Enhancing special care dentistry with sensory-adapted dental environment A comparative study

Aim: To compare and evaluate the effect of sensory-adapted dental environment (SADE) and regular dental environment in reducing anxiety levels in children with intellectual disabilities. Materials and Methods: This study was carried out in children with mild intellectual disabilities aged 8–13 years. The developmental screening test was utilized in screening and including these children with IQ scores between 52 and 67, and after random allocation, children were subjected to oral prophylaxis in the SADE and regular dental environment. Anxiety levels were assessed at baseline, 5 min, and at the end of the procedure using Venham's anxiety rating scale, pulse rate, and blood pressure values. Results: The data were coded and analyzed using software SPSS (IBM version 22.0) for statistical analysis. Comparison between the groups was done using independent t-test and repeated measured ANOVA for objective assessment of intergroup and intragroup anxiety levels, respectively, and using Mann–Whitney U-test and Friedman's test for subjective assessment of intergroup and intragroup anxiety levels, respectively. Conclusion: These findings suggest that SADE significantly decreased anxiety levels and cooperative behavior in children with mild intellectual disability and can be used as an alternative behavior management technique in effectively handling children with intellectual disability.

Desafíos en el tratamiento de ortodoncia en paciente con síndrome de down, reporte de caso

RESUMEN: El Síndrome de Down es una condición genética que se identifica por la presencia de un grado variable de discapacidad cognitiva, rasgos y características físicas singulares, que también repercuten a nivel estomatognático. El objetivo de este reporte de caso es reflejar los desafíos terapéuticos que podemos enfrentar para lograr un tratamiento integral en estos pacientes. Madre de paciente consulta por apiñamiento dentario. Presenta enfermedades sistémicas asociadas al Síndrome de Down, alteraciones sensoriales, gingivitis generalizada, lesiones de caries, anomalías dentomaxilares y fibroma traumático en flanco lingual. El tratamiento incluyó adaptación a la atención odontológica, odontología preventiva y restauradora, periodoncia y ortodoncia. Luego de 25 meses de tratamiento, se logró el alta integral, debiendo modificar los objetivos del tratamiento y el manejo terapéutico ortodóncico en diversas ocasiones. Es posible realizar tratamientos integrales en pacientes con Síndrome de Down, considerando una buena adaptación, objetivos alcanzables y trabajo en equipo multidisciplinario.

ABSTRACT: Down Syndrome is a genetic condition identified by the presence of a variable degree of cognitive disability and unique physical characteristics and traits, which also have an impact on the stomatognathic system. The aim of this case report is to report the therapeutic challenges that we can face to achieve a comprehensive treatment. Patient's mothers consult for dental crowding. The patient presents systemic diseases associated with Down Syndrome, sensory anomalies, generalized gingivitis, dental caries lesions, maxillary dental anomalies, and traumatic fibroma in the tongue. The treatment included adaptation to dental care, preventive and restorative dentistry, periodontics and orthodontics. After 25 months of treatment, comprehensive discharge was achieved, with modifications in the treatment objectives and orthodontic therapeutic management in several occasions. Comprehensive treatment in patients with Down Syndrome is possible, considering a good adaptation to the treatment, achievable objectives and multidisciplinary teamwork.

Profile of Back-Referrals to Special Newborn Care Units

Objective: To study the outcomes of neonates back-referred from a tertiary care centre to special newborn care units (SNCUs) for step-down care. Methods: This prospective cohort study was conducted at a tertiary care neonatal unit and SNCUs in neighbouring states. We studied preterm and term neonates back-referred to district SNCUs from September, 2018 to April, 2019. The infants were followed up till 3 months corrected age, for mortality, re-hospitalization, emergency visits and unscheduled outpatient visits. Preterm inborn neonates <32 weeks gestation discharged directly to home formed the controls. Results: 201 back-referred neonates (study cohort) and 55 preterm neonates discharged to home (controls) were followed up till 3 months corrected age. Amongst the back-referred neonates, 5% died, 7% required re-hospitalization, 11% made emergency visits, and 24% made unscheduled outpatient visits. These outcomes were similar to the controls. Conclusion: Back-referral of convalescing neonates is a safe method of utilizing the limited healthcare resources in tertiary care centers in developing country settings.

Special Health Care Needs – Dentist Perception in Hyderabad, Telangana State

In the practice of dentistry we come across patients who need to be attended with special care as they disabled. Treating such patients require knowledge and expertise to manage them with utmost care. Aim: The study aimed to explore dentists’ perception and level of satisfaction with their dental education in preparing them to provide care to patients with special health care needs. Methods: This was a cross-sectional study. Study participants were dentists working in clinics in Hyderabad city, Telangana state. Results: Dentists reported good amount of confidence in caring for patients with special health care needs. A relationship existed between the quality of dental education and the dentists’ perception of their patient care. A great proportion of respondents were willing to attain educational activities to enhance their knowledge and skills. Conclusion: There is a need to organize extensive programs on management of patients who need special health care services. However the level of perception and the confidence to treat such patients among the dentists belonging to Hyderabad city is satisfactory.

Oral Health Behaviours and Preventive Dental Care Experiences Among Patients with Special Health Care Needs at Special Care Dentistry Clinic, University of Malaya

@#To assess the oral health behaviour and preventive dental care experiences of patients with special health care needs (SHCN) who attended the Special Care Dental (SCD) Clinic at University of Malaya. Data were collected from 31 patients using a self-administered questionnaire which consisted of questions pertaining to their oral health behaviours and experiences on receiving preventive dental care (PDC). For patients who were unable to answer due to existing health conditions, parents or primary caregivers were approached as proxy. Descriptive analysis was conducted and reported based on percentages to identify the oral health behaviour and PDC of the individuals. Majority brushed their teeth at least once a day (84%), used fluoridated toothpaste (87%) and oral hygiene aids (58%). However, almost half of them (48%) required assistance from parents or caregivers during tooth brushing and consumed sugary snacks in between meals (58%). About 80% had received PDC where the type of care received was mainly oral hygiene advice (77%). Slightly more than 80% preferred the one-to-one demonstration method during PDC. Most gave positive evaluation on their PDC experience especially on items pertaining to the dentist’s attitude. Whilst most of the SHCN patients in this study had positive perception on the PDC that they received and practised good brushing behaviour, their dietary habits need to be improved. Thus, regular preventive dental visit amongst SHCN patients is important for appropriate and comprehensive dental care in maintaining oral health..

Study of metabolic syndrome prevalence and its risk factors of patients with type 2 diabetes in special care unit / 中国综合临床

Objective To investigate the prevalence and risk factors of metabolic syndrome (MS) in patients with type 2 diabetes in special care unit.Methods Two thousand three hunrded and sixty patients with type 2 diabetes were selected as our subject in The Sixth People's Hospital Affiliated to Shanghai Jiaotong University from Jan.2010 to Jul.2012.Among these patients,462 patients from special care unit were served as special care group and 1 898 patients from endocrinology ward were assigned to control group.The disease history information was recorded and physical examination and biochemical tests,including blood lipids,blood pressure,fasting glucose,glycosylated hemoglobin,serum insulin,C peptide were measured.Results (1) In special care group,there were 335 male (72.5％) and the prevalence of smoking,alcohol drinking and the proportion of the high income people were 40.5％,24.9％,76.6％ respectively,higher than that of control group (56.6％,24.6％,10.7％,12.7％ ;x2 =32.1,16.9,12.3,32.8 ;P ＜ 0.01).The body mess index (BMI),levels of waist circumference,alanine aminotransferase (ALT),gamma glutamyhransferase (γ-GT),triglyceride (TG),serum uric acid and fasting C peptide in special care group were ((25.6 ± 3.7) kg/m2,(91.0 ± 9.5) cm,(27.8 ±19.7) U/L,(34.1 ±26.3) U/L,(2.35 ±2.31) mmol/L,(333.7 ±85.5) μmol/L,(2.11 ±1.04) μg/L) higher than those of control group ((24.8 ± 3.5) kg/m2,(89.1 ± 10.3) cm,(23.0 ± 16.1) U/L,(29.2 ±23.2) U/L,(1.82 ±1.64) mmol/L,(317.1 ±85.2) μ mol/L,(1.74 ± 1.05) μg/L;F =11.44,6.90,16.65,8.35,18.23,7.34,21.21 ; P ＜ 0.01).The age,duration of diabetes,systolic blood pressure,level of serum high-density lipoprotein-cholesterol (HDL-C),and glycosylated hemoglobin were ((52.9 ± 11.1) years,5 (2,10) years,(126.7 ± 15.2) mmHg,(1.02 ± 0.32) mmol/L,(8.44 ± 1.99) ％) lower than those of control group((60.4 ± 12.2) years,7 (2,12) years,(131.9 ± 17.3) mmHg,(1.10 ± 0.32) mmol/L,(9.16 ±2.32)％;F =79.41,12.71,18.93,12.78,18.52; P ＜ 0.01); (2) The rate of overweight/obesity,dyslipidemia and MS prevalence rates in special care group were 55.6％,68.4％,60.2％,significantly higher than the control group(46.1％,52.9％,50.6％ ;x2 =7.59,18.76,7.18,P ＜ 0.01).While the prevalence of hypertension in special care group was significantly lower than control group(39.6％ vs 50.7％,x2 =10.15,P =0.01).There was on significant difference between male and female in term of the prevalence of the MS in the special care group(61.2％ vs 57.5％,x2 =0.01,P =0.92).According to age,patients in special care group were divided into three groups and that were ＜45 years group,45-59 years group and ≥60 years group.With the increase of age group of female,the prevalence of MS was increasing(33.3％,48.0％,74.1％ ;x2 =4.43,P =0.04).Among the male patients,there was no significant different was seen among three groups (58.8％,62.5％,55.6％ ;x2 =0.05,P =0.87).(3) Multiple Logistic regression analysis showed that the independent risk factors of MS in special care group including age(OR =1.071,95％ CI(1.027-1.117),P =0.01),BMI (OR =1.391,95％ CI(1.112-1.739) ; P =0.013),waist circumference (OR =1.126,95％ CI(1.039-1.222) ; P =0.004),TG (OR =1.747,95 ％ CI(1.124-2.717) ; P =0.013) and diastolic blood pressure (OR =1.111,95％CI(1.045-1.180);P =0.001).HDL-C(OR=0.048,95％CI(0.005-0.464) ;P =0.009) were protective factors of MS in special care group.Conclusion Approximately 3/5 patients with diabetes in special care unit got MS.The factors including age,BMI,waist circumference,diastolic blood pressure,TG,HDL-C were related to MS occurrence.

Health seeking behavior of the mother for the special care new-born units discharged child: A comparative study.

Establishment of special care new-born units (SCNU) in hospitals not only serves to provide the intensive care to sick neonates, but presents with opportunities to enhance knowledge and modify attitude and practices of their parents through behavior change communication (BCC). A cross-sectional study was conducted in Dibrugarh District, Assam from January to June, 2011 to assess differences in health-care seeking behavior of these mothers from mothers of newborns who were born at home and mothers who had normal uneventful institutional deliveries. Mothers of 29 SCNU discharged, 34 institutions delivered and 26 home delivered children were interviewed using a semi-structured interview schedule and a knowledge, attitude and practice (KAP) survey tool. Mothers of children admitted to SCNU scored better in questions related to vaccination, contraception, protection of child from infections and cold and perceptions about traditional healers, but overall KAP scores in the three groups were not found significantly different.

Campo institucional da odontologia para pacientes com necessidades especiais na região metropolitana de São Paulo / Curriculum education higher dentistry

O objetivo desse estudo foi avaliar a implementação da Odontologia para Pacientes com Necessidades Especiais como especialidade odontológica e sua projeção institucional na região metropolitana de São Paulo, no que diz respeito à formação de profissionais e provisão de serviços nessa área. Espera-se com a descrição e análise dos serviços avaliados, contribuir para o desenvolvimento de rotinas de atendimento aos pacientes com necessidades especiais, por parte de entidades e profissionais, bem como incentivar instituições formadoras a incrementar a oferta de recursos didáticos e motivar as entidades que não disponibilizam essa atividade aos seus educandos que o façam. Foram analisados três ambientes, nos quais o paciente com necessidades especiais pode receber atendimento odontológico e estudantes e profissionais formados podem receber educação odontológica na especialidade doze faculdades de Odontologia, três cursos de especialização e três centros de atendimento especializados. Em função da amplitude temática e institucional envolvida, propôs-se o seguinte recorte: pacientes com paralisia cerebral (representando o grupo de pacientes com deficiências neurológicas ou psicomotoras), pacientes com aids (representando o grupo de pacientes com doenças infecto-contagiosas) e pacientes com diabetes (representando o grupo de pacientes com doenças crônicas)...

The aim of this study was to evaluate the implementation of Special Care Dentistry as dental specialty and its institutionalization in the metropolitan region of Sao Paulo, as regards professional training and the provision of services in this area. It is hoped that the description and analysis of evaluated services, contribute to improve the provision of services aimed at these patients by institutions and professionals, as well as encouraging educational institutions to increase the supply of teaching resources and motivate entities that do not offer this activity to their students to do so. We analyzed three environments in which the patient with special needs can receive dental care and dental students and professionals can receive dental education in the specialty - twelve dental schools, three courses of specialization and three specialized centers for dental services. In accordance with the scope and institutional themes involved, we selected patients with cerebral palsy (representing the broad group of patients with neurological or psychomotor deficits), AIDS patients (representing the broad group of infectious diseases) and patients with diabetes (representing the broad group of chronic diseases). Managers, teachers and dentists were asked to provide information about the structures of its units and the educational model proposed to their students by answering to semi-structured interviews. We concluded that the Special Care Dentistry is a reality in the urban setting researched. The institutions studied provide relevant services to patients with special needs, but the educational system in this emerging area of dentistry does not meet the needs of dental patients, and colleges do not address adequately the education of its students with a holistic view of these patients, and do not fulfill their social obligation to integrate and include patients with special needs...

Can the special care neonatal unit admission cut-off be lowered down to 1500g babies.

Objective. The study was conducted to find out whether there is any significant difference in outcome if low birth weight babies weighing between 1500g and 1800g are managed by keeping them with their mothers, i.e., without special care neonatal unit (SCNU) admission. Methods. It was a retrospective study for which data was collected from past medical record section of 6 months duration from 01.07.06 to 31.12.06, Medical College, Kolkata. The subject of the study was babies born with weight between 1500g and 2000g, divided into 2 groups. Group A representing babies born between weight 1500g and 1800g, groups B representing babies born between 1801g and 2000g. The groups were compared with regard to four variable namely average material age, sex of the babies, singleton or twin pregnancy, mode of delivery and gestational maturity. Test of one proportion was used for statistical analysis of outcome. Results. Total number of live born babies in group A were 198 and in group B 223. Two group were comparable with respect to average maternal age (23.7 yr), sex distribution, singleton or twin pregnancy and number of cesarian section or vaginal delivery and proportion of small for gestational age (SGA) babies. In both the group 13 babies required SCNU admission after being given to their mothers in the postnatal ward. No significant difference in outcome was observed between the groups. Conclusion. We conclude that the recommended guidelines for giving institutional care to babies below 1800g may be lowered down to 1500g. However, more babies should be evaluated prospectively, over a longer duration of time, before changing the standard guidelines.

Organisation of Special and Intensive Care Facilities for Babies

No abstract available.

Clinical and Statistical Obervation of Sick Babies in SCBU

Clinical and statistical analysis were performed on 573 cases of neonates who were admitted in the special care baby unit, St. Benedict Hospital, from January 1978 to June 1979. The results were as following: 1) Sex ratio of male to female was 1.04:1. 2) According to the route of admission, The ratio of "non-referred patients" to "referred patients was 1.86:1. 3) About the parity incidence, the first baby was 57.1%, the second was 29.7%, and the third was 9.6%. 4) About the age on admission, the babies of the one day I\of age was 45.5% and 86.9% was within 1 week of age. 5) According to the duration of admission, 1-7 days group was the most common(59.6%) and the next were 8-14 days group(24.6%), 15-21 days group(6.1%) 6) According to the duration of admission, 1-7 days group was the most common(59.6%) and the next were 8-14 days group(24.6%), 15-21 days group(6.1%). 7) About the maternal education of non-referred patients, group of high school educated was the most common(45.6%), followed by college(22.3%), middle school(15.3%), and primary school(9.7%). 8) On distribution of the maternal age of non-referred patients, the group of 20-30 years of age was the most common(51.7%), followed by 20-25 years of age (23.3%). Admission rate according to maternal age, higher incidence was seen over 31 years of age. 9) The most common placentas weight of non-refered patients was 600-800 gm. Group(39.9%) and the highest incidence of pre-term was the group of 200-400gm. 10) The most frequent problem was hyperbilirubinemia, followed by prematurity, infectious diseases, respiratory tract diseases, congenital anomalies, diseases associated with metabolism and birth injury. 11) According to the age of initiation of treatment in hyperbilirubinemic patients, the most common age was 4 day(30.5%) and the next was 3 days(25.1%), Suspected causes ware idiopathic(51.2%), blood group incompatibility(17.1%), prematurity(15.3%) and so on. 12) The main diseases associated with prematurity were hyperbilirub-inemia(47.9%), pneumonia(15.1%), RDS(8.4%). 13) Mortality rate were 26.6% in pre-term, 7.4% in post-term, 2.6% in full-term and mortality rate of all admission was 8.0%. Generally, the shorter gestational age and lower birth weight, the higher the mortality rate of premature infants was observed. 14) The leading causes of death were immaturity(48.5%), RDS(24.2%), pneumonia(21.2%) in pre-term, pneumonia(27.3%), kernicterus(18.2%) in full-term and anencephaly & placental dysfunction syndrome in postern 2 cases.