Preventive strategies in oral health for special needs patients

Countering the Identified Barriers to Delivered Oral Care for Children With Special Healthcare Needs: A Narrative Review

Children with Special Health Care Needs (SHCNs) have poor oral health as a result of structural and systemic barriers. These children frequently have limited access to dental treatment, a higher prevalence and incidence of dental problems, and worse oral hygiene than the rest of the population. This review aims to offer an understanding of the existing oral care barriers of children with SHCNs. We reviewed the literature on children with SHCNs and their caregivers to identify the implications of the barriers faced by these individuals. Some of the perceived barriers to appropriate oral healthcare faced by these children include obstacles to adequate oral care and hygiene in the home, challenging behaviours, and limited preventive care and accessibility. We focussed on interventions and different management approaches to support the stakeholders responsible for these children. There is a need for strong communication as well as care coordination between caregivers, dentists, and other providers to achieve positive outcomes. The current dental healthcare system appears to desert the needed demands of this demographic.

Acceptance of the use of silver fluoride among Brazilian parents of children with special health care needs

Background

Children with special health care needs including Down Syndrome, Autism Spectrum Disorder and Down Syndrome experience difficulties in receiving dental treatment. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) are a minimally invasive treatments options to arrest dental caries without sedation; local or general anaesthesia (GA).

Aim

Evaluation of Brazilian's parents' acceptance of the use of SF in CSHCN.

Methods

After receiving education on SF, 100 Parents of CSHCN completed a questionnaire concerning their acceptance of SF, in different dental situation.

Result

Majority of parents (74,5%) agreed to the use of SF for their children. SF was more acceptable on posterior teeth (74,5%) when compared to its use on anterior teeth (43,1%). Parents accepted to use SF in order: to reduce infection and pain (82,4%); to avoid dental injection (72,5%) and treatment under GA (84,3%). The Majority of parents accepted the properties of SF (82,4%) and Silver (80,4%).

Conclusion

Silver Fluoride was accepted as a treatment option for caries, by Brazilian parents of CSHCN. SF should be considered as a treatment option for caries limited to dentine for CSHCN, taking into consideration the individual needs and opinions with regard to aesthetics and exposure to fluoride and silver.

Oral health in youth with visual impairment: A longitudinal survey

This longitudinal survey aims to demonstrate improvement in oral hygiene among a group of youth with visual impairment (VI) achieved by repeated oral hygiene training, compare their progress with healthy peers (CG) and assess their oral health knowledge. In 100 VI (55♀, 45♂; ± 17.8 years) and 45 CG (23♀, 22♂; ± 17.2 years) oral hygiene training and a Quigley-Hein Plaque Index (QHI) rating were repeated six times at three-month intervals. The VI were divided into four subgroups according to the toothbrush hardness/type. A questionnaire was given to both groups. Appropriate statistical analyses were performed at 5% significance level. Both groups showed reduction in QHI, the VI had overall higher QHI values than CG. Use of an electric toothbrush in VI led to lower QHI in the last examination (p < 0.03). 69% of participants recommended dental specialists to improve communications by acquiring more illustrative aids. VI changed toothbrush less often (p < 0.02). A higher incidence of dental plaque was confirmed in VI compared to CG. After education and individual training, gradual plaque reduction has occurred in both groups. Using an electric toothbrush in VI resulted in better QHI outcomes. Repetitive preventive intervention in youth with VI helped them to adopt healthier oral hygiene habits.

Comparative Evaluation of Oral Health Status and Treatment Needs of Children With Autism Spectrum Disorder: A Cross-Sectional Study

INTRODUCTION

 Oral health care is essential yet challenging in children with autism spectrum disorder (ASD) due to their impaired emotional and behavioral stability, lack of communication skills, and inability to perform daily home hygiene routines properly. The present study was planned with the aim of assessing the Oral Health Status and Treatment Needs of children with ASD in comparison with children without any systemic disease.

METHODS

A total of 160 children, in the age group of 5-14 years, divided equally into two groups, i.e., Group A (children with ASD) and Group B (children without any systemic disease), were assessed for Dental caries, Oral Hygiene Status, and Treatment Needs. The behavior of children in each group, during oral examination, was also assessed and recorded. Student t test and Chi square test were used for quantitative and qualitative analysis, respectively.

RESULTS

The mean age of participating children was 7.96±2.43 years with a male predominance (male to female ratio - 1.58:1). Children with ASD displayed more negative behavior with 15% showing definitely negative behavior, 21.2% negative behavior on Frankl's Behavior Rating scale; the statistically lower prevalence of dental caries (Group A - mean decayed, missing and filled primary teeth (dmft): 1.7±3.2, mean decayed, missing and filled permanent teeth (DMFT): 0.19±0.71; Group B - mean DMFT: 5.44±4.88, mean DMFT: 1.01±1.51; p=0.0001), better oral hygiene (Group A - 18.8% showed good Simplified Oral Hygiene Index Score (OHI-S), 56.2% showed fair OHI-S; Group B - 6.2% showed good OHI-S and 46.3% showed fair OHI-S) and lower treatment needs compared to children without any systemic disease.

CONCLUSION

 Children with ASD showed better oral health and lower treatment needs. This suggests that introducing oral hygiene care and diet modifications in daily routine can significantly improve the Oral Health Status in children with ASD.

The oral phenotype and dental management in patients with maple syrup urine disease; case report and scoping review

BACKGROUND AND OBJECTIVES

The literature about oral manifestations and dental management in maple syrup urine disease (MSUD) is sparse. The aim of this report is to present a new case of MSUD with special emphasis on oral findings and to review the relevant literature.

METHOD

A case report of a 4-year-old boy with MSUD was described according to the CARE guidelines for describing case reports. Scoping review of relevant literature was performed, according to the PRISMA-ScR guidelines, by searching PubMed, Medline, Embase, and the grey literature for articles describing dental management and/or oral manifestations in MSUD.

RESULTS

The initial search identified 219 articles, but only 4 met the inclusion criteria. Rampant caries and plaque induced gingivitis were the main oro-dental findings in MSUD. Other oral findings included enamel hypoplasia, skeletal abnormalities, and abnormal oral behaviors. Disease-related factors appeared to play a major role in the development of the observed oral phenotype.

CONCLUSION

Oral health in MSUD seems to be influenced by the reliance on semi-synthetic diet and associated neurocognitive complications. Tailored oral health promotional interventions should be included in the multidisciplinary management of patients with MSUD.

Evaluation of a special needs dental workshop for health professionals and students in Trinidad and Tobago

Aims

This study aimed to evaluate a special needs dental workshop for dentists, allied dental health professionals and students in Trinidad and Tobago.

Methods

This feedback study conducted in 2019-2020, included two surveys, one at the time of the workshop and a second survey one year after it. The first survey utilized an anonymous self-administered questionnaire enquiring about the reason for attendance, profession/education, demographics, and difficulties faced in treating patients with special needs. The follow-up study used an online survey tool assessing the workshop and queried comments/suggestions. The Chi-square test served for statistical analysis.

Results

Of the 176 attendees 131 participated (response: 74.4%). The majority (81.5%) were females. Most attendees were dental students (50.3%) or dentists (38.9%). Knowledge acquisition (73.1%) and professional development (14.2%) were the main motives for attendance while communication (31.8%) and non-compliance (34.5%) were the main problems faced in treating patients with special needs. The follow-up evaluation (post-workshop) (response: 72.5%) showed that most participants (90.5%) assessed the workshop as positive; 80% reported an increase in their knowledge and 64.2% perceived a need for further education.

Conclusion

These findings suggest a considerable demand for special needs dental services and continuing education and show that workshops can actively affect patient care.

Oral Care for Children with Special Healthcare Needs in Dentistry: A Literature Review

Oral health is a very important aspect of general health, especially for vulnerable groups such as children with special healthcare needs. It is important to provide appropriate oral care in order to promote quality of life and good health for everyone, especially for children with special healthcare needs. Method: We reviewed the recent literature to collect knowledge regarding the delivery of quality oral care to children with special healthcare needs. We also explored some of the treatment management options that could address the needs of these children when attending dental clinics. Result: Unfortunately, we noted significant inequalities with issues related to oral health among those children. This situation often results in limitations to the activities of daily living for these children. There is therefore a need for much-needed advancements and refinements in oral healthcare to address the needs of children who have special healthcare needs. Conclusions: Providing children with special healthcare needs with high-quality dental care may necessitate active liaisons with healthcare facilitators and will require work across professions to make certain that these children’s oral health is also prioritized. Coordinated efforts by dental professionals are needed to provide dental health education and preventive interventions for these children.

Management of Chronic Ulcer Mimicking Oral Squamous Cell Carcinoma in Down Syndrome Child with Motoric Disorders

Introduction

Down syndrome is a congenital genetic disorder caused by an error in cell division, resulting in the presence of an additional third chromosome 21. Down syndrome is one of the leading causes of intellectual disability. Millions of these patients face various health issues. This study aimed to provide information about the challenges in the management of chronic ulcer mimicking OSCC in Down Syndrome child with motoric disorders.

Case

A 12-year-old boy with Down Syndrome and motoric disorders was referred to Oral Medicine Department. In the extraoral examination, the patient had a dysmorphic face and dry lips. Lymph node examination could not be assessed because the patient wore a cervical collar. The intraoral examination showed an irregular ulcer with 1×0.7 cm in diameter, indurated margin, and white-yellowish base at the right lateral border of the tongue. The 55 teeth were sharp and caused an occlusion trauma to the right lateral border of the tongue. The patient was diagnosed with a chronic traumatic ulcer mimicking OSCC based on clinical examination. The medication given to the patient were sodium chloride 0.9%, povidone-iodine mouthwash 1%, and petroleum jelly.

Conclusion

Children with Down syndrome often suffer from orofacial abnormalities which can affect their oral health and their family’s quality of life. Dental and oral care for Down Syndrome children with motoric disorders required some challenges and collaboration with their parents, families, and caregivers.

Reliability of Screening Methods to Diagnose Oral Dryness and Evaluate Saliva Secretion

In this study, we evaluated the reliability and reproducibility of widely implemented salivary flow rate and oral dryness tests. In experiment 1, twenty young and healthy Japanese participants volunteered to participate. For each participant, the oral moisture (OM) level, unstimulated whole saliva volume (U-WSV), and stimulated whole saliva volume (S-WSV) were measured at the same time on two separate days. In experiment 2, twenty-seven patients who were over 65 years of age volunteered to participate. The OM level and U-WSV were measured at the same time on two separate days. In Experiment 1, the intra-class correlation coefficients (ICCs) corresponding to the S-WSV, U-WSV, and OM level were 0.23, 0.28, and 0.16, respectively, for the young participants. In Experiment 2, the ICCs corresponding to the U-WSV/spitting and OM level were 0.83 and 0.12, respectively, for the older participants. The results of Bland–Altman analysis confirmed the absence of systematic error, with the exception of the OM level results in Experiment 2, which indicated systematic bias. In conclusion, we believe that there is currently no consistent and reliable screening test for assessing salivary flow rate and oral dryness, although the spitting test was determined to be highly reliable.

Multiple Sclerosis: Impact on Oral Hygiene, Dysphagia, and Quality of Life

Multiple sclerosis (MS) is an autoimmune disease in which the immune system reacts by damaging the central nervous system, specifically myelin and oligodendrocytes. It is the most debilitating neurological disease among young adults, causing personal, familiar, social, and professional limitations. Multiple sclerosis can cause disturbances in the orofacial district, due to a demyelination process on the nerves of the head and neck district. The aim of this study was to evaluate the oral health status, dysphagia, and quality of life of patients affected by MS. For this study, 101 patients aged between 12 and 70 (47 males, 54 females) affected by MS were selected, and three questionnaires were handed out and anonymously filled in by them: An oral hygiene test, DYMUS (DYsphagia in MUltiple Sclerosis), and IOHIP-14 (Italian version Oral Health Impact Profile). Through the analysis of the questionnaires it was possible to observe pathological conditions, such as gingival inflammation, xerostomia, dysphagia, neuralgia, and dysarthria. Through the analysis it was possible to outline how the roles of a medical team, composed of a dentist, otolaryngologist, and dental hygienist, are fundamental in coping with other medical figures, during the whole development of the diseases, as well as to prevent possible complications.

Oral Health Status of Children with Autism in Central Italy

Children with autism spectrum disorder (ASD) have significantly higher prevalence and caries severity compared to the average population. Knowledge about the oral health indices of children with this mental disorder is key to designing efficient plans of intervention. This paper reports the results of a study on the oral health status of children with ASD in central Italy. This is the first study of this type in Italy. The sample consists of 229 autistic children aged between 5 and 14 years, attending the Unit of Special Needs Policlinico Umberto I in Rome. Each patient received an intraoral examination to investigate decayed, missing, and filled teeth as well as periodontal status. Information on demographic attributes, dietary habits, medical history, and child’s cooperativeness at the first visit was also recorded. Of the participants, 79.26% presented signs of gingivitis and about 90% of them had plaque. Caries prevalence was 66.38%. The average of the total number of decayed, missing, and filled teeth in the permanent and primary dentition was 2.91. Among the factors considered, only dietary habits and the periodontal indices showed statistically significant association with caries prevalence and caries severity. Despite the selection bias, that prevents us to interpret the results presented as epidemiological evidence, our study suggests that children with ASD in central Italy represent a population at risk.

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.

Practicing Dentists' Self-Efficacy and Associated Factors in Managing the Treatment of Adults with Mental and Physical Disabilities: An Exploratory Cross-Sectional Study in Riyadh, Saudi Arabia

Background: Provision of oral healthcare to adults with mental and physical disabilities (AMPD) remains a challenging area across various healthcare systems. The present study aimed to assess self-reported efficacy and investigate factors associated with self-efficacy in the management of AMPD among practicing dentists in Saudi Arabia. Methods: A pilot-tested, self-administered questionnaire was distributed to a convenience sample of 1000 dentists. Descriptive and inferential analyses were performed on the collected responses. Results: Among the respondents (54%), 43% were males. Only 14% described their self-efficacy in managing AMPD as "High". Multivariable regression analyses revealed significant associations between "High" self-efficacy and male gender (Odd ratio (OR) = 2.39, 95% CI = 1.16-4.89), experience practicing dentistry for 11 years or more (OR = 2.19, 95% CI = 1.04-4.47), specialization in pediatric dentistry (OR = 3.98, 95% CI = 1.31-12.07), previous experience in managing AMPD (OR = 4.23, 95% CI = 1.59-11.22), and awareness of regulations for managing AMPD (OR = 2.62, 95% CI = 1.42-4.38). The interaction of gender x age was significantly associated (p = 0.028) with "High" self-efficacy. Gender-stratified analyses revealed a significant association between age and "High" self-efficacy among male dentists only. Conclusions: The findings of the present study highlight that a large percentage of dentists reported "Low/Moderate" self-efficacy in managing AMPD, particularly among female dentists. However, further studies are required to verify the factors associated with self-efficacy in the present study, and to identify other factors that may influence self-efficacy in managing AMPD.