Prevalence of Bruxism in Children and Adolescents with Cerebral Palsy: Systematic Review and Meta-analysis

AIMS

To perform a systematic review and meta-analysis compiling data on the prevalence of bruxism in children and adolescents with cerebral palsy.

METHODS AND RESULTS

Searches were carried out in PubMed/Medline, Web of Science, and Scopus databases to identify the articles published by February 2023. Two independent reviewers, and in duplicate, employed a two-stage process to select publications. The same two reviewers performed the data extraction. Studies were included when the following eligibility criteria were met: performed in children and/or adolescents with cerebral palsy and reporting bruxism. Potentially eligible studies were read in full and excluded that: not presented numerical data on the prevalence of bruxism; not reported how the bruxism was assessed; not reported data about the cerebral palsy; and not an observational study. The risk assessment of bias was assessed by the Newcastle- Ottawa Scale. After reading the titles and abstracts of the 358 identified articles, eight articles from 1966 to 2020 were included. The main reason for not including the studies was not to report data about bruxism (59.3%), and 44.5% were excluded for not reporting data from patients with cerebral palsy. The studies were carried out in schools, university hospitals, or centers for patients with special needs (Brazil, the United States, and Egypt). The pooled prevalence of bruxism in children and adolescents with cerebral palsy was 46% (95%CI: 0.38-0.55) after removing one study.

CONCLUSION

The pooled prevalence of bruxism in children with cerebral palsy can be considered high since almost half of the studied population is affected by this condition. PROSPERO #CRD42021225781.

Oral health-related quality of life in children and adolescent with autism spectrum disorders and neurotypical peers: a nested case-control questionnaire survey

PURPOSE

Oral health-related quality of life (OHRQoL) of children with autism following an oral preventive regimen (ASDsP) was compared to that of children with autism without a preventive regimen (ASDsNP) and of neurotypical peers (NT).

METHODS

An online survey was carried out using the Parental/Caregiver Perception Questionnaire (P-CPQ) and the Family Impact Scale (FIS). Scores were assigned to items, with the total score ranging from 0 to 120 (worst QoL). The median scores were compared amongst groups using the Mann-Whitney and Kruskal-Wallis tests. A multivariate linear regression assessed the relationship between questionnaire scores and demographical variables.

RESULTS

Overall, 168 questionnaires from the ASDsP and the ASDsNP groups, respectively, and 336 from the NT group were selected ASDsP compared to ASDsNP showed lower P-CPQ Emotional wellbeing, FIS Emotion (p < 0.01) and Conflict (p < 0.05), and FIS total score (p < 0.01). In addition, they were less nervous (p < 0.05), shy (p < 0.01), with better sleep (p < 0.05), and with happier parents (p < 0.01). Compared to NT, ASDsP showed higher P-CPQ + FIS, P-CPQ, and FIS total scores (p < 0.01) and P-CPQ Functional limitation, Social wellbeing (p < 0.01), Emotional wellbeing (p < 0.05), and FIS Activity, Emotion and Conflict (p < 0.01).

CONCLUSION

The preventive regimen reduces parental stress, improving the quality of life of children and families.

Impact of dental fluorosis on the oral health-related quality of life: a systematic review

OBJECTIVE

The aim of this systematic review is to investigate the literature to assess the effect of dental fluorosis on the Oral Health-Related Quality of Life (OHRQoL).

MATERIALS AND METHODS

Included studies were epidemiological investigations, clinical trials, or human studies that directly compared the impact on OHRQoL between individuals with dental fluorosis and those without, utilizing valid OHRQoL assessment tools. The searches were conducted up to March 2024 in databases, including PubMed, Scielo, LILACS, Scopus, Web of Science, Embase, and the Virtual Health Library. Additionally, gray literature sources such as Google Scholar, OpenGrey, Ibict/BDTD, and ProQuest were searched. Reference lists were also manually reviewed for potential eligible studies. The risk of bias in cohort studies was assessed using the Newcastle-Ottawa Scale (NOS), while its modified version was employed for cross-sectional studies. A narrative synthesis of the results was conducted.

RESULTS

16 studies were included in this Systematic Review. In total, 16,314 participants, aged 8 to 18, were assessed across the studies. Most of the included studies were cross-sectional, except for one cohort study. In assessing OHRQoL across different age groups and severities of dental fluorosis, the impact varied. A negative association between dental fluorosis and OHRQoL was found in 9 of the included studies, a positive association was found in 1 study, and no significative association was identified in 6 studies. Limitations in the included studies primarily pertained to cross-sectional designs, with significant issues such as the absence of sample size calculations, lack of non-response rate reporting, limited consideration of confounding factors, and substantial heterogeneity stemming from diverse diagnostic methods and assessment tools.

CONCLUSION

The findings of the systematic review demonstrate a complex and varied relationship between dental fluorosis and OHRQoL in children and adolescents. These conclusions may have limitations in scientific evidence. The findings emphasize the need for further investigations to explore the intricate aspects of this relationship and identify contributing factors to varying outcomes.

CLINICAL RELEVANCE

Dental caries preventive fluoridated measures might be indicated even if there would be a risk for mild dental fluorosis as the fluoridated public water.

REVIEW REGISTRATION

This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under number: CRD42020186552.

Systemic Factors Affecting Orthodontic Treatment Outcomes and Prognosis - Part 1

This article explores the intersection of various systemic conditions with orthodontic treatment. Renal diseases, including chronic kidney disease and renal transplant, present challenges such as delayed tooth eruption and gingival overgrowth, necessitating careful orthodontic planning and collaboration with physicians. Liver diseases, particularly hepatitis, heighten the risk of periodontal disease and mandate strict infection control measures during orthodontic procedures. Ehlers-Danlos syndrome poses challenges related to collagen fragility, rapid tooth movement, and orthodontic relapse. Autoimmune diseases like diabetes mellitus and juvenile idiopathic arthritis require tailored orthodontic approaches considering oral complications and joint involvement.

Oral Health Care for Children and Youth With Developmental Disabilities: Clinical Report

Oral health is an essential component of overall health for all individuals. The oral health of children and youth with developmental disabilities (CYDD) involves unique characteristics and needs of which pediatricians and pediatric clinicians can be aware. Risk for oral disease in CYDD is multifactorial and includes underlying medical conditions, medications, and ability to participate in preventive oral health care and treatment, and lack of access to providers is common for this population despite being eligible for Medicaid. Pediatric clinicians are uniquely positioned to support the oral health needs of CYDD and their families through the medical home. This clinical report aims to inform pediatric clinicians about the unique oral health needs of CYDD. It provides guidance on assessing caries risk and periodontal status using structured screening instruments; understanding dental trauma, the role of diet and caries risk, trauma prevention, and malocclusion; and providing anticipatory guidance on oral hygiene that includes tooth brushing, use of fluoridated toothpaste, assessing community water fluoridation, advocating for a dental home by 1 year of age, and transition to adult dental care as part of adolescent health care. It also highlights special considerations for dental treatment rendered under sedation or general anesthesia that CYDD may need. Pediatric clinicians can help reduce risk of CYDD developing dental disease by understanding the unique needs of their patients and their barriers to accessing oral health care in their community, communicating with the child's dental home, and advocating for safe and accessible dental procedures.

The Impact of Socioeconomic Factors on Pediatric Oral Health: A Review

This narrative review examines the impact of socioeconomic status (SES) on pediatric oral health, emphasizing disparities in dental caries prevalence and oral health-related quality of life (OHRQoL) among children from different socioeconomic backgrounds. Utilizing an extensive literature search through PubMed, Google Scholar, and the chat.consensus.app plugin, we synthesized findings from studies published up to December 2023. The review highlights a consistent association between lower SES and adverse pediatric oral health outcomes, influenced by parental education, household income, food security, and neighborhood conditions. It also underscores the importance of the life-course perspective, showing how early-life socioeconomic disadvantages can have long-lasting effects on oral health. Furthermore, the review points to the critical role of school-based oral health education programs and the complex interplay between mental health, SES, and pediatric oral health. By examining the impact of socioeconomic factors across different childhood stages and the effectiveness of educational interventions, this review calls for targeted interventions and policy initiatives aimed at reducing socioeconomic inequalities in pediatric oral health. The findings advocate for a multifaceted approach to improve oral health outcomes for children across socioeconomic backgrounds, ensuring equitable access to oral health care and promoting overall well-being.

Bruxism, parafunctional oral habits and oral motor problems in children with spastic cerebral palsy: A cross-sectional study

BACKGROUND

Individuals with spastic cerebral palsy are more predisposed to parafunctional oral activities and oral motor problems because of spasticity.

OBJECTIVES

The aim of the study was to evaluate the relationship between the gross motor function classification system score (GMFCS), age, bruxism, parafunctional oral habits and oral motor problems in children with cerebral palsy.

METHODS

This cross-sectional study included 63 children with spastic cerebral palsy, aged 3-18 years, with developmental disabilities. The relationship between parentally reported bruxism, parafunctional oral activity rates, oral motor problems, and GMFCS was analysed.

RESULTS

The prevalence of bruxism was 52.4%, and the rate decreased as age increased. There was a greater likelihood of bruxism in individuals with tongue thrust (OR [95% CI] = 8.15 [1.4-47.3]) and swallowing problems (OR [95% CI] = 5.78 [1.3-24.68]).

CONCLUSION

In children with spastic cerebral palsy, bruxism and the rate of parafunctional oral habits were high, thus affecting oral motor activities. A relationship was found between oral motor problems and increased GMFCS levels, but no relationship was found between bruxism and GMFCS levels. Children with spastic cerebral palsy who display tongue thrust or swallowing problems have an increased likelihood of presenting with bruxism.

Optical spectral diagnostics of the oxygenation level in periodontal tissues and photodynamic therapy using methylene blue in children with cerebral palsy

Dental diseases occur in children with cerebral palsy three times higher than in healthy children. Low values of the unstimulated salivation rate (<0.3 ml per minute), pH and buffer capacity, changes in enzyme activity and sialic acid concentration, as well as increased saliva osmolarity and total protein concentration, which indicates impaired hydration, are the factors in the development of a gingiva disease in case of cerebral palsy. This leads to increased bacterial agglutination and the formation of acquired pellicle and biofilm, leading to the formation of dental plaque. There is a tendency toward an increase in the concentration of hemoglobin and a decrease in the degree of hemoglobin oxygenation, as well as an increase in the generation of reactive oxygen and nitrogen species. Photodynamic therapy (PDT) with the use of photosensitizer methylene blue improves blood circulation and the degree of oxygenation in periodontal tissues, as well as eliminates a bacterial biofilm. Analysis of back diffuse reflection spectra makes it possible to conduct non-invasive monitoring determine tissue areas with a low level of hemoglobin oxygenation for precision photodynamic exposure.

Aim

To improve the effectiveness of phototheranostics methods using, namely PDT with simultaneous optical-spectral control, for the treatment of gingivitis in children with complex dental and somatic status (cerebral palsy).

Methods

The study involved 15 children (6-18 y.o.) with various forms of cerebral palsy, in particular, spastic diplegia and atonic-astatic form and with gingivitis. The degree of hemoglobin oxygenation was measured in tissues before PDT and on the 12th day. PDT was performed using laser radiation (λ = 660 nm) with a power density of 150 mW/cm² with a five-minute application of 0.01% MB. The total light dose was 45 ± 15 J/cm². For statistical evaluation of the results, a paired Student's t-test was used.

Results

The paper presents the results of phototheranostics using methylene blue in children with cerebral palsy. An increase in the level of hemoglobin oxygenation from 50 to 67% (p < 0.001) and a decrease in blood volume in the microcirculatory bed of periodontal tissues were shown.

Conclusion

Photodynamic therapy methods with application of methylene blue make it possible to assess the state of the gingival mucosa tissue diseases objectively in real time, and to provide effective targeted therapy for gingivitis in children with cerebral palsy. There is a prospect that they can become widely used clinical methods.

Factors associated with dental caries experience of Thai preschool children with cerebral palsy

AIM

To investigate the factors association with dental caries experience in the primary dentition of Thai preschool children with cerebral palsy.

METHODS AND RESULTS

A cross-sectional study was conducted among sixty Thai preschool children with cerebral palsy, aged 3-6 years old. Caries experience was determined by identifying decayednon-cavitated and cavitated lesion, missing, and filled surfaces of deciduous teeth(dmfs). Sociodemographic data, CP motor types, dietary habits, oral health behaviors and dental plaque index were collected. Multiple linear regression analysis was carried out to identify the strength of the association between factors and dental caries experience. The prevalence of dental caries was 91.66%. The average dmfs was 20.30 ± 21.63 surfaces/individual. The multiple linear regression indicated that dmfs was significantly associated with snacking carbohydrate between meals more than two times/day (β ± SE = 0.372 ± 0.125; p = 0.004), spastic type of cerebral palsy (β ± SE = 0.309 ± 0.124; p = 0.015) and one-time daily tooth brushing (β ± SE = 0.306 ± 0.124; p = 0.017).

CONCLUSIONS

Nine out of 10 preschool children with CP experienced dental caries. Spastic type of CP had more risk to develop dental decay. Caries prevention for preschool children with CP should emphasis on controlling the frequency of carbohydrate snack no more than two times/day and reinforcing tooth brushing at least twice daily.

Risk Factors for Dental Caries Experience in Children and Adolescents with Cerebral Palsy—A Scoping Review

Cerebral palsy is a developmental motor disorder which has far-reaching impacts on oral health. This scoping review examined the extent of research undertaken regarding the risk factors affecting dental caries experience in children and adolescents with cerebral palsy. Data were obtained from the electronic databases Web of Science and PubMed, using 10 search strings, for studies published between 1983 and 2018. Eligible studies were required to have investigated caries in children under 18 with cerebral palsy, as well as be written in English. 30 papers published were identified for inclusion in the review. These included 23 cross-sectional, 6 case–control, and 1 longitudinal study. Studies were categorized into six domains of risk factors: socioeconomic status (SE); cerebral palsy subtype (CPS); demographics (D); condition of oral cavity (OC); dental habits (DH); nutrition and diet (ND). This review was conducted and reported in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The most significant risk factors were caregiver-related education levels, oral health literacy, and sugar intake; this underlines the important role of special education and dental awareness in reducing dental caries incidence in CP children. Other factors showed divergent findings, highlighting the need for standardization and culturally specific studies in future literature.

Oral health-related quality of life in children and adolescents with cerebral palsy: paired cross-sectional study

OBJECTIVES

To evaluate the impact of oral health conditions on the Oral Health-Related Quality of Life (OHRQoL) in children and adolescents with Cerebral Palsy (CP) and compare with children and adolescents without CP.

METHODS

This was a paired cross-sectional study, consisting of 121 children and adolescents with CP and 121 without CP, aged 6 to 14 years. Caregivers filled a socioeconomic-demographic and the Parental-Caregiver Perceptions Questionnaire (P-CPQ). Physical examination of the oral cavity assessed the dental caries experience, need for treatment, consequences of untreated dental caries, presence of dental trauma, bruxism and malocclusion. A descriptive analysis and Kruskal-Wallis and Mann-Whitney tests (p < 0.05) were performed. Variables with p values ≤ 0.20 in the bivariate analysis were included in the adjusted model analysis. Variables with a p value < 0.05 remained in the final Poisson Regression model.

RESULTS

Caries experience had a negative impact on the quality of life of both groups, with and without CP. Presence of gastroesophageal reflux and difficulty to opening the mouth also had a negative impact on the OHRQoL of the group with CP.

CONCLUSION

Children and adolescents with CP suffered a greater negative impact on OHRQoL than individuals without CP. Difficulty in opening the mouth and the presence of GER had a negative effect on the quality of life of individuals with CP, while dental caries had a negative impact on the OHRQoL of children and adolescents of both groups.

Bruxism in children and adolescents with cerebral palsy

This study aims to summarize the existing evidence from primary studies in order to answer the following question: "are children and adolescents with cerebral palsy (CP) frequently affected by bruxism?". For such, databases Web of Science, Medline (via PubMed), Lilacs, SciELO, Scopus and Wiley Online Library were used, with the keywords “Cerebral Palsy” and “Bruxism” alone and in combination, without the restriction of the publication date. The search included all articles published until May 2020. A total of 229 publications were found, of which 12 were selected, after careful analysis. Retrospective data analyses, cross-sectional studies and observational case-control studies published in English and with samples composed of children and/or adolescents were included. Case reports, literature reviews and studies whose sample consisted of adults-only were excluded. In the evaluated studies, bruxism was present in all samples with cerebral palsy. However, oral signs and symptoms resulting from this parafunction were reported only in three studies, in which the presence of dental wear and pain was evaluated. Therefore, bruxism in children and adolescents with cerebral palsy is a frequent oral condition, however, knowledge about the associated and risk factors for the occurrence of this problem in these patients remains limited.

A scoping review of oral health outcomes for people with cerebral palsy

INTRODUCTION

Good oral health is important for good overall health. Studies have reported poorer oral health outcomes for people with cerebral palsy, but there has been no synthesis of the evidence surrounding this and, there are no clear oral health recommendations for people with cerebral palsy globally. This review synthesizes the existing knowledge base on oral health in people with cerebral palsy and provides recommendations for future research.

METHODS

A scoping review was conducted to assess the current literature. Databases were searched using relevant search terms. Study outcomes were synthesized according to their reported outcomes.

RESULTS

One hundred seventy three studies were included in this review. Children with cerebral palsy have an increased risk for dental caries and untreated caries. Higher saliva osmolality is a major contributor to increased dental caries. People with cerebral palsy are more likely to experience tooth wear and bruxism. Children and their care-givers have poor oral health related quality of life. There is a large unmet need for oral healthcare in this group. There is no suggested plan for the prevention of poor oral health for this group. A high number of studies included related to research is conducted in low- and middle-income countries, care should be taken in applying results outside this context. There is a lack of research conducted in people with cerebral palsy, 18 years and over.

CONCLUSION

There is a higher risk for poor oral health in people with cerebral palsy and there is a large unmet need to dental care in this group. This study highlights the need for further research to focus on adults with cerebral palsy and an of understanding the oral health care outcomes in the context of settings. The authors recommend the inclusion of classification systems and the integration of disability inclusive language in future studies.

Caries prevalence using ICDAS visual criteria and risk assessment in children and adolescents with cerebral palsy: A comparative study

AIMS

To compare the dental caries prevalence using the International Caries Detection and Assessment System (ICDAS) and the caries risk by Caries Management by Risk Assessment (CAMBRA) in individuals with cerebral palsy (CP) and normoactives (NAs).

METHODS AND RESULTS

Sixty children and adolescents aged 6-12 years (30 CP/30 NA) were clinically evaluated by one calibrated examiner using two-digit ICDAS criteria and converted into components of dmf/DMF indices: d2mf2/D2MF2 (enamel and dentin lesions) and d3mf3/D3MF3 (dentin lesions). An adapted CAMBRA was used for risk classification. The mean d2mf2s/d2mf2t and D2MF2S/D2MF2T for CP were 17.0 ± 16.8/7.5 ± 4.3 and 10.7 ± 17.6/5.3 ± 5.8, respectively, and for NA were 17.2 ± 16.9 /6.9 ± 4.8 and 11.1 ± 11.7/5.5 ± 4.7, respectively. The mean d3mf3s/d3mf3t and D3MF3S/D3MF3T for CP were 10.1 ± 16.7/3.0 ± 4.1 and 4.9 ± 15.6/0.2 ± 0.4, respectively, while for NA the mean values were 9.8 ± 13.0/3.5 ± 3.8 and 2.1 ± 5.7/0.9 ± 2.0, respectively. There were no statistically differences for caries prevalence and risk in both groups (p > 0.05).

CONCLUSIONS

Dental caries was highly prevalent in CP and NA children and adolescents. Enamel and dentin lesions and high caries risk were the most common condition.

Oral health status and parental perception of child oral health-related quality of life among children with cerebral palsy in Bangalore city: A cross-sectional study

AIM

To assess and compare the oral health status and parental perception of child oral health-related quality of life (OHRQoL) among children with and without cerebral palsy (CP).

METHODS AND RESULTS

A cross-sectional comparative study was conducted among 300 children aged 5-15 years with and without CP in Bangalore city. Oral health status was assessed using WHO 2013 criteria, and malocclusion was assessed using Angle's classification of malocclusion. Parental perception of child OHRQoL was assessed using parental caregivers perceptions questionnaire. Chi-square test, Student's t-tests and logistic regression were applied. Majority of the study participants were males with a mean age of 10 years. Caries experience, gingivitis, dental trauma, and dental erosion were significantly higher among children with CP than the comparison group. Mean parental perception of child OHRQoL score among CP was significantly higher than that of comparison group (P < .001). Odds of having caries experience, gingivitis, dental trauma, and Angle's Class II/III malocclusion were significantly higher among CP children with poor OHRQoL compared to those without these conditions.

CONCLUSION

Oral health status among children with CP was poor than the children without CP. Parents perceived poor OHRQoL among children with CP when compared to those without CP. Hence CP has an impact on oral health necessitating preventive care.

Oral health-related quality of life among pediatric liver transplant candidates

To assess the impact of oral conditions on the oral health-related quality of life (OHRQoL) of pediatric liver transplant candidates. This cross-sectional study included 60 children aged 13 to 48 months who were liver transplant candidates that attended the AC Camargo Cancer Center, São Paulo, Brazil. On the day of oral examinations, the children's mothers were invited to answer two questionnaires; one related to children's OHRQoL using the B-ECOHIS and another related to socioeconomic/demographic characteristics. Thereafter, a single, adequately trained dentist carried out children's oral examinations for gingival inflammation (Silness-Löe index), dental plaque (Green-Vermillion Simplified index), dental caries (dmft index), developmental defects of enamel (DDE index), tooth discoloration, oral mucosal/lip alterations. The data collected also included socioeconomic/demographic characteristics and liver disease. The adjusted Poisson regression model was used to associate children's socioeconomic/demographic characteristics and clinical conditions to the outcome. The adjusted regression model showed that children with untreated caries lesions (RR = 3.35, p < 0.0001) and tooth discoloration (RR = 1.74, p = 0.04) had poorer total B-ECOHIS scores. Dental discoloration and untreated caries lesions had a negative impact on the OHRQoL in pediatric liver transplant candidates.

Physiologic and behavioural signs during a dental appointment in children and teenagers with Cerebral Palsy: a comparative cross-sectional study

AIM

To evaluate the heart rate (HR) and behaviour of children and teenagers with Cerebral Palsy (CP) when having a dental appointment.

METHODS

A comparative cross-sectional study was carried out with 60 participants with CP, between 2 and 14 years old (study group-SG), and 60 normotypical individuals (CG). The sample was paired according to age, gender and socioeconomic status. Behaviour was evaluated during dental prophylaxis using the Frankl Scale, and HR was measured at five moments: before the appointment, when sitting in the dental chair, during the clinical examination, during prophylaxis and immediately after prophylaxis. Mann-Whitney, Friedman and Chi-square tests were applied at a significance level of 5%.

RESULTS

SG presented significantly higher HR (p < 0.001) and more participants with uncooperative behaviour (p < 0.001) than CG in all observational periods. Furthermore, SG participants with uncooperative behaviour presented higher HR values than those in SG who were cooperative in all observational periods (p ≤ 0.002).

CONCLUSIONS

Individuals with CP have a higher HR before and during the clinical session, and are frequently more uncooperative with the procedure than normotypical individuals.

The Impact of Gross Motor Function on the Oral Health-Related Quality of Life in Young Adults with Cerebral Palsy in Saudi Arabia

Background

There is evidence that gross motor function impacts the health-related quality of life of young adults with cerebral palsy. This study aimed to assess gross motor function, oral health and oral health-related quality of life (OHRQoL), and the relationship between them in young adults with cerebral palsy.

Methods

The sample comprised 46 individuals aged between 13 and 17 years with Gross Motor Function Classification Scores (GMFCS) ranging from level I to level III. The individuals and their parents were administered an Arabic version of the child perception questionnaire for adolescents. Parental and child perception scores, DMFT, and gingival index were compared across GMFCS levels using the one-way ANOVA and Scheffe's post hoc test.

Results

Children with level III GMFCS had a significantly higher child perception score (CPQ) and parental perception score (PPQ) than those with level I or level II scores. There was a significant association between function (GMFCS) and the CPQ score in children (p = 0.016). No significant associations were found between the CPQ score and either dental caries (DMFT) or gingival bleeding (GI) scores. Children with GMFCS level III had a significantly higher DMFT (p = 0.016). No significant associations were found between the CPQ score and either dental caries (DMFT) or gingival bleeding (GI) scores. Children with GMFCS level III had a significantly higher DMFT (p = 0.016). No significant associations were found between the CPQ score and either dental caries (DMFT) or gingival bleeding (GI) scores. Children with GMFCS level III had a significantly higher DMFT (

Conclusion

Motor function has a significant impact on both the oral health and the OHRQoL of adolescents and young adults with spastic cerebral palsy.

Cerebral palsy and bruxism: Effects of botulinum toxin injections-A randomized controlled trial

Objective

Cerebral palsy (CP) includes disturbances in muscular control caused by perinatal brain injury. Masticatory muscle involvement hampers functions such as chewing and talking. Bruxism and temporomandibular disorders are overrepresented. Neuromuscular blocks with botulinum toxin type A (BTX‐A) may alleviate problems due to muscular hyperactivity. The aim was to evaluate masticatory muscle BTX‐A injections in subjects with CP and bruxism.

Methods

A prospective, parallel, randomized, placebo‐controlled, and double‐blind trial in 12 patients with CP was performed. End points were alterations in objective and subjective oral capacities after two BTX‐A or corresponding placebo injections. Matched, healthy references were also evaluated.

Results

The reference group demonstrated stronger and more efficient oral functions compared with the CP group. Subjective and objective oral capacities appeared to vary considerably between CP patients and also over time in this patient group and were poorly correlated. No significant effect of BTX‐A compared with placebo on outcome variables was observed at group level, but continued treatment with BTX‐A was requested by the majority of the patients.

Conclusion

The evidence is unable to support the use of BTX‐A for the treatment of affected masticatory muscles in CP, but the findings are inconclusive in certain respects. Larger, more homogeneous groups of CP patients need to be evaluated in future trials.

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

Background

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

Aim

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

Setting

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

Methods

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

Results

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

Conclusion

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

Dermatoglyphics as a Noninvasive Tool for Predicting Dental Caries in Cerebral Palsy and Healthy Children: An In Vivo Study

AIM

To find the association of dermatoglyphics and dental caries in normal and cerebral palsy (CP) children.

MATERIALS AND METHODS

A total of 150 children of age group 6-12 years were selected and divided into three equal groups. Group I constituted of 50 CP caries-active children, group II constituted of 50 healthy caries active children, and group III consisted of 50 healthy caries-free children. World Health Organization (WHO) criteria were used for diagnosis and recording of decayed, missing, filled teeth (DMFT)/deft scores. Fingerprints of both hands were taken using a stamp pad and analyzed using the Cummin and Midlo method.

RESULTS

The results were statistically analyzed using one-way analysis of variance (ANOVA) and post hoc Tukey's honestly significant difference (HSD). The data for the entire study were calculated using statistical package for social sciences (SPSS) statistical software 19.0 version. The mean DMFT/deft score was the highest for the CP caries-active group compared to the healthy caries-active and healthy caries-free children. Dermatoglyphic pattern distribution in the CP caries-active group showed more whorls and that in the healthy caries-free group showed more arches. Intergroup comparisons for DMFT/deft and dermatoglyphic patterns were significant except between CP caries-active children and healthy caries-active children.

CONCLUSION

Association of dermatoglyphics and dental caries was observed among CP caries-active children, healthy caries-active children, and healthy caries-free children. This association can be helpful in identifying the possible genetic predisposition and early prediction of dental caries in CP children, so as to initiate oral health measures at an early stage.

CLINICAL SIGNIFICANCE

Maintaining oral hygiene has always been a challenge in children because of many difficulties like behavior management and lack of dexterity, and it becomes all the more difficult in the case of children with special needs. Dermatoglyphics can be proven to be a very useful, noninvasive, and economical tool for the preliminary diagnosis of diseases of suspected genetic origin like dental caries and CP.

HOW TO CITE THIS ARTICLE

Somani R, Gupta MP, et al. Dermatoglyphics as a Noninvasive Tool for Predicting Dental Caries in Cerebral Palsy and Healthy Children: An In Vivo Study. Int J Clin Pediatr Dent 2019;12(3):237-242.

A 4-year follow-up case of extrusive luxation in a patient with cerebral palsy

Cerebral palsy (CP) is a condition caused by brain damage before, during, or shortly after birth. Communication can be a challenge when treating patients with CP. Some patients can communicate verbally, while others use augmentative alternative communication tools or have individualized means of communication. Therefore, professional dental treatment in individuals with CP is challenging, especially if the patient is affected by dental trauma and requires emergency treatment. This report shows how individualized communication skills assessment allowed us to successfully manage a 9-year-old patient with CP, who suffered extrusive luxation of the permanent lower incisor. In the present case, the teeth were repositioned briefly after the trauma had occurred and then stabilized with a flexible splint according to international guidelines. The teeth remained vital and periodontal repair was observed during the 4-year follow-up.

A cross sectional study to evaluate the oral health status of children with intellectual disabilities in the National Capital Region of India (Delhi-NCR)

BACKGROUND

Children with intellectual disabilities (ID) have usually been reported to have poorer levels of oral hygiene and higher prevalence of dental caries than their compeers. The present study was conducted to assess the status of dental caries and oral hygiene in different categories of institutionalised children with ID (syndromic and non-syndromic) registered in various special schools of Delhi (National Capital Region, India).

METHODS

The present cross sectional study was conducted on 269 children [52 with cerebral palsy (CP), 35 with Down syndrome (DS), 30 with autism and 152 with non-syndromic intellectual disability] attending nine special schools who were examined for dental caries [Decayed, Missing and Filled Teeth index for permanent teeth (DMFT); decayed, missing/indicated for extraction, filled index for primary teeth (dmft) and prevalence of caries] and oral hygiene status [Oral Hygiene Index-simplified (OHI-S)]. The levels of disability were classified according to Stanford Binet scale as severe (IQ ≤ 35), moderate (IQ = 36-51) and mild (IQ = 52-67). Statistical analysis was performed using one way analysis of variance and post hoc test to compare the levels between groups at a significance level of P < 0.05.

RESULTS

Mean DMFT, dmft and OHI-S indices scores for all the children irrespective of the category and the level of ID were 2.12 ± 1.95, 0.97 ± 1.60 and 2.05 ± 1.07, respectively. As the level of ID increased among these children, the mean DMFT index and OHI-S index increased with no significant effect on dmft. However, children with severe ID had higher OHI-S and DMFT scores than children with mild or moderate ID. The dental caries prevalence was 86.53%, 68.57%, 76% and 86.18% in children with CP, DS, autism and non-syndromic intellectual disability, respectively.

CONCLUSIONS

The level of caries in permanent teeth and oral hygiene deteriorated with the increasing severity of ID as indicated by DMFT and OHI-S scores (severe > mild, moderate). However, the level of caries (dmft) was not affected by the level of ID in primary dentition. The prevalence of dental caries was highest among children with CP and least among children with DS.

What Increases the Risk of Dental Traumatism in Patients with Developmental Disabilities?

This study investigated risk factors for tooth injuries in individuals from a dental clinical reference service for patients with special needs in Belo Horizonte, MG, Brazil. This is a retrospective cohort study that evaluated 493 dental charts of individuals with or without tooth injuries at their first dental appointment. The dependent variable was the time of occurrence of new dental traumatic injuries and was measured in months. Gender, age, International Code of Diseases, mother's education, mouth breathing, hyperkinesis, pacifier use, thumb sucking, psychotropic drug use, tooth injuries at the first dental examination, involuntary movements, open bite, having one or more siblings and reports of seizures were the covariates. The Cox proportional hazards regression model was used to estimate the unadjusted and adjusted hazard ratios and their respective 95% confidence intervals. The average time that individuals remained free of dental traumatism was 170.78 months (95% CI, 157.89-183.66) with median of 216 months. The incidence of new events was 11.88%. The covariate associated with an increased risk of dental traumatism was a history of tooth injuries at the first dental appointment. The increase in dental trauma risk was 3.59 (95% CI, 1.94-6.65). A history of traumatic dental injury was the risk factor for the dental trauma found in this group of individuals with developmental disabilities.

Effects of dental treatment and systemic disease on oral health-related quality of life in Korean pediatric patients

Background

The findings that not only dental caries but also systemic disease can exert a negative effect on oral health-related quality of life (OHRQoL), and that dental treatment can improve OHRQoL have been confirmed in multiple studies. The purpose of this study is to investigate the impact of dental treatment on OHRQoL of Korean pediatric patients and the differences in OHRQoL between patients with and without systemic disease.

Methods

All the primary caregivers of pediatric patients who underwent dental treatments under either general anesthesia or intravenous deep sedation at Seoul National University Dental Hospital completed abbreviated versions of the Child Oral Health Impact Profile (COHIP-14) and Family Impact Scale (FIS-12) surveys on OHRQOL pre- and post-treatment (average: 2.4 ± 1.7 months after dental treatment). This is a case control study with patients divided into two groups according to the presence or absence of systemic disease.

Results

Data from 93 pediatric patients (46 male and 47 female, average patient age: 5.0 ± 3.4 years) were analyzed to compare OHRQoL before and after treatment with the Wilcoxon signed-rank test and to calculate the effect size using Cohen’s d. All of the patients exhibited an improvement in OHRQoL (COHIP-14: p <  0.001, effect size = 1.0; FIS-12: p <  0.001, effect size = 0.7). Patients with systemic diseases demonstrated lower OHRQoL in both pre- and post-treatment surveys than patients without systemic diseases (Wilcoxon Rank-sum test, both COHIP-14 and FIS-12: p <  0.05). The COHIP-14 appears to have a greater impact on the FIS-12 in patients with systemic disease than those without (explanatory power of 65.3 and 44.6%, respectively).

Conclusions

Based on the primary caregivers’ perceptions, dental treatment can improve the OHRQoL in Korean pediatric patients. Systemic disease results in a reduced OHRQoL, and the awareness of patients’ oral health appeared to have a greater impact on OHRQoL for family members of patients with a systemic disease.

Trial registration

KCT0002473 (Clinical Research Information Service, Republic of Korea) and 22 Sep 2017, retrospectively registered.

Oral health-related quality of life of Portuguese adults with mild intellectual disabilities

Individuals with disabilities are regarded as a highly vulnerable population group, particularly as far as oral health is concern. However, few studies have assessed the impact of the oral condition on the quality of life of these individuals. Therefore, the aim of this study is to expand knowledge on the oral health status of the Portuguese adults with mild intellectual disability, and to assess how the patient's oral health is related to their quality of life. A sample of 240 adults with mild intellectual disabilities linked to the Portuguese Federation for Intellectual Disability, were interviewed using a previously validated version of the Oral Health Impact Profile. An oral health examination was also conducted using three oral health indexes: Clinical Oral Health Index (COHI); Clinical Oral Care Needs Index (COCNI) and the Clinical Oral Prevention Index (COPI). Sociodemographic characteristics and dental health factors were also collected, following statistical analysis. More than half of the individuals (54,9%) presented one or more problems of major to severe impact on health (COHI level 2); only 4,6% of the individuals do not need treatment or examination (COCNI level 0) and 85% of the study sample needs measures of educational or preventive action (COPI level 1). In 76,9% of the participants, oral health had impact on the quality of life. The most affected dimensions of life were physical pain with 61,9%, followed by psychological discomfort and psychological disability with 45,1% and 45%, respectively. With relation to oral health factors and sociodemographic variables it was verified that fewer teeth and higher self-perception of need for dental treatment had a negative impact on the quality of life. On the other hand, institutionalization and an increase in at least one category in the self-perception of the oral health status had a positive impact on the quality of life. Given the high burden of oral disease and the considerable impact on quality of life found in this study, the establishment of guidelines to improve the oral health and quality of life of these individuals should be regarded as imperative.

The relationship between bruxism, sleep quality, and headaches in schoolchildren

[Purpose] Present study aimed to evaluate the relationship between sleep bruxism and headache in school children. [Subjects and Methods] This study was conducted with 103 children aged 3-6 years. The exclusion criteria were early tooth loss, dental appliance was used, physical or psychological limitations, chronic disease and continuous medication. Sleep bruxism was diagnosed based on an indication by parents of the occurrence of teeth clenching/grinding and incisor/occlusal tooth wear, following the criteria of the American Academy of Sleep Medicine. Sleep quality was evaluated by a questionnarie, detailing the child's sleep characteristics. [Results] Forty-nine children (47.6%) were diagnosed with sleep bruxism. Those with sleep bruxism were 3.25-fold more likely to present headache. Children whose parents were separated had a significantly greater frequency of sleep bruxism and primary headache. The relative risk of exhibiting primary headache was 13.1 among children with sleep bruxism whose parents were separated. [Conclusion] Children with SB demonstrated a greater risk of having primary headache and those whose parents were separated had a greater chance of having headache. Only sleep bruxism was associated with headache, clenching the teeth during waking hours was not correlated with primary headache.

Effects of Neuromuscular Electrical Stimulation on the Masticatory Muscles and Physiologic Sleep Variables in Adults with Cerebral Palsy: A Novel Therapeutic Approach

Cerebral palsy (CP) is a term employed to define a group of non-progressive neuromotor disorders caused by damage to the immature or developing brain, with consequent limitations regarding movement and posture. CP may impair orapharygeal muscle tone, leading to a compromised chewing function and to sleep disorders (such as obstructive sleep apnea). Thirteen adults with CP underwent bilateral masseter and temporalis neuromuscular electrical stimulation (NMES) therapy. The effects on the masticatory muscles and sleep variables were evaluated using electromyography (EMG) and polysomnography (PSG), respectively, prior and after 2 months of NMES. EMG consisted of 3 tests in different positions: rest, mouth opening and maximum clenching effort (MCE). EMG values in the rest position were 100% higher than values recorded prior to therapy for all muscles analyzed (p < 0.05); mean mouth opening increased from 38.0 ± 8.0 to 44.0 ± 10.0 cm (p = 0.03). A significant difference in MCE was found only for the right masseter. PSG revealed an improved in the AHI from 7.2±7.0/h to 2.3±1.5/h (p < 0.05); total sleep time improved from 185 min to 250 min (p = 0.04) and minimun SaO2 improved from 83.6 ± 3.0 to 86.4 ± 4.0 (p = 0.04). NMES performed over a two-month period led to improvements in the electrical activity of the masticatory muscles at rest, mouth opening, isometric contraction and sleep variables, including the elimination of obstructive sleep apnea events in patients with CP.

Dental caries and periodontal disease in Brazilian children and adolescents with cerebral palsy

The aim of the present study was determine the prevalence and factors associated with dental caries and periodontal disease in Brazilian children and adolescents with cerebral palsy (CP). This is a cross-sectional study conducted with 80 patients ranging in age from 2 to 18 years old. Oral exams were conducted by an examiner with records of DMFT, dmft, Gingival Bleeding Index (GBI) and Community Periodontal Index (CPI). The statistical analysis used Poisson Regression with robust variance estimation (α = 0.05). The prevalence of dental caries was 59.3%, with DMFT and mean dmft of 1.71 ± 2.42 and 2.22 ± 3.23, respectively. The mean GBI was 22.44%, and in the CPI, the prevalence of gingival bleeding, calculus, shallow and deep pockets were 94.73%, 79.62%, 12.90% and 3.22%, respectively. The caregiver’s educational level of less than eight years were associated with the dental caries experience (PR = 1.439; 95%CI = 1.09–1.89). The periodontal alterations were associated with female sex (PR = 0.82; 95%CI = 0.69–0.97), caregiver’s educational level of less than eight years (PR = 1.15; 95%CI = 1.03–1.29), poor oral perception (PR = 0.89; 95%CI = 0.80–0.98), serious communication problem (PR = 0.87; 95%CI = 0.76–0.99) and athetoid type of CP (PR = 0.85; 95%CI = 0.75–0.97). The patients with CP presented high dental caries experience and periodontal alterations, which were associated with their demographic, socioeconomic, oral health perception and systemic information.