Oral findings and dental treatment in a child with West syndrome

West syndrome (WS) is a rare, severe form of epilepsy that typically manifests early in infancy. It is considered a malignant condition that combines episodes of spasms that occur in clusters (infantile spasm), hypsarrhythmia on the electroencephalogram, and neuropsychomotor delay. Although WS has been widely investigated from a medical standpoint, few reports have focused on the oral findings in patients with this syndrome. This article reports the case history of a 7-year-old child diagnosed with WS. The major clinical features were generalized tooth wear and gingival enlargement, altered chronology and sequence of dental eruption, primary canine cusp-to-cusp relationship, ectopic dental eruption, and mildly arched palate. Multiple white spot lesions were also observed, possibly associated with poor oral hygiene, due to a fermentable carbohydrate-rich diet, and continuous use of sugar-containing medications. Dental care management of patients with special needs is discussed and the dental treatment for this child with WS is described.     

Practices of Maryland dentists: oral cancer prevention and early detection--baseline data from 1995

OBJECTIVES: To investigate practices and opinions of general dentists in Maryland, USA, related to oral and pharyngeal cancer prevention and early detection. DESIGN AND METHODS: A pre-tested, 34-item questionnaire, cover letter and addressed, stamped envelope were mailed in the summer, 1995, to a simple random sample of 800 members and non-members of the American Dental Association practicing in Maryland. A reminder postcard was sent 3 weeks after initial mailing; a second complete mailing to all non-respondents 6 weeks after first mailing. RESULTS: Over 90% of dentists asked about patient's current use of tobacco but only 77% assessed patient's history of tobacco use and types and amounts used. Fewer (66%) asked about present use of alcohol. Ninety percent reported providing an oral cancer examination at the initial appointment for patients 40 years of age or older; only 6% provided the examination for edentulous patients and only 40% reported palpating lymph nodes of patients 80% or more of the time. CONCLUSIONS: Dentists' reporting on providing oral cancer examinations and taking appropriate health histories are disappointing. These results call for comprehensive educational interventions in terms of changes in dental curricula and as continuing education courses especially since most dentists were interested in continuing education courses on oral cancer prevention and early detection.     

Opinions about oral cancer prevention and early detection among dentists practising along the Texas-Mexico border

OBJECTIVES: The purpose of this study was to assess dentists' opinions about oral cancer (OC) prevention and early detection. METHODS: Data were collected by a self-administered mail questionnaire sent to all 398 registered dentists practising along the Texas-Mexico border. RESULTS: The effective response rate to the survey was 40%. While 90% of respondents agreed that oral cancer examinations (OCE) should be provided annually for patients 40 years of age and older, only 59% of respondents believed their OC knowledge was current. While 99% agreed that dentists were qualified to perform OCE, only 54 and 68% respectively, agreed that dental hygienists and physicians were similarly qualified. Dentists who rated their undergraduate OC training favorably (OR = 2.68, 1.23-5.81, P = 0.011), had attended their last oral cancer continuing education (OCCE) course within the past 5 years (OR = 2.46, 1.25-4.86, P = 0.009), and those who performed OCE on all patients 40 years and older (OR = 2.64, 1.32-5.26, P = 0.005), were more likely to agree their OC knowledge was current. CONCLUSIONS: Respondents expressed diverse opinions about OC prevention and early detection. Positive opinion on currency of OC knowledge was associated with performance of OCE. Results indicate a need for OCCE targeting the study population as well as increased emphasis on OC curriculum in dental schools.     

Oral cancer knowledge and opinions among Maryland nurse practitioners

OBJECTIVES: As part of a Maryland statewide oral cancer needs assessment, a census of adult and family practice nurse practitioners was conducted to determine their knowledge of oral cancer risk factors, diagnostic procedures and related opinions. METHODS: Information was obtained through a pretested, 40-item, self-administered mail questionnaire of 389 nurse practitioners. A second complete mailing was sent three weeks after the initial mailing; two postal card reminders were mailed at 10 and 17 days after the second mailing, which yielded a response rate of 56 percent. RESULTS: Most nurse practitioners identified the use of tobacco, alcohol, and prior oral cancer lesions as real risk factors. But only 35 percent identified exposure to the sun as a risk for lip cancer. Respondents were not overly knowledgeable about the early signs of oral cancer, most common forms, or sites for oral cancer. Only 19 percent believed their knowledge of oral cancer was current. Nurse practitioners who reported having a continuing education course on oral cancer within the past two to five years were 3.1 times more likely to have a high score on knowledge of risk factors and 2.9 times more likely to have a high score on knowledge of both risk factors and of diagnostic procedures than were those who had never had a continuing education course. CONCLUSIONS: The reported knowledge of oral cancer, in conjunction with opinions about level of knowledge and training, point to a need for systematic educational updates in oral cancer prevention and early detection.     

Opinions of dentists and directors of nursing concerning dental care provision for Adelaide nursing homes

BACKGROUND: The complex oral health problems of nursing home residents have been well documented. However, the influences on residents' oral health status, including opinions and experiences of dental professionals and nursing home staff, have not yet been adequately investigated. METHODS: The baseline questionnaire component of this longitudinal study was mailed to all registered dentists practising in Adelaide and Adelaide nursing home directors of nursing (DONs). RESULTS: 413 dentists and 97 DONs indicated that Adelaide dentists' interest and training in nursing home dentistry was low. Dental service provision for nursing home residents was very low and dentists preferred to provide treatment at their dental practices. Few dental hygienists were working in nursing homes and dental professionals provided little educational assistance for nursing home staff. Dentists and DONs held several common and many varying perceptions of the problems associated with dental care provision in nursing homes. Both identified a group of nursing home environmental constraints and a lack of portable dental equipment. DONs further identified a group of resident related problems, and dentists a group of dental practice-related problems. CONCLUSIONS: These study results provide important information concerning problems with nursing home dentistry for dental service providers, educators, policy-makers, administrators and nursing home staff.     

Oral cancer: experiences and diagnostic abilities elicited by dentists in North-western Spain

BACKGROUND: Opinions, knowledge, behaviours and attitudes of general dental practitioners on oral cancer prevention and detection have been reported from many countries. However, experiences and skills of oral cancer detection have not been evaluated systematically. OBJECTIVE: To obtain information on behaviours of screening and ability to correctly detect oral cancer and precancer among general dentists (GDP) in North-western Spain. SUBJECTS AND METHODS: Thirty-two randomly selected GDPs completed questionnaires and then classified 50 projected images of clinical lesions, into cancer, precancer or benign lesions. RESULTS: 87.5% reported conducting routine oral examinations, 84.4% provided routine advice to their subjects for risk modifications and 84.4% claimed to biopsy a suspected oral mucosal lesion that they detected in practice. In a quasi research setting using clinical slides, the sensitivity of visual diagnosis of a cancerous lesion was 61.4% and precancer 59.5%. The diagnostic accuracy reported here is lower than what is already reported by evaluation of published screening programmes by dentists. CONCLUSIONS: Our data from Spain suggest a need for improving the diagnostic ability of GDPs in the visual detection of oral cancer/precancer by strengthening continuing professional education.     

Oral cancer screening usefulness: between true and perceived effectiveness

Screenings, introduced in the 1920s, became rapidly popular in healthcare settings. Chance is an intrinsic screening characteristic. Roughly one half of screened subjects are correctly classified merely by chance, and in high‐prevalence settings, even inaccurate screenings detect several diseased individuals by chance, thus appearing effective. The viewpoint is another variable affecting screening perceived effectiveness. For example, public health officers, who seek for mortality rate reductions, look for high sensitivity, which, in turn, is affected by disease prevalence. The relative mortality rate reduction attributable to screening may therefore be significant in high‐prevalence areas and irrelevant in low‐prevalence areas. This explains why oral cancer visual screening is perceived effective in high‐prevalence countries and ineffective in low‐prevalence countries. Patients seek for reliable outcomes. Therefore, they require screenings with high positive (PV+) and negative (PV?) predictive values. In high‐prevalence areas, PV+ is high, while PV? is low. The reverse occurs in low‐prevalence areas. Thus, even for accurate screenings, the perceived effectiveness due to misclassification is low among false‐negative patients in high‐prevalence areas, who are misclassified as unaffected by the disease, and among false‐positive patients in low‐prevalence areas, who are subjected to psychophysical sufferings. This article explains the reasons for these and other paradoxes engendered by screening.     

Oral and pharyngeal cancer: knowledge and opinions of dentists in British Columbia and Nova Scotia

Oral and pharyngeal cancers are largely preventable and can be successfully treated when diagnosed at an early stage. Dentists in British Columbia and Nova Scotia were surveyed regarding their knowledge and opinions about oral and pharyngeal cancer. In February 1998 a pretested 41-item survey was mailed to a random sample of dentists in British Columbia and the population of dentists in Nova Scotia. A reminder postcard and one additional mailing were sent to nonrespondents. Of the 670 dentists supplying usable responses (response rate 55.2%) only 56.7% agreed that their knowledge of the subject was current. Most dentists correctly identified tobacco use (99.4%) and alcohol use (90.4%) as risk factors, but fewer correctly identified factors such as the use of spicy foods (57.0%) and poor oral hygiene (46.3%) as not being risk factors. Only 42.5% identified both erythroplakia and leukoplakia, in that order, as the conditions most likely associated with oral cancer. Indices of risk and diagnostic knowledge were constructed by summing the number of correct responses to items in each domain. On 16 risk factors the mean correct score was 9.2, and on 14 diagnostic procedures the mean correct score was 10.0. Only 38.5% of dentists had consistent levels of knowledge on both indices. Differences between the provinces were statistically significant (p < 0.01) for only 2 knowledge items. About three-quarters of all dentists (77.0%) were interested in taking continuing education courses. Dentists in British Columbia and Nova Scotia could benefit from undergraduate and continuing education courses to increase their knowledge of risk and diagnostic factors for oral cancer.     

Oral health in relation to wearing removable dentures provided by dentists,denturists and laboratory technicians

The aim of this study was to evaluate the oral health of elderly Finnish men wearing removable dentures supplied either by dentists, denturists or laboratory technicians. From a sample of 550 men, 362 subjects were both interviewed and clinically examined. The subjects were asked a range of questions related to their oral health and dentures. Clinical examinations were carried out by one dentist using well-defined criteria and without knowing the information the respective subjects had given in the interview. The 242 denture wearers had a higher frequency (P < 0.001) of mucous membrane lesions (78.7%) than the 120 non-wearers (27.5%). Differences between the denture providers were small, although subjects with dentures provided by dentists had less often most of the recorded mucous membrane lesions than other denture wearers. Coating of tongue and cheilitis angularis were the most commonly encountered lesions. High levels of yeast growth were observed more frequently (P < 0.02) among subjects who had obtained their dentures from dentists (41.3%) than from either denturists (17.1%) or laboratory technicians (18.2%). Among dentate subjects, the average number of remaining teeth was higher (P < 0.05) among those who had obtained their dentures from dentists (8.7) than among subjects wearing dentures from denturists (5.9) or laboratory technicians (6.2). Subjects wearing dentures supplied by dentists had slightly better oral health than other denture wearers. The observed differences can be at least partly explained by dentists' patients having higher number of remaining teeth and also more frequent check-up visits.     

Attitudes of dentists, working in Riyadh, toward people with a sensory impairment

This study was conducted to determine the attitudes of dentists, working in Riyadh, toward people with a sensory impairment (SI), according to the Scale of Attitude Towards Disabled Persons (SADP). The SADP scale was modified to focus solely upon sensory impairment. The modified scale was pre-tested and then incorporated into a self-administered questionnaire. This was then administered to 600 dentists (response rate, 73.7%) working in the city of Riyadh, Saudi Arabia. The modified scale showed itself to be reliable, with a Chronbach's coefficient α 0.616 and four-factor analysis, which accounted for 38.5% of the variance. Ninety-four percent of the dentists were generally positive toward SI in the society. There were, however, significant variations in attitudes, with a more positive score for dentists who had worked for 30 years or more ( p ± 0.005), were specialists ( p < 0.005), received little or no undergraduate training in this subject ( p < 0.05), and who received their undergraduate training in Europe/North America ( p < 0.001). However, in a stepwise regression model, all these variables were significant except for the years of practice. The modified SADP showed dentists, working in Saudi Arabia, having a positive attitude toward people with SI.     

Smoking and health: opinions and awareness among general dentists in Jordan

AIM: To examine dentists' awareness on major health risks associated with smoking and their opinions on factors that influence tobacco use. DESIGN: A pre-tested postal questionnaire survey. PARTICIPANTS: A randomly selected sample of 849 licensed general dentists who were practicing dentistry in Jordan. RESULTS: A response rate of 72.2% (613/849) was obtained. The majority of respondents (91.8%) related lung cancer to smoking, however, associations with other cancers (cancer of oesophagus, pancreas and urinary bladder) were the least reported (33.6%). Only 39% agreed that smoking is the most important cause of premature death, non-smokers were significantly more likely to believe in this than current smokers. Most dentists associated tobacco use with staining of teeth (97.2%), whereas fewer dentists reported that smokers have increased risks of oral cancer (83.7%) and potentially malignant oral lesions (76.7%). Friends and stress were the most frequently implicated factors in the habit of smoking. CONCLUSION: This study revealed a significant lack of awareness among Jordanian dentists with respect to serious health consequences of smoking. An educational programme targeted towards general dentists in Jordan is needed, focusing attention on tobacco related morbidity and mortality.