Dental health status of mentally and physically handicapped children and adults in the Galway Community Care Area of the Western Health Board

An epidemiological survey was carried out to assess the treatment needs on the mentally and physically handicapped in the Galway Community Care Area. The survey was conducted by both questionnaire and clinical examination. The results of the survey indicate that the pattern of dental caries for the mentally and physically handicapped children is similar to that for the rest of the child population in Ireland. The results also show that extraction has been the treatment of choice for the mentally and physically handicapped. The periodontal assessment of the handicapped adult population found that moderate pocketing accounted for the bulk of periodontal disease present.     

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.     

Energy intake, dental caries and periodontal disease in 11-year-old black children in two regions of Southern Africa: KwaZulu and Namibia

Abstract The study examined energy intake in relation to dental caries and periodontal disease in 11-yr-old rural and urban black children in low fluoride areas of KwaZulu and Namibia (0.15 ppm F) and one higher fluoride area of Namibia (1.56 ppm F). Twenty-four hour dietary recalls were conducted by trained interviewers and daily energy intake estimated using the MRC dietary analysis programme. DMFS was recorded according to WHO criteria; periodontal disease was measured using CPITN and SAS was used for statistical analysis. The prevalence of dental caries and periodontal disease (using CPITN), were compared within three energy groupings; ≤850 kcal/day; > 850, < 1400 kcal/day and ≥1400 kcal/day. The rural low fluoride Namibian children had the lowest mean energy intake (616 kcal/day), which also was the grouping with highest healthy periodontal prevalence (65%). The urban groups had higher energy intakes than the rural communities. Statistically significant effects on caries prevalence were seen for country and fluoride grouping; for periodontal disease, significant effects were noted for country, fluoride group and environment. Energy intake had no statistically significant effect, so this is not a risk marker for the disease.     

Inter-relationship of intelligence-quotient and self-concept with dental caries amongst socially handicapped orphan children

Context : India has been the focus of many health surveys among normal, physically, and mentally handicapped children. However, the data, concerning oral health conditions of socially handicapped children living in orphanages, are scanty. Aims: To study the effect of parental inadequacy, environmental deprivation, and emotional disturbances on dental caries through intelligence quotient (IQ) and self-concept in orphan children and also to co-relate dental caries with different levels of IQ and self-concept. Settings and Design: The study was carried out amongst socially handicapped children living in orphanages. Patients and Methods: 100 children in the age group of 10-14 years from orphanages were selected. Malin's Intelligence Scale for Indian Children (MISIC) was used to assess the intelligence quotient; self-concept questionnaire to assess self-concept of the child and recording of dental caries status of children was done as per WHO Index (1997). StatisticaL Analysis Used : To assess the relationship of dental caries with IQ, student's unpaired t-test was used and; to find the relationship between self-concept and dental caries, Karl-Pearson's coefficient of co-relation was applied. Results: the children in orphanages had a lower IQ and high caries experience but had an above average self-concept. There was also no co-relation between dental caries and self-concept. Conclusions: Orphan children, being socially handicapped, are at an increased risk for dental caries due to a lower IQ level, parental deprivation, and institutionalization. Moreover, lack of co-relation between dental caries and self-concept could be explained by the fact that dental caries is a lifelong process whereas different dimensions of self-concept are in a state of constant flux.     

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.     

Oral health condition of 12-year-old handicapped children in Flanders (Belgium)

Abstract The dental condition of 626 12-year-old handicapped children with mild mental or moderate to severe mental retardation or learning impairment, being 25% of the population of each of these groups, was examined in Flanders. An evaluation of oral cleanliness showed poor oral hygiene in 31.8% of the children. No significant differences were found in oral cleanliness among types of handicapping conditions. The mean DMFT score was 2.9 (s: 2.6) and DMFS score was 5.4 (s: 5.6). Almost 21% of the children were free of caries or fillings. No significant differences were found among groups of handicapped children. Handicapped children presented a low level of restorative care (restorative index score: 48.7%). Mildly mentally retarded children demonstrated the lowest restorative index (43.9%). The caries experience of first permanent molars represented the largest part of the DMFT score (64.1%). Sealants were present in 7.9% of children examined. A considerable percentage of mildly mentally retarded children and learning impaired children did not brush daily (22.1% and 20.9%) and did not receive help with toothbrushing from their parents or carers (91.0% and 94.7%, respectively).     

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.     

Noninvasive control of dental caries in children with active initial lesions. A randomized clinical trial

The aim of this study was to investigate whether DMFS increment can be decreased among children with active initial caries by oral hygiene and dietary counseling and by using noninvasive preventive measures. Except for mentally disabled and handicapped children attending special schools, all 11- to 12-year-olds in Pori, Finland, with at least one active initial caries lesion were invited to participate in the study and were then randomized into two groups. Children in the experimental group (n = 250) were offered an individually designed patient-centered preventive program aimed at identifying and eliminating factors that had led to the presence of active caries. The program included counseling sessions with emphasis on enhancing use of the children's own resources in everyday life. Toothbrushes, fluoride toothpaste and fluoride and xylitol lozenges were distributed to the children. They also received applications of fluoride/chlorhexidine varnish. The children in the control group (n = 247) received basic prevention offered as standard in the public dental clinics in Pori. For both groups, the average follow-up period was 3.4 years. A community level program of oral health promotion was run in Pori throughout this period. Mean DMFS increments for the experimental and control groups were 2.56 (95% CI 2.07, 3.05) and 4.60 (3.99, 5.21), respectively (p < 0.0001): prevented fraction 44.3% (30.2%, 56.4%). The results show that by using a regimen that includes multiple measures for preventing dental decay, caries increment can be significantly reduced among caries-active children living in an area where the overall level of caries experience is low.     

Dental Caries and Treatment Need in Schoolchildren Related to Medicaid Enrollment

Objectives : This study compared dental caries status and treatment need in four groups of children: those not enrolled in Medicaid, those enrolled in Medicaid who used dental services prior to a dental survey, those enrolled in Medicaid who used services after the survey, and those enrolled in Medicaid who did not use dental services. Methods : This study used data on 6,620 children 5 to 18 years of age, who were representative of North Carolina schoolchildren and who participated in a statewide oral health survey in 1986–87. Clinical results from the survey were linked with a separate data base of Medicaid claims and enrollment files from 1984 to 1992. With this link, the surveyed children were classified into the four study groups and dental status compared. Results : Medicaid-enrolled children who used services prior to the survey had the highest caries prevalence of all groups (DMFS=1.74 at ages 6 to 11 years), and had fewer treatment needs (D/DMFS=19%) than children outside of Medicaid (DMFS=0.95, D/DMFS=33%). Enrolled children who never used dental services had a caries prevalence (DMFS=0.83) similar to children outside of Medicaid, yet had greater unmet treatment need (D/DMFS=62%). Conclusion : Caries prevalence did not differ substantially among groups; however, the level of unmet treatment did vary. Some Medicaid-enrolled children had a significant portion of their restorative treatment needs met.     

Dental caries prevalence and treatment need among racial/ethnic minority schoolchildren

A study was undertaken to estimate dental caries prevalence and treatment need among racial/ethnic minority schoolchildren in the Bronx. Oral examinations were conducted on 148 second graders, 193 fourth graders and 299 sixth graders in three different schools. A single examiner trained to use the DMFS index according to National Institute of Dental and Craniofacial Research (NIDCR) diagnostic criteria and procedures examined all the children between November 1999 and July 2000. The study revealed that 39% of the children exhibited dental caries experience in their permanent dentition (mean DMFS = 1.45), treatment need (D/DMFS = 28%); 26.4% of children in their primary dentition (mean dfs = 1.01) and treatment need (d/dfs = 18%). Hispanic children (mean DMFS = 1.71) had higher dental caries experience compared to African-Americans (mean DMFS = 1.14). This was found to be statistically significant (p = 0.004). Treatment need in Hispanics was (30%, 17%) and in African-Americans (30%, 18%) in permanent and primary dentition respectively. Treatment need was highest among sixth grade African-Americans in their permanent dentition and in second grade Hispanics in the primary dentition. The study showed a difference in dental caries prevalence, but the treatment need percentages did not differ between Hispanics and African-Americans in both dentition.     

Caries experience and oral hygiene status of blind, deaf and mentally retarded female children in Riyadh, Saudi Arabia.

OBJECTIVE: To determine the caries experience and oral hygiene status in blind, deaf and mentally retarded female children in Riyadh, Saudi Arabia. METHOD: All (N=218) the 6-7-year-old and 11-12-year-old blind, deaf and mentally retarded female children registered with the Presidency of Girls' Education schools in Riyadh were examined for dental caries and oral hygiene in a dental operatory setting. RESULTS: All (100%) the blind 6-7-year-old had caries with a mean dmft score of 6.58 (SD 2.02). The caries prevalence in blind 11-12-year-olds was 88.2% with a mean DMFT score of 3.89 (SD 2.67). Among 6-7-year-old blind children 8.3 %, and in 11-12-year-old blind children 29.4% had good oral hygiene. The caries prevalence in deaf 6-7-year-olds was 95.7% with a mean dmft score of 7.35 (SD 3.51). The caries prevalence in 11-12-year-old deaf children was 93% with a mean DMFT of 5.12 (SD 3.45). Less than one-fifth (17.4%) of the 6-7-year-old deaf children and only 7.0% of 11-12-year-old deaf children had good oral hygiene. The caries prevalence in mentally retarded 6-7-year-old was 93.9% with a mean dmft of 8.00 (SD 4.1). All the mentally retarded 11-12-year-old had carious teeth with a mean DMFT score of 5.81 (SD 2.95). Only 3.1% of the mentally retarded 6-7-year-old and none of the mentally retarded 11-12-year-olds had good oral hygiene. CONCLUSIONS: Caries prevalence and severity in all the three groups of female special children were very high, and the number of children with good oral hygiene was very low.     

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.     

Dental Caries and Sealant Prevalences in Schoolchildren in Tennessee

This article presents findings on the prevalence of dental caries and dental sealants from the 1988 oral health survey of schoolchildren in Tennessee. The purpose of the study was to describe the prevalence of dental caries, dental sealants, and periodontal disease, as well as the need for restorative, exodontia, and periodontal treatment among schoolchildren. A multistage probability sample was designed to represent 927,000 children enrolled in grades K-12 in public and private schools across the state. Analyses of the data collected from the examination of 2,588 children aged 5-17 revealed that 55 percent were caries free in their permanent dentition and that the mean DMFS score was 2.86. For those aged 5-9, the mean dfs score was estimated to be 5.52. Only 10 percent of schoolchildren in Tennessee had dental sealants on their teeth. Comparisons of the results of this survey with those reported from earlier state surveys indicated that caries levels have declined steadily. We assumed that the reduction in caries experience observed in Tennessee is the result of widespread exposure of children to systemic and topical fluorides. Further reduction in caries experience is possible with continued fluoridation of community water supplies, in conjunction with increased utilization of pit and fissure sealants.     

Dental caries and administrative status occurrence in Finnish children with mentally handicapping conditions

Caries prevalence was recorded in 204 Finnish children, aged 9 to 10 years (125 had mentally handicapping conditions, 79 had no mentally handicapping conditions—identified in this paper as “normal”). The children with mentally handicapping conditions used preventive fluoride less frequently and their standard of oral hygiene was much poorer than that of the normal children. In the registered children with mentally handicapping conditions, caries occurrence was less than that in the normal children. In the unregistered children with mentally handicapping conditions, caries occurrence was greater than in the normal children. Irrespective of administrative status or severity of mentally handicapping conditions, these children received less dental treatment than the normal children with regard to treatment need. The need to further educate dental care personnel in the dental treatment of these children seems evident, especially as long as the dental care system is not able to meet the restorative dental treatment needs of the children with mentally handicapping conditions. The necessity of preventive regimens for these children should be emphasized even at low levels of caries occurrence.     

Influence of diagnostic adjuncts to the measurement of caries prevalence at different caries thresholds

OBJECTIVES: To determine the influence of diagnostic adjuncts (dental brushing and drying) in dental caries diagnosis. To analyse the underestimation levels in epidemiological examinations when compared to traditional dental setting examinations. To evaluate the influence of including noncavitated (NC) carious lesions in the estimation of the disease. PARTICIPANTS: 51, 12-year-old children. INTERVENTIONS/METHODS: Four epidemiological exams performed in an outdoor setting and one performed in a traditional dental setting (visual-tactile method associated or not with diagnostic adjuncts). MAIN OUTCOME MEASURES: DMFS (Decayed, Missing and Filled Surfaces) index, according to the WHO criteria. RESULTS: When compared to exams carried out in a traditional dental setting, the epidemiological examinations showed no significant statistical differences for the DMFS score (p>0.05), presenting underestimation levels lower than 10% (except for the low prevalence caries group in the WHO exam). For the DMFS, previous dental brushing was more relevant than previous dental drying, although drying was the most important resource for NC diagnosis (p<0.05). CONCLUSION: The visual/tactile method, with or without diagnostic adjuncts, can diagnose cavitated lesions efficiently, but not NC lesions. However, for the low caries prevalence group, the implementation of dental brushing prior to an exam could be suggested.     

Evaluation of a school-based fluoride mouthrinsing and clinic-based sealant program on a non-fluoridated island

For many years the children of Guam have experienced a high prevalence of dental caries. Surveys conducted on the fluoride-deficient island found that caries levels were double those of US mainland children. In 1976 a school-based fluoride mouthrinse program was initiated involving over 22,000 children in grades kindergarten through eight in weekly rinses with 0.2% neutral NaF. A clinic-based dental pit and fissure sealant program was added in 1984 to the fluoride mouthrinse program. Over 15,000 children participated annually in the sealant program where more than 75,000 teeth were sealed the first year. After 8 yr of fluoride mouthrinsing (1976-1984) mean DMFS scores were 1.79 surfaces per child lower compared to baseline, a decrease of 0.22 DMFS per child per year. During this period proximal DMFS scores decreased 61%, buccal-lingual surfaces 31%, and occlusal surfaces 7%. After 2 yr of fluoride mouthrinsing and sealant application combined overall DMFS scores decreased an additional 2.34 surfaces per child, a reduction of 1.17 DMFS per child per year. Most of this decline took place on pit and fissure surfaces. For the 10-yr period a reduction of 4.13 DMFS per child was seen--a decline from 7.06 DMF at baseline to 2.93 DMF surfaces per child in 1986. This long-term evaluation indicates that dental sealants when used in combination with fluoride mouthrinse were particularly effective in lowering the prevalence of dental caries. Schoolchildren in participating grades on Guam now have dental caries rates close to those of US schoolchildren.     

Oral health in Latvian 15-year-olds

Oral hygiene, caries and periodontal conditions were assessed in a representative sample of 15-year-old Latvian schoolchildren, comprising 506 subjects. Caries, diagnosed on the cavity level, was detected in 97.6 % of the population. The mean DMFT and DMFS were 8.1 and 14.1, respectively. Although 91% of the children had had restorative treatment, the D component accounted on average for 33% of the DMFS score. Visible dental plaque was found in 98.4% of the children; in a majority (88%) abundant plaque deposits were recorded. Community Periodontal Index of Treatment Needs (CPITN) was assessed by standard WHO methods. Deviation from periodontal health was observed in 90.7% of the children. Calculus was recorded in 26.1% and gingival pockets in 25.9% of the sample. Additionally, 38.7% of the children had gingival bleeding. The mean number of sextants with healthy periodontal conditions was 2.5. Calculus and pocketing averaged 0.6 and 0.4 sextants, respectively. Attachment loss, recorded in 11.7% of the subjects, did not exceed 3 mm. The results showed high caries prevalence, considerable need for treatment and virtual absence of oral hygiene.     

Malocclusion and orthodontic treatment need of handicapped individuals in South Canara,India

AIMS: To estimate the prevalence and the severity of malocclusion and treatment need for 329 handicapped individuals. SUBJECTS AND SETTING: 329 handicapped individuals aged 11-30 years, attending eight different nonresidential special schools of South Canara, India. METHOD: Examination and recording using the Dental Aesthetic Index (DAI). RESULTS: 53% had a dental appearance which required no orthodontic treatment, 24% had a definite malocclusion, where treatment was 'elective' and treatment for a further 12% was considered to be 'highly desirable'. The remaining subjects (11%) had a handicapping malocclusion where treatment was considered mandatory. CONCLUSIONS: The prevalence of definite and severe malocclusions was higher in the mentally subnormal individuals when compared to other handicapping conditions. Orthodontic services for the handicapped have generally been neglected.     

Oral health in adolescents with immigrant background in Stockholm

Dental caries and periodontal health was studied in 225 18- and 19-year-old adolescents with different ethnic background. The results showed that immigrant adolescents exhibit an increased prevalence of periodontal disease compared to the Swedish control group whereas no differences were found concerning the prevalence of dental caries. Alveolar bone loss was diagnosed on one or more surfaces in 4.3% of the Swedish adolescents compared to 16.2% in the immigrant group. Subgingival calculus was found among 5.3% of the Swedish adolescents compared to 35.1% in the immigrant group. This study shows that immigrant adolescents must be considered at high risk to develop periodontal disease during adolescents while dental caries can be managed.     

Oral health status among schoolchildren in Romania, 1992

Abstract – In Romania, systematic information on the occurrence of oral diseases in children is scarce. The purpose of the present study was to describe the prevalence and the pattern of dental caries in schoolchildren, and to use the data to provide a baseline for planning and evaluation of oral health care. A national sample of children at grade I ( n = 729) and grade 6 ( n = 660) was chosen consistent with the WHO pathfinder principle. Clinical examinations were carried out according to the recording system for the Danish Municipal Dental Service and the following results were obtained. In children of grade 1 (7-yr-olds) the prevalence proportion of caries in primary teeth was 86% and in permanent teeth 39%. The mean caries indices were 11.4 dels and 1.3 DMFS. At grade 6 (12-yr-olds) the prevalence proportion of caries in primary teeth was 17% and in permanent teeth 90%. The mean caries experience was 0.8 defs and 6.5 DMFS, and a mean of 4.1 DMFT was observed. In both groups, the D-component of the caries index was dominant. The children were also classified by caries severity zone. At grade 1, 61% had a very severe pattern of caries in the primary teeth, i.e. caries in pits/fissures, proximal surfaces, smooth surfaces, and incisors. Forty-three percent of the children at grade 6 showed this pattern in permanent teeth. In Romanian schoolchildren the present level and pattern of dental caries are most severe and the implementation of oral health promotion and prevention at the community level is urgently needed.