Covid-19 y la odontología latinoamericana para pacientes con necesidades especiales / Covid-19 and latin american dentistry for patients with special needs / Covid-19 and dental care for patients with special needs in Latin America

Resumen La región de América Latina se ha convertido en la más afectada del mundo por la pandemia del COVID-19. Y personas con necesidades especiales, población ya vulnerable, están sufriendo un impacto significativo de la crisis actual. Dado que estas personas no pueden dejar de ser protegidas y cuidadas, un grupo de profesores de 10 países de América Latina se reunió para analizar la situación de la odontología para pacientes con necesidades especiales en la región. En todos los países, se evidenció que el confinamiento y las restricciones de desplazamiento están interrumpiendo el acceso a bienes y servicios esenciales para ellos. En cuanto a la odontología, la disposición general es posponer los procedimientos de rutina, a menos que sean clínicamente urgentes o de emergencia; adoptar estrictas medidas de protección personal y evitar o minimizar las intervenciones que puedan producir aerosoles. La atención odontológica remota, teleodontología, se considera como una herramienta fundamental en este momento, ya que permite evaluar la necesidad de atención presencial y ofrecer soporte, información y seguridad a los pacientes y familias. La pandemia nos ha demostrado, a todos, que impulsar la Promoción de la Salud es el verdadero camino, y que no debemos esperar a que se presenten condiciones que afecten la calidad de vida.

Resumo: A região da América Latina tem se tornado a mais afetada do mundo pela pandemia do COVID-19. E as pessoas com necessidades especiais, população já vulnerável, estão sofrendo um impacto significativo da crise atual. Uma vez que essas pessoas não podem deixar de ser protegidas e cuidadas, um grupo de professores de 10 países de América Latina se reuniu para analisar a situação da odontologia para pacientes com necessidades especiais na região. Em todos os países se verificaram que o confinamento e restrições de movimento estavam interrompendo o acesso a bens e serviços essenciais para eles. Para a odontologia, a orientação geral é adiar procedimentos de rotina, a menos que seja clinicamente urgente ou emergencial; adotar medidas rígidas de proteção individual e evitar ou minimizar intervenções que possam produzir aerossóis. O atendimento odontológico à distância, teleodontología, é considerada uma ferramenta fundamental neste momento, pois permite avaliar a necessidade de atendimento presencial e oferecer suporte, informação e segurança aos pacientes e famílias. A pandemia tem demostrado, para todos, que trabalhar na Promoção da Saúde é o verdadeiro caminho, e que não devemos esperar por condições que afetem a qualidade de vida.

Abstract Latin America has become the most affected region by the COVID-19 pandemic in the world. People with special needs-an already vulnerable population-are suffering terrible consequences on account of this crisis. These people need to be protected and cared for at all times. Therefore, a group of lecturers from ten Latin American countries came together to analyze the regional situation of dental care for patients with special needs. Every country shows evidence that lockdowns and movement restrictions interrupt these people's access to essential goods and services. The general course of action regarding dental care is to postpone routine procedures unless they are clinically urgent or an emergency, implement strict personal protection measures and avoid or minimize processes that may produce aerosols. Remote dental care is considered essential these days since it allows practitioners to assess the need for face-to-face care and offer support, information, and safety to patients and families. The pandemic has shown us all that supporting health promotion is the true path and that we should not wait until conditions that affect people's quality of life appear to act.

Avaliação do nível de percepção de cirurgiões-dentistas das redes pública e privada de um município do norte do Rio Grande do Sul sobre atenção em saúde a pacientes com necessidades especiais / Assessment dentists level of perception in public and private service of a city in the north of Rio Grande do Sul about health care for patients with special needs

Objetivo: identificar a percepção de cirurgiões-dentistas das redes pública e privada do município de Erechim, RS, sobre atenção em saúde a pacientes com necessidades especiais, avaliando conhecimento, preparo e limitações para o atendimento odontológico. Métodos: este estudo de caráter transversal ocorreu no período de março a agosto de 2019, por meio da aplicação de questionário próprio semiestruturado para cirurgiões-dentistas. Resultados: participaram da pesquisa 82 cirurgiões-dentistas, sendo a maioria (58,54%) atuantes na rede privada; 56,10% não cursaram uma disciplina específica em sua graduação sobre cuidados a pacientes com necessidades especiais. Em contrapartida, dos que cursaram, para a maioria, a disciplina era obrigatória e teórico-prática. Conclusão: apesar de somente 42,68% se sentirem muito bem ou bem preparados, somente 10,98% nunca realizaram atendimentos. Mesmo não tendo cursado uma disciplina específica em sua graduação, os cirurgiões-dentistas de Erechim, RS, realizam o atendimento e, quando necessário, o encaminhamento desses pacientes. Por manifestarem o interesse em se manterem atualizados sobre o tema, ações de educação continuada serão de fundamental importância.(AU)

Objective: assess dentists perception, about oral health care for patients with special needs, of public and private service of Erechim, RS, evaluating their knowledge, preparation and limitations for dental care. Methods: this cross-sectional research was conducted from March to August 2019, using questionnaires for dentists. Results: eighty-two dentists participated in the research, the majority (58.54%) are from the private service, 56.10% did not attend a specific discipline, in their graduation, about dental care for patients with special needs. In contrast, for those who attended, the discipline was compulsory and theoretical- -practical. Conclusion: although only 42.68% feel very well, or well prepared, only 10.98% never attended dental care. Even though they did not attend a specific discipline in their graduation, the dentists of Erechim, RS, perform dental care and, when necessary, they referral these patients. As they express their interest in keeping up to date on the topic, continuing education actions will be of fundamental importance.(AU)

Prevalence of Dental Caries among Visually Impaired Institutionalized Adolescents in Lagos State.

OBJECTIVES: To assess and compare caries prevalence among institutionalized visually impaired and sighted 10dash;19 year old children in Lagos State, Nigeria. METHODS: A cross sectional study of institutionalized visually impaired and sighted 10-19-year-old adolescents was carried out using the World Health Organisation (WHO) Basic Oral Methods caries diagnostic criteria. A random sample of 10-19-year-old visually impaired and sighted institutionalised children was carried out. The mean decayed, missing, filled teeth (dmft/DMFT) and significant caries (SiC) indices of both groups were obtained and compared with Chi-square test using SPSS version 20. RESULTS: Mean age of visually impaired participants was 16 years while that of sighted was 12.5 years. The male to female ratio was 1:1 among the visually impaired participants and 1:1.5 among the sighted. Caries prevalence of 28.8% (64/222), mean dmft/DMFT 1.98±1.25 and 27.5% (63/229), mean dmft/DMFT 1.90±1.28 were obtained for the sighted and visually impaired 10dash;19 years old children respectively. The significant caries (SiC) indices for both groups were 3.3. CONCLUSION: Caries prevalence among the visually impaired and sighted adolescents in this study was considerable with no significant differences between them. Both populations had significant caries experiences. There is therefore need for oral health promotion among both sighted and visually impaired institutionalized adolescents in this environment.

[Dental and oral surgical treatment of the mentally retarded in Hungary: the situation in the past, currently and hopes for the future]. / A szellemi fogyatékosok fogászati-szájsebészeti ellátásának múltja, jelene és remélt jövoje Magyarországon.

Introduction: Dental care for mentally disabled people poses a growing challenge for healthcare. In Hungary, the number of mentally disabled people needing special dental care is ca. 100 000. Aim: The aim of our retrospective analysis is to provide a summary of the demographic data and the treatment outcomes of patients with mental disorders treated at the Department of the Oral and Maxillofacial Surgery of the Semmelweis University in the past five years. Method: Dental care for patients with a severe level of mental disability can be carried out in general anaesthesia only. At Semmelweis University, in the Oral and Maxillofacial Department, 1717 mentally disabled adults received dental care during the past five years. (Patients included people with a mild, medium or severe level of mental disability, patients with Down's syndrome, autism, epilepsy or panic disorder.) Results: The single biggest achievement seems to be the fact that the issue of acute dental care and oral surgery has basically been settled. A workable relationship has been forged with foundations and organizations dealing with the problems of these patients. It has been realized, however, that in the case of mentally disabled patients there is an enormous need for prevention and ongoing care. Conclusions: Up to now no survey has been carried out in Hungary with the aim of objectively revealing the dental care needs of these patients. Internationally, however, several surveys have been published. It can be stated on the basis of these that both caries frequency and the presence of parodontal diseases increase in correlation with age and the level of disability. Oral hygiene is insufficient, patients or their caretakers do not get proper information, only a few of them receive adequate training and they are not motivated to keep up oral health. Dental care, except for tending acute cases, is not satisfactory. For the sake of prevention, cooperation is needed with non-governmental organizations, foundations, special education teachers and psychiatrists specialized in this field. Orv Hetil. 2019; 160(35): 1380-1386.

Oral health care for patients with developmental disabilities: A survey of Michigan general dentists.

AIMS: The aim of this study to examine the level of access to dental care in Michigan for individuals with DD and explore the dentists' practices, attitudes, and perceived barriers to providing care to this vulnerable population. METHODS AND RESULTS: A survey was mailed to a random sample of 1250 general dental practitioners with an active license in the State of Michigan. The survey included questions related to dentists' demographic information, opinion about willingness, barriers, and training needs associated with delivering care to children and adults with developmental disabilities. Descriptive statistics were computed and chi-squared tests and logistic regression models analyzed the association between predictor and key outcome variables. Results show that most dentists treated individuals with developmental disabilities (80.3%). Respondents who indicated that they currently do not treat these patients identified behavior management of patient (67.9%), inadequate training and experiences (52.4%) and severity of patient's condition (41.7%) as the most common reasons for not providing care to individuals with developmental disabilities. CONCLUSION: A majority of Michigan general dentists treat patients with developmental disabilities. Addressing barriers like training and improved reimbursements might help in increasing the number of dentists willing to treat patients with developmental disabilities.

Access to dental services for children with intellectual and developmental disabilities - A scoping review.

BACKGROUND: Children with Intellectual and Developmental Disabilities (IDD) face considerable challenges in participating in dental services. These challenges include resource constraints and inadequate skills of health service providers to work with this population. AIM: The aim was to scope published studies that addressed access to dental services for children with IDD in order to determine the extent to which various barriers have been researched, using an access framework derived from the literature. Access was defined to include the six dimensions of accessibility, availability, affordability, accommodation, acceptability, and appropriateness. METHOD: Arksey and O'Malley's scoping review framework was used. Relevant databases (e.g., Medline) were searched for all empirical studies conducted from January 2000 to February 2017 that met inclusion criteria. Data were extracted along the six dimensions of the access framework. RESULTS: Sixteen international studies were identified which indicated common key barriers to dental service use: the difficulties of physical inaccessibility, lack of access to information among carers, lack of knowledge of disability issues, and low experience and skills in caring for children with IDD among dental practitioners. CONCLUSIONS: Key recommendations made were exploring dental practitioners' understanding of disability legislation and developing training for practitioners to expand on issues specific to IDD.

[Difficulties in dental health care for the disabled]. / Difficultés de prise en charge de la santé bucco-dentaire des personnes en situation de handicap.

Upper Normandy has several disadvantages in terms of access to dental health care for disabled people: an insufficient medical population, a lack of dental schools and dental care networks.A cross-sectional epidemiological investigation, using a questionnaire form, was carried out between November 2014 and February 2015 with a cohort of dentists in this region.The topics on this form focused firstly on accessibility and compliance with standards of dental offices and the influencing factors which are hampering their accessibility implementation, and secondly on the oral care of disabled patients by practitioners of this region : the impact of incentives, influencing factors which are complicating the dental care and the usage of private and public structures.If the care of disability concerns most practitioners, an apprehension is observed in the adaptation of these doctors' treatment protocols for these specific patients. The expectations of dentists concerning disability are multiple : the creation of specific care networks, better coordination of medical and social actors, and specific training programs concerning the dental care of disabled patients.

Assessment of dental caries, oral hygiene status, traumatic dental injuries and provision of basic oral health care among visually impaired children of Eastern Odisha.

CONTEXT: The magnitude and severity of oral health problems in visually impaired population are worse than in general population, and they tend to have more untreated dental diseases and more problems accessing dental care. AIMS: The aim of this study is to assess dentition status and treatment needs, oral hygiene status, and traumatic dental injuries among institutionalized children attending special schools for the visually impaired in eastern Odisha. SETTINGS AND DESIGN: A descriptive, cross-sectional study was conducted using a universal sampling protocol. SUBJECTS AND METHODS: American Dental Association Type III clinical examination was carried out using plane mouth mirrors and community periodontal index probes under adequate natural illumination by a single examiner assisted by a trained recording assistant. After completion of the study, all participants were provided with basic oral health care through outreach programs. STATISTICAL ANALYSIS: Comparisons were done using Student's t-test, analysis of variance, and Chi-square test. RESULTS: Caries prevalence for primary and permanent dentition was 15% and 46%, respectively. Mean oral hygiene index-simplified (OHI-S) was 2.43 ± 1.03. The prevalence of traumatic dental injuries was 11%. A statistically significant difference in mean decayed, missing, and filled teeth (DMFT/dmft) was observed in children consuming liquid sugar as compared to solid and those consuming sticky sugars as compared to nonsticky. A statistically significant difference in mean OHI-S scores was observed when compared with frequency of changing toothbrush. CONCLUSIONS: This sample of visually impaired children has a high prevalence of dental caries, traumatic dental injuries, and poor oral hygiene. Unmet needs for dental caries were found to be high indicating very poor accessibility and availability of oral health care.

Physical, mental and cognitive disabilities in relation to utilization of dental care services by nursing home residents.

OBJECTIVE: The main purpose of this study was to investigate factors affecting dental care utilization among nursing home residents in Jordan. METHODS: A total of 221 subjects with a mean age of 62.4 years (121 males and 100 females) taken from among nursing home residents across Jordan were recruited and composed a convenience sample for this study. The Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Tinetti Assessment Battery for gait and balance (TAB), Disability of Arm, Shoulder, and Hand test (DASH) were administered and oral health status was assessed for all subjects and examined as expected correlates of dental care utilization among nursing home residents. RESULTS: The response rate was about 88%. One-third of residents suffered from total edentulism and most of the remaining dentate residents exhibited periodontal disease (90%). Of the dentate sample, 90% of residents had bleeding upon probing, 85% were diagnosed with tooth mobility, 88% had presence of dental calculus, and 30% were diagnosed with root caries. Of the denture wearers, 59.1 % reported having soreness with their dentures and 32% of denture wearers reported having poor quality dentures. MMSE score, suffering from tooth sensitivity and having diabetes mellitus were identified to be indicators for utilization of dental care services among the study population. CONCLUSION: Regular oral care, assessments, and rehabilitation services are considered to be limited for nursing home residents in Jordan. Based upon these findings, future interventions should address oral health among nursing home residents in Jordan.

Effects of medical and mental status on treatment modalities in patients treated under general anaesthesia at the KTU Faculty of Dentistry in Trabzon, Turkey: A comparative retrospective study.

This study evaluated the differences in dental conditions and treatment modalities between disabled and non-cooperative healthy children under general anaesthesia. The data were collected from paediatric patients between 3 and 15 years of age who received dental treatment under general anaesthesia. Patients with at least one mental/physical disturbance (group 1) and other healthy non-cooperative patients (group 2) were compared with regard to gender, age, weight, and treatment time-type. The statistical analyses were performed using Fisher's exact and Mann-Whitney U tests. No significant differences were observed between the groups with regard to gender, weight and treatment-time (p>0.05). The numbers of treated teeth (p<0.01) and extractions (p<0.001) were higher in group 1 than in group 2, whereas the frequency of advanced restorative procedures for group 1 was lower than that for group 2, including preventive-resin-restoration (p<0.001), glass-ionomer-cement (p<0.05), root-canal (p<0.001) and stainless-steel-crowns (p<0.001). This study supports the hypothesis that the general condition of the patients may alter the type of treatment provided and confirms the necessity of performing preventive procedures.

Prognostic factors of single-visit endodontic and restorative treatment under general anaesthesia for special needs patients.

The aim of this study was to evaluate the longevity of teeth with single-visit endodontic and restorative treatment under general anaesthesia (GA) for special needs patients and to investigate factors associated with survival and success. Data were collected from 381 teeth in 203 patients [mean (s.d.) age = 27·0 (14·1)]. All endodontic and restorative procedures were performed during a single GA session except for cementation of crowns in the cases requiring crown restoration (38%). A total of 267 teeth (70·6%) were followed-up for 6-81 months [mean (s.d.): 32·7 (20·0)]. Patients and teeth with and without follow-up were compared. Kaplan-Meier analysis with generalised Wilcoxon test was used to compare the mean survival and success period. Cox proportion hazard regression model was applied for multivariate analysis. At the end of the observation period, 10 teeth had a crown fracture (5-year survival rate = 89·8%), and an additional 10 teeth had primary or secondary caries (5-year success rate = 86·4%). Risk factors associated with survival were age (>40), non-parental caregiver, cooperation level and periodontal disease. A soft diet was an additional risk factor against the success of teeth. Single-visit endodontic and restorative treatment under GA showed favourable outcomes, suggesting a promising treatment option for special needs patients. Patient- and dental-specific circumstances need to be carefully considered to enhance the longevity of reconstructed teeth.

[Dental care for disabled people]. / Soins bucco-dentaires pour les patients handicapés.

CONTEXT: Patients with disabilities represent a population with special needs whose dental care management constitutes a public health problem. This article describes dental care of disabled people in a hospital dental care unit to highlight the difficulties encountered and propose ways to improve this care. METHODS: A retrospective descriptive study was carried out on patients followed between 2010 and 2016 as part of the partnership between the Albert Chenevier Hospital odontology department and the RHAPSOD'IF network. The data collected by means of ?follow-up sheets? described the procedures performed and any medication used. These anonymised records were analysed by Excel software. RESULTS: Dental care sessions for the 434 disabled persons consisted of visits (42 to 57%), restorations and scalings each represented 1/6 of all procedures performed (14 to 19% and 14 to 18%), and surgery and radiography each represented 1/8 of procedures (4 to 12% and 6 to 11%). There were almost no dental prostheses (0 to 1%). Most dental care sessions were performed without premedication (61 to 76%). CONCLUSION: This type of dental care requires training of families and caregivers, a good interpersonal approach and time to build a relationship of trust. Participation in a network is important to help, support, and advise the practitioner and to provide financial support.

Caregiver Burdens and Preventive Dental Care for Children with Autism Spectrum Disorder, Developmental Disability and/or Mental Health Conditions: National Survey of CSHCN, 2009-2010.

Objective The purpose of this study is to examine the burdens of caregivers on perception of the need and receipt of preventive dental care for a subset of children with special health care needs-children with Autism Spectrum disorder, developmental disability and/or mental health conditions (CASD/DD/MHC). Methods The authors used the 2009-2010 National Survey of CSHCN. The survey included questions addressing preventive dental care and caregivers' financial, employment, and time-related burdens. The associations of these burdens on perceptions and receipt of preventive dental care use were analyzed with bivariate Chi square analyses and multinomial logistic regressions for CASD/DD/MHC (N = 16,323). Results Overall, 16.3 % of CASD/DD/MHC had an unmet preventive dental care need. There were 40.0 % of caregivers who reported financial burden, 20.3 % who reported employment burden, and 10.8 % who reported time burden. A higher percentage of caregivers with financial burden, employment burden, and time-related burden reported that their CASD/DD/MHC did not receive needed preventive dental care (14.1, 16.5, 17.7 % respectively) compared to caregivers without financial, employment, or time burdens (9.0, 9.6 %, 11.0 % respectively). Caregivers with financial burden (adjusted multinomial odds ratio, 1.38 [95 % CI 1.02, 1.86] and employment burden (adjusted multinomial odds ratio, 1.45 [95 % CI 1.02, 2.06] were more likely to report that their child did not receive preventive dental care despite perceived need compared to caregivers without financial or employment burdens. Conclusions for practice Unmet needs for preventive dental care were associated with employment and financial burdens of the caregivers of CASD/DD/MHC.

A review of daycase GA services for Special Care patients at University Hospital, Bristol.

This paper describes and discusses a review of adult special care dentistry day cases in a UK hospital over a two year period and makes recommendations for other such reviews and for practice. Dental public health competencies illustrated: oral health needs assessment and evaluation of dental health services.

Dental Economics and the Increasing Numbers of Individuals with Disabilities in New Jersey.

The dual needs of 1) providing increasing oral healthcare for individuals with special needs, and 2) improving the economics of dental practice, are explored in a review of the State of New Jersey and its counties.

Access Barriers to Dental Health Care in Children with Disability. A Questionnaire Study of Parents.

BACKGROUND: A patient's with disability everyday life is rife with many limitations such as architectural, transport, information as well as medical, psychological, legal, economic and social barriers. The aim of this study was to evaluate access to dental health care of special-care schoolchildren with intellectual disability on the basis of their parents' opinion. MATERIAL AND METHOD: A questionnaire survey was carried out among 264 parents/caregivers of children from eight special-care schools in Poznan (Poland). Close-ended questions concerned children's barriers in access to dental care and parents' satisfaction with their children's dental care. RESULTS: Only 31.8% parents/caregivers did not have any problems with access to dental care and the most commonly reported barrier to obtaining dental care was protracted waiting time for a visit (36.7%). Most commonly, children were treated in dental surgery conditions (90.1%). Only 42.1% respondents were satisfied with their children's dental care. CONCLUSIONS: The research revealed that there is a need to improve the access of children with disability to dental care. Hence, it seems to be beneficial to set up specialist dental surgeries in special-care schools which would improve the access of children with disability to prophylaxis as well as dental treatment.

Oral health needs of athletes with intellectual disability in Eastern Europe: Poland, Romania and Slovenia.

OBJECTIVES: The aims of this study were to evaluate the oral condition and treatment needs of Special Olympics (SO) athletes from Poland, Romania and Slovenia. METHODS: A cross-sectional study was performed with data collected through standardised oral screening of athletes who participated in the annual SO events held in Poland, Romania and Slovenia, between 2011 and 2012. The data were compiled and transferred to an SPSS data file for analysis using descriptive statistics. RESULTS: A total of 3,545 athletes participated in the study. Among the main findings, the prevalence of untreated decay was 41% in Poland and 61% in Slovenia, whilst 70% of the Romanian athletes had signs of gingival disease and only 3.8% presented molar fissure sealants. In addition, 47% of Polish athletes were in need of urgent treatment. CONCLUSIONS: Analysis of the results obtained following screening showed comparable oral health needs of athletes with intellectual disability among countries. Exploration of the oral health systems of the countries revealed similar significant co-payments and lack of incentive for dentists to treat patients with special needs. The results from Romania, Poland and Slovenia demonstrated the need for a structured system in which a special population is a target for oral-health-related education programmes and system-included preventive, restorative and maintenance interventions.

Fatores de risco para a cárie dentária em pacientes com deficiências do desenvolvimento / Risk factors for dental caries in patients with developmental disabilities

O objetivo do presente estudo foi investigar fatores de risco para cárie dentária em crianças com deficiências de desenvolvimento que foram tratados em um serviço de referência para cientes com necessidades especiais, Belo Horizonte, MG, Brasil. Esta é uma coorte retrospectiva que avaliou 401 prontuários de indivíduos sem experiência de cárie dentária na primeira consulta odontológica. A variável dependente foi a ocorrência de uma nova lesão de cárie dentária ou restauração. O tempo para a ocorrência de uma nova lesão de cárie ou restauração foi medido em meses. Sexo, idade, Código Internacional de Doenças (CID), escolaridade da mãe, o consumo de açúcar, o uso de creme dental com flúor, higiene oral, respiração bucal, relato de xerostomia, condição gengival, uso de drogas psicotrópicas, utilização de medicamentos para a asma, história pregressa de asma foram as covariáveis estudadas. O modelo de regressão de Cox de riscos proporcionais foi utilizado para estimar as taxas de risco bruto e ajustado com seus respectivos intervalos de confiança de 95%. O tempo médio que os indivíduos permaneceram livres de cárie dental restauração foi igual a 107,46 meses (IC 95% 95,41-119,51), com mediana de 94 meses. Para cada aumento de um ponto na escala de consumo de sacarose, houve um aumento do risco de cáries em 1,07 (IC de 95% 1,01- 1,15). O consumo de sacarose foi o único fator de risco significativo para cárie neste grupo de indivíduos com deficiências do desenvolvimento

Learning from a Special Care Dentistry Needs Assessment.

UNLABELLED: The General Dental Council recognised special care dentistry (SCD) as a speciality in 2008 and local service reviews have been carried out in order to develop SCD services. A needs assessment was completed to inform the implementation of recommendations from a 2010 review of SCD in Wales. AIM: The aim of this paper is to outline the process, findings and learning from the needs assessment and the implications for SCD. METHOD: A focused needs assessment approach was used. Stakeholder consultations were used to develop a working definition for the needs assessment. Data were collected from existing health and social care sources and analysed using descriptives and geographic information system (GIS) mapping. RESULTS: Data sources for needs assessment were limited. Analysis showed that health conditions were common in the population and increased with age. The majority of people who reported seeing a dentist were seen in general dental practice. Older people with health conditions were less likely to report seeing a dentist. Patients often needed to travel for specialist care services. CONCLUSION: General dental practice teams have a significant role in caring for SCD patients. Careful planning of specialist care, joint working and enhancing skills across the general practice team will reduce the burden of care and enhance patient safety. Improvements in data for assessment of SCD needs are required to help this process.

Campus-Based, Community-Based, and Philanthropic Contributions to Predoctoral Pediatric Dental Clinical Education: Two Years of Experiences at One Dental College.

The aim of this study was to investigate the contribution of a tiered predoctoral pediatric dentistry clinical education model to competency achievement by dental students over a two-year clinical education. Retrospective data were obtained for academic years 2012-13 and 2013-14 from three sources: a campus-based, dental school-housed clinic; division-directed clinics in community-based pediatric and special needs clinics (DDC); and clinics affiliated with the dental college's community-based dental education (CBDE) program, the OHIO Project (OP). A fourth dataset was obtained for the same two-year period from a biannual clinic event held at the college in conjunction with Give Kids a Smile Day (GKAS). Procedures considered essential to the care of children were sorted by 12 dental codes from all services for patients 18 years of age and younger. The dental school clinic provided 11,060 procedures; the DDC, 28,462; the OP, 17,863; and GKAS, 2,028. The two-year total was 59,433 procedures. Numbers of diagnostic and preventive procedures were 19,441, restorative procedures were 13,958, and pulp and surgical procedures were 7,392. Site contribution ranged from 52.2 to 144.9 procedures per attending student, with the DDC yielding the highest per student average for each year (126.4 and 144.9) and the dental school clinic the lowest (52.2 and 53.1). This study found that a combination of school-based, community-based, and philanthropic pediatric dental experiences offered a large number of essential pediatric dentistry experiences for predoctoral dental students, with CBDE opportunities offering the largest contribution.