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We were interested to read the recent review on “Dental disease in children with chronic illness”,1 having recently undertaken a review of the dental health of the children at The David Lewis Centre School. This is a residential school for children with severe refractory epilepsy and associated neurodisability. There are 65 children age 7–19 years. Over 50% of the children require two or more antiepileptic drugs and other long term medications.
The children are at risk of poor dental hygiene because:
Regular long-term medications may contain sugar
Effective dental hygiene can be difficult to achieve for children with these impairments.
The David Lewis Centre has an on-site pharmacy; wherever possible tablets or capsules are dispensed. If liquids are necessary these are sugar free. A dental team experienced in working with children with severe learning difficulties reviews the dental health of all children every four months and offers advice to care staff about the best ways to maintain the children’s dental hygiene.
The decayed, missing, filled (DMF) index for the children at the centre is 20%. The DMF index for Macclesfield (the nearest town) children is 38%, and is 56% for children from Manchester. In addition two-thirds of the DMF for children at the centre is due to injuries caused by seizures rather than decay.
With careful prescribing and regular dental care it is possible to achieve a good level of dental hygiene for children on long term medications and significant neurodisability.
Competing interests: none declared
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