Paediatric dentists' identification and management of underweight and overweight children.

Introduction: Dental caries and obesity are growing challenges for the NHS. Dentists are in the unique position of being able to identify both conditions and intervene, following UK government strategy of 'making every contact count'. Aims: Identify specialists in paediatric dentistry's (SPD) current practice regarding diagnosis and management of underweight or overweight/obese children presenting to dental services. Materials and methods: An online survey was emailed to the UK SPD group. Questions investigated whether height, weight or body mass index (BMI) were measured, actions taken, and dentists' feelings regarding their role. Results: 49/118 (42%) SPDs responded. All felt they had a responsibility to identify underweight or overweight/obese children. Around a quarter (26%) measured BMI 'always' or 'often', while 37% did not measure BMI. Only 41% of SPDs who measured BMI took action more than twice in a year. Most commonly (90%) the child's GP was informed. Conclusions: SPDs were supportive of the identification of underweight or overweight/obese children. However, many felt uncertain about BMI interpretation. Thus, few routinely measured BMI or acted on abnormal results. SPDs would benefit from training, alongside development of a local protocol, regarding BMI calculation and interpretation.

Do you see what I see? Identification of child protection concerns by hospital staff and general dental practitioners.

Aim An exploration of the threshold that dentists, doctors and nurses recognise for dental and child protection (CP) actions in sample clinical cases, and any differences between these professional groups.Method We present a cross-sectional survey of dentists, doctors and nurses (50 each), who regularly examine children, utilised five fictitious vignettes, combining an oral examination image and clinical history reflecting dental and CP issues. Demographics were collected, and each participant gave their likely action for the cases presented.Results Dentists were significantly better at answering the dental element than the doctors and nurses, (P <0.0001) with no significant difference between these two; only 8% of the latter had undergone any training in assessment of dental health. Although 90.6% of all professionals had undergone CP training, dentists were significantly less accurate at identifying the CP component than doctors and nurses, (P <0.0001) between whom there were no significant differences. Those with higher levels of CP training were most accurate at identifying correct CP actions.Conclusions CP training is effective at improving recognition of child maltreatment, although there remains a worrying lack of knowledge about thresholds for action among dentists. Doctors and nurses have minimal training in, or knowledge of, dental health in children, thus precluding appropriate onward referrals.

Paediatric conscious sedation: views and experience of specialists in paediatric dentistry.

OBJECTIVES: The objectives were three-fold: to investigate the level of conscious sedation training received prior to and during specialist training in paediatric dentistry; to establish the use of conscious sedation during and following specialisation; and to determine the attitudes of specialists in paediatric dentistry to conscious sedation. SUBJECTS AND METHODS: A self-administered postal questionnaire was sent to all specialists in paediatric dentistry registered with the General Dental Council in January 2008. Non-responders were contacted again after a four-week period. RESULTS: A response rate of 60% was achieved. Of the 122 respondents, 67 (55%) had received sedation training as an undergraduate; 89 (75%) had been trained during specialisation. All respondents performed dental treatment under sedation as a trainee and the majority used nitrous oxide inhalation sedation (NOIS). Over 90% of respondents felt that NOIS should be available to all children, both in appropriate primary care settings and in hospitals. One hundred and twenty-one (99%) respondents thought that all trainees in paediatric dentistry should have sedation training. CONCLUSIONS: The most popular form of sedation amongst specialists in paediatric dentistry was NOIS. However, some of the respondents felt that children should have access to other forms of sedation in both the primary care and hospital settings. Additional research on other forms of sedation is required to evaluate their effectiveness and safety.

Hurler's syndrome: dental findings in a case treated with bone marrow transplantation in infancy.

Hurler's syndrome, also known as mucopolysaccharidosis I (MPS I-H), is a rare condition inherited as an autosomal recessive trait. It is caused by a deficiency in alpha-L-iduronidase, an enzyme that participates in the degradation of the glycosaminoglycans (GAGs) heparin sulphate and dermatan sulphate. Children with Hurler's syndrome appear nearly normal at birth but, left untreated, show a progressive mental and physical deterioration caused by a build-up of GAGs in all organs of the body. Death is often caused by cardiac or respiratory failure and usually occurs before the second decade of life. In recent years, bone marrow transplantation (BMT) has been employed in the management of patients with Hurler's syndrome. However, the dental findings observed in these cases have not previously been reported in the dental literature. Here we report a patient aged 11 years and 6 months, presented to a Specialist Paediatric Dentistry Unit, who was successfully treated by BMT at 18 months of age.