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.     

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).     

不同性别骨性Ⅱ类无鼾青少年患者的上气道、舌骨及牙颌软硬组织差异性研究

目的:比较不同性别12～16岁青少年上气道、舌骨及牙颌软硬组织差异及其相关性，为临床制定具有性别差异的诊疗参考。方法:选择70例骨性Ⅱ类青少年患者，男女比例为1∶1，年龄、垂直骨面型严格匹配。用Invivo 5进行三维重建并测上气道、舌骨及牙颌软硬组织指标，进行独立样本 t检验及Pearson相关性分析。 结果:男、女性患者舌咽体积分别为[(6.68±2.71) cm 3、(5.36±1.73) cm 3， P＝0.019]，男、女性患者舌骨垂直距离分别为[(101.56±16.72) mm、(92.44±19.11) mm, P＝0.037]，具有统计学意义。男、女性Y轴角、NP-FH、RH、PFH、AFH、FHR、OP-SN、IOB、U1-E、Sn-G均有统计学意义。男性上气道与颌骨有显著相关性，女性上气道与牙齿角度及软组织有显著相关性。 结论:男性舌咽体积更大，牙颌软硬组织趋向于 平面平整且上唇及颏部靠前的水平生长型。临床上制定不同性别的诊疗方案时，男性趋向于着重考虑颌骨指标对上气道及舌骨的影响，女性着重考虑牙性指标对上气道及舌骨的影响，旨在逐步建立反映不同性别患者特征的颌骨及牙性指标，为预判不同性别患者治疗后上气道形态及舌骨位置的改变提供一定参考依据。     

不同性别骨性Ⅱ类无鼾青少年患者的上气道、舌骨及牙颌软硬组织差异性研究

目的:比较不同性别12～16岁青少年上气道、舌骨及牙颌软硬组织差异及其相关性，为临床制定具有性别差异的诊疗参考。方法:选择70例骨性Ⅱ类青少年患者，男女比例为1∶1，年龄、垂直骨面型严格匹配。用Invivo 5进行三维重建并测上气道、舌骨及牙颌软硬组织指标，进行独立样本 t检验及Pearson相关性分析。 结果:男、女性患者舌咽体积分别为[(6.68±2.71) cm 3、(5.36±1.73) cm 3， P＝0.019]，男、女性患者舌骨垂直距离分别为[(101.56±16.72) mm、(92.44±19.11) mm, P＝0.037]，具有统计学意义。男、女性Y轴角、NP-FH、RH、PFH、AFH、FHR、OP-SN、IOB、U1-E、Sn-G均有统计学意义。男性上气道与颌骨有显著相关性，女性上气道与牙齿角度及软组织有显著相关性。 结论:男性舌咽体积更大，牙颌软硬组织趋向于 平面平整且上唇及颏部靠前的水平生长型。临床上制定不同性别的诊疗方案时，男性趋向于着重考虑颌骨指标对上气道及舌骨的影响，女性着重考虑牙性指标对上气道及舌骨的影响，旨在逐步建立反映不同性别患者特征的颌骨及牙性指标，为预判不同性别患者治疗后上气道形态及舌骨位置的改变提供一定参考依据。     

Relapse in fronto-orbital advancement: a pilot study

Our unit policy in fronto-orbital advancement (FOA) and remodeling has been initial overcorrection to improve the ultimate aesthetic outcome of surgery. To assess relapse of anteroposterior (AP) correction in patients with cranial synostosis undergoing FOA and remodeling, a retrospective pilot study identified patients from the unit database. Serial AP calvarial measurements were used to record surgical and postsurgical changes. Patients showing a change in measurements toward preoperative values were considered to have relapsed. Associated factors were recorded, and statistical analysis was carried out using SPSS.Thirty-one patients (female n = 10, male n = 21) with a median age at surgery of 17 months and a mean weight of 11 kg were included in the study. The mean hospital stay was 7 days. The mean advancement was 13 (SD, 4) mm, and relapse occurred in 65% (20/31). Mean AP relapse at 5 months was 6.2 mm. No patient required subsequent FOA. No significant correlation was found between relapse and age, weight, hospital stay, and syndromic status. Anteroposterior relapse of the fronto-orbital segment occurred in two thirds (65%) of our cohort at 5 months. A prospective study is now under way to analyze this further. The results of this pilot study suggest that strategies to minimize or to compensate for relapse may enhance the ultimate surgical result.     

Detection of bifid mandibular condyle using computed tomography

Objective: To determine the frequency and characteristics of bifid mandibular condyle (BMC) using computed tomography (CT) evaluation. Study Design: A retrospective study was carried out using the CT records of 550 patients referred to the Medical School of Erciyes University (Kayseri, Turkey) between 2007 and 2010. T-tests were used to compare frequency of BMC between the left and right sides and between female and male patients. Statistical analysis was performed using SPSS software and a chi-squared test. Results: Of the 550 Patients, 10 patients (1.82%) were found to have BMCs. Five patients were female (50%) and five were male (50%). Of these 10 patients, 7 (70%) had unilateral and 3 (30%) had bilateral BMCs. As a result, a total of 13 BMCs were found in 10 patients. No statistically significant differences were found between either the right- and left-sided BMCs or between female and male patients (p >.05). Conclusions: To our knowledge, this is the first retrospective study investigating the prevalence and characteristics of BMC using computed tomography. Although BMC is an uncommon anomaly, it may be a more frequent condition in the Turkish population. Further studies and research on the orientation of duplicated condylar heads should be carried out. Key words:Computed tomography, bifid condyle, double-headed condyle, orientation, frequency.     

Efficacy of a 0.5% chlorhexidine gel on the control of gingivitis in Brazilian mentally handicapped patients

OBJECTIVE: To evaluate the effectiveness of a 0.5% chlorhexidine gel on the reduction of interdental gingival bleeding. MATERIAL AND METHODS: Forty-three mentally handicapped subjects, living in an institution (Casas André Luiz, Brazil), were enrolled in a double-blind randomised clinical trial. The subjects were randomly divided into two groups: test (chlorhexidine gel) and control (placebo gel). The gel was applied with trays, twice a day, over a period of 8 weeks. The interdental bleeding index (IBI) was recorded before and after the period in which the gel was used. RESULTS: Statistical analysis showed that baseline IBI scores were similar (p=0.82) for test and control groups (55.6% and 54.5%, respectively). After 8 weeks, a statistically significant (p<0.001) decrease in IBI means took place in the test group (33.2%). The control group presented a small increase (60.6%) in IBI scores. The difference between groups was significant at the end of the study (p<0.001). CONCLUSION: The results indicated that the use of a 0.5% chlorhexidine gel was effective in reducing interdental gingival bleeding in special patients.     

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.     

Risk factors for nausea and vomiting after day care general anesthesia in mentally challenged patients undergoing dental treatment

Clinically, the incidence of postoperative nausea and vomiting (PONV) may be higher in mentally challenged patients than in normal healthy patients. The aim of this study was to investigate the risk factors for PONV after day care general anesthesia in mentally challenged patients undergoing dental treatment. We analyzed data on 231 day care general anesthesia cases involving mentally challenged patients undergoing dental treatment. Anesthetic records for the past 5 years were investigated retrospectively. Ten items (age, body weight, sex, duration of general anesthesia, use of propofol, use of sevoflurane, use of nitrous oxide, use of neostigmine, treatment accompanied with bleeding, and transfusion volume) were selected as risk factors for PONV. Postoperative nausea and vomiting was evaluated using the postoperative check sheet and linear discriminant analysis was performed to distinguish PONV incidence using the 10 items as independent variables. The reliability of the linear discriminant function was evaluated using a misjudgment rate and information criteria (AIC). Postoperative nausea and vomiting was observed in 13 cases out of 231 cases. The discriminant function with the smallest AIC (-25.0718) consisted of two independent variables: y=-0.077x(1)-0.001x(2)+0.0716(x(1)=use of propofol, x(2)=age). The misjudgment rate was 31.6%. This result suggests that PONV decreases when propofol is used and that the incidence of PONV decreases with age. To investigate other risk factors, an additional analysis was performed using 83 out of the 231 cases in which sevoflurane was used as an anesthetic agent. The results of the subgroup analysis suggest that the incidence of PONV decreases in male patients and higher weight patients, although the patient's body weight may be related to age, as the study cohort included many children. It is suggested that the major risks for PONV in mentally challenged patients after day care general anesthesia are no use of propofol, lower age, female sex and lower weight.     

Morphology and growth of the mandible in Crouzon, Apert, and Pfeiffer syndromes

The purpose of this study was to examine mandibular morphology and growth in patients with Crouzon, Pfeiffer, and Apert syndromes using posteroanterior cephalograms. Fifteen patients with Apert (n = 2), Crouzon (n = 11), and Pfeiffer (n = 2) (11 female, 4 male) syndrome were included in this study. All patients had serial posteroanterior cephalograms at 5, 10, and 15 years of age. The bicondylar width, bigonial width, bicondylar/bigonial ratio, and ramus to intercondylar plane angle for each patient were measured on the cephalograms and compared with age-match controls. An analysis of variance analysis was carried out to detect differences between patients and controls and sex differences between patients. In both male and female patients, there was a statistically significant reduction in bicondylar width compared with age-matched controls. Male patients also had a statistically significant increase in bigonial width compared with controls and female patients at 10 and 15 years. The resulting bicondylar/bigonial ratios were significantly reduced, and the ramus to intercondylar plane angles were significantly increased in both male and female patients compared with controls. Unlike previous reports of patients with syndromic synostosis, this study demonstrates that the mandible has significant morphologic and growth abnormalities, including constriction of bicondylar width with near normal bigonial width in female patients. These findings suggest a narrowing at the cranial base with resulting restriction of normal transverse mandibular growth at the condyle. The secondary nature of the mandibular finding is suggested by the near normal or increased transverse growth at the gonion in females and males, respectively. Consequently, the ramus appears torqued inward, forming a greater angle with the cranial base.     

Evaluation of gustatory function in postmenopausal women

OBJECTIVE: The aim of this study is to evaluate the gustatory function in postmenopausal women. SUBJECTS AND METHODS: Whole mouth taste test and spatial taste test were administered to 20 postmenopausal women (Group 1) and 20 age-matched male subjects (Group 2). Further investigations were carried out for subjective assessment of taste alteration and nutritional differences between premenopausal and postmenopausal periods. RESULTS: There was a significant reduction in sucrose perception and in palatal sensitivity in postmenopausal women (p<0.05). Only 7(35%) of the female patients noticed alteration in taste perception during the postmenopausal period. Alteration in dietary habits after menopause was reported by 9 (45%) patients. CONCLUSION: This study demonstrates that taste perception of the tongue does not change, but that there is a disorder in palatal perception in postmenopausal women. Furthermore, there is tendency to preference of sweeter foods during menopause.     

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.     

Use and effect of clinical photographic records on the motivation and oral hygiene practices of a group of mentally handicapped adults

A study was undertaken to test the hypothesis that clinical photographic records can be used to motivate oral hygiene performance in mentally handicapped adults. Plaque reduction over the period of the study was shown to be higher in the test group than the control group but differences between the test and control groups were not statistically significant. The small numbers involved (29) and the difficulties in matching subjects may have mitigated against demonstrating a statistically significant difference between the two groups. All participants demonstrated high levels of toothbrushing ability during the practical aspects of the study but this was not maintained through daily oral hygiene practices in the majority of subjects.     

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).     

应用颌后切口行老年患者腮腺下极肿物切除术

目的：老年患者腮腺下极肿物采用单纯颌后切口，行肿物及区域性腺体切除术，并与传统术式比较，评价治疗效果。方法：老年腮腺下极肿物患者40例，随机分为2组，第一组应用单纯颌后切口，第二组采用常规耳前颌后“S”形切口，进行肿物及区域性腺体切除术，解剖并保留面神经颈面干，比较2组患者组织反应程度、面神经功能、肿瘤复发率、面部美观、病人满意度，评价治疗效果。结果：单纯颌后切口术后渗出少，组织反应轻，疤痕不明显，Frey综合征发生率低，病人满意率高，上述指标均有统计学差异（P〈0．05）。2组患者肿瘤复发率、面神经功能障碍、涎瘘发生率无明显差别（P〉0．05）。结论：单纯颌后切口创伤小，并发症低于传统术式，术后颜面美容效果更为理想。     

下颌支矢状劈开截骨后退术后下唇感觉功能障碍的影响因素

目的：探讨下颌支矢状劈开截骨后退术后下唇感觉功能障碍的发生及其恢复的影响因素。方法：设置性别、远心骨段移动距离、下牙槽神经暴露情况3组变量，对随访时间达术后24周的19例37侧下颌支矢状劈开截骨术患者术后下唇感觉功能障碍情况进行研究。使用触觉检查、痛觉检查和两点辨别觉检查3种检查方法，参照BMRC感觉功能评定标准，观察在不同变量值的情况下，术后4周、12周、24周下唇感觉功能的变化。使用SAS6．12统计软件包，进行多个样本率的χ^2检验，了解下唇感觉功能障碍的发生及恢复情况。结果：性别差异对术后下唇感觉功能障碍程度无显著影响（P〉0．05）。下牙槽神经暴露者的术后下唇感觉优秀恢复率为25．0％，非暴露者为96．6％，两者差异有统计学意义（P〈0．05）。下颌骨远心骨段后退幅度〈6mm者，下唇感觉优等恢复率为100．0％，下颌骨远心骨段后退幅度I〉6mm者为68．2％，两者差异有统计学意义（P〈0．05）。结论：术中完全暴露下牙槽神经以及大幅度的下颌远心骨段后退会显著增加术后下唇感觉障碍的程度。在手术方案的设计中，将下颌后退幅度控制在6mm以内是比较安全的。     

Dental services for children with mental handicaps: policy changes and parental choices

Dental services for children with mental handicaps are subject to conflicting policies. On the one hand, the community dental service is being asked to move towards a more specialised role and to focus on disadvantaged groups such as people with mental handicaps. On the other hand, policies for community care have stressed that handicapped people are stigmatised by specialised provision and should have access to all the services used by non-handicapped people. A longitudinal study of 162 mentally handicapped children provided an opportunity to assess parents' opinions on this issue. The results showed high levels of contact with the dental services. Most parents were satisfied with the care their children had received, although there was some suggestion of a preference for receiving care from the general dental practitioner service. However, parents whose children were hard to manage tended to prefer the more specialised care provided by the community dental service. The results of the study suggested that there is a continuing role for the community dental service and that general dental practitioners may need support from the community dental service to help them meet the demands of parents whose children have a mental handicap.     

髁突骨折分型及手术治疗50例临床分析

目的 研究出现移位和功能障碍的下颌髁突骨折的分型和疗效.方法 2007年7月至2010年7月,收治有骨折移位和功能障碍的下颌髁状突骨折的患者50例(69侧),依据骨折线的水平分为髁突囊内,髁突颈部和髁突下骨折,采用不同手术方法和固定方法进行治疗.术后3天、1个月、3个月、6个月、1年进行临床随访,从临床和影像学两方面评估术后恢复情况.囊内骨折根据杨驰教授的骨折线分类方法,将骨折分为分为A、B、C、M四型,回顾性分析不同类型手术的特点.结果 50例患者中获得3个月以上随访的48例(66侧),术后平均随访10.45个月,随访期末平均开口度33.89 mm(31.5~43.7 mm),8侧出现暂时性额纹消失,3个月后7侧恢复.术后总体满意度97.92%(47/48),仅1例骨折患者因1年后伴有颞区皮肤麻木和额纹消失不满意,其余无严重并发症出现.结论 对于发生移位和功能障碍的下颌骨髁突骨折分型的不同采取不同的手术方法可达到良好的治疗效果,但对术者的手术技巧和经验要求较高.     

Dentofacial changes and oral health status in mentally challenged children

The study was carried out on 69 mentally challenged individuals. They were subjected to detailed clinical evaluation for dentofacial abnormalities and oral health status. Of the 69 mentally handicapped individuals 27 had Downs syndrome and 42 had cerebral palsy. Characteristic facial abnormalities were seen in children with Downs syndrome. In cerebral palsy, fracture maxillary anteriors were more evident. All the Downs syndrome cases had abnormal TMJ movements but in cerebral palsy only 35.7% of individuals had abnormal TMJ movements. In both the groups, submandibular lymph adenopathy was reported. Present study revealed dental caries in 56.0% of the individuals. Fair clinical level of oral hygiene in 60% of the individuals was seen.     

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.