Determinants for oral hygiene and periodontal status among mentally disabled children and adolescents

Comparative Assessment of the Efficacy of the GumChucks Flossing System and String Floss for Plaque Removal in Mentally Disabled Children: A Randomized Clinical Trial

Background

Mentally disabled children have been found to have poor oral hygiene, a greater prevalence of periodontal disease, and higher caries prevalence. Flossing is an important oral hygiene skill adjacent to toothbrushing in plaque removal than brushing alone in children. GumChucks is a novel flossing device designed to assist children with easy and proper flossing techniques. To compare the efficacy of the GumChucks flossing system and string floss (SF) for plaque removal in mentally disabled children.

Materials and methods

Participants were randomly assigned to either GumChucks or SF. At baseline, a toothbrushing and flossing demonstration was given to all the participants. Gingival index (GI) and plaque index (PI) were recorded at baseline, 1 week, and 4 weeks postusage.

Results

Overall, there was a significant reduction in GI and PI after first use with children using GumChucks compared to SF floss. After 1 week and 4 weeks of postusage, children in the GumChucks group demonstrated significantly greater improvement in GI (1.03 ± 0.60), (1.12 ± 0.66), and PI (0.97 ± 0.53), (1.10 ± 0.54) from baseline p ≤ 0.05.

Conclusion

GumChucks was an effective alternative plaque removal, with recommended caretakers' supervision for mentally disabled children.

How to cite this article

Takle TV, Vishwakarma PY, Dodamani AS, et al. Comparative Assessment of the Efficacy of the GumChucks Flossing System and String Floss for Plaque Removal in Mentally Disabled Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2024;17(3):255-259.

Periodontal status of students living with disability in Amhara region, Ethiopia: a cross-sectional study

Background

Periodontal disease is the most common oral health problem among individuals living with disabilities. Any physical impairment and/or mental handicap can compromise the capability to perform oral health care. Individuals with poor oral hygiene practice were prone to dental caries, periodontal disease, and upper respiratory tract infections. Despite the high prevalence of disabled people in Ethiopia, data are scarce about their periodontal status. The aim of this study was to determine the prevalence and determinant factors of periodontal disease among students living with disability in the Amhara region.

Methods

A school-based cross-sectional study was done on eight special needs schools in Amhara regional state from November 30, 2020, to April 10, 2021. A simple random sampling technique using a computer random generator was employed to recruit the study participants. The participants were interviewed for sociodemographic characteristics, oral hygiene practice, type of disability, and medical condition through a pre-tested semi-structured questionnaire. The periodontal status of the participants was evaluated using the community periodontal index (CPI). Data entry was done using the Epi-data and analyzed using SPSS 26. Binary logistic regression analysis was used to identify the predictors of periodontal disease at a 5% level of significance.

Results

A total of 443 study participants were involved with a mean age of 15.84 ± 3.882. Among these, 27.5% (95%CI 23.4–32.0) had a periodontal pocket depth of ≥ 4 mm, and 56.7% had bleeding on probing. The prevalence of periodontal disease was higher in participants with poor oral health status (52.2%), dental caries (34.8%), class-2 malocclusion (46.1%), and low monthly income (30.4%), visually impaired (30%), and mentally disorder (29.9%). Age of above 18 years (AOR = 3.41, 95%CI 1.40, 8.28), low family monthly income (AOR = 2.21; 95%CI 1.22, 4.03), malocclusion (AOR = 1.59, 95%CI 1.01, 2.54), poor oral health status (AOR = 9.41; 95%CI 4.92, 17.98), and dental caries (AOR = 1.85, 95%CI 1.21, 2.82) were independent predictors of periodontal disease.

Conclusions

A substantial amount of disabled school students in the study area had periodontal disease. The study found that there was a statistically significant association between age, family monthly income, malocclusion, oral health status, and dental caries with periodontal disease. The implementation of school oral health programs has a great benefit for the oral health status of disabled school students.

Oral Health Status in Mentally Disabled Children, Dental Care Knowledge of Parents, and the Impact of Audiovisual Oral Health Education Program

Aims and objectives

The aims and objectives of this study were to evaluate the oral health status in a group of mentally disabled children, to identify the oral health knowledge of parents and to assess the impact of audiovisual oral health education program.

Materials and methods

The study sample comprised of 120 mentally disabled subjects aged 5-16 years and 40 parents attending a vocational institute in Jaipur, India. Caries status and oral hygiene status were assessed by DMFT Index and Simplified Oral Hygiene Index (OHI-S) of Greene and Vermillion, respectively. Twenty pre- and post-structured close-ended questions were designed and a 5-minute video on oral health education was prepared. Data was analyzed by using one way ANOVA test followed by Post hoc Tukeys HSD Test, Wilcoxon Signed Rank Test, and Chi-square test. Effectiveness index was calculated to find the impact of AV Teaching Program.

Results

Oral hygiene status deteriorates as the severity of mental retardation increases but it was not found significantly associated with oral hygiene status. An effectiveness index of at least 0.5 indicates that the instructional media was satisfactorily effective.

Conclusion

Maximum children with poor oral hygiene were in the category of severe mental retardation and mean OHI-S score decreases from severe-to-mild mental retardation. The newly designed audiovisual aid on complete oral health care was effective at some levels in improving the oral health knowledge of the parents/caregivers of mentally retarded children.

How to cite this article

Shah RK, Choudhary S, Tandon S. Oral Health Status in Mentally Disabled Children, Dental Care Knowledge of Parents, and the Impact of Audiovisual Oral Health Education Program. Int J Clin Pediatr Dent 2022;15(2):143-148.

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.

Oral hygiene negligence among institutionalized mentally disabled children in Mysore city-A call for attention

BACKGROUND

Oral health is integral part of general health. In certain conditions especially among mentally disabled, oral health is neglected. Studies have shown that mentally disabled population has the risk of poor oral health. People with disabilities deserve the same opportunities for oral health and hygiene as those who are healthy, but sadly dental care is the most common unmet health care need of the disabled people.

METHODOLOGY

This comparative, descriptive cross-sectional study was conducted among institutionalized mentally disabled and normal children of age group 6-13 years in Mysore city.

RESULTS

Majority of mentally disabled children, that is, 36.73% (n = 180), had poor oral hygiene when compared with normal children, that is, 9.18% (n = 45). This difference was statistically highly significant (P < 0.000). The significant differences in the gingival status and severity of mental disability were seen (P < 0.001). The result showed that the gingival health worsens with increase in the severity of mental disability.

CONCLUSION

The present study showed the dental negligence among mentally disabled children where the parents, caretakers, and dentists are responsible. Oral health promotion programs should be conducted for special group children, their parents, as well as caretakers.

Characterization of oral health in a Portuguese population with mild intellectual disability

AIMS

This study aims to characterize the hygiene habits, the self-perception of the need for treatment and the oral condition of a population with a disability.

METHODS AND RESULTS

This research is part of an observational, cross-sectional epidemiological study on oral health and quality of life of people with mild intellectual disabilities living in (or attending) institutions of the Central Region of Portugal that were affiliated with HUMANITAS (Portuguese Federation for Mental Disability) in 2016. A sociodemographic and oral health questionnaire, applied on the form of an interview to 240 individuals aged between 18 and 64 years, was used. Statistical analyses were performed using SPSS version 22.0. It was verified that 32.9% of the individuals had less than 20 teeth. Only 15% of all individuals used removable prosthesis. About 21% didn't do oral hygiene daily. Only 28.4% of the sample visited the dentist in the last 6 months. Note that 75.2% of the sample stated their need for dental treatment and less than half (37.4%) described their oral condition as good or superior.

CONCLUSION

Dental care among adults with intellectual disability is one of the most unattended health needs. Evidence suggests that inadequate oral health habits are more prevalent in the studied population than in the Portuguese population.

The Dental Needs and Treatment of Patients with Down Syndrome

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

Oral Health Status of Institutionalized Individuals with Intellectual Disabilities in Lebanon

OBJECTIVES

To assess the dental status of institutionalized intellectually disabled individuals in Lebanon and the role of background and behavioural determinants.

MATERIAL AND METHODS

Oral health was recorded for 652 individuals (6, 12, 15 and 35 - 44 years old) using the decayed, missing and filled teeth/decayed and filled teeth (DMFT/dft) index. Data collected was statistically analysed with statistical significance set at P = 0.05.

RESULTS

Overall, mean DMFT index score was 5.86 (SD 6); composed of 3.64 (SD 4.05) decayed (D) teeth; 1.71 (SD 4.38) missing (M) teeth; 0.87 (SD 2.51) filled (F) teeth. DMFT was highest in adults (12.71 [SD 7.43]) and had a large component of missing (6.24 [SD 7.02]) and filled (3.31 [SD 4.56]) teeth. DMFT scores ranged between 3.5 (SD 4.44) at 6 years and 4.8 (SD 4.52) at 15 years and the decayed component was the main contributor. In multivariate analyses, governorate of residence was statistically significantly (P ≤ 0.040 and P ≤ 0.044) associated with D and DMFT, the degree of disability and caretaker educational level were statistically significantly (P = 0.009 and P = 0.008) associated with D, oral hygiene practices were statistically significantly (P ≤ 0.017; P < 0.001; P ≤ 0.017; P < 0.001) associated with D, M, F and DMFT and sugar consumption was statistically significantly (P ≤ 0.03 and P ≤ 0.019) associated with D and DMFT.

CONCLUSIONS

In Lebanon, preventive and treatment programs to improve the oral health status of institutionalized intellectually disabled subjects are needed.

ORAL HEALTH OF DOWN SYNDROME CHILDREN IN BOSNIA AND HERZEGOVINA

Introduction:

The objective of this study was to determine the oral health condition Down syndrome (DS) children in Bosnia and Herzegovina, by analizing oral health of Down syndrome individuals in two largest regions, Sarajevo and Tuzla Canton.

Patients and Methods:

Caries and oral health status of Down syndrome children aged 6-18 years were examined and assessed according WHO 1997 criteria. DS individuals were divided in to four age groups: I (0-6 yrs); II (7-12 yrs); III (13-18 yrs).

Results:

The mean dmft/DMFT index for age group I is (6,40±6,05); II (2,05±2,04) and III (10,30±6,80). The analysis of oral hygiene of Down syndrome children by using the debris index, it was found that 43,9% have very good oral hygiene, 33,3% respondents have good oral hygiene, 15,8% were with poor oral hygiene, while the very poor hygiene had 7% subjects. By using Pearson’s correlation to the value of DMFT, debris index and age of examinees with Down syndrome, it is established a statistically significant positive correlation between analyzed variables. Values of CPI index according to age groups were as follows: I (0,1); II (0,17) and III group (0,4).

Oral Health of Down Syndrome Adults in Bosnia and Herzegovina

Introduction:

The objective of this study was to determine the oral health condition Down syndrome (DS) adults in Bosnia and Herzegovina, by analyzing oral health of Down syndrome individuals in two largest regions, Sarajevo and Tuzla Canton.

Patients and Methods:

Caries and oral health status of 33 Down syndrome adults aged 19-45 years were examined and assessed according WHO 1997 criteria.

Results:

The mean DMFT index is 15,96±8,08. The analysis of oral hygiene of Down syndrome children by using the debris index, is found that 42,4% have very good oral hygiene, 21,2% respondents have good oral hygiene, 27,3% are with poor oral hygiene, while the very poor hygiene have 9,1% subjects. The Value of CPI index is 0,82.

Relationship between periodontal status and degree of visual impairment in institutionalized individuals

Objective:

Periodontal disease is a set of inflammatory infections that affect the supporting structures of the dentition. Patients with visual impairment (VI) may have more difficulty in cleaning and maintaining oral health. The purpose of this study was to investigate the possible relationship between periodontal status and degree of VI in institutionalized individuals.

Materials and Methods:

Fifty-two visually impaired individuals were included in this cross-sectional study. The periodontal parameters assessed were clinical attachment level (CAL), probing depth (PD), and visible plaque index. The degree of VI was established as: Group 1 (mild or moderate VI), Group 2 (severe or profound VI), and Group 3 (completely blind); and the types of VI were considered as congenital and acquired. Fisher's exact, Kruskal–Wallis, Mann–Whitney, and Spearman correlation coefficient test were used. The level of significance was set at 5%.

Result:

Only plaque index was higher on proximal surfaces of subjects with mild/moderate VI when compared to the other degrees of VI (P = 0.01). Furthermore, we observed higher values for interproximal CAL (P = 0.01), total PD (P = 0.04), and interproximal PD in subjects with acquired VI when compared to subjects with congenital VI (P = 0.01).

Conclusions:

These findings suggest that periodontal status may be more related to the type of disability than with the degree of VI. Acquired VI people presented a worse periodontal health than the group with congenital VI.

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.

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

OBJECTIVE

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

METHODS

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

RESULT

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

CONCLUSION

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

Impact of oral health behaviors on dental caries in children with intellectual disabilities in Guangzhou, China

Dental care is consistently reported as one of the primary medical needs of children with disabilities (IDC). The aim of the present study was to explore the influence of oral health behaviors on the caries experience in children with intellectual disabilities in Guangzhou, China. A cross-sectional study was carried out in 477 intellectually disabled children, 12 to 17 years old, who were randomly selected from special educational schools in Guangzhou. A self-administered parental questionnaire was used to collect data on socio-demographic characteristics and oral health behavior variables, and 450 valid questionnaires were returned. Multiple regression analysis was used to examine the factors associated with dental caries. The average age of those in the sample was 14.6 years (SD = 1.3), 68.4% of whom were male, and the caries prevalence rate was 53.5% (DMFT = 1.5 ± 2.0). The factors significantly affecting the development of dental caries in IDC included gender, the presence or absence of cerebral palsy, and the frequency of dental visits and toothbrushing. In conclusion, the presence of cerebral palsy contributed to an increase risk of caries experience in intellectually disabled children, while toothbrushing more than twice a day and routine dental visits were caries-protective factors. Oral health promotion action may lead to a reduction in dental caries levels in IDC.

Oral hygiene and gingival health status of children with Down syndrome in Yemen: A cross-sectional study

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.

Dental caries and periodontal status of mentally handicapped institutilized children

BACKGROUND

Dental caries and periodontal disease are the most prevalent dental disease among mentally retarded children worldwide.

AIMS AND OBJECTIVES

A study was carried out in Jodhpur city of Rajasthan state of India to assess the Dental caries and periodontal Status of Mentally handicapped attending special schools children in Jodhpur city.

MATERIALS AND METHODS

A cross-sectional descriptive survey was conducted in 80 mentally handicapped subjects, attending a Special Needs school in Jodhpur City. Dental caries and Periodontal Status were recorded following the WHO basic oral health survey.

RESULTS

None of the subject had healthy periodontal status, dental caries was found in 79.2% of the subjects, Lymphadenopathy was observed in highest number of subjects 55 (76.3%).

CONCLUSION

Health professionals should therefore be aware of the impact of mental illness and its treatment on oral health, Health personnel should receive training to support and provide all possible services to this population.

The impact of handicap severity on oral and periodontal status of patients with mental retardation

AIM

Mental retardation (MR) subjects comprise a considerable amount of the community and are susceptible to oral and periodontal problems due to insufficient oral care. The aim of this cross-sectional study was to determine the oral health and periodontal status of MR patients in Turkey with regard to periodontal indices and Decay missed filling teeth (DMFT) scores and compare findings according to severity of the MR.

MATERIALS AND METHODS

One hundred and five MR patients were included to the study and divided into 3 groups according to MR severity diagnoses. Demographic variables like age, gender, disabled sibling, BMI, living an institution and clinical parameters like plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), missing teeth and DMFT scores were recorded from all subjects. Appropriate statistical analyses were used to compare the findings.

RESULTS

There were no statistically significant differences between groups according to age, gender, disabled sibling, living status and DMFT scores. Clinical periodontal indices and the number of missing teeth were showed a statistically significant increasing trend with the severity of MR (p < 0.05). Correlation analysis showed significant positive correlations between PI and periodontal disease measures like GI, PD, CAL and BOP and also between PI and DMFT (p < 0.05).

CONCLUSION

The deteriorated teeth condition and deprived periodontal health of MR patients may be most likely caused by the poor oral hygiene and may be worsen with the severity of the MR. Clinical significance: Knowledge of oral and periodontal status of mental retardation patients has great importance for public health and family education.

Oral hygiene and periodontal status of teenagers with special needs in the district of Nalgonda, India

OBJECTIVES

To assess oral hygiene status, oral hygiene practices and periodontal status among 14-17-year-old visually impaired, deaf and dumb, intellectually disabled and physically challenged and normal teenagers in the district of Nalgonda, South India.

MATERIALS AND METHODS

Seven hundred and fifty teenagers in the age group of 14-17 years, constituting visually impaired, deaf and dumb, intellectually disabled, physically challenged and normal teenagers, were studied. Oral hygiene status and periodontal status were assessed using clinical indices and compared.

RESULTS

Among the five groups chosen for the study, the intellectually disabled group had the highest plaque scores and poor oral hygiene. The visually impaired and deaf and dumb had better oral hygiene compared with other disability groups. Physically handicapped showed higher loss of attachment scores and deleterious and parafunctional habits. Normal teenagers had good oral hygiene and lower plaque scores. Oral health status relied basically on proper use of oral hygiene aids and training of the groups by their care takers.

CONCLUSION

Disabled groups showed poor oral hygiene and higher incidence of periodontal disease, which may be attributed to the lack of coordination, understanding, physical disability or muscular limitations. Hence, more attention needs to be given to the dental needs of these individuals through ultimate, accurate and appropriate prevention, detection and treatment.

The impact of dietary and tooth-brushing habits to dental caries of special school children with disability

The daily oral activities may severely influence oral health of children with disabilities. In this survey, we analyzed the impact of dietary and tooth-brushing habits to dental caries in special school children with disabilities. This cross-sectional survey investigated 535 special school children with disabilities aged 6-12 years, 60.93% males, 39.07% females from 10 special schools in Taiwan. Oral examinations were carried out by dentists with a Kappa score of their inter-examiner agreement exceeding 0.8. Data on demographics, diet, and tooth-brushing habits of children with disabilities were collected using a standardized questionnaire completed by parents/caregivers. More than three quarters of the participants were combined with severe or profound disability. Children with profound severity in disability had a higher percentage (67.37%) in teeth-brushing by parents/caregivers compared to those children with mild/moderate severity in disability which had a higher percentage (81.60%) in teeth-brushing by themselves. Children whose teeth were brushed by parents/caregivers had a better dental health, and lower caries prevalence. The main risk factors related to decayed teeth of children with disabilities are frequency of sweets intake, ability to brush teeth and with plaque or not. The dental health education, prevention program and periodical oral check-up to children with disabilities and their parents/caregivers should be reinforced. Brushing skill should be taught to children according to their type, severity and individual characteristics of disability.