually impaired and sighted 10-19-year-old adolescents was carried out using the World Health Organisation (WHO) Basic Oral Methods caries diagnostic criteria. A random sample of 10-19-year-old visually impaired and sighted institutionalised children was carried out. The mean decayed, missing, filled teeth (dmft/DMFT) and significant caries (SiC) indices of both groups were obtained and compared with Chi-square test using SPSS version 20.

RESULTS

Mean age of visually impaired participants was 16 years while that of sighted was 12.5 years. The male to female ratio was 1:1 among the visually impaired participants and 1:1.5 among the sighted. Caries prevalence of 28.8% (64/222), mean dmft/DMFT 1.98±1.25 and 27.5% (63/229), mean dmft/DMFT 1.90±1.28 were obtained for the sighted and visually impaired 10dash;19 years old children respectively. The significant caries (SiC) indices for both groups were 3.3.

CONCLUSION

Caries prevalence among the visually impaired and sighted adolescents in this study was considerable with no significant differences between them. Both populations had significant caries experiences. There is therefore need for oral health promotion among both sighted and visually impaired institutionalized adolescents in this environment.

[Difficulties in dental health care for the disabled]

Upper Normandy has several disadvantages in terms of access to dental health care for disabled people: an insufficient medical population, a lack of dental schools and dental care networks.A cross-sectional epidemiological investigation, using a questionnaire form, was carried out between November 2014 and February 2015 with a cohort of dentists in this region.The topics on this form focused firstly on accessibility and compliance with standards of dental offices and the influencing factors which are hampering their accessibility implementation, and secondly on the oral care of disabled patients by practitioners of this region : the impact of incentives, influencing factors which are complicating the dental care and the usage of private and public structures.If the care of disability concerns most practitioners, an apprehension is observed in the adaptation of these doctors' treatment protocols for these specific patients. The expectations of dentists concerning disability are multiple : the creation of specific care networks, better coordination of medical and social actors, and specific training programs concerning the dental care of disabled patients.

Access to dental services for children with intellectual and developmental disabilities - A scoping review

BACKGROUND

Children with Intellectual and Developmental Disabilities (IDD) face considerable challenges in participating in dental services. These challenges include resource constraints and inadequate skills of health service providers to work with this population.

AIM

The aim was to scope published studies that addressed access to dental services for children with IDD in order to determine the extent to which various barriers have been researched, using an access framework derived from the literature. Access was defined to include the six dimensions of accessibility, availability, affordability, accommodation, acceptability, and appropriateness.

METHOD

Arksey and O'Malley's scoping review framework was used. Relevant databases (e.g., Medline) were searched for all empirical studies conducted from January 2000 to February 2017 that met inclusion criteria. Data were extracted along the six dimensions of the access framework.

RESULTS

Sixteen international studies were identified which indicated common key barriers to dental service use: the difficulties of physical inaccessibility, lack of access to information among carers, lack of knowledge of disability issues, and low experience and skills in caring for children with IDD among dental practitioners.

CONCLUSIONS

Key recommendations made were exploring dental practitioners' understanding of disability legislation and developing training for practitioners to expand on issues specific to IDD.

[Dental care for disabled people]

CONTEXT

Patients with disabilities represent a population with special needs whose dental care management constitutes a public health problem. This article describes dental care of disabled people in a hospital dental care unit to highlight the difficulties encountered and propose ways to improve this care.

METHODS

A retrospective descriptive study was carried out on patients followed between 2010 and 2016 as part of the partnership between the Albert Chenevier Hospital odontology department and the RHAPSOD'IF network. The data collected by means of ?follow-up sheets? described the procedures performed and any medication used. These anonymised records were analysed by Excel software.

RESULTS

Dental care sessions for the 434 disabled persons consisted of visits (42 to 57%), restorations and scalings each represented 1/6 of all procedures performed (14 to 19% and 14 to 18%), and surgery and radiography each represented 1/8 of procedures (4 to 12% and 6 to 11%). There were almost no dental prostheses (0 to 1%). Most dental care sessions were performed without premedication (61 to 76%).

CONCLUSION

This type of dental care requires training of families and caregivers, a good interpersonal approach and time to build a relationship of trust. Participation in a network is important to help, support, and advise the practitioner and to provide financial support.

Effects of medical and mental status on treatment modalities in patients treated under general anaesthesia at the KTU Faculty of Dentistry in Trabzon, Turkey: A comparative retrospective study

This study evaluated the differences in dental conditions and treatment modalities between disabled and non-cooperative healthy children under general anaesthesia. The data were collected from paediatric patients between 3 and 15 years of age who received dental treatment under general anaesthesia. Patients with at least one mental/physical disturbance (group 1) and other healthy non-cooperative patients (group 2) were compared with regard to gender, age, weight, and treatment time-type. The statistical analyses were performed using Fisher's exact and Mann-Whitney U tests. No significant differences were observed between the groups with regard to gender, weight and treatment-time (p>0.05). The numbers of treated teeth (p<0.01) and extractions (p<0.001) were higher in group 1 than in group 2, whereas the frequency of advanced restorative procedures for group 1 was lower than that for group 2, including preventive-resin-restoration (p<0.001), glass-ionomer-cement (p<0.05), root-canal (p<0.001) and stainless-steel-crowns (p<0.001). This study supports the hypothesis that the general condition of the patients may alter the type of treatment provided and confirms the necessity of performing preventive procedures.

Dental Economics and the Increasing Numbers of Individuals with Disabilities in New Jersey

The dual needs of 1) providing increasing oral healthcare for individuals with special needs, and 2) improving the economics of dental practice, are explored in a review of the State of New Jersey and its counties.

A review of daycase GA services for Special Care patients at University Hospital, Bristol

This paper describes and discusses a review of adult special care dentistry day cases in a UK hospital over a two year period and makes recommendations for other such reviews and for practice. Dental public health competencies illustrated: oral health needs assessment and evaluation of dental health services.

Campus-Based, Community-Based, and Philanthropic Contributions to Predoctoral Pediatric Dental Clinical Education: Two Years of Experiences at One Dental College

The aim of this study was to investigate the contribution of a tiered predoctoral pediatric dentistry clinical education model to competency achievement by dental students over a two-year clinical education. Retrospective data were obtained for academic years 2012-13 and 2013-14 from three sources: a campus-based, dental school-housed clinic; division-directed clinics in community-based pediatric and special needs clinics (DDC); and clinics affiliated with the dental college's community-based dental education (CBDE) program, the OHIO Project (OP). A fourth dataset was obtained for the same two-year period from a biannual clinic event held at the college in conjunction with Give Kids a Smile Day (GKAS). Procedures considered essential to the care of children were sorted by 12 dental codes from all services for patients 18 years of age and younger. The dental school clinic provided 11,060 procedures; the DDC, 28,462; the OP, 17,863; and GKAS, 2,028. The two-year total was 59,433 procedures. Numbers of diagnostic and preventive procedures were 19,441, restorative procedures were 13,958, and pulp and surgical procedures were 7,392. Site contribution ranged from 52.2 to 144.9 procedures per attending student, with the DDC yielding the highest per student average for each year (126.4 and 144.9) and the dental school clinic the lowest (52.2 and 53.1). This study found that a combination of school-based, community-based, and philanthropic pediatric dental experiences offered a large number of essential pediatric dentistry experiences for predoctoral dental students, with CBDE opportunities offering the largest contribution.

Learning from a Special Care Dentistry Needs Assessment

The General Dental Council recognised special care dentistry (SCD) as a speciality in 2008 and local service reviews have been carried out in order to develop SCD services. A needs assessment was completed to inform the implementation of recommendations from a 2010 review of SCD in Wales.

AIM

The aim of this paper is to outline the process, findings and learning from the needs assessment and the implications for SCD.

METHOD

A focused needs assessment approach was used. Stakeholder consultations were used to develop a working definition for the needs assessment. Data were collected from existing health and social care sources and analysed using descriptives and geographic information system (GIS) mapping.

RESULTS

Data sources for needs assessment were limited. Analysis showed that health conditions were common in the population and increased with age. The majority of people who reported seeing a dentist were seen in general dental practice. Older people with health conditions were less likely to report seeing a dentist. Patients often needed to travel for specialist care services.

CONCLUSION

General dental practice teams have a significant role in caring for SCD patients. Careful planning of specialist care, joint working and enhancing skills across the general practice team will reduce the burden of care and enhance patient safety. Improvements in data for assessment of SCD needs are required to help this process.

Weighing up the weighted case mix tool (WCMT): a psychometric investigation using confirmatory factor analysis

OBJECTIVE

To assess the use of the WCMT in two Scottish health boards and to consider the impact of simplifying the tool to improve efficient use.

DESIGN

A retrospective analysis of routine WCMT data (47,276 cases).

CLINICAL SETTING

Public Dental Service (PDS) within NHS Lothian and Highland.

METHOD

The WCMT consists of six criteria. Each criterion is measured independently on a four-point scale to assess patient complexity and the dental care for the disabled/impaired patient. Psychometric analyses on the data-set were conducted. Conventional internal consistency coefficients were calculated. Latent variable modelling was performed to assess the 'fit' of the raw data to a pre-specified measurement model. A Confirmatory Factor Analysis (CFA) was used to test three potential changes to the existing WCMT that included, the removal of the oral risk factor question, the removal of original weightings for scoring the Tool, and collapsing the 4-point rating scale to three categories.

RESULTS

The removal of the oral risk factor question had little impact on the reliability of the proposed simplified CMT to discriminate between levels of patient complexity. The removal of weighting and collapsing each item's rating scale to three categories had limited impact on reliability of the revised tool. The CFA analysis provided strong evidence that a new, proposed simplified Case Mix Tool (sCMT) would operate closely to the pre-specified measurement model (the WMCT).

CONCLUSIONS

A modified sCMT can demonstrate, without reducing reliability, a useful measure of the complexity of patient care. The proposed sCMT may be implemented within primary care dentistry to record patient complexity as part of an oral health assessment.

Use of oral healthcare and need to expand population that is served: a commentary

General population demographics are undergoing dramatic changes. Long-term customary populations that provided the bulwark for successful dental practices are being replaced by the many minority populations. Despite these significant general population developments, the demographic profile of the dental profession has experienced (and, apparently, based on dental student populations, will continue to experience) limited changes. The economic strength of the profession may well be predicated upon its responses to these developments. The question remains, "Is the profession preparing for them?".

Dental caries among disabled individuals attending special schools in Vhembe district, South Africa

OBJECTIVES

To determine the prevalence of dental caries among disabled individuals attending special schools in Vhembe districts.

MATERIAL AND METHODS

A cross-sectional descriptive study was conducted from January to June 2012 among disabled individuals receiving special care in four specialised schools of Vhembe District. The research protocol had been approved by the Ethics Committee of the University of Limpopo, Polokwane Campus. Informed consent was obtained from the parents of the participants and from the respective school principals. Oral health examinations took place at the school under natural light, with participants seated on an ordinary chair/wheelchair. Dental caries examinations were carried out, using a mirror and wooden spatula in accordance with World Health Organisation (WHO) criteria and methods. Decayed, missing and filled primary and permanent teeth (dmft, DMFT) were recorded. All disabled individuals who were available during a screening period, were included. Those who were not available, as well as those whose health conditions could be compromised by dental examinations, were excluded.

RESULTS

The number of decayed teeth ranged from 0-7 in children below 6 years, 0-12 in children below 11 years; and 0-17 among young adults. The mean decay scores and the numbers of missing teeth increased with age. Only 3 (0.04%) individuals had dental fillings. The mean dmft score of children under 6 years was 5.51 (+/- 2.1), ranging from zero to 8. The mean DMFT's of the 11-18 and 19 years and older groups were 7.38 (+/- 3.22) and 10.24 (+/- 2.97) respectively.

CONCLUSIONS

Disabled individuals exhibited higher caries prevalence and unmet dental needs than the same age general population in Limpopo. Preventive measures and dental treatment should be considered urgent requirements at special needs schools in the Vhembe District.

Caries experience and treatment need in adults with intellectual disabilities in two German regions

OBJECTIVE

The aim of the study was to determine the caries experience, caries prevalence, dental treatment need and care index of adults with intellectual disabilities living in the German federal states of Baden-Württemberg and Sachsen which differ distinctly with respect to the socio-economic conditions.

RESEARCH DESIGN

In 2007, legal custodians of all persons working in special day-care institutions (n=2037) were asked to give consent for dental examinations of their custodees. Some 21.9% consented. Thus, 428 persons received a dental examination in the day-care institutions.

RESULTS

The mean age of the participants was 35.5 years (range 18-64). Caries prevalence was 93.7% (95% CI 91.3-95.9) in Baden-Württemberg and 97.6% (95% CI 96.2-99.0) in Sachsen. All caries-free persons (n=19) were younger than 35 years. The mean DMFT of the whole sample was 12.3 (95% CI 11.6-12.9). Although DMFT values were the same in both German regions, persons from Baden-Württemberg had more missing teeth than those from Sachsen but untreated carious defects were more common in Sachsen.

CONCLUSIONS

Dental care for those with intellectual disabilities could be better harmonised within Germany. Furthermore, specific dental care and dental treatment strategies could be introduced in Germany in order to reduce caries prevalence and number of extracted teeth in persons with intellectual disabilities.

Oral care experiences and challenges in children with autism spectrum disorders

PURPOSE

The purpose of this study was to investigate the differences between children with autism spectrum disorders (ASD) and their typically developing peers in relation to aspects of oral care.

METHODS

Participants included 396 parents of ASD children or typically developing 2- to 18-year-olds. Parents completed a 37-item questionnaire designed by authors to elicit information about oral care in the home and dental office. Descriptive, bivariate, and multivariate regression analyses were conducted to examine the association between diagnostic group and oral care variables.

RESULTS

Significantly more parents of ASD children than parents of typically developing children reported difficulty across almost all oral care variables explored, including oral care in the home, oral care at the dentist, and access to oral care. Following multivariate regression to control for possible confounders-including age, gender, Hispanic status, and paternal education level-all previously significant variables remained significant.

CONCLUSION

This study indicates that children with autism spectrum disorders experience greater difficulties and barriers to care in both the home and dental office settings than their typically developing peers.

Dental needs and management of children with special health care needs according to type of disability

PURPOSE

The purpose of this study was to investigate the dental needs and management of special health care needs children in Rio de Janeiro, Brazil, according to the type of disability.

METHODS

Records of 428 0- to 19-year-old patients who received dental treatment at the Patients Special Care Needs Clinic (Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro) from 1996-2009 were analyzed. Information about the type of disability, use of medication, dental exam findings, management during treatment, dental treatment performed, and follow-up examinations were collected. Children were divided into 2 groups: those with medical conditions and those with intellectual disability.

RESULTS

Patients with medical conditions used more medications and were older than those with intellectual disability. The most common dental treatments received were dental restorations (63%) and extractions (47%). There was no association between the type of disability and dental treatment needed. Children with intellectual disability were 3 times more likely to need general anesthesia and 7 times more likely to need physical restraint for dental care than the other group.

CONCLUSIONS

Children with intellectual disability have a greater chance of requiring advanced management techniques during dental treatment. The development of effective oral health programs is recommended as well as a specific education program for their parents.

New York State ranked favorably for adults and reasonably well for children in terms of oral health standards

Results from the National Health Interview Survey place New York State at or near the top among states for the oral health standards of its residents. Nevertheless, continued unmet service needs exist, particularly for minority populations, individuals in lower income families and residents with disabilities.

Would you believe that about 1-in-5 U.S. children has a disability?

A review of a series of federation reports documents the numbers of youngsters with a variety of special health care needs who are residents in our communities and are dependent upon local dentists for needed services. The increased costs for health care and complexities of access to this care are emphasized. While dental schools have introduced changes in their curricula to improve the preparation of new graduates to provide services for patients with special health care needs, the challenge is to provide current practitioners with programs to ensure the treatment of youngsters (and the not so young) with disabilities.

Survey of ambulatory surgery dentistry

A telephone survey of New York State's most significant providers of Medicaid hospital ambulatory surgery dental treatment for special needs patients was conducted in June and July of 2011 to assess whether there had been changes in the availability of dental services following implementation of the Ambulatory Patient Groups (APG) Medicaid payment methodology and the April 2011 35% reduction in fee-for-service reimbursement to dentists who provide this dental care. With release of "Oral Health in America: A Report of the Surgeon General" in 2000, attention was focused on the link between oral health and general health, with the report highlighting the difficulties individuals with special needs experienced with respect to their oral health and accessing dental care. The New York State Department of Health in 2005 released its "Oral Health Plan for New York State." It had three stated objectives pertaining to those with special needs. None of these objectives has been met, and the response to this survey revealed waiting times for access to ambulatory surgery dental programs of up to two years and an overall probable 10% to 15% decrease in availability as a direct result of the APG payment methodology and reduction in fee-for-service reimbursements. New York is failing not only to meet the objectives of its own oral health plan, but also to adequately meet the dental health care needs of its most vulnerable citizens.

More than 71 million seniors (including 26 million with disabilities) will reside in the United States in 2030

In the coming years the United States will experience a burgeoning number of senior residents, including those with disabilities. A review of these developments and the dental and medical concerns in the delivery of dental services is presented.

Anteroposterior, vertical and space malocclusions in adolescents with special needs in Lagos, Nigeria

OBJECTIVE

To determine the prevalence of malocclusion in adolescents with special needs and to compare the results with those of other authors.

METHODS

The study sample consisted of 230 adolescents with special needs aged 12-17 years randomly selected from 5 special school/centres in Lagos. Occlusal anteroposterior relationships were assessed based on Angle classification.

RESULTS

Normal occlusion was seen in 11.7%, Angle's class I malocclusion in 77.4%, class II malocclusion in 8.3% and class III malocclusion in 2.6%. Over 63% had normal overbites, and 6.5% and 12.5% had increased and reduced values, respectively. Overjet relationship was normal in 50%, increased in 25.7% and reduced in 6.5%. Crowding was observed in 29% of the subjects and midline diastema in 27%. Males had a significantly higher prevalence of midline diastema than females (p < 0.05). The intellectually impaired had significantly higher frequency of class II division 1 malocclusion and anterior openbite when compared with the other disabled groups.

CONCLUSION

Class I malocclusion is the most prevalent occlusal pattern among adolescents with special needs. Statistically significant differences in occlusal pattern were observed between the disabled groups.

A preliminary analysis of the US dental health care system's capacity to treat children with special health care needs

PURPOSE

The purpose of this study was to use existing data to determine capacity of the US dental care system to treat children with special health care needs (CSHCN).

METHODS

A deductive analysis using recent existing data was used to determine the: possible available appointments for CSHCN in hospitals and educational programs/institutions; and the ratio of CSHCN to potential available and able providers in the United States sorted by 6 American Academy of Pediatric Dentistry (AAPD) districts.

RESULTS

Using existing data sets, this analysis found 57 dental schools, 61 advanced education in general dentistry programs, 174 general practice residencies, and 87 children's hospital dental clinics in the United States. Nationally, the number of CSHCN was determined to be 10,221,436. The distribution, on average, of CSHCN per care source/provider ranged from 1,327 to 2,357 in the 6 AAPD districts. Children's hospital dental clinics had fewer than 1 clinic appointment or 1 operating room appointment available per CSHCN. The mean number of CSHCN patients per provider, if distributed equally, was 1,792.

CONCLUSIONS

The current US dental care system has extremely limited capacity to care for children with special health care needs.

Unmet dental needs and barriers to care for children with significant special health care needs

PURPOSE

The purpose of this study was to conduct the first known large scale survey of parents of children with special health care needs (CSHCN) to determine their child's: oral health status; access to dental care; perceived barriers (environmental/system and nonenvironmental/family); and oral health quality of life, accounting for each child's medical diagnosis and severity of diagnosis.

METHODS

A 72-item survey was sent to 3760 families of CSHCN throughout urban and rural Massachusetts.

RESULTS

The study yielded 1,128 completed surveys. More than 90% of the children had seen a dentist within the past year; 66% saw a pediatric dentist, and 21% needed intense behavioral interventions. Although most families had high education levels, private dental insurance, and above average incomes, 20% of CSHCN had an unmet dental need. Children with craniofacial anomalies had twice as many unmet needs and children with cystic fibrosis had fewer unmet needs. Children with cerebral palsy, autism, developmental delay, and Down syndrome had more aversions to dental treatment, more treatment complications posed by their medical conditions, and more difficulty finding a dentist willing to provide care. Children with cystic fibrosis, metabolic disorders, or hemophilia encountered fewer barriers to care.

CONCLUSIONS

The data paint a picture of high unmet dental needs with subpopulations of children with special health care needs who are more at risk for system barriers and internal family barriers to care based on their medical diagnoses.

Place of residence affects routine dental care in the intellectually and developmentally disabled adult population on Medicaid

OBJECTIVE

To compare the likelihood of intellectually and developmentally disabled (ID/DD) adults receiving a dental cleaning across places of residence.

DATA SOURCES

Medicaid and Minnesota's Medicaid Management Information System (MMIS) databases.

STUDY DESIGN

All adults with DD assessments in MMIS in 2001-2002.

DATA EXTRACTION METHODS

All completed DD assessments in 2001-2002 linked to Medicaid utilization data for same recipients for same years.

CONCLUSIONS

The most disabled individuals are generally least likely to receive a dental cleaning. Individuals living in their own or a family home are less likely to receive the procedure than those living in ICF/MRs or a group home, even after controlling for disability, with those living in a group home falling in between ICF/MR and own/family home residents. The level of preventive dental care that ID/DD adults receive in community settings may be inadequate, particularly for persons living in own homes or with family.

Health needs and economics in Oklahoma

A review of government and private agency reports document many of the health issues, including the low comparative oral health ranking as compared to the standing in other states, faced by the residents of Oklahoma. The complex issues of funding oral health services are considered in terms of the potential for increasing services to individuals with disabilities who are "aging out" of the Medicaid dental program.

Wheelchair-accessible dental offices in Nagasaki, Japan

OBJECTIVE

To determine the proportion of dental offices in Nagasaki, Japan, that are wheelchair accessible and to identify factors related to the adoption of barrier-free designs within the study area.

METHODS

All 703 dental offices managed by members of the Nagasaki Prefecture Dental Association were studied. We evaluated the accessibility of the offices to wheelchair users and compared the percentage and adjusted odds ratio of the accessible dental offices according to dental office characteristics.

RESULTS

Of the respondents, 62% deemed their offices accessible. The percentage and adjusted odds ratio of accessible offices were significantly higher for offices offering more specialties, providing more frequent home visits, and with younger head dentists.

CONCLUSION

According to the self-reported results from dentists, more than one third of the dental offices in Nagasaki were not easily accessible by mobility-impaired persons. Dentists should the understand architectural and perceptual barriers faced by handicapped persons and the aged and consider barrier-free office designs for all patients.

Provision of dental care for special care patients: the view of Irish dentists in the Republic of Ireland

STATEMENT OF PROBLEM

Part 2 of the Disability Act 2005 requires that all people with a disability are entitled to a needs assessment and, by implication, provision of identified care needs. This process started with children aged 0-6 in 2007 and will roll out to all people with disabilities by 2011. Oral health is part of that needs assessment but it may be that dentists are not in a position to provide that care, by virtue of a lack of education, training or facilities. The majority of dental care delivered would seem, from information gathered as part of this study, to be of an emergency nature. This study aimed to identify the shortfalls in service provision, and their potential causes, to inform what it is hoped will be a positive directive on special care dentistry (SCD) in the proposed National Oral Health Strategy.

PURPOSE OF STUDY

To assess the provision of dental services for special care patients (SCPs) by dental practitioners in Ireland. To review the educational background of primary dental care providers in SCD.

MATERIALS AND METHODS

A postal and online questionnaire was sent to every third dentist on the Dental Register in Ireland. An analysis of data was performed using Statistical Programme for Social Sciences (SPSS).

RESULTS

There were 782 questionnaires distributed. Of the 274 (35% response rate) dentists returning questionnaires, 236 were deemed suitable for inclusion; those dentists working in general practice or the Health Service Executive (HSE) only were included. Treatment provided by dental practitioners included emergency services (775), extractions (72%) and restorative intervention (72%). Oral hygiene instruction for the carers of SCPs was provided by 52% of respondents. Of those surveyed, 25% claimed an awareness of the Disability Act 2005. Qualitative analysis of a definition of SCD and the perceived barriers to care were recorded. Additional fees for the treatment of SCPs were deemed necessary by 78% of respondents. An experience of training in SCD was recorded by 41%, and 65% of dentists expressed a willingness to partake in some/further training.

CONCLUSIONS

While the treatment of SCPs was reported by the majority of respondents (66%), the most common service provided was the management of dental emergencies. The need for a greater emphasis on preventive care was highlighted. Knowledge of the Disability Act 2005 was limited and responsible agencies need to increase awareness of the requirements for professional groups, like dentists, under the Act.

Barriers to dental care for children in Virginia with autism spectrum disorders

PURPOSE

The purposes of this study were to examine the reported use of dental services for families of children with autistic spectrum disorders and identify barriers that affect their access to dental care.

METHODS

Participants were caregivers of at least 1 child with an autism spectrum disorder. Caregivers completed a questionnaire that assessed access and barriers to dental services. Descriptive, bivariate, and multivariate regression analyses were conducted to examine dental care access issues in relation to individual factors.

RESULTS

Each respondent's household income and child's history of difficult behavior in the dental office were significantly related to the ability to receive care when needed and whether the child had a regular dental provider. An inability to find a dentist with the skills or willingness to work with people with disabilities was the most frequent reason cited for not having a regular dental provider.

CONCLUSIONS

Children with autism spectrum disorders who display difficult behavior are less likely to have a dentist for routine car, have longer intervals between dental appointments, and receive care when needed.

Orthodontists' and orthodontic residents' education in treating underserved patients: effects on professional attitudes and behavior

The U.S. surgeon general's report on oral health in 2000 stressed the importance of providing dental care for underserved patient groups. Given that orthodontic treatment is less likely to be covered by dental plans than other procedures and is often considered an elective treatment, it is not surprising that access to orthodontic care is an especially severe problem for underserved patient groups. The purpose of this study was to explore the degree to which orthodontic residents and orthodontists perceived that their graduate orthodontic education had prepared them well to treat underserved patients and whether this education affected their professional attitudes and behavior concerning providing care for members of historically underserved patient groups. Survey data were collected from 135 residents in U.S. and Canadian graduate orthodontic programs and from 568 active members of the American Association of Orthodontists (AAO). While the majority of residents and orthodontists felt well prepared to treat patients from different ethnic/racial backgrounds (quality of clinical education: residents: 86.4 percent; orthodontists: 82.3 percent), considerably fewer respondents felt well prepared to treat patients on Medicaid (64.7 percent and 34.4 percent), pro bono cases (45.4 percent and 33.4 percent), patients with special needs (52.8 percent and 35 percent), patients with craniofacial anomalies (65.3 percent and 52.6 percent), and patients with developmental delays (45.5 percent and 30.5 percent). Perceptions of the quality of education correlated significantly with the professional attitudes and the actual/projected behavior concerning providing care for patients from these underserved patient groups. Given the lack of access to orthodontic care for patients from underserved patient groups, initiatives are needed to change this situation. These findings showed a clear relationship between how future orthodontists are educated about providing care for patients from underserved populations and their professional attitudes and behavioral intentions to provide care for individuals who historically have encountered access to care barriers. Dental education has to accept the responsibility to prepare future dental care providers to be able to treat patients from underserved groups.

Access to dental services for people with a physical disability: a survey of general dental practitioners in Leicestershire, UK

OBJECTIVE

To investigate the availability of facilities, including parking, accessibility and toilet amenities, for physically disabled people at dental practices in Leicestershire, and views relating to the provision of treatment, as reported by general dental practitioners.

BASIC RESEARCH DESIGN

A cross-sectional postal questionnaire-based study.

SETTING

General Dental Service practices in Leicestershire, United Kingdom.

PARTICIPANTS

Questionnaires were sent to all General Dental Service practices (n=123) within Leicestershire.

MAIN OUTCOME MEASURES

Facilities for physically disabled people as reported by general dental practitioners and views of practitioners in relation to provision of treatment.

RESULTS

The response rate from general dental practices was 80%. The views of 120 (42%) of the 284 dentists approached relating to the provision of treatment to people with a physical disability were recorded. Although up to 77% of the dental practices were considered by practitioners to be accessible to someone using a wheelchair, only 7% also had suitable parking and toilet facilities. The majority of responding dentists treated patients with a physical disability, but 76% of practitioners found it difficult to provide treatment to this group. Concerns regarding the financial cost of providing treatment were raised. There is evidence that conditions are less than optimal in general practice settings for patients with a physical disability receiving treatment. Only nine of the 123 practices in Leicestershire had appropriate parking, access and toilet facilities for physically disabled people.

CONCLUSION(S)

Facilities for physically disabled people at general practices in Leicestershire are limited. If inequalities in dental health among the physically disabled are to be successfully reduced, steps must be taken to make practices more easily accessible with suitable facilities, and to increase awareness of services offered by appropriate dental practices.

Another perspective on individuals with disabilities: an editorial

In 2005, there were nearly 40 million individuals (14.9% of the population), 5 years of age and older, with one or more disabilities (not including individuals living in institutions).(1) There is a great variation at the state level: the proportion of the population with disabilities ranges as high as 10.4% in Maine for youngsters between 5 and 20 years, to 52.1% for individuals 65 years and older in Mississippi. By contrast, the lowest proportion of youngsters 5 to 20 years of age with disabilities was in Connecticut (4.5%) and the lowest proportion for individuals 65 years or older with disabilities was in Nevada (33.3%). Political and social factors may be affecting the number of services available and many people with disabilities are not receiving these services. This editorial discusses some of the factors that may affect access to oral health services for people with disabilities.

Dental needs and status of autistic children: results from the National Survey of Children's Health

PURPOSE

The purpose of this study was to assess the oral health status and dental needs of a nationally representative sample of 1- to 17-year-old children with or without autism.

METHODS

In the 2003 National Survey of Children's Health, parents reported their child's oral health status and needs. The condition of the child's teeth, demographics, time since last dental visit, and dental needs were assessed in autistic children (N=495) and nonautistic children (N=95,059). For a subset of children with reported fair or poor teeth, specific problems about their dentition were assessed for autistic children (N=69) and nonautistic children (N=7,002). Weighted percentages and chi-square statistics were calculated.

RESULTS

According to parents, 69% of nonautistic children and 52% of autistic children had their teeth in excellent or very good condition (P <.001). The dental status of children with autism and without autism, identified with fair or poor teeth, was comparable.

CONCLUSIONS

Overall, parents of US autistic children were more likely to report their children's dentition to be in fair or poor condition than parents of US nonautistic children. Children with or without autism who had fair or poor teeth are faced with similar dental problems.

Results of a dental care protocol for mentally handicapped patients set in a primary health care area in Spain

OBJECTIVE

Disabled people have the same right as other people to receive the health care they need, but they sometimes have difficulties to achieve it. In Castilla y Leon it has come into effect a law to guarantee Primary and Secondary Care coordination to provide dental treatment under sedation or anaesthesia to mentally disabled people who need it. Our aim is to evaluate the results of the implementation of such a law through a specific protocol in our health setting.

STUDY DESIGN

Descriptive, made in a Health Area over a year, on mentally disabled people who were sent to hospital for treatment under anaesthesia after Primary Dental Care Units assessment. It has been studied the age, gender, mental disease, dental diagnosis and treatment undergone.

RESULTS

108 patients attended the program (51% male), with a mean age of 31 years. 67% presented profound learning disability, 19% mental illness with disability, 11% presented cerebral palsy and another 3% had autism. Most frequent dental pathologies were caries (86%) and dental plaque (71%). Most common dental procedures were tooth extraction (78%), professional tooth cleaning (75%) and fillings (67%).

CONCLUSIONS

We achieved to provide necessary dental treatment to a large number of disabled people, who would not have received it otherwise. It was a challenge to plan and implement the protocol coordinating Health Care Levels and workers. It still has to be done an economic and efficiency analysis of procedures and a patient satisfaction study.

Dental treatment for disabled children in the Spanish Public Health System

The Spanish Public Health System is stepping up its efforts to meet all the medical needs of the population. Oral health is of increasing interest for society, especially for parents who are keen for their children to have healthy teeth. Disabled children with both physical and mental disabilities do not always receive the dental care they need. The purpose of this bibliographical review is to evaluate the services provided by the Spanish Public Health System to such children. We have noted marked differences in the types of dental treatment given to these patients in the different Autonomous Communities of Spain. Some, such as Asturias, Navarra and Extremadura, offer specific care for disabled children. Others, such as Ceuta and Melilla, provide more general care.

Oral health conditions of community-dwelling cognitively intact elderly persons with disabilities

OBJECTIVES

To present descriptive information on oral health and health care of community-dwelling elderly persons with disabilities who are living at home.

BACKGROUND

Most previous studies have focused on specific subpopulations, namely, persons who are essentially healthy and independent, are homebound, or are nursing home residents. Little information appears to be available on community-residing elderly persons with disabilities.

MATERIALS AND METHODS

A total of 641 participants aged 65 years and over in a Medicare Demonstration who were cognitively intact, completed an oral health questionnaire within 1 year of Demonstration entry. Demonstration participants were required to be living in the community, need or receive help with 2+ activities of daily living (ADLs) or 3+ instrumental ADLs (IADLs), and have recently experienced significant health services utilisation.

RESULTS

Subject mean age was 79.1 years, 73.8% were female, and 4% were minority. They were dependent in a mean of 1.8 ADLs and 2.9 IADLs. 43.1% reported that they had no natural teeth, 77.4% had dentures, 58.8% frequently felt their mouth was dry, 5.2% had jaw pain now and 6.1% had at some time experienced burning sensations in their mouth or tongue. 40.4% reported that they were currently in need of dental treatment, although 56.2% indicated they now had a dentist, and 42.1% identified having a dental visit within the past 12 months. 19.7% indicated some dental insurance coverage.

CONCLUSION

This is one of the first studies to focus on community-dwelling elderly people with disabilities. Substantial oral health morbidity was reported.

Changes and factors associated with dentists' willingness to treat patients with severe disabilities

OBJECTIVE

This study investigated changes in dentists' willingness to treat severely disabled patients and to understand dentists' opinions on reimbursements after the implementation of a dental care financial reward program in Taiwan.

METHODS

Three hundred dentists from 29 teaching hospitals were randomly selected to answer a structured questionnaire, and 184 structured questionnaires were returned. Multiple regression analysis was used to examine the factors associated with dentists' willingness to treat severely disabled patients.

RESULTS

Approximately 60% of the dentists said reimbursements for treatment of severely disabled patients were reasonable. 50.4% of dentists were willing or very willing to treat disabled patients. Seventy-nine percent dentists affected by the program had a higher willingness but 83.7% dentists said this program did not make a significant difference to their income. 52.8% of dentists agreed the program would increase the quality of dental care. The factors significantly affecting dentists' willingness included dentist's age, specialty field, perception of the program in promoting the quality of dental services, and perception of the ability to provide adequate treatments for severely disabled patients.

CONCLUSIONS

The rewards program significantly increased the willingness of most hospital-base dentists to treat the severely disabled patients although the effect of incentive to their income was limited.

Conceptual frameworks for understanding system capacity in the care of people with special health care needs

This paper seeks to (1) identify strengths and weaknesses of the US health care system regarding oral care for persons with special needs; (2) provide a framework for understanding system capacity; and (3) describe the context within which dental care is provided in the United State. It explores a series of concepts that help explain the current lack of access for those with special needs and synthesizes options for improvement.

A review of the oral health of individuais with disabilities in Puerto Rico and among U.S. Hispanics

More than 51 million U.S. civilian noninstitutionalized residents have some form of long-lasting disability, including almost 1 million residents of Puerto Rico. The goal of this report is to review available data in an effort to stimulate recognition of the oral health needs of Puerto Rican residents with disabilities. The authors conducted a review using a series of U.S. Census Bureau reports to develop comparative relationships between Puerto Rican residents, the total U.S. population and the total U.S. Hispanic population. The review compared the proportion of these groups with disabilities, the proportion of the population who live below the poverty threshold, and oral health status. The review of available government and private agency data for the general population indicates that the percentage of Puerto Rican residents with disabilities is greater than the percentage of the total U.S. population and the total U.S. Hispanic population. In addition, compared to the total U.S. population, a greater percentage of total U.S. Hispanic children is living in poverty, has unmet dental needs, is uninsured for health services, and has not visited dentists for extended periods. Particularly limited information is available regarding the oral health needs and services for Puerto Rican residents with disabilities. It is essential for future government and private agency surveys and reports to emphasize the economic status of the Puerto Rican population, recognize the distribution of particular disabilities among the various racial/ethnic populations, and increase general attention to the oral health of the residents of Puerto Rico with specific concerns regarding individuals with disabilities.

Parental oral health care of mentally retarded children in Ilala municipality, Dar es Salaam, Tanzania

OBJECTIVE

The aim of this study was to investigate oral hygiene practices and oral health care given by parents to mentally retarded children in Dar es Salaam, Tanzania.

METHODS

A total of 140 questionnaires were distributed; only 100 questionnaires were completed and thus were included in the analysis, a 71.4% response rate. Questionnaires inquired on oral hygiene practices, supervision or assistance during tooth brushing, examination of the oral cavity, and measures taken in an event of oral health problems.

RESULTS

Sixty-five per cent of the children are able to brush their teeth, whereas 35% are brushed by a family member. About 74% of the children who brush themselves brush occasionally or once per day while 26% brush more than once per day. More than 58% of the children who brush themselves brush under supervision. A statistically significant difference was observed in respect of bleeding on brushing which was among 61% of the children who brush occasionally or once per day and among 29% of the children who brush more than once per day (Pearson chi2 = 5.13, P = 0.024). Sixty-four per cent of parents occasionally examine their children's oral cavity. Few parents take their children to a dentist in an event of toothache/cavity on a tooth (26%) or bleeding on brushing (37%).

CONCLUSION

Most children are able to brush their teeth themselves. Majority of those who cannot brush are assisted. Bleeding on brushing and tooth cavities are common problems but few children are taken to a dentist for care.

A preliminary investigation into tooth care, dental attendance and oral health related quality of life in adult stroke survivors in Tayside, Scotland

OBJECTIVE

The aim of this study was to investigate patterns of oral care, dental attendance and oral health-related quality of life among adults who had suffered a stroke.

BACKGROUND

Stroke is the most common cause of adult disability in the UK. Seventy per cent of strokes occur in adults over 65 years of age. A mild stroke may leave little residual disability but in cases of moderate or severe stroke the disability may be significant and may impact on oral health and function.

MATERIALS AND METHODS

A cross-sectional survey was conducted among adults surviving 1 year after stroke, between January and July 2001. A medical screening was carried out which included an assessment of disability and handicap using the modified Rankin scale. A structured interview was conducted to identify normal patterns of oral care and dental attendance and to elicit if since suffering a stroke any changes had occurred or were likely to occur. The Short Form Oral Health Impact Profile (OHIP-14) was administered prior to an oral examination. Analysis used SPSS 11.0 for Windows. Parametric and nonparametric tests were undertaken (t-tests and chi-squared tests with Yates correction where appropriate).

RESULTS

Forty-one adults were recruited into the study comprising 21 female and 20 male. They ranged in age from 50 to 87 years and the mean age was 69 years (SD = 9.8). Forty per cent of participants experienced moderate disability or greater following their stroke. Thirty-seven per cent had difficulty with tooth cleaning. The most frequently reported problem was being unable to use one hand properly as a result of the stroke. There was a significant association between the degree of disability following stroke and difficulty with tooth cleaning (P = 0.015). Disability as a result of the stroke was cited as the main reason for reported or projected attendance pattern change. The most frequently experienced OHIP-14 dimension was functional limitation (39%).

CONCLUSION

Individuals who have been left disabled after a stroke may require help with or advice on oral care and information on how to access dental services in a setting appropriate to their disability. Further research is needed to identify the dental needs of adults with stroke and to identify appropriate interventions to meet these needs.

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.

The practice of conscious sedation by Senior Dental Surgeons in the Health Board Dental Service in the Republic of Ireland

OBJECTIVE

To establish the nature and extent of the practice of conscious sedation by Senior Dental Surgeons in the Health Board Dental Service (HBDS) in the Republic of Ireland and to determine the barriers to the use of conscious sedation.

DESIGN

Postal questionnaire survey.

SETTING

The Health Board Dental Service in the Republic of Ireland in 2002.

SUBJECTS AND MATERIALS

Questionnaires were sent to fifty-five Senior Dental Surgeons working in the HBDS.

RESULTS

Fifty questionnaires (90.9%) were returned. Less than a quarter of Senior Dental Surgeons reported current sedation use in their area. Oral sedation was the most commonly used method with few using relative analgesia and less using intravenous sedation. Forty percent of Senior Dental Surgeons surveyed reported receiving training in conscious sedation as an undergraduate. Nearly 60% of those surveyed reported using conscious sedation in a previous employment. All respondents said the main barrier to the use of conscious sedation in the HBDS was the lack of training opportunities on the subject in Ireland.

CONCLUSIONS

Conscious sedation techniques other than oral, are used to a very limited extent in the HBDS in Ireland. There is great interest amongst Senior Dental Surgeons in the increased use of conscious sedation techniques. A lack of training opportunities is the main barrier to the expansion of their use.

Children with special health care needs: results of a national survey

The purpose of this review of the 2001 National Survey of Children with Special Health Care Needs (SHCN) was to offer an overview of these youngsters from the perspective of parents. Survey findings include: (1) Nearly 13% (9.4 million) of US children were reported to have SHCN, with the highest prevalence rates among children living in poverty and among Native American children. (2) Dental care was the most commonly reported needed service that was not received. (3) Despite the availability of public forms of insurance, compared to children with private insurance, low-income SHCN children are 2 to 3 times more unlikely to obtain needed health services. (4) SHCN children have a significant impact on family time requirements, economics, and employment patterns. The challenge is to use this information to improve services for SHCN children.

General anesthesia: as a challenge and treatment need option in pediatric dentistry

OBJECTIVE

The purpose of this study was to determine the type and characteristics of the interventions, indications of dental treatment and procedures performed to patients treated under general anesthesia (GA) by pediatric dentistry residents, during the 1997-1999 period.

METHOD

A sample of 57 hospital records of patients treated as part of the Special Pediatric Course at the Puerto Rico Pediatric Hospital were reviewed. Statistical analysis was done using the chi-square test for inferences on proportions.

RESULTS

MR patients made up 59.7% and NMR patients made up 40.3% of the sample studied. Ages ranged from 2 to 35 years with a mean age of 11 years (SD=8.54). MR patients were classified into 7 categories: mental retardation (38.2%), cerebral palsy (14.7%), epileptic (5.9%), mental syndromes (26.9%), hydrocephalic (5.9%), autism (5.9%) and others (2.9%). The NMR were classified into 5 categories: early childhood caries (65.2%), cardiac patients (8.7%), maxillofacial anomalies (4.3%), organic syndromes (13.1%) and others (8.7%). The dental procedures performed were: dental extractions 84%(MR) and 68% (NMR), restorative procedures 87.3%(MR) and 12.7%(NMR). Oral prophylaxis was performed in 76.8%, fissure sealants in 10.7% and topical fluoride applications in 21.8%.

CONCLUSION

Dental extraction was a frequently performed procedure in both groups. The prevalence of exodontia and restorative procedures indicates the need to design and implement prevention programs for special pediatric patients.

Ohio dental care providers' treatment of young children, 2002

BACKGROUND

Adequate access to dental care for young children--particularly those from low-income families--is a public concern. The authors conducted a survey of Ohio dental care providers to examine factors influencing their willingness to care for these children.

METHODS

Random samples of Ohio general practitioner (GPs) dentists and pediatric dentists (PDs) and all Ohio safety-net dental clinics completed a mail survey regarding treatment of children aged 0 through 5 years. The authors categorized responses by provider type and further analyzed GPs' responses by years since graduation and geographic character.

RESULTS

Few Ohio GPs (8 percent) recommended a first dental visit by 1 year of age. While 91 percent of GPs treated children aged 3 through 5 years, only 34 percent treated children aged 0 through 2 years, most often for emergency visits or examinations. Only 7 percent of all GPs and 29 percent of PDs accepted patients enrolled in Medicaid without limitations.

CONCLUSIONS

Children's being young (0-2 years of age) and having Medicaid as a payment source made GPs substantially less likely to treat them. Children's being enrolled in Head Start made GPs somewhat more likely to treat them.

PRACTICE IMPLICATIONS

New strategies for ensuring dental care access for young children from low-income families are necessary. Such strategies may take the form of interpeer advocacy, education, practice incentives or creation of coordinated GP and PD teams.

Regional variation in dental procedures among people with an intellectual disability, Ontario, 1995-2001

BACKGROUND

The literature indicates that people with an intellectual disability have a prevalence of dental caries that is either lower than or similar to that of the general population. However, many of their caries go untreated, and extractions are more often used as a means of treatment than in the general population. A substantial percentage (40%) of day admissions to hospital of people with intellectual disabilities in Ontario is related to dental diseases. In this paper, we examine whether rates of in-hospital dental procedures are evenly distributed across Ontario and discuss possible explanations for the findings.

MATERIALS AND METHOD

A retrospective analysis was made of routinely collected hospital admission data for people with an intellectual disability. Age- and gender-adjusted rates for dental procedures were calculated using the direct method of adjustment and 1996 census population estimates of Ontario. Three different summary measures for the assessment of regional variation were used.

RESULTS

Two areas had dental procedure rates among those with an intellectual disability that were significantly lower than the overall Ontario rate: Hamilton-Wentworth and Quinte-Kingston and Rideau. The 3 district health council areas with the highest rates for dental procedures were Niagara, Essex-Kent and Lambton, and Durham-Haliburton-Kawartha and Pine Ridge; all 3 rates were higher than the overall Ontario rate.

CONCLUSIONS

The use of day surgery and in-hospital visits to treat dental diseases in people with an intellectual disability varies considerably by region in Ontario. Observed differences may indicate inequities.