Christine Park Clinical lecturer/ Honorary Post CCST StR in Paediatric Dentistry Glasgow Dental Hospital & School

1. The Impact of Oral Health Assessment
on Comprehensive Medical
Assessments for Children with Welfare
Concerns
Christine Park
Clinical lecturer/ Honorary Post CCST StR in Paediatric
Dentistry
Glasgow Dental Hospital & School

2. Background: Child Abuse - Caries
 903 children, 5-13years
 430 child abuse: 473 controls
 DMFS -2 dentists
 logistic regression analysis to control other
variables whilst influence of abuse was
evaluated on untreated teeth
 Abused children 8 x more likely to have
untreated decayed teeth
Green at al. Paed Dent 1994

3. Background: Child Abuse - Caries
 66 children, 56% boys
 Children admitted to CAST from 1991-2004
 Age 2-6 yrs (primary dentition)
 Untreated caries in- 57% ‘neglected’, 62%
physically/sexually abused
 General population of 5 yr olds in Toronto with
untreated decay = 30%
Valencia-Rojas et al 2008

4. Child Abuse - Caries
 52 witness to violence or subject of violence
 65 eating disorder
 120 controls
 Abused children higher plaque index, higher
untreated decay, more evidence of gingival
bleeding than other 2 groups.
Montecchi et al 2009

5. Children with welfare concerns-
GGC NHS Dental data
 277 children with identified welfare
concerns
 All resided in areas with SIMD quintiles
of 3 or less

6. CMAs and COAs
Sites
 Bridgeton
 Possilpark
 Drumchapel
 Southbank Centre
 Govanhill
 Greenock
 Vale of Leven
 RAH
 RHSC dental dept

7. Dental data
 Registration with dental services
70.7%
 30 children (10.6%) required urgent
dental care.

8. Providers of further dental care,
pathways of care
 46.3% return to their own GDP (n=131)
 43.1% attend community dental service (n = 122)
 30 (10.6%) children required joint care between hospital
dental service / community dental service /own GDP
 Direct referral possible from COA dentist

9. Caries (Dental decay)
 62% of children aged 9 years or younger had caries
 79% of children aged 10 years or over had caries
 dmft aged 9 and younger was 7.26
 DMFT for older age group was 3.7

10. Decayed, missing, filled teeth
 Mean decayed teeth and missing teeth were higher than
national means
 More untreated decay and more teeth missing due to
dental caries
 More difficulties accessing appropriate dental care when
their dental caries is still able to be treated by
restorative means rather than extraction.

11. Caries/ SIMD
 In the 2014 NDIP survey 53% of
primary 1 children who lived in SIMD 1
areas were caries free.
 In CMA children there were 171
children aged 9 years and younger
who lived in SIMD 1 areas and only
36% of them were caries free.

13. Dental Opinions
 This child’s oral soft tissues and teeth are in good
condition and there is no evidence of oral neglect. I
have no current concerns in relation to his/her oral
condition and care
 There is no current evidence of dental decay although
oral hygiene is poor and regular toothbrushing is not
an established routine for this family. There is a lack
of parental supervision of brushing which would be
appropriate for a child of this age. The parents/carers
have been given appropriate advice and issued with
an agreed action plan to address this. If this is not
implemented this would constitute dental neglect

14.  There is evidence of premature extraction of primary teeth
under general anaesthetic. This is indicative of previous
oral neglect. At present however, this child has no
evidence of dental decay and in my opinion there is no
current evidence of dental neglect. He/she is at an
increased likelihood of developing further dental decay and
they will require close dental follow up on an ongoing basis
 This child does not attend the dental services and the
parent/carer is reliant on the ‘school dental checks’ for
dental care. This is not appropriate as it is recommended
that every child is registered with a dentist and attends for
regular dental check ups. The parents/carer have agreed
to registration of this child with a general dental
practitioner for regular care and prevention. If this is not
implemented this would constitute dental neglect.

15.  This child is an irregular dental attender and has a history
of only attending when in pain. In my opinion this pattern
of attendance is indicative of neglect by the parent/carer
 This child has poor oral hygiene and several grossly
carious teeth. This is indicative of oral neglect and he/she
is likely to experience future episodes of pain if appropriate
dental care is not sought. In my opinion this is evidence of
dental neglect
 This child has evidence of oral infection related to a grossly
carious primary/secondary tooth. This is indicative of oral
neglect and if appropriate dental treatment is not sought it
is likely that this child will suffer from episodes of severe
pain. In my opinion this is evidence of dental neglect

16. Conclusion
 Dental input useful to CMAs and
multi-disciplinary working useful to
dentists
 Details of family dentist important but
so is assessment by more specialist
dentist

17. Thank you for listening!