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

Low level light therapy in the management of paediatric oral and oropharyngeal mucositis

Oral and oropharyngeal mucositis is a common, debilitating condition experienced by patients undergoing oncology treatment. There are many different management strategies, with low level light therapy (LLLT) an emerging field. Ongoing research on the topic of LLLT for mucositis has resulted in LLLT being included in national clinical guidelines. The number of centres currently using LLLT for paediatric patients with oropharyngeal mucositis is growing, with Glasgow having successfully used this treatment method for a number of years. Across medicine and dentistry, LLLT is coming to the fore and is a treatment modality of which we should all be aware. CPD/Clinical Relevance: New technologies and treatment modalities are areas with which practitioners should stay up to date. Low level light therapy continues to be a growing research field

How Danish dentists and dental hygienists handle their role in child abuse and neglect matters

Objective: To identify how the dental team perceives its role in safeguarding children, to identify barriers to referral to social services, to compare data with data previously reported from Denmark, and to assess if increased focus on safeguarding children has had an effect on how the dental team handles its responsibility to refer to social services. Material and methods: The study is based on a Danish version of a questionnaire previously used in Scotland and Denmark. The questionnaire was sent to a random sample of the Danish dental team. Results: The number of returned questionnaires was 964 (67.0 %) with valid data. Of these, 40.8% had had a suspicion of child abuse or neglect and 50.0 % had referred their concern to social services. Frequently reported barriers to referral were uncertainty about observations, signs, and symptoms of abuse and neglect, and uncertainty about referral procedures. A total of 84 (8.9%) of the respondents had received both undergraduate and postgraduate training on the topic, and 64.4% of the respondents found that the dental staff could recognize signs and symptoms of abuse and neglect. Conclusion: Findings suggest a continuous need for a focus on the awareness and training of the Danish dental staff on the important topic of child abuse and neglect

Porphyromonas gingivalis is a Strong Risk Factor for Alzheimer’s Disease

Porphyromonas gingivalis (P. gingivalis) is one of the several important bacterial pathogens associated with the sporadic Alzheimer’s disease (AD). Different serotypes are either capsulated or are non-capsulated. It has been demonstrated that P. gingivalis (non-capsulated) can reproduce the neurodegenerative AD-like changes in vitro, and a capsular P. gingivalis (strain W83) could reproduce the cardinal hallmark lesions of AD in a wild-type mouse model. All P. gingivalis forms express proteolytically active proteases that enable cleavage of the amyloid precursor protein (APP) and tau resulting in the formation of amyloid-beta and neurofibrillary tangles (NFTs). Tau is an established substrate for gingipains, which can cleave tau into various peptides. Some of the P. gingivalis fragmented tau protein peptides contain “VQIINK” and “VQIVYK” hexapeptide motifs which map to the flanking regions of the microtubule binding domains and are also found in paired helical filaments that form NFTs. P. gingivalis can induce peripheral inflammation in periodontitis and can also initiate signaling pathways that activate kinases, which in turn, phosphorylate neuronal tau. Periodontal disease related inflammation has metabolic implications for an individual’s peripheral and brain health as patients suffering from generalized periodontitis often have related co-morbidities and are “at risk” of developing AD. The aim here is to discuss the role of P. gingivalis behind such associations with the backdrop of huge efforts to test P. gingivalis virulence factors clinically (GAIN Trial: Phase 2/3 Study of COR388 in Subjects with AD) with inhibitors, which may lead to an intervention by reducing the pathogenic bacterial load

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

Tooth replantation: a worthwhile exercise?

Ako se izbije zub, to je ozbiljan napad na zubna tkiva i okolni parodont, pa tako postupak replantacije završava vrlo različito. Pritom je glavni zadatak održati vitalnost stanica parodontnog ligamenta i njegovo funkcijsko cijeljenje te povećati mogućnost revaskularizacije pulpe. Kako bi se ustanovilo je li replantacija zuba vrijedna truda, potrebna je analiza dokaza na dvama područjima – može li se replantirani zub zadržati trajno (uspješno parodontalno cijeljenje) ili može li, uz nadomjesnu resorpciju (ankilozu), razmjerno normalno rasti i održati alveolarni greben do uporabe nadomjestka kojim će se popuniti prostor ako je zub izgubljen u kasnim adolescentnim godinama.Avulsion is a serious assault on both dental tissues and the surrounding periodontium and in consequence the process of replantation creates a wide range of outcomes. The main aim of replantation is to maintain periodontal cell viability and the possibility of functional healing of the periodontal ligament (PDL) and maximise the possibility of pulpal revascularisation. To identify whether replantation is worthwhile requires analysis of the evidence in two areas: whether the replanted tooth can be retained indefinitely (successful periodontal healing), or whether even in the presence of replacement resorption (ankylosis) relatively normal growth and maintenance of alveolar ridge contour can occur until utilisation of a prosthesis to fill the space when the tooth is lost in late teenage years

Endodontic Management of Traumatised Permanent Anterior Teeth

Traumatised permanent anterior teeth can require endodontic treatment which may be immediate as part of acute trauma management, or delayed due to the development of sequelae. This paper will enable clinical decision making by exploring a range of situations in which endodontic treatment may be indicated, and also offer practical advice regarding effective endodontic treatment for paediatric dental trauma patients. Endodontic treatment of traumatised permanent teeth in paediatric patients is often challenging. However, with timely decision making and appropriate treatment, these teeth can often last throughout childhood and adolescence thus ensuring that a young patient does not have the social burden of a missing tooth and needing a prosthesis, and has the maximum restorative options available to them as they enter adulthood

In real life: evaluating primary care based undergraduate dental education in Northwest England

Aim: To explore how working at Dental Education Centres (DECs), away from the university campus, has influenced the attitudes of dental students towards providing dental care in a primary setting, and whether students feel that this model of dental education meets their perceived training needs. Design: Exploratory, qualitative interview study. Methods: Semi-structured interviews with five 4th BDS students analysed using thematic analysis. Results: The main theme identified was ‘real life dentistry’ as students described how their clinical experiences and the teaching at DECs would prepare them for life as a general dental practitioner. Students felt they had a positive impact on their patients, and although some felt they could not comment on the impact to the community, others thought that this was likely to be positive. Discussion: Students believed they experienced ‘real life dentistry’ which would prepare them well for their foundation year and future practice. They also believed they had a positive impact on their patients