A comparison of the nutritional knowledge of dental, dietetic and nutrition students.

Conflicts in dietary messages remain widespread. Such conflicts can have negative effects on the behaviour, motivation and attitudes of individuals. Inconsistencies in dietary advice may be linked to inadequate training of professionals. Literature suggests that the nutrition training of dentists and oral health training of dietitians and nutritionists is limited. This study was designed to provide information on the nutritional knowledge of dental, dietetic and nutrition students and how this conforms to national nutritional guidelines, identifying differences between professional groups and conflicts in undergraduate training. Self-administered questionnaires were completed by 124 dental, dietetic and nutrition students at Cardiff University and the University of Wales Institute, Cardiff (UWIC). Significant inter-group differences (p <0.05) were observed in relation to recommendations concerning the between-mealtime consumption of a wide range of snacks and drinks. Dental students were mainly concerned with oral health problems (for example, acid erosion), while dietetic and nutrition students were mainly concerned with general health problems (for example, obesity). Just over a third of dental students felt that they had received sufficient training in the dietary management of patients. In conclusion, a common risk-factor approach and consistent nutrition guidelines are essential to improve health. In addition, recommendations should be made to incorporate oral health into the training of nutritionists and general health into the training of dentists.

An assessment of nutritional information in oral health education leaflets.

INTRODUCTION: Dental caries prevalence in UK children remains high and obesity, closely linked to Type 2 diabetes, is rising. Literature suggests that dentists may not give dietary advice due to a lack of clear and consistent guidelines. OBJECTIVE: The aim of the study was to determine whether oral health education leaflets with a food and nutritional focus conform to existing UK national nutritional guidelines from the Department of Health (DoH), the Food Standards Agency (FSA) and the Committee on Medical Aspects of Food and Nutrition Policy (COMA). METHOD: A sample of 30 information leaflets, aimed at parents and children aged 3-16 years, was sourced during the winter of 2005-2006. A qualitative content analysis was carried out to identify key recommendations on type, frequency and quantity of food and drink and general diet-related health advice. RESULTS: Most leaflets (21) promoted milk and water in agreement with nutritional guidelines. Timing of sugary food and drink to mealtimes (25) and decreasing frequency of 'sugary' e.g. non-milk extrinsic (NME) sugar containing foods (22) and drinks (25) reflected guidelines. Inconsistencies were, however, recorded in the leaflets. Five leaflets advised that frequency of consumption rather than the amount of sugary food or drink was important for oral health. This conflicts with nutritional guidelines, aimed at tackling obesity, to decrease both amount and frequency. There was conflicting advice on healthy snacks. Crisps were presented as 'healthy' by two leaflets; another two advised against snacking on dried fruit, conflicting with FSA guidelines that dried fruit contributes to "5 a day". Sixteen leaflets promoted cheese as 'healthy' with no limits on portion size; this could conflict with nutritional guidelines associated with percentage energy contribution of saturated fat to the diet. CONCLUSION: While there was agreement between leaflet content and nutritional guidelines, there were inconsistencies. Dental professionals should acknowledge these when selecting leaflets for lay dissemination.

The United Kingdom's specialist workforce in paediatric dentistry: current and future trends.

OBJECTIVE: To provide information relevant to the current and predicted future profile of the UK's specialist workforce in paediatric dentistry. DESIGN: Postal questionnaire. SUBJECTS: Two hundred and twenty-one registered dentists whose names appeared on the Specialist List in Paediatric Dentistry and who were identified as resident within the United Kingdom. RESULTS: Questionnaires were returned by 192 specialists, a response rate of 86.9%. This paper is, however, based on data provided by 187 respondents currently practising in the United Kingdom (54 (28.9%) male and 133 (71.1%) female). The majority of respondents were based in England (138) and practised in hospital settings (120). Eighty-two respondents (14 males and 68 females) stated that they were working part-time and 57 (5 males and 52 females) indicated that they had already taken a break at some time during their career. Eighty-four (45.2%) respondents plan to retire during the next ten years. CONCLUSIONS: Working patterns associated with a feminised workforce will have a considerable impact on the volume of service that can be provided. Workforce planners must be cognisant of the need to increase the number of specialists in training to take account of service lost through part-time working and career breaks.

Paediatric dentistry in outreach settings: an essential part of undergraduate curricula?

INTRODUCTION: Although placements in primary care settings remote from dental schools are becoming a common feature of undergraduate dental curricula, little evidence is available regarding the experience of paediatric dentistry gained in this way. MATERIALS AND METHODS: Treatment logs relating to salaried primary care placements undertaken by the Class of 2007 at Cardiff University School of Dentistry were examined, particular attention being paid to paediatric-specific procedures. RESULTS: Forty-nine logs relating to placements undertaken in South East Wales and 51 relating to those in North Wales were retrieved. In South East Wales, 90% of students gained experience of primary tooth restoration, 61% carrying out primary endodontics. Sixty-three percent of students undertaking placements in South East Wales and 69% of those placed in North Wales gained experience of primary tooth extraction under local anaesthesia. All but three students gained experience of administering inhalation sedation. DISCUSSION: The findings of this study should go some way towards reassuring those who have expressed concern that recruitment difficulties within dental schools inevitably lead to increasing numbers of students qualifying without clinical experience of paediatric dental procedures considered to be within the remit of a newly qualified dental practitioner. However, there remains wide variation in the breadth and depth of experience of individual students and it is still possible for some students to graduate without what might be considered core experience in paediatric dentistry. CONCLUSION: Salaried primary care settings are ideally placed to provide students with experience of paediatric-specific procedures. Clinical education in paediatric dentistry should, therefore, incorporate the strengths of dental school and placement education.

Case report: segmental odontomaxillary dysplasia--a rare disorder.

BACKGROUND: Segmental odontomaxillary dysplasia (SOD) is a rare developmental disorder of the maxilla characterised by abnormal growth and maturation of bone, teeth and gingival of the affected segment. Due to the rarity of the disorder, the full range of clinical manifestations is unknown. Since there are concerns that cases may be subject to misdiagnosis, this report aims to increase awareness of the condition among paediatric dentists. CASE REPORT: A 7-year-old boy was initially referred regarding failure of eruption of maxillary primary molars. Characteristic clinical and radiographic findings led to the diagnosis of SOD. Interestingly, the patient presented with unilateral ectopic eyelashes, a finding previously unreported in association with this condition. TREATMENT: Reassurance was provided regarding the benign nature of the condition. While no active intervention was needed at the time of diagnosis, close monitoring is essential. Future management may require surgical, orthodontic and prosthetic input. FOLLOW-UP: A period of four years elapsed between initial presentation of the condition and its definitive diagnosis. No significant increase in the unilateral maxillary swelling was noted. The patient will continue to be monitored on a regular basis. CONCLUSION: SOD is a rare cause of facial asymmetry. Prompt diagnosis can reassure both patient and healthcare professionals. Reporting of cases is encouraged to help determine the full range of clinical manifestations and establish a management protocol.

Dermatitis artefacta of the lip in an adolescent.

UNLABELLED: Self-inflicted trauma is found in several patient groups including those with learning and developmental delay, the very young and those suffering from psychiatric disturbance. The diagnosis of artefactual disease can only be made when all possible organic disease has been excluded by specific investigations. The case presented is that of a 15-year-old girl complaining of persistent bleeding and crusting of her lips. Investigations provided no real information as to the cause of the allegedly spontaneous bleeding. The diagnosis of artefactual disease was finally decided upon and a referral to a child and adolescent psychiatrist made. CLINICAL RELEVANCE: Patients with unusual clinical signs may be examined regularly by their GDP. This case clearly illustrates the importance of considering a psychological disorder and referral in the differential diagnosis of conditions appearing with unusual clinical signs.

The Cardiff dental survey: oral hygiene and gingival health between the ages of 11-12 and 30-31 years.

OBJECTIVE: To examine oral hygiene and gingival health in relation to ageing in the second and third decades. DESIGN: Cohort study. SETTING: Cardiff, 1981, 1984, 1989 and 2000. SUBJECTS AND METHODS: Three hundred and thirty-seven subjects were examined at the ages of 11-12 and 30-31 years and 250 at baseline and all follow-up examinations; plaque and bleeding on probing were recorded. RESULTS: Oral hygiene and gingival health improved as subjects moved through adolescence to adulthood. In general, females demonstrated less plaque and gingivitis than males. Whole mouth mean plaque and bleeding scores were lower at age 30-31 than 11-12. In those subjects examined on all four occasions, a switch from buccal to lingual predominance in the distribution of plaque and gingivitis occurred between 11-12 and 15-16 years. Oral hygiene and gingival health at 30-31 were statistically significantly associated with these parameters at previous examinations but this association became weaker as the interval between the two examinations lengthened. CONCLUSIONS: Although oral hygiene and gingival health improve between adolescence and adulthood, individual practices are established at a relatively early age. In encouraging adolescents and young adults to improve standards of oral hygiene, emphasis should be placed on the importance of brushing lingual surfaces.

Cardiac risk factors for dental procedures: knowledge among dental practitioners in Wales.

OBJECTIVES: To determine knowledge and educational needs of dental practitioners in Wales regarding congenital or acquired cardiac disease and the provision of antibiotic prophylaxis. DESIGN: Self-administered postal questionnaire. SETTINGS: Cardiff University Dental Hospital, district general hospitals (HDS), all general dental practices (GDP) and community dental service (CDS) clinics throughout Wales. Methods A questionnaire sent to 1,182 dentists in Wales in 2004-5. RESULTS: 528 questionnaires were returned (a response rate of 45%). These were analysed using one-way analysis of variance to compare summary scores between the occupation groups. Significant differences in knowledge of cardiac risk factors for infective endocarditis and for dental procedures requiring cover were observed between the occupation groups. The majority of dentists (92% GDPs, 94% CDS and 77% HDS) requested postgraduate education in cardiac risk factors and laminated flow diagrams for their surgeries as the preferred educational format. CONCLUSION: The knowledge of Welsh dentists regarding cardiac conditions or procedures which are risk factors for paediatric and adult patients varied according to place of work. The study identified potential for under- and over-prescription of antibiotic prophylaxis within the current guidance. There was confusion as to which patient groups and cardiac conditions required prophylaxis and for which particular dental procedures. Postgraduate education detailing advances in cardiology practice is necessary for dentists.

Hurler's syndrome: dental findings in a case treated with bone marrow transplantation in infancy.

Hurler's syndrome, also known as mucopolysaccharidosis I (MPS I-H), is a rare condition inherited as an autosomal recessive trait. It is caused by a deficiency in alpha-L-iduronidase, an enzyme that participates in the degradation of the glycosaminoglycans (GAGs) heparin sulphate and dermatan sulphate. Children with Hurler's syndrome appear nearly normal at birth but, left untreated, show a progressive mental and physical deterioration caused by a build-up of GAGs in all organs of the body. Death is often caused by cardiac or respiratory failure and usually occurs before the second decade of life. In recent years, bone marrow transplantation (BMT) has been employed in the management of patients with Hurler's syndrome. However, the dental findings observed in these cases have not previously been reported in the dental literature. Here we report a patient aged 11 years and 6 months, presented to a Specialist Paediatric Dentistry Unit, who was successfully treated by BMT at 18 months of age.

An unusual distribution of supplemental teeth in the primary dentition.

Supernumerary teeth are more common in the permanent than the primary dentition. In the latter, the majority occur in the maxillary lateral incisor region or as a mesiodens. Indeed, in one study conducted in the USA, all 26 cases of primary supernumerary teeth examined were found to be lateral incisors. This report describes a case presenting with three erupted supernumerary (supplemental) teeth in the primary dentition, including, somewhat unusually, bilateral duplication of maxillary canines.

The dental management of a patient with hyperimmunoglobulinemia E syndrome: a case report.

Hyperimmunoglobulinemia E recurrent infection syndrome (also known as Job's syndrome) is a rare multi-system primary immunological disorder in which non-immunological abnormalities of the dentition, bones and connective tissue are also seen. A previous study has reported the occurrence of dental abnormalities in three-quarters of individuals diagnosed as suffering from this condition. The present authors report the case of a boy whose prolonged retention of the primary dentition was associated with delayed eruption of permanent teeth. They emphasize the need for early intervention in order to help minimize later orthodontic problems.

Special Care Dentistry: attitudes of Specialists in Paediatric Dentistry practising in the UK to the creation of a new specialty.

OBJECTIVES: This study was designed to examine the attitudes of Specialists in Paediatric Dentistry (SPDs) practising in the UK towards the creation of a specialty of Special Care Dentistry (SCD). DESIGN: Data were collected by postal questionnaire. Sample and methods. Two hundred and eleven dentists whose names were entered on the General Dental Council's Specialist List in Paediatric Dentistry, and who were resident and practising in the UK, were asked to complete a questionnaire consisting of both open and closed questions. RESULTS: Questionnaires were returned by 167 (79.2%) of the eligible SPDs. One hundred and sixty respondents (95.8%) expressed an opinion in relation to the creation of a specialty of SCD. One hundred and forty-three respondents (85.6%) stated that they supported such a proposal. However, slightly fewer (n = 149) respondents were prepared to indicate what they considered to be the remit of the proposed specialty. Ninety-two respondents (55.1%) considered that it should be restricted to the provision of specialist care for adults with 'special needs'; the remaining 57 respondents felt that it should provide specialist care across the entire age spectrum. CONCLUSIONS: Among SPDs, there is overwhelming support for the creation of a specialty of SCD, the majority view being that this should be dedicated to the provision of specialist care for adults with 'special needs'.

Fluid for thought: availability of drinks in primary and secondary schools in Cardiff, UK.

OBJECTIVE: While adequate hydration is undoubtedly essential for health, well-being, performance and learning, it is important to recognize that drinks may also have significant detrimental effects on both general and dental health. Since, on weekdays, at least half of a child's recommended daily fluid intake must be imbibed at school, this study sought to examine the provision of drinks in that setting. SUBJECTS AND METHODS: A self-administered postal questionnaire study was sent to the head teachers of all 107 state primary and all 20 state secondary schools in Cardiff, South Wales, UK. RESULTS: A response rate of 81.9% was achieved. Children had access to fresh drinking water from at least one drinking fountain in 69 (66.4%) of the 104 schools who responded to the questionnaire. Milk was available in 69 (80.2%) of the 86 responding primary schools. Sixteen (88.9%) of the 18 responding secondary schools had drink vending machines selling a variety of drinks. CONCLUSIONS: While primary schools appear largely to restrict the availability of drinks to those conducive to the maintenance of good general and dental health, secondary schools appear to foster the use of vending machines. Guidelines should be developed on the use and content of vending machines in schools in order to both meet school objectives and promote healthy choices.

Tooth agenesis: a report of missing molars in two generations.

A recent review has suggested that tooth agenesis is becoming more evident in society, though it is not known whether this observation is related to better detection methods and patient awareness or whether there is a real trend towards an increase in prevalence. In this paper we report developmental absence of permanent molars in two generations, and discuss the possible clinical implications of this pattern of tooth agenesis.

Premature exfoliation of primary molars related to the use of formocresol in a multivisit pulpotomy technique: a case report.

Since its introduction in 1904, formocresol has become one of the most widely studied dental medicaments. In the United Kingdom, it is the preferred primary tooth pulpotomy medicament of the majority of Specialists in Paediatric Dentistry. Reports of adverse effects resulting from its clinical use are rare. This paper presents a case of premature exfoliation of primary molars that may be related to the use of formocresol in a multivisit pulpotomy technique.

Vital pulpotomy in the primary dentition: attitudes and practices of Specialists in Paediatric Dentistry practising in the United Kingdom.

OBJECTIVES: This study was designed to examine the attitudes and practices of Specialists in Paediatric Dentistry practising in the United Kingdom in relation to vital pulpotomy in the primary dentition. DESIGN: Data were collected by postal questionnaire. SAMPLE AND METHODS: All dentists whose names were entered on the General Dental Council's Specialist List in Paediatric Dentistry, and who were resident and practising in the United Kingdom, were asked to complete a questionnaire consisting of nine questions. RESULTS: Questionnaires were returned by 184 (86.8%) of the eligible Specialists in Paediatric Dentistry. These yielded a sample group of 179 Specialists practising the primary vital pulpotomy technique. The most commonly used medicament was formocresol, with a 1 : 5 dilution being used by 66.5% of the sample. More than half (54.2%) of the Specialists practising the technique expressed concern regarding their preferred medicament. Without exception, their concerns related to the potential adverse effects of formocresol and formaldehyde. Seventy-five respondents (41.9% of the sample) were considering changing their technique. One hundred and thirty-seven Specialists stated that they routinely took preoperative radiographs, while postoperative radiographs were routinely taken by 107 Specialists (76.5% and 59.8% of the sample, respectively). Rubber dam isolation was used by 62.6% of the sample. CONCLUSIONS: The majority of Specialists are adhering to the UK national clinical guideline for pulp treatment of the primary dentition. However, significant numbers are considering changing their chosen technique. There is a lack of consensus on the use of pre- and postoperative radiographs; specific guidance with respect to their use is required.

Increased primary tooth size in a 47,XXY male: a first case report.

Increased tooth size has previously been reported in association with Klinefelter syndrome. However, until now, this observation has been restricted to the permanent dentition. In this paper, we report increased mesio-distal width in the primary incisor and molar teeth of a 47,XXY male.

Can tooth brushing damage your health? Effects on oral and dental tissues.

Circumstantial evidence based on anecdote, case reports, epidemiological data and studies in vitro and in situ implicate tooth brushing with toothpaste with tooth wear, gingival recession and dentine hypersensitivity. This review attempts to assess the clinical significance of the potential harm produced by this most common oral hygiene habit. The toothbrush alone appears to have no effect on enamel and very little on dentine. Most toothpaste also has very little effect on enamel and in normal use would not cause significant wear of dentine in a lifetime of use. Wear of enamel and dentine can be dramatically increased if tooth brushing follows an erosive challenge. Gingival recession has a multi-factorial aetiology and certain individuals and specific teeth may be predisposed to trauma from tooth brushing. Tooth brushing is known to cause gingival abrasions but how these relate to gingival recession is not known. The role of toothpaste in gingival abrasion and recession surprisingly has received little if any attention. Gingival recession most commonly exposes dentine and localises sites for dentine hypersensitivity. Some toothpaste products can expose dentinal tubules but erosion is probably the more dominant factor in dentine hypersensitivity. There is no evidence to indicate that electric and manual toothbrushes differ in effects on soft and hard tissues. It is only under, over or abusive use or when combined with erosion that significant harm may be thus caused. In normal use it must be concluded that the benefits of tooth brushing far out-way the potential harm.

Development of low erosive carbonated fruit drinks. 1. Evaluation of two experimental orange drinks in vitro and in situ.

OBJECTIVES: To determine the in vitro erosive potential and in situ erosive effect of two new formulation low calorie carbonated orange drinks with that of two conventional diet products and water. METHODS: In the in vitro study, six specimens of deciduous and permanent enamel were randomly allocated to each of the five products and a '4h' protocol employed. In the in situ study, 15 healthy volunteers participated in a single centre, single blind, 5-phase crossover study, conducted according to Good Clinical Practice, and employing a validated model. RESULTS: The in vitro erosive potential of the experimental formulations was less than that of the comparators at all time points. Conversely, the observed erosive potential of both experimental formulations was greater than that of the control. Consistent statistically significant differences were found in relation to permanent enamel only. Unfortunately, the in situ study did not produce results entirely consistent with those of the in vitro study. Notably, a generally progressive loss of enamel was observed in specimens exposed to the control. CONCLUSIONS: The data from the in vitro study show the experimental formulations to have low comparative erosivity. However, the methodologies in vitro and in situ somewhat unusually do not correlate in ranking the erosivity of drinks. The results of this study should therefore be viewed with caution, further research being clearly warranted.