Richard Balmer

The prevalence of molar incisor hypomineralisation in Northern England and its relationship to socioeconomic status and water fluoridation

BACKGROUND Molar incisor hypomineralisation (MIH) is a condition which has significant implications for patients and service provision. AIMS The aim of this survey was to determine the prevalence of MIH in 12-year olds in Northern England and to consider the relationship with socioeconomic status and background water fluoridation. DESIGN Twelve-year-old children were examined for the presence of MIH. Participating dentists were trained and calibrated in the use of the modified Developmental Defects of Enamel index. Children were examined at school under direct vision with the aid of a dental mirror. A diagnosis of MIH was attributed to a child if they had a demarcated defect in one or more of their first permanent molars. RESULTS Of 4795 children that were selected, 3233 (67.4%) were examined. Overall prevalence of MIH was 15.9% (14.5-17.1%). There was an association between prevalence of MIH and deprivation quintiles with a positive correlation in the first 4 quintiles (P < 0.05). There was no difference in prevalence between fluoridated Newcastle and other areas. CONCLUSION Prevalence of MIH is equivalent to other European populations. Prevalence was related to socioeconomic status but not to background water fluoridation.

The experiences with oral health and dental prevention of children with congenital heart disease

OBJECTIVE To examine the degree to which children, considered to be at risk from infective endocarditis, had received professional education and preventive procedures in regard to dental health, and to evaluate the knowledge of their parents of the link between oral health and infective endocarditis. MATERIALS AND METHODS Questionnaires were distributed to the families of 38 children under the care of paediatric cardiology. A short dental examination was carried out. Parents were asked if they knew why oral health was of particular importance in their child. RESULTS Of the children, 58% demonstrated evidence of previous or current dental disease, with 24% having had at least one filling, 13% with one or more teeth showing deficiency of enamel, and 39% with untreated dental caries. Only 79% of the children were registered with a dentist. According to Chi squared test, there was no difference in the dental health of registered and non registered children. Of the study group, 29% had received instruction in oral hygiene, 42% had received dietary advice, 13% had received advice regarding fluoride supplementation or had had fluoride professionally applied, and 8% had had fissure sealants. These percentages remained relatively low even if only registered children, or only registered children with previous or current dental disease, were considered. Only 64% of parents were aware of the link between the oral health of their children and infective endocarditis. Parents of children who were registered were more likely to be aware of this link than parents of children who were not registered. CONCLUSIONS In spite of being registered with general dental practitioners, few children with congenital heart disease had received basic education in dental hygiene. Even children known to have had dental disease and, therefore, considered to be more vulnerable, were overlooked.

Current concepts in hypophosphatasia: case report and literature review

BACKGROUND.  Hypophosphatasia (HP) is characterized by defective mineralization of bone and teeth because of deficient alkaline phosphatase activity. There are generally six recognized clinical forms, of which the most severe is often lethal prenatally or early in life. In milder forms, such as odontohypophosphatasia (OHP), premature exfoliation of primary teeth may be the only clinical manifestation. CASE REPORT.  A 20-month-old girl was referred to the Specialist Paediatric Salaried Dental Service within the Harrogate and District NHS Foundation Trust with mobility of tooth numbers 71 and 81. Clinical examination revealed grade III mobile 71 and 81, with minimal gingival inflammation and plaque deposits. There were no other dental findings and no significant medical history. Tooth numbers 71 and 81 exfoliated prematurely with no evidence of root resorption, shortly after presentation. Haematological and urinary investigations showed no abnormalities. Histological examination showed a complete absence of cementum. A diagnosis of OHP was made. After 10 months of dental follow-up, no further teeth have increased mobility. CONCLUSION.  Odontohypophosphatasia should be included as a differential diagnosis in children presenting with early loss of primary teeth. The dentist may be the first health care professional to whom the patient presents.

An evaluation of paediatric dental general anaesthesia in Yorkshire and the Humber

Background Following major change in UK policy regarding dental general anaesthesia (DGA) in 2001, there appears to be little information available about paediatric DGA services, their organisation, availability and utilisation.Aims To establish the location, organisation and monitoring systems of paediatric DGA services in Yorkshire and the Humber Strategic Health Authority and to audit these services against existing standards of best practice.Design A postal survey of all potential paediatric DGA providers in Yorkshire and the Humber.Results Thirty-one possible DGA service providers were identified, 24 of which provided paediatric DGAs. Of 84 DGA lists identified, 75 regularly treated children, and nine were run on an ad hoc basis. The lists were held in 20 centres. The number of patients treated per list varied depending on treatment provided, ranging from 3.9 to 7.5 patients per list. Maximum waiting times varied from three to 84 weeks. Outcome data recording methods varied. Just over half of respondents used the Hospital Episode Statistics system; the remainder used other systems, or none.Conclusions There was much variation in how DGA lists were organised. Most lists met some of the accepted standards, but very few met all. Waiting times were largely in accordance with national targets.

Understanding child neglect. Current perspectives in dentistry.

The aim of this paper is to update the reader on the subject of dental neglect in children. Recent national guidelines produced by the National Institute for Health and Clinical Excellence and the British Society of Paediatric Dentistry have raised the profile of this condition by providing specific, evidence-based recommendations for recognition and response to dental neglect. Dental neglect may be a sign of general neglect or may be considered maltreatment in itself. The specific dental and non-dental features are described and actions secondary to a diagnosis of dental neglect are discussed. Three types of intervention are described: preventive dental team management, preventive multi-agency management, and referral to child protection services. With increasing awareness of this condition and through access to the expertise of other specialist agencies in this field, the primary care practitioner can play a key role in safeguarding the welfare of children.

The dental health of children subject to a child protection plan

BACKGROUND In the United Kingdom, child maltreatment is an area of increased awareness and concern. AIM To compare the dental health of children subject to child protection plans with controls. DESIGN Children had to be aged between two and 11 years, medically healthy, and subject either to a child protection plan or attending the paediatric outpatient orthopaedic or general surgery clinics (control group). All children had a standardized oral examination. RESULTS Seventy-nine children were examined in each group. Children with child protection plans had statistically higher levels of primary tooth decay than controls (mean dmft 3.82 and 2.03, Mann-Whitney U test P = 0.002). After adjusting for socioeconomic status, the incidence rate ratios for the occurrence of dental caries in the primary dentition in children with a child protection plan was 1.76 (95% CI: 1.44-2.15) relative to the controls. There was no statistical difference in the levels of permanent tooth decay between the study and control groups (mean DMFT 0.71 and 0.30, respectively). The care index was significantly lower (P = 0.008, Mann-Whitney U test) in the study group (1.69%) compared to the control group (6.02%). CONCLUSIONS Children subject to child protection plans had significantly higher levels of dental caries in the primary dentition.

The oral health of children considered very high risk for infective endocarditis

BACKGROUND Children with previous experience of infective endocarditis or with prosthetic heart valve are considered at very high risk for infective endocarditis. AIM The aim of this study was to compare the dental health of a group of these children with a group of healthy controls and to determine parental awareness of the importance of good oral health. DESIGN Oral examination was carried out in 28 children with previous infective endocarditis or a prosthetic heart valve to assess oral health. Findings were compared to a healthy control group of 28. Questionnaires were distributed to the parents to assess awareness of oral health. RESULTS There was no significant difference in DMFT scores of study and control group (2.43 +/- 3.72 and 1.36 +/- 2.5 respectively) or in DMFT scores of study and control group (1.5 +/- 1.73 and 1.15 +/- 1.42 respectively), 36% of the study group had untreated caries. Parental knowledge of the link between oral health and infective endocarditis was excellent. CONCLUSIONS There were no significant differences between the oral health of cardiac children and healthy children although the dmft and DMFT scores of the study group were high. Of concern was the proportion of children with untreated caries in spite of good dental awareness and attendance.

An investigation into dental anxiety amongst paediatric cardiology patients

BACKGROUND There is evidence that children with cardiac conditions have high levels of untreated dental disease. One possible explanation is that they are more dentally anxious as a result of increased exposure to medical interventions. Therefore, the primary aim of this study was to compare the level of dental anxiety between paediatric cardiology patients and healthy children. METHODS The study group comprised 54 children (mean age 12.2 years) who attended the outpatient paediatric cardiology clinic in tertiary care. The control group (n = 53, mean age 12.38 years) was recruited from consultant-led new-patient orthodontic clinics. Child dental anxiety was measured using the Modified Child Dental Anxiety Scale (faces version). The parents completed the Modified Dental Anxiety Scale along with a questionnaire regarding their childs medical and dental histories. RESULTS The mean level of dental anxiety was significantly higher in the study group (P < 0.05). Analysis of covariance indicated that overnight hospital admission history may have influenced the strength of this relationship. CONCLUSIONS Paediatric cardiology patients had significantly increased levels of dental anxiety. It is likely that aspects of their medical history, notably overnight hospital admissions, are contributory factors.