People with disability are subject to inequality in oral health both in terms of prevalence of disease and unmet healthcare needs. Over 18% of the global population is living with moderate to severe functional problems related to disability, and a large proportion of these persons will require Special Care Dentistry at some point in their lifetime. It is estimated that 90% of people requiring Special Care Dentistry should be able to access treatment in a local, primary care setting. Provision of such primary care is only possible through the education and training of dentists. The literature suggests that it is vital for the dental team to develop the necessary skills and gain experience treating people with special needs in order to ensure access to the provision of oral health care. Education in Special Care Dentistry worldwide might be improved by the development of a recognised academic and clinical discipline and by providing international curricula guidelines based on the International Classification of Functioning, Disability and Health (ICF, WHO). This article aims to discuss the role and value of promoting and harmonising education in Special Care Dentistry as a means of reducing inequalities in oral health.

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Background: Dental anxiety is a public health problem but no epidemiological study has been undertaken in France to evaluate its prevalence. The aim of this study was to estimate the prevalence, severity and associations of dental anxiety in a sample of the French adult population.

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The oral health program presented here was undertaken in three French centers for persons with special needs. The program aimed to educate the carers about dental disease, to motivate them with regard to prevention, and to improve the oral hygiene and oral health of the residents. This study evaluated the impact of the program in terms of change in attitudes and behavior expressed by the carers by means of a questionnaire. Following demonstration of oral hygiene techniques on an individual basis, the number of residents who had their teeth cleaned more than once a day rose from 24% to 52% (p < 0.05). The percentage of carers able to clean both posterior and anterior teeth of their key residents increased from 24% to 60% (p < 0.05), and the percentage finding tooth cleaning easy increased from 36% to 60% (non-significant). The intervention was thus deemed moderately successful, although the carers continued to take better care of their own oral health than that of the residents. The need for ongoing training is emphasized, both for the carers of those with special needs and for the dental profession. The lack of a validated means of measuring the impact of such interventions on care providers for this population is discussed.

The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N2O/O2 was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N2O/O2), were shown to be safe and effective in patients with intellectual disability when administered by dentists.

The aim of this study was to compare levels of dental care utilization, receipt of dental services, and oral hygiene habits between a sample of individuals with Down syndrome (DS) and their siblings. Data were collected by means of a recently validated, French-language, questionnaire measured of oral health and its related problems for individuals with DS. A cross-sectional survey was undertaken of parents of children with DS attending a national meeting for families and carers of individuals with DS in France. Older individuals with DS were significantly more likely to visit a dentist regularly than their older non-DS siblings, but the group with DS was significantly less likely to have received any dental treatment. The group with DS was significantly more likely to have difficulty finding both medical and dental services. Parents were nearly twice as likely to report problems finding dental services for their child with DS as they were medical services. In a multiple logistic regression analysis within the DS group, it was found that older age, regular speech therapy and ophthalmology consultations, and reports of no difficulty finding a dentist were independently associated with increased odds for regular dental consultations. Analysis of the findings suggests that the parents of children with DS in France frequently encounter problems of access to oral health care and that individuals with DS are less likely to receive dental services than are their non-DS siblings.

The current study aimed to verify if the safety and effectiveness of inhalation sedation with 50% nitrous oxide in oxygen (N(2)O/O(2)) is maintained when the premix is administrated by trained general practitioners in their dental surgeries compared to its use in the hospital. Success (completion of planned treatment), cooperation (modified Venham scale), and adverse events were recorded. The acceptability of the technique to the patients, the level of patient cooperation, the ease of use, and the satisfaction of the dentist were also evaluated. Thirty-three general practitioners included 549 patients and recorded 638 sessions of N(2)O/O(2) sedation for dental treatment. Of the sessions, 93.7% were successful in terms of both sedation and treatment. Patient cooperation was seen to improve under N(2)O/O(2) sedation, and for 91% of the sessions, the patients declared that they would like future treatment to be undertaken in the same way. No serious adverse events were recorded. Minor adverse events were noted for 10% of the sessions (behavioural, vagal, and digestive disorders). These results were similar to those found for sessions undertaken in hospital practice. The main difference was in the type of patient treated-more patients received N(2)O/O(2) sedation in general practice for a one-off indication or for dental phobia, and more patients with intellectual disability and more pre-cooperative children were treated in hospital practice. This study gives strong supporting evidence for the safety and effectiveness of inhalation sedation using 50% N(2)O/O(2) in general dental practice for healthy patients.