A review of malocclusion among individuals with mental and physical disabilities

Orthodontic findings in adults with Trisomy 21

OBJECTIVES

Objective of this study was to describe orthodontic findings in adults with Down's syndrome, a matter insufficiently regarded in literature.

MATERIALS AND METHODS

A group of 104 adults (33.8 ± 15 years) with trisomy 21 had an orthodontic check-up in their accustomed environment. Anamnestic and dental findings completed the examination and descriptive analysis was performed using SPSS23. Relative frequencies with 95% confidence intervals were compared to the average population (SHIP-study, 2003; DMS IV, 2006).

RESULTS

Among the participants 46.2% (36.3-56.2%) (SHIP 36.7%) had already undergone orthodontic treatment. In 87.5% (79.6-93%) of the patients, less than 25.6 properly functioning permanent teeth (DMS IV's mean) were found. Gingival bleeding and recessions, as well as periodontal disease, were increasingly found in older affected persons. Patients with Down's syndrome showed less crowding, e.g., maxillary incisors 28% (19.3-39%) versus 41.9% (SHIP). Frontal open bite (35.2% (25.3-46.1%) versus 3.6% (SHIP)) and frontal crossbite (40.9% (30.5-51.9%) versus 4.2% (SHIP)) were more often observed. No considerable differences in frequencies of orthodontic findings were detected in the comparison of the subgroups "18-28 years" versus ">28 years", "with" versus "without orthodontic treatment", "male" versus "female", "with" versus "without periodontal problems", or "with" versus "without orofacial disturbances".

CONCLUSIONS

Within the bounds of this study, we gathered orthodontic findings in adults with trisomy 21 for the first time. In comparison to the average population, the subject group showed a greater number of complex orthodontic findings.

CLINICAL RELEVANCE

These persisting dental and orofacial problems must be considered when treating patients with Down's syndrome.

Home-based oral health program for adults with intellectual disabilities: An intervention study

BACKGROUND

Poor oral health is common in adults with intellectual disabilities leading to risk of mouth and lung infections. Yet, little is known about the benefits of preventative oral health programs.

OBJECTIVE/HYPOTHESIS

This prospective longitudinal experimental mixed methods study evaluated the efficacy of an oral health program aimed at improving knowledge and behaviours in adults with intellectual disabilities living in supported housing.

METHODS

A 90-min training session was provided to residents and their staff at 12 houses (56 residents; 67 staff). Follow-up training sessions (at 1 week, 1,2,3 months) were tailored to the learning abilities, behavioural/physical challenges, and independence of residents. Outcome measures were collected pre, 1, 2 and 3 months (n = 36): dental exam, plaque index, gingival signs, tongue coating index and behavioural rating scale. At 3 months, support workers (n = 10) and residents (n = 19) were interviewed. Residents' interviews were supported by Talking Mats®.

RESULTS

Most residents (94%) required support for oral cares; with 63% fully dependant on their support workers. 24 (63%) residents had significantly improved plaque scores at 3 months (p < .001). Resident interviews were restricted by communication competency but supported interviews indicated positive responses to 3-sided toothbrush 91%, interdental brush/flosser 60%, and mouthwash 100%. Support worker interviews revealed perceived health and social benefits including fresher breath and benefits of routines.

CONCLUSIONS

Oral health programs for adults with intellectual disabilities living in supported housing are well received by staff and residents, leading to changes in oral care routines and measurable changes in oral health.

Effects of a disability-simulating learning unit on ableism of final-year dental students - a pilot study

OBJECTIVES

This study aimed to describe a disability-simulating learning unit (DSLU) to raise dental students' awareness of the special needs of patients with disabilities as well as to measure the effect of the DSLU on ableism.

METHODS

A DSLU among final-year undergraduate dental students (n = 33), was developed and evaluated. The students were randomly divided into two groups (Group I, n = 17; Group II, n = 16). Group II only received conventional teaching (control group), whereas Group I was additionally exposed to the DSLU (intervention group). In the DSLU, typical physical restrictions and the associated difficulties in attending dental appointments were simulated with the help of simulation suits. Four different stations offered the opportunity to experience typical signs of disability in a dental context. About 2 months after the DSLU, both groups were asked to answer the Symbolic Ableism Scale (SAS). An analysis was conducted to examine the participants' average total score and several subscores. The Mann-Whitney U Test was employed to control the differences between the study groups.

RESULTS

Overall, the students in the intervention group had a significantly (p = .001) lower mean SAS summary score (median = .37; IQR .32-.42) than the students in the control group (median = .50; IQR .39-.53). For the components "individualism" (p < .0001) and "excessive demands" (p = .002) significant group differences could be observed.

CONCLUSION

The DSLU is a potentially feasible and effective method for influencing students' ableism attitude.

Assessment of dental malocclusion and soft-tissue features among children with special needs in the Western UP region: A cross-sectional study

Aims

Assessment of dental malocclusion and soft-tissue features among children with special needs and their correlation with normal children.

Subjects and Methods

A cross-sectional study was carried out among 128 children (63 special health-care needs children and 65 normal children), between 8 and 18 years of age. Two special schools (Vatsalya and Jeevandhara) were included in the study for case group and two local schools (one government and one private) were included in the study for control group. Index of Orthodontic Treatment Need was used to measure the malocclusion. To assess and compare various facial features, extra-oral photographs were taken from two different views (frontal and side).

Statistical Analysis Used

Data were analyzed using ANOVA and Chi-square test, with keeping level of significance at P < 0.05.

Results

The result of the present study demonstrated a significant difference between the study and control group with respect to overjet, caries, stains and calculus, soft-tissue facial profile, lip competency, and Korkhaus lip step. Soft-tissue comparison demonstrated facial asymmetry; lip incompetency was more prevalent in the study group compared to the control group. Overall, it was concluded that malocclusion was more prevalent in the study group compared to their counterparts.

Conclusions

Malocclusion was more prevalent in children with disability compared to their counterparts. On clinical examination, a significant difference in relation to overjet, caries and stains, and calculus was observed, whereas a significant difference on soft-tissue examination was observed in facial profile, lip competency, and Korkhaus lip step in the study group compared to normal children.

Cerebral palsy: Oral manifestations and dental management

Cerebral palsy is a set of non-progressive neuromuscular disorders caused by defects in the developing fetal brain. Its prevalence is about 2:1000. Although CP does not directly result in any particular oral abnormalities, some conditions are more prevalent or severe in CP patients than in the general population. The purpose of a paediatric dentist is to promote overall oral health wellness and to motivate parents and other primary caregivers to practice good oral hygiene at home. The aim of this article is to provide a general overview of dental health issues that affect people with CP and to analyze key preventative and practical management techniques for this common comorbidity.

Comparison of Malocclusion Prevalence, Type and Severity between Cerebral Palsy and Healthy Subjects: A Prospective Case-Control Study

Background: To analyze the prevalence, type and severity of malocclusions in a group of patients with cerebral palsy (CP) using a facial and occlusal analysis and the Dental Aesthetic Index (DAI). Methods: A prospective, case–control study was made of two groups, a cerebral palsy and a control group, with the determination of the facial and occlusion analysis in the three spatial planes. The Dental Aesthetic Index (DAI) was used to assess the severity of malocclusion. Results: The patients with CP presented a higher prevalence of increased facial lower third height and a greater tendency towards right-side canine and molar class II malocclusion, narrower transverse relationship and crossbite. The DAI scores were statistically significantly higher in the CP group. Increased physical impairment in the CP group was associated to greater DAI scores. Conclusions: The prevalence and severity of malocclusion were significantly greater in the CP group. The type of malocclusion predominantly found in these patients was molar class II, with open bite, increased overjet and a narrow arch. The CP group also presented mixed breathing with higher DAI scores and decreased facial lower third height.

Dental health status and hygiene in children with cerebral palsy: A matched case-control study

BACKGROUND

Children with cerebral palsy (CP) are at risk for oral pathology and parafunctional habits, and are reliant on caregivers for oral hygiene.

AIM

To evaluate oral hygiene habits and oral examination findings among a group of children with CP and a healthy age- and gender-matched control group.

DESIGN

A comparative, cross-sectional study, consisting of a questionnaire component and a standard dental examination component, each applied to both groups.

RESULTS

Eighty-three children with CP and 84 healthy children were included. Parents of children with CP were more likely to be of low educational level and lack a professional line of occupation (P < .05). Children with CP were less likely to be responsible for oral hygiene maintenance, adhere to toothbrushing, or receive procedural dental care (P < .001). Food packing and drooling were significantly more likely in children with CP. Malocclusion type III was more prevalent among children with CP, as was higher gingival index and gingival enlargement index-horizontal component (P < .001). There were no differences in caries experience between the CP and control groups.

CONCLUSIONS

Children with CP have suboptimal oral hygiene habits, limited access to procedural dental care, higher parafunctional habits, and increased periodontal pathology.

Barriers and facilitators in the orthodontic treatment of teenagers with neurodevelopmental disabilities

INTRODUCTION

Patients with neurodevelopmental disabilities often experience barriers to dental care. Despite greater access to orthodontic treatment, information about the perceptions of patients with neurodevelopmental disabilities regarding orthodontic care remains scarce. The objective of this research was to investigate perceptions of patients, caretakers, and orthodontic residents regarding the barriers to and facilitators of orthodontic care for patients with neurodevelopmental disabilities.

METHODS

A qualitative study was conducted through semistructured interviews of 26 subjects: 10 patients with neurodevelopmental disabilities (4 with cognitive disabilities, 4 with autism spectrum disorder, and 2 with communication disorder), 8 caretakers, and 8 orthodontic residents. The responses were analyzed qualitatively by content analysis.

RESULTS

Four dimensions of analysis were identified: previous experience, barriers to care, facilitators of care, and perception of care. There are different orthodontic care barriers and facilitators perceived by patients, caretakers, and residents treating patients with neurodevelopmental disabilities. Factors such as the reason for consultation, previous experience or exposure to orthodontic care or attention, and personal motivation of those involved were used to model the care of these patients.

CONCLUSIONS

There are barriers and facilitators in orthodontic care for patients with neurodevelopmental disabilities, caretakers, and orthodontic residents. Educational programs in orthodontics must work to improve access and care for patients and educational training programs for students and clinical faculty.

[Dental Health of Children and Adolescents in the Rhine-Erft District attending Secondary General and Special Needs Schools: A 5-year comparison]

BACKGROUND

Nationally there is a lack of data on the prevalence and experience of caries among 10- to 14-year-old schoolchildren with increased caries risk, and in the second period of mixed dentition/early period of permanent dentition.

AIM

To compare caries prevalence and experience and prevalence of fissure sealant (FV) among schoolchildren with disability attending special needs schools (FS) with children with lower level of educational attainment attending secondary general schools (HS).

METHODS

Dental health of schoolchildren aged 10 to 14 years attending FS or HS was determined according to WHO standards in two study periods (UP1=school year 2010/2011; UP2=school year 2015/2016). Data were anonymized and analyzed with MS Excel 2019 and IBM^® SPSS Version 26. The study was approved by the ethics committee of the University of Witten/Herdecke (#119/2016).

RESULTS

Data on 2539 schoolchildren were available for analysis. Prevalence of caries in schoolchildren attending HS (UP1=36.5%; UP2=32.7%) and FS (UP1=31.4%; UP2=33.3%) was very similar as also the corresponding mean DMFT values. There was a significant difference in caries prevalence between the 2 groups in UP1 and a significant decrease between UP1 and UP2 among schoolchildren attending HS. With respect to FV, 50.7% (UP1) and 50.9% (UP2) of schoolchildren attending HS and 36.3% (UP1) and 52.1% (UP2) of schoolchildren attending FS had at least one FV. Furthermore, caries experience and caries prevalence of schoolchildren with at least one FV of both school types was significantly lower compared to schoolchildren without FV. Mean DMFT values for schoolchildren attending HS were 0.53 (UP1, FV>0), 1.16 (UP1, FV=0), and 0.49 (UP2, FV>0), 0.99 (UP2, FV=0) with p<0.001 in each case. Mean DMFT values for schoolchildren attending FS were 0.56 (UP1, FV>0), 0.9 (UP1, FV=0) (p=0.01), and 0.51 (UP2, FV>0), 1.02 (UP2, FV=0) (p=0.003).

CONCLUSIONS

Dental health of schoolchildren attending HS and FS in the REK is significantly poorer compared to the general population. This suggests that both these groups belong to population-subgroups with an increased risk of developing caries. In order to improve this situation, caries prevention measures should be implemented beyond primary school age in children attending these 2 types of school.

A prospective clinical evaluation of fixed dental prostheses made of metal alloys in patients with cerebral palsy

Background

In general, the prevalence of caries and other oral and dental issues is increased in patients with disabilities, such as those with cerebral palsy. Providing appropriate dental treatment at a primary dental clinic for patients with cerebral palsy and intellectual disability, among other conditions, is challenging.

Objective

The objective of this study was to evaluate the longevity and investigate the related prognostic factors of fixed prostheses in patients with cerebral palsy.

Methods

The records of 36 cerebral palsy patients were used for collecting and analyzing data. A total of 155 prostheses made from metal alloys were finally included in this study. Annual failure rates were calculated; patient‐ and tooth‐related variables associated with prosthesis failure were assessed by a multivariate Cox‐regression analysis and frailty models to introduce random effects.

Results

The 10‐year prosthesis survival rate was 62% and the 20‐year survival rate was 36%. In terms of prosthesis‐related variables, the type of prosthesis had a significant effect, and the hazard ratio of fixed partial dentures was 2.32 times that of single‐unit crowns. In terms of patient‐related variables, the presence of epilepsy had a significant effect on survival, and the hazard ratio for comorbid epilepsy was 3.76 times that for those without comorbid epilepsy.

Conclusions

Our findings suggested that fixed prostheses placed in patients with cerebral palsy might have a particularly low survival rate in cases with comorbid epilepsy. It might also be important to consider the type and/or design of the prosthesis carefully to ensure a better prognosis.

Introducing the Beatalk technique: using beatbox sounds and rhythms to improve speech characteristics of adults with intellectual disability

BACKGROUND

Individuals with intellectual disability (ID) often demonstrate speech impairments and reduced intelligibility. However, traditional treatment methods, which involve using repetitive verbal and non-verbal exercises, may not be fully suitable for this population. As adults with ID tend to lose interest and motivation facing the demands of a typical speech therapy session, other intervention methods are needed. The current study tested a novel intervention technique, Beatalk, based on practising vocally produced sounds and rhythms, imitating the sounds produced by rhythm machines in an a cappella musical context (i.e., human beatboxing). Human beatboxing may be a particularly effective tool since it involves intense production of speech sounds (phonemes) that can be misarticulated in the presence of speech disorders; it is relatively easy to learn and practice, and is also considered 'fun'.

AIMS

As many of the features of beatboxing make it a promising method for speech therapy, this pioneering study aimed to examine its effectiveness in comparison with a traditional speech therapy.

METHODS & PROCEDURES

Twelve adults with moderate ID and low speech intelligibility (age 24-48 years) participated in a speech therapy group for 6 weeks. Six participants were assigned to the Beatalk (study) group and six to a traditional (control) therapy group. Pre- to post-treatment changes in speech intelligibility and voice measures were assessed.

OUTCOMES & RESULTS

The preliminary data demonstrate that both types of therapy groups resulted in improved performance in articulation accuracy and voice measures, yet the Beatalk technique yielded larger gains.

CONCLUSIONS & IMPLICATIONS

The results present initial evidence for the beneficial effect of the Beatalk technique as an intervention tool for adults with ID. It is an easy-to-use technique in the context of speech therapy, and may enhance verbal communication skills in this population.

Interdisciplinary Management of a Class III Anterior Open Bite Malocclusion in a Patient With Cerebral Palsy

Dentofacial disharmony in patients with cerebral palsy (CP) can lead to low self-esteem and functional limitations. However, medical and behavioral challenges in patients with developmental disorders often prevent dental practitioners from offering the necessary treatment. This report describes the clinical interdisciplinary management of a 20-year-old man with CP, including orthodontic, periodontal, and orthognathic surgery therapy. The patient presented with the chief complaint of having difficulty chewing, was wheelchair dependent, had poor orofacial muscle control, and exhibited a Class III malocclusion with a skeletal anterior open bite. The lower midline was shifted 3 mm to the right, there was severe maxillary spacing, and the patient had gingival overgrowth. A combined orthodontic, periodontal, and orthognathic surgery treatment approach was chosen to meet the patient's interdisciplinary needs. Because of his physical limitations, it was necessary to avoid complicated and prolonged orthodontic treatment mechanics. Interdisciplinary therapy improved the patient's oral function, periodontal health, and facial esthetics and led to a good occlusion, which remained stable 1 year after treatment. Regardless of the treatment challenges, combined orthodontic and surgical therapy in the present patient with CP led to favorable treatment results and improved the patient's self-esteem, confidence in social interactions, and speaking and chewing abilities.

Prevalence of malocclusion in individuals with and without intellectual disability: A comparative study

OBJECTIVE

The aim of this study was to compare the prevalence malocclusion between individuals with intellectual disability (ID) and a control group without disability (NID).

METHODS

A total of 202 individuals (123 with ID and 79 with no impairment) were included in the study. Data were collected through oral examinations using the Angle classification of malocclusion and the dental aesthetic index (DAI).

RESULTS

According to Angle's classification of malocclusion, it was found that 37.6% of all participants presented malocclusion. Class II malocclusion was the most common form of malocclusion in both groups, whereas class III cases were present almost exclusively in ID group (91.7%). The mean DAI score was 30.85 (± 13.7), being higher in the ID group (32.80) than in the control group (27.81; p = 0.003). A total of 45 (22.3%) participants had DAI scores of 36 and above, which indicate a handicapping malocclusion requiring mandatory orthodontic treatment. From those needing mandatory orthodontic treatment, the majority (84.4%) belonged to ID group. Mandibular irregularity (56.4%) and incisal segment crowding (45%) were the most common features of the malocclusion. Linear regression indicates that having an intellectual disability predicts severe or very severe malocclusion.

CONCLUSIONS

In this study, the prevalence of malocclusion was found to be higher and more severe in intellectual disabled participants. The dental practitioner should understand the particular relevance of this problem especially in patients with intellectual disabilities where impaired oral functions and poor appearance may further complicate oral health and increase negative social responses.

Orthodontic Protocol Using Mini-Implant for Class II Treatment in Patient with Special Needs

Improving facial and dental appearance and social interaction are the main factors for special needs (SN) patients to seek orthodontic treatment. The cooperation of SN patients and their parents is crucial for treatment success. Objective. To show through a case report the satisfactory results, both functional and esthetic, in patients with intellectual disability, congenital nystagmus, and severe scoliosis. Materials Used. Pendulum device with mini-implants as anchorage unit. Results. Improvement of facial and dental esthetics, correction of Class II malocclusion, and no root resorption shown in the radiographic follow-up. Conclusion. Knowing the limitations of SN patients, having a trained team, motivating and counting on the cooperation of parents and patients, and employing quick and low-cost orthodontic therapy have been shown to be the essential factors for treatment success.

Crown-root Fracture Restoration on a Patient with Autism Spectrum Disorder

Children with intellectual and physical disabilities including autism are susceptible to dental trauma as a sequela from falls due to poor muscular coordination. In addition, their altered muscle tonus often results in an open bite with labial flaring of the maxillary incisors and lip incompetence, predisposing these teeth to fractures. This case report describes an alternative approach of restoring a fractured maxillary permanent central incisor with a composite strip crown during surgical repositioning of the periodontium on an autistic patient. The prognosis of the incisor is guarded due to the probability of re-injury. However, the decision to maintain the tooth clinically was esthetically preferable in comparison to an extraction or decoronation.

Influence of craniomandibular and cervical pain on the activity of masticatory muscles in individuals with Temporomandibular Disorder

PURPOSE

This study aimed to establish the prevalence of pain in the craniomandibular and cervical spine region in individuals with Temporomandibular Disorders (TMD) and to analyze the effects of these disorders on the bilateral activation of anterior temporalis (AT) and masseter (MA) muscles during the masticatory cycle.

METHODS

The participants were 55 female volunteers aged 18-30 years. The presence of TMD and craniomandibular and cervical spine pain was evaluated by applying the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire and using a combination of tests for the cervical region. The muscle activity of AT and MA during the masticatory cycle was assessed using the symmetry and antero-posterior coefficient indices.

RESULTS

The AT activity during the masticatory cycle is more asymmetric in individuals with TMD. The craniomandibular pain, more prevalent in these individuals, influenced these results.

CONCLUSION

Individuals with TMD showed changes in the pattern activity of AT. The craniomandibular nociceptive inputs can influence the increase in asymmetry of the activation of this muscle.

Dentofacial and cranial changes in down syndrome

Objectives

This study aimed to determine the prevalence of certain oral characteristics usually associated with Down syndrome and to determine the oral health status of these patients.

Methods

The cross-sectional study was conducted among patients attending a special education program at Faculty of Dentistry, Jamia Millia Islamia, Delhi, India. The study design consisted of closed-ended questions on demographic characteristics (age, sex, and education and income of parents), dietary habits, and oral hygiene habits. Clinical examination included assessment of oral hygiene according to Simplified Oral Hygiene Index (OHI-S), dental caries according to decayed, missing, and filled teeth (DMFT) index, periodontal status according to the Community Periodontal Index of Treatment Needs (CPITN), and malocclusion according to Angles classification of malocclusion. Examinations were carried out using a using a CPI probe and a mouth mirror in accordance with World Health Organization criteria and methods. Craniometric measurements, including maximum head length and head breadth were measured for each participant using Martin spreading calipers centered on standard anthropological methods.

Results

The majority of the patients were males (n = 63; 82%) with age ranging from 6–40 years. The Intelligence Quotient (IQ) score of the patients indicated that 31% had moderate mental disability and 52% had mild mental disability. 22% exhibited hearing and speech problems.12% had missing teeth and 15% had retained deciduous teeth in adult population. The overall prevalence of dental caries in the study population was 78%. DMFT, CPITN and OHI scores of the study group were 3.8 ± 2.52, 2.10 ± 1.14 and 1.92 ± 0.63 respectively. The vast majority of patients required treatment (90%), primarily of scaling, root planing, and oral hygiene education. 16% of patients reported CPITN scores of 4 (deep pockets) requiring complex periodontal care. The prevalence of malocclusion was 97% predominantly of Class III malocclusions. Further 14% presented with fractured anterior teeth primarily central incisor. The percentage means of cephalic index was 84.6% in the study population. The brachycephalic and hyperbrachycephalic type of head shape was dominant in the Down syndrome individuals (90%).

Conclusion

The most common dentofacial anomaly seen in these individuals was fissured tongue followed by macroglossia.

Does caries risk assessment predict the incidence of caries for special needs patients requiring general anesthesia?

OBJECTIVES

The aim of this study was to correlate the caries-related variables of special needs patients to the incidence of new caries.

MATERIALS AND METHODS

Data for socio-demographic information and dental and general health status were obtained from 110 patients treated under general anesthesia because of their insufficient co-operation. The Cariogram program was used for risk assessment and other caries-related variables were also analyzed. Within a defined follow-up period (16.3 ± 9.5 months), 64 patients received dental examinations to assess newly developed caries.

RESULTS

At baseline, the mean (SD) values of the DMFT (decayed, missing and filled teeth) and DT (decayed teeth) for the total patients were 9.2 (6.5) and 5.8 (5.3), respectively. During the follow-up period, new caries occurred in 48.4% of the patients and the mean value (SD) of the increased DMFT (iDMFT) was 2.1 (4.2). The patients with a higher increment of caries (iDMFT ≥3) showed significantly different caries risk profiles compared to the other patients (iDMFT <2) (p < 0.05). Close correlations existed between the caries increment and several caries-related variables; baseline DMFT, insufficient self-tooth-brushing and malocclusion were greatly associated with new caries development.

CONCLUSIONS

Caries risk assessment could predict the incidence of future caries in hospital-based dentistry. Past caries experience and inadequate oral hygiene maintenance were largely related to caries development in special needs patients.

Cerebral palsy: a dental update

Special and medically compromised patients present a unique population that challenges the dentist’s skill and knowledge. Providing oral care to people with cerebral palsy (CP) requires adaptation of the skills we use everyday. In fact, most people with mild or moderate forms of CP can be treated successfully in the general practice setting. This article is to review various dental considerations and management of a CP patient.

How to cite this article: Sehrawat N, Marwaha M, Bansal K, Chopra R. Cerebral Palsy: A Dental Update. Int J Clin Pediatr Dent 2014;7(2):109-118.

The prevalence of malocclusion and its association with dental caries among 12-18-year-old disabled adolescents

BACKGROUND

To assess the prevalence of malocclusion among 12-18-year-old disabled adolescents in Chennai, Tamil Nadu, India, by using the Dental Aesthetic Index (DAI) and to determine the association of malocclusion with dental caries.

METHODS

This cross-sectional study included 243 children with various mental disabilities with or without physical infirmities. The Dental Aesthetic Index (DAI) and the dentition status were recorded using the World Health Organization Oral Health Surveys - Basic Methods (1997) Pro-forma. The Decayed (D), Missing (M) and Filled (F) components of the DMF index were calculated using the Dentition Status and Treatment Need (DSTN). A Chi-square test, ANOVA, and t-test were used to derive inferential statistics.

RESULTS

The mean DAI score ± standard deviation was 39.0 ± 12.3. A total of 123 (50.6%) participants (74 males and 49 females) had DAI scores of 36 and above, which indicated a handicapping malocclusion requiring mandatory orthodontic treatment. Sixty-nine (28.4%) adolescents (36 males and 33 females) had DAI scores between 31 and 35, which indicated severe malocclusion, for which orthodontic intervention was desirable. Incisal segment crowding (84.8%) was the most common aspect of the malocclusion. The mean DMFT score was 4.36 ± 3.81, and 82.8% of the participants had a DMFT score > 0. There was no statistically significant correlation between the mean DAI and DMFT scores (r = 0.090, p = 0.15). Only 16 (6.6%) of the adolescents had minor or no anomaly not needing orthodontic treatment.

CONCLUSIONS

The prevalence of malocclusion and dental caries was found to be high. However, there was no positive correlation between the severity of malocclusion and dental caries among the surveyed disabled adolescents.

Dental treatment under general anesthesia in a group of patients with cerebral palsy and a group of healthy pediatric patients

This is a comparative study between two groups, one of healthy children and the other of children with cerebral palsy, which underwent dental treatment under general anesthesia at Hospital Sant Joan de Déu Barcelona. The purpose of the study was to compare and determine oral pathology, frequency, severity and postoperative complications in pediatric patients with and without an underlying disease which undergo a dental treatment under general anesthesia.

Orthodontic treatment for disabled children: a survey of parents' attitudes and overall satisfaction

Background

Many patients with disability require orthodontic treatment (OT) to achieve adequate oral function and aesthetic appearance. The cooperation of disabled patients and of their parents is central to the success of OT, as treatment can involve ethical dilemmas. The aim of this study was to analyze the motivation, expectations and overall satisfaction with OT among parents of patients with disabilities.

Methods

The parents of 60 disabled Spanish children with physical, mental and/or sensory impairment undergoing OT were surveyed on attitudes to OT and level of satisfaction with the outcomes. The survey consisted of 23 questions in 4 sections: attitude and adaptation, benefits, adverse effects, and level of satisfaction after completion of OT. A control group formed of the parents of 60 healthy children undergoing OT at the same institution were also surveyed.

Results

Parents of disabled children undergoing OT showed a high level of motivation and they are willing to collaborate in oral hygiene procedures. Adaptation to the removable appliances was poorer in disabled children but adaptation to fixed appliances was excellent. OT can provide a marked improvement in quality of life, social relationships and oral functionality in disabled children.

Conclusions

Among parents of disabled children undergoing OT, the perceived level of overall satisfaction was very high and expectations were often exceeded.

Alterações no controle motor mandibular e cervical de crianças com paralisia cerebral

Objetivo: analisar a atividade elétrica dos músculos Temporal e Masseter e o padrão de postura e movimento de cabeça e mandíbula de crianças com Paralisia Cerebral (PC).Métodos: a amostra deste estudo compreendeu 32 voluntários com PC espástica e com Desenvolvimento Típico, com a faixa etária de 7 a 13 anos de idade, caracterizados com base na Classificação de Angle e Critério de Diagnóstico para Pesquisa das Disfunções Temporomandibulares (RDC/TMD). De forma simultânea, foram avaliadas a postura e movimentação da cabeça e mandíbula e a atividade elétrica dos músculos Temporal e Masseter por meio da cinemática e eletromiografia.Resultados: a PC não foi associada a presença de DTM ou com a alteração da oclusão dentária. No grupo PC, foi observada maior assimetria do músculo temporal (p<0.05), maior extensão da cabeça na máxima abertura da boca (p<0.05), maior amplitude de extensão da cabeça (p<0.01) e maior amplitude de projeção anterior da cabeça (p<0.05).Conclusão: a maior assimetria na atividade muscular, a maior extensão e projeção anterior da cabeça durante o ciclo mastigatório podem ser causas das desordens da função motora oral das crianças com PC.

Resting position of the head and malocclusion in a group of patients with cerebral palsy

Cerebral palsy are found as a result of these disorders, along with associated neuromuscular functional alterations that affect the resting position of the head. In this context, the resting position of the head could be responsible for several skeletal and dental occlusal disorders among patients with cerebral palsy. Objective: To assess the presence of malocclusions in patients with cerebral palsy, define the most frequent types of malocclusions, and evaluate how the resting position of the head may be implicated in the development of such malocclusions. Study design: Forty-four patients aged between 12-55 years (18 males and 26 females) were studied. Occlusal conditions, the Dental Aesthetic Index (DAI), changes in the resting position of the head, and breathing and swallowing functions were assessed. Results: Orthodontic treatment was required by 70.8% of the patients, the most frequent malocclusions being molar class II, open bite and high overjet. These individuals showed altered breathing and swallowing functions, as well as habit and postural disorders. The resting position of the head, especially the hyperextended presentation, was significantly correlated to high DAI scores. Conclusions: The results obtained suggest that patients with cerebral palsy are more susceptible to present malocclusions, particularly molar class II malocclusion, increased open bite, and high overjet. Such alterations in turn are more common in patients with a hyperextended position of the head.

Key words:Cerebral palsy, malocclusion, head position, disabled patients.

Association between executive/attentional functions and caries in children with cerebral palsy

The aim of the present study was to evaluate the existence of an association between attention/executive functions and the development of dental caries in individuals with cerebral palsy (CP). Seventy-six children with CP were selected from a physical rehabilitation center and a school serving children with disabilities. The control group was made up of 89 children without neurological impairment. Socioeconomic status, presence of teeth with cavities due to caries, degree of motor impairment and intellectual, executive and attentional functions were assessed. Mean age of participants was 8.9 years (SD=3.56). The CP group had a significantly lower performance (p<0.05, Mann-Whitney test) on the intelligence, attentional function and executive function tests in comparison to the control group. Controlling for the clinical diagnosis (CP or control group), motor impairment and intellectual function, the significant explanatory variables for the presence of teeth with cavities were performance on the Complex Rey figure test (OR=0.941) and the Digit Span subtest of the Wechsler Intelligence Scale for Children in backward order (OR=0.581). After controlling for intellectual function, clinical diagnosis and motor impairment, deficits in executive and attentional functions increased the odds of developing dental caries in children with cerebral palsy.

The association between childhood obesity and tooth eruption

Obesity is a growth-promoting process as evidenced by its effect on the timing of puberty. Although studies are limited, obesity has been shown to affect the timing of tooth eruption. Both the timing and sequence of tooth eruption are important to overall oral health. The purpose of this study was to examine the association between obesity and tooth eruption. Data were combined from three consecutive cycles (2001-2006) of the National Health and Nutrition Examination Survey (NHANES) and analyzed to examine associations between the number of teeth erupted (NET) and obesity status (BMI z-score >95th percentile BMI relative to the Centers for Disease Control and Prevention (CDC) growth reference) among children 5 up to 14 years of age, controlling for potential confounding by age, gender, race, and socioeconomic status (SES). Obesity is significantly associated with having a higher average NET during the mixed dentition period. On average, teeth of obese children erupted earlier than nonobese children with obese children having on average 1.44 more teeth erupted than nonobese children, after adjusting for age, gender, and race/ethnicity (P < 0.0001). SES was not a confounder of the observed associations. Obese children, on average, have significantly more teeth erupted than nonobese children after adjusting for gender, age, and race. These findings may have clinical importance in the area of dental and orthodontic medicine both in terms of risk for dental caries due to extended length of time exposed in the oral cavity and sequencing which may increase the likelihood of malocclusions.

Does intellectual disability affect the development of dental caries in patients with cerebral palsy?

The aim of this study was to evaluate if the severity of intellectual disability is a factor that affects the development of dental cavities in patients with cerebral palsy. This cross-sectional study was conducted on 165 individuals who were selected from a physical rehabilitation center, a special public school and a regular public school. Of these, 76 individuals had been diagnosed with spastic cerebral palsy and 89 had no neurological impairment. The subjects were matched based on age and gender and selected randomly by lottery. All patients were examined to determine the number of dental cavities, and tested for their intellectual functioning (Raven Test) and motor abilities. The study showed that children with CP who presented with intellectual disabilities had a larger number of dental cavities than children with CP without intellectual disabilities. Considering intellectual functioning and motor impairment in the multivariate logistic regression, only intellectual functioning was found to have a significant effect on the development of dental cavities. These results suggest that intellectual disability can be considered a contributing factor for the development of dental caries in patients with cerebral palsy.

A review of cerebral palsy for the oral health professional

Individuals who have cerebral palsy (CP) face many physical challenges throughout their lifetimes in addition to societal barriers that can have an impact on quality of life. The ability to access appropriate dental care has long been an issue for people who have disabilities. Dentists should be integral members of teams of professionals involved in optimizing the health of individuals who have CP. As with all members of this interdisciplinary team, oral health care providers should have a thorough knowledge of the medical, cognitive, and rehabilitative issues associated with CP. With this knowledge the best possible health care can be provided.

Cerebral palsy: medical aspects

Cerebral palsy describes a wide spectrum of motor problems caused by a nonprogressive lesion of the developing brain. It is variably associated with a variety of other developmental and medical problems that present challenges to parents and care providers alike. This article provides an overview of etiology and diagnosis, with a system-based discussion of management.