Dental health for children with special educational needs and disability

There are 1.37 million children and young people (CYP) with special educational needs and disability (SEND) in the UK. These CYP have more complex needs and may require more expertise, support and reasonable adjustments in the dental setting. There are high levels of unmet dental need for this cohort of CYP. Unmanaged dental disease, such as dental caries, can impact on a child's quality of life and wellbeing. All healthcare professionals who have contact with CYP with SEND have an important role to play in trying to improve the oral health of their patients. This can be achieved by educating parents, carers and patients, delivering consistent and supportive dental preventative messages, and where required, liaising with, or signposting to dental professionals. This paper outlines oral conditions that CYP with SEND experience, how they are managed by the dental team, reasonable adjustments, and evidence-based guidelines that should be followed to help prevent and treat oral disease.     

Dental neglect in children

Untreated dental diseases, particularly dental caries, can lead to a range of adverse impacts on children, including pain and infection. Yet caries is preventable if a child's basic oral health needs are met. Dental neglect occurs when there is persistent failure to meet those needs. Dentists and paediatricians can work together with other health and social care professionals to identify children with dental neglect and to intervene to safeguard their oral and general health and development.     

Early childhood caries: current evidence for aetiology and prevention

BACKGROUND: Despite the fact that it is largely preventable, dental caries (decay) remains one of the most common chronic diseases of early childhood. Dental decay in young children frequently leads to pain and infection necessitating hospitalization for dental extractions under general anaesthesia. Dental problems in early childhood have been shown to be predictive of not only future dental problems but also on growth and cognitive development by interfering with comfort nutrition, concentration and school participation. OBJECTIVE: To review the current evidence base in relation to the aetiology and prevention of dental caries in preschool-aged children. METHODS: A search of MEDLINE, CINALH and Cochrane electronic databases was conducted using a search strategy which restricted the search to randomized controlled trials, meta-analyses, clinical trials, systematic reviews and other quasi-experimental designs. The retrieved studies were then limited to articles including children aged 5 years and under and published in English. The evidence of effectiveness was then summarized by the authors. CONCLUSIONS: The review highlighted the complex aetiology of early childhood caries (ECC). Contemporary evidence suggests that potentially effective interventions should occur in the first 2 years of a child's life. Dental attendance before the age of 2 years is uncommon; however, contact with other health professionals is high. Primary care providers who have contact with children well before the age of the first dental visit may be well placed to offer anticipatory advice to reduce the incidence of ECC.     

Dental caries and vitamin D status in children in Asia

Dental caries and vitamin D inadequacy are known to affect children worldwide. Vitamin D has a vital role in tooth formation. There is growing evidence linking suboptimal serum vitamin D level with dental caries in children. This paper reviews the literature on both the prevalence of dental caries and of vitamin D deficiency in children in four Asian regions, discusses their associated risk factors, and reviews the global evidence on the association between dental caries and vitamin D in children. Caries prevalence in children ranged from 40% to 97% in Eastern Asia, 38–73.7% in Southern Asia, and 26.5–74.7% in Western Asian countries. Moreover, a higher prevalence of vitamin D deficiency in Asian children was identified, even in countries in equatorial regions, ranging from 2.8% to 65.3% in Eastern Asia, 5–66.7% in Southern Asia, 4–45.5% in Western Asia and 38.1–78.7% in Central Asian countries. Obesity, age, female gender, higher latitude, season, darker skin pigmentation, sunlight protection behaviors, less sunlight exposure and low intake of food containing vitamin D were important factors associated with lower serum vitamin D in Asia. Suboptimal vitamin D level in children may be a significant risk factor for dental caries, and requires further research to ascertain such an association in children in Asia, as well as to understand its exact influence on caries risk and development.     

Periodontal disease and dental caries in primary school children in rural areas of Delhi

A study was conducted in rural areas of Delhi to determine the prevalence of periodontal disease and dental caries amongst children of both sexes aged 5 to 14 years. 458 children studying in primary schools in four different villages were examined. These children came from a segment of rural community with low socio-economic level and following a traditional rural life style and dietary habits. Prevalence of periodontal disease and dental caries was found to be low despite perfunctory oral health care system with no fluoridation of water supply and indifference to oral health care practices among the children. This could be attributed to simple, coarse and traditional fibrous food consumed by the children.     

Cardiovascular disease risk factors and dental caries in adolescents: effect of a preventive program in Northern Sweden (the Norsjö project)

Since 1985 a 10 year prevention programme aiming to reduce cardiovascular diseases (CVD) has been running in the county of Västerbotten in Northern Sweden. The project started in Norsjö. The present investigation is a study on dietary intake, medical CVD risk factors and dental caries in five cross-sectional groups of 15-year-olds during 5 years (1987–1991) of the "Norsjö project". Most of the measured medical and dietary variables followed a similar trend, i.e. a positive trend during the first 3 years (1987–1989) and in the last 2 years (1990–1991) the averages returned towards baseline values. Dental caries prevalence followed a similar trend. Parental educational level did not have a major influence on diet or medical CVD risk factors, but higher caries scores were noted in adolescents with parents with "low" education compared with adolescents where the parents had higher educational levels. The results from the study also point to the fact that dental caries prevalence together with body mass index may indicate adolescents with CVD risk factors at unfavourable levels. Dietary counselling by dental personnel to adolescents with high caries and moderate obesity can be of advantage in reducing caries risk, as well as risk for development of CVD at higher ages.     

Unique Factors Affecting the Management and Prevention of Caries in the Childhood Cancer Survivor

Childhood cancer survivors are at high risk for a myriad of complications secondary to oncologic treatment regimens. Caries is one of the major sequela of oncologic treatment that place the childhood cancer survivor at risk for complications in adulthood. Dental caries can be prevented with optimum dental care, early identification, and patient education. A barrier to their prevention is the lack of routine dental care received by this population. Health care providers are in a prime position to remedy this problem through their frequent contact with the childhood cancer survivor during sick and well-child office visits. The purpose of this article is to convey information and tools related to dental caries in the pediatric cancer survivor younger than 18 years to enhance primary care providers’, acute care pediatric nurse practitioners’, and oncology providers’ knowledge of risk stratification, early identification, and treatment regimens for caries in the childhood cancer survivor.     

Efficacy of a public promotion program on children's oral health

Objective

To assess the efficacy of the Baby's Mouth early dental care prevention and promotion program in preventing oral diseases (caries, gingivitis, or malocclusions) in children attended since 2010.

The role of medications in dental caries formation: need for sugar-free medication for children

Most paediatric medicines are prescribed in a liquid form that includes sugar in the formulation. Accumulating evidence, on a clinical and experimental basis, shows a significant association between the intake of sucrose-based medication and an increased incidence of dental caries. Many of the children on long-term medication for chronic medical problems are particularly at risk from the consequences of developing dental caries; dental disease, sepsis or treatment procedures can put the general health or even life of the child at risk. The need to use sucrose in medications should be reassessed; medicines containing sugar should be labelled accordingly; and medical and dental professionals should be aware of potential problems related to sucrose-based medications.     

Epidemiological study of oral dental health of 4-year-old children in french nursery schools]

The departmental service of maternal and infantile protection (PMI) of Moselle (Lorraine region), together with the Paediatric Dentistry Department from Nancy University, organized a study of the dental health of 4-year-old children. AIMS OF THE STUDY: To assess the children dental health; to evaluate parental knowledge of dental health; to identify the factors associated with caries amongst children. MATERIAL AND METHODS: The study was a cross sectional observation. A random sample of 4-year-old children was selected among 11 586 children in nursery schools. The study was based on a clinical examination performed by a dentist and a structured questionnaire completed by parents. RESULTS: The overall proportion of children affected by caries was 37.5%. The mean dmft score was 1.51 (sd = 2.82) and 11.6% of the children had caries which affected their upper incisors, a sign of early childhood caries. Only 6.2% had received dental treatment on at least 1 occasion. There was a clear disparity in dental health: 1 child out of 3 suffered from caries but 1 out of 2 children in priority education districts was affected, compared with only 1 out of 4 children coming from a rural area. The questionnaires completed by parents showed a lack of knowledge of dental health and inadequate use of current prevention facilities. The multivariate logistic regression analysis showed that the variables that were significantly associated with caries in 4 year-old children were the mother's education, the low social background, the level of consumption of drinks containing sugar by both children and parents, the consumption of fluoride, and the level of knowledge about fluoride. CONCLUSION: Preventive measures must be developed in close relationship between pediatricians and dentists. Initial training of health care professionals has to be reinforced. Health care professionals in paediatrics are far more likely to meet mothers and young children than are dentists.     

Dental Caries in Turkish Immigrant Primary Schoolchildren

ABSTRACT. Dental caries and the utilization of the Public Dental Service in Sweden were investigated in 84 Turkish immigrant children born in Sweden, 69 Turkish children bom in Turkey and 85 Swedish age- and sex-matched controls. Dental fear was also studied. The mean age of the children was 8.3 years. Turkish immigrant children had more caries both in the primary and in the permanent teeth than Swedish children. Children born in Turkey had more caries in the primary dentition than those born in Sweden. Turkish children came more often for emergency visits than Swedish children and expressed dental fear more frequently. Turkish immigrant children therefore constitute a high risk group for caries and need supervision early after immigration.     

Epidemiological study of dental caries

A total of 2000 children (1–14 year age group) attending pediatric OPD, school clinic & well body clinic of Dr. R.N. Cooper Municipal Hospital & K.E.M Hospital, Mumbai were examined for caries prevalence and 35.6% had dental caries. Parental income was not shown to have any bearing on caries prevalence. Parental literacy, particularly maternal literacy was shown to influence caries prevalence in children. The prevalence was low in well-nourished children and in those taking vegetarian type of diet. Frequency of sweet consumption was shown to be associated with prevalence of dental caries. In 1–4 year age group it was noted that bottle fed children were more affected by dental caries. Tooth brush with paste was the commonest method used for cleaning their teeth in all age groups in our study. Caries prevalence was low in those children using tooth brush than in those using tooth powder. Those children who were using neem datun were found to be less affected with dental caries. Dental caries was also found to be low in those who rinsed their mouth with water after food.     

Craniofacial and dental malformations in Costello syndrome: A detailed evaluation using multi‐detector row computed tomography

Costello syndrome is a rare multiple congenital anomaly syndrome caused by heterozygous germline HRAS mutations, which is characterized by intellectual disability, growth retardation, distinctive facies, loose skin, cardiomyopathy and a preposition to malignancies. Although teeth abnormalities have been encountered in nearly two‐thirds of the patients in literature, the evaluation tended to be limited to the extent which can be obtained from physical examination. We investigated detailed craniofacial, oral and dental findings in four patients with Costello syndrome. In this study, images reconstructed by multi‐detector row computed tomography (MDCT) were used as substitutes for dental cast study and panoramic and lateral cephalometric radiograph studies to evaluate dental arches, tooth size, relationships between craniofacial and dental structures, and hypodontia. All four patients showed true/relative macrocephaly with facial bone hypoplasia and gingival hypertrophy. Occlusal attrition, malocclusion, small dental arches, microdontia, and convex face were noted in three patients. In addition, one patient showed dental caries, conic tooth and gingivitis, and another patient showed hypodontia. Our study suggests that craniofacial and dental abnormalities are common in Costello syndrome patients and comprehensive dental care should be provided from early infancy. To our knowledge, this is the first study of thorough craniofacial and dental evaluation by using MDCT in Costello syndrome. MDCT is a useful tool for precise evaluation of craniofacial and oral manifestations in patients with congenital anomaly/intellectual disability syndromes.     

Knowledge of Flemish paediatricians about children's oral health – results of a survey

Objective: To examine the knowledge paediatricians have about oral health in children.
Methods: A questionnaire on oral health knowledge was mailed to all members of the Flemish Paediatric Association representing 350 out of 676 Flemish paediatricians. Questions concerned timing of the first dental visit, effects of thumb sucking, fluoride supplements, trauma, fluorosis, mutans streptococci and caries, prevention of dental caries, nursing bottle caries and use of sealants.
Results: Two hundred seventy-six questionnaires (79%) were returned. Of the respondents, 71% said they have had some training on dental topics, and most rely on information brochures to be informed on dental subjects. Parents frequently questioned paediatricians about dental eruption. Paediatricians stated that the first dental visit should be scheduled at the age of 3. Eighty-three percent of the paediatricians stated that thumb sucking was harmful to dentition; 7% regularly prescribed fluoride supplements. Knowledge about fluorosis was moderate. Paediatricians judged community water fluoridation and tooth brushing after consuming erosive drinks as effective. The efficacy of dairy products was underrated. Seventy-three percent of the paediatricians were aware of nursing bottle caries, whereas only 39% were familiar with fissure sealing.
Conclusion: Initiatives are needed to improve knowledge about oral health of physicians involved in preventive health care of children.     

Amélioration de la santé orale des enfants avec autisme : les outils à notre disposition

Autism spectrum disorder (ASD) is a life-long heterogeneous psychiatric disorder, characterized by impaired social interaction and communication, and the presence of repetitive and stereotyped behaviors as well as restricted interests. These features have an impact on the oral health of these individuals: high risk of dental caries, poorer periodontal status, and bruxism are often described. Children with ASD often provide limited collaboration with medical procedures, particularly those considered invasive such as dental care. Children with ASD are prone to agitation, self-injury, and emotional dysregulation; they can also present hypersensitivity to sensory input. These features make it difficult for professionals to examine and treat children with ASD; they interfere with dental care and constitute a barrier to it. Most of them are treated under general anesthesia or sedation. Therefore, children with ASD present a challenge for the dental community. Adapted and specific strategies are required to allow individuals with ASD to go beyond the barriers of dental care. Different tools and techniques of evidence-based practice can be considered: visual pedagogy, behavioral approaches, and numeric devices can be used. Pediatricians have a key role in the oral care of children with autism. The aim of this article is to present the oral health associated with ASD, to set out the possible ways to improve oral health, to enable the practitioner to detect problems, to raise awareness, and to help patients and their families in their care pathway.     

Nutrient supplementation may adversely affect maternal oral health – a randomised controlled trial in rural Malawi

Nutritional supplementation during pregnancy is increasingly recommended especially in low‐resource settings, but its oral health impacts have not been studied. Our aim was to examine whether supplementation with multiple micronutrients (MMN) or small‐quantity lipid‐based nutrient supplements affects dental caries development or periodontal health in a rural Malawian population. The study was embedded in a controlled iLiNS‐DYAD trial that enrolled 1391 pregnant women <20 gestation weeks. Women were provided with one daily iron–folic acid capsule (IFA), one capsule with 18 micronutrients (MMN) or one sachet of lipid‐based nutrient supplements (LNS) containing protein, carbohydrates, essential fatty acids and 21 micronutrients. Oral examination of 1024 participants was conducted and panoramic X‐ray taken within 6 weeks after delivery. The supplement groups were similar at baseline in average socio‐economic, nutritional and health status. At the end of the intervention, the prevalence of caries was 56.7%, 69.1% and 63.3% (P = 0.004), and periodontitis 34.9%, 29.8% and 31.2% (P = 0.338) in the IFA, MMN and LNS groups, respectively. Compared with the IFA group, women in the MMN group had 0.60 (0.18–1.02) and in the LNS group 0.59 (0.17–1.01) higher mean number of caries lesions. In the absence of baseline oral health data, firm conclusions on causality cannot be drawn. However, although not confirmatory, the findings are consistent with a possibility that provision of MMN or LNS may have increased the caries incidence in this target population. Because of the potential public health impacts, further research on the association between gestational nutrient interventions and oral health in low‐income settings is needed.     

Successful and unsuccessful experiences in combating the antifluoridationists

Local physicians and dentists can support community water fluoridation programs by responding effectively to the polemic of antifluoridationists. Written and audiovisual materials are available to assist in this effort. Four case histories and discussion illustrate how health care professionals can play an important role in the prevention of dental caries by working on behalf of community water fluoridation.     

Anti-Streptococcus mutans antibodies in saliva of children with different degrees of dental caries

The aim of this study was to evaluate the relationship between the secretory immune system and dental caries. Forty-nine 3–5-year-old children with primary dentition were classified into three groups according to their caries indices: no caries (group I), one or two surfaces with caries lesions (group II) and rampant caries (group III). Lower numbers of mutans streptococci were found in group I in relation to groups II and III. Secretory IgA and anti-S. mutans IgA, IgM and IgG antibody levels were not significantly different among the groups. Western blotting analysis showed that some S. mutans proteins, including the 39, 59, 97 and 150 kDa molecular mass bands, were recognized by almost all the saliva samples. Antibodies against the 185 kDa band, known as antigen I/II, were present in all adults’ saliva and in only one child in group III. The absence of antibodies to the 185 kDa band in children’s saliva suggest a specific immunologic immaturity. Further prospective studies will be necessary to establish the possible effect of reactivity to this antigen on the S. mutans colonization in this age group.     

Odontoblasts: Specialized hard‐tissue‐forming cells in the dentin‐pulp complex

Odontoblasts are specialized cells that produce dentin and exhibit unique morphological characteristics; i.e., they extend cytoplasmic processes into dentinal tubules. While osteoblasts, which are typical hard‐tissue‐forming cells, are generated from mesenchymal stem cells during normal and pathological bone metabolism, the induction of odontoblasts only occurs once during tooth development, and odontoblasts survive throughout the lives of healthy teeth. During the differentiation of odontoblasts, signaling molecules from the inner enamel epithelium are considered necessary for the differentiation of odontoblast precursors, i.e., peripheral dental papilla cells. If odontoblasts are destroyed by severe external stimuli, such as deep caries, the differentiation of dental pulp stem cells into odontoblast‐like cells is induced. Various bioactive molecules, such as non‐collagenous proteins, might be involved in this process, although the precise mechanisms responsible for odontoblast differentiation have not been fully elucidated. Recently, our knowledge about the other functional activities of odontoblasts (apart from dentin formation) has increased. For example, it has been suggested that odontoblasts might act as nociceptive receptors, and surveillance cells that detect the invasion of exogenous pathogens. The regeneration of the dentin‐pulp complex has recently gained much attention as a promising future treatment modality that could increase the longevity of pulpless teeth. Finally, congenital dentin anomalies, which are concerned with the disturbance of odontoblast functions, are summarized.     

Infant oral health and oral habits

Many oral diseases and conditions, including dental caries (cavities) and malocclusions, have their origins early in life. Prudent anticipatory guidance by the medical and dental professions can help prevent many of the more common oral health problems. This article provides information on the rationale for early dental examination and instructions for pediatric and family practitioners in scheduling and conducting an early oral intervention appointment. In addition, feeding practices, non-nutritive sucking, mouth breathing, and bruxing are discussed, including their effects on orofacial growth and development.