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Specialised dental care for children with complex disabilities focusing on child's functioning and need for general anaesthesia
Jönköping University, School of Health and Welfare, HHJ. CHILD. National Oral Disability Centre for Rare Disorders, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
Departement of Pediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden.
CHU Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France.
Jönköping University, School of Health and Welfare, HHJ. CHILD. Jönköping University, School of Education and Communication, HLK, CHILD. Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work.ORCID iD: 0000-0001-9597-039X
2016 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, 1-8 p.Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: To describe and analyse dental care and treatment modalities for children with complex disabilities from a biopsychosocial perspective, with special focus on dental treatment under general anaesthesia (GA) and its relationship to child's functioning.

METHOD: An ICF-CY Checklist for Oral Health was completed using structured interview, direct observations, and dental records for patients attending a specialist paediatric dentistry clinic. Descriptive and comparative data analysis was performed. Performance qualifiers from the ICF-CY component Activities and participation were used to calculate functional factors.

RESULTS: Median referral age was 1.5 years and the majority were referred by their paediatrician. Almost all visited a dental hygienist regularly. Dental treatment under GA was common and was combined in 78% of sessions with medical treatment. Children with limitations in their interpersonal interactions and relationships were most likely to have dental GA.

CONCLUSION: Children without caries experience had been referred for specialist dental care at an earlier age than children with caries experience. GA was a common treatment modality and dental and medical treatments were coordinated under the same GA for a majority of children. By using the ICF-CY, it was possible to identify functional limitations characterising children with disabilities that require dental treatment under GA. Implications for Rehabilitation Early referral to a specialist in paediatric dentistry is valuable for oral disease prevention in children with disabilities. Availability of dental treatment under general anaesthesia (GA) is also important. Combining dental and medical interventions during the same GA session optimises resources both for the individual and for the health organisation. Children with limitations in interpersonal interactions and relationships are more likely to need dental treatment under GA than other children.

Place, publisher, year, edition, pages
2016. 1-8 p.
Keyword [en]
Built heritages, Human capital, Regional growth, Multilevel
National Category
Dentistry Social Work
Identifiers
URN: urn:nbn:se:hj:diva-34117DOI: 10.1080/09638288.2016.1236406PubMedID: 27871192Local ID: HHJCHILDIS, HLKCHILDISOAI: oai:DiVA.org:hj-34117DiVA: diva2:1050653
Available from: 2016-11-29 Created: 2016-11-29 Last updated: 2017-04-12
In thesis
1. A biopsychosocial approach to functioning, oral health and specialist dental health care in children with disabilities – Swedish and international perspectives
Open this publication in new window or tab >>A biopsychosocial approach to functioning, oral health and specialist dental health care in children with disabilities – Swedish and international perspectives
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Maintaining good oral health may be more important for children with disabilities than others, since problems with oral health may increase the impact of a disability, or the medical condition may increase the risk for poor oral health. In addition, the risk for oral health problems may be influenced by the functioning of the child. Functioning can also affect the child’s ability to cooperate in the dental setting, and how dental treatment is performed. A medical diagnosis alone does not provide enough information about a child’s functioning, nor oral health. Thus, there is a need for a holistic perspective of oral health and dental health care in children with disabilities. The International Classification of Functioning, Disability and Health - Children and Youth (ICF-CY) enables a structured assessment of the biopsychosocial consequences of a health condition.

Aim: The overall aim of this thesis was to investigate how biopsychosocial factors relate to oral health and specialist dental health care in children with disabilities in a Swedish, and an international context, with special focus on the experience of dental treatment under general anaesthesia (DGA).

Material and methods: The research was conducted using a quantitative, cross-sectional, comparative and descriptive design. An ICF-CY Checklist for Oral Health was completed with data from a structured interview with children 0-16 years old, referred for specialist dental health care, and their parents/carers. Additional information was retrieved from dental and medical records. Three groups were included in data analyses: one large international group of 218 children from Argentina, France, Ireland and Sweden; one large Swedish group with 99 children with complex disabilities; and one international group of children with disabilities and manifest dental caries from Argentina, France and Sweden.

Results: The ICF-CY Checklist for Oral Health identified both common and varying functional, social and environmental aspects relevant for oral health and oral health care in children who had been referred to specialist dental clinics in four countries. Swedish children with caries experience had been referred to a paediatric dental specialist clinic at a significantly older age than caries-free children. The medical diagnoses were not significantly related to dental caries or child functioning in the large Swedish group with complex disabilities and low caries prevalence, nor was there a significant relationship between dental caries and child functioning. Collinearity between dental caries and problems in the functioning factor ’Interpersonal interactions andrelationships’ was observed in the international group of children with disabilities and manifest dental caries. DGA sessions with combined medical and dental treatment were common in the large Swedish study group. Children with experience of DGA had more severe problems in intellectual functions than those without experience of DGA. Problems in interpersonal interactions and relationships increased, while problems with mobility decreased, the likelihood for children having had experience of DGA. On international group level, dmft/DMFT was significantly higher in children with the experience of DGA than in those without DGA experience, but looking at Argentina, France and Sweden separately, this was not true for the Swedish children. There were significant, international differences between the prevalence of dmft/DMFT, DGA and environmental barriers.

Conclusion: The biopsychosocial perspective, operationalised by the ICF-CY, contributes a holistic view on oral health and specialist dental health care in children with disabilities. In addition to certain differences, children with different health status from different countries share many functional and environmental aspects, important for oral health and dental health care. Early referral to a paediatric specialist dental clinic seemed favourable for oral health. The medical diagnosis was not related to child functioning or dental caries. Child functioning had a significant impact on DGA, and in children with disabilities and manifest dental caries, child functioning also had a correlation with caries. The dental caries burden was a stronger factor than functioning for the experience of DGA, however, dental health organisation and country context seemed to matter the most. Combining dental and medical procedures during the same GA session is good use of resources for both the individual and the society. To ensure children with complex disabilities to have the possibility of achieving equivalent good oral health as other children, DGA is one important factor.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare, 2017. 96 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 082
Keyword
children, disabilities, oral health, dental care, functioning, ICF, dental general anaesthesia
National Category
Dentistry Pediatrics
Identifiers
urn:nbn:se:hj:diva-35359 (URN)978-91-85835-81-2 (ISBN)
Public defence
2017-05-12, Forum Humanum, School of Health and Welfare, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2017-04-20 Created: 2017-04-12 Last updated: 2017-04-21Bibliographically approved

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