In handicapped groups, the maintenance of oral hygiene can be a major problem, and chemical plaque control offers many advantages. This study compared the effectiveness of chlorhexidine gluconate, delivered as a 0.2% mouthrinse, a 0.2% spray, and a 1% gel in trays, in controlling dental plaque and gingival bleeding in a group of 49 spastic children. All three delivery methods produced an improvement in plaque and gingival bleeding scores. However, the gel was significantly more effective than either the mouthwash or the spray. There was no significant difference between delivery methods in the amount of tooth staining.

This study examines, from photographic records, the prevalence of accidental damage to maxillary incisor teeth in a group of 968 11/12-year-old South Wales school-children; 15.3% showed evidence of trauma ranging from enamel fractures or discolouration to actual loss of a tooth. Boys (19.4%) showed a higher prevalence of trauma than girls (11%). Maxillary central incisors were the most at risk from trauma, with coronal fractures being the most commonly sustained injury. Those subjects who showed evidence of trauma had an statistically (p less than 0.001) but not clinically significantly greater overjet than did those who had none. The percentage of subjects suffering trauma increased significantly with increasing overjet, but lip incompetence did not affect the prevalence of accidental damage. Though statistically unsupported due to the small numbers involved in this cohort, it appeared that the rougher nature of boys activities and their more active participation in sports were of greater importance than the magnitude of their overjet in determining whether their teeth were at risk from trauma. In contrast, it was the magnitude of the overjet which was the dominant factor in girls. Despite the wide availability of relatively simple means of restoration and, in the majority of cases, regular dental examinations, only 14.8% of traumatised teeth had received treatment at this age.

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Necropsies were performed on 14 psittacine birds of various species suspected to have proventricular dilatation disease (PDD). Eight of the birds exhibited neurological signs (seizures, ataxia, tremors and uncoordinated movements) and digestive tract signs (crop stasis, regurgitation, inappetance and presence of undigested food in the faeces). At necropsy, the birds had pectoral muscle atrophy, proventricular and ventricular distention, thinning of the gizzard wall, and duodenal dilation. In addition, five birds had a transparent fluid (0.2 to 1.0 ml) in the subarachnoidal space of the brain, and one bird had dilatation of the right ventricle of the heart. The histological lesions differed from earlier reports of PDD in that peripheral (sciatic, brachial and vagal) neuritis was seen in addition to myenteric ganglioneuritis, myocarditis, adrenalitis, myelitis and encephalitis.

Chlorhexidine has been used as an aid to or replacement for oral hygiene measures in special needs groups such as the handicapped. Previous studies have indicated that spray delivery of chlorhexidine is both effective and acceptable. This study evaluated twice daily use of a 0.2% chlorhexidine spray as an adjunct to toothbrushing in a group of physically and mentally handicapped adults attending a day training center. The study was a double-blind, placebo controlled, cross-over design involving two 31 days regimens separated by 30 days. Plaque, bleeding on probing, and pocketing were measured at the beginning and end of each regimen. There were clinically and statistically significantly lower plaque and bleeding scores at the end of the chlorhexidine compared to the placebo period. Pocketing was also significantly less after chlorhexidine, although in clinical terms the difference was small. The apparent acceptability and effectiveness of the regimen suggests that small doses of chlorhexidine delivered by sprays may be of considerable value as an aid to oral hygiene in handicapped individuals.

The delivery of chlorhexidine by spray systems have been found useful in controlling plaque in handicapped individuals. This study using a single blind crossover design compared chlorhexidine delivery by mouthwash and spray for plaque inhibitory effects. A group of 14 volunteers participated in two 4 day, no oral hygiene regimens. During one regimen chlorhexidine was professionally sprayed onto the teeth twice a day and during the other chlorhexidine was rinsed twice a day under supervision. Plaque regrowth from a zero baseline was recorded using a plaque index and by area. Little plaque accumulated during the two periods. There was no significant difference in plaque measurements following the use of the spray or mouthwash. This study demonstrated that chlorhexidine when sprayed under optimal conditions was as effective as a mouthwash at controlling plaque despite only requiring one seventh of a dose from a rinse. The results have implications for the use and delivery of chlorhexidine for plaque control and are relevant to the proposed mode of action of this antiseptic.

As part of a study of chlorhexidine used for plaque control in handicapped children, preferences and difficulties with the three delivery methods were evaluated by questionnaire. The delivery methods were a 0.2% mouthwash, 0.2% spray, and 1% gel in trays. Responses from parents and house parents revealed the least preference for, and most difficulties with, the gel in trays. The spray was the most popular and 96% of the respondents would be prepared to use this indefinitely as a method of oral hygiene. The most effective method was the gel in trays, but results of the questionnaire suggested that the respondents would be unwilling to use it for prolonged periods. The importance of user acceptance and compliance to the long-term success of oral hygiene methods was evident.

The majority of Specialists are adhering to the UK national clinical guideline for pulp treatment of the primary dentition. However, significant numbers are considering changing their chosen technique. There is a lack of consensus on the use of pre- and postoperative radiographs; specific guidance with respect to their use is required.