Environmental impact of the supervised toothbrushing programme amongst children in Scotland.

OBJECTIVES: To understand the environmental impact of providing a nationwide supervised toothbrushing programme (Childsmile) for 5-year-old children in Scotland. METHODS: A life cycle assessment was conducted to assess the annual environmental effects of the supervised toothbrushing programme in early years childcare, as well as each dental procedure (dental restoration under local anaesthesia (LA), single tooth extraction under LA, and multiple teeth extraction under general anaesthesia) spanning from 2001/02 to 2009/10. The expected savings in annual carbon dioxide equivalent (CO2e) emissions for all combined dental treatments in subsequent years were calculated compared to those in 2001/02. RESULTS: An overall decrease in CO2e emissions was evident in the Childsmile programme and across all dental procedures. The estimated reduction in emissions across all procedures varied from 102.5 tonnes in 2002/03 to 461.1 tonnes in 2009/10 when compared to 2001/02. Within three years, the expected emissions savings from all combined dental procedures surpassed the emissions generated by implementing the Childsmile programme. CONCLUSIONS: Over time, there was a significant reduction in annual CO2e emissions for all combined dental treatments in children. In the eighth year of the Childsmile, emissions savings were more than 4.5 times greater than the emissions generated during its implementation. CLINICAL SIGNIFICANCE: The study highlights the importance of educating public by individual dentists about the environmental impact of caries prevention programmes and paediatric dental treatments as this may influence patient choice. It also encourages commissioners of community dental programmes to support the implementation of supervised toothbrushing programmes in early years childcare.

The Oral Microbiome in Treatment-Naïve Paediatric IBD Patients Exhibits Dysbiosis Related to Disease Severity that Resolves Following Therapy.

BACKGROUND: There is a limited literature describing the oral microbiome and its diagnostic potential in paediatric inflammatory bowel disease [IBD]. METHODS: We examined the dorsum tongue microbiome by V1-V2 sequencing in a cohort of 156 treatment-naïve children diagnosed with IBD compared to 102 healthy control children. Microbiome changes over time following treatment were examined in a subset of patients and associations between IBD diagnosis and dysbiosis were explored. RESULTS: Analysis of community structure of the microbiome in tongue samples revealed that IBD samples diverged significantly from healthy control samples [PERMANOVA p = 0.0009] and exhibited a reduced abundance of Clostridia in addition to several major oral genera [Veillonella, Prevotella and Fusobacterium species] with an increased abundance of streptococci. This dysbiosis was more marked in patients with severe disease. Higher levels of the potential pathobionts Klebsiella and Pseudomonas spp. were also associated with IBD. In terms of predicted functions, the IBD oral microbiome was potentially more acidogenic and exhibited reduced capacity for B vitamin biosynthesis. We used a machine learning approach to develop a predictive model of IBD which exhibited a mean-prediction AUC [area under the ROC curve] of 0.762. Finally, we examined a subset of 53 patients following 12 months of therapy and could show resolution of oral dysbiosis as demonstrated by a shift towards a healthy community structure and a significant reduction in oral dysbiosis. CONCLUSION: Oral dysbiosis found in children with IBD is related to disease severity and resolves over time following successful IBD treatment.

First tooth, first visit, zero cavities: a practical approach to the infant oral health visit.

The IDA adopted a formal policy on children's oral health in 2011. There is increasing evidence to support early dental visits for children. The background to the infant oral health visit is discussed and a systematic approach to the practicalities of the visit is offered. General dental practitioners are encouraged to offer the first oral health visit before the first birthday, and this paper aims to give them practical advice concerning this visit. The feature is accompanied by a companion paper that reviews the literature pertaining to the topic, and serves to complement the recent clinical feature published in the Journal of the Irish Dental Association.

First tooth, first visit, zero cavities: a review of the evidence as it applies to Ireland.

STATEMENT OF THE PROBLEM: There is increasing evidence that the first oral health visit should occur before 12 months of age. Anecdotally, most children in Ireland are not seen at an optimal age. PURPOSE OF THE STUDY: To review the benefits, on both an individual and population basis, of children receiving oral healthcare before 12 months of age, and to apply the appropriate available evidence to the current oral health landscape in Ireland. RESULTS: From an individual perspective, there is published evidence of the benefits of infants attending a dentist before the age of 12 months. These benefits include the opportunity to risk assess the child, provide tailored oral health education and institute preventive care. From an oral health promotion perspective, there are additional benefits of providing population level programmes for children at an early age. CONCLUSIONS: Introduction of the first dental visit by 12 months of age should be firmly on the health agenda here in Ireland.

Dental health and management for children with congenital heart disease.

Congenital heart disease (CHD) is one of the most common developmental anomalies. Children with CHD are at increased risk of developing oral disease, and are at increased risk from the systemic effects of oral disease. Recent changes in guidelines related to prophylaxis against infective endocarditis have highlighted the importance of establishing and maintaining oral health for this group of patients. The management of children with CHD can be complex and, unfortunately, many of these children do not receive the care they require. The challenges that these children pose are discussed, and suggestions are made for the appropriate management of these patients and the key role that all those working in primary dental care have to play.

Alveolar lymphangioma in infants: report of two cases.

The alveolar lymphangioma is a benign but relatively rare condition found only in the oral cavities of black infants. Dentists practising in Ireland may be unaware of this condition due to its racial specificity. This paper presents two case reports of multiple alveolar lymphangiomas found in black infants in a children's hospital in Ireland. The epidemiology, aetiology, clinical presentation, histology, and management options are discussed. The photographs should aid the practitioner in recognising these lesions.

The critical incident technique: a useful tool for conducting qualitative research.

The critical incident technique (CIT) is a well-established qualitative research tool used in many areas of the health sciences, including nursing, medicine, and dentistry, and their respective education systems. It is a flexible set of principles that can be modified and adapted to meet the specific situation at hand. By gathering factual reports made by observers, researchers can build a picture of the situation under study. The CIT maximizes the positive and minimizes the negative attributes of anecdotes, effectively turning anecdotes into data. In this, the first of two companion articles, the origins and current state of the CIT and its potential applications in dentistry and dental education are described.

The critical incident technique and pediatric dentistry: a worked example.

Evaluating dental students' experiences in pediatric dentistry may help dental educators better prepare graduates to treat the children in their communities. This qualitative investigation aimed to collect and analyze data using the critical incident technique (CIT). Sixty dental students at one southwestern dental school participated in 103 recorded interviews. They described 150 positive and 134 negative experiences related to the pediatric dentistry clinic. Analysis of the data resulted in the identification of four key factors related to their experiences: 1) the instructor; 2) the patient; 3) the learning process; and 4) the learning environment. The contribution made by the patient to dental students' education has not been previously addressed. The CIT is a useful data collection and analysis technique that provides rich, useful data and has many potential uses in dental education.

Attitudes and practices of nurses on a pediatric cancer and stem cell transplant ward: adaptation of an oral care protocol.

This study evaluated nurses' current practices and understanding of oral health for hematology and oncology patients. A written questionnaire administered to 33 nurses on the pediatric cancer and blood disorders unit of Children's Medical Center of Dallas included questions on oral evaluation, oral hygiene, and case-based questions. Information gathered was used to develop an oral care protocol. The study found that nurses were proficient in diagnosing obvious conditions including mucositis and pseudomembranous candidiasis, but they were less than proficient when diagnosing less easily recognizable conditions such as xerostomia. The nurses were found to have inadequate knowledge of the treatment and oral hygiene protocols for conditions that they could and could not diagnose. The protocol based on the questionnaire results included information gathering, oral hygiene protocol, evaluation of viral infection, evaluation of fungal infection, oral assessment guide, and treatment protocol. Through information gathering, an oral health care policy may be developed and implemented to aid in the treatment of children undergoing care for malignancies.