Dental caries experience, oral health status and treatment needs of dental patients with autism

Objectives

Autism is a lifelong neurodevelopmental disorder. The aims of this study were to investigate whether children with autism have higher caries prevalence, higher periodontal problems, or more treatment needs than children of a control group of non-autistic patients, and to provide baseline data to enable comparison and future planning of dental services to autistic children.

Material and Methods

61 patients with autism aged 6-16 years (45 males and 16 females) attending Dubai and Sharjah Autism Centers were selected for the study. The control group consisted of 61 non-autistic patients chosen from relatives or friends of autistic patients in an attempt to have matched age, sex and socioeconomic status. Each patient received a complete oral and periodontal examination, assessment of caries prevalence, and caries severity. Other conditions assessed were dental plaque, gingivitis, restorations and treatment needs. Chi-square and Fisher''s exact test of significance were used to compare groups.

Results

The autism group had a male-tofemale ratio of 2.8:1. Compared to controls, children with autism had significantly higher decayed, missing or filled teeth than unaffected patients and significantly needed more restorative dental treatment. The restorative index (RI) and Met Need Index (MNI) for the autistic children were 0.02 and 0.3, respectively. The majority of the autistic children either having poor 59.0% (36/61) or fair 37.8% (23/61) oral hygiene compared with healthy control subjects. Likewise, 97.0% (59/61) of the autistic children had gingivitis.

Conclusions

Children with autism exhibited a higher caries prevalence, poor oral hygiene and extensive unmet needs for dental treatment than non-autistic healthy control group. Thus oral health program that emphasizes prevention should be considered of particular importance for children and young people with autism.     

Oral health in Hlabisa, KwaZulu/Natal--a rural school and community based survey

AIMS: To investigate rates of dental caries and periodontal disease, available dental services and resources and perceived needs in a rural South African community. DESIGN: A cross-sectional field study including situational analysis and focus group discussions. SETTING: KwaZulu/Natal, South Africa. PARTICIPANTS: A total of 520 children, adolescents and adults. METHODS: WHO caries scores and periodontal CPI score were determined through clinical examinations in five age groups, 5-6 years, 12 y, 15 y, 35-54 y, 55 y+. Focus groups included ten 15-year-old children and ten adults. RESULTS: Caries prevalences and (mean scores) were 5-6 y 64% (dmft 3.0), 12 y 24% (DMFT 0.4), 15 y 27% (DMFT 0.8), 35-54 69% (DFT 2.6) and 55 y+ 80% (DFT 2.7). Most caries was untreated and where present, treatment had been extraction. Dental caries rates were low and except for 5-6 y were within WHO targets for the year 2000. Periodontal disease prevalence was high but would respond to improved oral hygiene. Knowledge of oral health was rudimentary. CONCLUSIONS: A district-wide oral health promotion programme is required preceded by research to define effective health education messages. Access to simple but effective preventive and curative services would seem reasonable. In view of the lack of resources ART is suggested as caries treatment.     

Oral health status and treatment needs in institutionalized psychiatric patients: one year descriptive cross sectional study.

BACKGROUND AND OBJECTIVES: Psychiatric patients are one of the special groups requiring attention as they are often neglected. Oral health is an major determinant of general health for psychiatric patients and may have a low priority in the context of mental illness. The present study was conducted to assess the oral health status and treatment needs of institutionalized psychiatric patients of Davangere. METHODS: 220 psychiatric patients admitted in two general hospitals of Davangere during the period of one year were included in the study. The oral health status was evaluated with respect to caries, oral hygiene, and periodontal status. RESULTS: Of the 180 examined with the response rate of 81.8%. 58.3% were males, mean age was 36.7 years, 57.8% had < 1 year of mental illness with a mean of 2.2 years, and 90% were self-sufficient. The multiple logistic regression analysis showed that the mean DMFT (0.92) increased with age, duration of mental illness, and irregularity of oral hygiene habits (P<0.001). Mean OHI-S score was 3.3 and multiple logistic regression analysis showed that the mean OHI-S score increased with age (P<0.001). The multiple logistic regression analysis showed that the CPI score increased with age, duration of mental illness, and degree of helplessness (P<0.001). INTERPRETATION AND CONCLUSION: The findings of this study demonstrates low caries prevalence, poor oral hygiene, and extensive unmet needs for dental treatment.     

Oral health status and practices of dentate Bhil adult tribes of southern Rajasthan,India

Aims : To assess the oral health status of the Bhil tribal population of Southern Rajasthan and to investigate the association of age, oral hygiene and dental visiting practices with oral health status. Design : A cross sectional study of Bhil tribal adults chosen by a multi stage stratified random sampling procedure. Participants : The total sample size was 1,590 male tribal dentate subjects aged 15–54 years. Methods : Clinical recordings of oral hygiene status (OHI ‐ S), caries status (DMFT and DMFS) and treatment needs, and periodontal status (CPI). The Chi square test was applied to discrete data and one way ANOVA for continuous data. Multivariate analyses were carried out to test the association of age, frequency of cleaning teeth, material used for cleaning teeth and dental visiting habits with caries and periodontal status. Results : Debris, calculus and oral hygiene index scores increased with age. The overall mean DMFT and DMFS scores were 5.34±6.48 and 18.94 ± 35.87 respectively. Extraction was the most required treatment (1.74 ± 3.66 teeth) followed by one surface fillings (1.34 ± 1.65 teeth). Shallow periodontal pockets were prevalent (40%) among the 35–44 years age group whereas deep pockets were most common (11.6%) in the oldest age group. More than half the sextants (3.15) were excluded amongst the oldest study group. All the independent variables namely age, frequency of cleaning teeth, substance used for cleaning teeth and visiting habits were statistically significantly related to caries and periodontal status. Conclusions : The study population was characterised by a lack of previous dental care, high treatment needs, high prevalence of periodontal disease and poor oral hygiene. Under these circumstances, the implementation of a basic oral health care programme for the Bhil population is a high priority.     

Dental study of handicapped children attending special schools in Birmingham, UK

The prevalence of dental caries, the levels of oral hygiene and the periodontal treatment requirements were assessed in 3562 handicapped children and 1344 randomly selected normal children attending schools in Birmingham, UK. The effect of different types of handicapping condition on these parameters was also evaluated. This investigation showed that there were few differences in caries prevalence when comparing handicapped children with children attending normal schools. However, the provision of dental care showed significant differences, with the handicapped children receiving less restorative treatment. There were also significantly poorer levels of oral hygiene and a greater prevalence of periodontal disease in the handicapped children attending special schools. The type of handicapping condition had a significant effect on the periodontal problems observed; those children with mental retardation having the poorest levels of oral hygiene and the greatest periodontal treatment requirements.     

Oral manifestations in a group of adults with autism spectrum disorder

Objective: A number of studies have evaluated the oral health of patients with autism spectrum disorder (ASD), though most have involved children, and no specific oral manifestations have been described. The present study describes the buccodental disorders and hygiene habits in a group of adults with ASD. Study Design: A prospective case-control study was made of a group of patients with ASD (n=30), with a mean age of 27.7±5.69 years, and of a healthy age- and gender-matched control group (n=30). An evaluation was made of the medical history, medication, oral hygiene habits and oral diseases, with determination of the CAOD, CAOS and OHI-S oral hygiene scores. Results: Most of the patients in the ASD group used two or more drugs and were assisted in brushing 2-3 times a day. The most frequent manifestations were bruxism, self-inflicted oral lesions and certain malocclusions. The CAOD and CAOS scores were significantly lower than in the controls. Conclusions: Adults with ASD and assisted dental hygiene presented fewer caries than the non-disabled population. However, bruxism, ogival palate and anterior open bite were frequent in the patients with ASD. Key words:Autism spectrum disorder, caries, dental hygiene, oral manifestations.     

Caries levels, Streptococcus mutans counts, salivary pH, and periodontal treatment needs of adult Down syndrome patients

The prevalence of dental caries and periodontal treatment needs in an institutionalized Down syndrome (DS) population was examined as well as the relationship between caries prevalence, salivary pH and salivary levels of Streptococcus mutans. Twelve patients with DS, aged 20 to 48, were compared with two similar age and gender control groups: healthy, and non-Down institutionalized mentally retarded patients. The pH levels did not differ significantly among the three groups. As to periodontal needs expressed by the CPITN, the institutionalized groups had the highest needs compared with the healthy group. Down adults, who were cariesfree, had significantly lower S . mutans counts compared with the patients with caries. In addition, the cariesfree patients with DS had much lower CPITN scores compared with the patients with caries .     

Dental health and treatment needs in institutionalized psychiatric patients in Italy

Abstract The caries prevalence, oral hygiene status, periodontal health and the treatment needs were assessed in a group of institutionalized psychiatric patients in Catanzaro, Italy. Of the total sample of 297 subjects, 165 (55.6%) were males, the mean age was 55.1 yr, the great majority (90.6%) was able to care for themselves, on average they had been institutionalized for 12.9 yr, and almost two-thirds were schizophrenic (65%). They did not receive any assistance in daily oral hygiene procedures, only 7.4% had visited a dentist and exclusively for emergency care. A total of 33 (11.1%) patients were edentulous, and the multiple logistic regression analysis showed a highly significant increase of edentulousness with increasing age (P < 0.001). No caries-free subjects were found and among the dentate the DMFT and DMFS scores for all age groups were respectively 15.5 and 88.6. The stepwise linear regression analysis showed that the mean DMFT index increased with age (t = 6.86; P < 0.00l), and in the partly or totally helpless patients it was significantly higher than in the self-sufficient patients (1=2.78; P= 0.006). Of the 264 dentate subjects, only 25 (9.5%) had no need of dental treatment: 213 (80.7%) required extractions with a mean number per person of 6.3 and the need for conservative dental care was recorded in 154 (58.3%) patients with a mean need for patient of 2.8. Mean OH1-S score was 4.2 and the stepwise linear regression analysis showed that it increased with age (t = 5.73; P < 0.01) and with the length of institutionalization (t =3.42; P < 0.001). Only 0.9% of the entire sample was found with healthy periodontal tissue; bleeding on probing or a higher score was found in 4.6% of examined sextants; calculus in 10.1%; shallow pockets and deep pockets in 19.6%. and 64.8% of all sextants. The results of the multiple logistic regression analysis indicated that the number of subjects with deep pockets as highest score increased with increasing age (P < 0.001), and with the increasing length of institutionalization (P=0.005). The findings of this study demonstrate high caries prevalence, poor oral hygiene and periodontal health, and extensive unmet needs for dental treatment. More coordinated efforts between the social and dental care sector must be maintained to serve adequately the need of this disadvantaged group.     

Effect of controlled oral hygiene procedures on caries and periodontal disease in adults

Abstract The present report describes the result of a clinical trial in which a group of adults have been maintained on a proper oral hygiene standard over a 6-year period. In 1971–72, 375 individuals were recruited to a test group and 180 to a control group. During the 6 years of trial, 65 persons from the test group and 34 controls were lost. The patients were divided into three age groups; I <35 years, II 36–50 years, III >50 years. The members of the test and control groups were first subjected to a Baseline examination which included assessments of oral hygiene, gingivitis, periodontal disease and caries. Following this examination all caries lesions were treated and ill-fitting dental restorations adjusted. Each patient was also given a detailed case presentation and a dental prophylaxis. The control group patients were not involved in any further dental health programs during the subsequent 6-year period. Once a year, however, they were recalled to a public dental health clinic for examination and received symptomatic dental treatment. The test group participants, on the other hand, were given a preventive treatment, repeated once every 2–3 months which included (1) instruction and practice in oral hygiene techniques and (2) meticulous prophylaxis. The patients were re-examined 3 and 6 years after the baseline examination. At the Follow-up examinations the parameters studied at the Baseline examination were recorded again. The findings demonstrated that a preventive program which stimulates individuals to adopt proper oral hygiene habits may resolve gingivitis and prevent progression of periodontal disease and caries. Traditional dental care, on the other hand, did not prevent the progression of caries and periodontitis in adults.     

Age, degree of mental retardation, institutionalization, and socioeconomic status as determinants in the oral hygiene status of mentally retarded individuals

Oral hygiene has been implicated as a causal factor in the development of dental caries and periodontal disease in mentally retarded individuals. Little attention, however, has been given to the determinants of oral hygiene status. The present paper assesses the oral hygiene status of institutionalized (I) and noninstitutionalized (NI) mentally retarded (MR) individuals aged 4 through 25, in relation to age, degree of mental retardation, and socioeconomic status. Institutional status was found to be a major determinant in oral hygiene conditions of the study group, as IMR individuals had significantly higher OHI scores than NIMR individuals. Associations of age and OHI were significant only for NIMR. Although differences between land NI groups, with respect to degree of mental retardation, were seen for mildly, moderately, and severely retarded, no significant difference in OHI scores between I and NI profoundly retarded was seen. Socioeconomic status was not found to be a significant factor in the oral hygiene status of MR individuals. This study emphasizes the need to assess age, degree of mental retardation, and institutional status when implicating oral hygiene in caries and periodontal disease prevalence in MR individuals.     

Effect of controlled oral hygiene procedures on caries and periodontal disease in adults

Abstract The present investigation was carried out to determine if the occurrence of caries and the progression of periodontitis can be prevented in adults, and maintained at a high level of oral hygiene by regularly repeated oral hygiene instructions and prophylaxis. An attempt was also made to study the progression of dental diseases in individuals who received no special oral hygiene instruction but regularly received dental care of a traditional type. Two groups of individuals from one geographic site were recruited in 1971-72 for the trial; 375 were assigned to a test and 180 to a control group. A baseline examination revealed that the socio-economic status, the oral hygiene status, the incidence of gingivitis and the caries experience were similar among the test and control participants prior to the start of the study. During the subsequent 3-year period, the control patients were seen regularly once a year and given traditional dental care. The test group participants, on the other hand, were seen once every 2 months during the first 2 years and once every 3 months during the third year. On an individual basis they were instructed in a proper oral hygiene technique and given a careful dental prophylaxis including scaling and root planing. Each prophylactic session was handled by a dental hygienist. A re-examination was carried out towards the end of the third treatment year. The results of the trial clearly showed that it is possible, by regularly repeated tooth cleaning instruction and prophylaxis, to stimulate adults to adopt proper oral hygiene habits. The findings also demonstrated that persons who utilized proper oral hygiene techniques during a 3-year period had negligible signs of gingivitis, suffered no loss of periodontal tissue attachment, and developed practically no new carious lesions. The control patients, who during the same period received merely symptomatic treatment, suffered from gingivitis, lost periodontal tisssue support and developed several new as well as recurrent, carious lesions. These results indicate that dental treatment is a highly ineffective means of curing caries and periodontal disease.     

Oral health of homeless adults in Stockholm, Sweden

The aim of the present study was to record and describe the oral condition of homeless adults in Stockholm, Sweden. There have been no clinical studies of the oral health of the homeless in Sweden since the 1970s. The study population comprised 147 homeless individuals (110 M, 37 F) in the age range 22-77 years. All underwent oral examination, including registration of periodontal status and caries data. The results show that homeless adults in Stockholm have fewer remaining teeth than the general population. Because conservative periodontal treatment is expensive and time-consuming, teeth with doubtful prognoses are usually extracted and only those with optimal periodontal health are retained. Another consequence of inadequate periodontal treatment, including insufficient oral hygiene instruction, is the high percentage of tooth surfaces with plaque accumulation. Heavy plaque accumulation will also have an effect on caries progression, expressed in this study as high DMFT values. Loss of teeth is likely to create dental and chewing problems, possibly resulting in increased dental and medical treatment needs.     

Salivary antioxidants and oral health in children with autism

Individuals with autism vary widely in abilities, intelligence, and behaviours. Autistic children have preferences for soft and sweetened food making them susceptible to caries. A wide spectrum of medical and behavioural symptoms is exhibited by children with autism, which makes routine dental care very difficult in them. Mental retardation is evident in approximately 70% of individuals with autism and most psychiatric disorders including autism are associated with increased oxidative stress.ObjectivesTo evaluate the oral health status of children with autism and to determine the salivary pH and total salivary antioxidant concentration (TAC).Materials and methods101 subjects with autism between age group of 6 and 12 year were part of the study and 50 normal healthy siblings of same age group were taken as control group. Oral health status was analysed using oral hygiene index-simplified and dentition status index. The salivary total anti-oxidant level was estimated using phosphomolybdic acid using spectrophotometric method and the salivary pH using the pH indicating paper. The results were statistically analyzed using Mann–Whitney U test.ResultsA statistically very highly significant difference was seen in the mean oral hygiene index scores (autistic group – 1.2 and control group – 1, P < 0.001) and the mean salivary total antioxidant concentration (autistic group – 5.7 μg/ml and control group – 38 μg/ml, P < 0.001). No statistical significant difference was observed in the dental caries status and the salivary pH of autistic group and the control group.ConclusionsSimilar dental caries status was observed in children with autism and their healthy normal siblings. Oral hygiene was poor in children with autism whereas the Salivary TAC was significantly reduced in autistic children.     

Special oral hygiene and preventive care for special needs

Many dental patients have special preventive needs related to dental caries and periodontal disease, and most patients with intellectual or physical disabilities have specialized needs. This article suggests that these needs often go overlooked. To best care for patients with these needs, the dental practitioner should identify special oral hygiene needs among his or her patients, provide them with oral hygiene instruction and implement the specific oral hygiene preventive and treatment procedures described here.     

Dental status of patients with mental disorders in a Nigerian teaching hospital: a preliminary survey

Although individuals with mental disorders are reported to experience dental problems similar to the general population, evidence suggests they actually have higher risks of dental disease and increased oral health needs. This study describes the dental status of 105 psychiatric outpatients in a Nigerian hospital. Information was obtained from subject interviews, medical records, and an oral examination to determine their dental caries and periodontal disease status. The oral hygiene status of the study participants was poor; the mean oral hygiene index score was 2.7 ± 1.20. The decayed, missing, and filled teeth ranged from 0 to 9 with a mean of 2.3 ± 2.28. Only five subjects (4.9%) had restorations and the mean number of filled teeth was .14 ± .67. The subjects’ age was significantly related to the mean oral hygiene score (p= .005), the mean gingival score (p= .006), and caries occurrence (p= .047). The oral health status of psychiatric patients in Nigeria is poor, indicating the need to provide oral health education and increase access to dental care for these patients.     

An epidemiologic survey of oral health in Swaziland

An epidemiologic survey of oral health was conducted on 480 schoolchildren and 400 adults in Swaziland. Age groups 7, 14, 20-24 and 35-44 were selected, and nine sampling sites were chosen in various parts of the country. Oral hygiene was generally poor, visible soft deposits being prevalent in all age groups and calculus in adults. Advanced periodontal disease was present in most people over 35 years of age, and intense gingivitis was widespread in all age groups. Dental caries was found to be a common problem, affecting practically every person, in many cases quite severely. There was a tendency towards accumulation of the disease in children. Some geographic variation was found in the prevalence and severity of dental caries and periodontal disease. An additional sample of privileged children was examined, and among these children 14-year-olds showed significantly higher DMFS values than their age mates in the rest of the country. Tooth defects, including fluorosis, and oral mucosal diseases did not seem to constitute severe problems of oral health in Swaziland. On the basis of these data a public dental health program has been initiated which emphasizes prevention.     

Oral health status and dental needs of autistic children and young adults

Aim: Children with autism might need more dental care than non‐autistic, healthy children. The aims of this study were: (a) to describe the caries experience and treatment needs of autistic children aged 6–16 years in the United Arab Emirates; and (b) to provide baseline data at national and regional levels to enable comparisons and future planning of dental services for children with autism. Methods: All children attending a day centre in Sharjah, United Arab Emirates, for autism were selected for the study. Sixty‐one autistic children aged 6–16 years (45 males and 16 females) were included in the study. Each patient received a complete oral and periodontal examination using codes and criteria as described by the World Health Organization. Results: The overall mean for Decayed, Missing, and Filled Teeth/decayed, missing, and filled teeth was 2.4. Female autistic children had significantly higher mean Decayed, Missing, and Filled Teeth/decayed, missing, and filled teeth scores (4.4) than males (1.63). The percentage of decayed, missing, and filled teeth increased with increasing age. The restorative index and met need index for the autistic children aged 11–15 years were 0.02 and 0.10, respectively. Conclusion: Effective oral health promotion strategies need to be implemented to improve the oral health status of autistic children.     

Oral health of children with attention deficit hyperactivity disorder

This study assessed and compared oral health and oral‐health behaviours among children with and without attention deficit hyperactivity disorder (ADHD). The study included 31 children, 12–18 yr of age, with ADHD and 31 age‐ and gender‐matched children without ADHD. Clinical data were recorded by a trained and calibrated examiner for caries, traumatic dental injuries, periodontal health, tooth wear, and salivary function. A questionnaire was also given to parents or caregivers about the oral health habits and behaviours of these children. Data were compared using Mann–Whitney U‐tests and chi‐square tests. No significant differences were found between children, with or without ADHD, in caries extent or prevalence, dental trauma prevalence, prevalence of periodontal disease or plaque, tooth wear, or unstimulated salivary flow. Children with ADHD had a significantly higher percentage of sites with gingival bleeding, as well as a higher frequency of parent‐reported dislike of dentists, bruxism, history of assisted toothbrushing, and toothbrushing duration <1 min. They also had higher attendance at government dental clinics. The findings indicate that children with ADHD have poorer oral hygiene and more adverse oral‐health attitudes and behaviours than do children without ADHD.     

The effect of dental education and dental treatment on the dental status of a handicapped population: a longitudinal study

Thirty-nine patients, aged 3 to 22, who have handicapping conditions were examined twice in a range of 1 1/2 years to determine oral hygiene level, periodontal treatment needs, and level of caries. During this period, each patient was given periodontal treatment, including scaling, caries treatment, and oral health education, which also was given to hospital staff members. Findings showed a slight increase in the DMF rate, a minor improvement in oral hygiene, and a significant reduction in periodontal treatment needs. The results showed that without cooperation of the staff members, a dental education program would not succeed in this setting.     

The condition of the stomatognathic system in children with gluten-dependent coeliac disease

Stomatological examination was carried out of 38 children with coeliac disease. The condition of teeth with regard to caries was better than in children without coeliac disease. Occlusal abnormalities were noted in one-third of patients, in one-third of children with mixed teeth the dental age was delayed in relation to calendar age. No periodontal and mucosal changes were observed. The state of oral hygiene was estimated as good.