5.5 THOSE WHO DO NOT ATTEND A DENTIST REGULARLY Regular dental examination, at least once a year, is important for caries prevention and management. However, only 55% of Scottish children under 18 were registered with a dentist in 1995/96. 108 This suggests that many children in the target age group of this guideline do not undergo regular dental checks. The main barriers to attending a dentist have been identified as fear, the organisation and image of dental practices and cost 109 (although direct patient charges are not an issue for children). Dental indifference and apathy also play a part. In other age groups patients have been successfully encouraged to register with a dentist by a member of their primary care team. 101 The primary care team may be able to counsel patients who do not attend a dentist, and help them to overcome their own particular barriers to dental care. Medical practitioners can also help promote good oral health by providing dental advice to their patient when dental caries is discovered. Dental advice could also be introduced into appropriate clinics, such as an asthma clinic. GPs should actively encourage high caries risk children to attend for dental care. 5.6 MEDICALLY COMPROMISED This group includes those with a condition that makes dental treatment more hazardous, and includes patients with: cardiac disease immunosuppression, including HIV haemophilia and other bleeding disorders disability. Patients in these groups may be more susceptible to poor oral health and subsequent caries development and / or dental treatment may be hazardous. By careful attention to preventive dental care, the need for dental treatment may be minimised. Many of these patients see their doctor, primary care team member, or hospital specialist regularly. There is an opportunity, therefore, for the non-dental health professional to promote caries prevention in these patients by encouraging them to attend a dentist. Congenital heart disease is important in this age group. There is an increasing number of children who have undergone successful cardiac surgery but may still be predisposed to infective endocarditis. Children with heart defects should receive maximal preventive dental care, to minimise the need for dental surgical procedures. However, there is evidence from the North East of England that such children are under- registered. 110 To address the prevention of infective endocarditis, the recommendations of the British Society for Antimicrobial Chemotherapy 111 have been widely accepted and are reproduced in the BNF. It is important that patients at risk are well informed about the problem. Obtaining an accurate medical history is the simplest way to identify these patients. However, medical history given to a dentist by a patient may not be accurate.