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 A national survey conducted between July 2023 and February 2024 (as yet unpublished) found that nearly one-third of families under SWCS experienced difficulties accessing dental services.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
As healthcare professionals there is a legal responsibility to provide support and make reasonable adjustments for patients with additional needs, such as autism and learning disabilities. Mind, a health charity, defines reasonable adjustments as ‘changes to prevent your disability putting you at a disadvantage compared with others who are not disabled’, this ensures equal access to services [1]. The Equality Act 2010 created a legal framework that reflects on accessibility to care for children and young people with additional needs [2]. In response, NHS England developed a Reasonable Adjustment Digital Flag on the NHS Spine, this allows health professionals to record and share reasonable adjustments an individual may need [3]. Guidance released in 2019 by Public Health England under ‘Oral Care and People with Learning Disabilities’, stated the importance of being ‘anticipatory’ with reasonable adjustments [4]. The Oliver McGowan mandatory training package was formulated to enable staff to understand autism from the perspective of the patient and how to make adjustments [5]. The patient journey through the paediatric dental department at University College Hospital London (UCLH) begins with a telephone assessment followed by a face-to-face assessment. A detailed patient history taken at the telephone appointment should help identify patients who may need reasonable adjustments and the support required.
To evaluate the existing pathway for patients with additional needs and make improvements that enhance the patient experience when attending the paediatric dental department.
This was a retrospective service evaluation with the data extracted from the hospital's electronic health record system (EHRS) by the author. Patients attending telephone and face-to-face new patient clinics in November 2023 were reviewed. Patients were identified as having additional needs through the referrals and information gathered at the telephone assessment. Inclusion criteria included all patients with neurodiversity, learning difficulties, developmental delay or complex medical histories. Patient records were reviewed to assess if a digital flag alert was present, if a 60-min appointment was requested and booked, and if reasonable adjustments were identified and recorded.
A second service evaluation was completed for patients seen in July 2024 and included a survey of staff on the use of the BSPD Autism Questionnaire, which was introduced as part of the action plan for the first evaluation [6]. The survey had three open questions, which were: likes, dislikes and recommended changes. This was completed by all staff groups involved in the care of patients with additional needs.
There were 26 children identified with AN in Evaluation 1 and 30 children in Evaluation 2 (Table 1). There were improvements in all areas evaluated between the first and second evaluations, pa
Between April 2023 and March 2024, 32 514 children in England were admitted to hospital with dental decay [1], with many of these admissions necessitating a general anaesthetic (GA) for dental treatment. As demand for this service results in often lengthy waiting lists, it is important that GA lists are used to capacity and cancellations minimised. To aid this, a robust pre-assessment process beginning at initial clinical assessment is needed; all children listed for GA should have a thorough medical history taken and a nurse-led pre-assessment prior to admission. However, where a child has a complex medical history or requires significant reasonable adjustments, a pre-assessment by a consultant anaesthetist may be required [2]. These anaesthetist-led pre-assessments are usually conducted via review of clinical notes, with or without an appointment. However, according to the Association of Paediatric Anaesthetists of Great Britain and Ireland, there is significant variation in the availability of these services around the United Kingdom [3].
The paediatric dentistry department in Leeds Teaching Hospitals Trust (LTHT), UK, has two GA pathways: an ‘extraction only’ list for fit and well children or those with mild systemic disease, and a pathway for medically complex children and comprehensive care treatment delivered at the Leeds Children's Hospital (LCH). Anaesthetist input for medically complex children is often requested as part of nurse-led pre-assessment [4], however, at LCH this additional input is requested by the dental clinician at the time of GA listing via an electronic listing form. This form becomes part of the patient's electronic record and is viewable by all specialities.
Prior to this evaluation, no local protocol existed to inform the criteria for referral. Anecdotally, high variation was observed in the quality of referral and the dental clinician decision to refer for anaesthetist pre-assessment. Concern had been raised by the pre-assessment anaesthetists that the paediatric dental team were referring more patients than other surgical specialties, and that limited quality of referrals may result in preparation issues leading to cancellations at short notice or on the day of GA. A service evaluation was therefore conducted to explore the pre-assessment pathway for these patients and their GA outcomes.
To evaluate and develop the pathway for consultant anaesthetic GA pre-assessments to improve referral quality and service utilisation.
Evaluation One included a retrospective review of all patients on the waiting list for GA at LCH in October 2022. Those on the extraction only pathway and those awaiting comprehensive care who were fit and well were excluded from analysis, as these children would not require anaesthetist-led pre-assessment. All records were reviewed and evaluated for referral to the pre-assessment service. The dental notes (including medi
The amount of fluoride maintained in the oral cavity aids in the remineralization process.
To evaluate and compare plaque and salivary fluoride levels following applications of silver diamine fluoride (SDF), sodium fluoride varnish (NaFV), or both.
Sixty preschoolers randomly received 38% SDF, 5% NaFV, or both (SDF + NaFV). Plaque and saliva were collected at baseline; 5, 30, and 60 min; and 24 and 48 h post-application. Fluoride levels in plaque and saliva were evaluated and statistically compared (p < 0.05).
Salivary fluoride levels peaked 5 min post-application in all groups and recovered to baseline within 1 to 24 h. Plaque fluoride levels peaked between 5 and 60 min, then returned to baseline within 1 to 24 h. The SDF group had significantly lower plaque and salivary fluoride levels than the other groups. There were no differences in plaque or salivary fluoride levels between NaFV and SDF + NaFV groups; however, the SDF + NaFV group had the longest salivary fluoride retention.
The application of SDF in combination with NaFV (highest fluoride exposure) resulted in higher fluoride levels in plaque and saliva of preschoolers. Since these levels returned to baseline in less than 24 h, further studies are required to establish the implications for caries arrest and prevention.
Background: Moderate sedation is a behavior guidance technique in pediatric dentistry, and evaluating existing regimens can improve sedation outcomes and safety.
Aim: To determine if behavior at consult and sedation medication dosages is associated with sedation success and the patient's behavior using diazepam, meperidine, and hydroxyzine (DMH) regimen.
Design: A retrospective chart review of 324 patients who underwent 404 oral moderate sedations with (DMH) from April 2017 to June 2022. Sedations were graded as Successful or Unsuccessful and Positive (Frankl F3 or F4) or Negative (Frankl F1 or F2) behavior. Primary variables included Frankl behavior at consult and medication dosages. Logistic regression models were used to determine if these factors were associated with sedation success and behavior while adjusting for other patient and sedation characteristics.
Results: DMH yielded mostly successful sedations (89%) and Positive Behavior (Frankl F3 or F4) (72%). Lower Frankl scores at consult (OR: 2.3, p = 0.0140) were associated with increased odds of sedation failure. Increased age (OR: 0.8, p = 0.0047) was associated with decreased odds of failure. Meperidine dose demonstrated a significant association with improved sedation while controlling for age and behavior (p < 0.0001).
Conclusion: The (DMH) is an effective moderate sedation regimen. Patient selection is a significant factor in sedation success.
Background: Evidence suggests that pediatric patients requiring endodontic treatment in the permanent dentition are often a "missed population".
Aim: This study surveyed pediatric dentists and endodontists about the frequency with which they encounter pediatric patients requiring endodontic treatment, their training, practice patterns, and decision-making considerations for the treatment of immature permanent teeth.
Design: Surveys were distributed to endodontists (n = 2457) and pediatric dentists (n = 3974) in the United States. Data were analyzed using descriptive statistics and X2 analysis. The level of significance was set at 0.05.
Results: The response rate was 13.1% (n = 840). The frequency of clinicians encountering pediatric patients requiring endodontic treatment for permanent teeth did not differ significantly by specialty. Pediatric dentists and endodontists reported statistically significant differences in their practice patterns related to the performance of vital pulp therapy (p < 0.001) and procedures for necrotic immature permanent teeth (p < 0.001). Among specialists, apexification was more frequently performed than regenerative endodontic procedures (REPs) (p < 0.001). When asked to consider clinical and patient factors related to the treatment of necrotic immature permanent teeth, pediatric dentists most frequently responded that they were "unsure" of their preferred treatment.
Conclusion: Standardized clinical knowledge and management of immature permanent teeth between specialties may improve interdisciplinary care for pediatric patients.
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