Oral health status in epileptic children

Expanding the Phenotypic and Genotypic Spectrum of Weaver Syndrome: A Missense Variant of the EZH2 Gene

Introduction

Weaver syndrome (WS) is a rare autosomal dominant disorder characterized by distinctive facial features, pre- and post-natal overgrowth, macrocephaly, and variable developmental delay. The characteristic facial features are ocular hypertelorism, a broad forehead, almond-shaped palpebral fissures and, in early childhood, large, fleshy ears, a pointed "stuck-on" chin with horizontal skin creases, and retrognathia. Heterozygous pathogenic/likely pathogenic variants in the enhancer of zeste homolog 2 (EZH2) gene are responsible for WS.

Case Presentation

Here, we report a male patient with a heterozygous likely pathogenic variant in EZH2 gene who has tall stature, distinctive facial features, mild development delay, hypoxic-ischemic encephalopathy with a MRI finding of periventricular leukomalacia, gingival hypertrophy, and early onset high hypermetropia.

Conclusion

This case demonstrates the importance of reporting detailed molecular and clinical findings in patients to expand the genotypic and phenotypic findings of this rare syndrome.

Modern sedative agents and techniques used in dentistry for patients with special needs: A review

According to the World Health Organisation, approximately 1.3 billion people worldwide experience substantial disability due to physical, mental or sensory impairment. People with special needs require special consideration and more time or altered delivery methods when receiving dental treatments. Various factors, such as patients' lack of cooperation, cognitive impairment and complex medical status, may lead dental practitioners to recommend conscious sedation. Several pharmacological agents and administrative routes are available, which achieve varying levels of sedation ranging from minimal to deep. Pre-operative assessment and careful case selection are necessary to determine the appropriate sedative agent, route of administration and level of sedation for each patient. Thus, a thorough understanding of the pharmacokinetics, risks and benefits, and implications of various sedatives available for PSN is essential to achieve the desired clinical outcomes. This review critically presents the considerations associated with the use of various sedative agents for PSN in dentistry. Considerations include patients' pre-anaesthesia medical comorbidities, cardiorespiratory adverse effects and cooperativeness, and the viable alternative treatment modalities.

Assessment of Oral Health Status in Epileptic Children and Healthy Children in Bengaluru City: A Comparative Study

Introduction

Objective

Material and methodology

Results

Conclusion

How to cite this article

Gingival overgrowth induced by anticonvulsant drugs: A cross-sectional study on epileptic patients

OBJECTIVE

Our aim was to estimate the prevalence of gingival overgrowth (hyperplasia) and to determine whether active molecules affect the severity of overgrowth in a group of epileptic patients.

BACKGROUND

The effects of phenytoin on oral health have been explored in different studies, yet little information is available on other antiepileptic drugs.

METHODS

Data were collected from 213 subjects of both sexes, from 5 to 80 years. Patients taking the same antiepileptic therapy for at least 1 year and meeting the inclusion criteria of the study (n = 162) were subjected to measurement of gingival overgrowth according to the modified Harris and Ewalt classification and O'Leary's plaque control record (OLR). Descriptive statistics were calculated. Data were analyzed using Pearson's r correlation coefficient and chi-square test. Significance level was set at 5%.

RESULTS

The active drugs lamotrigine, oxcarbazepine, and phenobarbital were significantly associated with gingival overgrowth in 61%, 71%, and 53% of cases, respectively, and phenytoin, valproic acid, and carbamazepine in 50%, 44%, and 32% of cases, respectively.

CONCLUSION

Different antiepileptic molecules may be related to gingival overgrowth. In addition to phenytoin, also lamotrigine, oxcarbazepine, and phenobarbital were associated with increased prevalence of gingival overgrowth. In the management of epileptic patients, dentists should take into account different drugs as possible causes for gingival overgrowth and warn for possible alternatives.

Oral health status of children with epilepsy in Hong Kong

AIM

This study assessed and compared the oral health status, dental trauma experience and oral health habits of children with and without epilepsy.

METHODS

Thirty-five children with epilepsy aged 3-18 years old were recruited from the pediatric neurology clinics of 2 university-affiliated district hospitals. A sample of 35 age- and gender-matched healthy children was recruited as controls. Clinical data on caries, gingival health, oral hygiene level and dental trauma were collected and compared between the groups. Information about children's oral health habits and reported dental trauma experience were obtained by structured questionnaire.

RESULTS

Children with epilepsy had significantly poorer gingival health than healthy controls. No significant differences in dental caries experience, oral hygiene level, dental trauma experience, oral health habits and dental care service utilization were observed between the children with and without epilepsy. Among the children with epilepsy, those taking more than 1 antiepileptic drug had a greater prevalence of dental caries when compared with those receiving mono-antiepileptic drug therapy. The presence of gingival hyperplasia indicated poorer gingival health in epileptic children.

CONCLUSION

The study shows that children with epilepsy had poorer oral health status in terms of gingival health than those without epilepsy.

Caregivers' perceptions of the oral-health-related quality of life of children with special needs in Johannesburg, South Africa

Background

The prevalence of dental caries and its effect on the oral-health-related quality of life (OHRQoL) of children with special needs (CSNs) have not been established in South Africa.

Aim

The study aimed to assess how caregivers of CSNs who attended Down Syndrome Association outreach sites in Johannesburg, South Africa, perceived the contribution of OHRQoL to the quality of life of these children.

Setting

The study was conducted at Down Syndrome Association (DSA) outreach sites in Johannesburg. These sites cater for children with several types of disabilities including cerebral palsy, hydrocephalus, autism, epilepsy and developmental delays. The association schedules and facilitates support group meetings for the caregivers of children with Down syndrome and other disabilities. These meetings are held at the outreach sites that are located at different district hospitals and community health centres in Johannesburg and are co-facilitated by the association’s outreach coordinator together with a team of physiotherapists, occupational therapists and speech therapists.

Methods

This cross-sectional study was composed of a convenient sample of 150 caregiver and child pairs from five outreach sites during January – June 2015. The short-form Parent-Caregiver Perception Questionnaire (P-CPQ) was used. The caries status of the children was assessed using the decayed, missing and filled teeth (dmft/DMFT) indices (whereby dmft or DMFT stands for decayed missing filled teeth in primary dentition [dmft] and in permanent dentition [DMFT]) based on World Health Organization guidelines.

Results

The mean age of the caregivers was 39.52 years (standard deviation [SD] 9.26) and 8.72 years (SD 6.07) for the children. The mean P-CPQ score was 12.88 (SD 12.14). All the caregivers stated that dental caries had a negative impact on the OHRQoL of the CSNs. However, 60% of caregivers stated that an oral condition had no impact on the child’s overall well-being. The majority (56.7%) of the caregivers rated their children’s overall oral health status as average and only 12% reported the oral health status to be poor. There was a high prevalence of untreated caries among the CSNs regardless of the type of disability.

Conclusion

All the caregivers stated that dental caries had a negative impact on the OHRQoL of the CSNs. However, they appeared to have contradictory perceptions of the oral health needs or status of their children.

Association between epilepsy and oral maxillofacial trauma: A systematic review and meta-analysis

A systematic literature search was conducted (through April 2017), using Web of Science, PubMed and Virtual Health Library, manual reference list, and grey literature searches. The quality of the studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale. The meta-analysis was performed using R software. A total of 30 studies was included in this review. From a total of 25 studies included in the meta-analysis, the prevalence of oral and maxillofacial injuries among epileptic subjects was 19%. Among the epileptic patients who suffered some type of injury due to epileptic seizures, 52% had facial soft tissue injuries (95%CI: 28-75%), 18% suffered dental trauma (95%CI: 11-29%), and 12% (95%CI: 4-28%) suffered maxillofacial fractures. Epileptic patients were more likely to have oral and maxillofacial injuries than healthy individuals (OR: 5.22, 95%CI: 2.84-9.36) and subjects with psychogenic nonepileptic seizures (OR: 2.77, 95%CI: 1.28-5.99), but not than patients with special needs (OR: 2.45,95%CI: 0.95-6.31).

Effect of Halita mouthwash on oral halitosis treatment: A randomized triple-blind clinical trial

Background . Halitosis (oral malodor) is a common problem all over the world and its prevalence has been estimated at 23‒ 50%. Halitosis originates from oral cavity in 85% of patients. This clinical trial was conducted to evaluate the efficacy of the Halita mouthwash in oral halitosis treatment. Methods . Fifty subjects with an organoleptic score of >2 at baseline participated in this triple-blinded clinical trial. Subjects were divided into 2 groups. Group I subjects (N=25) were instructed to rinse with 0.2% chlorhexidine (CHX) mouthwash twice a day for 1 week. Group II subjects (N=25) used Halita mouthwash with the same instruction. Halitosis was evaluated at baseline and one week after using the mouthwashes by organoleptic method. Data were analyzed with chi-squared and Mann-Whitney U tests (P<0.05). Results . In the Halita group subjects exhibited 2.04±0.65 reduction in OLS. OLS reduction in the chlorhexidine group was 1.95±0.74. Statistical analysis showed no significant difference between the two groups (P>0.05). Conclusion . Based on the results, Halita mouthwash has the same effect on oral halitosis as routine 0.2% CHX mouthwash. Halita mouthwash has fewer side effects because of lower concentration of chlorhexidine. Therefore 0.2% CHX mouthwash could be replaced by Halita mouthwash for the treatment of halitosis.

Effect of Halita mouthwash on oral halitosis treatment: A randomized triple-blind clinical trial

Background. Halitosis (oral malodor) is a common problem all over the world and its prevalence has been estimated at 23‒ 50%. Halitosis originates from oral cavity in 85% of patients. This clinical trial was conducted to evaluate the efficacy of the Halita mouthwash in oral halitosis treatment. Methods. Fifty subjects with an organoleptic score of >2 at baseline participated in this triple-blinded clinical trial. Subjects were divided into 2 groups. Group I subjects (N=25) were instructed to rinse with 0.2% chlorhexidine (CHX) mouthwash twice a day for 1 week. Group II subjects (N=25) used Halita mouthwash with the same instruction. Halitosis was evaluated at baseline and one week after using the mouthwashes by organoleptic method. Data were analyzed with chi-squared and Mann-Whitney U tests (P<0.05). Results. In the Halita group subjects exhibited 2.04±0.65 reduction in OLS. OLS reduction in the chlorhexidine group was 1.95±0.74. Statistical analysis showed no significant difference between the two groups (P>0.05). Conclusion. Based on the results, Halita mouthwash has the same effect on oral halitosis as routine 0.2% CHX mouthwash. Halita mouthwash has fewer side effects because of lower concentration of chlorhexidine. Therefore 0.2% CHX mouthwash could be replaced by Halita mouthwash for the treatment of halitosis.

Oral health and dental status in people with epilepsy in rural China

PURPOSE

We evaluated the oral health and dental status of people with epilepsy, and their relationship to seizure frequency, in a community cohort in rural China.

METHODS

A cross-sectional study of people with epilepsy was carried out in areas in Henan, Shanxi and Ningxia provinces of China. All participants underwent a specially designed "Oral health and Dental status Questionnaire". Univariate and multivariate analyses were used to explore the relationships between seizure frequency and oral health and dental status.

RESULTS

A total of 875 people participated. Almost two thirds (65.8%) reported brushing their teeth at least once a day but 634 (73.0%) brushed their teeth for less than 3 min each time. Only 80 (9.1%) had visited a dental clinic in the previous year. Multivariate logistic regression analysis showed that having 1-4 seizures/month (OR 0.60, 95%CI 0.40-0.90) or >4 seizures/month (OR 0.38, 95%CI 0.22-0.66) was associated with decreased odds of brushing teeth at least once a day, and higher seizure frequency was associated with increased odds of dental injury due to seizures (OR 2.07, 95%CI 1.22-3.50 for <1 seizure/month; OR 2.12, 95%CI 1.25-3.58 for 1-4 seizures/month; OR 3.09, 95%CI 1.57-6.07 for >4 seizures/month).

CONCLUSION

Seizure frequency was significantly associated with seizure-related dental injury, and with the lack of good oral health practice. Improvement in the oral health of people with epilepsy in resource-poor areas should be encouraged.

Dental Decay and Oral Findings in Children and Adolescents Affected by Different Types of Cerebral Palsy: A Comparative Study

OBJECTIVE

To compare dental caries and oral findings in patients affected by different types of Cerebral Palsy (CP).

STUDY DESIGN

This cross-sectional study involved 120 children and adolescents with a diagnosis of CP. WHO diagnostic criteria were used to determine DMFT (caries diagnosis), the pocket depth and attachment level (periodontitis diagnosis). Additionally, the study evaluated dental erosion, traumatic dental injuries, treatment needs index (TNI), oral habits, malocclusions, gingival overgrowth, and dental fluorosis.

RESULTS

The most frequent CP type was spastic (62.5%), followed by mixed (18.3%), ataxic (10%), and athetoid (9.1). Patients affected by mixed CP showed a higher prevalence in decayed, DMFT index and TNI compared with the other types of CP (p<0.05). The frequency of malocclusion in the clinical evaluation was 87.5% and in plaster models was 49.2%.

CONCLUSIONS

Dental caries was an important issue in mixed and athetoid CP groups. Oral habits and malocclusions were the most significant oral health problems in individuals with CP.

Comparative evaluation of oral hygiene status and gingival enlargement among epileptic and healthy children as related to various antiepileptic drugs

Background

Epilepsy is a gathering of neurological disorders characterized by epileptic seizures. Epileptic children, who are on active treatment with antiepileptic drugs, have a well-recognized side effect of gingival enlargement. Therefore, all efforts should be made, particularly for the population who are diagnosed or affected by the systemic disease. This study was conducted with an aim to determine oral hygiene status and gingival enlargement among epileptic and healthy children as related to various antiepileptic drugs.

Materials and Methods

The cross-sectional observational study was conducted in the department of pedodontics and attached general hospital. A sample size of 120 participants with 60 healthy and 60 epileptic children between age 2 and 14 years were included. Oral health status of participants was examined using oral hygiene simplified index and plaque index. Gingival enlargement was assessed using Miranda-Brunet index. For statistical analysis, one-way ANOVA test, independent t-test, and Pearson's Chi-square test were used.

Results

From the total participants included in the study, 49% of participants had good oral hygiene from healthy group, and 28% participants had poor oral hygiene from the epileptic group. Sodium valproate was the most common drug used and was associated with increased gingival enlargement.

Conclusion

Conclusion can be drawn that epileptic children under medication had poor oral hygiene and an increased risk for gingival enlargement as compared to their healthy counterparts. It must be stressed that the epileptic patients should be given dental care without conditions and provided with best possible care to restore esthetics and functions.

Dental health and odontogenic infections among 6- to 16-year-old German students with special health care needs (SHCN)

OBJECTIVES

This cross-sectional study aimed to assess dental health and odontogenic infections in students with special health care needs (SHCN) in the Free State of Thuringia, Germany.

METHODS

From 1283 students with SHCN aged 6-16 years, 66.0 % (n = 848 of whom are 35.7 % females and 64.3 % males) with intellectual/learning disabilities (ID/LD), physical disabilities (PD), and sensory disorders (SD) participated after informed consent in oral examinations according to WHO standards. Dental caries was assessed by dmft/DMFT, odontogenic infections by pufa/PUFA. Fissure sealants (FS) were scored in permanent molars. Data were compared to regional and national reference data and analysed by t test and age-adjusted logistic regression models.

RESULTS

Students with SHCN revealed 41.2 % caries prevalence in permanent and 31.7 % in primary teeth. Highest prevalence/experience of caries and odontogenic infections in primary teeth was recorded in 6-11-year-olds with PD (65.1 %/2.3 dmft; 14.0 %/0.3 pufa). Most affected permanent teeth were observed in students with ID/LD (12-16-year-olds 59.6 %/2.4 DMFT; 6-11-year-olds 2.8 %/0.03 PUFA). All odontogenic infections in 12-16-year-olds occurred in males; n = 9 students revealed n = 9 teeth with pufa/PUFA. Students with ID/LD aged 6-11 years exhibited lowest prevalence of FS (29.0 %) and mean of 0.8 FS. Students with SHCN suffered more than twice as frequent from untreated dental caries and benefited up to 29.0 % less from FS than peers without disabilities.

CONCLUSION

This first study investigating odontogenic infections of German students with SHCN revealed highest prevalence in primary teeth and in males. Oral health among students with SHCN is reduced, and FS are underutilized compared to German students without disabilities.

CLINICAL RELEVANCE

Reinforcing the application of FS in students with SHCN might contribute to reducing disparities in oral health.

Adjusting to a seizure-free "new normal" life following discontinuation of antiepileptic drugs during adolescence

This qualitative study sought to understand how children in adolescence adjust to their newly acquired normal life without epilepsy, following discontinuation of antiepileptic drugs during this dynamic period of growth and development. Three major themes with subthemes were identified: 1) setting the body and mind free; 2) engaging in self-regulation; and 3) protection by significant others. A sense of relief from constraints related to treatment schedules, special diets, and avoiding seizure-provoking activities was expressed by all participants. Freedom from side effects of the antiepileptic drugs improved life at home and school. Most of the participants said that they were not worried about seizure recurrence but would use caution against a possible relapse. Family members also must adjust to a new lifestyle. Medical staff needs to provide support and adequate care to adolescents during their period of identity adjustment following antiepileptic drug discontinuation.

Dental treatment for handicapped patients; sedation vs general anesthesia and update of dental treatment in patients with different diseases

Dental treatment on Handicapped Patients is often difficult because many people with a wide range of ages (from children to the elderly) with different pathologies that can affect the oral cavity and differ widely are included in this group. This situation creates some controversy, because according to pathology, each patient will be treated differently depending on collaboration, general health status, age or medication used to treat this pathologies. According to this situation we can opt for an outpatient treatment without any kind of previous medication, a treatment under conscious or deep sedation or a under general anesthesia treatment. With this systematic review is intended to help clarify in which cases patients should be treated under general anesthesia, sedation (conscious or deep) or outpatient clinic without any medication, as well as clarify what kind of treatments can be carried in private dental clinics and which should be carried out in a hospital. It will also discuss the most common diseases among this group of patients and the special care to be taken for their dental treatment.

Halitosis: From diagnosis to management

Halitosis is formed by volatile molecules which are caused because of pathological or nonpathological reasons and it originates from an oral or a non-oral source. It is very common in general population and nearly more than 50% of the general population have halitosis. Although halitosis has multifactorial origins, the source of 90% cases is oral cavity such as poor oral hygiene, periodontal disease, tongue coat, food impaction, unclean dentures, faulty restorations, oral carcinomas, and throat infections. Halitosis affects a person's daily life negatively, most of people who complain about halitosis refer to the clinic for treatment but in some of the people who can suffer from halitosis, there is no measurable halitosis. There are several methods to determine halitosis. Halitosis can be treated if its etiology can be detected rightly. The most important issue for treatment of halitosis is detection etiology or determination its source by detailed clinical examination. Management may include simple measures such as scaling and root planning, instructions for oral hygiene, tongue cleaning, and mouth rinsing. The aim of this review was to describe the etiological factors, prevalence data, diagnosis, and the therapeutic mechanical and chemical approaches related to halitosis.

Impact of oral health in patients with multiple sclerosis and epilepsy: a survey in a neurology clinic

This study investigated the impact of oral health on neurological disorders using the Oral Health Impact Profile (OHIP). A total of 460 subjects completed the OHIP, including 141 control subjects who did not have any neurological conditions. Of the 319 subjects with a neurological diagnosis who were enrolled in the study, 31% had multiple sclerosis (MS), 34% had epilepsy, and 34% had other neurological conditions. Compared to the control group, mean age (p = .001), education (p = .003), and household income levels (p ≤ .001) were statistically significantly lower among subjects with epilepsy than in the other two groups. The majority of the study populations were Caucasian and the percentage was highest in those with MS (87%). Patients with any neurologic diagnosis had greater physical pain and disability than controls. Adjusting for demographic variables, the impact of physical disability was statistically significantly higher in patients with any neurological diagnosis (including MS and epilepsy) (OR = 4.49). In multinomial regression, the strongest association of physical disability impact was noted in patients with epilepsy (OR = 5.17). The physical disability domain of the OHIP is more commonly associated with a neurological diagnosis, including MS, and the association is strongest in patients with diagnosis of epilepsy.

Diet and halitosis

PURPOSE OF REVIEW

The present article reviews the current knowledge of halitosis with particular emphasis upon the interplay of diet and disease of the gastrointestinal tract upon oral malodour.

RECENT FINDINGS

Transient-altered breath smell usually reflects the effects of foodstuffs, whereas longstanding halitosis is almost always because of oral disease such as gingivitis or periodontitis. There is, however, increasing evidence that upper gastrointestinal tract disease may give rise to halitosis and that extracts of foodstuffs may be future therapeutic agents for the treatment of halitosis derived from the mouth or upper gastrointestinal tract.

SUMMARY

There is some interplay between the halitosis and the gastrointestinal tract, and it is possible that the therapy of halitosis may be aided by investigations of the effects of foodstuffs upon bacteria that give rise to volatile sulphur compounds.