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PubMed2005

What do children's global ratings of oral health and well-being measure?

OBJECTIVES: To explore the constructs children incorporate in the responses to global ratings of their oral health (OH) and OH-related overall well-being (OWB). METHODS: Data were collected as part of a project to validate the Child Perceptions Questionnaire for ages 11-14 (CPQ11-14), a self-report measure of OH-related quality of life. Its 37 questions are organized in the symptoms, functional limitations, emotional and social well-being domains. Children were recruited from paediatric dentistry, orthodontic and orofacial dental clinics. To identify the CPQ11-14 domain scores and questions predicting the global ratings, correlation and multiple regression analyses were used. RESULTS: Of the 123 children, 22.8% rated their OH as 'Fair/Poor' and 30.1% reported that their OWB was affected by their oral/orofacial condition. Positive significant correlations were observed between the OH ratings and the CPQ11-14 oral symptoms and emotional well-being domains, and between the OWB ratings and all four CPQ11-14 domains. The number of the CPQ11-14 questions significantly correlated with the OH and OWB ratings were 8 and 19, respectively. Only the symptoms domain entered the model for the OH (R2=0.05), while age, functional limitations and emotional well-being domains predicted the OWB (R2=0.18). The OH model included three questions (R2=0.13) and the OWB model included age and six questions (R2=0.25). In both models all but one of the questions came from the emotional and social well-being domains. CONCLUSIONS: These findings suggest that children view OH and its impact on well-being as multidimensional concepts. Further research, including qualitative studies, is needed to better understand the referents children use when responding to global ratings and the factors that determine their responses.

Adolescent↗

PubMed1996

Measurement of tooth mobility in children using the periotest.

This study investigated the use of the periotest for measuring tooth mobility of upper permanent incisor teeth in children. A total of 160 children, with equal numbers of boys and girls aged between 9 and 16 years had two periotest readings made on their four upper incisor teeth. In all 1,280 measurements were collected and analysed. The results showed that the second periotest readings were statistically significantly higher than the first. Periotest readings were lower for girls than boys of the same ages. The periotest may have a place as a diagnostic tool in paediatric dentistry and dental traumatology, however, further research is necessary before the periotest can be used to assist in the diagnosis and assessment of healing of traumatised teeth.

Adolescent↗

PubMed2004

The cost of treating children and adolescents with injuries to their permanent incisors at a dental hospital in the United Kingdom.

The aim was to estimate the total cost, including the direct costs (outpatient costs) and indirect costs (missed working day) of treating children and adolescents with traumatic injuries to their incisors. Factors such as the number of treatment visits and the success of outcome were also investigated. The sample was taken from patients who attended the dental trauma clinic at a London teaching hospital between 1990 and 2001. Eighty-one patients, with 111 traumatized incisors were included in this study. The mean age was 9.9 (SD = 2.33) years and the male:female ratio was 3:2. The median number of visits and median treatment duration were eight visits and 21 months, respectively. Sixty-two per cent of the patients lived >5 miles and 25% lived >10 miles from the hospital; 44% of the patients had uncomplicated and 56% had complicated trauma to their incisors. Accidental falls, falls involving a second person, sport-related injuries and road accidents accounted for 30, 22, 22 and 17% of the total injuries. For uncomplicated trauma, 97% of the patients had a successful outcome but this was reduced to 58% for complicated trauma. The average total cost of treating a patient with one traumatic injury was 856 pounds. The best predictor for higher number of visits and unsuccessful outcome was complicated trauma with odd ratios of 4.5 and 24 (95% CI 1.5-13.7 and 2.9-194.2), respectively. It was concluded that the indirect cost was a considerably large proportion (39%) of the total cost. More specialists in paediatric dentistry are needed to improve access to care locally and thus reducing the indirect travelling cost.

Accidental Falls↗

PubMed2006

The role for 'reminders' in dental traumatology: 4. The use of a computer database for recording dento-alveolar trauma in comparison to unstructured and structured paper-based methods.

The aims of this study were to investigate the effectiveness of a computer database (CD) developed for this study, a plain paper unstructured history (USH) and structured histories (SH) for the recording of important prognostic factors for simulated dento-alveolar trauma. Twelve vocational trainees, seven postgraduates in paediatric dentistry and 24 general dental practioners were randomly assigned to using USH, SH or CD. Each dentist visited a series of simulated trauma cases (with models, photos, radiographs and actors) and was asked to record important prognostic factors for each injury and make a diagnosis. There were a total of 243 dentist contacts with the trauma stations. The average percentage of important prognostic factors recorded per station was: USH 53%, SH 75.3% and CD 58.6%. SH was significantly better than the other two methods (P < 0.001, anova). Interestingly, those general dental practitioners (GDPs) who qualified prior to 1990 were significantly poorer at recording important prognostic information using CD. This effect was not obvious when using USH and SH. It was also seen that USH and SH were significantly better at helping clinicians reach a correct diagnosis as compared with CD (P < 0.001, chi-squared). A paper-based SH was the most effective method for collecting essential prognostic information for simulated trauma cases used in this study. At present, the introduction of our CD for recording of trauma is not justified without significant modification.

Chi-Square Distribution↗

PubMed2004

Undergraduate teaching in gerodontology in Austria, Switzerland and Germany.

OBJECTIVE: To survey the present state of undergraduate teaching in the domain of gerodontology in Germany, Switzerland and Austria. STUDY PARTICIPANTS: All universities of Austria (A), Germany (D) and Switzerland (CH). PROTOCOL: A questionnaire on undergraduate teaching in gerodontology was mailed to all Deans (A: n = 3; CH: n = 4; D: n = 31) and all independent departments except paediatric dentistry and orthodontics (A: n = 11; CH: n = 15; D: n = 111). RESULTS: The questionnaires were completed and returned by 29 Deans (A: n = 2; CH: n = 4; D: n = 23) and 102 departments (A: n = 7; CH: n = 8; D: n = 87). In Austria, gerodontology is a very small component of the dental curriculum and the Deans did not want this to be increased. Most German universities claimed to teach some aspects of gerodontology to undergraduate students and 87.4% of the Deans voted for separate lectures in gerodontology. In Switzerland, gerodontology seems well established. The results of questionnaires from the independent departments revealed that in all three countries lectures were more prevalent (A: n = 0; CH: n = 4; D: n = 6) than practical training in nursing homes (A: n = 0; CH: n = 3; D: n = 6). CONCLUSION: Considering the demographical shift which is leading to an increasing proportion of elderly in the population, the weighting of gerodontology in the undergraduate dental curriculum should be considered for revision in Austria and Germany.

Austria↗

PubMed1990

Survey of dental practice/dental education in Victoria. Part IV. Specialist dental practice.

A survey of dentists registered with the Dental Board and resident in the State of Victoria included two sections, one for specialist/restricted practitioners and the other for practitioners, who had gained a postgraduate degree from the University of Melbourne between December 1982 and 1987. The responses of the former suggested that demand for most specialist services appears to be reasonably healthy at the moment and the majority of the latter indicated that they had been adequately trained for specialist practice. It was suggested that there are several market forces which could influence the number of applicants seeking specialist training in future. Strongest demand was likely to be sustained for oral surgery and orthodontics. This is despite evidence of a decline in demand for specialist orthodontic services in private practice. Attention was drawn to the 1986 Ministerial Review of Dental Services in Victoria, in which concern was expressed for the lack of access to orthodontic services for low income families. It was proposed that more cost-effective methods of deploying orthodontic personnel could be used, as in other countries, to provide this access. Demand for specialist services in endodontics, paediatric dentistry, periodontics and prosthodontics could decline in future as general practitioners steadily broaden their range of services through continuing education courses.

Dentists↗

PubMed1991

A national survey of dentists' management of children with anxiety or behaviour problems.

Seven-hundred and sixty dentists, selected randomly from all States and Territories except Victoria, responded to a questionnaire survey on beliefs, attitudes and the techniques used in the management of children with anxiety or behaviour problems. The most common techniques used were permitting the child some degree of control over terminating treatment if difficulties were experienced, coaxing and reinforcing positive behaviours, and furnishing waiting areas with child-oriented play materials. Most respondents never used TV or video-tape distraction strategies, film or video-modelling tape or hypnosis. More than half of the respondents believed there was insufficient information available to them on current anxiety/behaviour management techniques. The use of particular management techniques varied by gender, age, university of graduation, State or Territory of residence, and membership of the Australian and New Zealand Society of Paediatric Dentistry. Patterns of use of particular techniques showed similarities and contrasts with other studies. Patterns of use in the national sample were almost identical to the frequency and pattern of use by Victorian dentists. In contrast, however, North American studies have reported a higher frequency of use of hand-over-mouth, and lower use of general anaesthesia within the armamentarium of techniques and strategies used by dentists to manage anxious or difficult children.

Adolescent↗

PubMed1997

Dental attitudes, knowledge, and health practices of parents of children with congenital heart disease.

A total of 60 children with severe congenital cardiac disease from the Great Ormond Street Hospital for Children and Guy's Hospital children's department were matched for age, gender, social class, and ethnic origin with 60 healthy children from the trauma clinic of the Department of Orthodontics and Paediatric Dentistry at Guy's Dental Hospital, London. The parents' attitude, knowledge, and dental health practices were assessed by questionnaire. The cardiac group had significantly poorer dental health practices than the healthy group. Of the cardiac children 18% had never visited the dentist compared with only 3% for the healthy group. It is difficult to assess the importance of this in terms of a serious health hazard. Current practice of cardiac physicians is to recommend that children with heart disease seek out and attend a dentist, the advice usually being accompanied by the presentation of a 'heart card' detailing antibiotic prophylaxis regimens if extractions are required. The data presented here shows that this strategy has failed.

Adolescent↗

PubMed2006

Short forms of the Child Perceptions Questionnaire for 11-14-year-old children (CPQ11-14): development and initial evaluation.

BACKGROUND: The Child Perceptions Questionnaire for children aged 11 to 14 years (CPQ11-14) is a 37-item measure of oral-health-related quality of life (OHRQoL) encompassing four domains: oral symptoms, functional limitations, emotional and social well-being. To facilitate its use in clinical settings and population-based health surveys, it was shortened to 16 and 8 items. Item impact and stepwise regression methods were used to produce each version. This paper describes the developmental process, compares the discriminative properties of the resulting four short-forms and evaluates their precision relative to the original CPQ11-14. METHODS: The item impact method used data from the CPQ11-14 item reduction study to select the questions with the highest impact scores in each domain. The regression method, where the dependent variable was the overall CPQ11-14 score and the independent variables its individual questions, was applied to the data collected in the validity study for the CPQ11-14. The measurement properties (i.e. criterion validity, construct validity, internal consistency reliability and test-retest reliability) of all 4 short-forms were evaluated using the data from the validity and reliability studies for the CPQ11-14. RESULTS: All short forms detected substantial variability in children's OHRQoL. The mean scores on the two 16-item questionnaires were almost identical, while on the two 8-item questionnaires they differed by only one score point. The mean scores standardized to 0-100 were higher on the short forms than the original CPQ11-14 (p < 0.001). There were strong significant correlations between all short-form scores and CPQ11-14 scores (0.87-0.98; p < 0.001). Hypotheses concerning construct validity were confirmed: the short-forms' scores were highest in the oro-facial, lower in the orthodontic and lowest in the paediatric dentistry group; all short-form questionnaires were positively correlated with the ratings of oral health and overall well-being, with the correlation coefficient being higher for the latter. The relative validity coefficients were 0.85 to 1.18. Cronbach's alpha and intraclass correlation coefficients ranged 0.71-0.83 and 0.71-0.77, respectively. CONCLUSION: All short forms demonstrated excellent criterion validity and good construct validity. The reliability coefficients exceeded standards for group-level comparisons. However, these are preliminary findings based on the convenience sampling and further testing in replicated studies involving clinical and general samples of children in various settings is necessary to establish measurement sensitivity and discriminative properties of these questionnaires.

Adolescent↗

PubMed1999

Management of the submerged deciduous tooth: I. Aetiology, diagnosis and potential consequences.

The management of submerged deciduous teeth can present a dilemma for general practitioner and specialist alike. These teeth are often extracted to avoid potential problems. The recent literature, mainly publications in specialist journals of paediatric dentistry and orthodontics, suggests that a conservative approach is often preferable, particularly when the permanent successor is present. The purpose of this article is to review the aetiology, diagnosis and potential consequences of submerging deciduous molars; a second paper will discuss the treatment options available.

Child, Preschool↗

PubMed2002

Outcomes associated with restored and unrestored deciduous molar teeth.

INTRODUCTION: Most dental treatment for children in the United Kingdom (UK) is provided by general dental practitioners (GDPs) working in the National Health Service (NHS). A working party of the British Society of Paediatric Dentistry, in a special publication from the Dental Practice Board, has suggested that failure to provide restorative care for the deciduous dentition is unacceptable, yet GDPs are filling fewer teeth in young children. The study aimed to evaluate the health outcomes obtained from restoring carious deciduous molar teeth. METHOD: The dental records of 677 children cared for by 50 GDPs in the north west of England were analysed. RESULTS: The results showed that 18.8% of deciduous molars with unrestored caries and 17.0% with a history of restorative care went on to be extracted because of pain or sepsis. CONCLUSION: The results suggest that the risk of carious deciduous molars being extracted is similar whether these teeth receive restorative care or not.

Dental Caries↗

PubMed2005

Use of SMS text messaging to improve outpatient attendance.

OBJECTIVE: To evaluate the effect of appointment reminders sent as short message service (SMS) text messages to patients' mobile telephones on attendance at outpatient clinics. DESIGN: Cohort study with historical control. SETTING: Royal Children's Hospital, Melbourne, Victoria. PATIENTS: Patients who gave a mobile telephone contact number and were scheduled to attend any of five outpatient clinics (dermatology, gastroenterology, general medicine, paediatric dentistry and plastic surgery) in September (trial group) or August (control group), 2004. MAIN OUTCOME MEASURES: Failure to attend (FTA) rate compared between the group sent a reminder and those who were not. RESULTS: 2151 patients were scheduled to attend a clinic in September; 1382 of these (64.2%) gave a mobile telephone contact number and were sent an SMS reminder (trial group). Corresponding numbers in the control group were 2276 scheduled to attend and 1482 (65.1%) who gave a mobile telephone number. The FTA rate for individual clinics was 12%-16% for the trial group, and 19%-39% for the control group. Overall FTA rate was significantly lower in the trial group than in the control group (14.2% v 23.4%; P < 0.001). CONCLUSIONS: The observed reduction in failure to attend rate was in line with that found using traditional reminder methods. The ease with which large numbers of messages can be customised and sent by SMS text messaging, along with its availability and comparatively low cost, suggest it may be a suitable means of improving patient attendance.

Ambulatory Care↗

PubMed2001

Interrelationship between dental age and chronological age in Somali children.

OBJECTIVE: To compare dental age (DA) with chronological age (CA) in Somali and white Caucasian children, resident in Sheffield. DESIGN: Cross-sectional study. SETTING: Paediatric dentistry clinic, Charles Clifford Dental Hospital, Sheffield. SUBJECTS: Somali children under 16 years of age and age- and gender-matched white Caucasian subjects. OUTCOME MEASURES: Dental age was determined for each subject, using their existing panoramic radiographs. Comparisons of the difference between dental age and chronological age (DA-CA) were made for gender and ethnic group, using independent sample t tests at the 0.05 level of significance. RESULTS: The sample group comprised 162 subjects: 84 Somali and Caucasian boys (mean age 10.55 years) and 78 Somali and Caucasian girls (mean age 11.24 years). The mean difference between DA and CA was found to be 1.01 years for Somali boys, 0.19 years for Caucasian boys, 1.22 years for Somali girls, and 0.52 years for Caucasian girls. The difference between DA and CA was significantly greater in Somali subjects than in Caucasian children. A few Somali subjects showed a marked discrepancy between chronological age and dental age (range -1.75 to 5.42 years), which was most evident in 8- to 12-year-old children. CONCLUSION: Somali children are significantly more dentally advanced than their Caucasian peers. This finding highlights the need for population-specific dental development standards for accurate dental age assessment.

Adolescent↗

PubMedDate not supplied

General and dental characteristics of Bloch-Sulzberger syndrome. Review of literature and presentation of a case report.

A case report of Bloch-Sulzberger Incontinentia Pigmenti is presented, in which the dental symptoms are considered as a base, not just for a review of this disorder within the scope of Integrated Paediatric Dentistry, but also in order to establish an adequate dental treatment for the affected children. There should be interdisciplinary coordination, leading to better treatment and therefore an improved quality of life for these patients.

Anodontia↗

PubMed2002

The anxiety in bruxer child. A case-control study.

BACKGROUND: The etiopathogenesis of bruxism in children is not clear although different authors would associate it with several factors, changes in dentition, malocclusions, certain parasomnias and most notably emotional stress. This study was performed to test the hypothesis that anxiety states measured by "Anxiety Scale for evolutive age" may affect the development of bruxism. METHODS: A total of eighty-six children, aged between 7 and 1, were evaluated. In the study-group were enlisted forty-three children with bruxism selected among patients afferent to the paediatric dentistry clinic. The forty-three non bruxer children, the control group, were chosen through the Pair Matching procedures, so that each bruxer child had a matching age case control. The gravity of bruxism was scored by means of 0 to 3 graduated scale of dental wear. The psychological aspects were estimated by means of an Anxiety Scale for evolutive age. Statistical analysis was undertaken using the "Odds Ratio" on statistically significant values. The most significant level was evaluated by the Mc Nemar test. RESULTS: Remarkable differences in anxiety levels were found among the children of the two groups; 72% of bruxers showed significant anxiety scores versus 12% of non bruxers. The results of Odds Ratio reveal that a bruxer child has a 16 times greater probability to be anxious than an non bruxer one. CONCLUSIONS: The data provide support for the concept that anxiety state is a prominent factor in the development of bruxing behaviour in children.

Anxiety↗

PubMed2001

Referral of children to a general anaesthetic dental service in Tayside.

OBJECTIVE: To determine the adequacy of child referral for dental general anaesthesia (DGA) by local dental practitioners, given the recent guidance document to dentists from the General Dental Council and in addition, to determine the subsequent treatment and factors which influence treatment selection. DESIGN: A prospective study. SETTING: Department of Paediatric Dentistry, Dundee Dental Hospital, Dundee. SUBJECTS: Children [n = 84] who were referred for dental extractions under general anaesthetic over a three month period. RESULTS: Non-surgical dental extractions under general anaesthetic were requested in nearly 90% of referrals. In the majority of cases, the referral was deemed inadequate; e.g. the medical history was not mentioned in the majority of cases (85.7%) despite nearly one-fifth of patients having a relevant medical history. In general, referring practitioners under-estimated the extent of disease, requiring treatment plans to be changed in 76% of cases; all changes represented an increase in the number of dental extractions undertaken. The most common reasons for general anaesthetic use were: multiple dental extractions (73.8%); the patient's anxiety (63.1%); and patient's age (41.7%). As an alternative to general anaesthesia, treatment was undertaken successfully using inhalation sedation in nearly 15% of cases. CONCLUSION: Dental extractions under general anaesthetic are still a common reason for referral. Referring practitioners frequently provide inadequate information, in addition to under-estimating the treatment required. Alternative forms of anxiety management are available and should be considered for children requiring dental extractions.

Adolescent↗

PubMed2003

General dental practitioners' perception of their role within child protection: a qualitative study.

AIM: This was to assess general dental practitioners' knowledge, attitudes and practice regarding their role within child protection in relation to child abuse. METHODS: Structured interviews with seven key informants from general dental practice (2), local dental committees (1), social services (2), paediatric dentistry (1) and community child health (1), together with five focus groups comprising 23 general dental practitioners (GDPs) on Health Authority Lists in Tyne and Wear and Northumberland (UK). RESULTS: GDPs reported feelings of isolation with little communication with other health professionals or local authority services. The majority had scarcely considered child protection issues in their clinical practice although those qualified for less than 15 years were more aware. GDPs acknowledged a lack of awareness of signs and symptoms of physical abuse and even less confidence in dealing with emotional or sexual abuse. Dentists expressed concern, even fear, about the outcomes of reporting suspicions, and had little knowledge of the local Child Protection mechanisms. CONCLUSION: GDPs in Tyne and Wear and Northumberland feel unprepared to undertake a role in the child protection process with confidence. National and local initiatives may be required to address existing barriers.

Attitude of Health Personnel↗

PubMedDate not supplied

Oral manifestations of graft versus host disease. Case report.

This study has been carried out in order to understand and increase our knowledge about the oral manifestations and the treatment required for Graft Versus Host Disease. The complication of allogeneic transplants with haematopoietic cells is revised. The clinical case report deals with a nine-year-old girl who was treated in our unit of Integrated Paediatric Dentistry after referral by her paediatrician. The symptoms of Graft Versus Host Disease are basically characterised by immunodeficiency, diarrhoea, weight loss, dermatological and hepatic alterations and oral manifestations. This group of syndromes, caused by the fact that the receptor acquires 30% to 50% of the donor's immune system, can become acute leading to a 20% to 30% mortality rate. The syndromes are chronic in 50% of cases, when sometimes the destruction of the salivary glands is the only manifestation and has a mortality rate of 5%. From the odontological point of view 80% of patients are affected, although we should make the distinction between the manifestations which are directly caused by the disease, and those caused by chemotherapy or radiotherapy. Oral manifestations (caries, mucositis, ulcers, infections, etc) should be treated as soon as possible. Positive co-operation between physicians is of vital importance.

Child↗