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Perez MM, Lus ACM, Campos PH, Amaral SFD, Lussi A, Diniz MB, Guaré RO. Association of salivary parameters and erosive tooth wear in preschool children. Braz Oral Res 2023; 37:e093. [PMID: 37820251 DOI: 10.1590/1807-3107bor-2023.vol37.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/01/2023] [Indexed: 10/13/2023] Open
Abstract
The aims of this study were to 1) assess the association between erosive tooth wear (ETW) according to the BEWE (Basic Erosive Wear Examination) scoring system and salivary parameters and 2) compare salivary parameters according to ETW severity in the subgroup of children with ETW. This cross-sectional study included 52 preschool children aged 5 years paired by sex. A calibrated examiner assessed ETW using BEWE criteria, and stimulated saliva was collected to determine salivary flow, osmolality, pH, and buffering capacity. The children were divided into two groups: without ETW (n=26; BEWE score 0) and with ETW (n=26; BEWE scores 1 and 2). Logistic regression analysis was used to determine the magnitude of the association between ETW and salivary parameters and estimates of odds ratios (OR). In the unadjusted analysis, the ETW group was more likely to have lower salivary flow (OR = 0.079; 95%CI = 0.013-0.469; p = 0.005) and lower osmolality (OR = 0.993; 95%CI = 0.985-1.000; p = 0.049). In the adjusted analysis, salivary flow remained significantly associated with ETW (OR = 0.087; 95%CI = 0.014-0.533; p = 0.008). Lower salivary osmolality values were observed in ETW, especially in preschool children with more severe ETW (BEWE score 2). Receiver operating characteristic (ROC) determined a salivary osmolality cutoff point of < 201 for the presence of ETW. In conclusion, salivary flow rate was significantly associated with ETW prevalence. Lower values of salivary osmolality were observed in preschool children with distinct erosive lesions with significant loss of tooth structure (BEWE 2).
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Affiliation(s)
| | | | | | | | - Adrian Lussi
- University of Freiburg, Department of Operative Dentistry & Periodontology, Freiburg, DE
| | - Michele Baffi Diniz
- Universidade Cruzeiro do Sul, Department of Dentistry, São Paulo, SP, Brazil
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Morozova NS, Kozlitina IA, Makarov VI, Loschenov VB, Grinin VM, Ivanov SY, Kashtanova MS. Optical spectral diagnostics of the oxygenation level in periodontal tissues and photodynamic therapy using methylene blue in children with cerebral palsy. Front Public Health 2023; 11:961066. [PMID: 36794072 PMCID: PMC9922788 DOI: 10.3389/fpubh.2023.961066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023] Open
Abstract
Dental diseases occur in children with cerebral palsy three times higher than in healthy children. Low values of the unstimulated salivation rate (<0.3 ml per minute), pH and buffer capacity, changes in enzyme activity and sialic acid concentration, as well as increased saliva osmolarity and total protein concentration, which indicates impaired hydration, are the factors in the development of a gingiva disease in case of cerebral palsy. This leads to increased bacterial agglutination and the formation of acquired pellicle and biofilm, leading to the formation of dental plaque. There is a tendency toward an increase in the concentration of hemoglobin and a decrease in the degree of hemoglobin oxygenation, as well as an increase in the generation of reactive oxygen and nitrogen species. Photodynamic therapy (PDT) with the use of photosensitizer methylene blue improves blood circulation and the degree of oxygenation in periodontal tissues, as well as eliminates a bacterial biofilm. Analysis of back diffuse reflection spectra makes it possible to conduct non-invasive monitoring determine tissue areas with a low level of hemoglobin oxygenation for precision photodynamic exposure. Aim To improve the effectiveness of phototheranostics methods using, namely PDT with simultaneous optical-spectral control, for the treatment of gingivitis in children with complex dental and somatic status (cerebral palsy). Methods The study involved 15 children (6-18 y.o.) with various forms of cerebral palsy, in particular, spastic diplegia and atonic-astatic form and with gingivitis. The degree of hemoglobin oxygenation was measured in tissues before PDT and on the 12th day. PDT was performed using laser radiation (λ = 660 nm) with a power density of 150 mW/cm2 with a five-minute application of 0.01% MB. The total light dose was 45 ± 15 J/cm2. For statistical evaluation of the results, a paired Student's t-test was used. Results The paper presents the results of phototheranostics using methylene blue in children with cerebral palsy. An increase in the level of hemoglobin oxygenation from 50 to 67% (p < 0.001) and a decrease in blood volume in the microcirculatory bed of periodontal tissues were shown. Conclusion Photodynamic therapy methods with application of methylene blue make it possible to assess the state of the gingival mucosa tissue diseases objectively in real time, and to provide effective targeted therapy for gingivitis in children with cerebral palsy. There is a prospect that they can become widely used clinical methods.
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Affiliation(s)
- Natalia S Morozova
- Department of Pediatric Dentistry and Orthodontics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Iuliia A Kozlitina
- Department of Pediatric Dentistry and Orthodontics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Vladimir I Makarov
- Laser Biospectroscopy Laboratory, Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia.,Department of Laser Micro-, Nano- and Biotechnologies, Institute for Physics and Engineering in Biomedicine, National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow, Russia
| | - Victor B Loschenov
- Department of Laser Micro-, Nano- and Biotechnologies, Institute for Physics and Engineering in Biomedicine, National Research Nuclear University MEPhI (Moscow Engineering Physics Institute), Moscow, Russia.,Laboratory of Laser Biospectroscopy, Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| | - Vasiliy M Grinin
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Sergey Yu Ivanov
- Department of Maxillofacial Surgery, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Department of Maxillofacial Surgery, The Peoples' Friendship University of Russia, Moscow, Russia
| | - Maria S Kashtanova
- Department of Pediatric Dentistry and Orthodontics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Evaluation of salivary parameters and Streptococcus' Mutans count in children with cerebral palsy in Egypt: a case control study. BMC Oral Health 2022; 22:411. [PMID: 36123671 PMCID: PMC9487054 DOI: 10.1186/s12903-022-02447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with cerebral palsy (CP) are at high risk for dental caries. Alteration of some salivary properties encountered among them compared to healthy children, could play a role in this elevated risk. OBJECTIVES The aim of the present study was to assess salivary physicochemical properties; including total antioxidant (TAC), flow rate, viscosity, pH and buffering capacity, as well as Streptococcus mutans level among children with CP, also to correlate these variables to their caries experience. MATERIALS AND METHODS This case control study included 80 children with CP, study group (SG) and matched number of healthy children for control group (CG). Interview-based questionnaire, clinical examination, salivary biochemical and microbiological investigations using MALDI-TOF were done. RESULTS In SG, the caries experience in primary teeth dmft and S. mutans log value were significantly higher than CG (P = 0.039, P = 0.002) while unstimulated salivary flow rate, buffering capacity and salivary TAC were significantly lower (P < 0.0001). Multivariate linear regression showed that the presence of CP was significantly associated with the greatest variation in caries experience in the primary teeth and permanent teeth. Higher unstimulated salivary flow rate, or an increase in buffering capacity by 1 ml of acid/ml of saliva were associated with lower number of the affected primary and permanent teeth. On the other hand, One-unit increase in S. mutans log count and higher salivary TAC were associated with higher caries experience. CONCLUSION Children with CP have higher caries experience (dmf) due to lower salivary protective factors and higher S. mutans counts.
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Cui S, Akhter R, Yao D, Peng XY, Feghali MA, Chen W, Blackburn E, Martin EF, Khandaker G. Risk Factors for Dental Caries Experience in Children and Adolescents with Cerebral Palsy—A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138024. [PMID: 35805684 PMCID: PMC9265822 DOI: 10.3390/ijerph19138024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022]
Abstract
Cerebral palsy is a developmental motor disorder which has far-reaching impacts on oral health. This scoping review examined the extent of research undertaken regarding the risk factors affecting dental caries experience in children and adolescents with cerebral palsy. Data were obtained from the electronic databases Web of Science and PubMed, using 10 search strings, for studies published between 1983 and 2018. Eligible studies were required to have investigated caries in children under 18 with cerebral palsy, as well as be written in English. 30 papers published were identified for inclusion in the review. These included 23 cross-sectional, 6 case–control, and 1 longitudinal study. Studies were categorized into six domains of risk factors: socioeconomic status (SE); cerebral palsy subtype (CPS); demographics (D); condition of oral cavity (OC); dental habits (DH); nutrition and diet (ND). This review was conducted and reported in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The most significant risk factors were caregiver-related education levels, oral health literacy, and sugar intake; this underlines the important role of special education and dental awareness in reducing dental caries incidence in CP children. Other factors showed divergent findings, highlighting the need for standardization and culturally specific studies in future literature.
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Affiliation(s)
- Sarah Cui
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia; (S.C.); (D.Y.); (X.-Y.P.); (M.-A.F.); (W.C.); (E.B.); (E.F.M.)
| | - Rahena Akhter
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia; (S.C.); (D.Y.); (X.-Y.P.); (M.-A.F.); (W.C.); (E.B.); (E.F.M.)
- Correspondence: ; Tel.: +61-2889-04348
| | - Daniel Yao
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia; (S.C.); (D.Y.); (X.-Y.P.); (M.-A.F.); (W.C.); (E.B.); (E.F.M.)
| | - Xin-Yun Peng
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia; (S.C.); (D.Y.); (X.-Y.P.); (M.-A.F.); (W.C.); (E.B.); (E.F.M.)
| | - Mary-Anne Feghali
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia; (S.C.); (D.Y.); (X.-Y.P.); (M.-A.F.); (W.C.); (E.B.); (E.F.M.)
| | - Winnie Chen
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia; (S.C.); (D.Y.); (X.-Y.P.); (M.-A.F.); (W.C.); (E.B.); (E.F.M.)
| | - Emily Blackburn
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia; (S.C.); (D.Y.); (X.-Y.P.); (M.-A.F.); (W.C.); (E.B.); (E.F.M.)
| | - Elizabeth Fieldja Martin
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, NSW 2006, Australia; (S.C.); (D.Y.); (X.-Y.P.); (M.-A.F.); (W.C.); (E.B.); (E.F.M.)
| | - Gulam Khandaker
- Central Queensland Public Health Unit (Rockhampton), Rural and District Wide Service, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia;
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Parmar A, Shannon K, Casas M, Orkin J. Dental care in children with medical complexity: A retrospective study. Paediatr Child Health 2022; 27:141-146. [PMID: 35712035 PMCID: PMC9191913 DOI: 10.1093/pch/pxab112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/18/2021] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives Children with medical complexity (CMC) are defined by complex, chronic multi-system disease with significant medical fragility. Limited research exists on dental care in CMC, which is an important part of oral health and overall health. Objectives of this study were to (1) determine the frequency and type of dental visits at a tertiary paediatric hospital of all CMC between 2015 and 2020 and (2) identify the factors associated with dental visits. Methods A retrospective chart review of the electronic records of CMC who were seen at a paediatric hospital from 2015 to 2020 was completed. The number and type of dental visits, demographic and clinical information were reviewed. Poisson regression models were used to test the association between the outcome (number of dental visits) and potential factors associated with receiving dental care. Results Four hundred and eighty-seven CMC (mean age=7.3 ± 4.6 years, 43.7% female) were included in this study. CMC were seen by dentists at the hospital 4.4 ± 3.8 times since 2015, which is approximately once per year over a 5-year period. Dental visits were mostly preventative (66.4% of all visits). CMC had more dental visits if they had dental care funding compared to no funding if they were living in a community with a population >100,000 people and if they were being followed by a greater number of sub-specialists. Conclusions This study highlights the importance of funding, access to paediatric dental specialists, and care coordination support to improve access to dental care for CMC to optimize oral health.
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Affiliation(s)
- Arpita Parmar
- Department of Paediatrics, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kelsey Shannon
- Department of Paediatrics, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Michael Casas
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada,Department of Dentistry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julia Orkin
- Correspondence: Julia Orkin, Medical Director, Complex Care Program, Staff Paediatrician, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada. Telephone 416-813-7654, fax (416)-813-5663, e-mail:
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Lansdown K, Irving M, Mathieu Coulton K, Smithers-Sheedy H. A scoping review of oral health outcomes for people with cerebral palsy. SPECIAL CARE IN DENTISTRY 2021; 42:232-243. [PMID: 34706111 DOI: 10.1111/scd.12671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/10/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Good oral health is important for good overall health. Studies have reported poorer oral health outcomes for people with cerebral palsy, but there has been no synthesis of the evidence surrounding this and, there are no clear oral health recommendations for people with cerebral palsy globally. This review synthesizes the existing knowledge base on oral health in people with cerebral palsy and provides recommendations for future research. METHODS A scoping review was conducted to assess the current literature. Databases were searched using relevant search terms. Study outcomes were synthesized according to their reported outcomes. RESULTS One hundred seventy three studies were included in this review. Children with cerebral palsy have an increased risk for dental caries and untreated caries. Higher saliva osmolality is a major contributor to increased dental caries. People with cerebral palsy are more likely to experience tooth wear and bruxism. Children and their care-givers have poor oral health related quality of life. There is a large unmet need for oral healthcare in this group. There is no suggested plan for the prevention of poor oral health for this group. A high number of studies included related to research is conducted in low- and middle-income countries, care should be taken in applying results outside this context. There is a lack of research conducted in people with cerebral palsy, 18 years and over. CONCLUSION There is a higher risk for poor oral health in people with cerebral palsy and there is a large unmet need to dental care in this group. This study highlights the need for further research to focus on adults with cerebral palsy and an of understanding the oral health care outcomes in the context of settings. The authors recommend the inclusion of classification systems and the integration of disability inclusive language in future studies.
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Affiliation(s)
- Karen Lansdown
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Michelle Irving
- School of Public Health, Faculty of Medicine and Health, Menzies Centre for Health Policy, University of Sydney, Camperdown, Australia
| | - Kimberly Mathieu Coulton
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance Research Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
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Castelo Branco CMC, Cabral GMP, Castro AMGS, Ferreira ACFM, Bonacina CF, Lussi A, Santos MTBR, Diniz MB. Caries prevalence using ICDAS visual criteria and risk assessment in children and adolescents with cerebral palsy: A comparative study. SPECIAL CARE IN DENTISTRY 2021; 41:688-699. [PMID: 34171134 DOI: 10.1111/scd.12621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
AIMS To compare the dental caries prevalence using the International Caries Detection and Assessment System (ICDAS) and the caries risk by Caries Management by Risk Assessment (CAMBRA) in individuals with cerebral palsy (CP) and normoactives (NAs). METHODS AND RESULTS Sixty children and adolescents aged 6-12 years (30 CP/30 NA) were clinically evaluated by one calibrated examiner using two-digit ICDAS criteria and converted into components of dmf/DMF indices: d2mf2/D2MF2 (enamel and dentin lesions) and d3mf3/D3MF3 (dentin lesions). An adapted CAMBRA was used for risk classification. The mean d2mf2s/d2mf2t and D2MF2S/D2MF2T for CP were 17.0 ± 16.8/7.5 ± 4.3 and 10.7 ± 17.6/5.3 ± 5.8, respectively, and for NA were 17.2 ± 16.9 /6.9 ± 4.8 and 11.1 ± 11.7/5.5 ± 4.7, respectively. The mean d3mf3s/d3mf3t and D3MF3S/D3MF3T for CP were 10.1 ± 16.7/3.0 ± 4.1 and 4.9 ± 15.6/0.2 ± 0.4, respectively, while for NA the mean values were 9.8 ± 13.0/3.5 ± 3.8 and 2.1 ± 5.7/0.9 ± 2.0, respectively. There were no statistically differences for caries prevalence and risk in both groups (p > 0.05). CONCLUSIONS Dental caries was highly prevalent in CP and NA children and adolescents. Enamel and dentin lesions and high caries risk were the most common condition.
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Affiliation(s)
| | | | | | | | | | - Adrian Lussi
- Department of Operative Dentistry and Periodontology, University Medical Centre, Freiburg, Germany.,School of Dental Medicine, University of Bern, Switzerland
| | | | - Michele Baffi Diniz
- Post-graduate Program in Dentistry, Cruzeiro do Sul University, São Paulo, Brazil
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Anjugam P, Mahesh Mathian V, Gawthaman M, Vinod S, Yamuna Devi E. Salivary Biomarker Levels and Oral Health Status of Children with Cerebral Palsy and Their Healthy Siblings: A Comparative Study. Rambam Maimonides Med J 2021; 12:RMMJ.10437. [PMID: 33938802 PMCID: PMC8092958 DOI: 10.5041/rmmj.10437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The dental needs of cerebral palsy children are an area of study much in need of attention. The neglect of this aspect should be rectified, and simpler diagnostic methodologies should be established and used to serve this purpose. AIM This study aimed to determine oral health status and salivary biomarkers (salivary flow rate, pH, buffering capacity) among children with cerebral palsy (CP), to compare their data with that of their healthy siblings, and to evaluate the relationship between salivary biomarkers and dental caries. METHODS A total of 30 CP children (study group) and 30 normal healthy siblings (controls) were selected between the ages of 5 and 12 years. Salivary biomarkers were assessed, and oral health status was examined. STATISTICAL ANALYSIS Chi-square test was used for comparison of oral health status. Unpaired t test was used to compare caries indexes (decay/filled teeth-primary dentition [dft] and decay/missing/filled teeth-permanent dentition [DMFT]) and salivary biomarkers between the groups. Pearson correlation was used to find the correlation between salivary biomarkers and caries. RESULTS The dft scores were significantly higher in the study group (P<0.05). The pH values and salivary flow rates were significantly lower in the study group (P<0.05 and P<0.001, respectively). There was a significant correlation between DMFT scores and salivary flow rate in the study group (P<0.05). CONCLUSION Low pH and low salivary flow rate might be risk factors for dental caries in CP populations; moreover, the significant correlation between DMFT score and salivary flow rate suggests that salivary flow rate could be used as a screening tool for assessing at-risk subjects in such populations.
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Association between Antimicrobial Peptide Histatin 5 Levels and Prevalence of Candida in Saliva of Patients with Down Syndrome. Antibiotics (Basel) 2021; 10:antibiotics10050494. [PMID: 33925785 PMCID: PMC8145106 DOI: 10.3390/antibiotics10050494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
There are no studies on Candida colonization and micropeptides of saliva in any patient. Therefore, we studied the effects of the salivary antimicrobial peptide histatin 5 on oral fungal colonization; subjects were subdivided into Down syndrome (D) and normal (N) groups by age: N-1 and D-1, age <20 years; N-2 and D-2, age >40 years. Histatin 5 concentration in saliva was measured by enzyme-linked immunosorbent assay. Oral Candida species were identified using CHROMagar Candida. Candida colonization was significantly enhanced in the D-1 and D-2 groups compared to the N-1 and N-2 groups. There was no predominant difference in salivary histatin 5 concentration between the D-1 and N-1 groups, but it was significantly lower in the D-2 group than in the N-2 group. Only in the N-2 group was there a correlation between the concentration of histatin 5 and total protein, while no correlation was found in the other groups. In elderly patients with Down syndrome, the decrease in histatin 5 shown in this study may lead to oral Candida colony formation. Therefore, the results of this study suggest that a deficiency of the antimicrobial peptide histatin 5 could possibly induce oral Candida infection in DS.
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Mei C, Hodgson M, Reilly S, Fern B, Reddihough D, Mensah F, Pennington L, Losche A, Morgan A. Oromotor dysfunction in minimally verbal children with cerebral palsy: characteristics and associated factors. Disabil Rehabil 2020; 44:974-982. [PMID: 32744922 DOI: 10.1080/09638288.2020.1788179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To explore the characteristics and associated factors of oromotor dysfunction in minimally verbal children with cerebral palsy (CP) aged five to six years, recruited from a population-based registry. Methods: Twenty children with CP who were minimally verbal completed a standardised, observational oromotor assessment. Linear regression analyses examined the relationship between oromotor dysfunction and potential associated factors (e.g., fine and gross motor function, communication, and feeding). Results: Oromotor dysfunction affected every participant and was identified in all structures examined (i.e., face, jaw, lips, and tongue). Oromotor movements showed little dissociation among jaw, lip, and tongue movements. Oromotor dysfunction was univariately associated with the Manual Ability Classification System levels IV-V (p = 0.001), reduced communication skills (p = 0.002), and a prolonged eating duration (>45 min) (p = 0.006), even when non-verbal cognition served as a covariate. Interpretation: Oromotor dysfunction was highly prevalent in our sample of minimally verbal children with CP, having significant functional impacts on feeding and communication. Findings suggest that fine motor function (i.e., Manual Ability Classification System levels IV-V) is a stronger predictor than gross motor function for identifying children with CP who are minimally verbal and at risk of oromotor dysfunction.IMPLICATIONS FOR REHABILITATIONOromotor dysfunction was highly prevalent in our sample of minimally verbal children with cerebral palsy.Severe fine motor impairment strongly predicted oromotor dysfunction, indicating that fine motor function may provide an early indicator of impaired oromotor function for this clinical population.Robust, standardised measures of motor speech-related oromotor development suitable for children with cerebral palsy who are minimally verbal are lacking.Until such a measure is developed, formal evaluation may be achieved via oral motor assessments standardised for typically developing children, with the caveat one must interpret the results with caution.
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Affiliation(s)
- Cristina Mei
- Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | | | - Sheena Reilly
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | | | - Dinah Reddihough
- Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Lindsay Pennington
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Annabel Losche
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Morgan
- Murdoch Children's Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
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Habibe CH, Yoshida RA, Gorjão R, de Gutierrez GM, Heller D, Birbrair A, Santos MTBR. Comparison of salivary cytokines levels among individuals with Down syndrome, cerebral palsy and normoactive. J Clin Exp Dent 2020; 12:e446-e451. [PMID: 32509226 PMCID: PMC7263772 DOI: 10.4317/jced.56336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/24/2020] [Indexed: 11/12/2022] Open
Abstract
Background Individuals with Down syndrome (DS) present increased susceptibility to infections and high prevalence of periodontal disease. The objective of this study is to evaluate the salivary concentrations of IL-1β, IL-6, IL-8, IL-10, TNFα and IL-12p70 of DS individuals and compare to cerebral palsy (CP) and normoactive patients (all with gingivitis).
Material and Methods Twenty-two individuals with DS, 24 with CP and 22 normoactive participated in this cross-sectional study. Salivary flow rate, osmolality rate, Oral Hygiene Index, Gingival Index (GI) and salivary inflammatory markers IL-1β, IL-6, IL-8, IL-10, TNFα and IL-12p70 were evaluated. Shapiro-Wilks, Chi-square, ANOVA One-Way and Kruskal Wallis tests were applied with significance level at 5%.
Results The groups were homogenous for gender, age, and IL12p70 cytokine (p>0.05). GI was significantly higher in DS compared to CP and healthy (p<0.05). CP presented reduced salivary flow and increased osmolality rate. CP showed significantly higher values for TNFα, IL10, and IL6 compared to DS and normoactive (p<0.05). DS and CP presented significantly higher values of IL-1β and IL8 compared to normoactive (p<0.05).
Conclusions Individuals with CP have higher risk to develop periodontal disease due to reduced salivary flow rate, increased salivary osmolality rate and elevated TNFα, IL-10, IL-6 compared to DS. Key words:Cytokines, biomarkers, gingivitis, periodontal diseases, Down syndrome, cerebral palsy, saliva.
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Affiliation(s)
- Carolina-Hartung Habibe
- DDS, MSc, PhD, Professor, Pediatric Dentistry, Centro Universitário de Volta Redonda, UniFOA, Av. Lucas Evangelista de Oliveira Franco, 866, Volta Redonda. Brazil
| | - Rosemeire-Arai Yoshida
- DDS, MSc student, Postgraduate Program in Dentistry, Cruzeiro do Sul University, Rua Galvão Bueno, 868 - Liberdade, São Paulo. Brazil
| | - Renata Gorjão
- MSc, PhD, Adjunt Professor, Postgraduate Program Interdisciplinary in Health Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868 - Liberdade, São Paulo. Brazil
| | - Gabriela-Mancia de Gutierrez
- DDS, MSc, Ph.D student, Postgraduate Program in Dentistry, Cruzeiro do Sul University, Rua Galvão Bueno, 868 - Liberdade, São Paulo. Brazil
| | - Debora Heller
- DDS, MSc, PhD, School of Dentistry, Cruzeiro do Sul University, Rua Galvão Bueno, 868 - Liberdade, São Paulo - SP, 01506-000, Brazil. Experimental Research Center, Albert Einstein Israeli Hospital, São Paulo, São Paulo, Brazil
| | - Alexander Birbrair
- DDS, MSc, PhD, Department of Radiology, Columbia University Medical Center, New York, New York 622 W 168th St, New York, NY 10032, EUA. Department of Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria-Teresa-Botti-Rodrigues Santos
- DDS, MSc, PhD, Associate Professor, Individuals with Special Needs, Postgraduate Program in Dentistry, Cruzeiro do Sul University São Paulo, SP, Brazil
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12
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Tzouanaki A, Agouropoulos A, Kavvadia K, Papagiannoulis L. A comparative study on oral health status in Greek preschool children with neurodevelopmental disorders with movement limitations. SPECIAL CARE IN DENTISTRY 2019; 39:421-428. [PMID: 31131909 DOI: 10.1111/scd.12390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 01/31/2019] [Accepted: 02/09/2019] [Indexed: 11/28/2022]
Abstract
AIM To assess the oral health status of preschool children with neurodevelopmental disorders (NDD) in Greece and compare it to that, of healthy children of the same age. METHODS AND RESULTS The sample consisted of 146 preschool children with NDD and movement limitations attending the rehabilitation centers of ELEPAP and 165 healthy children matched for age and maternal origin. Caries prevalence, dmft index, precavitated carious lesions (WSL) prevalence Visual Plaque Index (VPI), Restorative Index (RI), Mutans Streptococci (MS) levels, saliva buffer capacity, gingival hyperplasia, tooth wear and developmental dental defects were assessed. Data were analyzed using parametric and nonparametric tests (P ≤.05). The NDD group, compared to the healthy controls, had significantly lower caries prevalence (P <.001), dmft index (P <.001), VPI (P <.001) and MS levels (P = .027), significantly higher WSL prevalence (P <.001), and visited the dentist at an older age (P <.001). Significant determinants of WSL in the NDD group was the VPI (P = .009) and the presence of MS (P <.028). CONCLUSION Preschool children with NDD had lower prevalence of manifested caries but higher prevalence of WSL. However, most oral health parameters need improvement for both groups indicating the need for proper early interventions especially in the NDD group.
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Affiliation(s)
- Aikaterini Tzouanaki
- Department of Pediatric Dentistry, National and Kapodistrian University of Athens, Faculty of Dentistry, Greece
| | - Andreas Agouropoulos
- Department of Pediatric Dentistry, National and Kapodistrian University of Athens, Faculty of Dentistry, Greece
| | - Katerina Kavvadia
- Department of Pediatric Dentistry, National and Kapodistrian University of Athens, Faculty of Dentistry, Greece
| | - Liza Papagiannoulis
- Department of Pediatric Dentistry, National and Kapodistrian University of Athens, Faculty of Dentistry, Greece
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Gutierrez GM, Siqueira VL, Loyola-Rodriguez JP, Diniz MB, Guaré RO, Ferreira ACFM, Santos MTBR. Effects of treatments for drooling on caries risk in children and adolescents with cerebral palsy. Med Oral Patol Oral Cir Bucal 2019; 24:204-210. [PMID: 30818313 PMCID: PMC6441593 DOI: 10.4317/medoral.22729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/24/2018] [Indexed: 11/29/2022] Open
Abstract
Background Neuromuscular impairment makes individuals with cerebral palsy (CP) more prone to drooling. Among the treatment options, there are procedures that interfere with saliva production. It is imperative to evaluate the effect of the different modalities since the reduction in salivary flow rate/production may exacerbate the risk of dental caries. Material and Methods The aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP. Study design A total of 142 children and adolescents with CP, aged 6 to 18 years, were assigned to groups based on the different treatments they had received for drooling: G1—anticholinergic drugs (n = 18), G2—botulinum toxin injection (n = 16), G3—salivary glands surgery (n = 16), G4—no treatment (n = 42), and G5—non-drooling subjects (n = 50). All participants were evaluated on the Simplified Oral Hygiene Index, and for the prevalence of dental caries (decayed, missing, and filled teeth index and white spot lesions). Unstimulated whole saliva was collected, and salivary flow rate and osmolality were measured. Chi-square, ANOVA and Poisson regression were calculated. Prevalence ratios and their respective 95 % confidence intervals were obtained. The significance level was fixed at 5%. Results No differences were found in the decayed, missing, and filled teeth index (p = 0.128) and Simplified Oral Hygiene Index (p = 0.674) among the different groups. G3 presented significantly higher percentages of WSL (p<0.001), lower values of salivary flow rate (p<0.001), and higher values of osmolality (p<0.001). The white spot lesion prevalence ratio was higher only for G3 (Prevalence ratio = 14.36; IC 95% = 4.64-44.40; p<0.001). Conclusions Children and adolescents with CP who had received surgical treatment for drooling exhibited higher number of white spot lesions because of the reduced salivary flow rate and higher salivary osmolality. Key words:Cerebral palsy, saliva, sialorrhea, dental caries, osmolar concentration.
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Affiliation(s)
- G-M Gutierrez
- Universidade Cruzeiro do Sul, Rua Constantino de Sousa, 454, apto 141, zip code: 04605-001, São Paulo - SP, Brazil,
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14
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Makkar A, Indushekar KR, Saraf BG, Sardana D, Sheoran N. A cross sectional study to evaluate the oral health status of children with intellectual disabilities in the National Capital Region of India (Delhi-NCR). JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:31-39. [PMID: 30338591 DOI: 10.1111/jir.12553] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 09/06/2018] [Accepted: 09/23/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Children with intellectual disabilities (ID) have usually been reported to have poorer levels of oral hygiene and higher prevalence of dental caries than their compeers. The present study was conducted to assess the status of dental caries and oral hygiene in different categories of institutionalised children with ID (syndromic and non-syndromic) registered in various special schools of Delhi (National Capital Region, India). METHODS The present cross sectional study was conducted on 269 children [52 with cerebral palsy (CP), 35 with Down syndrome (DS), 30 with autism and 152 with non-syndromic intellectual disability] attending nine special schools who were examined for dental caries [Decayed, Missing and Filled Teeth index for permanent teeth (DMFT); decayed, missing/indicated for extraction, filled index for primary teeth (dmft) and prevalence of caries] and oral hygiene status [Oral Hygiene Index-simplified (OHI-S)]. The levels of disability were classified according to Stanford Binet scale as severe (IQ ≤ 35), moderate (IQ = 36-51) and mild (IQ = 52-67). Statistical analysis was performed using one way analysis of variance and post hoc test to compare the levels between groups at a significance level of P < 0.05. RESULTS Mean DMFT, dmft and OHI-S indices scores for all the children irrespective of the category and the level of ID were 2.12 ± 1.95, 0.97 ± 1.60 and 2.05 ± 1.07, respectively. As the level of ID increased among these children, the mean DMFT index and OHI-S index increased with no significant effect on dmft. However, children with severe ID had higher OHI-S and DMFT scores than children with mild or moderate ID. The dental caries prevalence was 86.53%, 68.57%, 76% and 86.18% in children with CP, DS, autism and non-syndromic intellectual disability, respectively. CONCLUSIONS The level of caries in permanent teeth and oral hygiene deteriorated with the increasing severity of ID as indicated by DMFT and OHI-S scores (severe > mild, moderate). However, the level of caries (dmft) was not affected by the level of ID in primary dentition. The prevalence of dental caries was highest among children with CP and least among children with DS.
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Affiliation(s)
- A Makkar
- Department of Paediatric Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - K R Indushekar
- Department of Paediatric Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - B G Saraf
- Department of Paediatric Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
| | - D Sardana
- Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, Hong Kong, S.A.R
| | - N Sheoran
- Department of Paediatric Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, India
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15
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Ruiz LA, Diniz MB, Loyola-Rodriguez JP, Habibe CH, Garrubbo CC, Santos MTBR. A controlled study comparing salivary osmolality, caries experience and caries risk in patients with cerebral palsy. Med Oral Patol Oral Cir Bucal 2018; 23:e211-e215. [PMID: 29476677 PMCID: PMC5911353 DOI: 10.4317/medoral.22135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 01/12/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is a permanent neurological disorder accompanied by secondary musculoskeletal masticatory disorder, with repercussion on chewing and deglutition functions. In these conditions, the liquids ingestion is compromised resulting in salivary osmolality alteration. The objective of this study was to compare salivary osmolality, caries experience and caries risk between normoreactive individuals and patients with CP. MATERIAL AND METHODS The participants were 4-20 years old: 52 patients with CP treated at a reference rehabilitation centre (study group, SG), and 52 normoreactive individuals (control group, CG). Saliva was collected for five minutes using cotton rolls. Following centrifugation, salivary osmolality was determined by freezing point depression osmometry. Evaluations included caries experience (DMFT index), and caries risk based on a caries-risk assessment tool (CAT). Descriptive and inferential statistics (Chi square and Student t tests) were used to compare the groups. Receiver operating characteristic (ROC) analyses were performed and the area under the ROC curve (Az) was calculated. The level of significance was set at 5%. RESULTS The groups were homogeneous for sex (p=0.843) and age (p=0.128). In the SG, spastic type CP was the most prevalent (80.8%), and patients showed significantly higher salivary osmolality values compared with the CG (p<0.001). No significant differences in caries experience (p=0.159) or caries risk (p=0.297) were observed. ROC curve analysis determined a salivary osmolality cutoff point of >74 for the SG and >54 for the CG in the presence of dental caries. A significant correlation was verified between salivary osmolality and the DMFT index for the SG (p≤0.05). CONCLUSIONS Although patients with CP showed higher salivary osmolality values, higher caries experience and caries risk were not observed compared with normoreactive individuals.
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Affiliation(s)
- L-A Ruiz
- Universidade Cruzeiro do Sul, School of Dentistry, Department of Patients with Special Needs, Rua Constantino de Sousa, 454, apto 141, ZIPCODE: 04605-001 São Paulo, SP, Brazil,
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Santos MTBR, Diniz MB, Guaré RO, Ferreira MCD, Gutierrez GM, Gorjão R. Inflammatory markers in saliva as indicators of gingival inflammation in cerebral palsy children with and without cervical motor control. Int J Paediatr Dent 2017; 27:364-371. [PMID: 27785840 DOI: 10.1111/ipd.12270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIM To evaluate the relation among gingival inflammation, salivary osmolality, levels of IL-1β, IL-6, IL-8, TNF-α, and s-IgA concentrations in children with spastic CP with or without cervical motor control in a cross-sectional study. DESIGN Unstimulated whole saliva and the gingival index were collected in 37 and 34 CP children with and without cervical motor control, respectively. The data were dichotomized as follows: (=0) absence of gingival inflammation and (≥0.1) presence of gingival inflammation. RESULTS The group without cervical control presented statistically higher mean values of salivary osmolality, s-IgA, and cytokines. In addition, statistically positive correlation between the gingival index and salivary cytokines was observed in the group with cervical control. Salivary osmolality, salivary cytokines, and s-IgA from both groups presented a significant positive correlation. Significant differences (P = 0.00336) in the values of salivary osmolality were observed between the CP individuals with (93.9 ± 32.7) and without gingival inflammation (74.4 ± 16.6). ROC analysis was performed, and values of salivary osmolality >80 indicated a sensitivity of 0.54 and a specificity of 0.79. CONCLUSIONS Children without cervical motor control presented a more pronounced oral inflammatory status that was characterized by higher levels of cytokines.
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Affiliation(s)
| | | | | | | | | | - Renata Gorjão
- Postgraduate Interdisciplinary Program in Health Sciences, Institute of Physical Activity Sciences and Sports, Cruzeiro do Sul University, São Paulo, SP, Brazil
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Santos MTBR, Ferreira MCD, Guaré RO, Diniz MB, Rösing CK, Rodrigues JA, Duarte DA. Gingivitis and salivary osmolality in children with cerebral palsy. Int J Paediatr Dent 2016; 26:463-470. [PMID: 26726753 DOI: 10.1111/ipd.12220] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate the influence of salivary osmolality on the occurrence of gingivitis in children with cerebral palsy (CP). DESIGN A total of 82 children with spastic CP were included in this cross-sectional study. Oral motor performance and gingival conditions were evaluated. Unstimulated saliva was collected using cotton swabs, and salivary osmolality was measured using a freezing point depression osmometer. Spearman's coefficient, receiver operating characteristic (ROC), and multiple logistic regression analyses were performed. RESULTS Strong correlation (r > 0.7) was determined among salivary osmolality, salivary flow rate, visible plaque, dental calculus, and the occurrence of gingivitis. The area under the ROC to predict the influence of salivary osmolality on the occurrence of gingivitis was 0.88 (95% CI 0.81-0.96; P < 0.001). The cutoff value of 84.5 for salivary osmolality presented good sensitivity and specificity, both higher than 77%. The proportion of children presenting salivary osmolality ≤84.5 mOsm/kgH2 O and gingivitis was 22.5%, whereas for the group presenting osmolality >84.5 mOsm/kgH2 O, the proportion of children with gingivitis was 77.5%. Salivary osmolality above 84.5 increased the likelihood of gingivitis fivefold, whereas each additional 0.1 mL of salivary flow reduced the likelihood of gingivitis by 97%. CONCLUSION Gingivitis occurs more frequently in children with CP showing increased values of salivary osmolality.
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Affiliation(s)
| | | | - Renata Oliveira Guaré
- Pediatric Dentistry, Institute of Dentistry, Cruzeiro do Sul University, São Paulo, Brazil
| | - Michele Baffi Diniz
- Pediatric Dentistry, Institute of Dentistry, Cruzeiro do Sul University, São Paulo, Brazil
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Cardoso AMR, Gomes LN, Silva CRD, Soares RDSC, Abreu MHNGD, Padilha WWN, Cavalcanti AL. Dental caries and periodontal disease in Brazilian children and adolescents with cerebral palsy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 12:335-53. [PMID: 25551517 PMCID: PMC4306865 DOI: 10.3390/ijerph120100335] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/09/2014] [Indexed: 11/23/2022]
Abstract
The aim of the present study was determine the prevalence and factors associated with dental caries and periodontal disease in Brazilian children and adolescents with cerebral palsy (CP). This is a cross-sectional study conducted with 80 patients ranging in age from 2 to 18 years old. Oral exams were conducted by an examiner with records of DMFT, dmft, Gingival Bleeding Index (GBI) and Community Periodontal Index (CPI). The statistical analysis used Poisson Regression with robust variance estimation (α = 0.05). The prevalence of dental caries was 59.3%, with DMFT and mean dmft of 1.71 ± 2.42 and 2.22 ± 3.23, respectively. The mean GBI was 22.44%, and in the CPI, the prevalence of gingival bleeding, calculus, shallow and deep pockets were 94.73%, 79.62%, 12.90% and 3.22%, respectively. The caregiver’s educational level of less than eight years were associated with the dental caries experience (PR = 1.439; 95%CI = 1.09–1.89). The periodontal alterations were associated with female sex (PR = 0.82; 95%CI = 0.69–0.97), caregiver’s educational level of less than eight years (PR = 1.15; 95%CI = 1.03–1.29), poor oral perception (PR = 0.89; 95%CI = 0.80–0.98), serious communication problem (PR = 0.87; 95%CI = 0.76–0.99) and athetoid type of CP (PR = 0.85; 95%CI = 0.75–0.97). The patients with CP presented high dental caries experience and periodontal alterations, which were associated with their demographic, socioeconomic, oral health perception and systemic information.
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Affiliation(s)
- Andreia M R Cardoso
- Department of Dentistry, State University of Paraiba, Campina Grande, PB, 58429-500, Brazil.
| | - Lays N Gomes
- Department of Dentistry, Federal University of Paraiba, João Pessoa, PB, 58051-900, Brazil.
| | - Clara Regina D Silva
- Department of Dentistry, Federal University of Paraiba, João Pessoa, PB, 58051-900, Brazil.
| | - Renata de S C Soares
- Department of Dentistry, State University of Paraiba, Campina Grande, PB, 58429-500, Brazil.
| | - Mauro Henrique N G de Abreu
- Department of Community and Preventive Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, 31270-901, Brazil.
| | - Wilton W N Padilha
- Postdoctoral fellow, State University of Paraiba, Campina Grande, PB, 58429-500, Brazil.
| | - Alessandro L Cavalcanti
- Department of Dentistry, State University of Paraiba, Campina Grande, PB, 58429-500, Brazil.
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