Oral care and sensory sensitivities in children with autism spectrum disorders

Children with autism spectrum disorders (ASD) are at high risk for oral disease. The aim of this study was to examine the contribution of sensory processing problems to challenges in receiving oral care for children with ASD. A questionnaire was sent to the parents of 206 children with disabilities to test the hypotheses that children with ASD, relative to children with other disabilities, experience greater difficulty with home‐based and professional oral care, and that these difficulties may relate in part to sensory processing problems. The results partially supported these hypotheses. Compared to children with other disabilities, those with ASD had greater behavioral difficulties and sensory sensitivities that parents believed interfered with their child’s oral care. Among children with ASD, sensory sensitivities were associated with oral care difficulties in the home and dental office, and with behavioral difficulties in the dental office. Utilizing strategies to modify the sensory environment may help facilitate oral care in children with ASD.     

Improving dental visits for individuals with autism spectrum disorders through an understanding of sensory processing

The increasing prevalence of autism spectrum disorder (ASD) suggests that dental practices will be seeing patients with this diagnosis more frequently. Although patients with ASD have similar dental needs to other patients, the symptoms of the disorder may influence the ability of dental practitioners to provide necessary care. Dental professionals may be unaware of the difficulties with sensory processing common to patients with ASD. However, awareness of sensory processing issues and knowledge of strategies to improve the sensory experience for individuals with ASD may improve dental visits for these patients and allow for enhanced dental care provision.     

Survey of toothbrushing duration in 85 uninstructed English schoolchildren

85 uninstructed children aged 11-13 years brushed their teeth and were unaware that they were recorded on video tape. By viewing the films, the time spent brushing in each of 16 areas of the dentition and the number of strokes used in each area were obtained. The mean overall brushing time was 60.3 s (+/- 23.8); the mean number of strokes used by each subject was 397 (+/- 224). More time was spent and more strokes employed brushing mandibular than maxillary arches, labial and buccal than occlusal areas, and occlusal than lingual areas. The percentages of time spent and number of strokes used brushing lingual areas were low.     

Measurement of plaque growth following toothbrushing

A method measuring plaque by area has been developed which can be used to evaluate the antiplaque effect of agents such as dentifrices when used in combination with toothbrushing. The extent of disclosed plaque 24 hours after treatment on tooth surfaces previously cleaned of all observable plaque was drawn by the examiner onto accurate enlarged scale drawings of the outline of the labial surfaces of all incisors, canines, premolars and 1st molars. Areas were then measured by an electronically recording planimeter. Three separate blind crossover trials were performed using this plaque area measurement in which a minimum of 15 subjects brushed normally on one occasion only, with either a calcium carbonate dentifrice or water. Compared with when subjects brushed with water, a statistically significant reduction of 45%-52% in plaque was observed in subjects 24 hours after brushing with the dentifrice in each of the three trials. In a study with 27 subjects, the periodontal condition of the papillae was found to be related to plaque present on labial surfaces on adjacent teeth as measured by this method. The teeth adjacent to papillae which bled on probing had 77% greater plaque area than teeth adjacent to papillae which did not bleed. Plaque area measured by this method on a continuous scale has a sensitivity advantage over the commonly used four-point plaque indices, especially when comparing effective antiplaque treatments or combination of treatments.     

Cervical abrasion in relation to toothbrushing and periodontal health

Abstract – Cervical abrasion and some factors related to oral hygiene habits and periodontal health were investigated in 250 subjects aged 21–60 yr. The subjects were considered dentally aware since they had visited their dentist on a regular basis over the past several years. A high occurrence rate of cervical abrasion was noted with 85% of subjects exhibiting at least one superficial lesion. Manifest or deep lesions, although less common, were present in 22% of subjects. Both prevalence and severity increased with age. The severity expressed as the mean number of lesions was 7.3 for the total sample. It increased significantly with calculus index, frequency of periodontal pockets, and reduction of the alveolar bone height. No significant associations were observed between abrasion and oral hygiene factors. It is concluded that cervical abrasion, although most likely related to toothbrushing, may not be synonymous with periodontal health. Ineffective toothbrushing may not only fail to prevent disease but may also cause cervical abrasion.     

Effects of toothbrushing on eroded dentine

It is an established assumption that eroded dental hard tissues are particularly prone to toothbrush abrasion. Only a few studies have aimed to show this for dentine and, if so, disregarded the complex histological structure of this tissue. Therefore, the present study sought (i) to investigate the effects of toothbrushing on eroded dentine and (ii) to analyze how the organic matrix influences the outcome of established methods for quantifying dental hard tissue loss. The effects of brushing were investigated by optical (P-O) and mechanical (P-M) profilometry, by longitudinal microradiography (LMR), and by scanning electron microscopy (SEM). The SEM images showed that a demineralized organic layer had developed, which was unaffected by brushing. For substance loss, there was no significant difference between eroded and eroded/abraded samples. Considerable differences occurred, however, when results from the different methods were compared. P-O yielded the lowest (7.0 +/- 3.4 microm) and LMR the highest (109.8 +/- 10.7 microm) substance loss values. When the organic material was removed enzymatically, all methods gave comparable results. The results of this study do not lend support to the notion that brushing increases substance loss of eroded dentine. Profilometry was not suitable for measuring mineral loss, unless the organic material was removed.     

Influence of social norms on toothbrushing behavior of preschool children

Two hundred and eighty mothers of preschool children were interviewed in order to determine first, their children's toothbrushing habits and secondly, their expectations concerning the brushing behavior of preschool children in general. The influence of social and demographic factors on children's brushing behavior was also investigated. The results showed that the practice of toothbrushing is widespread and mothers play the central role in teaching the brushing routine. However, the social norms concerning oral hygiene were imprecise, indicating that mothers had no social support for teaching their children to brush and no information on how brushing should be carried out. Dental health educators should encourage mothers of young children to develop positive attitudes towards toothbrushing and teach them the correct technique.     

The impact of powered and manual toothbrushing on incipient gingival recession

Aim: To compare clinical effects of manual and powered toothbrushes on sites of localized gingival recession over 12 months. To evaluate patterns and the extent of toothbrush bristle wear.
Methods: A longitudinal, single-blind, randomized, parallel group clinical trial compared the effects of one manual and one powered toothbrush on incipient lesions of localized gingival recession. Toothbrush wear was evaluated concurrently by wear index and wear rating.
Results: Sixty patients were recruited and randomized to two groups with 52 (26 per group) attending the final visit at month 12. There were no differences between groups for full-mouth plaque index, pocket depth or bleeding on probing at baseline and month 12. There were no differences at target sites for clinical attachment level, pocket depth, bleeding on probing, plaque index, width of keratinized gingiva or maximal height of recession. There were no differences between the wear of the brushes as measured by wear index or wear rating.
Conclusion: There was no progression of gingival recession in subjects using either toothbrush over 12 months. There was no difference in the overall wear of the powered and manual toothbrushes over successive 3-month periods.     

Uninstructed toothbrushing behaviour in young adults in relation to cigarette smoking in Newcastle

Abstract Video recordings were obtained of 50 men aged 18–20 yr (25 smokers, 25 non-smokers) brushing their teeth. From repeated viewing of the films the total brushing time and the number of strokes used in each of 16 areas of the mouth were obtained for each subject. Comparisons between smokers and non-smokers of time spent brushing, and number of brushing strokes used overall and in each area of the mouth, showed no significant differences. However, the distribution of brushing strokes around the mouth was more uniform in the non-smokers than in the smokers, which may indicate a tendency towards less favourable toothbrushing performance in smokers.     

Relationship between reported toothbrushing and dental caries in adults

The relationship of toothbrushing to dental decay has remained unclear. In the present study an effort was made to throw more light on this problem. Clinical and interview data were obtained from 212 males. Potential confounding risk indicators were controlled by a multivariate confounder summarizing score. In general it was found that the values of caries prevalence indicator were consistently higher for sporadic toothbrushers. It was concluded that the current study provides evidence in favor of a positive association between toothbrushing and low caries prevalence.     

Use of a Picture Exchange Communication System for preventive procedures in individuals with autism spectrum disorder: pilot study

The aim of the present study was to evaluate the use of the Picture Exchange Communication System (PECS) in individuals with autism spectrum disorder (ASD) in order to facilitate patient‐professional communication during preventive procedures. In this study, 26 patients with ASD, between 5 and 19 years of age (10±3.3 y), were divided into two groups: G1 (n = 13) with no previous experience of dental treatment, and G2 (n = 13), with such previous experience. The initial approach followed the principles of the Son‐Rise Program®. The seven PECSs presented the routine of the dental office: “room,” “ground,” “chair,” “dentist,” “mouth,” “low,” and “triple.” Each PEC was used up to three times in order to acquire the skill proposed. It was verified that G2 required a greater number of times to achieve the acceptance of PECS “ground,” “dentist,” “mouth,” and “triple” (p < .05). We concluded that PECS facilitated patient‐professional communication during preventive procedures, including for ASD patients with previous dental experience.     

Mechanical stimulation by toothbrushing increases oxygen sufficiency in human gingivae

Abstract We studied the immediate effect of mechanical stimulation with a toothbrush on oxygen sufficiency in human gingivae. Teeth were brushed with a modified Bass technique at various forces (100, 200, and 300 g) for various times (5. 10, and 30 s). Hemoglobin (Hb) oxygen saturation was measured before and intermittently for 60 min after brushing, by non-invasive tissue reflectance speetrophotometry. Hb oxygen saturation increased within a few min after brushing and then slowly returned to the initial level. Toothbrushing at 200 g for 10 s caused the longest-lived increase in Hb oxygen saturation; saturation remained about 6% above the baseline level for more than 25 min. Before brushing, Hb oxygen saturation was significantly lower in inflamed gingivae than in healthy gingivae (P<0.05). After brushing of inflamed gingivae. the Hb oxygen saturation almost reached the level measured in healthy gingivae before brushing. These findings suggest that stimulation with a toothbrush increases oxygen sufficiency in both healthy and inflamed gingivae.     

Trends in toothbrushing and utilization of dental services in Finland

Abstract Prevention and control of common dental diseases highly depends on individual behavior, and during the last decades, individuals have increasingly been required to take responsibility for their own oral health. In Finland the rate of toothbrushing and dental visits were first surveyed nationwide in 1971 by interviews with a sample of 1063 individuals, drawn to represent the total population aged 15 yr and over. At the time, 68% of the 829 dentulous interviewees claimed to brush at least once a day. Using another sample of 1006 interviewees, drawn in the same manner, in 1990 the brushing rate was found to have increased to 91% 853 dentulous subjects. Daily brushing was more frequent among women (98%) than men (83%). The most distinct positive change regarding brushing frequency was found among men and those with only elementary education. In 1971 the interval between the two most recent dental visits was 1 yr or less for 44% of all the interviewees and for 25% it was more than 5 yr. In 1990, 53% of the interviewees had visited a dentist within a year and the visiting interval was more than 5 yr for 16%. The youngest subjects were the most frequent visitors: 60% of them in 1971 and 74% in 1990. The results indicate a clear trend toward more frequent brushing in Finland. However, this trend regarding dental visits does not seem to be equally remarkable.     

Gingival recession and toothbrushing in an Italian School of Dentistry: a pilot study

The aim of this pilot study was to evaluate the prevalence of gingival recession at buccal tooth surfaces in a student population of Bologna University Dental School. A total of 55 subjects, attending the 1st and 5th year of the course were examined. The clinical examination involved assessment of plaque, calculus, width of keratinized gingiva, buccal probing depth and buccal gingival recession. Information about toothbrushing behavior was collected in an interview. The multiple regression analysis showed that level of education (p=0.002), toothbrushing technique (p=0.013) and toothbrushing frequency (p=0.016) are significant contributors to gingival recession. Notwithstanding the limits of a preliminary study, a higher prevalence of buccal recession is observed in the final year students, which have also a significantly lower % of buccal surfaces with calculus (p=0.014). In addition, it clearly appears that there is the necessity to investigate other factors connected with toothbrushing (pressure, time, toothpaste quantity) in order to provide an oral hygiene education without undesired effects.     

An epidemiologic approach to toothbrushing and dental abrasion

Abrasion lesions were recorded in 818 individuals representing the adult population of 430,000 residents of the Stockholm region, Sweden. The subjects were asked about toothbrushing habits, toothbrush quality and dentifrice usage; these factors were related to abrasion criteria. Abrasion was prevalent in 30% and wedge-like or deep depressions were observed in 12%. The relationship between abrasion and toothbrushing was evident, the prevalence and severity of abrasion being correlated to toothbrushing consumption. The importance of the toothbrushing technique for the development of abrasion lesions was elucidated. Horizontal brushing technique was strongly correlated to abrasion. It was demonstrated by treating the data with the statistical AID analysis that toothbrushing factors related to the individual (brushing frequency and brushing technique) exert a greater influence than material-oriented toothbrushing factor such as dentifrice abrasivity and bristle stiffness.