Comparative study of oral health status of mentally sub-normal, physically handicapped, juvenile delinquents and normal children of Bombay.

Prevalence study on dental caries and periodontal disease carried out in 94 mentally subnormal, 92 physically handicapped, 74 juvenile delinquents and 206 normal children (11-14-year-old) revealed high prevalence of periodontal disease in handicapped (95 to 100%) and low in normal children (54.37%). The point prevalence of dental caries was higher in normal children (84.9%, DMFS 6.19) followed by juvenile delinquents (75.67%, DMFS 4.3), physically handicapped (73.91%, DMFS 4.3) and mentally subnormal (64.9%, DMFS 4.48).     

A survey of complete denture prosthetics for the elderly, the handicapped and difficult patients.

A survey was carried out to establish information on the facilities and management of the elderly and the handicapped and to evaluate the treatment of the difficult edentulous patient in general dental practice. A postal questionnaire was sent to a total of 1090 dentists in three regions of England and Wales. There was a 50.4% response. Ninety-nine per cent of practitioners were able to treat the ambulant elderly, whereas only 72% offered treatment if the patient was wheelchair dependent. Ninety-six per cent of all respondents undertook domiciliary visits. All practitioners provided prosthetic treatment (complete and partial dentures) for the elderly, whereas fewer felt able to treat the physically and the mentally handicapped. There was less conservative and periodontal treatment provided than prosthetic treatment. A similar pattern was obtained in all three regions. Forty-seven per cent preferred to treat difficult complete denture patients privately, 44% under the NHS and 6% not at all. There were regional variations in the referral patterns of these difficult denture cases. The majority of respondents considered that there should be more opportunities for postgraduate education in prosthetic dentistry.     

Caries, oral hygiene and periodontal disease in handicapped adults

Caries, periodontal disease, oral hygiene and treatment needs were assessed in a group of handicapped adults. The study group comprised 199 individuals aged 17-64 yr, most of whom were mentally subnormal. The mean DMFT values ranged from 17.4 in the 17-24-yr-old age group to 26.9 in the 55-64-yr-old age group. Tooth loss increased rapidly with advancing age. In all age groups the F component was less than 20% and high numbers of untreated carious lesions were found. Of the group studied, 90% needed some conservative treatment. Oral hygiene was poor and a high prevalence of periodontal disease was found. Of the dentulous persons, 49% needed scaling and 34% complex periodontal treatment. The percentage of study group patients requiring dental treatment was very high, so that it can be concluded that dental care for the handicapped is insufficient. This situation must be improved and a suitable system for the delivery of preventive measures must be devised for this group of the population.     

Malocclusions in physically and/or mentally handicapped children

The purpose of this work was to study the morphological characteristics of dental occlusion in groups of physically and/or mentally handicapped children, taking into consideration the need of a detailed classification of medical diagnosis and degree of mental capacity. The material consisted of physically handicapped children with normal intelligence, including the subgroups Cerebral palsy and Others (other medical diagnoses), and severely mentally retarded children with or without a physical handicap, including the subgroups Down's syndrome, Cerebral palsy and Others. Totally 115 children (3-17 years) were studied with respect to occlusion, space conditions, hypodontia and received orthodontic treatment, and compared to matched control groups of healthy children. The severely mentally retarded children in all of the handicap groups had the highest prevalence of, and often the most severe, malocclusions compared to their controls. The results indicate that the mental status is more important for the orthodontic status than the medical diagnosis.     

The organisation of dental care for groups of mentally handicapped persons

One hundred and eighty-nine mentally handicapped persons attending both residential and non-residential institutions were examined during 1984/85. All were assessed for treatment need for caries; periodontal need was also assessed in 43 of the older patients. At base-line examination it was found that a high proportion of the dental caries remained untreated and most of the treatment that was provided consisted of extractions. Treatment was subsequently provided by a health board dental officer, junior hospital staff, final year undergraduate students or a consultant in paediatric dentistry. Most treatment requirements were met by the non-consultant personnel. A follow-up examination completed during 1987 showed a considerable improvement in the treatment of caries; periodontal treatment need remained unchanged. It can concluded from this study that it is feasible to set up an effective dental service for mentally handicapped groups, that improvements in the treatment of dental caries can be achieved in a relatively short period of time and that most treatment requirements can be met by non-consultant staff. Continuing care, particularly for periodontal disease, remains a problem.     

Persistent neutropenia in a young child with a chromosome anomaly. Case report

Patients suffering from neutropenia are more susceptible to infection due to a defect in the body's defences. The young subject of this case report had a rare chromosome anomaly which may have been responsible for the neutropenia or may have modified the effect of the neutropenia.
After traumatizing two deciduous central incisors, inflammation of the periodontal tissues did not resolve and eventually the traumatized teeth exfoliated with little evidence of root resorption. Instigation of oral hygiene procedures remarkably improved the health of the periodontum. With time, the gingival health deteriorated as the child, being physically and mentally handicapped, refused dental treatment. She was unco-operative with attempts to brush her teeth and maintained an unfavourable digit-sucking habit.     

Periodontal status and treatment needs of 12-15 year old institutionalized mentally handicapped school children in Ibadan, Nigeria.

Mentally handicapped children are known, to have poor periodontal health. But previous studies lack conformity due to the use of different indices by the different authors. Twenty-five institutionalized mentally handicapped school children in Ibadan, Nigeria were studied with the aim of assessing their periodontal health and per treatment needs using the CPITN which is known to be simple and has international uniformity. The result showed that none of the children had healthy periodontium and all the children will need oral hygiene care with a significant percentage (8%) requiring complex periodontal care. The need for comprehensive preventive dental program is discussed since the hallmark of management of the children is prevention.     

Dental care for the handicapped adolescent

A total of 932 physically, mentally and multiple handicapped children, including many adolescents, were examined at their special schools in a mobile dental unit, during a 4-year pilot period, and 744 were treated. Their dental needs were compared with those of 450 children at normal schools. Although a greater proportion of handicapped children were caries-free, more required extractions and periodontal treatment. In the group aged 12-16 years there were more decayed teeth, more missing teeth and fewer fillings than in the controls of the same age. Over 90 per cent of the 744 children were treated satisfactorily in the mobile clinic, cooperation being acceptable in 79 per cent. Only 2 per cent were totally uncooperative and required a general anaesthetic, even for an examination. In total, 8.5 per cent of the children received some treatment under general anaesthesia. Treatment should aim to create understanding by adolescent or parent of good dental health, to obtain oral health, to create the most pleasing appearance possible, to encourage acceptance of further treatment and, where possible, to involve adolescent patients by providing treatment along normal lines.     

Dental caries experience and periodontal status of handicapped institutionalised black high school pupils in Soshanguve, Pretoria.

This study compares the oral health status, as reflected by caries experience and periodontal status, of 3 cohorts of institutionalised handicapped pupils. The 3 groups of impairments studied were physical, visual and aural disability. 267 institutionalised handicapped high school pupils were examined. 163 (61 per cent) were physically, 84 (31.5 per cent) visually, and 20 (7.5 per cent) aurally handicapped. 34 per cent of the study population was caries-free with a mean DMFT of 2.63. There was no statistically significant difference (p greater than 0.05) between the caries experience of the three handicapped groups. Similarly no significant difference (p greater than 0.05) was observed between males and females. More than half of the calculus accumulation occurred among the physically disabled. At the 90 per cent confidence interval there was no significant difference in bleeding and shallow pocketing among the three groups. However, there was a significant difference for the presence of calculus. The physically disabled pupils consistently indicated the highest proportion of bleeding, calculus accumulation and shallow pocketing.     

The oral health in different groups of adults with mental handicaps attending Birmingham (UK) adult training centres

The policies of normalisation and integration into the community of people with mental handicap have significant implications for dental care. Before dental services can be planned, the extent of the problem needs to be identified. A total of 382 people with mental handicap living in the community and attending day centres was examined; 52 of these people were edentulous. The mean age of the dentate adults was 30.9 years and the mean DMFT was 9.59. This was low in comparison with data available from national studies but when component parts of the DMF were evaluated it was apparent that far less restorative care had been received by the adults with mental handicap. There were also significant differences in the mean DMFT between mentally handicapped people who had additional handicaps; the mean DMFT for people with Down's syndrome was 10.95, whilst those mentally handicapped people who also had epilepsy had a mean DMFT of 11.19. The oral hygiene and periodontal condition was also poor and there were significant differences between the sub-groups. However, despite people with Down's syndrome having lower levels of plaque, they showed evidence of greater periodontal destruction. When resources are allocated, consideration should be given to raising the oral health of adults with mental handicap up to at least the same level as that of the rest of the population.     

Chlorhexidine compared with other locally delivered antimicrobials

Based on the association of bacterial plaque with the initiation of chronic gingivitis and progression of chronic periodontitis, chemical antiplaque agents have been employed both in prevention of periodontal disease and its treatment. In supragingival plaque control regimens, chlorhexidine has not been superceded as a chemical anti-plaque agent, although other compounds have been shown to be useful. The local side-effects of chlorhexidine and other cationic antiseptics, however, limit their long-term use for prevention. Extrinsic tooth staining in particular remains the greatest problem. Short-term anti-plaque uses for chlorhexidine include as an adjunct to mechanical cleaning in the initial oral hygiene phase of treatment, in situations where mechanical oral hygiene is difficult, including postsurgery, intermaxillary fixation, fixed orthodontic therapy, physically and mentally handicapped individuals, systemic diseases with oral manifestations such as leukaemia. More recent interest in chlorhexidine has resulted from the delivery of compounds subgingivally in the treatment of chronic periodontitis. Such methods have extended the use of chlorhexidine into areas inaccessible to the action of antimicrobial drugs delivered locally by conventional means, such as tooth brushing or mouth rinsing. Available evidence suggests that chlorhexidine may not be as effective as some antimicrobial drugs whose activity is more specific for those organisms considered particularly pathogenic to the periodontal tissues.     

Complications of orthodontic-orthognathic surgery treatment in mentally handicapped patients.

AIM: The aim of this study was to analyse possible intra- and postoperative complications and long-term results in combined orthodontic-orthognathic treatment of mentally handicapped patients compared with a control group of patients without handicap. PATIENTS AND METHODS: A group of 20 mentally handicapped patients (male = 7, female = 13) and of 102 non-handicapped patients (male = 36, female = 66) were evaluated retrospectively. The results of the two point-discrimination sensory test and the cephalometric findings of both groups were assessed. Complications during and after the operation, the results of nerve function tests and relapse rates were reported. The statistical analysis was carried out using binary logistical regression analysis with adjustment according to the diagnosis and the type of operation (p < 0.05) RESULTS: No significant differences could be found between the mentally handicapped and the non-handicapped patients. Only the nerve function test immediately postoperatively revealed differences between the two patient groups. The relapse rate in mentally handicapped patients was similar to non-handicapped patients. Forty-seven months after the operation, relapse (change in the ANB angle of more than 0.5 degrees ) was observed in four patients only (handicapped patients). CONCLUSION: Orthognathic surgical procedures in mentally handicapped patients can be carried out with a similarly high success rate as in mentally healthy patients.     

Behaviour management needs for the orthodontic treatment of children with disabilities

A displeasing dental appearance may have a significant emotional impact on an individual's well being. Although malocclusions occur more often in physically and/or mentally handicapped children than in normal children, the most severely handicapped patients are those least likely to receive orthodontic treatment. This investigation studied the modes of behaviour management used in the orthodontic treatment of disabled children, and the preferred criteria. The files of 49 disabled children were retrospectively evaluated. Two classification systems, the Frankl Behaviour Rating Scale (FBRS), and that of Owen and Graber were found to be unsuitable for determining the appropriate treatment modality. Five specific factors, frequently seen in disabled children, gag reflex, drooling, uncontrollable movements, inability to remain still, and the need for additional procedures, were graded and a scoring system was devised to include these factors within the assessment. This scoring system may be used to evaluate new patients and to assist in the choice of the appropriate behavioural management mode.     

Differences in dental health observed within a group of non-institutionalised mentally handicapped adults attending day centres.

A group of 350 mentally handicapped adults living in the community and attending three social services day centres were dentally examined in 1989. Although all those examined were collectively classified as a group of people with a mental handicap and therefore "a population group with special needs", great differences were observed in the dental health of the sub-groups attending each of the centres; it was evident that they did not constitute a uniform group of people. Those who were less mentally handicapped had better oral hygiene, less gingival inflammation, more fillings and fewer teeth extracted because of caries. Overall DMFT was similar at all centres but a greater proportion of the less handicapped group had active, untreated caries. Seventy-four per cent of the less mentally handicapped people attended the general dental services, and up to seventy per cent of those with a greater handicap were reported as attending the community dental service. Dental care for non-institutionalised mentally handicapped adults living in the community cannot be planned with the assumption that they are a homogeneous group of people.     

The use of 0.2% chlorhexidine spray as an adjunct to oral hygiene and gingival health in physically and mentally handicapped adults

Chlorhexidine has been used as an aid to or replacement for oral hygiene measures in special needs groups such as the handicapped. Previous studies have indicated that spray delivery of chlorhexidine is both effective and acceptable. This study evaluated twice daily use of a 0.2% chlorhexidine spray as an adjunct to toothbrushing in a group of physically and mentally handicapped adults attending a day training center. The study was a double-blind, placebo controlled, cross-over design involving two 31 days regimens separated by 30 days. Plaque, bleeding on probing, and pocketing were measured at the beginning and end of each regimen. There were clinically and statistically significantly lower plaque and bleeding scores at the end of the chlorhexidine compared to the placebo period. Pocketing was also significantly less after chlorhexidine, although in clinical terms the difference was small. The apparent acceptability and effectiveness of the regimen suggests that small doses of chlorhexidine delivered by sprays may be of considerable value as an aid to oral hygiene in handicapped individuals.     

Telescopic retained overdentures in mentally handicapped and schizophrenic patients--a retrospective study

For a long time the dental treatment of choice for mentally handicapped patients was extraction of teeth due to the lack of oral hygiene. Recent studies show the possibilities of restorative and prosthodontic treatment even in this group of patients. The records of 58 patients of a psychiatric clinic treated with 84 telescopic overdentures were examined. The highest survival rates after 7 years were in the light mentally retarded group with 86% and the overdentures with 3 anchor teeth with 81%. Schizophrenic patients and overdentures with only one anchor tooth presented only 29% and 37% survival respectively. It can be concluded that the number of anchor teeth and the kind of mental illness should be considered when planning treatment for mentally handicapped patients with overdentures.     

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.     

Assessment of periodontal status and treatment needs of a disabled population using the CPITN.

The Community Periodontal Index of Treatment Needs (CPITN) was used to assess the periodontal status of 213 handicapped persons attending seven institutions in Johannesburg. Fewer than 2% had healthy mouths, 8% had bleeding only, followed by calculus (46%), shallow pockets (40%) and deep pockets (4%). The mean number of sextants with bleeding or higher score was 5.9. Oral hygiene instruction was indicated for 98% and prophylaxis for 90% of the participants. The CPITN was easily used in the disabled population but may overestimate treatment need in view of the current understanding that periodontal disease does not automatically progress from a low CPITN level to the next. A more appropriate measure of treatment need in handicapped persons is required.     

Various family problems of early education of early treated children with clefts]

To prevent retardation in personality development of physically and mentally handicapped children and adolescents, more attention should be paid to the qualification of parents, kindergarten teachers and teachers to educate handicapped children, and so those with cleft lips and palates. This is corroborated by findings obtained of 21 mothers of early-treated cleft children who had been involved in the present study. To qualify parents and co-educators to educate and care cleft children, they are needing sympathetic guidance by, and paedagogical advice from, all those who are contributing to rehabilitation.     

Handicapped and oral pathology. Clinico-statistical survey

Dental and periodontal conditions of 80 handicapped adults were examined. The epidemiological survey was made by following the WHO suggestions and showed that there are patients in great need of primary and secondary prevention. The results of the research point out a DMFT of 18.78 and extractions were practically the only dental therapy received by these specific patients. Periodontal diseases were surveyed by the use of the CPITN index, and exhibited high values of dental calculus in younger. Furthermore, as the patients increased in age, periodontal pockets appeared and edentulous patients increased.