Oral health status of adults with Down syndrome in Hong Kong

The aim of this survey was to study the oral health status of Hong Kong Chinese adults with Down syndrome (DS). Sixty‐five community‐dwelling adults with DS (aged 17 to 42 years, 26.8±6.4) and age‐and gender‐matched contrais attending a dental hospital were included in a cross‐sectional survey. The subjects with DS had fewer filled (2.4±4.6 vs. 2.7±3.1, p=0.017) and fewer decayed (1.1±2.5 vs. 1.7±2.4, p=0.007) teeth than the control subjects. Significantly more peg‐shaped maxillary lateral incisors and retained primary teeth (p<0.001) were observed in subjects with DS, compared to the control subjects. Adults who had DS had a significantly higher percentage of surfaces with detectable plaque (81.5±19.1 vs. 61.9±16.0. p<0.001) and a higher percentage of sites with bleeding on probing (76.3±25.8 vs. 55.6±21.4, p<0.001). A higher proportion of subjects with DS showed one or more occurrences where probing pocket depth was ≥6mm than control subjects (49%vs. 24.5%, p<0.021). In conclusion, while having fewer caries, Hong Kong Chinese adults with DS had poorer periodontal health than age‐ and gender‐matched control subjects.     

Assessment of salivary total antioxidant levels and oral health status in children with Down syndrome

Down syndrome (DS) is an autosomal chromosomal disorder caused by trisomy of all or a critical part of chromosome 21. Individuals with DS have high levels of oxidative stress throughout their lifespan. It has been suggested that levels of antioxidants could be altered in response to an infection or disease. Aim: To assess the total antioxidant capacity (TAC), nitric oxide (NO), and sialic acid (SA) of saliva in children with DS and its relation to their oral health status. Materials and methods: Thirty‐four noninstitutionalized children in the age group of 7–12 years having DS formed the study group. The control group consisted of 34 normal, healthy children. The W.H.O. criteria were used for diagnosis and recording of dental caries. Oral hygiene status was assessed using the simplified oral hygiene index. Estimation of TAC, NO, and SA levels in saliva was done. Data obtained were subjected to statistical analysis. Results: In comparison to normal children, DS children showed significantly lower TAC of saliva and significantly higher salivary SA levels. In both groups of children, dental caries was higher in primary dentition when compared to their permanent dentition.     

Supervised toothbrushing and oral health education program in Kuwait for children and young adults with Down syndrome

The authors report on the effectiveness of a school-based, supervised toothbrushing program among a group of 112 children with Down syndrome in Kuwait. The study involved 45 boys and 67 girls, who ranged in age from 11–22 years (mean, 14.8 years). The participants had moderate mental retardation and attended one of two special needs schools. Plaque was scored according to the Silness and Loe plaque index and gingivitis according to the Loe and Silness gingival index. Supervised toothbrushing and dental health education sessions were conducted twice a week. The program was evaluated at the end of three months. The mean plaque score decreased from 1.93 to 0.95 (p < 0.001), and the mean gingival score from 2.00 to 0.83 (p < 0.001). This three-month supervised toothbrushing program was effective in reducing plaque and gingivitis scores, but the key to long-term success of the program is sustaining the children's motivation to make oral hygiene a part of their daily life.     

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.     

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.     

Use of children''s oral health services in Finland with special reference to heavy consumption

The consumption of oral health services among 4-16-yr-old children in Finland is described, including an analysis of heavy consumption. Data representative of all Finnish children were collected for 4518 children from municipal health centers and homes. The response rate was 85%. Children with orthodontic visits during the year were excluded from the analyses. Of the preschoolchildren 12% and of the school-age children 4% did not use any oral health services during the studied year. Non-users did not differ from the others in terms of socioeconomic status, distance to a health center or type of residential area. Public oral health services were used very unevenly. Half of the children consumed only one-fifth of the services and the next one-third used about one-third of the services. The heavy consumers, about one-fifth of the total, used as much as half of all the services. Among preschoolchildren, the heavy consumers were mainly from lower socioeconomic groups. In contrast, no clear predictive factors were found for heavy consumption among the schoolchildren. Heavy consumers had more both treated and untreated caries than the other children did. Their treatment was mainly restorative; at least half of them did not receive adequate preventive care. Finnish public oral health care clearly should make more efforts to ensure that heavy consumers of dental services do not remain so.     

The oral health of children of dentists

ABSTRACT – In order to assess the long term effect of dental health education, the gingival state and dental conditions of 68 dentists' children aged 11.4 ± 3.4 years were compared with those of their age- and sex-matched classmates from (a) parents with anoUier academic education of corresponding length, and (b) parents with no academic or high school education. A tendency for bleeding of the gingival margins at pressure was observed most often in children with non-academic parents and was least frequent in dentists' children. The reported frequency of toothbrushing being the same in all three groups, it was suggested that the efficacy of the brushing among the dentists' children must be superior to that of the others. Also the DMF scores were found to be lowest in the group of dentists' children. The non-academic children correspondingly presented the lowest frequency of intact first molars. The study confirmed the already accepted view that the educational level of the parents correlates positively with the dental health of their children. The finding that dentists' children are even better off than children of other academic parents was concluded to justify an intensification of dental health education in future dental care.     

Psychoprophylaxis for oral conscious sedation for dental care in Down syndrome adults with behavioral disorder

Down syndrome (DS) presents with prevalent diseases in the oral cavity and the need of constant dental care and follow‐up. The use of conscious sedation (CS) for dental care in adult DS with behavioral disorders is poorly documented. The aim of this study was to evaluate the effectiveness and safety of CS procedures with oral midazolam using previous psychoprophylaxis sessions in DS adult patients with behavioral disorders. Methods: Twenty‐nine DS adults with behavioral disorders. The patients were managed with psychoprophylaxis followed by oral CS using 15 or 30 mg midazolam. Vital parameters were monitored. The Houpt and Brietkopf and Buttner scales were used. Results: Patients under CS received an initial dose of 15 mg midazolam; however, 51.72% needed a 30 mg dose at the following sessions. Results showed that 71.4% treated with the 15 mg dose had Houpt scale overall behavior scores of 4 or 5, while 93.33% of those receiving 30 mg had scores of 5 or 6 (chi‐square = 15.95 p < .01). Conclusion: Psychoprophylaxis sessions followed by CS procedures using oral midazolam in adult DS with behavioral disorders were shown to be a useful strategy to perform routine dental treatment safely. Midazolam produces anterograde amnesia, and participants were more cooperative in the following visits.     

The impact of HIV on oral health and subsequent use of dental services

OBJECTIVE: This study examined differences in health and access to dental services among a nationally representative sample of patients with HIV using Andersen's Behavioral Model of Health Services Use. METHODS: This investigation is a longitudinal study that used structural equation modeling to analyze data from the HIV Cost and Services Utilization Study, a probability sample of 2,864 adults under treatment for HIV infection. Key predisposing variables included sex, drug use, race/ethnicity, education, and age. Enabling factors included income, insurance, and regular source of care. Need factors included mental, physical, and oral health. Dependent variables included whether a respondent utilized dental services and number of visits. RESULTS: More education, dental insurance, usual source of dental care, and poor oral health predicted a higher probability of having a dental visit. African Americans, Hispanics, those exposed to HIV through drug use or heterosexual contact, and those in poor physical health were less likely to have a dental visit. Of those who visited dental professionals, older persons, those with dental insurance, and those in worse oral health had more visits. African Americans and persons in poor mental health had fewer visits. CONCLUSIONS: Persons with more HIV-related symptoms and a diagnosis of AIDS have a greater need for dental care than those with fewer symptoms and without AIDS, but more pressing needs for physical and mental health services limit their access to dental services. Providers should better attend to the oral health needs of persons with HIV who are in poor physical and mental health.     

Comparison of oral health status of young persons from Dunedin, New Zealand, and Heidelberg, Australia

This study compared the oral health status of 600 6-16-yr-old young persons: 297 from Heidelberg, Victoria, Australia (an area of recent water fluoridation and a predominantly marketplace delivery system) and 303 from Dunedin, New Zealand (an area with established water fluoridation and a long-standing school based public delivery system). A greater proportion of Heidelberg subjects, in each of three age groups, were caries free. Level of dental plaque varied both with study area and with age group. Dunedin subjects in the younger age groups had lower mean levels of plaque than their Heidelberg peers. The New Zealand dental service delivery system was consistently closer, in each age group, to meeting defined dental needs than the Australian system. The similarities and contrasts between this study and the WHO-ICS illustrate the importance for planners to consider carefully differences in local conditions which may affect service and morbidity projections.     

A comparison of salivary IgA in children with Down syndrome and their family members

The aim of this study was to compare total IgA in the whole saliva of children with Down syndrome with levels in sibling and parent groups. IgA measurements were presented as the concentration in saliva (μg/ml) and also adjusted for salivary flow rate (SFR; μg/min). Twenty children with Down syndrome, ten siblings and twenty parents were recruited. Stimulated whole saliva was collected from the participants and SFR calculated. The measurement of salivary IgA (sIgA) was carried out using an indirect competitive Enzyme-Linked Immunosorbent Assay. The difference in the mean SFR between children with Down syndrome, parents and siblings were not statistically significant. The mean salivary concentration of IgA was higher in children with Down syndrome (95.1 μg/ml) compared with siblings (48.3 μg/ml; p = 0.004). When adjusted for SFR children with Down syndrome had mean sIgA levels of 98.8 μg/min and the siblings 48.6 μg/min (p = 0.008). The children with Down syndrome had sIgA levels similar to those of the parents (92.5 μg/ml; 93.2 μg/min). There was a positive correlation between age and sIgA concentration in the siblings (p = 0.008) but not for children with Down syndrome (p = 0.363). This suggests that under similar environmental influences, the levels of sIgA in children with Down syndrome are higher than in the siblings, from a very young age.     

Policy and research in oral health care

The purpose of the paper is to highlight the interrelationship between social and health policy, and health services research. The principles and concepts in social and health policy in the Scandinavian welfare states are described with reference to oral health care. The concept of policy analysis is defined and distinctions are made between "analysis of policy", and "analysis for policy". The policy perspective is discussed with the focus on the planning - budgeting - implementation - evaluation cycle and related to the WHO Strategy for Health for All. Finally, the implications for oral health services research in Scandinavia are emphasized.     

Oral health status and reasons for not attending dental care among 12- to 16-year-old children with Down syndrome in special needs centres in Jordan

To cite this article:
Int J Dent Hygiene 10 , 2012; 259–264
DOI: 10.1111/j.1601‐5037.2012.00545.x Al Habashneh R, Al‐Jundi S, Khader Y, Nofel N. Oral health status and reasons for not attending dental care among 12‐ to 16‐year‐old children with Down syndrome in special needs centres in Jordan. Abstract: Objectives: The objective of this study was to assess oral health status, treatment needs, soft and hard tissue findings, as well as reasons for not attending dental care among children with Down syndrome (DS) registered in special needs centres in Jordan. Methods: The sample consisted of a total of 206 participants with a mean age of 13.66 ± 1.47 comprising 103 with DS and 103 age‐ and gender‐matched non‐DS/public school children. Clinical levels of oral hygiene were assessed using Simplified Oral hygiene index, and caries detection was carried out according to WHO caries recording criteria. Results: Children who had DS had a significantly higher percentage of surfaces with severe gingival index (39.9 ± 9.1 versus 15.9 ± 8.0, P < 0.001) and a higher mean of probing pocket depth than children without DS (2.27 ± 0.2 versus 1.81 ± 0.32, P < 0.000). Significantly more peg‐shaped maxillary lateral incisors and retained primary teeth (P < 0.001) were observed in subjects with DS, compared with non‐DS children. Average decayed, missing and filled teeth (DMFT) was significantly lower in male children with DS compared with male non‐DS children only (P = 0.034). The most common reason cited for not taking children to the dentist for DS group was ‘Not aware of the dental problems of their children’ and for non‐DS groups ‘No awareness of the importance of dental visit’ (61.2% and 53%, respectively). Conclusions: While having similar caries level, Jordanian teenagers with DS had more dental anomalies, poorer periodontal health and less dental attendance than age‐ and gender‐matched non‐DS/public school children.     

Medical problems and oral care of patients with Down syndrome: a literature review

When planning the dental treatment of patients with Down syndrome (DS), dental practitioners should always consider their general health, in order to achieve a holistic and interdisciplinary approach. This article presents a literature review of the primary medical conditions in patients with DS that may affect their general health care and the appropriate clinical delivery of oral health care.     

Epidemiologic oral health survey of Argentine children

Abstract An epidemiologic oral health survey of 2279 children aged 7–8 and 12–13 was carried out in eight different regions of Argentina using methods and criteria recommended by the WHO. The children examined lived in rural or urban areas and were of Caucasian or Amerindian extraction. Periodontal status showed that 75% of this population had soft deposits, while calculus and gingivitis increased with age. Calculus: 0.4 at 7 yr to 16.1 at 13: gingivitis: 2.7% at 7 yr to 27.2% at 13. At age 8, the mean number of DMF per child was 3.9. The percentage of caries-free children with permanent dentition dropped from 60% at age 7 to 32% at age 13. In Amerindian children, all these parameters were higher. Both the mean DMF and DMF per child were substantially lower in natural fluoride areas than in non-fluoride areas. Data from this first nationwide epidemiologic study in this country provide baseline data for further investigations. According to the data obtained in this study, Argentine regions may be classified as high, medium or low risk areas, although a lack of adequate dental care was found in all regions. With these risk priorities as a guideline, we propose an initial strategy consisting of a carefully planned and selective program of primary dental health care.