A comprehensive 30-month preventive dental health program in a pre-adolescent population with Down's syndrome: a longitudinal study

Oral health status in individuals with Down syndrome

Down syndrome (DS) is a neurodevelopmental disorder of known genetic cause, with a wide array of oral and systemic manifestations. The aim of the present study is to determine the level of oral hygiene status and practice of a group of individuals with DS in Benghazi/Libya. In this cross–sectional study 124 individuals were recruited from The Rehabilitation Centre of Special Needs in the city of Benghazi, Libya. Questionnaires were distributed among the attendees, covering oral health aspects and diet habits. Oral examination was conducted to evaluate oral health status among individuals with DS. The data were analysed descriptively and inferentially (including Chi-square test and Fisher’s exact test) using the Statistical Package for Social Science version 20 (SPSS). Most of DS individuals brush their teeth once daily (62%), spending less than one minute in brushing (44%). For diet habits, more than half (55%) eat sweet snacks between meals. For the dental status, 47% of the subject had zero DMFT, followed by score 2 in 21%. The highest percentage in Oral hygiene Index (OHI) was scored 1 by 46% of participants. The zero CPITN score was seen in 54.5%. Our results have shown a weaker tendency of DS towards oral hygiene. This should strengthen our goal of guiding and encouraging parents of individuals with DS to be more cautious in providing help and supervision of their individuals’ practice of oral health care.

Teaching Oral Hygiene Skills to Elementary Students with Visual Impairments

This study investigated the effects of a program that taught oral hygiene skills to students with visual impairments using group instruction and individual coaching. The results showed that the program enhanced the oral hygiene skills of the three participants significantly, and its effectiveness lasted for at least two months after the instruction ended.

Associations between Diet, Dietary and Oral Hygiene Habits with Caries Occurrence and Severity in Children with Autism at Dammam City, Saudi Arabia

AIM:

The purpose of the study is to achieve the baseline information of the autistic child’s oral health status about the diet, dietary and hygiene habits. The association of these factors with dental caries were assessed.

MATERIAL AND METHODS:

The survey was composed of self-administered questionnaires to parents about their children’s’ demographic data followed by questions related to diet, dietary and hygiene habits. This is later followed by oral examination for estimating the decayed, missing and filled [dmft] scores as per WHO norms. The variables are analysed using t-tests and ANOVA. Pearson’s correlation coefficients were calculated for each of the independent variables to examine for autocorrelation.

RESULTS:

The mean age for the present study is 5.8 years with more predilections of caries in females. The autistic children prefer soft diet and pouch it in oral cavity resulting in increased caries though not significant. Other foods like nuts and pulses confectioneries and soft drinks resulted in increased caries, and our study shows significant relation. Consumption of sugars between meals and increased quantity of sugar per day also increased dental caries with highly significant results in our study. Hygiene habits also made a difference in the occurrence of caries though, in our study, it’s not significant.

CONCLUSIONS:

The study suggests that the oral health education programs should be conducted for the parents, caregivers and the teachers about the diet, dietary and the hygiene habits and the role they play in maintaining the oral hygiene.

Prevention and Periodontal Treatment in Down Syndrome Patients: A Systematic Review

The aim of this systematic literature review was to evaluate which type of periodontal preventive and therapeutic approaches presents superior outcomes in patients with Down syndrome (DS). Studies reporting different methods of periodontal care from DS patients were considered eligible. Included clinical studies should indicate at least two periodontal parameters in different periods of assessment. Screening of the articles, data extraction and quality assessment were conducted independently and in duplicate. Electronic search according to the PICO search, with both Key-words and MESH terms were conducted in MEDLINE, EMBASE and CENTRAL databases until March 2016. Manual search was conducted in four journals, namely Journal of Periodontology, Journal of Clinical Periodontology, Journal of Periodontal Research and Special Care in Dentistry and their electronic databases were searched. Electronic and manual search resulted in 763 papers, and of them 744 were excluded after title/abstract assessment. The full text of 19 potentially eligible publications was screened and 9 studies met inclusion criteria. The results demonstrated the importance to introduce youngest DS patients in preventive programs, as well as participation of parents, caregivers or institutional attendants in supervising/performing oral hygiene. In studies with higher frequency of attendance, all age groups presented superior preventive and therapeutic results, irrespective of the therapeutic approach used (surgical/nonsurgical/periodontal care program). The important factors for reducing periodontal parameters were the frequency of the appointments and association with chlorhexidine/plaque disclosing agents as adjuvant treatment. This systematic review demonstrated that early introduction in periodontal care, participation of parents/caregivers/institutional attendants, frequency of attendance and association with chemical adjuvants (independently of the periodontal treatment adopted) seems to improve periodontal outcomes in preventive and periodontal treatment of DS patients. Registration number (Prospero): CRD42016038433.

Second molar impaction associated with lip bumper therapy

INTRODUCTION:

Although lip bumpers (LBs) provide significant clinical gain of mandibular arch perimeter in mixed-dentition patients, orthodontists are reluctant to use them due to the possibility of permanent second molar eruptive disturbances.

OBJECTIVE:

The present study was conducted to assess second molar impaction associated with the use of LBs, and to investigate how they can be solved.

MATERIAL AND METHODS:

Lateral and panoramic radiographs of 67 patients (34 females and 33 males) were assessed prior (T₁) and post-LB treatment (T₂). LB therapy lasted for approximately 1.8 ± 0.9 years. Concomitant rapid palatal expansion (RPE) was performed in the maxilla at LB treatment onset. Impaction of mandibular second molars was assessed by means of panoramic radiographs in relation to the position of first mandibular molars. Horizontal and vertical movements of first and second molars were assessed cephalometrically on lateral cephalometric radiographs based on mandibular superimpositions.

RESULTS:

Eight (11.9%) patients had impacted second molars at the end of LB therapy. Two patients required surgical correction, whereas five required spacers and one patient was self-corrected. Mandibular first molar tip and apex migrated forward 1.3 mm and 2.3 mm, respectively. Second molar tip showed no statistically significant horizontal movement.

CONCLUSION:

Although LB therapy increased the risk of second molar impaction, impactions were, in most instances, easily solved.

Avaliação da incidência de cárie em pacientes com síndrome de Down após sua inserção em um programa preventivo

O objetivo deste trabalho foi verificar a incidência de cárie dentária por meio dos índices CPO-D, CPO-S, ceo-d e ceo-s em indivíduos com síndrome de Down regularmente matriculados em um programa preventivo. Foram examinados 24 indivíduos com síndrome de Down de ambos os sexos, com idade entre um e 48 anos. A prevalência (situação experimental inicial) e a incidência (situação experimental final) de cárie dentária foram verificadas utilizando-se os índices CPO-D, CPO-S, ceo-d e ceo-s iniciais e finais dos participantes. Dos 24 indivíduos examinados, dez (42,0%) eram livres de cárie. A prevalência de cárie dentária mostrou valores de CPO-D= 2,33; CPO-S= 3,60; ceo-d= 1,75 e ceo-s= 2,80; enquanto a incidência de cárie apresentou valores de 2,33; 3,80; 1,10 e 1,90, respectivamente. Os indivíduos com síndrome de Down avaliados neste estudo apresentaram baixos índices de cárie e pequena incidência de novas lesões, enfatizando a importância da manutenção desses pacientes em programas preventivos.

Importance of Oral Hygiene Habits in Mentally Disabled Children

Background

The main factor related to gingival/periodontal problems in disabled individuals is the inadequacy of the plaque removal from the teeth. Motor coordination problems and muscular limitation in neuromuscularly disabled individuals along with the difficulty in understanding the importance of oral hygiene in mentally disabled individuals have resulted in the progression of inflammatory diseases.

Case report

This report describes a case of cerebral palsy child who developed gingival hyperplasia due to poor oral hygiene practices which remarkably improved by proper motivation and adaptation of oral hygiene measures.

Conclusion

It is important that the caretakers especially mother is informed about the importance of maintaining proper oral hygiene and the harmful effects of not doing so. It forms our duty to guide them towards maintaining good oral hygiene and thereby help in improving overall health of these children.

Evaluation of the mechanical and chemical control of dental biofilm in patients with Down syndrome

OBJECTIVE

To evaluate the mechanical and chemical control of dental biofilm in patients with Down syndrome, using different experimental dentifrices.

MATERIAL AND METHODS

Forty institutionalized children between ages 7 and 13 years in the mixed dentition phase participated in this study. An experimental cross-over, blind clinical trial was used, having the following protocols: fluoridated dentifrice (protocol G1); fluoridated dentifrice + chlorhexidine (protocol G2); fluoridated dentifrice + chlorhexidine + plaque-disclosing agent (protocol G3); and fluoridated dentifrice + plaque-disclosing agent (protocol G4). Each experimental stage lasted 10 days with a 15-day washout. The evaluated parameters were Plaque Index and gingival bleeding.

RESULTS

The initial clinical conditions between each stage were similar. Statistical differences were observed (P < 0.001) for the clinical conditions evaluated before and after the treatments. The dentifrices containing plaque-disclosing agent, irrespective of their association with chlorhexidine, produced a greater reduction in the final plaque index. As for gingival bleeding, the dentifrice containing erythrosine and the one containing chlorhexidine produced similar results. The dentifrice containing an association of chlorhexidine and erythrosine gave the best results.

CONCLUSION

With the methodology employed, it was possible to conclude that the combination of drugs (chlorhexidine, fluorine and erythrosine) within one dentifrice can be useful in controlling dental biofilm and in the reduction of gingival bleeding.

Factors associated with malocclusions in children and adolescents with Down syndrome

INTRODUCTION

Our aims in this study were to determine the prevalence of malocclusion stemming from vertical or transversal occlusal alterations in subjects with Down syndrome (DS) and the associations with individual, socioeconomic, and behavioral factors.

METHODS

A cross-sectional study was carried out with 112 pairs of mothers and their children with DS between 3 and 18 years of age attending a genetics clinic at a public hospital in Rio de Janeiro, Brazil. Data were collected with a questionnaire given to the mothers and a clinical examination of the child or adolescent. Univariate, bivariate, and multiple logistic regression (backward stepwise) analyses were conducted.

RESULTS

The results showed a prevalence of malocclusion in 74% of the sample. After the adjustment of the logistic regression model, these variables--age, nail or finger biting habit, mouth posture, and cold or sore-throat episodes in the previous 6 months--were associated with the prevalence of malocclusions in these subjects.

CONCLUSIONS

The data demonstrate a high prevalence of malocclusions stemming from vertical or transversal occlusal alterations in children and adolescents with DS. Age, nail or finger biting, mouth posture, and upper airway infections were related to malocclusions in these patients.

The outcome of a preventive dental care programme on the prevalence of localized aggressive periodontitis in Down's syndrome individuals

BACKGROUND

Periodontal disease in Down's syndrome (DS) individuals develops earlier and is more rapid and extensive than in age-matched normal individuals. The present study evaluated a group of DS patients, who had been participating in a 10-year preventive dental programme, for the impact of the programme on their periodontal status.

METHODS

Thirty DS patients (mean age 23.3 +/- 4 years) were compared with 28 age-matched healthy controls (mean age 22.8 +/- 5 years). The hygiene level, gingival condition and periodontal status (periodontal probing depth, clinical attachment level and radiographic alveolar bone loss) were determined.

RESULTS

In spite of similar oral hygiene and gingival measures, DS patients, as opposed to the control ones, had a severe periodontal disease. The prevalence, extent and severity of periodontitis in the DS group were significantly greater than in the control group. The teeth most commonly and severely affected were the lower central incisors and the upper first molars. DS patients lost significantly more teeth due to periodontitis.

CONCLUSIONS

The clinical and radiographic picture found in the present DS group is characteristic of localized aggressive periodontitis. Within the limitations of this study, it seems that the preventive dental programme had no effect on periodontal destruction progression of localized aggressive periodontitis in DS individuals and that impaired oral hygiene plays a relatively minor role in the pathogenesis of this disease. Future controlled studies are needed to assess the effectiveness of different preventive dental programmes in preventing the progression of periodontitis in DS patients.

Vision and oral health needs of individuals with intellectual disability

Over the past 20 years, there has been an increased emphasis on health promotion, including prevention activities related to vision and oral health, for the general population, but not for individuals with intellectual disability (ID). This review explores what is known about the prevalence of vision problems and oral health conditions among individuals with ID, presents a rationale for the increased prevalence of these conditions in the context of service utilization, and examines the limitations of the available research. Available data reveal a wide range of prevalence estimates for vision problems and oral health conditions, but all suggest that these conditions are more prevalent among individuals with ID compared with the general population, and disparities exist in the receipt of preventive and early treatment for these conditions for individuals with ID. Recommendations for health improvement in these areas include better health planning and monitoring through standardized population-based data collection and reporting and increased emphasis on health promotion activities and early treatment in the healthcare system.

A Comparison of the Gingival Health of Children with Down Syndrome to Healthy Children Residing in an Institution

The purpose of this study was to compare the onset and severity of gingivitis in children with Down syndrome, when compared to a healthy control group of children. The subjects included 41 children with Down syndrome ages two to 14 years (mean age: 7.6 years) and 112 age-matched healthy controls. We assessed the gingival health of all subjects using the gingival inflammation (M-PMA) index and periodontal probing depth (PD). Children were divided into three age categories: <5 years (AI), 5 to <10 years (AII), and 10 to <17 years (AIII). Supragingival plaque was measured using the Oral Hygiene Index (OHI) and the subjects were screened with the BANA test (Perioscan-Oral-B). Measurement of the M-PMA index in the healthy children showed an age-related increase (F = 10.369, p < 0.001), and the M-PMA index at the younger age group <5 year (AI) was significantly lower than that for the other two age groups All or AIII (p < 0.005, p < 0.001). In contrast, the M-PMA index values at AI and AIII in the subjects with Down syndrome were significantly higher than those for healthy children (p < 0.001, p < 0.001). Both groups had an age-related increase in PD (F = 3.388, p < 0.05 & F = 10.806, p < 0.001), and PD at AIII was significantly higher than that at AI in both groups (p < 0.01, p < 0.001). The children with Down syndrome showed an age-related increase in the BANA test score (F = 3.452, p < 0.05), and the BANA test score at AIII was significantly higher than that at AI (p < 0.02). The BANA test score in the healthy children was not age-related but was significantly higher than that in the children with Down syndrome (p < 0.02, p < 0.05).

Periodontal conditions and subgingival microflora in Down syndrome patients. A case-control study

OBJECTIVES

The periodontal conditions and the subgingival microflora of children, adolescents and young adults (8-28 years old) with Down syndrome were investigated in the present cross-sectional study and compared with those of healthy individuals and subjects with cerebral palsy.

MATERIAL AND METHODS

Seventy Down syndrome patients, 121 age-matched healthy individuals and 76 patients with cerebral palsy participated in the present study. Full-mouth recordings of clinical parameters (probing depth, probing attachment level, bleeding on probing, hygiene index) and the community periodontal index of treatment needs were assessed and subgingival plaque samples were taken from the Ramfjord teeth and analysed for 14 species using "checkerboard" DNA-DNA hybridization.

RESULTS

Clinical indices of periodontal inflammation and treatment needs were statistically significant higher among Down syndrome patients compared with the other two groups (ANOVA, p=0.000). Important periodontal pathogens colonize these subjects earlier and at higher levels (chi-squared test, p=0.000).

DISCUSSION

Down syndrome patients display more severe periodontal destruction earlier, and heavier colonization with periodontal pathogens compared with age-matched healthy individuals and patients with cerebral palsy.

Views and experiences of parents and siblings of adults with Down Syndrome regarding oral healthcare: a qualitative and quantitative study

AIMS

To investigate experiences and expectations of parents/siblings of adults with Down Syndrome (DS) regarding oral healthcare, and explore factors impacting on access and experience of dental care for this group.

DESIGN

A two phase qualitative and quantitative study using in-depth interviews with a convenience sample of six parents/siblings, and a postal questionnaire of 200 parents/siblings of adults with DS who are members of the Down Syndrome Association.

RESULTS

The main themes elicited from the qualitative interviews related to concern, experiences, parents'/siblings' attitudes, preferences and information. The response rate from the postal questionnaire was 63.5%. Adults with DS attended the dentist regularly but received little restorative treatment. Experience of oral healthcare was influenced by the attitudes and skills of dental health professionals; stigma; and relatives' expectations of dentists, their oral health beliefs, information and support received, knowledge and priorities. Parents/siblings wanted dentists to be proactive in providing more information on oral health issues in collaboration with other health and social care professionals.

CONCLUSIONS

Whilst most adults with DS visited the dentist regularly, relatively little treatment had been provided. Parents highlighted a need for appropriate and timely oral health information early in their child's life, and access to dentists who were sympathetic, good communicators and well-informed about DS.

Parotid salivary immunoglobulins, recurrent respiratory tract infections and gingival health in institutionalized and non-institutionalized subjects with Down's syndrome

BACKGROUND

The purpose of the present study was to evaluate the possible correlation between recurrent respiratory infections (RRIs), gingival health and the secretion rates of salivary immunoglobulins (Igs) in institutionalized (I) and non-institutionalized (NI) individuals with Down's syndrome (DS).

METHODS

Stimulated parotid saliva was collected from nine I and 14 NI subjects with DS. Salivary flow rate, secretion rates of total salivary IgM, IgG and IgA, and the incidence of RRIs were determined. Gingival health was recorded by using the plaque index, the gingival index and the percentage of bleeding surfaces (BS).

RESULTS

The mean salivary flow rate and parotid Ig secretion rates in the I group were 25% of those of the NI group. The prevalence of RRIs in the I group was more than twice that in the NI group. Oral hygiene and gingival health were significantly better in the NI group.

CONCLUSIONS

The lower parotid Ig secretion rates in I individuals with DS might be a possible factor involved in their susceptibility to recurrent infections compared to NI subjects with DS.

A study of the dental treatment needs of children with disabilities in Melbourne, Australia

A selected population of children with disabilities in Melbourne, Australia, was studied with reference to their oral disease and treatment needs. A total of 300 children (aged 9-13 years), 150 attending special developmental schools (SDS) and 150 attending special schools (SS), received an oral examination and the parent/guardian completed a questionnaire. Six levels of function were defined, based on the child's independence for five self-care activities (brushing teeth, feeding self, dressing self, walking and performing toilet). The caries experience of children in the SS was lower than in SDS (d + D: 1.3 +/- 1.6 versus 1.5 +/- 2.4; dmft + DMFT: 2.0 +/- 2.3 versus 2.5 +/- 3.1); those attending SDS had higher unmet preventive and restorative needs. Significant associations were seen between the number of decayed teeth, the dmft + DMFT index, and the level of function (p < 0.005). Periodontal disease was prevalent; significant associations were seen between periodontal status, the need for periodontal therapy, and the level of function (p < 0.005). Assessment of the level of function by staff could assist in triaging individuals for urgent dental examination. Despite 41 per cent of children requiring simple treatment, the preventive and treatment needs of many remained unmet. Following examination, diagnosis and treatment planning by a dentist, much of the preventive, simple treatment and oral health promotion could be performed by trained dental auxiliaries. An epidemiological survey followed by the implementation and evaluation of a long-range public dental health care plan for children and adolescents with disabilities is needed urgently.

Dental care access among individuals with Down syndrome in France

The aim of this study was to compare levels of dental care utilization, receipt of dental services, and oral hygiene habits between a sample of individuals with Down syndrome (DS) and their siblings. Data were collected by means of a recently validated, French-language, questionnaire measured of oral health and its related problems for individuals with DS. A cross-sectional survey was undertaken of parents of children with DS attending a national meeting for families and carers of individuals with DS in France. Older individuals with DS were significantly more likely to visit a dentist regularly than their older non-DS siblings, but the group with DS was significantly less likely to have received any dental treatment. The group with DS was significantly more likely to have difficulty finding both medical and dental services. Parents were nearly twice as likely to report problems finding dental services for their child with DS as they were medical services. In a multiple logistic regression analysis within the DS group, it was found that older age, regular speech therapy and ophthalmology consultations, and reports of no difficulty finding a dentist were independently associated with increased odds for regular dental consultations. Analysis of the findings suggests that the parents of children with DS in France frequently encounter problems of access to oral health care and that individuals with DS are less likely to receive dental services than are their non-DS siblings.