International journal of paediatric dentistry最新文献

I have mixed emotions as I write my final BSPD supplement as BSPD honorary editor. As ever, it has been a privilege to see the vibrant culture of sharing best practice in clinical work, quality improvement, and research in our specialty, evidenced in the abstracts for our annual conference and the Quality Improvement Bulletin contained in this supplement. However, I am of course sad to be leaving behind the role of honorary editor of BSPD. I have greatly enjoyed working alongside members of the BSPD executive and council to improve the oral health of children and can now count my executive colleagues as lifelong friends. The role has given me the opportunity to be involved in a great breadth of activity related to paediatric dentistry and meet many amazing people. I wish my successor, Professor Richard Balmer, every success as he takes up the reins and can only hope he enjoys it as much as I have.

The abstracts will be presented at our much anticipated conference, to be held in London, under the leadership of Local Organising Committee chair, Dr Dania Siddik. Dr Ursula Devalia will commence her term as president during the conference which has the theme of ‘Foundations for the Future’, an apt strapline for much of this supplement which shows off some of the new talent and rising stars of our profession, which illustrates a bright future! I would especially like to thank members of the Conference Abstracts and Prizes Committee for their very hard work in reviewing the abstracts and in advance for their judging of the prize competitions as well as Jade Lawson at our conference organisers, Fitwise, for her work in administering all of the abstract processes.

As ever, I am indebted to the editorial team for our Quality Improvement Briefing, under the new leadership of Dr Armaana Ahmad. Armaana and the rest of the QIB team, Dr Laura Timms and Dr Claudia Heggie, have curated an excellent set of articles that will provide inspiration for quality improvement across the United Kingdom and beyond. I hope you enjoy reading the supplement, and thank you to BSPD for the opportunity to serve the speciality over the last 5 years.

Cleft lip and/or palate (CLP) affects approximately 1.7 per 1000 live births [1]. Children with CLP face a significantly higher risk of dental anomalies, caries and delayed development, requiring early preventive dental care [1]. These children may have differences in the number, size, shape and timing of tooth eruption, as well as enamel defects [1]. In response, national CLP standards recommend that preventive dental advice be provided by 6 months [2].

Furthermore, a national initiative by BSPD for all children, ‘Dental Check by 1’ (DCBy1), encourages parents and guardians to take their baby to the dentist by age one to enable preventive advice [3]. There are limited published data regarding access to dental care for children and young people (CYP) under cleft services following the COVID-19 pandemic. Pre-pandemic data from the South-West Cleft Service (SWCS) reported that 92% of children were registered with a general dental practitioner (GDP) [4]. This did not, however, appear to translate into adequate preventive care. Since the pandemic, dental access for this population has worsened. A national survey conducted between July 2023 and February 2024 (as yet unpublished) found that nearly one-third of families under SWCS experienced difficulties accessing dental services.

In light of this, an audit was undertaken to evaluate whether children with CLP under SWCS received timely preventive care and dental contact in line with national standards.

A two-cycle retrospective audit was conducted. Children were identified from cleft birth lists held by SWCS.

This audit demonstrated dental access issues for CYP with experience of CLP. Difficulties accessing dental care included long waiting times and finding a dental home. Regular dental attendance is associated with less caries experience and a better oral health-related quality of life, so long-term solutions must be found [6]. In cycle 2, dental awareness and the provision of preventative advice improved significantly, largely due to the content of the telephone contact and wider provision of the cleft dental pack.

Many parents or carers that were offered an appointment with the cleft dental team were willing to travel to Bristol for this and had concerns they wished to discuss, such as dental development (the path or sequence of eruption, absence of teeth and position), gingival overgrowth and maxillary labial frenum abnormality. This highlighted the importance of early engagement with cleft dental services. The introduction of telephone contact at 6 months increased the percentage of patients seen by a dentist, despite GDP visits falling, through appointments made with the cleft dental team at Bristol Dental Hospital instead. This was not a viable option for all patients. In cycle 2, as locality data were collected, we identified that three families declined the offer of an a

Oral mucositis (OM) is one of the most frequent side effects of cancer treatment. It is associated with intense oral pain, eating and swallowing difficulties, bacteraemia, opioid prescription, increased enteral or parenteral nutrition requirements, extended in-patient hospital stays, interruptions to cancer treatment, and a higher 100-day mortality [1, 2].

Photobiomodulation treatment (PBM) refers to the application of a range of non-ionising red and near-infrared light sources to positively influence cellular metabolism. PBM has an anti-inflammatory effect, wound healing properties, and promotes analgesia in patients with OM [3]. PBM is recommended for use in children by the Paediatric Oncology Group of Ontario (POGO) in clinical practice guidance in OM prevention [4].

The Royal Hospital for Children, Glasgow (RHC) is a Principal Treatment Centre for paediatric oncology, led by oncologists and haematologists, with Advanced Nurse Practitioners (ANPs) having a vital role in the patient's treatment journey. RHC was an early adopter of PBM in the United Kingdom [5], with treatment delivered by the paediatric dentistry team using a class 3B laser since 2012 primarily on an inpatient basis. It has been empirically embraced by paediatric oncology patients, parents, and staff who report it to be easy and beneficial, with frequent requests for treatment and positive feedback from families [6].

The LaserPen from Reimers & Janssen GmbH is operated in continuous wave (CW) mode at a wavelength of 810 nm with an output power of 500 mW. At the time of writing, PBM is delivered at RHC as a treatment for established mucositis rather than for prevention. The local protocol for delivery of PBM is dictated by mucositis severity according to the World Health Organisation (WHO) oral mucositis scale. The protocol specifies the total laser energy (J) to be delivered to each mucositis-affected area of the mouth and throat. Full details of this protocol have been published previously [6]. Class 3B lasers are potentially harmful to the eyes, and safety precautions must be taken. Locally, the agreed standards include laser safety training for PBM providers, eye protection for all people present for PBM delivery, and designated laser-safe rooms with window coverings and signage on external doors.

Existing guidance does not specify which staff groups should deliver PBM and this has been highlighted as a barrier to its use [5]. At the outset of this evaluation, PBM was delivered solely by the paediatric dentistry team, limited to 9-5 pm Monday to Friday (excluding public holidays). Patient/parent feedback through local service questionnaire, indicated desire for wider access to PBM—‘Usually [my son's] mucositis would occur at [the] weekend and I just wish it [PBM] was available at the weekends as he's in pain all weekend then has instant relief afte

Early childhood caries is a strong predictor for caries experience in later years [1]. It is therefore pertinent to focus on the prevention of dental caries from an early age. Health visitors (HV) in the United Kingdom are health providers who have contact with children from birth. They are therefore well positioned to engage families in good oral health practices from a young age [2]. HV are also able to signpost families towards suitable care arrangements.

It is widely acknowledged that access to an NHS general dental practitioner in the United Kingdom is a challenge [3]. The COVID-19 pandemic compounded this, due to the cessation of routine dental care and preventive services [4]. Despite a return to routine services in June 2020, there is still a significant backlog of patients seeking registration with a dentist [4].

Simultaneously, there is a lack of suitable patients in the undergraduate (UG) paediatric dental clinics in Dundee Dental Hospital and School (DDH). This negatively impacts students' opportunities to achieve sufficient experience in caring for children and, therefore, to graduate as safe and proficient clinicians.

To improve both the access to care for patients and increase clinical experience for students, a new pathway was created for direct HV and self-referrals (SR) to the UG clinic. Referrals to the dental hospital can be submitted by any parent or guardian whose child does not have a dentist. HV were advised to refer children whose oral health was of concern and who were not registered with a dentist. All referrals are vetted by consultants, and appropriate patients are subsequently booked into the clinic. Since its introduction in September 2022, the pathway has not been formally reviewed and thus a service evaluation was designed.

To formally assess utilisation of clinics receiving solely HV referrals and SR, and translation of that into clinical experience for students.

After review of the results, potential areas of improvement were identified and implemented. To measure any improvement, a second evaluation was carried out using the same methodology. However, for expediency, only a 6-month time-period was evaluated. This was from 1 March 2024 to 31 July 2024.

In the first evaluation, 95 patients utilising the new referral pathway were allocated a new patient assessment over a 12-month period, a mean of 7.9 patients per month. This increased to 68 patients allocated over a 6-month period, a mean of 11.3 patients per month in the second evaluation. The data collected from the assessment appointment in the first and second service evaluations are summarised in Table 1 and data collected relating to the outcomes after initial assessment are summarised in Table 2.

Following a team discussion of the results, an action plan was developed. This included providing education for the clinical supervising team on the impor