Dental caries prevalence and treatment needs of Down syndrome children in Chennai, India

Oral health status in individuals with Down syndrome

Down syndrome (DS) is a neurodevelopmental disorder of known genetic cause, with a wide array of oral and systemic manifestations. The aim of the present study is to determine the level of oral hygiene status and practice of a group of individuals with DS in Benghazi/Libya. In this cross–sectional study 124 individuals were recruited from The Rehabilitation Centre of Special Needs in the city of Benghazi, Libya. Questionnaires were distributed among the attendees, covering oral health aspects and diet habits. Oral examination was conducted to evaluate oral health status among individuals with DS. The data were analysed descriptively and inferentially (including Chi-square test and Fisher’s exact test) using the Statistical Package for Social Science version 20 (SPSS). Most of DS individuals brush their teeth once daily (62%), spending less than one minute in brushing (44%). For diet habits, more than half (55%) eat sweet snacks between meals. For the dental status, 47% of the subject had zero DMFT, followed by score 2 in 21%. The highest percentage in Oral hygiene Index (OHI) was scored 1 by 46% of participants. The zero CPITN score was seen in 54.5%. Our results have shown a weaker tendency of DS towards oral hygiene. This should strengthen our goal of guiding and encouraging parents of individuals with DS to be more cautious in providing help and supervision of their individuals’ practice of oral health care.

Salivary Cortisol as a Stress Monitor During Third Molar Surgery

Background

Procedures in oral surgery, especially surgical extraction of the impacted mandibular third molar is often considered anxiety-producing and stressful. This study evaluated the effect of oral sedation (5 mg diazepam) on the physiological stress level in subjects that underwent surgical extraction of the mandibular third molar by measuring the change in salivary cortisol concentration.

Subjects and methods

204 salivary samples were collected from 102 subjects between 9.00 am and 12.00 pm to standardise the diurnal variations of cortisol secretion. Saliva samples were collected 45 min before and 15 min after surgical extraction from each subject in either group. The samples were stored in the freezer (- 20 °C) until analysis was done in the laboratory using salivary cortisol ELISA kits (DiaMetra S.r.l., Eagle Biosciences, Italy), and the cortisol concentration was measured with a microplate reader.

Results

There was a statistically significant change (p = <0.001 between the pre-surgical extraction salivary cortisol concentration of all subjects with a median of 7 ng/ml and post-surgical extraction salivary cortisol concentration of both the study and the control groups with a median of 17 ng/ml and 15 ng/ml, respectively. Only 11.8% of subjects in the study group had a reduction in post-surgical salivary cortisol concentration, while in the control group, 3.9% of subjects had a reduction in post-surgical salivary cortisol concentration. There was no statistically significant difference between the two groups (p = 0.135).

Conclusions

Hence, oral sedation has no significant impact on physiological stress during the surgical extraction of the mandibular third molar. However, salivary cortisol concentration can adequately reflect the stress induced by surgical extraction in subjects and its usefulness as a biomarker in stress research. Furthermore, the type of disimpaction of mandibular third molar affects salivary cortisol concentration, with distoangular disimpaction having the highest cortisol concentration and more stressful to subjects when compared to other types of disimpaction.

Oral Health Status of Down's Syndrome Patients in Aseer, Saudi Arabia

Introduction:

It was observed that compared to the general population, mentally challenged subjects have higher rates of poor oral hygiene. Gingivitis is a common finding with moderate or severe variety reported most commonly. Periodontal disease is the most significant oral health problem, which can even lead to mobility of tooth and tooth loss. It is essential to generate oral health precautionary agendas and familiarize it with them.

Materials and Methods:

Four Centres of rehabilitation in the Aseer region of Saudi Arabia were included and subjects of 3–24 year age group was examined. Written informed consent was obtained from directors of Centres. Caries, oral hygiene status, soft-tissue and hard-tissue lesions were evaluated and statistically analyzed.

Results:

Higher Decayed, Missing and Filled Teeth score was observed in the present study in contrast to many other studies. Periodontal disease was seen in higher age group with higher percentages. Poor oral hygiene was seen in 27.3% of males and 66.7% of females. Tongue lesions comprised 85.7%, which accounted for the major part of soft-tissue abnormality. Various occlusal abnormalities (75%) and developmental tooth disturbances (53.6%) constitute the higher portion in hard-tissue abnormality.

Conclusion:

Dentists should be conscious of the range of oral anomalies that can manifest in this group of the patients. The microbial or serological investigation was not done which could have explained the etiology behind these lesions. In spite of these confines, the survey result have provided information regarding the oral health status of Down's syndrome subjects and the necessity of focusing on oral health need.

Oral health status among visually impaired schoolchildren in Northeast China

BACKGROUND

Visual impairment is an important disability affecting a substantial proportion of people globally. The aim of this study was to assess the oral health status of visually impaired schoolchildren in northeast China, and to investigate the influencing factors.

METHODS

The study was performed in 2015, according to the criteria and methods used in the Third National Oral Health Epidemiological Survey in China. One hundred and three visually impaired schoolchildren from the only special school for the blind in northeast China were included in the study. Oral examinations were performed to assess the caries of deciduous and permanent teeth, periodontal disease, malocclusion. A questionnaire-based survey was conducted to investigate oral health-related behaviors, knowledge and attitude about oral care.

RESULTS

The overall prevalence of caries was 78.64%, and mean number of caries was 2.43 ± 2.75. The prevalence of caries in deciduous and permanent teeth was 65.22 and 71.84%, respectively. The rates of gingival bleeding and dental calculus were 44.66 and 67.96%, respectively. Malocclusion was observed in 49.51% of the children with visual impairment. The prevalence of caries was significantly higher in girls than boys (P < 0.05). The logistic regression analysis identified the knowledge level of parents and the toothache experience as risk factors for oral health, while the daily use of fluoride toothpaste could reduce the caries incidence.

CONCLUSIONS

This group of visually impaired schoolchildren exhibited a high prevalence of dental caries, poor periodontal health, and severe malocclusion. Oral health status is relatively poor among visually impaired schoolchildren in northeast China. Factors that significantly affected the prevalence of dental caries included education level of the mother, experience of toothache, and use of fluoride toothpaste.

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.

Comparative study of oral health among trisomy 21 children living in Riyadh, Saudi Arabia: Part 2, gingival condition

BACKGROUND

Trisomy 21 (T21) is a congenital disorder characterized by triplication of Chromosome 21 components. Patients with T21 have an increased risk of acquiring periodontal disease due to their inability to maintain good oral hygiene. Consequently, it is important to determine an approach for disease prevention in this population.

AIM

The purpose of the study was to assess the periodontal health, through the prevalence of gingivitis and plaque, among children with T21 living in Riyadh, Saudi Arabia.

SUBJECTS AND METHOD

This study included 93 children with T21 and 99 age- and gender-matched children without T21 between the ages of 7 and 15 years. Parents were informed about the study and provided informed consent. Trained examiners using standardized tools assessed the prevalence rates of gingivitis and plaque in all children.

RESULTS

Gingivitis prevalence was elevated among T21 children (46.9%) compared to controls (34%) in all arch sextants except the mandibular middle (P < 0.01). Comparing the two groups, the prevalence of plaque was higher in the maxillary right sextant of the T21 group and the mandibular middle sextant of the control group (P < 0.05).

CONCLUSION

T21 children have significantly elevated plaque levels, resulting in greater prevalence of gingivitis, compared to healthy children. Preventive measure, such as oral health awareness programs, should be delivered early to parents and continued at school to encourage and motivate children.

A comparative study of oral health amongst trisomy 21 children living in Riyadh, Saudi Arabia: Part 1 caries, malocclusion, trauma

BACKGROUND

Trisomy 21 (T21) is a genetic disorder stemming from a chromosomal abnormality and characterized by general and mental retardation. Depending on the population, T21 is known to affect 1 in every 600-2000 live births. The current literature provides a mixed view on the oral health status of T21 individuals.

AIM

To establish the prevalence of dental caries, malocclusion, and trauma amongst children with T21 compared with non-T21 children in Riyadh, Saudi Arabia.

METHODS

This cross-sectional study recruited non-T21 and T21 children between the ages of 7-15 years who were studying at the Saut Society. After informed consent was obtained from parents and both groups were matched by age and gender, trained examiners screened children at the dental clinic of King Saud University to record the presence of dental caries, malocclusion, and trauma in both groups.

RESULTS

While there was no statistical difference between the two groups with regard to the mean decayed, missing, and filled teeth (DMFT) index (2.66 for T21 versus 3.11 for controls), T21 children had a higher prevalence of incisal fractures compared to the control group (24.73% versus 4.95%, respectively) and that was statistically significant (P < 0.05). There were also highly significant group differences concerning the prevalence of malocclusion. Therein, 45% of T21 children had a Class III incisor relationship compared with 8% of control children, and 50% of T21 children had a Class III molar relationship compared with 8% of control children.

CONCLUSIONS

While there was no significant difference in the incidence of caries between children with and without T21, practitioners should be aware of the disparities in malocclusion and trauma in this vulnerable population.

Association between Dental Caries and Down Syndrome: A Systematic Review and Meta-Analysis

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.

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.

Comparative study between dental caries prevalence of Down syndrome children and their siblings

The purpose of this epidemiological study was to determine the differences in the prevalence of caries between individuals with Down syndrome (DS) and their siblings. A sibling-matched, population-based and cross-sectional survey was performed. This study involved 138 (62%) children with DS and 86 (38%) siblings, aged 2-26. The children were compared in different subgroups: [2, 6], [6, 12], and [13, 26]. Data was gathered through the use of a complete questionnaire and clinical observation. Data analysis was performed by using SPSS® v.18.0 software with any p value <.05 considered as significant. The DS group presented a significantly higher percentage of children within the caries-free group: 72% versus 46% of the siblings group (p < .001). In the age gap [2, 6[the median value of DMFT was the same in both groups (p = .918). In the age gap [6, 12] the median value of DMFT in the DS group was 0 and in the siblings group was 1 (p = .004). In the age gap [13, 26] the median value of DMFT in the DS group was 0, whereas in the siblings group the median value was 3, which constitutes a significantly high difference (p = .003). The results of this study suggest that Portuguese children with DS have lower caries prevalence than their siblings.

The potential use of propolis as a cariostatic agent and its actions on mutans group streptococci

Propolis is a resinous substance made by bees. It possesses many biological activities, and many studies have reported its potential application in the control of dental caries. However, variability in the chemical composition of propolis is a potential problem in its quality control, especially since propolis has already been incorporated into products for oral use. Therefore, a critical analysis of the available data on propolis is warranted. The present review discusses the in vitro and in vivo studies published in the period between 1978 and 2008 regarding the effects of propolis on Streptococcus mutans growth, bacterial adherence, glucosyltransferase activity, and caries indicators. Several investigations carried out with crude propolis extracts, isolated fractions, and purified compounds showed reductions in Streptococcus mutans counts and interference with their adhesion capacity and glucosyltransferase activity, which are considered major properties in the establishment of the cariogenic process. Data from in vivo studies have demonstrated reductions in Streptococcus mutans counts in saliva, the plaque index, and insoluble polysaccharide formation. These findings indicate that propolis and/or its compounds are promising cariostatic agents. However, the variation in the chemical composition of propolis due to its geographical distribution is a significant drawback to its routine clinical use. Thus, further studies are needed to establish the quality and safety control criteria for propolis in order for it to be used in accordance with its proposed activity.