唇裂及/或腭裂儿童12个月前的牙科经验

IF 1.9 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE
R. Sladden, H. Wilson, R. Bennett, A. Hollis
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引用次数: 0

摘要

唇裂和/或腭裂(CLP)影响大约每1000个活产婴儿中有1.7个。患有CLP的儿童出现牙齿异常、龋齿和发育迟缓的风险明显较高,需要及早进行预防性牙科护理。这些孩子可能在出牙的数量、大小、形状和时间上存在差异,也可能存在牙釉质缺陷。作为回应,国家CLP标准建议在6个月前提供预防性牙科咨询。此外,BSPD为所有儿童发起了一项全国倡议,即“1岁牙科检查”(DCBy1),鼓励父母和监护人在婴儿1岁之前带他们去看牙医,以便提供预防性建议。关于2019冠状病毒病大流行后唇腭裂服务下儿童和青少年获得牙科护理的公开数据有限。来自西南唇腭裂服务处(SWCS)的大流行前数据报告称,92%的儿童在普通牙科医生(GDP) bbb注册。然而,这似乎并没有转化为充分的预防保健。自大流行以来,这一人口获得牙科服务的情况恶化了。在2023年7月至2024年2月期间进行的一项全国调查(尚未公布)发现,近三分之一的SWCS家庭在获得牙科服务方面遇到了困难。鉴于此,我们进行了一项审核,以评估在SWCS下患有CLP的儿童是否得到了及时的预防保健和符合国家标准的牙科接触。进行了两个周期的回顾性审核。从SWCS持有的唇裂出生名单中确定儿童。该审核显示了具有CLP经验的CYP的牙科准入问题。获得牙科护理的困难包括等待时间长和找牙医之家。定期看牙医可以减少龋齿,提高口腔健康相关的生活质量,因此必须找到长期的解决方案。在第2周期,牙科意识和预防性建议的提供显著改善,这主要是由于电话联系的内容和更广泛地提供唇腭裂牙科包。许多父母或护理人员都愿意去布里斯托尔,并有他们希望讨论的问题,如牙齿发育(出牙的路径或顺序,牙齿的缺失和位置),牙龈过度生长和上颌唇系带异常。这突出了早期接受唇腭裂牙科服务的重要性。尽管国内生产总值(GDP)的访问量下降,但6个月后电话联系的引入增加了患者看牙医的比例,取而代之的是与布里斯托尔牙科医院的唇腭裂牙科小组预约。这并不是对所有患者都可行的选择。在第2个周期中,随着当地数据的收集,我们发现,由于距离布里斯托尔牙科医院很远,三个家庭拒绝了与唇腭裂牙科小组的预约,尽管他们从未见过牙医。其中两个家庭来自埃克塞特,一个被称为牙齿沙漠的地区。这次审计的主要限制是不确定儿童是否接受了预防性牙科咨询。父母/照顾者可能记得看牙医,但可能不记得是否给予预防建议或其细节。另一个限制是,虽然所有家庭都收到了一个牙科包,但没有确认家庭,特别是那些无法联系的家庭收到的牙科包的数量。自第2周期以来,每月在普利茅斯的一家诊所开设唇腭裂牙科诊所,西南地区唇腭裂牙科工作人员也有所增加。需要进一步的工作来提高有CLP经验的CYP获得初级保健的机会。在6个月开始电话联系后的第2周期,注意到两项审计标准有所改进。然而,结果表明,大多数西南地区的CLP儿童都错过了DCBy1,这表明存在重大的获取问题。这表明需要增加对这些高风险、优先患者的服务。作者声明无利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Dental Experience of Children With Cleft Lip and/or Palate by 12 Months

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 appointment with the cleft dental team—despite never having been seen by a dentist—due to the distance from Bristol Dental Hospital. Two of these families were from Exeter, an area known to be a dental desert.

The main limitation of this audit is the uncertainty regarding whether children received preventive dental advice. Parents/carers might recall a dental visit but may not remember if preventive advice was given or its details. Another limitation is that although all families were sent a dental pack, the number of packs received by families, particularly those who were uncontactable, was not confirmed.

Since cycle 2, monthly cleft dental clinics have been introduced at a spoke clinic in Plymouth and there has been an increase in the cleft dental workforce in the South-West. Further work is needed to enhance primary care access for CYP with experience of CLP.

Improvements in both audit standards were noticed in cycle 2 after the introduction of telephone contact at 6 months. However, the results indicate that most children with CLP in the South-West miss DCBy1, indicating significant access issues. This demonstrates the need for increased service provision for these high-risk, priority patients.

The authors declare no conflicts of interest.

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来源期刊
CiteScore
5.50
自引率
2.60%
发文量
82
审稿时长
6-12 weeks
期刊介绍: The International Journal of Paediatric Dentistry was formed in 1991 by the merger of the Journals of the International Association of Paediatric Dentistry and the British Society of Paediatric Dentistry and is published bi-monthly. It has true international scope and aims to promote the highest standard of education, practice and research in paediatric dentistry world-wide. International Journal of Paediatric Dentistry publishes papers on all aspects of paediatric dentistry including: growth and development, behaviour management, diagnosis, prevention, restorative treatment and issue relating to medically compromised children or those with disabilities. This peer-reviewed journal features scientific articles, reviews, case reports, clinical techniques, short communications and abstracts of current paediatric dental research. Analytical studies with a scientific novelty value are preferred to descriptive studies. Case reports illustrating unusual conditions and clinically relevant observations are acceptable but must be of sufficiently high quality to be considered for publication; particularly the illustrative material must be of the highest quality.
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