Balancing the role of the dental school in teaching, research and patient care; including care for underserved areas.

Inequalities within dentistry are common and are reflected in wide differences in the levels of oral health and the standard of care available both within and between countries and communities. Furthermore there are patients, particularly those with special treatment needs, who do not have the same access to dental services as the general public. The dental school should aim to recruit students from varied backgrounds into all areas covered by the oral healthcare team and to train students to treat the full spectrum of patients including those with special needs. It is essential, however, that the dental student achieves a high standard of clinical competence and this cannot be gained by treating only those patients with low expectations for care. Balancing these aspects of clinical education is difficult. Research is an important stimulus to better teaching and better clinical care. It is recognized that dental school staff should be active in research, teaching, clinical work and frequently administration. Maintaining a balance between the commitments to clinical care, teaching and research while also taking account of underserved areas in each of these categories is a difficult challenge but one that has to be met to a high degree in a successful, modern dental school.

Oral hygiene in 12-year-old disabled children in Flanders, Belgium, related to manual dexterity.

As part of a larger epidemiological survey of a stratified sample of 12-year-old handicapped children in Flanders, Belgium, the present study describes gingival health, gingival hypertrophy, oral cleanliness and the presence of calculus. Statistical analysis was performed with motor skills, brushing help, the use of chemical agents, the use of anti-epileptic drugs, the knowledge of parents and educators (or caregivers) and their opinion of the oral hygiene of their children/ pupils as response variables. From this study, it became clear that mildly mentally retarded and learning-impaired children had significantly better manual dexterity skills than moderately and severely mentally retarded and physically impaired children. However, this was not reflected in improved oral hygiene. The use of chemical plaque controlling agents was found to be extremely low and, with the exception of children with gingival hyperplasia, the users of these agents did not have better oral hygiene. No difference was found between subtypes in the opinion of parents and educators on oral status. There was, however, a difference between their assessment and the clinical picture. It was concluded that there was a need for in-service training programmes in oral health care for educators as well as for parents.

Oral health condition of 12-year-old handicapped children in Flanders (Belgium).

The dental condition of 626 12-year-old handicapped children with mild mental or moderate to severe mental retardation or learning impairment, being 25% of the population of each of these groups, was examined in Flanders. An evaluation of oral cleanliness showed poor oral hygiene in 31.8% of the children. No significant differences were found in oral cleanliness among types of handicapping conditions. The mean DMFT score was 2.9 (s: 2.6) and DMFS score was 5.4 (s: 5.6). Almost 21% of the children were free of caries or fillings. No significant differences were found among groups of handicapped children. Handicapped children presented a low level of restorative care (restorative index score: 48.7%). Mildly mentally retarded children demonstrated the lowest restorative index (43.9%). The caries experience of first permanent molars represented the largest part of the DMFT score (64.1%). Sealants were present in 7.9% of children examined. A considerable percentage of mildly mentally retarded children and learning impaired children did not brush daily (22.1% and 20.9%) and did not receive help with toothbrushing from their parents or carers (91.0% and 94.7%, respectively).

[Oral hygiene of handicapped subjects in Flanders]. / L'hygiène buccale des handicapés en Flandre.

As part of an epidemiology survey within the population of handicapped 12-year old in Flanders this article describes several parameters related to oral health. On the average, it became obvious that oral hygiene had to be seriously increased. The presence of plaque and calculus is very typical for types 1, 2, 4 and 8. In addition, it is most striking to conclude that groups where a maximum of self-handiness is expected, do not score any better. The application of chemical controlling agents and the use of fluoride supplements is found extremely low. Finally, a lack was found, with respect to adequate oral hygiene instructions. There is a real need for in-service training programs for educators as well as for parents.

[Status of the teeth and degree of care in handicapped in Flanders]. / Etat de la dentition et degré de soin chez les handicapés en Flandre.

In general, handicapped 12-year old do not show statistical relevant differences with non-handicapped age-matched children in Flanders regarding general caries prevalence, caries distribution and total caries experience. However, important differences were found for the restorative index showing a higher caries treatment need in handicapped children. When the results were analysed according to the type of handicapping condition, it was seen that children with borderline and mild mental handicap and children with speech-, language and/or learning difficulties show the most unfavorable picture. They have a high caries prevalence and caries experience and a low restorative index. Additional analysis of the results can throw some light on the presence of additional caries risk indicators and contributing caries risk factors.

[Dental status and dental preventive behavior in Flanders]. / Etat de la denture et comportement de prophylaxie dentaire en Flandre.

Socio-economic factors are important parameters for dental health status and preventive behavior. In an epidemiologic survey of +/- 8000 5- and 12-year old schoolchildren in Flanders significant differences in dental attendance, brushing habits and caries prevalence were found between 12-year old boys and girls. Ethnic differences were pronounced. Dental attendance and brushing frequency were lower in non-West-European children. These children showed a higher caries attack rate at the age of 5 but in 12-year olds the opposite was noted. Interprovincial differences should probably be attributed to differences in social levels.

[Polychlorodibenzo-p-dioxins (author's transl)]. / Les polychloro dibenzo-p-dioxines

Polychlorodibenzo-p-dioxins (chlorodioxins) appear most frequently by heating of chlorophenols in alkaline solution specially when producing organic derivatives. Consequently chlorodioxins may contaminate several industrial chemical products largely used, for instance, as pesticides. Occasionally, chlorodioxins are also synthesized from chlorophenols or their derivatives in situ during industrial processes. Chlorodioxins are the cause of chloracne and chick edema which killed thousands of broiler chickens in the U.S.A. Furthermore chlorodioxins seem to be foetotoxic possible even for man. The present paper is the first part of our work. It is a review of the chemical and toxicological properties of chlorodioxins. We hope to publish later a review of analytical methods and the results of our analyses.