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Abstracts in Developmental Dentistry

in H. Barry Waldman DDS MPH PhD, Articles

Fukuda H, Saito T, Tsunomachi M, Doutsu T. Wheelchair-accessible dental offices in Nagasaki, Japan. Community Dent Health. 2010 Sep;27(3):187-90.

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.

Altun C, Guven G, Akgun OM, Akkurt MD, Basak F, Akbulut E.
Oral health status of disabled individuals attending special schools. Eur J Dent. 2010 Oct;4(4):361-6.
OBJECTIVES: The purpose of this study was to determine the prevalence of the dmft-DMFT indexes and the oral hygiene status of 136 individuals attending a special school for the disabled.
METHODS: Participants were grouped according to disability [Mental Retardation (MR), Cerebral Palsy (CP), Autistic Disorder (AD), Down Syndrome (DS), Other (OTH)] and age [2-6 years (n=24), 7-12 years (50 children) and 13+ years (62 children]. Caries examinations were carried out in accordance with WHO criteria and oral cleanliness was evaluated by visually assessing the presence of plaque on teeth.
RESULTS: Overall, 15.4% of children had no caries or fillings. While dmft and DMFT levels (P>.05) did not vary significantly by type of disability, oral cleanliness did. Children with autism were observed to maintain the best oral hygiene and those with mental retardation (MR), the poorest.
CONCLUSIONS: It is important for the dentist to concentrate on a preventive approach and provide proper dental education to parents of disabled individuals. Among the children with disabilities, more attention should be paid to the oral hygiene of MR group.

Al-Haddad KA, Al-Hebshi NN, Al-Ak'hali MS. Oral health status and treatment needs among school children in Sana'a City, Yemen. Int J Dent Hyg. 2010 May;8(2):80-5.

Data on the oral health status and treatment needs among Yemeni children are lacking.
OBJECTIVES: To assess caries prevalence, treatment needs and gingival health status among school children in Sana'a City and to examine how these are affected by age, gender and khat chewing.
METHODS: 1489 children (6- to 14-year old) were randomly selected from 27 schools representing all nine districts of Sana'a City. Dental caries and treatment needs were evaluated using standard WHO oral survey methods. The plaque index (PI), calculus index (CI) and the gingival index (GI), recorded at the six Ramfjord's teeth, were used to assess gingival health status.
RESULTS: 4.1% of the study subjects were caries-free. Prevalence of these was significantly higher among the males. The decayed component accounted for >85% of the scores. The highest dmfs/dmft means were found among the 6-8 years age group, while the highest DMFS/DMFT means were scored by the 12-14 years age group. The need for restorative treatment and extractions was high; the former was significantly higher among the females. All subjects had gingivitis. Khat chewing did not affect caries experience; however, it was significantly associated with higher periodontal scores.
CONCLUSIONS: The prevalence of caries, gingivitis and treatment needs among children in Sana'a city is high. More surveys in other Yemeni cities to generate comprehensive data are required.

Waldman HB, Wong A, Perlman SP. Preparing the profession to care for youngsters with special health care needs. J Okla Dent Assoc. 2010 Jul-Aug;101(5):20-2.

The complex issues involved in providing dental services to the increasing numbers of youngsters with special health care needs require the preparation of students and practitioners to meet these developments. A review of the changes in dental school requirements, the extent of needed services, the increased costs, and a challenge for current practitioners is presented.

Freudenthal JJ, Boyd LD, Tivis R. Assessing change in health professions volunteers' perceptions after participating in Special Olympics healthy athlete events. J Dent Educ. 2010 Sep;74(9):970-9.

This study assessed perceptions of health professions student and faculty volunteers who participated with athletes at the 2009 Special Olympics World Winter Games in Healthy Athlete venues. The volunteers' perceptions and expectations of the abilities of intellectually disabled athletes were measured by administering pre-event and post-event questionnaires consisting of demographic questions and the Prognostic Belief Scale (PBS). Invitations to participate in the study were sent to 165 students and faculty members; of those, eighty (48.5 percent response rate) responded to the pre-event questionnaire, and sixty-seven (40.6 percent response rate) responded to the post-event questionnaire. Of the eighty respondents to the pre-event questionnaire, fifty-five (68.7 percent) also completed the post-event questionnaire. The ANOVA comparing pre- and post-event PBS scores between groups found a trend towards higher scores among the volunteers, but analysis did not demonstrate a significant effect in either group (p=.68) or the interaction of group by time (p=.46). Despite the findings from the PBS, participants' statements suggest the experience had an impact on their perceptions and expectations. Although not statistically significant, this study found a positive trend pre- to post-event in the volunteers' perceptions of the abilities of athletes with intellectual disabilities. In addition to didactic and clinical education, volunteer experiences may enhance care providers' knowledge, skill, and confidence levels for treating clients with intellectual disabilities.

Meurs D, Rutten M, de Jongh A. Does information about patients who are intellectually disabled translate into better cooperation during dental visits? Spec Care Dentist. 2010 Sep;30(5):200-5.

The objective of this study was to investigate whether having background information about a patient with an intellectual disability (ID) would have a positive effect on the level of cooperation during a first dental visit. Study participants were 57 consecutive dental patients (mean age = 24.3 years, range: 4 to 69) with ID, who received a first oral examination at a center for special dental care. They were randomly assigned to a condition in which the dentist either received information about the patient prior to a dental visit (n = 29) or not (n = 28). Patients were assessed on the level of displayed cooperation, using a behavior-rating scale. Patients with less-severe levels of ID displayed better cooperation. No significant difference was found between the cooperation scores of both groups. The results suggest that the availability of comprehensive information concerning patients who are intellectually disabled prior to a dental appointment does not enhance cooperative behavior.

Miyawaki T, Kohjitani A, Maeda S, Egusa M, Mori T, Higuchi H, Kita F, Shimada M. Intravenous sedation for dental patients with intellectual disabilitJ Intellect Disabil Res. 2004 Nov;48(Pt 8):764-8.

BACKGROUND: The poor quality of oral health care for people with intellectual disability (ID) has been recognized, and the strong fears about dental treatment suggested as a major reason for disturbances of visits to dentists by such patients. Intravenous sedation is a useful method for relieving the anxiety and fear of such patients about dental treatment, and is frequently essential for ID patients undergoing dental treatment. However, decision regarding the dose of sedative required to be administered for an adequate level of sedation is difficult because the effect of sedation cannot be adequately assessed in patients with severe ID. As an appropriate sedative dose for dental patients with ID has not been fully established, we investigated sedative doses required and the effect of sedation in patients with ID, compared with other dental patients.
METHODS: Intravenous sedation was induced with a bolus intravenous administration of midazolam (2-3 mg) and maintained with a continuous infusion of propofol. The dose of propofol was titrated to achieve an adequate level of sedation: asleep but responding to painful stimulation. The efficacy of sedation, the required doses of propofol, and the wake-up times were investigated for all subjects. The efficacy of sedation was evaluated by judging whether the patient became cooperative and allowed the dental treatment to be carried out or not. The complications induced by intravenous sedation were also evaluated in each subject.
RESULTS: Intravenous sedation was effective for dental treatment in all subjects with or without ID. Wake-up times of subjects with ID were similar to those of the other subjects. Severe complications were not seen during or after intravenous sedation.
CONCLUSION: The results of this study show that intravenous sedation is a useful method for dental patients with ID as well as for other dental patients, but indicate that dental patients with ID need higher doses of sedative to obtain an adequate level of sedation.

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