Intended learning outcomes for undergraduate training in paediatric dentistry.
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Child↗
Biomedical subjects
E S Davenport
Publications and source records attributed to E S Davenport.
The effects of diet, breast-feeding and weaning on caries risk for pre-term and low birth weight children.
OBJECTIVES: The aims of this study were to determine the prevalence of dental disease in 3-4-year-old children born pre-term and low birth weight (PLBW) in East London, UK, to make comparisons with normal birth weight children (NBW), and to investigate the impact of dietary habits on the development of dental caries in primary teeth. DESIGN: This was a cross-sectional study. SUBJECTS AND METHODS: The subjects were 100 children (54 boys and 46 girls) with a mean age (+/- SD) of 41.70 +/- 5.11 months. The children were resident within walking distance of the dental hospital and were invited to attend with their parents. Demographic data and information about feeding practices from infancy to the present were ascertained by structured questionnaire. Dental caries status was determined, and height, weight and head circumference were also measured. RESULTS: Sixty children had experienced dental caries with a mean (+/- SD) dmft of 2.98 +/- 3.93, 25 of whom had a dmft greater than 5. Normal birth weight children (3.00 +/- 4.18) and boys (3.55 +/- 4.48) had a significantly increased dmft over PLBW children (2.95 +/- 3.35) and girls (2.29 +/- 3.04). The PLBW children were more likely to have used a bottle from birth and one in four children were still using a bottle at the time of the dental examination. The PLBW children were significantly more likely to eat sugar than NBW children, scoring 5.53 +/- 2.10 and 4.61 +/- 1.94, respectively. CONCLUSIONS: A clear relationship exists between poor diet and PLBW in a group of children resident in the East End of London. Targeted infant feeding programmes, education and support for families with regard to dental care is of importance to avoid an unnecessary amount of dental disease in young children.
Bottle Feeding↗
Developing teaching and learning innovations in dental training: the example of the Progress File Learning System.
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Education, Dental↗
Learning throughout life: can a progress file help?
UNLABELLED: Modern dentistry demands continuous professional development. This paper reports part of a project to develop a lifelong learning tool known as a progress file for members of the dental team. AIM: To elucidate the views of dentists (as employers/managers) and dental therapists (as employees) on the potential use at work of a progress file. To obtain feedback from these groups on a prototype progress file for dental therapists. METHOD: Consultations were conducted with an opportunistic sample of 15 dentists and 32 dental therapists. Twenty eight dental therapists trialled the prototype for 6 months and 15 dentists appraised it. Opinion was obtained through interview and questionnaire, yielding largely qualitative data, which was content-analysed. FINDINGS: Both dentists and therapists were positively disposed towards a progress file at work but considered its success conditional upon factors including input from the team leader and rewarding dentists for time spent on supporting file users. Evaluation of the prototype was mainly positive. Trial data bore out many impressions from the consultations. CONCLUSION: A progress file that addresses the needs of both employers and employees has potential to help all members of the dental team meet the demands of lifelong learning.
Attitude of Health Personnel↗
Maternal periodontal disease and preterm low birthweight: case-control study.
Periodontal disease has been suggested to be an important risk factor for preterm low birthweight (PLBW). Here we report a case-control study of 236 cases (infants < 37 wks and weighing < 2499 g) and a daily random sample of 507 controls (> or = 38 wks and weighing > or = 2500 g). Clinical periodontal indices were measured on the labor wards. Associated risk factors for periodontal disease and PLBW were ascertained by means of a structured questionnaire and maternity notes. The risk for PLBW decreased with increasing pocket depth (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.68 to 1.00). After adjustment for maternal age, ethnicity, maternal education, smoking, alcohol consumption, infections, and hypertension during pregnancy, this decreased further (OR 0.78, 95% CI 0.64 to 0.99). We found no evidence for an association between PLBW and periodontal disease. Our results do not support a specific drive to improve periodontal health of pregnant women as a means of improving pregnancy outcomes.
Adolescent↗
Mechanisms of risk in preterm low-birthweight infants.
The periodontal diseases share many common risk factors with preterm low birth weight. Examples are, age, socioeconomic status and smoking (Fig. 5). Studies to date have only shown an association between the two conditions, and this does not indicate a causal relationship. However, since the inflammatory mediators that occur in the periodontal diseases, also play an important part in the initiation of labor, there are plausible biological mechanisms that could link the two conditions. The challenge for the future is to characterize the nature of the factors that predispose a mother to give birth prematurely to infants less than 2500 g and to assign relative probabilities to each. Studies are taking place in many parts of the world to determine the probability of a preterm low-birth-weight outcome, the interdependence of the factors that contribute to a birth event and possible casual relationships between these factors. Further information about the details of the effects of maternal infection will come from intervention studies, animal studies and more detailed examination of the mechanisms.
Animals↗
Practice-based learning: views on the development of a reflective learning tool.
CONTEXT: This study reports the first part of a funded project to develop a tool to improve and record learning, known as a Progress File. A Progress File typically contains an element of reflection and a means of recording achievement. AIM: The aim of the study was to collect and understand the attitudes and experiences of students and tutors with regard to reflection, and to determine their views on the development and implementation of a Progress File for one member of the dental team, the dental therapist. METHOD: A consultation exercise was undertaken in four institutions which train dental therapists. A total of 76 students and tutors were interviewed individually or in groups. Examples of reflective tools were used to prompt discussion and feedback. Emergent themes were derived from content analysis. RESULTS: Participants identified many uses for the Progress File within and beyond their courses. They also expressed concerns regarding the effectiveness and feasibility of Progress File learning within present educational environments. DISCUSSION AND CONCLUSION: Successful integration of the Progress File into courses of medical and dental education may depend upon institutional culture change and a move towards a system which facilitates and rewards reflection on learning. The results will inform development of the File.
Attitude of Health Personnel↗
An innovation in the assessment of future dentists.
'The assessment of students is a serious and often tragic enterprise.' The central question in assessment is 'What is one trying to assess?'. Is it factual knowledge, ability to apply and problem solve, clinical competencies or indeed other attributes? The domain being assessed requires appropriate methods. Professionals involved in examination development have identified three characteristics which all assessment methods demand: reliability, validity and feasibility. This article sets out to describe these features.
Attitude of Health Personnel↗
The East London Study of Maternal Chronic Periodontal Disease and Preterm Low Birth Weight Infants: study design and prevalence data.
The influence of subject-based and environmental factors on the balance between the subgingival microbial challenge and the host response in periodontal diseases illustrates the intimate link between oral and systemic health. From this stems the hypothesis that the persistent Gram-negative challenge and associated inflammatory sequelae in periodontal disease may have consequences extending beyond the periodontal tissues themselves. This paper addresses the design of a case-control study to examine the relationship between preterm low birth weight (PLBW) and maternal periodontal disease. We present preliminary data on the prevalence of these 2 conditions in a group of mothers at the Royal Hospitals Trust, London, U.K. Cases are defined as mothers delivering an infant weighing less than 2,500g before 37 weeks gestation and controls as mothers delivering an infant of more than 2,500g after 38 weeks. We estimated that a study involving 800 mothers (1:3 case:control) should have sufficient power to detect an association with a minimum odds ration of 3 at the 5% significance level. Demographic details of 177 subjects demonstrated that they were representative of the local population, and the prevalence of PLBW was within the expected range. However, the extent and severity of periodontal disease were higher than predicted and may have reflected elevations in gingival inflammation associated with pregnancy. The final outcome of the study should help determine the need for further interventionist studies to demonstrate a causal relationship between periodontal disease and PLBW, as well as provide information on the prevalence of periodontal diseases in this study population.
Adolescent↗
Caries incidence, mutans streptococci and lactobacilli in irradiated patients during a 12-month preventive programme using chlorhexidine and fluoride.
Radiotherapy (RT) near salivary glands results in changes in the oral flora in favour of cariogenic organisms and an increased susceptibility to caries. The aim of this study was to assess the effect of a 12-month preventive programme on caries incidence and on the levels of mutans streptococci (ms) and lactobacilli in tongue loop samples taken from patients before, during and after RT. The regime consisted of 2 x daily rinsing with 10 ml 0.2% chlorhexidine, diluted 1:1 with water, for 1 week before RT, during RT and for 4 weeks after RT. This was then substituted with a 0.05% NaF rinse daily. A saliva substitute containing 2 ppm F was used as required. Scaling was carried out before RT and dietary advice and oral hygiene instruction given. Appropriate radiographs were taken at baseline and after 6 and 12 months. Tongue loop samples for microbiology were taken in the middle and end of RT and subsequently at 6, 8, 12, 24, 40 and 52 weeks. Whenever levels of ms exceeded 2 x 10(5) cfu/ml sample, 1% chlorhexidine gel in custom-made applicator trays was applied by the subject for 5 min daily for 14 days. In 25 subjects completing the programme, there was a total of 3 new caries lesions after 12 months. Thirteen pre-existing enamel lesions were arrested. There were significant reductions (p < 0.005) in ms levels from baseline values during RT and 4 weeks after RT. There were no significant increases in ms levels throughout the study.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
A comparison between commercial kits and conventional methods for enumeration of salivary mutans streptococci and lactobacilli.
Mutans streptococci (ms) and lactobacilli levels were determined by conventional and commercial dip-slide methods in three groups of young subjects, aged 5-6 years (93 subjects), 12-13 years (78 subjects) and 18-20 years (81 subjects). Using the same paraffin-stimulated saliva samples, ms and lactobacilli were estimated by conventional viable counts on modified mitis-salivarius agar (MSB) and Rogosa agar plates, and by inoculation of Dentocult SM and Dentocult LB dip-slides (Orion Diagnostica, Finland). The salivary ms and lactobacilli counts obtained from conventional agar plates were significantly correlated (P < 0.0001) with the dip-slide estimates of these organisms (Kendal Tau = 0.56, 0.71 respectively). Subjects in Group 2 showed the highest proportion (77 per cent) of individuals with salivary ms levels above 2.5 x 10(5) cfu/ml saliva; 99 per cent of that group had detectable levels of lactobacilli. Significantly different median salivary ms and lactobacilli levels were demonstrated between all groups except for lactobacilli levels between Groups 2 and 3. These dip-slide tests provided suitable and simple methods for screening salivary lactobacilli and ms levels which may have a useful role in the assessment of caries risk.
Adolescent↗
Caries in the preschool child: aetiology.
Although a substantial number of preschool children are caries free at 5 years of age, there remain a small proportion with caries who require a considerable amount of effort and time invested in them. Therefore, the multifactorial nature and ramifications of dental caries are considered in turn. The evidence cited is pertinent, especially in relation to our multiracial society and current disease levels for this age group.
Bacterial Physiological Phenomena↗
The use of general anaesthesia for tooth extraction in children in London: a multi-centre study.
Following publication of the Poswillo report, the continued use of general anaesthesia in dentistry became the subject of a major debate. In particular, the provision of general anaesthetic services by general dental practitioners in order to carry out simple extractions for child patients has been called into question. Other authors have strongly supported the continued need for general anaesthesia and insist that for some patients it remains the technique of choice. There is, however, little evidence of current patterns of attendance from which argument may be advanced to support or refute the differing views. In this study data was drawn from three London dental teaching hospitals providing out-patient general anaesthesia for extractions. During the 12-month period investigated 7852 general anaesthetics had been administered for child patients. There was evidence of an increase in numbers at one centre when results were compared to those of a previous study and some evidence of a change in pattern of referral with time at the same centre, with an increase in the numbers of patients referred by general dental practitioners. Eighty-three per cent of the anaesthetics had been given for the extraction of carious primary teeth, with an average of 3.3 being extracted per child. Nearly one-third of the anaesthetics were for children under the age of 5 years.
Analysis of Variance↗
Changes in the referral pattern of child patients from the GDS to the CDS following the introduction of capitation in October 1990. General Dental Services. Community Dental Services.
OBJECTIVE: To observe the changes in the criteria for, rate of, and pattern of, referral of child patients from the General Dental Services (GDS) to the Community Dental Services (CDS) which may have occurred following the introduction of capitation as the method of remuneration for general dental practitioners (GDPs) for the treatment of child patients in The new contract 1990. DESIGN: GDP referral criteria and attitude to capitation were assessed in two districts (North Downs and Weybourne Trusts) using a questionnaire distributed to 179 GDPs. Reasons for referral, and treatment received within the CDS, were collated from the dental records of referred children, before and after the introduction of capitation. RESULTS: The response rate from the GDPs was 87%, of whom 82% had referred child patients to the CDS. The results showed that 65% of GDPs indicated a preference for treatment of children under a fee per item system, whereas only 17% favoured capitation. Although 60% believed that their referral of patients to the CDS had not changed following capitation, an analysis of the referred children's dental records revealed that there had actually been a 57% increase in the number of referrals from GDPs to CDS following the introduction of capitation. The GDPs considered the most important referral criteria were for non cooperation or general anaesthesia. More cooperative children had been referred and more routine restorative procedures, less inhalation sedation and deciduous extractions were carried out following the introduction of capitation. CONCLUSIONS: This study has shown that following the introduction of capitation there had been an increase in the number of referrals from the GDS to the CDS.
Adolescent↗