A service evaluation of an intervention to increase application of topical fluoride varnish in general dental practice in South Yorkshire.

PURPOSE: Dental caries is still common in children in the UK despite many available preventative interventions. Application of topical fluoride varnish can reduce caries experience. National and international guidance recommends at least twice-yearly application of topical fluoride varnish, however guidance is not always followed. This project aimed to first identify the proportion of patients receiving fluoride varnish by their primary care dental practitioner prior to their referral to a secondary care service and subsequently increase this rate by introducing an intervention. METHODS: The intervention required the referring practitioner to document the date of which topical fluoride was applied prior to referral. Referrals without this information were rejected. Data were collected pre and post this change in policy to ascertain fluoride application rates. Parents and children were questioned about the frequency of application, and referral forms were reviewed for practitioner-reported application. RESULTS: Topical fluoride application rates improved by 19% points for patient-reported application, and 31% points for practitioner-reported application. The biggest increase in application rate was in the cohort of patients receiving 6-monthly fluoride application. CONCLUSION: This study demonstrated that a simple intervention, mandating that primary care dental practitioners record the most recent application of topical fluoride before referring a patient to secondary care, can improve the rates of topical fluoride varnish application in the UK.

Service evaluation of patients with orofacial granulomatosis and patients with oral Crohn's disease attending a paediatric oral medicine clinic.

AIM: Presenting features associated with orofacial granulomatosis (OFG) and oral Crohn's disease (OCD) are varied, making successful diagnosis and management difficult. The aim of this service evaluation was to establish a profile of patients with these conditions attending a paediatric oral medicine clinic and to determine their overall satisfaction with the care received. STUDY DESIGN: A retrospective case note analysis to establish the patient profile and a postal patient satisfaction questionnaire for service evaluation. METHODS: All patients with OFG and OCD who had attended the joint paediatric dentistry/oral medicine clinic at Charles Clifford Dental Hospital, Sheffield in the previous 14 years were included in the study. Hospital case notes were retrospectively reviewed and patient demographics, clinical features, investigations, diagnosis, treatment and outcomes of treatment were recorded. An anonymous patient satisfaction questionnaire using the Healthcare Satisfaction Generic Module of the Paediatric Quality of Life Inventory (PedsQLTM) was distributed to all patients by mail. RESULTS: A total of 24 patients (13 females and 11 males) were identified. Median age at presentation was 11 years (SD± 3.79, range 2-15). Fifteen patients (63%) were diagnosed with OCD, and 9 (37%) with OFG. Overall, the most common orofacial feature was oral ulceration (75%) followed by lip/facial swelling (71%), angular cheilitis (67%) and mucosal cobblestoning (67%). Differences in presentation were seen between the two conditions with oral ulceration (87%) and mucosal cobblestoning (80%) being the most frequently observed features of OCD and lip swelling (78%) and angular cheilitis (67%) being the most common features of OFG. 58% of patients reported relief of symptoms through treatment. Thirteen patient satisfaction questionnaires were completed (54%). 85% (n=11) felt the overall care received in the clinic was 'excellent'. CONCLUSIONS: This service evaluation highlights the variety of presenting features of OFG and OCD. Despite only a moderate response to treatment, patient satisfaction with the service was high, emphasising the importance of good communication when managing children with chronic, debilitating conditions.

Initial management of paediatric dento-alveolar trauma in the permanent dentition: a multi-centre evaluation.

OBJECTIVE: To investigate the time lapse prior to provision of emergency dental care and appropriateness of earliest treatment provided for children with dental trauma. DESIGN: A multi-regional prospective and cross-sectional survey. SETTING: Paediatric dental departments of Liverpool, Manchester and Sheffield. SUBJECTS: One hundred and fifty referred or emergency paediatric patients with trauma to the permanent incisors. RESULTS: One hundred and fifty subjects were recruited. Mean age of the subjects was 11.1 years (SD = 2.6; range = 6.2-16.6); 100 were male and 50 were female. The mean time interval from injury until initial presentation to a health care professional was 22.6 hours (SD = 76.1; range = 0-672). Thirty-six percent of children (n = 54) first presented to a general dental practitioner whilst 30% (n = 45) presented to accident and emergency medical staff. Following initial assessment, a further mean time lapse of 8.1 hours (SD = 43.7; range = 0-504) was incurred in 25% of cases prior to dental referral. In 39% of subjects (n = 58/150), treatment was considered inappropriate. The most frequent example of inadequate management was failure to protect exposed dentine, which was found for 71% (n = 24/34) of complicated crown fractures and 40% (n = 25/62) of uncomplicated crown fractures. CONCLUSION: This study identified marked delays in the management of some paediatric dental trauma to permanent incisor teeth which, in itself, could be suboptimal. Greater educational and clinical support would seem to be warranted in this area of service provision.

Auriculotemporal nerve syndrome in association with congenital haemangiopericytoma: a case report.

BACKGROUND: Auriculotemporal nerve syndrome is characterised by recurrent episodes of facial gustatory flushing and/or sweating along the cutaneous distribution of the auriculotemporal nerve. The condition is rare in children and is normally a sequel of perinatal birth trauma. We report a case of a sixteen-month-old boy referred by paediatric oncology with recurrent, unilateral facial flushing of the left cheek which had been present for 2 months. The flushing only occurred during mastication. The patient had also received treatment for a rare vascular tumour, congenital haemangiopericytoma, of the left cheek and parotid region. The possible association between auriculotemporal nerve syndrome and congenital haemangiopericytoma is discussed. Knowledge of the presentation, aetiology and management of Auriculotemporal Nerve Syndrome can provide much needed reassurance to those suffering with this condition.

Extraction of first permanent molar teeth: results from three dental hospitals.

OBJECTIVE: To evaluate and compare the reasons for and pattern of extraction of first permanent molars (FPMs) in three UK dental hospitals. DESIGN: Prospective multicentre study. SETTING: Hospital. SUBJECTS: Three hundred children attending Manchester Dental Hospital, Liverpool Dental Hospital and Charles Clifford Dental Hospital (Sheffield) who required extraction of at least one FPM. RESULT: The mean age in months was 129 (SD 22.7), 139 (SD 29.4), and 133 (SD 26.8) for Manchester, Liverpool and Sheffield respectively. Forty-five percent and 48% of children had four FPMs extracted at Manchester and Sheffield respectively, compared to 25% in Liverpool. The main reason for extraction was caries with poor prognosis (70%); molar incisor hypomineralisation was the reason for extraction in 11% of cases. General anaesthesia was the main anaesthetic method used in 77%, 55%, and 47% of cases in Manchester, Liverpool and Sheffield respectively. Sixty-eight percent of cases had not received previous treatment for the FPMs and 5% had fissure sealants detected. Forty percent of children had had previous extractions. CONCLUSION: The children who are attending the hospitals for extraction of FPMs tend to be older than the recommended age for achieving spontaneous space closure. This study highlights the need for extensive prevention programs targeted at those children with high caries risk.

Smooth muscle hamartoma of the hard palate.

A small polypoid lesion was removed from the incisive papilla region of a healthy female aged 8 years. It was composed of non-cycling smooth muscle fibres that were immunoreactive for various muscle antigens, surrounded by basement membrane containing collagen IV, arranged as bundles and mixed with CD34(+) interstitial cells, mast cells, dendrocytes and nerves. The lesion could be attributed to dysgenesis affecting media of vessels emerging from the incisive foramen. Intra-oral smooth muscle hamartomas tend to favour regions featuring complex developmental events.