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Peripheral Oxidation Markers in Down Syndrome Patients: The Better and the Worse. DISEASE MARKERS 2021; 2021:5581139. [PMID: 34257747 PMCID: PMC8260317 DOI: 10.1155/2021/5581139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
Oxidative stress plays an important role in Down syndrome (DS) pathology since the gene dose effect leads to abnormal levels of certain enzymes and metabolites. In this review, we focused on relatively easy-to-obtain, peripheral markers of oxidative stress and inflammation, in order to compare the levels of these markers in DS patients and chromosomally healthy persons. Studies taking into account age- and sex-matched control groups were of particular interest in this context. We analyzed the factors that influence the levels of said markers in both groups (i.e., the usefulness of the markers), including the age of DS patients, occurrence of regular trisomy 21 or mosaicism, physical activity of patients, and the onset of Alzheimer's disease in DS. This paper was conceived as a handbook-to help for selecting suitable, easy-to-obtain markers for monitoring of the health status of DS patients (e.g., in nutritional studies and during dietary supplementation).
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Ningrum V, Bakar A, Shieh TM, Shih YH. The Oral Health Inequities between Special Needs Children and Normal Children in Asia: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2021; 9:410. [PMID: 33918280 PMCID: PMC8065439 DOI: 10.3390/healthcare9040410] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 12/31/2022] Open
Abstract
This meta-analysis aimed to analyze the oral health inequalities among special needs children during 2004-2019 in Asia to reveal the importance and the needs of establishing integrated and equitable special needs dentistry care system in Indonesia. PubMed, Scopus, Cochrane Library, Web of Science, and Wiley Online Library were systematically searched for full-text observational studies published from 1 January 2004 to 15 January 2020, in English in Asia. Studies that included children under 18 years of age with special needs and compared them to healthy controls were selected. Study quality was assessed using the Joanna Briggs Institute 2017 Critical Appraisal Checklist. Risk of bias was assessed using the ROBINS-E tool. The decayed, missing, and filled permanent teeth (DMFT) index indicated that special needs children who suffer from intellectual disability or autism spectrum disorder had significantly more caries than normal children (p < 0.001). The special needs children who had more caries than normal children lived in countries that had a high average DMFT value among 12 years old children (p < 0.001), and these two variables showed a positive correlation in meta-regression analysis (p < 0.001). Having an integrated and equitable care system and elevating children's oral health are important to maintain special needs children's oral health.
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Affiliation(s)
- Valendriyani Ningrum
- School of Dentistry, Baiturrahmah University, Padang 25586, Indonesia; (V.N.); (A.B.)
| | - Abu Bakar
- School of Dentistry, Baiturrahmah University, Padang 25586, Indonesia; (V.N.); (A.B.)
| | - Tzong-Ming Shieh
- School of Dentistry, China Medical University, Taichung 404333, Taiwan;
| | - Yin-Hwa Shih
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
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Caries experience in children and adolescents with Down Syndrome: A systematic review and meta-analysis. Arch Oral Biol 2020; 115:104715. [DOI: 10.1016/j.archoralbio.2020.104715] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 11/18/2022]
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Differential Expression of Inflammation-Related Genes in Down Syndrome Patients with or without Periodontal Disease. Mediators Inflamm 2019; 2019:4567106. [PMID: 31772502 PMCID: PMC6854216 DOI: 10.1155/2019/4567106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022] Open
Abstract
Aim Aware that Down Syndrome patients present among their clinical characteristics impaired immunity, the aim of this study is to identify the statistically significant differences in inflammation-related gene expression by comparing Down Syndrome patients with Periodontal Disease (DS+PD+) with Down Syndrome patients without Periodontal Disease (DS+PD-), and their relationship with periodontitis as a chronic oral inflammatory clinical feature. Materials and Methods Case study and controls on eleven Down Syndrome patients (DS+PD+ vs. DS+PD-). RNA was extracted from peripheral blood using a Qiagen PAXgene Blood miRNA Kit when performing an oral examination. A search for candidate genes (92 selected) was undertaken on the total genes obtained using a Scientific GeneChip® Scanner 3000 (Thermo Fisher Scientific) and Clariom S solutions for human, mouse, and rat chips, with more than 20,000 genes annotated for measuring expression levels. Results Of the 92 inflammation-related genes taken initially, four genes showed a differential expression across both groups with a p value of <0.05 from the data obtained using RNA processing of the patient sample. Said genes were TNFSF13B (p = 0.0448), ITGB2 (p = 0.0033), ANXA3 (p = 0.0479), and ANXA5 (p = 0.016). Conclusions There are differences in inflammation-related gene expression in Down Syndrome patients when comparing patients who present a state of chronic oral inflammation with patients with negative rates of periodontal disease.
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Robertson MD, Schwendicke F, de Araujo MP, Radford JR, Harris JC, McGregor S, Innes NPT. Dental caries experience, care index and restorative index in children with learning disabilities and children without learning disabilities; a systematic review and meta-analysis. BMC Oral Health 2019; 19:146. [PMID: 31307444 PMCID: PMC6632188 DOI: 10.1186/s12903-019-0795-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 05/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background Children with learning disabilities (CLD) have worse health outcomes than children with no learning disabilities (CNLD). This systematic review compared caries experience and met dental care need for CLD to CNLD using Decayed, Missing, Filled Permanent Teeth (DMFT) and decayed, missing/extracted, filled primary teeth (dmft/deft), care index (CI), and restorative index (RI) values. Methods Without date or language restrictions four databases were searched for; cross-sectional studies comparing caries experience and CI/ RI in CLD matched to groups of CNLD. Screening and data extraction were carried out independently and in duplicate. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses were carried out (random effects model). Results There were 25 articles with 3976 children (1 to 18 years old), from 18 countries, fitting the inclusion criteria. Children with; Down syndrome were investigated in 11 studies, autism in 8 and mixed learning disabilities in 6. The overall mean DMFT for CLD was 2.31 (standard deviation±1.97; range 0.22 to 7.2) and for CNLD was 2.51 (±2.14; 0.37 to 4.76). Using standardised mean difference (SMD), meta-analysis showed no evidence of a difference between CLD and CNLD (n = 16 studies) for caries experience (SMD = -0.43; 95%CI = -0.91 to 0.05). This was similar for sub-groups of children with autism (SMD = -0.28; 95%CI = 1.31 to 0.75) and mixed disabilities (SMD = 0.26; 95%CI = -0.94 to 1.47). However, for children with Down syndrome, caries experience was lower for CLD than CNLD (SMD = -0.73; 95%CI = -1.28 to − 0.18). For primary teeth, mean dmft/deft was 2.24 for CLD and 2.48 for CNLD (n = 8 studies). Meta-analyses showed no evidence of a difference between CLD and CNLD for caries experience across all disability groups (SMD = 0.41; 95% CI = -0.14 to 0.96), or in sub-groups: Down syndrome (SMD = 0.55; 95%CI- = − 0.40 to 1.52), autism (SMD = 0.43; 95%CI = -0.53 to 2.39) and mixed disabilities (SMD = -0.10; 95%CI = -0.34 to 0.14). The studies’ risk of bias were medium to high. Conclusion There was no evidence of a difference in caries levels in primary or permanent dentitions for CLD and CNLD. This was similar for learning disability sub-groups, except for Down syndrome where dental caries levels in permanent teeth was lower. Data on met need for dental caries was inconclusive. Trial registration The protocol was published in PROSPERO: CRD42017068964 (June 8th, 2017). Electronic supplementary material The online version of this article (10.1186/s12903-019-0795-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark D Robertson
- School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HR, UK.
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - John R Radford
- School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HR, UK
| | - Jenny C Harris
- Community & Special Care Dentistry and Paediatric Dentistry, Charles Clifford Dental Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Scott McGregor
- Dundee University Library, University of Dundee, Dundee, UK
| | - Nicola P T Innes
- School of Dentistry, University of Dundee, Park Place, Dundee, DD1 4HR, UK
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Abstract
Down syndrome is a common disorder with many oral conditions and systemic manifestations. Dentists need to take a holistic approach including behavioral, oral, and systemic issues. This review of the literature focuses on oral anomalies, systemic interaction, management, and recommendations.
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Affiliation(s)
- Azizah Bin Mubayrik
- Department Oral Medicine & Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
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Domingues NB, Mariusso MR, Tanaka MH, Scarel-Caminaga RM, Mayer MPA, Brighenti FL, Zuanon ÂCC, Ibuki FK, Nogueira FN, Giro EMA. Reduced salivary flow rate and high levels of oxidative stress in whole saliva of children with Down syndrome. SPECIAL CARE IN DENTISTRY 2017; 37:269-276. [PMID: 29231976 DOI: 10.1111/scd.12258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIM To investigate salivary parameters between children with Down Syndrome (DS) and without DS. MATERIALS AND METHODS Stimulated whole saliva was collected from 18 children with DS and 23 without DS. Salivary flow rate, pH, and salivary buffering capacity were determined. Cariogenic microorganisms were quantified by culture, and periodontopathogens by quantitative real-time polymerase chain reaction. The antioxidant profile was quantified spectrophotometrically, while malondialdehyde (MDA) was quantified by high-performance liquid chromatography. Data were analyzed by Mann-Whitney test and Spearman correlation (α = 0.05). RESULTS Salivary flow rate was significantly lower in DS than in controls (p < 0.0001). Significant higher difference was observed for total protein dosage (p < 0.0001), superoxide dismutase activity (SOD) (p = 0.0002), and MDA (p < 0.001) in DS group. CONCLUSIONS Reduced salivary flow rate might be an important factor in oral diseases development. High salivary levels of SOD and MDA show the significant influence of the oxidative stress and the early-onset periodontal disease in DS people.
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Affiliation(s)
- Natália Bertolo Domingues
- Department of Orthodontics and Pediatric Dentistry, Araraquara Dental School, Universidade Estadual Paulista, UNESP, Araraquara, São Paulo, Brazil
| | - Matheus Racy Mariusso
- Department of Orthodontics and Pediatric Dentistry, Araraquara Dental School, Universidade Estadual Paulista, UNESP, Araraquara, São Paulo, Brazil
| | - Marcia Hiromi Tanaka
- Department of Microbiology, Institute of Science and Technology of São José dos Campos, Universidade Estadual Paulista, UNESP, São José dos Campos, São Paulo, Brazil
| | | | - Marcia Pinto Alves Mayer
- Department of Microbiology, Institute of Biomedical Sciences, Universidade de São Paulo, USP, São Paulo, São Paulo, Brazil
| | - Fernanda Lourenção Brighenti
- Department of Orthodontics and Pediatric Dentistry, Araraquara Dental School, Universidade Estadual Paulista, UNESP, Araraquara, São Paulo, Brazil
| | - Ângela Cristina Cilense Zuanon
- Department of Orthodontics and Pediatric Dentistry, Araraquara Dental School, Universidade Estadual Paulista, UNESP, Araraquara, São Paulo, Brazil
| | - Flávia Kazue Ibuki
- Department of Biomaterials and Oral Biology, Universidade de São Paulo, USP, São Paulo, São Paulo, Brazil
| | - Fernando Neves Nogueira
- Department of Biomaterials and Oral Biology, Universidade de São Paulo, USP, São Paulo, São Paulo, Brazil
| | - Elisa Maria Aparecida Giro
- Department of Orthodontics and Pediatric Dentistry, Araraquara Dental School, Universidade Estadual Paulista, UNESP, Araraquara, São Paulo, Brazil
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Zhou N, Wong HM, Wen YF, Mcgrath C. Oral health status of children and adolescents with intellectual disabilities: a systematic review and meta-analysis. Dev Med Child Neurol 2017. [PMID: 28627071 DOI: 10.1111/dmcn.13486] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To compare the oral health status of children and adolescents affected by intellectual disabilities with their unaffected counterparts. METHOD Citations published in English were searched from electronic databases (PubMed, Embase, Web of Science, and Scopus) from their start dates to March 2017. The whole process was conducted following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. The PICO (population, intervention/interest, comparator, outcome) principle was used to formulate the topic. Studies were synthesized through qualitative summary or, whenever possible, meta-analysis. RESULTS The initial search yielded 2393 records. Thirty-nine studies from 22 countries were identified for qualitative analysis; 26 studies were eligible for meta-analysis. Participants with intellectual disabilities had higher levels of dental plaque, worse gingival status, fewer decayed and filled permanent teeth, and similar caries experience between males and females. These findings were supported by both qualitative and quantitative analysis. Various patterns of caries experiences were indicated by qualitative analysis, but it was not substantiated by meta-analysis. INTERPRETATION There is increasing worldwide interest in oral health status of children with intellectual disabilities. Differences in dental plaque deposition, gingival inflammation, and the number of decayed and filled permanent teeth were investigated between children and adolescents with and without intellectual disabilities. Evidence remains elusive about the pattern of caries experience among those children.
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Affiliation(s)
- Ni Zhou
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Hai Ming Wong
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Yi Feng Wen
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Colman Mcgrath
- Department of Periodontology and Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR
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Ramezani GH, Moghadam MM, Saghiri MA, Garcia-Godoy F, Asatourian A, Aminsobhani M, Scarbecz M, Sheibani N. Effect of dental restorative materials on total antioxidant capacity and calcium concentration of unstimulated saliva. J Clin Exp Dent 2017; 9:e71-e77. [PMID: 28149467 PMCID: PMC5268120 DOI: 10.4317/jced.53272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/01/2016] [Indexed: 01/01/2023] Open
Abstract
Background To evaluate the effect of dental amalgam and composite restorations on total antioxidant capacity (TAC) and calcium (Ca) ion concentration of unstimulated saliva. Material and Methods Forty-eight children aged 6-10 years selected and divided into three groups of sixteen (8 males, 8 females). In group A and B, samples consisted of two class II dental composite or amalgam restorations, while in group C samples were caries-free (control group). Unstimulated saliva from all samples was collected and TAC was measured by spectrophotometry using an adaptation of 2, 2’-azino-di-(3-ethylbenzthiazoline-6-sulphonate) (ABTS) assay. The Ca ion level was estimated by an auto- analyzer. Data were analyzed with one- and two-way ANOVA test, at a p<.05 level of significance. Results Composite samples showed significantly higher TAC and lower Ca ion levels compared to amalgam and caries-free samples (p<.05). The TAC values showed only significant difference between groups (p<.05), while the Ca ion results showed significant differences within and between groups (p<.05). Conclusions Dental composite restorations increased TAC and decreased Ca ion levels more than amalgam restorations in saliva. Gender is an effective factor in changes induced in oral cavity as females showed more emphatic reaction to dental filling materials than males. Statement of Clinical Relevance Patients who have dental restorations, especially dental composites, should pay more attention to their dental hygiene, because dental restorations can increase oxidative stress and decrease Ca ion level in saliva, which might jeopardize remineralization process of tooth structures after demineralization. Key words:Amalgam, caries, composite, saliva, total antioxidant capacity.
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Affiliation(s)
- Gholam H Ramezani
- BDS, MS, DDS, Associate professor, Department of Pediatric Dentistry, Dental Branch, Islamic Azad University, Tehran, Iran
| | - Mona-Momeni Moghadam
- DDS Visiting researcher, Angiogenesis and Regenerative Group, Dr. H. Afsar Lajevardi Research Cluster, Shiraz, Iran
| | - Mohammad-Ali Saghiri
- BSc, MSc, PhD, Wisconsin institute for Medical Research and Department of Ophthalmology & Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Franklin Garcia-Godoy
- DDS, MSc, PhD, Bioscience Research Center, Health Science Center, College of Dentistry, University of Tennessee, Memphis, TN, USA
| | - Armen Asatourian
- DDS, Clinical instructor, Angiogenesis and Regenerative Sector, Dr. H. Afsar Lajevardi Research Cluster, Shiraz, Iran
| | - Mohsen Aminsobhani
- DDS, MSc, Associate professor, Endodontic Department, School of Dentistry, Tehran University of Medical Sciences and AJA University of Medical Sciences, Tehran, Iran
| | - Mark Scarbecz
- DDS, PhD, Professor, Bioscience Research Center, Health Science Center, College of Dentistry, University of Tennessee, Memphis, TN, USA
| | - Nader Sheibani
- BSc, MSc, PhD, Professor, Departments of Ophthalmology & Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Salivary and Urinary Total Antioxidant Capacity as Biomarkers of Oxidative Stress in Humans. PATHOLOGY RESEARCH INTERNATIONAL 2016; 2016:5480267. [PMID: 26966611 PMCID: PMC4761395 DOI: 10.1155/2016/5480267] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/10/2016] [Indexed: 12/20/2022]
Abstract
Total Antioxidant Capacity (TAC) is a biomarker often used in order to investigate oxidative stress in many pathological conditions. Saliva and urine can be collected noninvasively and represent attractive diagnostic fluids for detecting biomarkers of various pathological conditions. The reviewed case-control and intervention studies that measured salivary or urinary TAC revealed that diseases, antioxidant foods, or supplements and age, gender, and lifestyle factors influenced salivary or urinary TAC. Salivary and urinary TAC were particularly affected by oral or renal status, respectively, as well as by infection; therefore these factors must be taken into account in both case-control and intervention studies. Furthermore, some considerations on sample collection and normalization strategies could be made. In particular, unstimulated saliva could be the better approach to measure salivary TAC, whereas 24 h or spontaneous urine collection should be chosen on the basis of the study outcome and of the creatinine clearance. Finally, the uric acid-independent TAC could be the better approach to evaluate red-ox status of body, in particular after nutritional interventions and in diseases associated with hyperuricaemia.
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Association between Dental Caries and Down Syndrome: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0127484. [PMID: 26086498 PMCID: PMC4472226 DOI: 10.1371/journal.pone.0127484] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/14/2015] [Indexed: 11/19/2022] Open
Abstract
Scientific evidence of susceptibility to dental caries in the population with Down Syndrome (DS) is limited and conflicting, making it difficult to establish firm conclusions. The aim of this systematic review and meta-analysis was to obtain scientific evidence of the possible association between dental caries and individuals with DS, compared to individuals without DS (control). An electronic search of five databases was performed, with no language or publication date restrictions. The studies were selected by two independent reviewers (Kappa = 0.83). The systematic review included 13 studies, while eight studies were included in the meta-analysis. The studies are presumably all at risk of bias given their observational character. Two of these evaluated the presence or absence of caries in permanent and deciduous teeth, and six evaluated the mean DMFT index in permanent teeth. Combined odds ratios (OR), standard difference, standard error and a 95% confidence interval (CI) were obtained. The vast majority of the studies found that individuals from control groups had more carious lesions or caries experience than those with DS. The results were statistically significant in seven studies (p<0.05). Meta-analysis of two studies revealed that individuals with DS had a lower dental caries than those in the control group (OR = 0.36; 95% CI = 0.22-0.57). In six studies, individuals with DS had a significantly lower mean DMFT index than individuals from the control group (Sd = -0.18; SE = 0.09; 95% CI = -0.35--0.02). The quality of the studies varied and in general had a high risk of bias. Scientific evidence suggests that individuals with DS have fewer dental caries than individuals without DS.
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Al-Sufyani GA, Al-Maweri SA, Al-Ghashm AA, Al-Soneidar WA. Oral hygiene and gingival health status of children with Down syndrome in Yemen: A cross-sectional study. J Int Soc Prev Community Dent 2014; 4:82-6. [PMID: 25254190 PMCID: PMC4170549 DOI: 10.4103/2231-0762.139429] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: The objective of the present study was to assess the oral hygiene and gingival health status among Yemeni children with Down syndrome. Materials and Methods: The study sample comprised 101 children with Down syndrome attending special needs schools in Sana’a, Yemen. The calculus index (CI), plaque index (PI), and the gingival index (GI) were used to assess oral hygiene and gingival health status. Results: All subjects had gingivitis; the mean CI, PI, and GI scores were 0.58 ± 0.61, 1.45 ± 0.57, and 1.54 ± 0.64, respectively, with no significant difference found across gender. Stepwise linear regression analysis revealed that the best predictors in the descending order for CI were age and mother's education, and the best predictors for PI were IQ level, age, and father's education. Having severe mental retardation, older age, less educated parents were the most important predictors for poor gingival health status. Conclusions: These findings show that children with Down syndrome have poor oral hygiene and high levels of periodontal diseases. Hence, appropriate oral health education should be tailored to the needs of these children with the support of their teachers and parents.
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Affiliation(s)
| | - Sadeq Ali Al-Maweri
- Department of Oral Medicine and Periodontology, School of Dentistry, Sana'a University, Yemen
| | | | - Walid A Al-Soneidar
- Department of Oral Medicine and Periodontology, School of Dentistry, Sana'a University, Yemen
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