Minimal data sets
Sir,— We read with interest the paper by Ireland and co-workers (British Dental Journal2001; 190: 663–667) on the development of a minimal clinical data set of oral health status indicators for primary dental care in England. It was precisely this that Burke and Wilson set out to achieve when they published details in 19961, of a composite index of oral health (OHX) which was designed for use in general dental practice.
It is particularly interesting to note that, of the top 10 indicators identified by the core group chosen by Ireland, nine were suggested – and are still used, in the OHX. Indeed, the first three guidelines (Is your mouth free from pain?, Are you happy with the appearance of your teeth?, Can you comfortably chew an unrestricted diet?) are the same as those suggested in the OHX five years ago,1 which would appear to represent a substantial endorsement of the criteria in the OHX.
Preliminary data collected recently (which, when complete, will be submitted for consideration for publication) in a survey of 209 dentists who have been using a modification of the OHX, the Oral Health Score (OHS), in the Denplan Excel scheme have indicated widespread acceptance of the OHS by those who used it, with 87% of respondents considering the OHS valuable for measuring changes in patients' oral health and 84% considering it valuable as a patient motivational tool.
Additionally, 74% considered that the OHS provided a valid representation of patients' oral health at the time of examination. Given the similarities in the criteria for the OHX and OHS examinations, these endorsements add weight from practising dentists to the criteria for the OHX and OHS, and to the minimal data set presented by Ireland and his colleagues.
F. J. T. Burke, (University of Birmingham), M. Busby (Consultant to Denplan), R. Matthews (Chief Dental Officer), Denplan, Winchester
The authors respond:
The comments of Burke and colleagues are very encouraging as their research on the OHS, shortly to be submitted for publication, provides a very good example of how a minimum data set can be used in routine clinical practice. It is gratifying to note the level of agreement with respect to the indicators in the minimum clinical data.
Our paper is not intended to indicate any prioritisation of the indicators within the core group and clinicians should be free to aggregate or weight any or all of the indicators as they consider most appropriate.
However, the calculation of an index score at the chairside should ideally involve no additional clinical time otherwise the exercise is unlikely to be undertaken. It is to be hoped therefore, that when indices such as the OHS have been fully evaluated for validity and reliability in a primary care setting, that software manufacturers will incorporate them into dental systems.
Teething trouble
Sir,— I read with interest the article by M. P. Ashley 'It's only teething. A report of the myths and modern approaches to teething.' (British Dental Journal2001; 191: 4–8). As a dentist with a nine month-old daughter, this topic is definitely of my concern.
I would also like to share with you one of the myths that my baby sitter told me when my daughter's lower incisors were erupting at the age of eight months. She said that my daughter's stool would not only be watery but also presented with a mixture that was granular-like in appearance. Indeed her stool was in this appearance for a few weeks before her first teeth erupted. Until now, nobody can explain this phenomena and I wonder whether it is related to some gastrointestinal infection, as during teething they might have ingested some contaminated material when biting on different surfaces of objects. However, this feature was not seen after her teeth had erupted although she is still actively biting on different objects.
W. Lin Chai
Kuala Lumpur
Hazards and effects of mobile phones
Sir,— I assume that most of your readers are regular users of mobile phones. They may be interested in reading my personal experience of its unwanted side effects. Apart from scanned papers2, 3, 4— and of course usage — I have yet no personal experience on the effect on health of mobile phones.
However, recently, as I was the on-call consultant, I put my switched-on mobile on my desk about 20-30 cms from the laser printer as I was working on my computer.
I was just printing one of my letters out when the mobile went off. My printer stopped at once half way through. Having finished the call and looked at my printer, I had no chance to restart it. I removed the half printed paper by hand and wanted to print it again. It did not work. I had a closer look at my printer, looked up at the trouble-shooting menu, but it still refused to work. I asked a friend — a computer whizz-kid — to look at it.
He advised me that something happened to the electronics (the brain) of my printer and it should be replaced or rather buy a new one which would be cheaper and more advanced. Next day I bought a new printer and vowed not to put my mobile phone next to my printer/computer. I do not know whether mobile phones pose any health hazard for humans but I do know that it poses risks for my printer.
A. Ezsias
Llantrisant
Assessment of CAL
Sir,— I read with great interest the article on CAL (Computer Aided Learning) in the May issue of the BDJ (British Dental Journal2001; 190: 554–557). Having studied CAL and authored a program myself I felt it was a far from fair assessment of the computer's potential. I was wondering if Professor Kay could give some more details of the study. Such details may include the age of the participants, their previous computer experience and most importantly, the type of CAL used (e.g. was it didactic, interactive, problem-based etc) all of which may bias the results.
I grant you that reading from a computer is far from easy, I myself print out anything of interest, but I feel that the advantages to the computer should not be overlooked. The ability to show video images of procedures or, as my program showed, craniofacial growth and development cannot be more lucidly explained by a textbook or lecturer regardless of their quality.
Finally, although I do agree that comparisons of CAL and traditional education methods should be undertaken, I feel CAL should be used in conjunction with, as opposed to replacing, lectures and text books as seems to be implied in Professor Kay's conclusions.
E. Gamble
Manchester
Professor Kay responds:
Dr Gamble's interests in this study and the research is most welcome. The groups were randomly allocated and no statistically significant differences in the mean ages were detected. The participants' computer experience ranged from zero to extremely proficient, although no measurement was made. The CAL program had both didactic and interactive components.
The paper did not intend to imply that CAL should or should not replace traditional teaching methods – only that all educational techniques should be adequately evaluated against set objectives prior to their implementation.
Unusual presentation of multiple sclerosis
Sir,— A 29 year-old female was referred to the outpatient department for extraction of a symptomatic, mesially inclined, partially erupted LR8 (48). The surgery was completed without complication, under local anaesthetic.
She returned a week later complaining of an intermittent dropping of the right lip that was affecting her speech. Examination revealed spasm of the right depressor anguli oris muscle. Cranial nerve examination was otherwise normal.
The spasm was unresponsive to diazepam and blood investigations, including serum calcium were normal. A cranial MRI scan (Fig. 1 below) showed several areas very suggestive of demyelination within several parts of the brain. There was no abnormality demonstrated along the course of either facial nerve. The cerebrospinal fluid was positive for oligoclonal bands.
Multiple sclerosis is known to be precipitated by stressful events and in this case was brought on by a minor procedure under local anaesthetic.
J. Gabriel, R. W. Williams, D. J. Courtney Plymouth
This letter is published again because of a mistake in the nomenclature (British Dental Journal2001; 191170).
Goltz Syndrome
Sir,– I should like to point out a common misconception that has been made by Baxter, Shaw and Warren in their case study on Goltz Syndrome (British Dental Journal2000; 189: 550–553). They correctly describe the features of Goltz Syndrome in the case study of their two patients.
In their discussion, they mentioned the importance of differentiating between Goltz Syndrome and Gorlin-Goltz Syndrome. They then incorrectly suggest the features of the latter include naevoid basal cell carcinomas, odontogenic cysts, skeletal anomalies and intra-cranial calcifications. These in fact are the features of Gorlin's Syndrome (naevoid basal cell carcinoma syndrome) which is an autosomal dominant condition. Gorlin-Goltz is merely an eponym for focal dermal hypoplasia (Goltz Syndrome) which is a X-linked dominant condition.
I think the authors are not alone in their misconception regarding the classification of these syndromes and that the teaching in some UK Dental Schools may also reflect this.
R. Kerr
Exeter
The authors A M Baxter, M J Shaw and K Warren respond:
We thank Mr Kerr for his interest in our article. It is obvious from teaching undergraduates and the content of the above letter that there is a confusion in the terminology relating to naevoid basal cell carcinoma syndrome and focal dermal hypoplasia. This arises from the use of the names of the authors who described these syndromes. The use of eponyms is probably not the best way to categorise these conditions. Indeed, Gorlin himself states that the preferred title for Gorlin's syndrome is 'Nevoid basal cell carcinoma syndrome'.5
However, Mr Kerr is incorrect in his assertion that the term Gorlin-Goltz syndrome is 'merely an eponym for focal dermal hypoplasia'. Gorlin-Goltz syndrome is an eponym for naevoid basal cell carcinoma syndrome as correctly stated in the text of our paper. Gorlin himself, when referring to naevoid basal cell carcinoma syndrome, states that 'The syndrome has been designated by a variety of different terms including...Gorlin's syndrome and Gorlin-Goltz syndrome.'5
Indeed, Gorlin and Goltz described naevoid basal cell carcinoma syndrome in 1960 and it was through this paper that the syndrome became known as Gorlin-Goltz syndrome.6 Mr Kerr should also be aware that focal dermal hypoplasia is also called Goltz-Gorlin syndrome and this may be where Mr Kerr is confused with the nomenclature of these syndromes.
As to the position of other dental schools in the UK we are unable to comment but the standard textbooks on the subject use the term Gorlin-Goltz syndrome in relation to naevoid basal cell carcinoma syndrome.
More to chew over
Sir,— It is always exciting for non-clinical readers of the BDJ such as myself to see a headline like 'Choosing what you eat' on the cover (British Dental Journal2001; 191; issue 4). Professor Kay's commentary on the article 'Are we aware of what our patients eat?' states that 'paucity of information' poses a problem in the provision of dietary counselling. While the debate about what constitutes evidence in health promotion rages on there are however some useful pointers in the literature not referred to by Crossley and Khan.7
Stockley for example, provides a concise analysis of influences on food choice, while the Health Development Agency has outlined the features of effective interventions to improve diet and nutrition in the population.8, 9 Those dentists worried that they will not be able to play their part in tackling poor dietary habits, because of the social disparities between themselves and their less advantaged patients, can use these sources to deepen their understanding of the issues involved.
C. Stillman-Lowe
London
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