Child maltreatment in Dubai and the Northern United Arab Emirates: dental hygienists and assistants' knowledge.

PURPOSE: Dental assistants (DAs) and hygienists (DHs) should play an active role in the detection and reporting of child abuse and neglect (CAN). We aimed to investigate CAN knowledge of DAs and DHs in the United Arab Emirates (UAE) and some of the inhibiting factors to the process of CAN reporting. METHODS: A cross-sectional study design was utilized. We surveyed 186 DAs and DHs using a previously validated self-administered anonymous CAN knowledge questionnaire. Statistical analysis was performed using χ2-square, Fisher's exact test, t test/Mann-Whitney, and a ROC curve (p < 0.05). RESULTS: Among 186 DAs and DHs surveyed, satisfactory knowledge of CAN was demonstrated by 50.5%. DAs scored a significantly higher score of knowledge compared to DHs (p = 0.03). The most reported CAN referral inhibiting factor was "being afraid to get in trouble with parents". The recognition of a child with special needs and parents missing multiple appointments as risk factors for CAN was significantly higher in the DAs compared to DHs (p = 0.04, p = 0.024, respectively). Awareness of local laws was related to CAN knowledge in DAs (p = 0.012) and DHs (p = 0.008). CONCLUSION: The lack of appropriate knowledge regarding CAN necessitates a clear reporting process and better education for DAs and DHs in the UAE.

Can child safeguarding training be improved?: findings of a multidisciplinary audit.

INTRODUCTION: Child protection has become a very poignant subject in the UK. The Laming report into the death of Victoria Climbié led to the implementation of multidisciplinary safeguarding policies and training for healthcare professionals, social services staff and police. However, many dental practitioners, as well as other healthcare professionals, have little confidence when reporting their concerns and reducing the 'gap' between suspicion and reporting (Laming in The victoria climbie inquiry: report of an inquiry by Lord Laming, 2003. https://www.gov.uk/government/publications/the-victoria-climbie-inquiry-report-of-an-inquiry-by-lord-laming ). Our audit aimed to identify and address the barriers of reporting safeguarding concerns amongst the hospital team. MATERIALS AND METHODS: Questionnaires were distributed to staff at Surrey and Sussex Healthcare National Health Service Trust with a valid Safeguarding Children Level 3 certificate in order to assess their knowledge of safeguarding children. Changes to traditional safeguarding training (Group 1) were implemented to include a broader range of speakers, each speaking for shorter times with more personal and focused presentations (Groups 2 and 3). Three cohorts of participants were assessed including healthcare assistants, nurses, dentists, and doctors. RESULTS: Group 1 (n = 100) reported 64% experience of reporting compared with group 2 (n = 100) 43% and group 3 (n = 76) 51%. Confidence was higher in those with more experience in child protection. The most common barrier was the uncertainty of diagnosis. More barriers to reporting existed in the new style of training in groups 2 and 3. The scenarios were answered with appropriate concern and reporting by groups 1 and 2, however, less for group 3. DISCUSSION: Experienced and trained practitioners are more likely to refer children to child protection teams when they have concerns of abuse or neglect. Personalising training was shown to be less effective and the focus should be more on diagnosis and local protocols. Early training from undergraduate level was a unanimous request. CONCLUSION: Focused training on diagnosis and local protocols, accompanied by bespoke teaching for specific specialties would be the most constructive tool for safeguarding children. Exploring modern methods such as simulation-based training could be effective. Structured forms and local policies that are familiar to clinicians prevent omissions and encourage professional awareness.

Assessment of the knowledge of United Arab Emirates dentists of Child Maltreatment, protection and safeguarding.

AIM: Child safeguarding is society's responsibility. Dentists are uniquely positioned to recognise Child Abuse and Neglect (CAN) in dental practice and the wider society. The United Arab Emirates (UAE) introduced a child protection law in 2016. We aimed to assess the awareness of UAE dentists of child maltreatment, protection and safeguarding. Study Design A cross-sectional survey. MATERIALS AND METHODS: We surveyed 381 UAE dentists about the knowledge and practice of CAN and safeguarding issues using a self-administered anonymous questionnaire. Statistical analysis was carried out using Chi-square, t-test, ANOVA and Pearson's correlation test and statistical significance was set as p <0.05. RESULTS: Over 39 % (n=152) of the responders suspected CAN; male dentists suspected more CAN than females (p=0.015). Orthodontists, paediatric dentists (p<0.001) and female dentists (p=0.001) were more knowledgeable about diagnosing CAN. Paediatric dentists attended more CAN-related postgraduate training (p<0.001) than other specialties. Over 90% (n=346) believed that CAN should be addressed, 58.1% (n=224) and 54.1% (n=206) had CAN undergraduate and postgraduate training respectively but 53.5% (n=204) were unaware of local child protection guidelines. Dentists barriers to child protection reporting were; fear of family violence (59.6%, n=227), lack of knowledge of referral process (60.2%, n=228) and lack of diagnosis certainty (54.9%, n=206). UAE dentists qualified in Western and Asian countries had fewer barriers for child protection reporting (p=0.022) than the Arab and Gulf Cooperation Council qualified dentists. CONCLUSIONS: A large minority of UAE dentists suspected CAN. Factors influencing child protection reporting were identified. Dentists' gender, specialty, and country of qualification affected their knowledge of CAN and practice of safeguarding. Child protection training is recommended.

How do oral and maxillofacial surgeons manage concussion?

Craniofacial trauma results in distracting injuries that are easy to see, and as oral and maxillofacial surgeons (OMFS) we gravitate towards injuries that can be seen and are treatable surgically. However, we do tend not to involve ourselves (and may potentially overlook) injuries that are not obvious either visually or radiographically, and concussion is one such. We reviewed the records of 500 consecutive patients who presented with facial fractures at the Queen Elizabeth Hospital, Birmingham, to identify whether patients had been screened for concussion, and how they had been managed. Of the 500 cases 186 (37%) had concussion, and 174 (35%) had a more severe traumatic brain injury. The maxillofacial team documented loss of consciousness in 314 (63%) and pupillary reactions in 215 (43%). Ninety-three (19%) were referred for a neurosurgical opinion, although most of these were patients who presented with a Glasgow coma scale (GCS) of ≤13. Only 37 patients (7%) were referred to the traumatic brain injury clinic. Recent reports have indicated that 15% of all patients diagnosed with concussion have symptoms that persist for longer than two weeks. These can have far-reaching effects on recovery, and have an appreciable effect on the psychosocial aspects of the patients' lives. As we have found, over one third of patients with craniofacial trauma are concussed. We think, therefore, that all patients who have been referred to OMFS with craniofacial trauma should be screened for concussion on admission, and at the OMFS follow up clinic. In addition, there should be an agreement between consultants that such patients should be referred to the traumatic brain injury clinic for follow up.

The Hall Technique 10 years on: its effect and influence.

Dental caries in early childhood can have a very significant effect not only on the oral health of young children but on their quality of life and that of their families. Added to this are the long-term infective risks to the host of untreated caries in primary teeth but also the risk of damage to successor permanent teeth. Traditional restoration of damaged primary teeth has been shown to have only moderate outcomes depending on the techniques and materials used and the ability of children to cooperate because of age or other factors. The Hall technique has outperformed other techniques in randomised clinical trials. In this Opinion Article I will take a look back at the Innes et al. paper, first published in this Journal in 2006, that introduced the Hall Technique and the subsequent scientific literature which provided us with high quality scientific evidence of the efficacy of the technique. I will evaluate how this new technique has affected the management of early childhood caries and hence its influence on wider oral and general health.

Current and historical involvement of dentistry in child protection and a glimpse of the future.

Dental teams have been involved with child protection for over 40 years. This brief review summarises their involvement in the detection of various types of child abuse and goes on to discuss the gap between the proportions of dental professionals who suspect child abuse or neglect in their paediatric patients and those who refer such cases on. Potential reasons for this discrepancy are discussed, and a glimpse of the future is given as to where further research may be necessary to tackle this existing gap.

Establishing comprehensive oral assessments for children with safeguarding concerns.

The dental profession is well placed to contribute important information in child protection cases but no previous research has been reported that assesses the volume or impact of this information. Comprehensive oral assessment clinics were introduced and established as an integral part of comprehensive medical assessments for children with welfare concerns in Greater Glasgow and Clyde. An assessment protocol and standardised paperwork for comprehensive oral assessments were developed to enhance information sharing and patient access to appropriate care. Two cases are presented and discussed to demonstrate the value of dental input.

The Scottish dental practitioner's role in managing child abuse and neglect.

BACKGROUND: In 2005 Cairns et al. published a paper ( 2005; 15: 310-318) examining the role of the general dental practitioner (GDP) in child protection (CP) in Scotland. This involved a questionnaire sent out to Scottish GDPs in 2003. Subsequently in 2006 all UK dental practices were sent Child protection and the dental team, a manual detailing roles and responsibilities with regard to CP. During this time the profile of CP within dentistry increased. There has been no published research since 2006 investigating whether the gap between the proportion of GDPs who suspect child abuse/neglect in their patients and those who refer cases has changed. AIM: The aim of this research was to investigate whether this gap has changed between 2003 and 2010.Method A postal questionnaire based on that used by Cairns et al. was sent to 50% of GDPs in Scotland in March 2010. RESULTS: The response rate was 52% (53% male). Some 29% and 55% of respondents had received undergraduate or postgraduate training in child protection respectively. Over two thirds (37%) had suspected child abuse/neglect in one or more of their paediatric patients but only 11% had referred a case. The most common factor affecting the decision to refer was 'lack of certainty of the diagnosis' (74%). Some 77% thought that abused/neglected children had an increased caries increment and 73% of dentists were willing to get involved in detecting neglect. CONCLUSION: Dentists in Scotland appear to be suspecting and referring more cases of child abuse/neglect than previously. The vast majority are willing to get involved in detecting neglect.

Traumatic dental injury and social deprivation in five-year-old children in Scotland 1993-2007.

OBJECTIVE: To describe the pattern and time trends of dental injury and its sociodemographic determinants among five-year-old children in Scotland. DESIGN AND METHODS: A retrospective analysis of Scottish Health Boards' Dental Epidemiological Programme (SHBDEP) and National Dental Inspection Programme (NDIP) records for the period 1993-2007. Annual incidences were calculated by age, gender, health board and deprivation categories (DEPCAT). RESULTS: Out of 68,354 children examined only 405 (0.6%) had suffered dental injury with an overall incidence of 5.9/1000 population. There was a remarkable decrease in incidence over time. Virtually the same rates were recorded for the two genders (M:F = 1.13:1.0). The incidence varied significantly between health boards' areas (p <0.001); the highest incidence being reported in Dumfries (14.2/1,000 population), which was 11 times greater than that in Ayrshire (1.3/1,000 population). There was no significant association between risk of dental injury and increasing deprivation (p = 0.956); in DEPCAT 1 (most affluent) the incidence was 6.4/1,000 population, while in DEPCAT 7 (most deprived) the incidence was 5.7/1,000 population. CONCLUSION: The incidence of dental injury is varied among health boards, though it had significantly decreased since 1993. Gender and deprivation level had no effect on incidence of dental injury.

Sectioning of a double tooth aided by cone-beam computed tomography.

BACKGROUND: Double teeth present challenges for their clinical management. Recent advances in imaging, particularly cone-beam computed tomography (CBCT), have aided clinicians in accurate diagnosis and management. Data from CBCT imaging can be used for three-dimensional reconstruction to further aid pre-surgical planning. CASE REPORT: A 14-year-old Caucasian male presented with an aesthetically unacceptable double tooth in the 22 region. Clinical and radiographic examination and assessment included CBCT imaging and three-dimensional reconstruction. TREATMENT: Based on this information, together with a comprehensive assessment of the patient's motivation, a treatment plan consisting of extra-alveolar sectioning, re-implantation, endodontic therapy and composite resin restoration was carried out. FOLLOW-UP: The patient failed to return for follow-up at 6 months post-treatment. However, he did return at 12 months, where clinical and radiographic examination was undertaken. At this point the tooth was clinically sound and bony infill was seen radiographically. CONCLUSION: The information gained from the pre-surgical imaging with CBCT was useful in planning treatment in this case. However, this had to be combined with a careful assessment of the patient's motivation to ensure that the course of treatment embarked upon was likely to be successful whilst addressing the patient's concerns.

Incidence and prevention of traumatic injuries in paediatric handball players in Istanbul, Turkey.

AIM: To investigate the frequency of dental injuries in paediatric handball players. In addition, the players' habits with regard to mouthguard usage, as well as their general knowledge of the prevention of traumatic dental injuries (TDIs) were investigated. Data were collected by structured one-to-one interviews with children of 14 randomly selected handball teams in the amateur national league. METHODS: The questionnaire consisted of 15 questions. The age, gender, trauma experience and league status of each interviewee was recorded. The interviews took place mainly at national championships or tournaments. RESULTS: A total of 212 individuals, 74 girls and 138 boys, were interviewed. Forty-one of the 212 participants (19.3 %) had sustained a dental injury. The mean age of participants was 12 ± 1.6 years. Concussion was the most frequent finding and the cause of injury was a blow from another player. The number of individuals that were aware of mouthguards was only 15.6 % and surprisingly no players used mouthguards. CONCLUSIONS: The results show that handball players need more knowledge and education considering the prevention of TDIs from their sports clubs and dentists. The importance of adequate facial protection in contact sports should be endorsed by all sports clubs, and parents advised accordingly.

Early prognostic indicators and outcome prediction model for replanted avulsed teeth.

AIM: To identify early clinical variables that are most predictive of treatment outcome and to develop a model that will allow prediction of treatment outcomes based on these variables. STUDY DESIGN AND METHODS: A dental trauma database was used to randomly identify patients who had received treatment for avulsed teeth between 1998 and 2007. A data extraction form was designed and completed for each tooth. Demographic, diagnostic and treatment information recorded in the patient's records, in addition to radiographs, were viewed retrospectively. STATISTICS: The significance and the predictive power for each early clinical variable were assessed using a univariate logistic regression model. Only significant variables (p<0.05) were considered eligible for the prediction model and a c-index was then constructed for their respective predictive power (0.5 = no predictive power, 1.0 = perfect prediction). RESULTS: Of the original sample of 213 patients who had received treatment for avulsed teeth between 1998-2007 only 105 fulfilled the criteria for evaluation. Two models ('At first visit' and 'at initial treatment visits') were produced with a total of five variables that were significant and holding the greatest predictive power (high c-index): patient age (p=0.001, c=0.80); stage of root formation (p=0.001, c=0.76); storage medium (p=0.047, c=0.58); tooth mobility after dressing (p=0.001, c=0.70); and tooth mobility after splinting (p=0.003, c=0.70). These variables underwent multi-variate analysis and the final models had good predictive abilities (c-index of 0.80 and 0.74). CONCLUSION: These predictive models based on patient age, stage of root formation, storage medium, tooth mobility after dressing and tooth mobility after splinting were shown to have high predictive value and will enable a clinician to estimate the long term prognosis of avulsed and replanted teeth. It will enable planning for further treatment with a realistic view of outcome at an early stage.

The effect of casein phosphopeptide-amorphous calcium phosphate on enamel surface rehardening. An in vitro study.

AIM: Casein phosphopeptide stabilised amorphous calcium phosphate (CPP-ACP) has been shown to remineralise enamel subsurface lesions. The aim of this study was to determine the effect of a paste containing 10% CPP-ACP (Toothmousse; GC) on enamel surface microhardness in vitro. MATERIALS AND METHODS: Thirty enamel blocks (3x2 mm) were prepared for the study group from the buccal surface of extracted teeth. The microhardness of the enamel surface was determined for the specimens initially before artificial demineralisation. After demineralization the specimens were incubated in 10% CPP-ACP for 5 min. Artificial saliva was used as a remineralising solution for the control group. RESULTS: The mean baseline surface microhardness analyses of enamel blocks were 318.61±25.75 and 262.49±26.82. The data show that after demineralisation the mean microhardness decline in the experimental groups (247.05± 38.31 and 186.92± 63.77). The results showed that 10% CPP-ACP (281.79±26.32) was comparable to the control (252.27± 31.05) for remineralisation of enamel subsurface lesions in vitro. The highest surface microhardness recovery (%SMHR) was found for control, but the differences of % SMHR between 10% CPP-ACP and control was not statistically significant (p=0.805). CONCLUSION: From the results it can be concluded that CPP-ACP may have positive effects on enamel remineralisation.

An investigation into infant feeding in children born with a cleft lip and/or palate in the West of Scotland.

AIM: To investigate feeding practices in infants born with a cleft lip and/or palate (CLP) in the West of Scotland and the challenges that the parents of these children experienced especially in the first hours and months after birth. METHODS: A questionnaire involving a 'face-to-face' interview was completed with parents of cleft children under the age of 6 years with a cleft lip and/or palate attending the Oral Orthopaedic Prevention Clinic (OOPC). RESULTS: 90 questionnaires were completed and analysed. The incidence of breastfeeding in this study at birth was 54%. In comparison, the incidence of breastfeeding in Scotland nationally was 63% in the year 2000 and 70% in 2005 indicating a lower uptake of breastfeeding for this CLP population. Cleft type had a significant impact on whether the infant was breastfed (p<0.05), those with a cleft lip being more likely to be breastfed. Twenty-nine percent of cleft infants required the use of a naso-gastric tube (NGT) to assist feeding either in hospital during the days following birth or later when there were concerns about the infant's weight. Of these all but one had a CP+/- CL, (p<0.001); 26% of parents reported that their infant had used a pre-surgical appliance; 70% rated the appliance highly in terms of aiding feeding. The help and support given by the cleft team, especially Specialist Cleft Nurses (SCNs), was rated as positive in over 95% of cases but was less positive for the non-cleft health care professionals. Parents found it difficult to find the right feeding method for their baby until they received input from the SCNs and only a minority of parents managed to establish a regular feeding pattern. CONCLUSIONS: This study recommends the employment of more SCNs and an improvement of the knowledge of non-cleft health care professionals.