A paired comparison of dental care in Canadians with Down syndrome and their siblings without Down syndrome

OBJECTIVE: To test the hypothesis that, controlling for age, Canadians with Down syndrome (DS) have dental care that is different to that of their siblings without DS. METHODS: A cross-sectional survey of parents of children with DS among members of the Canadian Down Syndrome Society (CDSS), using a validated questionnaire. Parents were asked to complete two versions of the questionnaire: one for their child with DS and another for the sibling closest in age without DS. A total of 2327 questionnaires were distributed; 1221 questionnaires for people with DS and 950 for siblings without DS were returned. A paired analysis (McNemar test) of dental care indicators was performed on data from 938 family pairs, stratifying for age. RESULTS: For all the dental care indicators and age groups, many respondents indicated the same behaviours or experiences in their child with DS and a sibling without DS. However, depending on the particular form of dental care and the age group, 0-47% of families reported discordant dental care experiences for their child with DS and a sibling without DS. The greatest differences were observed for yearly consults (P = 0.029), restorations (P < 0.001), fluoride therapy (P = 0.013) and extractions (P = 0.029). CONCLUSION: These observations suggest that compared to their siblings without DS, Canadians with DS are receiving different dental care.     

静脉泵入咪达唑仑清醒镇静技术控制牙科恐惧症的临床效果评价

目的评价静脉泵入咪达唑仑控制牙科恐惧症的临床效果。方法选择31例对牙科治疗极度恐惧但能与医师良好沟通的患者,将其两侧需行根管治疗的2颗患牙分别纳入试验组和对照组,对照组为常规牙科治疗,试验组加用咪达唑仑静脉泵入清醒镇静技术,控制患者治疗过程中的恐惧。评价两组患者的治疗依从性和行为治疗效果,并观察试验组患者生命体征的变化及副作用的发生率。结果试验组、对照组的Houpt行为治疗效果评分和Frankl治疗依从性评分均存在显著性差异（z=- 4.846,P=0.000;z=- 4.907,P=0.000）。试验组患者采用镇静措施后血压、心率均有轻度降低,并有轻度的呼吸抑制,但不影响治疗完成。结论单纯咪达唑仑静脉镇静对于能够良好沟通、主观愿意配合的极度牙科恐惧患者具有较好的疗效。     

Use of moderate sedation for a patient with Down syndrome,intellectual disability,and Eisenmenger syndrome: a case report

For patients who have Eisenmenger syndrome (ES), perioperative risks are high even for noncardiac surgery, such as dental extractions. We report on the case history of a 38‐year‐old male patient with Down syndrome (DS), intellectual disability (ID), and ES. The patient was scheduled for extraction of the right maxillary second molar tooth. His physical health was poor. Following oxygenation, midazolam was administered intravenously very slowly until the optimum sedative level was obtained, with a total dosage of 3.5 mg. There were no marked changes in vital signs during the perioperative period, and the patient was discharged the same day. This case suggests that moderate or conscious sedation using midazolam for dental treatment of a patient with DS, ID, and ES was well tolerated. Several critical points are presented in this review.     

口服咪达唑仑治疗牙科恐惧症儿童的临床疗效观察

目的对牙科恐惧症儿童实施口服咪达唑仑镇静下的口腔治疗,评估治疗的安全性、有效性及其影响因素。方法选择在口腔科就诊的Frankl量表评分为1的有不良牙科治疗经历的30例患儿为研究对象,共进行了46人次的口服咪达唑仑（0.5～1.0 mg·kg-1）镇静下治疗。治疗时,记录患儿的心率、血氧饱和度、治疗内容及持续时间等。采用Houpt量表评估患儿治疗完成情况,治疗结束24 h后电话回访不良反应。结果46人次治疗中,患儿的生命体征平稳、安全,37人次（80.4％）完成了既定治疗,9人次（19.6％）镇静效果不理想,仅完成部分治疗。烦躁不安是术后最常见的不良反应。3岁以上儿童的治疗成功率高于3岁及以下儿童,性别、剂量和治疗内容与治疗成功率无关。结论口服咪达唑仑治疗牙科恐惧症儿童是一种安全有效的方法,3岁以上儿童的治疗效果较好。     

Access to dental care among adults with physical and intellectual disabilities: residence factors

Background:  There is limited information about access and barriers to dental care among adults with disabilities.
Methods:  A mailed questionnaire survey of carers of 18–44-year-old South Australians with physical and intellectual disabilities (care recipients; n = 485) in family homes, community housing and institutions. Bivariate associations were tested using chi-square tests. Odds ratios (ORs) and 95 per cent confidence intervals (CI) were estimated for irregular dental visits (IDV).
Results:  Carers from family homes and community housing were more likely to report problems in obtaining dental care than those at institutions (p < 0.001). Lack of dentists with adequate skills in special needs dentistry (SND) was the most frequently reported problem for carers from family homes and community housing. IDV were less likely (p < 0.01) for care recipients in institutions and community housing than in family homes. After adjusting for care recipients' age, gender and disability, odds of IDV was lower in community housing (OR = 0.2, 95% CI = 0.1, 0.3) and in institutions (OR = 0.1, 95% CI = 0.04, 0.3) relative to family homes.
Conclusions:  Care recipients in institutions and community housing had better access to dental care than those at family homes. The shortage of dentists in SND and treatment costs needs to be addressed.     

Medical problems and oral care of patients with Down syndrome: a literature review

When planning the dental treatment of patients with Down syndrome (DS), dental practitioners should always consider their general health, in order to achieve a holistic and interdisciplinary approach. This article presents a literature review of the primary medical conditions in patients with DS that may affect their general health care and the appropriate clinical delivery of oral health care.     

Dental care access among individuals with Down syndrome: a Malaysian scenario

Objective. The purpose of this cross-sectional study was to assess the legal representatives’ perceptions on dental care access of individuals with Down syndrome (DS) compared to their non-DS siblings in Peninsular Malaysia. Methods: This cross-sectional study was conducted throughout community-based rehabilitation centers (CBRC) and the Down Syndrome Organization. Legal representatives of individuals with DS within the criteria were given a structured and validated questionaire. Result. This study demonstrated that individuals with DS (76.9%) significantly utilized more health services than non-DS siblings (23.1%). The service most regularly used was speech therapy followed by opthalmology and dental services. Twenty-five per cent of respondents reported difficulty in finding dental care services for their DS child and 46.9% admitted that healthcare for their DS child took more time. The majority of DS individuals received less complex dental treatment and none received any orthodontic treatment, despite their severe occlusal problems. Conclusion. A high proportion of parents appear to be able to access dental and medical care for their DS child. However, some parents perceived difficulty in finding oral healthcare.     

The oral health of children with Down syndrome in Ireland

The authors investigated the oral health of a convenience sample of 71 children with Down syndrome. The study group had a lower caries prevalence but similar levels of unmet treatment needs as children at special and mainstream schools. Treatment experience varied with age: 5-year-olds had more extractions and fewer restorations, and 15-year olds had fewer extractions and more restorations. The number of teeth with fissure sealants was comparable to that of other children in Special Needs Schools. Although the study group had poor oral hygiene, a need for advanced periodontal treatment was not evident. Few had evidence of dental trauma. Malocclusion was prevalent. Through a government-funded program, most of the sample had seen a dentist within the previous year, and few parents reported problems accessing dental care.
This study suggests that services targeted toward groups with special needs could generate outcomes comparable to those seen in other service users. A finding that also may hold true for other underserved populations.     

Periodontal health in Down syndrome: Contributions of mental disability,personal, and professional dental care

Fifty‐five dentate patients with Down syndrome (DS) and 74 with mental disability non‐Down (MR) were compared to 88 control subjects. Subjects in the MR and Control groups were matched by gender and ethnicity to subjects with DS. All subjects were nonsmokers. Periodontal evaluation included plaque index (PI), gingival index (GI), bleeding on probing (BOP), and clinical periodontal attachment levels. Caries and missing teeth were recorded. Measures of personal dental hygiene and the frequency of professional dental care were also recorded. Most subjects brushed their teeth at least once per day, but did not floss. Both groups with DS and MR had significantly more missing teeth, more BOP, and higher GI and PI levels than the control group. Patients with DS had more attachment loss (AL) than the other two groups (p < .001). Increased AL in patients with DS was not associated with differences in socioeconomic status, personal/professional dental care, or mental disability.     

Knowledge and practice of behavioral management principles among dentists treating adults with learning disabilities

This study investigated U.K. dentists’ knowledge and practice of behavioral management principles (BMPs) as applied to adults with learning disabilities (AWLD). A postal questionnaire enquired into the dentists’ experience in managing AWLD, utilization of behavioral management techniques, and knowledge of BMPs. The response rate was 41% (N = 53). Two groups were investigated: specialists (dentists registered on the Special Care Dentistry specialists’ list, n = 37) and nonspecialists (dentists not on the list, n = 16). Although specialists treated more AWLD than nonspecialists, both groups of dentists reported they felt highly confident in managing AWLD. However, all dentists’ knowledge of the principles of nonpharmacological BMPs was low. Specialists had a tendency to use a greater range of nonpharmacological behavioral management techniques compared to non‐specialists. These results suggest that dental team members need more training in the theory and practice of BMPs, which might lead to less reliance on costly pharmacological interventions and a clinical experience that is more respectful of the dignity and independence of AWLD.     

Use of dental implants in patients with Down syndrome: a case report

Down syndrome is caused by trisomy of the 21st chromosome and is associated with well-described physical and systemic problems. Most people with Down syndrome have some degree of mental retardation as well as malformation of head and neck. Oral structures that are commonly affected include the tongue (microglossia), abnormalities in the number and shape of teeth, and poor quality (osteoporotic-like) of alveolar bone and jaw. These oral malformations as well as a tendency toward poor cooperation in the dental office contribute to the belief among dentists that people with Down syndrome are not good candidates for oral rehabilitation with dental implants. This article describes the use of dental implants in the oral rehabilitation of a 16-year-old boy with Down syndrome. Although more experience is needed before dental implants can be considered a suitable option during oral rehabilitation in people with Down syndrome, this case report shows a promising beginning.     

Oral health‐care utilization in adults with disabilities in Belgium

Leroy R, Declerck D. Oral health‐care utilization in adults with disabilities in Belgium.
Eur J Oral Sci 2013; 121: 36–42. © 2012 Eur J Oral Sci Reports on oral health‐service utilization among individuals with disabilities are very sparse. Nevertheless, such data are a prerequisite for the provision of proper care and for the development of optimal reimbursement schemes and may ultimately lead to better access to care. The objective of the present study was to provide data on oral health‐care utilization in Belgian residents with disabilities and to compare these data with the utilization pattern of their peers without special needs. Data from the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents, were used. The database contained prospective data on oral and general health‐care utilization and socio‐demographic variables from 1,221 individuals with disabilities and from 131,877 individuals without disabilities, collected from 2002 to 2008. Overall, annual dental‐attendance rates were very low and in those who attended, professional debridements, a cornerstone in preventive oral health care, were infrequently recorded. In adults with disabilities, significantly fewer radiographs, restorations, and endodontic treatments were recorded, whereas significantly more emergency visits were charged. Further research is indicated to evaluate whether this outcome points to high unmet oral‐treatment needs.     

Oral health status and reasons for not attending dental care among 12- to 16-year-old children with Down syndrome in special needs centres in Jordan

To cite this article:
Int J Dent Hygiene 10 , 2012; 259–264
DOI: 10.1111/j.1601‐5037.2012.00545.x Al Habashneh R, Al‐Jundi S, Khader Y, Nofel N. Oral health status and reasons for not attending dental care among 12‐ to 16‐year‐old children with Down syndrome in special needs centres in Jordan. Abstract: Objectives: The objective of this study was to assess oral health status, treatment needs, soft and hard tissue findings, as well as reasons for not attending dental care among children with Down syndrome (DS) registered in special needs centres in Jordan. Methods: The sample consisted of a total of 206 participants with a mean age of 13.66 ± 1.47 comprising 103 with DS and 103 age‐ and gender‐matched non‐DS/public school children. Clinical levels of oral hygiene were assessed using Simplified Oral hygiene index, and caries detection was carried out according to WHO caries recording criteria. Results: Children who had DS had a significantly higher percentage of surfaces with severe gingival index (39.9 ± 9.1 versus 15.9 ± 8.0, P < 0.001) and a higher mean of probing pocket depth than children without DS (2.27 ± 0.2 versus 1.81 ± 0.32, P < 0.000). Significantly more peg‐shaped maxillary lateral incisors and retained primary teeth (P < 0.001) were observed in subjects with DS, compared with non‐DS children. Average decayed, missing and filled teeth (DMFT) was significantly lower in male children with DS compared with male non‐DS children only (P = 0.034). The most common reason cited for not taking children to the dentist for DS group was ‘Not aware of the dental problems of their children’ and for non‐DS groups ‘No awareness of the importance of dental visit’ (61.2% and 53%, respectively). Conclusions: While having similar caries level, Jordanian teenagers with DS had more dental anomalies, poorer periodontal health and less dental attendance than age‐ and gender‐matched non‐DS/public school children.     

Relationship of dental status, sociodemographic status, and oral symptoms to perceived need for dental care

OBJECTIVE: Previous studies have noted a discrepancy between clinically determined oral health status (normative need), patients' perceptions, and perceived significance of dental signs and symptoms. Our objective was to quantify the relationships between normative need and self-reports to improve our understanding of the factors that contribute to perceived need for care. METHODS: Clinical examination and questionnaire data were derived from the Florida Dental Care Study, a study of oral health and dental care, in a representative sample of community-dwelling adults aged > or = 45 years. The questionnaire provided information about presence of signs and symptoms, self-ratings of oral health, perceived need for dental care, and sociodemographic status (SDS). Perceived need was measured on a 4-point nominal scale. RESULTS: Self-reported broken filling, broken denture, cavities, loose tooth, teeth that look bad, and toothache were strongly associated with self-reported perceived need for dental care. Satisfaction with dental health was also associated with perceived need, but self-rated oral health was not. Most measures of SDS were associated with perceived need. However, in a single multiple regression, with self-reported signs and symptoms accounted for, race, age group, sex, and educational attainment were not significantly associated with a currently perceived dental problem. CONCLUSIONS: Certain dental signs and symptoms were significantly associated with perceived need for dental care, as were certain aspects of SDS; even once differences in dental signs and symptoms had been taken into account. Disaggregating measurement of perceived need from a single dichotomous ('yes/no') scale to a 4-point nominal scale was elucidative.