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Abstracts in Developmental Dentistry

in H. Barry Waldman DDS MPH PhD, Articles

Chávez EM, Subar PE, Miles J, Wong A, Labarre EE, Glassman P. Perceptions of predoctoral dental education and practice patterns in special care dentistry. J Dent Educ. 2011 Jun;75(6):726-32.

The objective of this research project was to compare alumni perceptions of predoctoral dental education in the care and management of patients with complex needs to alumni practice patterns. Alumni from the University of the Pacific Arthur A. Dugoni School of Dentistry who graduated from 1997 to 2007 were surveyed regarding perceptions of their predoctoral education in the care of patients categorized and defined as medically compromised, frail elders, and developmentally disabled, as well as their practice patterns. Perceptions were rated on a Likert scale. Regression analyses were utilized. Three primary relationships were identified: 1) positive relationships emerged between perceptions of educational value, as students and practitioners, of the training they received compared to percentages of medically compromised patients they currently treat (p?0.05); 2) after practice experience, 2003-07 graduates reported significantly higher value of their education in this area compared to 1997-2002 graduates; and 3) alumni who reported treating more patients with complex needs during school reported treating significantly more of these patients in practice (p?0.05). We conclude that alumni who reported educational experiences as more valuable treat more patients with complex needs compared to those who valued them less. Alumni who reported having more opportunities to treat patients with complex needs as students treat a higher percentage of those patients than those reporting fewer. Even positive perceptions may underestimate the value of educational experiences as they relate to future practice.

Christensen LB, Hede B, Nielsen E. A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark. Gerodontology. 2011 May 10. doi: 10.1111/j.1741-2358.2011.00486.x. [Epub ahead of print]

Gerodontology 2011; doi: 10.1111/j.1741-2358.2011.00486.x A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, To describe the oral health and the oral-health-related quality ofDenmark Aim: life (OHRQoL) of citizens in Copenhagen City on admission to a specific oral health-care programme for disabled elderly persons. Further, to analyse how various factors influence the oral health and the OHRQoL among these patients. years) A cross-sectional study of 189 persons (average 85Methods: consecutively admitted to a special oral health-care programme. Clinical data and data from interviews comprising social factors, life-style, dental visit habits, oral hygiene practices and self-perceived oral health were collected. A modified index on perceived dysfunction, discomfort and disability due to oral Sixty-eight per cent had natural teeth, amongdisorders was used. Results: those 57% had decayed teeth and two out of three wore dentures. Smoking habits influence the number of teeth present and the OHRQoL (p<0.05) of the patients. Edentulousness, decayed teeth, and presence of dentures did not seem to cause OHRQoL problems, while higher OHRQoL scores (more problems) were OHRQoL ofreported by those with 1-9 teeth and tooth mobility. Conclusion: these patients can be increased by removal of loose teeth and provision of dentures to those with very few teeth rather than focus on traditional caries treatment.

Waldman HB, Wong A, Perlman SP. Almost 2 million seniors (including 662,000 with disabilities) will reside in New Jersey--how will their dental needs be met? J New Jersey Dent Assoc. 2011 Winter;82(1):26-8.

In the coming years, New Jersey (and the rest of the country) will experience a burgeoning number of senior residents, including those with disabilities. A review is carried out of these developments in one state and its counties, and the anticipated demand for dental services.

Outumuro M, Abeleira MT, Caamaño F, Limeres J, Suarez D, Diz P, Tomás I. Maxillary expansion therapy in children with Down syndrome. Pediatr Dent. 2010 Nov-Dec;32(7):499-504.

The purpose of this study was to evaluate orthodontic treatment with maxillary expanders (MEs) in a group of Down syndrome (DS) children while also analyzing the rate of activation of the appliance, the complications during the expansion phase, and the expansion outcomes.

METHODS:
Thirty-two DS children underwent ME treatment. Sixty-four controls matched for age, sex, and type of ME were selected. The variables analyzed were previous dental treatment, orthodontic diagnosis, and ME treatment.

RESULTS:
Slow activation of the ME was used in 28% of the DS patients vs 9% of controls (P > .03). Complications during expansion occurred in 10 DS patients (31%) but in none of the controls (P < .001). The most common complication was the appearance of oral ulcers. At the end of the expansion, the results were considered to be clinically successful in 21 DS patients (66%) and in 50 controls (78%).

CONCLUSIONS:
Maxillary expansion can be undertaken in DS children and is successful in a high proportion of cases if correct case selection has been performed. These patients, however, may require a slow activation of the appliance during the expansion phase and are more susceptible to the appearance of oral ulceration, which can affect the course of treatment.

Goldberg EM, Ferguson F. Treatment modalities for self-injurious behaviors observed in the special-needs patient: 2 case reports. Pediatr Dent. 2010 Nov-Dec;32(7):481-5.

Self-injurious behavior (SIB) is comprised of deliberate self-harm involving frequent and repetitive activities of a destructive nature. It is commonly observed in patients with developmental delay and a variety of syndromes. SIB frequently involves oral and facial tissues, requiring intervention from the dental team. The purpose of this case report was to compare and contrast the dental management of 2 patients exhibiting self-injurious behavior. The cases presented in this report discuss selection and application of fixed, semiremovable, and removable appliance therapy for SIB. Appliances utilized included fixed and removable "lip bumpers" as well as a novel semifixed splint to open the patient's bite to prevent SIB. It was important in both cases that the patients received regular follow-up exams so that the appliances could be appropriately altered as the patient adjusted.

Nelson LP, Getzin A, Graham D, Zhou J, Wagle EM, McQuiston J, McLaughlin S, Govind A, Sadof M, Huntington NL. Unmet dental needs and barriers to care for children with significant special health care needs. Pediatr Dent. 2011 Jan-Feb;33(1):29-36.

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.

Owens J. Barriers to oral health promotion in the Republic of Ireland.Scand J Public Health. 2011 Mar;39(6 Suppl):93-7.

This paper discusses the evaluation of a multi-sector oral health promotion intervention in the Republic of Ireland for children with disabilities. It argues that a lack of awareness about the context of interventions means that sometimes people's health concerns remain unaddressed through a lack of participation. This may actually increase rather than decrease health inequalities. Implementing qualitative methods to provide a context before proceeding with interventions may assist in providing approaches that are fit for purpose when trying to include people in health promotion.

METHODS:
A purposive sample of 15 parents or carers of children with disabilities and 18 non-dental professionals were interviewed in either focus groups or on a one-to-one basis.

RESULTS:
The qualitative analysis indicated that budget constraints were affecting joint working because non-dental professionals were overstretched, feeling that they only had the capacity to carry out day-to-day work with parents and children. The daily demands of caring for a child with disabilities for many parents meant that they were tied to a day-to-day existence.

CONCLUSIONS:
The qualitative evaluation suggested that an initial lack of knowledge about structural, procedural, and budgetary barriers, coupled with insight into the daily demands on parents caring for children with disabilities, meant that all parents were not enabled. Therefore, achieving the aims of the plan could not be a total success for all parents and children from the outset.

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