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Abstracts in Developmental Dentistry

in H. Barry Waldman DDS MPH PhD, Articles

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;30:200-5.

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.

Alaki SM. Can parents assess dental pain in children with cognitive impairment? J Clin Pediatr Dent. 2010;34:313-6.

It is often said that the "gold standard" for pain assessment in both children and adults is verbal report. This means that the individual is best at describing his or her pain experience. This however does not take into account individuals who lack the ability to communicate their feelings including those with cognitive immaturity such as infants and very young children, people with cognitive

Hartling L, Milne A, Tjosvold L, Wrightson D, Gallivan J, Newton AS.

A systematic review of interventions to support siblings of children with chronic illness or disability. J Paediatr Child Health. 2010 Jun 27.

Aim: Chronic illness or disability in children can have a deleterious effect on the psychosocial health of well siblings. This systematic review synthesized evidence from studies evaluating sibling-oriented care aimed at improving behavioral and emotional outcomes in well siblings of children with chronic illness or disability. Methods: Twenty electronic databases were searched. Study selection, data extraction and assessment of methodological quality were performed by two independent reviewers. Results: Five controlled and nine uncontrolled studies were included. In higher-quality controlled trials, benefits of sibling-oriented care included reduced anxiety, improved mood and behavioral adjustment; however, these findings were not consistently demonstrated across studies. Study differences made it difficult to determine which sibling care features were most salient. Conclusions: Study findings highlight the potential for enhancing emotional and behavioral outcomes in well siblings. Future evaluations need to clearly identify the intended purpose of the care (what improvements are intended) and which types of siblings are most likely to benefit. This approach may yield more consistent and clinically important results.

Klingberg G, Andersson-Wenckert I, Grindefjord M, Lundin SA, Ridell K, Tsilingaridis G, Ullbro C. Specialist paediatric dentistry in Sweden 2008 - a 25-year perspective Int J Paediatr Dent. 2010;20:313-21.

International Journal of Pediatric Dentistry 2010; 20: 313-321 Background. Pediatric dentistry in Sweden has been surveyed four times over the past 25 years. During this period postgraduate training, dental health, and the organization of child dental care have changed considerably. Aim. To investigate services provided by specialists in pediatric dentistry in Sweden in 2008, and to compare with data from previous surveys. Design. The same questionnaire was sent to all 30 specialist pediatric dental clinics in Sweden that had been used in previous surveys. Comparisons were made with data from 1983, 1989, 1996 and 2003. Results. Despite an unchanged number of specialists (N = 81 in 2008), the number of referrals had increased by 16% since 2003 and by almost 50% since 1983. There was greater variation in reasons for referrals. The main reason was still dental anxiety/behavior management problems in combination with dental treatment needs (27%), followed by medical conditions/disability (18%), and high caries activity (15%). The use of different techniques for conscious sedation as well as general anesthesia had also increased. Conclusions. The referrals to pediatric dentistry continue to increase, leading to a heavy work load for the same number of specialists. Thus, the need for more pediatric dentists remains.

Smith G, Rooney Y, Nunn J Provision of dental care for special care patients: the view of Irish dentists in the Republic of Ireland. J Ir Dent Assoc. 2010;56:80-4.

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 Program 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.

MacEntee MI.The educational challenge of dental geriatrics. J Dent Educ. 2010;74:13-9.

Education in dentistry as in medicine is guided principally by the ontology and theory of science, which provides definitions of health and disease, legitimizes research methods, and influences the role of the clinician. The challenge of managing chronic oral disease and disability prompts interest in social theory as much as science. Therefore, dental geriatrics requires a solid foundation in the humanities from the belief that the determinants of health and the cause of chronic diseases lie within an intermingling of biology, economics, sociocultural structure, and human behavior. The dental curriculum in many places is reorganizing from the horizontal foundation of basic sciences to an integration of foundational and clinical knowledge focused on clinical competencies and integrated care. The impact of this integration on dental geriatrics necessitates a more humanistic and naturalistic perspective in dental education to balance and challenge the current evidence for best clinical practice, which at present is based almost exclusively on science. Consequently, dental students should be exposed to a consilience of the science and the humanities if dentists are to address effectively the needs of an aging population.

Mulligan R, Vanderlinde MA. Treating the older adult dental patient: what are the issues of concern? J Calif Dent Assoc. 2009;37:804-10.

Requires a multifaceted approach that includes full engagement in life, maintenance of high physical and cognitive function, and avoidance of disease and related disability, so does the care of adult patients. This geriatric treatment model suggests that understanding the psychosocial, behavioral, and medical presentation of the older patient may prove to be the key to the ultimate success of the dental/oral treatment arrived at collaboratively by the dentist and the older patient.

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