June Nunn - Academia.edu (original) (raw)
Papers by June Nunn
Special Care in Dentistry, 2014
To investigate dental attendance patterns and reasons for nonattendance among older adults with i... more To investigate dental attendance patterns and reasons for nonattendance among older adults with intellectual disabilities (ID) in Ireland. A cross-sectional survey of quantitative data and text analysis of qualitative data drawn from a nationally representative sample of 753 people with ID over 40 years of age in Ireland. Participants were considered as regular or irregular dental attenders for analysis of quantitative data. Text analysis grouped open-ended responses for analysis. There were slightly more females. Mean age was 54.1 years (SD = 8.8). Almost half had moderate ID. A majority (86.5%) of respondents attended dental services within the last 2 years. Age and type of residence were associated with frequency of attendance (p < .01), as were dentate status and reported oral problems (p < .001). Text analysis revealed a lack of perceived need as a reason for not attending regularly. Older people with ID in Ireland report a very high level of regular dental attendance. Irregular attenders did not attend because they saw no need. There is a need to further study the importance of regular dental attendance for this population.
Evidence-Based Dentistry, 2000
ABSTRACT
Ireland/Advanced Dental Nursing, 2010
Int J Paediatr Dent, 2008
Objectives. Qualitative comparison of the clinical, radiographic and histological outcomes in a s... more Objectives. Qualitative comparison of the clinical, radiographic and histological outcomes in a small sample of cariously exposed primary molars, extracted after unsucessful pulp treatment by two vital pulpotomy methods. Subjects and methods. The primary molars were extracted, because of treatment failure, during a longitudinal clinical investigation of the relative efficacy of 20% Buckley's Formocresol versus calcium hydroxide powder as pulp dressings in vital pulp therapy (in press). Fifty-two child patients were sequentially enrolled in the longitudinal clinical investigation, 26 boys and 26 girls. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). Coronal pulp amputation was prescribed only in teeth with vital, cariouslyexposed pulp tissue. All cases were reviewed using predefined clinical and radiological criteria. Seventy-nine cariously-exposed primary molars required vital pulp therapy. Forty-four teeth were included in group F and 35 in group C. Five per cent (n = 2) of teeth in group F and 11 per cent of teeth (n = 4) in group C were terminated from the trial due to clinical and/or radiographic failure. Of the six teeth extracted, five were sufficiently intact to be retained for histological evaluation. Results. Post-extraction radiographs taken before specimen preparation showed reactionary dentine barrier (bridge) formation in teeth treated with calcium hydroxide. However, the narrowing of root canals, indicative of appositional reactionary dentine deposition, was seen in both groups (F and C). Histological examination confirmed these findings and revealed that pus cells were evident in all specimens examined. There was also histological evidence of resorption of reactionary dentine within the root canal and that forming the calcified barrier (dentine bridge). Conclusion. The clinical and radiographic outcomes for the five teeth correlate well with the reported findings from decalcified histological section. Although numbers are small, the histological findings may indicate possible reasons for treatment failure. There are few reports of this sort in the literature of this under-researched treatment modality.
Evaluation and program planning, Jan 15, 2015
Oral health training is often introduced into community-based residential settings to improve the... more Oral health training is often introduced into community-based residential settings to improve the oral health of people with intellectual disabilities (ID). There is a lack of appropriate evaluation of such programs, leading to difficulty in deciding how best to allocate scarce resources to achieve maximum effect. This article reports an economic analysis of one such oral health program, undertaken as part of a cluster randomized controlled trial. Firstly, we report a cost-effectiveness analysis of training care-staff compared to no training, using incremental cost-effectiveness ratios (ICERs). Effectiveness was measured as change in knowledge, reported behaviors, attitude and self-efficacy, using validated scales (K&BAS). Secondly, we costed training as it was scaled up to include all staff within the service provider in question. Data were collected in Dublin, Ireland in 2009. It cost between €7000 and €10,000 more to achieve modest improvement in K&BAS scores among a subsample of...
British Journal of Learning Disabilities, 2015
Int J Paediatr Dent, 2009
A case is described of resorption of the mesial aspect of a maxillary permanent first molar in a ... more A case is described of resorption of the mesial aspect of a maxillary permanent first molar in a 13-year-old boy whose maxillary second premolar was impacted. The premolar was partially erupted in the line of the arch and radiography revealed a radiolucent area involving enamel, dentine and cementum on the mesial aspect of the first molar. The first molar was extracted and the premolar erupted normally. The case emphasizes the importance of early diagnosis of developmental abnormalities.
Community dental health
A questionnaire survey of parents of handicapped children, to complement a clinical examination, ... more A questionnaire survey of parents of handicapped children, to complement a clinical examination, was carried out in 25 special schools in Newcastle and Northumberland. From the data collected a number of important issues are raised. Some parents have to travel greater distances than are necessary given the availability of dental services locally, either because it is more convenient or because their child requires special care. As a result perhaps the frequency of attendance of children with handicaps is poorer than that of normal children. With exceptions, most children were assessed as being amenable to routine dental care, and over one third of wheelchair bound patients claimed to be regular attenders, yet a smaller minority of handicapped child patients were seen routinely in general dental practice, compared with the usual child population. The need for greater efforts on the part of parents, dentists and other health care providers in improving the dental health of handicapped children is underlined.
Journal of dental education
British dental journal
First thoughts often assume that dental health is unlikely to be a priority for some time to come... more First thoughts often assume that dental health is unlikely to be a priority for some time to come in a war stricken country like Ethiopia. Paradoxically the very success of specialised feeding programmes, in some groups in particular, has accelerated the onset of the sort of dental disease that is becoming a feature of developing countries.
International Dental Journal
Two hundred and forty-three Ethiopian adults (18 years-old and over) were examined for caries, pe... more Two hundred and forty-three Ethiopian adults (18 years-old and over) were examined for caries, periodontal disease, malocclusions and enamel opacities. These adults were the parents of children cared for by an independent charitable organisation, the Ethiopian Gemini Trust. The prevalence of dental caries was generally low with a mean DMFT for the sample of 2.7 (+/- 0.2) and a mean DMFS of 6.7 (+/- 0.6), although one adult had a DMFS of 62. A high proportion of the adults (83.5 per cent) had calculus, but only 2 per cent had deep pocketing. Twenty-three per cent of the adults had a malocclusion and for 6 per cent of these this was moderate to severe. The most prevalent enamel defects were hypoplasias and diffuse opacities with 22 per cent of adults having one or more index teeth affected. Access to dental services was virtually non-existent as judged by the clinical status of these adults.
Community dental health
Developmental defects of enamel were assessed in 15-year-old children born and continuously resid... more Developmental defects of enamel were assessed in 15-year-old children born and continuously resident in three communities in the north east of England. In naturally fluoridated Hartlepool (F = 1.0-1.3 ppm), artificially fluoridated Newcastle (F = 1.0 ppm) and non-fluoridated ...
Special Care in Dentistry
This paper provides a survey of recent literature on the use of mouth sticks for patients who hav... more This paper provides a survey of recent literature on the use of mouth sticks for patients who have little or no use of their limbs. Criteria for mouth stick design, types of appliances, and the fabrication of such devices are described. Details are given of a case of a young child with arthrogryposis multiplex congenita, in whom a novel approach was used to allow the safe intra-oral retention of writing implements.
Community dental health
The recent past has seen many changes that have had an impact on the dental care of children: for... more The recent past has seen many changes that have had an impact on the dental care of children: for example, demographic changes, changes in the prevalence of dental caries, changes in manpower and changes in the organisation of dental services. The community dental service (CDS) in particular has had a major role to play in the provision of care to many children in this country. An analysis of the statistical returns to the Department of Health for the community dental services in England and Wales for the years 1985-1990 shows that staffing in the CDS has declined from 1,544 (Whole Time Equivalents--WTE) to 1,309 (WTE) in 5 years. The total clinical hours worked has also reduced from 2.02 million to 1.59 million in ten years. Hours spent on administration have increased from 53,490 to 87,091 in the same period. Clinical time spent on treating handicapped adults has increased almost ten fold from 14,644 hours in 1980 to 122,463 hours in 1990. Time devoted to mother and child (pre-school) services in about the same as in 1985. Hours spent on school services have reduced from a peak of almost 2 million in 1985 to 1.38 million in 1989-90. Trends in eight aspects of dental treatment are presented.
Health trends
For several years it has been recommended that aspirin should be avoided in children under the ag... more For several years it has been recommended that aspirin should be avoided in children under the age of 12 years because of the risk of Reye's Syndrome. In this study we investigated the reported use of analgesics among children who attended the Children's Department of the Dental Hospital in Newcastle upon Tyne. In addition the study also investigated the complaints that led to use of analgesics, the dose and frequency of administration of the analgesic, and past and current contact with medical services. Of 179 children investigated, 129 were under 12 years-old; of these 129 children under 12 years-of-age, 72 (56%) had taken an analgesic within the previous six months, 12 (17%) of whom took aspirin. Three of these children who had taken aspirin were reported to have had a serious illness in their lives, and would therefore have had significant contact with medical services. One-quarter of all children who had taken an analgesic did so for toothache. Inappropriate use of aspirin in children under 12 years-of-age indicates that health education about the possible risks of Reye's Syndrome needs to be improved.
The development of formocresol as a pulpotomy medicament is charted from the 19th Century to the ... more The development of formocresol as a pulpotomy medicament is charted from the 19th Century to the present day. While the solution has come in and out of vogue, few agents can seriously challenge its efficacy. Doubts about its toxicity, mutagenicity, and carcinogenicity have led, however, to a call for a more dilute formulation as well as a review of alternative medicaments. Problems arise in deriving an appropriate formula for a dilute version from existing formulations, which appear to have misinterpreted the concentration of constituents in the original solution.
Quintessence international
Children and adolescents, aged 2 to 18 years, from 300 poor families in Addis Ababa were examined... more Children and adolescents, aged 2 to 18 years, from 300 poor families in Addis Ababa were examined to determine the prevalence of the traditional practice of primary canine tooth removal. Fifteen percent of the primary canine teeth were found to have been affected, and 7% of the permanent canines had been damaged by this practice. A questionnaire to a subset of 40 families revealed some of the reasons that this procedure is still carried out, in spite of the considerable associated morbidity.
Special Care in Dentistry, 2014
To investigate dental attendance patterns and reasons for nonattendance among older adults with i... more To investigate dental attendance patterns and reasons for nonattendance among older adults with intellectual disabilities (ID) in Ireland. A cross-sectional survey of quantitative data and text analysis of qualitative data drawn from a nationally representative sample of 753 people with ID over 40 years of age in Ireland. Participants were considered as regular or irregular dental attenders for analysis of quantitative data. Text analysis grouped open-ended responses for analysis. There were slightly more females. Mean age was 54.1 years (SD = 8.8). Almost half had moderate ID. A majority (86.5%) of respondents attended dental services within the last 2 years. Age and type of residence were associated with frequency of attendance (p < .01), as were dentate status and reported oral problems (p < .001). Text analysis revealed a lack of perceived need as a reason for not attending regularly. Older people with ID in Ireland report a very high level of regular dental attendance. Irregular attenders did not attend because they saw no need. There is a need to further study the importance of regular dental attendance for this population.
Evidence-Based Dentistry, 2000
ABSTRACT
Ireland/Advanced Dental Nursing, 2010
Int J Paediatr Dent, 2008
Objectives. Qualitative comparison of the clinical, radiographic and histological outcomes in a s... more Objectives. Qualitative comparison of the clinical, radiographic and histological outcomes in a small sample of cariously exposed primary molars, extracted after unsucessful pulp treatment by two vital pulpotomy methods. Subjects and methods. The primary molars were extracted, because of treatment failure, during a longitudinal clinical investigation of the relative efficacy of 20% Buckley's Formocresol versus calcium hydroxide powder as pulp dressings in vital pulp therapy (in press). Fifty-two child patients were sequentially enrolled in the longitudinal clinical investigation, 26 boys and 26 girls. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). Coronal pulp amputation was prescribed only in teeth with vital, cariouslyexposed pulp tissue. All cases were reviewed using predefined clinical and radiological criteria. Seventy-nine cariously-exposed primary molars required vital pulp therapy. Forty-four teeth were included in group F and 35 in group C. Five per cent (n = 2) of teeth in group F and 11 per cent of teeth (n = 4) in group C were terminated from the trial due to clinical and/or radiographic failure. Of the six teeth extracted, five were sufficiently intact to be retained for histological evaluation. Results. Post-extraction radiographs taken before specimen preparation showed reactionary dentine barrier (bridge) formation in teeth treated with calcium hydroxide. However, the narrowing of root canals, indicative of appositional reactionary dentine deposition, was seen in both groups (F and C). Histological examination confirmed these findings and revealed that pus cells were evident in all specimens examined. There was also histological evidence of resorption of reactionary dentine within the root canal and that forming the calcified barrier (dentine bridge). Conclusion. The clinical and radiographic outcomes for the five teeth correlate well with the reported findings from decalcified histological section. Although numbers are small, the histological findings may indicate possible reasons for treatment failure. There are few reports of this sort in the literature of this under-researched treatment modality.
Evaluation and program planning, Jan 15, 2015
Oral health training is often introduced into community-based residential settings to improve the... more Oral health training is often introduced into community-based residential settings to improve the oral health of people with intellectual disabilities (ID). There is a lack of appropriate evaluation of such programs, leading to difficulty in deciding how best to allocate scarce resources to achieve maximum effect. This article reports an economic analysis of one such oral health program, undertaken as part of a cluster randomized controlled trial. Firstly, we report a cost-effectiveness analysis of training care-staff compared to no training, using incremental cost-effectiveness ratios (ICERs). Effectiveness was measured as change in knowledge, reported behaviors, attitude and self-efficacy, using validated scales (K&BAS). Secondly, we costed training as it was scaled up to include all staff within the service provider in question. Data were collected in Dublin, Ireland in 2009. It cost between €7000 and €10,000 more to achieve modest improvement in K&BAS scores among a subsample of...
British Journal of Learning Disabilities, 2015
Int J Paediatr Dent, 2009
A case is described of resorption of the mesial aspect of a maxillary permanent first molar in a ... more A case is described of resorption of the mesial aspect of a maxillary permanent first molar in a 13-year-old boy whose maxillary second premolar was impacted. The premolar was partially erupted in the line of the arch and radiography revealed a radiolucent area involving enamel, dentine and cementum on the mesial aspect of the first molar. The first molar was extracted and the premolar erupted normally. The case emphasizes the importance of early diagnosis of developmental abnormalities.
Community dental health
A questionnaire survey of parents of handicapped children, to complement a clinical examination, ... more A questionnaire survey of parents of handicapped children, to complement a clinical examination, was carried out in 25 special schools in Newcastle and Northumberland. From the data collected a number of important issues are raised. Some parents have to travel greater distances than are necessary given the availability of dental services locally, either because it is more convenient or because their child requires special care. As a result perhaps the frequency of attendance of children with handicaps is poorer than that of normal children. With exceptions, most children were assessed as being amenable to routine dental care, and over one third of wheelchair bound patients claimed to be regular attenders, yet a smaller minority of handicapped child patients were seen routinely in general dental practice, compared with the usual child population. The need for greater efforts on the part of parents, dentists and other health care providers in improving the dental health of handicapped children is underlined.
Journal of dental education
British dental journal
First thoughts often assume that dental health is unlikely to be a priority for some time to come... more First thoughts often assume that dental health is unlikely to be a priority for some time to come in a war stricken country like Ethiopia. Paradoxically the very success of specialised feeding programmes, in some groups in particular, has accelerated the onset of the sort of dental disease that is becoming a feature of developing countries.
International Dental Journal
Two hundred and forty-three Ethiopian adults (18 years-old and over) were examined for caries, pe... more Two hundred and forty-three Ethiopian adults (18 years-old and over) were examined for caries, periodontal disease, malocclusions and enamel opacities. These adults were the parents of children cared for by an independent charitable organisation, the Ethiopian Gemini Trust. The prevalence of dental caries was generally low with a mean DMFT for the sample of 2.7 (+/- 0.2) and a mean DMFS of 6.7 (+/- 0.6), although one adult had a DMFS of 62. A high proportion of the adults (83.5 per cent) had calculus, but only 2 per cent had deep pocketing. Twenty-three per cent of the adults had a malocclusion and for 6 per cent of these this was moderate to severe. The most prevalent enamel defects were hypoplasias and diffuse opacities with 22 per cent of adults having one or more index teeth affected. Access to dental services was virtually non-existent as judged by the clinical status of these adults.
Community dental health
Developmental defects of enamel were assessed in 15-year-old children born and continuously resid... more Developmental defects of enamel were assessed in 15-year-old children born and continuously resident in three communities in the north east of England. In naturally fluoridated Hartlepool (F = 1.0-1.3 ppm), artificially fluoridated Newcastle (F = 1.0 ppm) and non-fluoridated ...
Special Care in Dentistry
This paper provides a survey of recent literature on the use of mouth sticks for patients who hav... more This paper provides a survey of recent literature on the use of mouth sticks for patients who have little or no use of their limbs. Criteria for mouth stick design, types of appliances, and the fabrication of such devices are described. Details are given of a case of a young child with arthrogryposis multiplex congenita, in whom a novel approach was used to allow the safe intra-oral retention of writing implements.
Community dental health
The recent past has seen many changes that have had an impact on the dental care of children: for... more The recent past has seen many changes that have had an impact on the dental care of children: for example, demographic changes, changes in the prevalence of dental caries, changes in manpower and changes in the organisation of dental services. The community dental service (CDS) in particular has had a major role to play in the provision of care to many children in this country. An analysis of the statistical returns to the Department of Health for the community dental services in England and Wales for the years 1985-1990 shows that staffing in the CDS has declined from 1,544 (Whole Time Equivalents--WTE) to 1,309 (WTE) in 5 years. The total clinical hours worked has also reduced from 2.02 million to 1.59 million in ten years. Hours spent on administration have increased from 53,490 to 87,091 in the same period. Clinical time spent on treating handicapped adults has increased almost ten fold from 14,644 hours in 1980 to 122,463 hours in 1990. Time devoted to mother and child (pre-school) services in about the same as in 1985. Hours spent on school services have reduced from a peak of almost 2 million in 1985 to 1.38 million in 1989-90. Trends in eight aspects of dental treatment are presented.
Health trends
For several years it has been recommended that aspirin should be avoided in children under the ag... more For several years it has been recommended that aspirin should be avoided in children under the age of 12 years because of the risk of Reye's Syndrome. In this study we investigated the reported use of analgesics among children who attended the Children's Department of the Dental Hospital in Newcastle upon Tyne. In addition the study also investigated the complaints that led to use of analgesics, the dose and frequency of administration of the analgesic, and past and current contact with medical services. Of 179 children investigated, 129 were under 12 years-old; of these 129 children under 12 years-of-age, 72 (56%) had taken an analgesic within the previous six months, 12 (17%) of whom took aspirin. Three of these children who had taken aspirin were reported to have had a serious illness in their lives, and would therefore have had significant contact with medical services. One-quarter of all children who had taken an analgesic did so for toothache. Inappropriate use of aspirin in children under 12 years-of-age indicates that health education about the possible risks of Reye's Syndrome needs to be improved.
The development of formocresol as a pulpotomy medicament is charted from the 19th Century to the ... more The development of formocresol as a pulpotomy medicament is charted from the 19th Century to the present day. While the solution has come in and out of vogue, few agents can seriously challenge its efficacy. Doubts about its toxicity, mutagenicity, and carcinogenicity have led, however, to a call for a more dilute formulation as well as a review of alternative medicaments. Problems arise in deriving an appropriate formula for a dilute version from existing formulations, which appear to have misinterpreted the concentration of constituents in the original solution.
Quintessence international
Children and adolescents, aged 2 to 18 years, from 300 poor families in Addis Ababa were examined... more Children and adolescents, aged 2 to 18 years, from 300 poor families in Addis Ababa were examined to determine the prevalence of the traditional practice of primary canine tooth removal. Fifteen percent of the primary canine teeth were found to have been affected, and 7% of the permanent canines had been damaged by this practice. A questionnaire to a subset of 40 families revealed some of the reasons that this procedure is still carried out, in spite of the considerable associated morbidity.