Knowledge, attitude and practice among Health Visitors in the United Kingdom toward children's oral health.

OBJECTIVES: The purpose of this study was to determine knowledge, attitude, and practical behavior of health visitors regarding children's oral health in the United Kingdom (UK). METHODS: A web-based self-administered survey with 18 closed and 2 open ended questions was distributed to a convenience sample of approximately 9,000 health visitors who were currently employed in the United Kingdom and a member of the Institute of Health Visiting. RESULTS: A total of 1,088 health visitors completed the survey, resulting in a response rate of 12%. One-third of the health visitors reported that they had not received oral health training previously. Almost all agreed that oral health advice/promotion should be included in their routine health visiting contacts. Previous oral health training/education was associated with an increase in oral health knowledge; confidence in entering a discussion with parents/caregivers and willingness to be involved in dental referral process. CONCLUSIONS: The results of our study support the need for health visitors to receive oral health training in oral health promotion including oral health risk assessment, guidance on evidence based up-to-date prevention measures, increasing the dental attendance prevalence at early stages and awareness of including specific oral health guidelines/fact sheets into their regular practice.

A new primary dental care service compared with standard care for child and family to reduce the re-occurrence of childhood dental caries (Dental RECUR): study protocol for a randomised controlled trial.

BACKGROUND: In England and Scotland, dental extraction is the single highest cause of planned admission to the hospital for children under 11 years. Traditional dental services have had limited success in reducing this disease burden. Interventions based on motivational interviewing have been shown to impact positively dental health behaviours and could facilitate the prevention of re-occurrence of dental caries in this high-risk population. The objective of the study is to evaluate whether a new, dental nurse-led service, delivered using a brief negotiated interview based on motivational interviewing, is a more cost-effective service than treatment as usual, in reducing the re-occurrence of dental decay in young children with previous dental extractions. METHODS/DESIGN: This 2-year, two-arm, multicentre, randomised controlled trial will include 224 child participants, initially aged 5 to 7 years, who are scheduled to have one or more primary teeth extracted for dental caries under general anaesthesia (GA), relative analgesia (RA: inhalation sedation) or local anaesthesia (LA). The trial will be conducted in University Dental Hospitals, Secondary Care Centres or other providers of dental extraction services across the United Kingdom. The intervention will include a brief negotiated interview (based on the principles of motivational interviewing) delivered between enrollment and 6 weeks post-extraction, followed by directed prevention in primary dental care. Participants will be followed up for 2 years. The main outcome measure will be the dental caries experienced by 2 years post-enrollment at the level of dentine involvement on any tooth in either dentition, which had been caries-free at the baseline assessment. DISCUSSION: The participants are a hard-to-reach group in which secondary prevention is a challenge. Lack of engagement with dental care makes the children and their families scheduled for extraction particularly difficult to recruit to an RCT. Variations in service delivery between sites have also added to the challenges in implementing the Dental RECUR protocol during the recruitment phase. TRIAL REGISTRATION: ISRCTN24958829 (date of registration: 27 September 2013), Current protocol version: 5.0.

Situación de salud oral de niños uruguayos portadores de coagulopatías hereditarias: Centro Hospitalario Pereira Rossell, Montevideo, Uruguay / Oral health in uruguayan children with inherited bleeding disorders: Pereira Rossell Hospital, Montevideo, Uruguay

Propósito: describir la situación de salud oral de los niños portadores de coagulopatías atendidos en el Servicio de Hemoterapia del Centro Hospitalario Pereira Rossell de Montevideo,Uruguay, entre febrero del 2008 y diciembre del 2009, y compararla con un grupo sin coagulopatías. Método: se realizó un estudio retrospectivo de casos y controles. El grupo deestudio estuvo conformado por 39 pacientes (edad: 8,62 ±4,20 años) y el grupo de control, por 78 (edad: 6,5 ± 2,88 años). El análisis de los hallazgos fue descriptivo. Resultados: enel grupo de niños con coagulopatías se encontró un índice ceo-d 2,85 ± 2,41 y un CPO-d 1,96 ±2,59, ambos ligeramente superiores al grupo control. Según la clasificación de lacoagulopatía se registró: hemofilia A en 17 pacientes, hemofilia B en 7, deficiencia de factor XII en un paciente y enfermedad de von Willebrand en 14. La adherencia al tratamientofue calificada como buena en 15 pacientes, mientras que fue mala en los 24 pacientes restantes. Conclusión: este es un primer reporte de salud oral en niños con coagulopatías en Uruguay. Es necesario hacer un seguimiento y aumentar la cobertura de este programa para mantener la salud oral de estos pacientes...

Aim: Describe the oral health status of children with inherited bleeding disorders who attended the Pereira Rossell Hospital in Montevideo Uruguay for dental care, between February 2008 and December 2009, and compare it with children without bleeding disorders. Methods:A retrospective case-control study was carried out. The study group consisted of 39 patients (age: 8.62 ± 4.20 years), while the control group had 78 patients (age 6.5 ± 2.88). Descriptive analysis was done to the data. Results: The study group had a dmf-s index 2.85± 2.41 and a DMF-s 1.96 ± 2.59, being slightly higher than in the control group. The bleeding disorder classification was: Hemophilia A, 17 patients; Hemophilia B, 7 patients; factor XII deficit, 1 patient; and Von Willebrand disease, 14 patients. Commitment to the treatmentwas determined as good in 15 patients and bad in 24 patients. Conclusion: This is the first oral health report on children with bleeding disorders from this program in Uruguay. It isnecessary to follow up the patients and increase the program coverage in order to maintain the oral health of this kind of patients...

Role of pediatric nurse practitioners in oral health care.

Dental caries remain the most prevalent unmet health need in US children. Access to care is particularly problematic for poor children and is compounded by the shortage of dentists to meet the needs of this patient population. Expanding the roles of pediatricians, family physicians, and pediatric nurse practitioners (PNPs) who provide primary care services to children may be a strategy to address in this issue. Enhancements in current PNP education and certification processes are needed to support the expansion of oral health-related clinical responsibilities. Although oral health is included in the published curriculum for PNPs and certification exams require specific oral health knowledge, gaps in postgraduate training persist and few data document the extent to which current oral health-related educational goals are being achieved. We recommend enhancements in oral health education and research to evaluate curriculum innovations, the development of partnerships between stakeholder groups to leverage existing resources, and ongoing surveillance of oral health-related practice patterns among PNPs. Leadership at the national level is needed to develop policies that support curriculum changes and the implementation of oral health practice guidelines for PNPs that will improve access and reduce health disparities.

Evaluación del control odontológico de niños sanos realizado por enfermera / Evaluation of healthy children oral control perfomed by nurse

La Salud Bucal ha sido reconocida como una de las 16 Prioridades de Salud País, incluyéndola como una de las actividades preventivas del Control de Niños Sanos, recibiendo la denominación de Control Odontológico de Niños Sanos. Para conocer la situación actual de éste en el Consultorio Externo Valdivia y determinar si se siguen las normas establecidas para la programación, infraestructura, capacitación y ejecución, se planteó este estudio cuantitativo de tipo descriptivo, con una muestra correspondiente a 254 fichas a las que se les aplicó un Formato para Revisión de Registros y un cuestionario a las 5 enfermeras responsables de la realización del control de niño sano. Los resultados muestran que el Control Odontológico del Niño Sano se realiza de regular forma y que la cobertura alcanzada (82,28 por ciento) es menor a lo estipulado en la norma. Finalmente se recomienda realizar capacitación en los aspectos deficientes y programar evaluaciones y supervisiones periódicas

Experiences with sedation and restraint during dental treatment in Romania.

In August, 1995 dental treatment was provided in an orphanage in Romania. This treatment took place over three weeks using three different dentists. Two dental nurses served for full the duration. For the last two weeks the team was joined by a dental health educator. All have given accounts of their time in Romania. The patients had various degrees of handicap but generally co-operation for treatment was poor. Most patients needed pre-operative sedation of oral valium. A papoose board was used for restraint. All the contributors agree that this was extremely helpful in controlling the patients. Dental treatment was mostly-restricted to extractions. A parallel preventive programme was run by the dental health educator. The team encountered bureaucratic problems which were overcome. All 220 children in the orphanage were screened and treated. Local children and adults were also given dental treatment when time allowed. The team wish to express gratitude to all who helped and supported them. They plan a future mission in 1997. In 1994, a dental team had previously travelled to Romania and carried out treatment of handicapped children using sedation & restraint. The principal difference between 1994 and 1995 was the introduction of the papoose board as the method of restraint. The papoose board is a temporary restraint device for use during medical or dental procedures. It is a set of canvas flaps with velcro fasteners on a board. A head strap and wrist straps are important accessories. Pre-operative sedation was given to the children 2-3 hours in advance of dental treatment. This usually was 10-20 mg oral valium. The child was then led into the dental surgery by hand and placed on the papoose board, which was already situated on the reclined dental chair. Before the child realised what was happening the wrist straps and leg straps were in place. Within seconds the other straps were closed and the child was totally restrained and ready for dental treatment. Dental treatment was then carried out using local anaesthesia. Care has to be taken that the restraint does not impair the patient's breathing, circulation, cause over-heating or positional injuries. A dental health education programme was run in parallel with the treatment service. The individual accounts of experiences follow. Firstly, the joint account of Dental Nurses Catherine Treacey and Karen Vaughan from the Dublin Dental Hospital, who were working for the full three weeks. Then follow the accounts of the dentists. On week 1 by Anne O'Neill, who works with the Eastern Health Board in the Dun Laoghaire area, week 2 by Robert Gorby, a dentist in private practice in Carlow, and week 3 by Brendan Fanning who works part-time for the Eastern Health Board, in Wicklow and part-time in practice in Ashford, Co. Wicklow. The final account is of the dental health education programme by Miriam Henshaw, Health Educator who works for the Eastern Health Board in the Wicklow area.

Pediatric dental rehabilitation procedures in the OR.

Children with significant baby bottle tooth decay and children who are challenged by significant physical and emotional limitations are candidates for dental rehabilitaion procedures with general anesthesia. Rehabilitation of children's primary teeth is important to prevent pain, infection, and tooth loss. To provide skilled care for children undergoing dental rehabilitation procedures, perioperative nurses must understand normal dentition, tooth anatomy, and caries prevention and formation and be able to meet children's developmental and emotional needs. Perioperative nurses also must collaborate with dentists to maintain appropriate supply inventories that are unique to dental rehabilitation procedures.