Darius Sagheri

The value of education in special care dentistry as a means of reducing inequalities in oral health

People with disability are subject to inequality in oral health both in terms of prevalence of disease and unmet healthcare needs. Over 18% of the global population is living with moderate to severe functional problems related to disability, and a large proportion of these persons will require Special Care Dentistry at some point in their lifetime. It is estimated that 90% of people requiring Special Care Dentistry should be able to access treatment in a local, primary care setting. Provision of such primary care is only possible through the education and training of dentists. The literature suggests that it is vital for the dental team to develop the necessary skills and gain experience treating people with special needs in order to ensure access to the provision of oral health care. Education in Special Care Dentistry worldwide might be improved by the development of a recognised academic and clinical discipline and by providing international curricula guidelines based on the International Classification of Functioning, Disability and Health (ICF, WHO). This article aims to discuss the role and value of promoting and harmonising education in Special Care Dentistry as a means of reducing inequalities in oral health.

An Evaluation of Health-Related Quality of Life (HRQoL) in a group of 4-7 year-old children with cleft lip and palate.

Background and Objective:Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. The interventions’ intensity and psychosocial burden of the cleft may have a lasting impact on the child. The aim of this study was to assess the psychosocial functioning of 4 to 7-year-old children with non-syndromic CLP.Material and Methods:Health-Related Quality of Life (HRQoL) was assessed using the revised German KINDL HRQoL questionnaire, a five-point, 24-Likert-item questionnaire covering six domains (physical well-being, emotional well-being, self-esteem, family life, friends and school). The total score is the sum of all item scores. In addition, a chronic generic module consisting of six items, and a specific parent module consisting of 22 items have been added to the core KINDL questionnaire. Higher scores indicate better HRQoL. All the parents of 4 to 7-year-old children with non-syndromic CLP treated at the interdisciplinary CLP center at Cologne University Hospital were invited to participate in the study.Results:A total of 74 families were contacted, 61 of whom agreed to study participation (82% response). The 61 children (32 boys and 29 girls) had a mean age of 5.39 years. The mean values for the total scale were slightly lower for children with CLP, but when compared, CLP and non-CLP children revealed no statistically significant difference in HRQoL levels.Conclusion:This study demonstrated that 4 to 7-year-old children with CLP do not appear to experience major psychosocial problems when compared with their non-CLP peers.ZusammenfassungHintergrund und Ziel:Lippen-Kiefer-Gaumen-Segelspalten (LKGS-Spalten) sind die häufigsten angeborenen kraniofazialen Fehlbildungen. Die aufwendige Behandlung und die psychosozialen Belastungen durch die Spaltbildung hinterlassen unter Umständen einen bleibenden Einfluss auf das Kind. Ziel der Studie war die Untersuchung der psychosozialen Funktionsfähigkeit von 4- bis 7-jährigen Kindern mit nicht syndromassoziierten LKGS-Spalten.Material und Methodik:Die gesundheitsbezogene Lebensqualität wurde mit dem revidierten, deutschsprachigen KINDL-Fragebogen erfasst. Dieses Instrument besteht aus 24 likertskalierten fünfstufigen Items, die sich über sechs Dimensionen erstrecken (körperliches Wohlbefinden, psychisches Wohlbefinden, Selbstwert, Familienleben, Freunde und Schule). Der Gesamtwert wird aus der Summe der einzelnen Itemwerte gebildet. Dem KINDL-Fragebogen wurde ein chronisch-generisches Modul für chronische Erkrankungen hinzugefügt, bestehend aus sechs Items, sowie ein spezielles Elternmodul, bestehend aus 22 Fragen. Höhere Ergebniswerte zeigen ein höheres Maß an gesundheitsbezogener Lebensqualität an. Alle Eltern von 4- bis 7-jährigen Kindern mit nicht syndromassoziierten LKGS-Spalten, die das Kompetenzzentrum für oro- und kraniofaziale Fehlbildungen der Universitätsklinik Köln aufsuchten, wurden zur Teilnahme an der Studie eingeladen.Ergebnisse:Insgesamt wurden 74 Familien angeschrieben, von denen 61 an der Studie teilnahmen (Teilnahmequote von 82%). Die 61 Kinder (32 Jungen, 29 Mädchen) hatten ein Durchschnittsalter von 5,39 Jahren. Die Durchschnittswerte der Gesamtskala waren für Kinder mit LKGS-Spalten geringfügig niedriger, jedoch zeigte ein Vergleich zwischen Kindern mit LKGS-Spalten und ohne LKGS-Spalten keinen statistisch signifikanten Unterschied in der gesundheitsbezogenen Lebensqualität.Schlussfolgerung:Die vorliegende Studie zeigte, dass 4- bis 7-jährige Kinder mit LKGS-Spalten im Vergleich zu Gleichaltrigen ohne LKGS-Spalten keine ausgeprägten psychosozialen Probleme haben.

Influence of coronal restorations on the fracture resistance of root canal‐treated premolar and molar teeth: A retrospective study

To evaluate the influence of coronal restorations on the fracture resistance of endodontically treated teeth, 676 root canal-filled and restored posterior teeth were evaluated after a mean period of 9.7 (± 2.8; minimum: 5) years. A total of 86.2% of the endodontically treated and restored teeth survived the mean observation period of 9.7 years without fracture. The overall survival period was 13.6 (± 0.2) years. All teeth with gold partial crowns survived without fractures (n = 24). Teeth with crowns and adhesively sealed access cavities showed a mean survival period of 15.3 (± 0.4) years, with crown and bridge restorations 14.0 (± 0.3), with individual metal posts 13.9 (± 0.2), with composite fillings 13.4 (± 0.5), with prefabricated metal posts 12.7 (± 0.6), with amalgam fillings 11.8 (± 0.6) and with glass ionomer cements (GIC) 6.6 (± 0.5) years. Teeth with one or two surfaces restored by amalgam, composite or GIC showed a significantly lower fracture rate than teeth with three and more restored surfaces (P < 0.05). The mean fracture rate of teeth restored with GIC was significantly higher when compared with all other groups (P < 0.001). In general, endodontically treated teeth restored with prosthetic restorations demonstrated a significantly lower mean fracture rate than teeth restored with fillings. Cavities with up to three surfaces may well be successfully restored adhesively with composite filling material.

Applying Principles of Good Practice for Translation and Cross-Cultural Adaptation of Sleep-Screening Instruments in Children

With the increase in the number of international projects in pediatric sleep medicine, the need to adapt sleep-screening tools for use in cross-cultural settings has rapidly grown. However, accepted procedures for translating and adapting existing measures are not uniformly and consistently incorporated in epidemiologic studies, resulting in potential measurement problems. The aims of this brief report are to (a) give an overview of principles for the translation and cultural adaptation of pediatric sleep-screening instruments and (b) illustrate these procedures in describing the translation and adaptation of two widely used pediatric sleep-screening tools for a German population. Challenges in the development of cross-cultural adaptations of parent-report sleep-screening measures for children are also discussed.

The prevalence of dental fluorosis in relation to water or salt fluoridation and reported use of fluoride toothpaste in school-age children

Aim: To compare prevalence of dental fluorosis (DF) in permanent teeth in children whose domestic water supply was fluoridated since birth with that in a community where fluoridated salt was available. A second aim was to analyse the relationship between DF prevalence and reported use of fluoride toothpaste in early childhood. Study Design: Cross-sectional study. Methods: A representative, random sample of 12-year-old children was examined in water fluoridated Dublin (Ireland) and non-water fluoridated Freiburg (Germany), where fluoridated salt was available. DF was recorded using the Dean’s Index. The child’s early experience of toothpaste use was recorded using a questionnaire. Results: 377 children in Dublin and 322 children in Freiburg were examined. In Dublin 11.7% of the whole sample had a ‘Questionable’ level of DF, 9.8% had ‘Very Mild’, 3.7% had ‘Mild’ and 0.3% had ‘Moderate’ fluorosis. The corresponding percentages in Freiburg for all children were 10.9%, 4.0%, 3.4% and 0%. The results suggest that children in Dublin started brushing their teeth at an older age than in Freiburg, but no difference in DF levels was found between ‘early’ and ‘late’ users. Statistics: Fisher’s test revealed that the difference in DF levels between the two populations was statistically significant (p=0.03). Conclusions: The prevalence of aesthetically important DF (‘Mild’ and ‘Moderate’) was low and similar in both communities and considerably lower than the expected level at water fluoridation concentrations of 1ppm. However, the prevalence of ‘Very Mild’ fluorosis was twice as frequent in Dublin than in Freiburg.

Dental caries experience and barriers to care in young children with disabilities in Ireland.

OBJECTIVE Dental caries among preschool children remains a significant dental public health problem. In Ireland, there are no national data available regarding dental caries levels in preschool children. Furthermore, the number of young children with disabilities and their dental caries levels remains unknown. The aim of the present study was to measure the dental caries levels in a sample of preschool children with disabilities. METHOD AND MATERIALS A team of trained and calibrated dentists examined a sample of all 0- to 6-year old preschool children with disabilities in two health service administrative areas under standardized conditions. Dental caries was recorded using WHO criteria. RESULTS Of a total of 422 participants, 337 datasets were included in the study. Of these 337 examined children, approximately 75.1% had a cognitive disability and 12.9% had a noncognitive disability. In 12% of the children, a diagnosis had not yet been established. Dental caries at dentin level was detected from the age of 4 years. The overall mean decayed/missing/ filled teeth (dmft) was 0.49 (SD, 1.39). The analysis of mean dmft levels in children with positive (dmft > 0) scores revealed a mean dmft of 1.14. CONCLUSION The evidence from this study demonstrated that dental caries levels in preschool children with disabilities in Ireland are low when compared with the general population. Furthermore, children aged 3 years or younger exhibited no dental caries at dentin level and therefore were not affected by early childhood caries. An adjustment of current oral health prevention practice may lead to a further reduction in dental caries levels in this section of the child population.