Dental care access among individuals with Down syndrome in France

Factors related to parents' perceptions of oral health for children with Down syndrome in Japan

AIMS

To evaluate the perceptions of parents on general health, oral health, and dental care for children with Down syndrome (DS), and to investigate factors related to parents' perceptions of oral health.

METHODS AND RESULTS

An online questionnaire survey was conducted of parents of children with DS. Forty-three percent and 81% of the parents rated their child's oral health and general health as good, respectively. Parent-rated oral health was strongly associated with general health, followed by the parents' satisfaction with their child's dentist, halitosis, difficulty in dental examination, and the number of times they helped their child with toothbrushing. Seventy-seven percent of the parents were satisfied or rather satisfied with their child's dentist. The parents expected the dentist to reassure their child and to be specialized in the treatment of persons with disabilities. Seventy-three percent of the parents brushed their child's teeth at least once a day, and 92% brushed their own teeth at least twice a day. The number of times the parents brushed their own teeth was strongly associated with the frequency of brushing their child's teeth.

CONCLUSION

General health, a trusting relationship with the dentist, and parental perceptions of oral hygiene affect parent-rated oral health of children with DS.

Access to oral health care services for children with disabilities: a mixed methods systematic review

BACKGROUND

Children with disabilities experience poorer oral health and frequently have complex needs. The accessibility of oral health care services for children with disabilities is crucial for promoting oral health and overall well-being. This study aimed to systematically review the literature to identify the barriers and facilitators to oral health care services for children with disabilities, and to propose priority research areas for the planning and provision of dental services to meet their needs.

METHODS

This was a mixed methods systematic review. Multiple databases searched included MEDLINE, Scopus, PsycINFO, EMBASE, and CINAHL. The search strategy included Medical Subject Heading (MeSH) terms related to children, disabilities, and access to oral health. Eligibility criteria focused on studies about children with disabilities, discussing the accessibility of oral health care.

RESULTS

Using Levesque's framework for access identified barriers such as professional unwillingness, fear of the dentist, cost of treatment, and inadequate dental facilities. Facilitators of access offered insight into strategies for improving access to oral health care for children with disabilities.

CONCLUSION

There is a positive benefit to using Levesque's framework of access or other established frameworks to carry out research on oral healthcare access, or implementations of dental public health interventions in order to identify gaps, enhance awareness and promote better oral health practices. The evidence suggests that including people with disabilities in co-developing service provision improves accessibility, alongside using tailored approaches and interventions which promote understanding of the importance of dental care and increases awareness for professionals, caregivers and children with disabilities.

TRIAL REGISTRATION

Protocol has been registered online on the PROSPERO database with an ID CRD42023433172 on June 9, 2023.

Oral alterations in children with microcephaly associated to congenital Zika syndrome: A systematic review and meta-analyses

AIMS

To synthesize the oral alterations observed in children with microcephaly associated with congenital Zika virus syndrome (CZS), and to compare the oral alterations of these children to a normotypic healthy controls.

METHODS AND RESULTS

A search was performed in six electronic databases. Observational studies published that reported oral alterations in children with CZS were selected. Two authors independently extracted data, assessed study quality, using the Joanna Briggs Institute Critical Appraisal Checklist tools, and the certainty of evidence, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-one studies were included in this systematic review and meta-analysis. The pooled crude occurrence showed 88% of increased salivation (95%CI: 82%-94%), 83% of biofilm (95%CI: 75%-91%), and 73% of bruxism (95%CI: 52%-95%). Compared to normotypic controls, children with CZS-associated microcephaly had a higher chance to have difficulty in lip sealing (OR: 18.28; 95%CI: 1.42-235.91), inadequate lingual posture at rest (OR: 13.57; 95%CI: 4.24-43.44), and delayed eruption (OR: 12.92; 95%CI: 3.42-48.78), with very low certainty.

CONCLUSION

There are several oral alterations found among children with CZS-associated microcephaly. They are more prone to present some of these alterations, such as difficulty in lip sealing, although with very low certainty of evidence.

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.

Oral Health Care of People with Down Syndrome in Germany

BACKGROUND

Due to a dearth of information on preventive and supportive oral care for people with Down Syndrome (PDS) in Germany, caregivers of PDS were surveyed on the topic.

METHODS

An anonymized questionnaire was sent to the 610 members of the German Down Syndrome Association. The study was approved by the ethics committee of Witten/Herdecke University (# 165/2017).

RESULTS

The parents/caregivers of 207 PDS responded. These PDS were between 1 and 55 years old (mean age 24.4 years) and included 111 males and 96 females. At their first dental appointment, 40.7% (n = 82) had been younger than three years. Although 78.3% (n = 162) tooth brushed twice daily, only 30.9% (n = 64) brushed for 2-3 min; 84.0% (n = 135) did not use other dental hygiene products apart from toothbrushes. Age-specific differences were found: Although only 30.8% (n = 12) of PDS < 18 years (n = 39) independently performed dental self-care; this was 67.3% (n = 113) for PDS ≥ 18 years (n = 168). A statistically significant (p < 0.001; Chi-Square-Test) difference in toothbrush preferences emerged: While PDS < 18 years mainly used manual toothbrushes, PDS ≥ 18 years preferred electric toothbrushes. In contrast to 72.6% of PDS ≥ 18 years, only 51.3% of PDS < 18 years accepted most types of toothpaste.

CONCLUSIONS

Age-dependent differences in tooth brushing behaviour became evident within the group of PDS in Germany. Hence, better age-specific, inter-professional dental prophylaxis concepts need to be developed and offered for all age groups of PDS. These concepts should include personalized check-up intervals and hands-on instruction in dental hygiene procedures by dental practitioners.

Parents' perceptions of oral health, general health and dental health care for children with Down syndrome in Sweden

AIM

To describe parental perceptions of general health, oral health and received dental health care in Swedish children with Down syndrome (DS).

METHODS

Online questionnaire, quantitative data analysis (Chi-square test).

RESULTS

Parents of 101 children with DS (52 boys, 49 girls, mean age: 9.6 years) participated. Seventy percent rated their child's general health and 74% their child's oral health as good or very good. Parents, who rated their child's oral health as poor (8%), also reported that dental procedures were difficult. Children received dental care at general (55%) and specialist clinics (53%). Ninety-four percent of parents of children receiving specialist dental health care were satisfied compared to 70% of parents with children in general clinics. The parents most valued characteristics of dental professionals were patience (63%) and their ability to engage the child (68%). Parents wanted multidisciplinary collaboration.

CONCLUSION

Most parents rated their child's general and oral health as good or very good. Children with poor oral health were also reported to have difficulties coping with dental procedures. Parents wanted dental care to be tailored to meet their child's unique needs. They wanted dental professionals to have knowledge about children with a need for special care. Lastly, they requested multidisciplinary collaboration.

Oral Health Knowledge, Behaviour, and Access to Dental Care in Visually Impaired Individuals in Jordan: A Case-Control Study

Aim:

The study aimed to assess oral health knowledge, dental behaviors, and use of dental services in individuals with vision impairment in Jordan and identify barriers that affect their access to dental care in comparison with individuals without vision impairment.

Materials and Methods:

A case-control study was carried out among 399 parents/caregivers of individuals with vision impairment and individuals without vision impairment, which involved the completion of a self-designed questionnaire. A closed-ended, validated self-designed questionnaire was distributed. The questionnaire included questions addressing participants’ oral health knowledge, oral health behaviour, dental service use and barriers to accessing dental care. Data were analyzed using SPSS® software Version 22 with a 0.05 level of significance. A Chi-square test and contingency-table analysis were performed on the data.

Results:

Individuals with vision impairment in Jordan were significantly less knowledgeable about different oral health aspects than sighted counterparts. In addition, individuals with vision impairment used toothbrush, dental floss, and mouth rinse less frequently. They also visited dentists less regularly and mostly when only feeling pain. Limited access to dental services was observed among individuals with vision impairment compared to sighted individuals. Barriers, including embarrassment (22%), lack of knowledge of how to treat people with disabilities among dentists (12.5%), and inadequate facilities (13.7%), were significantly (P<0.05) more likely to be reported by visually impaired participants than the controls.

Conclusion:

Visually impaired individuals and their families should be given appropriate education about oral health care by oral health professionals to reduce the risk of having dental problems and oral disease and enhance their quality of life. Furthermore, recognizing the challenges in accessing dental care for this population could help oral health professionals to minimize these difficulties.

Dental Service Utilization and Barriers to Dental Care for Individuals with Autism Spectrum Disorder in Jordan: A Case-Control Study

Individuals with disabilities are at higher risk for oral diseases such as caries and periodontal disease. Therefore, regular dental care is essential to maintain oral health. However, individuals with disabilities encounter difficulties in accessing dental care. The challenges and barriers to oral care faced by individuals with autism spectrum disorder (ASD) have not been addressed in Jordan. The aim of this study was to examine the use of dental services in individuals with ASD in Jordan and identify barriers that affect their access to dental care in comparison with individuals without ASD. A case-control study was carried out among 296 parents/caregivers of individuals with ASD and individuals without ASD, which involved completion of a self-designed questionnaire. The majority of the participants in both groups had visited the dentist in the year preceding completion of the questionnaire. The main reason for visiting dental services was toothache (43%), and the least common reason was routine checkup (11.6%), with a significant difference (P < 0.05) observed between the two groups. Barriers including embarrassment (43.5%), a lack of specialized dental staff (28.6%), a lack of knowledge of how to treat people with disabilities (26.6%), and inadequate facilities (34%) were significantly (P < 0.05) more likely to be reported by individuals with ASD than the controls. In conclusion, knowing and understanding the barriers to accessing dental care could improve overall health for individuals with ASD. Furthermore, recognizing the challenges in accessing dental care for this population could help oral health professionals to minimize these difficulties.

The Dental Needs and Treatment of Patients with Down Syndrome

Down syndrome is a common disorder with many oral conditions and systemic manifestations. Dentists need to take a holistic approach including behavioral, oral, and systemic issues. This review of the literature focuses on oral anomalies, systemic interaction, management, and recommendations.

Special care dentistry: how prepared are we?

AIM

To assess and evaluate the confidence of the undergraduate dental team in Irish dental schools regarding their training in the field of special care dentistry (SCD).

METHOD

A questionnaire was distributed amongst the undergraduate dental teams within Cork University Dental School and Hospital (CUDSH) and Dublin Dental University Hospital (DDUH). The data were analysed to assess for differences between the median responses of the various groups.

RESULTS

A total of 139 students participated in the study; 82 from DDUH (59 dental science students, seven dental hygiene students and 16 dental nursing students) and 57 from CUDSH (43 dental science students and 14 dental hygiene students). Twenty-two per cent (n = 30) of respondents agreed that their training had been sufficient in providing treatment or assistance for patients requiring SCD. Seventy-five per cent agreed that more emphasis should be placed on clinical training in SCD (n = 76). Thirty-one per cent of students anticipated a high level of confidence in treating patients requiring SCD upon graduation (n = 43), with dental science students feeling the least prepared amongst the dental team.

CONCLUSION

Confidence levels of the undergraduate dental team were low with regard to SCD. The existing hands-on clinical training in SCD was deemed insufficient by the respondents. Students believed more emphasis should be placed on SCD training in the undergraduate curriculum.

Comparative study of oral health among trisomy 21 children living in Riyadh, Saudi Arabia: Part 2, gingival condition

BACKGROUND

Trisomy 21 (T21) is a congenital disorder characterized by triplication of Chromosome 21 components. Patients with T21 have an increased risk of acquiring periodontal disease due to their inability to maintain good oral hygiene. Consequently, it is important to determine an approach for disease prevention in this population.

AIM

The purpose of the study was to assess the periodontal health, through the prevalence of gingivitis and plaque, among children with T21 living in Riyadh, Saudi Arabia.

SUBJECTS AND METHOD

This study included 93 children with T21 and 99 age- and gender-matched children without T21 between the ages of 7 and 15 years. Parents were informed about the study and provided informed consent. Trained examiners using standardized tools assessed the prevalence rates of gingivitis and plaque in all children.

RESULTS

Gingivitis prevalence was elevated among T21 children (46.9%) compared to controls (34%) in all arch sextants except the mandibular middle (P < 0.01). Comparing the two groups, the prevalence of plaque was higher in the maxillary right sextant of the T21 group and the mandibular middle sextant of the control group (P < 0.05).

CONCLUSION

T21 children have significantly elevated plaque levels, resulting in greater prevalence of gingivitis, compared to healthy children. Preventive measure, such as oral health awareness programs, should be delivered early to parents and continued at school to encourage and motivate children.

Association between Dental Caries and Down Syndrome: A Systematic Review and Meta-Analysis

Scientific evidence of susceptibility to dental caries in the population with Down Syndrome (DS) is limited and conflicting, making it difficult to establish firm conclusions. The aim of this systematic review and meta-analysis was to obtain scientific evidence of the possible association between dental caries and individuals with DS, compared to individuals without DS (control). An electronic search of five databases was performed, with no language or publication date restrictions. The studies were selected by two independent reviewers (Kappa = 0.83). The systematic review included 13 studies, while eight studies were included in the meta-analysis. The studies are presumably all at risk of bias given their observational character. Two of these evaluated the presence or absence of caries in permanent and deciduous teeth, and six evaluated the mean DMFT index in permanent teeth. Combined odds ratios (OR), standard difference, standard error and a 95% confidence interval (CI) were obtained. The vast majority of the studies found that individuals from control groups had more carious lesions or caries experience than those with DS. The results were statistically significant in seven studies (p<0.05). Meta-analysis of two studies revealed that individuals with DS had a lower dental caries than those in the control group (OR = 0.36; 95% CI = 0.22-0.57). In six studies, individuals with DS had a significantly lower mean DMFT index than individuals from the control group (Sd = -0.18; SE = 0.09; 95% CI = -0.35--0.02). The quality of the studies varied and in general had a high risk of bias. Scientific evidence suggests that individuals with DS have fewer dental caries than individuals without DS.

Access Barriers to Dental Health Care in Children with Disability. A Questionnaire Study of Parents

BACKGROUND

A patient's with disability everyday life is rife with many limitations such as architectural, transport, information as well as medical, psychological, legal, economic and social barriers. The aim of this study was to evaluate access to dental health care of special-care schoolchildren with intellectual disability on the basis of their parents' opinion.

MATERIAL AND METHOD

A questionnaire survey was carried out among 264 parents/caregivers of children from eight special-care schools in Poznan (Poland). Close-ended questions concerned children's barriers in access to dental care and parents' satisfaction with their children's dental care.

RESULTS

Only 31.8% parents/caregivers did not have any problems with access to dental care and the most commonly reported barrier to obtaining dental care was protracted waiting time for a visit (36.7%). Most commonly, children were treated in dental surgery conditions (90.1%). Only 42.1% respondents were satisfied with their children's dental care.

CONCLUSIONS

The research revealed that there is a need to improve the access of children with disability to dental care. Hence, it seems to be beneficial to set up specialist dental surgeries in special-care schools which would improve the access of children with disability to prophylaxis as well as dental treatment.

Dental care access among individuals with Down syndrome: a Malaysian scenario

OBJECTIVE

The purpose of this cross-sectional study was to assess the legal representatives' perceptions on dental care access of individuals with Down syndrome (DS) compared to their non-DS siblings in Peninsular Malaysia.

METHODS

This cross-sectional study was conducted throughout community-based rehabilitation centers (CBRC) and the Down Syndrome Organization. Legal representatives of individuals with DS within the criteria were given a structured and validated questionaire.

RESULT

This study demonstrated that individuals with DS (76.9%) significantly utilized more health services than non-DS siblings (23.1%). The service most regularly used was speech therapy followed by opthalmology and dental services. Twenty-five per cent of respondents reported difficulty in finding dental care services for their DS child and 46.9% admitted that healthcare for their DS child took more time. The majority of DS individuals received less complex dental treatment and none received any orthodontic treatment, despite their severe occlusal problems.

CONCLUSION

A high proportion of parents appear to be able to access dental and medical care for their DS child. However, some parents perceived difficulty in finding oral healthcare.

Conscious sedation procedures using intravenous midazolam for dental care in patients with different cognitive profiles: a prospective study of effectiveness and safety

The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N₂O/O₂ was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N₂O/O₂), were shown to be safe and effective in patients with intellectual disability when administered by dentists.

Cross-cultural adaptation and validation of a Brazilian version of an instrument to assess impairments related to oral functioning of people with Down syndrome

Background

An instrument was developed in Canada to assess impairments related to oral functioning of individuals with four years of age or older with Down syndrome (DS). The present study attempted to carry out the cross-cultural adaptation and validation of the instrument for the Brazilian Portuguese language and to test its reliability and validity.

Findings

After translation and cross-cultural adaptation, the instrument was tested on caregivers of people with DS. Clinical examination for malocclusion was carried out in people with DS by two calibrated examiners. Inter and Intra examiner agreement was assessed by Intraclass Correlation Coefficient (ICC) and ranged from 0.92 to 0.97 respectively. Total of 157 people with DS and their caregivers were able to compose the sample. They were selected from eight institutions for people with DS in five cities of southeastern Brazil. The mean age of people with DS was 20.7 [±13.1] and for caregivers was 53.1 [±13.7]. The mean instrument score was 18.6 [±9.0]. Internal reliability ranged from 0.49 to 0.80 and external reliability ranged from 0.78 to 0.88. Construct validity was verified by significant correlations identified between malocclusion and the total instrument; and caregivers’ educational level and the instrument (p<0.05). Discriminant validity was proved as the instrument presented different mean comparing people with DS and non-DS (p<0.05).

Conclusions

Initial validity tests indicated that the instrument related to the oral health for people with DS may be a valid instrument to this segment of the population in Brazil.

The value of education in special care dentistry as a means of reducing inequalities in oral health

People with disability are subject to inequality in oral health both in terms of prevalence of disease and unmet healthcare needs. Over 18% of the global population is living with moderate to severe functional problems related to disability, and a large proportion of these persons will require Special Care Dentistry at some point in their lifetime. It is estimated that 90% of people requiring Special Care Dentistry should be able to access treatment in a local, primary care setting. Provision of such primary care is only possible through the education and training of dentists. The literature suggests that it is vital for the dental team to develop the necessary skills and gain experience treating people with special needs in order to ensure access to the provision of oral health care. Education in Special Care Dentistry worldwide might be improved by the development of a recognised academic and clinical discipline and by providing international curricula guidelines based on the International Classification of Functioning, Disability and Health (ICF, WHO). This article aims to discuss the role and value of promoting and harmonising education in Special Care Dentistry as a means of reducing inequalities in oral health.

Oral health care provided by Greek dentists to persons with physical and/or intellectual impairment

This study evaluated Greek dentists' attitudes toward the provision of oral health care for persons with physical and intellectual impairment (PPII). A questionnaire was used to select information on dentists' socioeconomic data, their office characteristics, oral health care they performed, and their views about oral healthcare delivery for PPII. The final sample consisted of 534 dentists. Descriptive statistics and Analysis of Variance (ANOVA) were used for the statistical analysis of the data. Most respondents were general practitioners (79.3%) providing oral health care to PPII, but 70% of the dentists had not been trained to treat them. In their opinion, oral health care for PPII demanded a lot of time and was hard to accomplish. Based on an evaluation of the results, this study suggests that continuing education and training of dentists to treat PPII are essential for this population in Greece.

Caries in Portuguese children with Down syndrome

OBJECTIVES

Oral health in Down syndrome children has some peculiar aspects that must be considered in the follow-up of these patients. This study focuses on characterizing the environmental and host factors associated with dental caries in Portuguese children with and without Down syndrome.

METHODS

A sibling-matched, population-based, cross-sectional survey was performed.

RESULTS

Down syndrome children presented a significantly greater percentage of children without caries, 78% vs. 58% of non-Down syndrome siblings. This difference in the DMFT index (number of decayed, missing and filled teeth) essentially reflects data obtained from treated teeth, for which 91% of children with Down syndrome had never had a tooth treated vs. 67% of siblings. This result was statistically significant, whereas results for decayed and lost teeth did not differ between Down syndrome children and their unaffected siblings. Additionally, in Down syndrome children, a delayed eruption of the second molar occurs. Down syndrome children and their siblings have similar oral hygiene habits, but a higher percentage of Down syndrome children visit a dentist before the age of three years, in comparison to their siblings. Bruxism was also more common in Down syndrome children compared to their siblings.

CONCLUSIONS

Our results show that Portuguese children with Down syndrome have lower caries rates than children without Down syndrome. This reduced prevalence may be associated with the parents' greater concern about oral health care in Down syndrome children, resulting in their taking them sooner to visit a dentist, as well as to a higher bruxism prevalence and delayed tooth eruption.

Uso de serviços odontológicos por pacientes com síndrome de Down

OBJETIVO: Tendo como perspectiva a prática da integralidade, o objetivo do estudo foi analisar os fatores relacionados à atenção odontológica recebida por crianças e adolescentes com síndrome de Down. MÉTODOS: Foi realizado um estudo transversal com 112 pares de mães com filhos sindrômicos de 3 a 18 anos, recrutados em ambulatório de genética de um hospital público, sem atendimento odontológico local, no Rio de Janeiro (RJ), 2006. Os dados foram coletados por meio de um questionário aplicado às mães e do exame bucal dos filhos. Para análise dos dados utilizou-se a regressão logística múltipla. Analisou-se a "atenção odontológica da criança ou adolescente com síndrome de Down", em função de características demográficas, socioeconômicas e comportamentais. RESULTADOS: A maioria dos sindrômicos (79,5%) já tinha ido pelo menos uma vez ao dentista (IC 90%: 72,3; 87,8). A experiência odontológica das crianças foi associada às variáveis: mães que afirmaram receber orientação de algum profissional, que assiste seu filho, para que o levasse ao dentista (OR=6,1 [2,5; 15,1]), crianças/adolescentes com história prévia de cirurgia (OR=2,5 [0,9; 7,1]) e idade entre 12 e 18 anos (OR=13,1 [2,0; 86,9]). CONCLUSÕES: A atenção odontológica recebida pelas crianças e adolescentes com síndrome de Down foi relacionada à orientação dos profissionais de saúde que os assistem, caracterizando um atendimento integral por parte da equipe de saúde.

Inequalities in oral health for children with disabilities: a French national survey in special schools

BACKGROUND

Despite wide recognition that children with disability often have poor oral health, few high quality, controlled results are available.

METHOD

Twenty-four objective and subjective criteria covering feeding, autonomy, access to dental care, oral hygiene, oral disease, general health and behavior were evaluated in a observational cross-sectional study of 2,487 children with disability (DC group), 4,772 adolescents with disability (DA group) and 1,641 children without disability (NDC group). Five algorithms ranked the subjects according to clinical criteria in three original oral health indices: the Clinical Oral Health Index (COHI), indicating the level of oral health problems, the Clinical Oral Care Needs Index (COCNI) giving dental care need levels, and the Clinical Oral Prevention Index (COPI) determining possible needs in terms of dental education initiatives.

RESULTS

DC-group children presented poorer oral health and had greater needs in both treatment and preventive oral health actions than NDC-group children (OR = 3.97, 95% CI = 3.25-4.86 for COHI; OR = 2.01, 95% CI = 1.77-2.28 for COCNI; OR = 5.25, 95% CI = 4.55-6.02 for COPI). These conditions were worse again in the DA group comparing to the DC group (OR = 3.52, 95% CI = 2.7-4.6 for COHI; OR = 1.52, 95% CI = 1.38-1.69 for COCNI; OR = 1.53, 95% CI = 1.39-1.69 for COPI).

CONCLUSION

Clinical indices generated by algorithmic association of various clinical indicators allow sensitive clinical measurement, and in this study demonstrated inequalities in oral health for children with disabilities schooling in institutions. Questions need now to be addressed as to the measures that could be taken to compensate for this situation.

Why is periodontal disease more prevalent and more severe in people with Down syndrome?

Periodontal disease has been found to be significantly more prevalent and more severe in people with Down syndrome. A series of studies have reported a prevalence of between 58% and 96% for persons younger than 35 years of age. This phenomenon cannot simply be attributed to poor oral hygiene. The etiology of periodontal disease in persons with Down syndrome is complex. In recent years, much focus has been placed on the altered immune response resulting from the underlying genetic disorder. This paper presents an overview of contemporary knowledge on periodontal disease in patients with Down syndrome.

A controlled national survey in France of health-related challenges for persons with Down syndrome

Despite recent research on the impact of disability on function, little information is available to evaluate the need for daily support in persons with Down syndrome. The aim of this study was to evaluate the prevalence and relative degree of difficulty experienced by this population in routine hygiene and health care when compared to their siblings. A proxy French language questionnaire was used for this cross-sectional survey of 199 persons with Down syndrome and 153 siblings (mean age 12.3 years, range < or = 1-48). Individuals in the study group had significantly more difficulty performing all activities related to routine hygiene and health care, and were 2-22 times more likely to need help than the control group. Certain acts of routine health care were performed more regularly by those in the study group (6/12 items), and specialist medical and paramedical visits were more regular (OR = 7-44). Increased difficulty and need for help in performing acts of basic self-care may reduce autonomy and social integration for persons with Down syndrome. Recommendations are made in relation to the training of caregivers and health professionals.

General practitioners' attitudes towards patients with disabilities: the need for training and support

PURPOSE

Some general practitioners (GPs) report discomfort in caring for people with disabilities. These feelings may impede the provision of quality health care to these patients.

METHOD

A cross-sectional survey interviewed 600 GPs in southeastern France and assessed their personal and professional characteristics, their attitudes and opinions towards people with disabilities, and their knowledge and practices in this field.

RESULTS

21.3% of the GP reported discomfort in treating people with mental impairments and 8.2% people with physical impairments. Discomfort with either type of impairment was more frequent among GPs who perceived frequent communication problems with persons with disabilities (p < 0.05) or who did not belong to a professional network (p < 0.10). GPs who reported less experience with the disabled patients (p < 0.05), no medical training about disabilities (p = 0.04), a lack of assistance during consultations (p = 0.02), and inadequate consultation time (p = 0.09) expressed more discomfort in caring for patients with mental impairments. GPs' discomfort was associated with their assessment of the patient's level of disability among patients with physical impairments (p = 0.01).

CONCLUSION

This study suggests that substantial obstacles related to GPs' attitudes impede the delivery of quality health care to patients with disabilities and that GPs need more support and guidance in dealing with them. These results raise also the issue of adequate time and remuneration for consultations with these patients.

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.

The oral health of children with Down syndrome in Ireland

The authors investigated the oral health of a convenience sample of 71 children with Down syndrome. The study group had a lower caries prevalence but similar levels of unmet treatment needs as children at special and mainstream schools. Treatment experience varied with age: 5-year-olds had more extractions and fewer restorations, and 15-year olds had fewer extractions and more restorations. The number of teeth with fissure sealants was comparable to that of other children in Special Needs Schools. Although the study group had poor oral hygiene, a need for advanced periodontal treatment was not evident. Few had evidence of dental trauma. Malocclusion was prevalent. Through a government-funded program, most of the sample had seen a dentist within the previous year, and few parents reported problems accessing dental care. This study suggests that services targeted toward groups with special needs could generate outcomes comparable to those seen in other service users. A finding that also may hold true for other underserved populations.

A paired comparison of dental care in Canadians with Down syndrome and their siblings without Down syndrome

OBJECTIVE

To test the hypothesis that, controlling for age, Canadians with Down syndrome (DS) have dental care that is different to that of their siblings without DS.

METHODS

A cross-sectional survey of parents of children with DS among members of the Canadian Down Syndrome Society (CDSS), using a validated questionnaire. Parents were asked to complete two versions of the questionnaire: one for their child with DS and another for the sibling closest in age without DS. A total of 2327 questionnaires were distributed; 1221 questionnaires for people with DS and 950 for siblings without DS were returned. A paired analysis (McNemar test) of dental care indicators was performed on data from 938 family pairs, stratifying for age.

RESULTS

For all the dental care indicators and age groups, many respondents indicated the same behaviours or experiences in their child with DS and a sibling without DS. However, depending on the particular form of dental care and the age group, 0-47% of families reported discordant dental care experiences for their child with DS and a sibling without DS. The greatest differences were observed for yearly consults (P = 0.029), restorations (P < 0.001), fluoride therapy (P = 0.013) and extractions (P = 0.029).

CONCLUSION

These observations suggest that compared to their siblings without DS, Canadians with DS are receiving different dental care.

Evaluation of a long-term oral health program by carers of children and adults with intellectual disabilities

The oral health program presented here was undertaken in three French centers for persons with special needs. The program aimed to educate the carers about dental disease, to motivate them with regard to prevention, and to improve the oral hygiene and oral health of the residents. This study evaluated the impact of the program in terms of change in attitudes and behavior expressed by the carers by means of a questionnaire. Following demonstration of oral hygiene techniques on an individual basis, the number of residents who had their teeth cleaned more than once a day rose from 24% to 52% (p < 0.05). The percentage of carers able to clean both posterior and anterior teeth of their key residents increased from 24% to 60% (p < 0.05), and the percentage finding tooth cleaning easy increased from 36% to 60% (non-significant). The intervention was thus deemed moderately successful, although the carers continued to take better care of their own oral health than that of the residents. The need for ongoing training is emphasized, both for the carers of those with special needs and for the dental profession. The lack of a validated means of measuring the impact of such interventions on care providers for this population is discussed.