Access to dental services for people with a physical disability: a survey of general dental practitioners in Leicestershire, UK.

OBJECTIVE: To investigate the availability of facilities, including parking, accessibility and toilet amenities, for physically disabled people at dental practices in Leicestershire, and views relating to the provision of treatment, as reported by general dental practitioners. BASIC RESEARCH DESIGN: A cross-sectional postal questionnaire-based study. SETTING: General Dental Service practices in Leicestershire, United Kingdom. PARTICIPANTS: Questionnaires were sent to all General Dental Service practices (n=123) within Leicestershire. MAIN OUTCOME MEASURES: Facilities for physically disabled people as reported by general dental practitioners and views of practitioners in relation to provision of treatment. RESULTS: The response rate from general dental practices was 80%. The views of 120 (42%) of the 284 dentists approached relating to the provision of treatment to people with a physical disability were recorded. Although up to 77% of the dental practices were considered by practitioners to be accessible to someone using a wheelchair, only 7% also had suitable parking and toilet facilities. The majority of responding dentists treated patients with a physical disability, but 76% of practitioners found it difficult to provide treatment to this group. Concerns regarding the financial cost of providing treatment were raised. There is evidence that conditions are less than optimal in general practice settings for patients with a physical disability receiving treatment. Only nine of the 123 practices in Leicestershire had appropriate parking, access and toilet facilities for physically disabled people. CONCLUSION(S): Facilities for physically disabled people at general practices in Leicestershire are limited. If inequalities in dental health among the physically disabled are to be successfully reduced, steps must be taken to make practices more easily accessible with suitable facilities, and to increase awareness of services offered by appropriate dental practices.

Verifiable CPD paper: factors that influence the dental attendance pattern and maintenance of oral health for people with multiple sclerosis.

OBJECTIVE: To determine the impact of multiple sclerosis (MS) on patient attendance at dental practices and maintenance of oral health. DESIGN: A cross-sectional postal questionnaire-based study. SETTING: Leicestershire, United Kingdom. SUBJECTS AND METHODS: People with MS in Leicestershire identified from local health authority records (n = 476). MAIN OUTCOME MEASURES: Number registered at dental practice, frequency of attendance, issues and perspectives relating to attendance and maintenance of oral health. RESULTS: A response rate of 61% (n = 289) was obtained. When compared to the general population, a higher number of people with MS were registered with a dentist (49%:88%) and displayed more frequent practice attendance (71%:81%) in the past year. People with MS reported difficulties in attending a dentist and maintaining oral health, which were exacerbated by deterioration in general health. Problems relating to reduced personal mobility had the greatest impact on attendance. CONCLUSIONS: MS has a negative impact on perceived patient attendance and maintenance of oral health. Patients with a progressive disability could benefit greatly from the provision of preventive oral health care. The importance of seeking care earlier rather than later needs to be emphasised to both professionals and patients alike. Further efforts are required to increase awareness of the importance of oral health to the quality of life of people with MS and ensure that individuals with physical disabilities receive the same access to dental services as the able-bodied.

The 80-20 phenomenon (80:20 distribution of caries)--myth or fact.

For the past decade the phrase '80% of caries experience is found in 20% of the population' has been repeated so frequently, including by respected academics, that it has become accepted as fact by many in the dental profession. But is it a true representation of the state of dental health in the UK population, or an unsubstantiated convenient statement? Epidemiological data do not support the assertion.

The effect of socio-economic status and ethnicity on the comparative oral health of Asian and White Caucasian 12-year-old children.

OBJECTIVE: To investigate the oral health of 12-year-old children of different deprivation but similar fluoridation status from South Asian and White Caucasian ethnic groups. DESIGN: An epidemiological survey of 12-year-old children using BASCD criteria, with additional tooth erosion, ethnic classification and postcode data. CLINICAL SETTING: Examinations were completed in schools in Leicestershire and Rutland, England, UK. Participants A random sample of 1,753 12-year-old children from all schools in the study area. MAIN OUTCOME MEASURES: Caries experience was measured using the DMFT index diagnosed at the caries into dentine (D3) threshold, and tooth erosion using the index employed in the Children's Dental Health UK study reported in 1993. RESULTS: The overall prevalence of caries was greater in White than Asian children, but varied at different levels of deprivation and amongst different Asian religious groups. There was a significant positive association between caries and deprivation for White children, but the reverse was true for non-Muslim Asians. White Low Deprivation children had significantly less tooth erosion, but erosion experience increased with decreasing deprivation in non-Muslim Asians. CONCLUSIONS: Oral health is associated with ethnicity and linked to deprivation on an ethnic basis. The intra-Asian dental health disadvantage found in the primary dentition of Muslim children is perpetuated into the permanent dentition.

The prevalence of tooth erosion in 12-year-old children.

OBJECTIVES: To establish the prevalence of tooth erosion in a representative sample of 12-year-old children in Leicestershire and Rutland. To determine if gender, ethnic group, deprivation or caries experience influences the prevalence of erosion. METHODS: A random sample of 1,753 12-year-olds resident in Leicestershire and Rutland were examined in 62 schools; 906 were boys and 847 girls; 1,379 were Caucasian and 316 Asian. Tooth erosion was assessed using the index employed in the survey of Children's Dental Health in England and Wales (1993). The Townsend index was used to record deprivation. RESULTS: Tooth erosion was found in 59.7% of the children, with 2.7% exhibiting exposed dentine. Significantly more boys than girls; Caucasian than Asian children; and those with caries experience, had erosion present (chi-square for all P<0.01). Overall no significant difference was found between deprivation categories, however socio-economically advantaged Caucasian children had significantly less tooth erosion than other groups. CONCLUSIONS: There was a high prevalence of tooth erosion in 12-year-old children. Significantly more erosion occurred in boys than girls, and culture appeared to influence prevalence. Children with caries experience had a higher prevalence of erosion than those without caries, which may reflect a lower level of dietary care. Deprivation seemed to affect the prevalence of tooth erosion in Caucasian children.

A multifactorial analysis of factors associated with dental erosion.

OBJECTIVES: This study prospectively examines the relationship of possible aetiological factors to the presence of tooth erosion in a cohort of children. PATIENTS AND METHODS: A random sample of 1,753 children was examined at age 12 and 1,308 of the same children were re-examined at age 14 years. The children were asked to complete questionnaires on both occasions, 1,149 subjects gave usable replies. The erosion index used was based upon the 1993 Survey of Children's Dental Health. Results were analysed using logistic regression. RESULTS: At age 12 significant positive associations were found between erosion and decay experience (odds ratio [OR] = 1.48), drinking fruit juice (OR = 1.42) or fizzy pop (OR = 1.59-2.52, depending on amount and frequency). The presence of calculus (OR 0.48) or eating fruit other than apples or citrus fruit (OR 0.48) reduced the chances of erosion. High consumption of carbonated drinks increased the odds of erosion being present at 12 years by 252% and was a strong predictor of the amount of erosion found at age 14. CONCLUSIONS: Of the factors investigated, a history of dental caries and a high consumption of carbonated drinks were most closely related to the presence of dental erosion. The risk of erosion bore a strong relationship to the amount and frequency of carbonated drink consumption.

Awareness of tooth erosion in 12 year old children and primary care dental practitioners.

OBJECTIVES: To compare the knowledge of tooth erosion in a sample of 12 year old children with that of the dentists responsible for their care and also to compare the giving and receiving of advice concerning erosion. METHOD: A random sample of 1753 children from all 62 state maintained schools in Leicestershire completed questionnaires. Questionnaires were also sent to the 257 General Dental Practitioners in Leicestershire. RESULTS: 1686 (96.2%) of children and 227 (82.5%) of dentists returned forms that could be analysed. 36% of dentists reported that they frequently noticed erosion on the teeth of their patients but 67.7% of dentists believed that less than 25% of 12 year olds had any erosion. 67.5% of dentists advised their patients about erosion only occasionally or rarely. Only 34.2% of the children had heard of tooth erosion and only 8.4% could recall their dentist mentioning the condition. 40% of children believed that the best way to avoid erosion was regular tooth brushing. CONCLUSION: The levels of awareness were low for both dentists and patients and the messages that were given by dentists were either forgotten or misunderstood by the children, or they were incorrect. Better communication and understanding is needed in this important area.

The progression of tooth erosion in a cohort of adolescents of mixed ethnicity.

OBJECTIVES: To establish the prevalence of tooth erosion in a sample of 12-year-old children and to monitor changes over the subsequent 2 years. METHODS: A random sample of 1753 children aged 12 years was drawn from all 62 state maintained schools in Leicestershire. A total of 1308 were re-examined 2 years later. Erosion was recorded on incisors and first molars using an erosion index based upon that from the Children's Dental Health in the United Kingdom 1993 survey. A score was also allocated to each subject according to the most advanced lesion in the mouth. RESULTS: Erosion was present in 56.3% of subjects at age 12 and 64.1% at age 14. Deep enamel or dentine was eroded in 4.9% and 13.1% of subjects, respectively, at the same ages. One hundred and sixty-one (12.3%) children who were erosion-free at 12 years of age developed erosion over the subsequent 2 years. Boys had more erosion than girls, as did white compared to Asian children. Associations were found between erosion experience and social deprivation. CONCLUSION: New erosive lesions developed in 12.3% of the subjects between the ages of 12 and 14 years. New or more advanced lesions were seen in 27% of the children over the 2 years of the study. Males, white children and social deprivation were significantly associated with erosion experience.

Asthma and tooth erosion. Is there an association?

OBJECTIVES: To investigate whether there is an association between asthma and tooth erosion in a representative random sample of adolescents in the East Midlands. METHODS: A random sample of 1753 12-year-old children was examined in all schools in Leicestershire and Rutland. 1308 children were re-examined 2 years later. Tooth erosion was assessed using the index employed in the Children's Dental Health in the UK Survey 1993. Asthma presence was recorded on a self-completed questionnaire at the time of the 12 years examination. Data on asthma prescribing over a one year period was obtained from the Prescription Pricing Authority. RESULTS: Asthma was present in 16.8% of 12-year-olds. Tooth erosion was recorded in 59% of children with asthma and in 59.7% who were asthma free. There was no significant difference in erosion prevalence between asthmatics and asthma free in a cohort of children at age 12 or 14 years, and the incidence of erosion was 12.8% and 12.3%, respectively. 88% of drugs prescribed for treatment of asthma had a pH above the critical pH of 5.5. CONCLUSION: There was no association between asthma and tooth erosion. The majority of drugs prescribed for the treatment of asthma are not potentially erosive.

Bilateral macrodontia of mandibular second premolars: a case report.

Macrodontia of single teeth is rare. This has been reported on only six occasions in scientific journals when affecting mandibular second premolars with associated morphological anomalies. The large crown size causes problems with eruption, and disrupts the dentition. There are consequent inherent difficulties for the extraction of these teeth. Once erupted, their anatomy predisposes them to caries. Most cases are seen in children, before interventive surgery has been completed. The morphological anomalies of these premolar Macrodonts appear quite distinct and may justify a separate unique categorization.

Multiple sclerosis, dental caries and fillings: a case-control study.

OBJECTIVES: To investigate the association between multiple sclerosis, dental caries, amalgam fillings, body mercury and lead. DESIGN: Matched case-control study. SETTING: Leicestershire in the years 1989-1990. SUBJECTS: Thirty-nine females with multiple sclerosis (of recent onset) were matched with 62 controls for age, sex and general practitioner. METHODS: Home interview of cases and controls within which there was an assessment of the DMFT index and blood and urine mercury and lead levels. RESULTS: The odds of being a MS case increased multiplicatively by 1.09 (95% CI 1.00, 1.18) for every additional unit of DMFT index of dental caries. This represents an odds ratio of 1.213 or a 21% increase in risk of MS in relation to dental caries in this population. There was no difference between cases and controls in the number of amalgam fillings or in body mercury or lead levels. There was a significant correlation between body mercury levels and the number of teeth filled with amalgam (controls: r = +0.430, P = 0.006, cases: r = +0.596, P = 0.001). CONCLUSION: There was evidence of excess dental caries among MS cases compared with the controls. This finding supports the strong geographical correlation between the two diseases. A further study of this association is recommended.