Oral health status and dental needs of an autistic population of children and young adults

Behavior of patients with autistic syndrome makes delivery of oral hygiene and dental treatment a problem. In this study, the oral health and needs of two groups of patients with autism were evaluated: noninstitutionalized children with a mean age of 11 and institutionalized adults with a mean age of 22. The latter group had severe periodontal problems; almost half required periodontal surgery. Many of the children also needed periodontal treatment. Adults were found to have lower decayed, missing, and filled teeth (DMFT) scores than functionally independent Israeli persons of the same age. This finding was surprising because institutionalized adults are predisposed to development of dental caries; they frequently consume sweets, have poor oral hygiene, and do not use fluoride. Noninstitutionalized children with autism had caries rates that were similar to rates of functionally independent peers.     

Xylitol in the prevention of oral diseases

Special needs populations such as the mentally disabled or developmentally disabled present a unique challenge for the dental professionals providing dental treatment. Among those challenges is oral health promotion through primary prevention of dental caries and periodontal disease. There are many barriers to adequate oral care for these special needs patients that include cost, physical limitations, low levels of perceived need and lack of dental knowledge by residents and staff, if the person resides in an institution. Primary prevention to maintain oral comfort and function tor these patients is a priority to support their quality of life. Typical oral health problems of these patients include hyposalivation, root‐surface caries, poor oral hygiene, a high prevalence of periodontal disease and dental caries. The purpose of this paper is to review information for the inclusion of xylitol in primary preventive regimens as an adjunct tor the prevention of oral diseases tor special needs patients.     

Relationship of dental treatment and oral hygiene to caries prevalence and need for periodontal treatment

The aim of this study was to examine the relationship between differences in dental attendance and oral hygiene patterns and dental caries and periodontal treatment needs. 1469 young people, aged 7, 12 and 15-19 years, and representing the urban (60%) and rural (40%) population from Spain were evaluated. Dental caries and periodontal treatment needs were registered according to the index D.M.F.T. and C.P.I.T.N., following the criteria of W.H.O. Regular dental attendance was observed in 16.6% of subjects examined, and only 9.4 saw a dentist regularly for dental prophylaxis. Statistical analyses showed that while the more frequent the dental visits, the lower the rate of caries, and periodontal treatment needs, the higher, however, the average number of fillings and the D.M.F.T. scores. These individuals had the higher number of functioning teeth, restored or sound, but they also had the disadvantage of having higher levels of disease experience. By the other way the individuals who saw the dentist regularly for dental prophylaxis presented the lower caries rate and periodontal treatment needs, the fewer tooth loss, and also an important reduction in the D.M.F.T. scores. Similar observations had been made in the individuals who brush their teeth frequently or with a correct technique. The results suggested that while frequent dental visits do not apparently help to prevent the onset of further dental disease, we can achieve this goal with regular preventive oriented dental therapy.     

Effect of antiasthmatic medication on dental disease: dental caries and periodontal disease

The prevalence of asthma has been increasing since the 1980s. Asthma and tooth decay are the two major causes of school absenteeism. There are few studies present in the literature. The objectives of the present study were to know the severity of dental caries and periodontal problems in children before and after taking antiasthmatic medication. The present study was conducted on 105, six- to fourteen-year-old asthmatic children to determine the condition of their dental caries and their periodontal status before and after taking antiasthmatic medication, for a period of 1 year and these were matched with their controls. The results showed that salbutamol inhaler shows increased caries rate with high significance over other groups, which was followed by salbutamol tablets and beclamethasone inhaler respectively. It has been concluded that antiasthmatic medication has its effects on dental caries and periodontal disease and asthmatic patients are recommended to adopt more precautionary oral hygiene practices and keep their caries activity and periodontal health under constant check.     

Incidence of dental caries among a group of university students in Turku

The aim of the present study was to estimate the incidence of dental caries in a group of university students during a 4-year interval between registrations. Eventual differences in the periodontal and oral hygiene conditions were also examined. In addition, the reasons for high prevalence of caries in freshmen were investigated. The material consisted of 116 students, initially examined clinically and radio-graphically in 1967, and later in 1971. The amount of untreated caries diminished from originally 15.0 to 9.9 decayed surfaces per student. Untreated caries was constantly less frequent among females than males. The caries incidence was 1.9 surfaces per year which corresponds to previous estimations of the caries increment in Finland. An improvement in the gingival conditions, eventually due to the decrease of untreated carious lesions, was registered. The difference between mean PH-values in 1967 and 1971 was not significant. Classification in subgroups according to gingival and oral hygiene conditions showed, however, that the group possessing poor oral hygiene conditions diminished in size. The indices of GI and PII were higher among males than females.

The poor dental conditions among the freshmen could be attributed to a mean of 6.4 years since the termination of previous regular dental treatment.     

What a public health planner wants from a periodontal assessment.

Despite certain shortcomings, the assessment of caries using the DMF system of scoring is relatively simple, reproducible and provides some indication of treatment needs and the success of the treatment measures provided. No such index is yet in existence which will give similar information about the much more complicated disease processes involved in periodontal disease. Early attempts to introduce suitable indices included the PI index PMA and OHI indices with their modifications. These indices have performed best in assessing disease status but gave little or no information about treatment needs, treatment achievement or failure. WHO attempted to simplify the indices so that they could be scored on a present or absent basis, but clinical trials revealed the impossibility of maintaining comparability even on this level. Subsequent refinement of the procedure has produced improvements in the system including the recording of five categories of treatment needs, namely special oral hygiene instruction, prophylaxis and oral hygiene, instruction, periodontal therapy without extraction of teeth and periodontal therapy with extraction of some or all teeth. The system is described in the second edition of the WHO manual on Oral Health Surveys. There is still need for epidemiologists to further refine the criteria of periodontal disease and to identify the significance of the various signs of gingival and periodontal pathology.     

Effect of controlled oral hygiene procedures on caries and periodontal disease in adults

Abstract The present report describes the result of a clinical trial in which a group of adults have been maintained on a proper oral hygiene standard over a 6-year period. In 1971–72, 375 individuals were recruited to a test group and 180 to a control group. During the 6 years of trial, 65 persons from the test group and 34 controls were lost. The patients were divided into three age groups; I <35 years, II 36–50 years, III >50 years. The members of the test and control groups were first subjected to a Baseline examination which included assessments of oral hygiene, gingivitis, periodontal disease and caries. Following this examination all caries lesions were treated and ill-fitting dental restorations adjusted. Each patient was also given a detailed case presentation and a dental prophylaxis. The control group patients were not involved in any further dental health programs during the subsequent 6-year period. Once a year, however, they were recalled to a public dental health clinic for examination and received symptomatic dental treatment. The test group participants, on the other hand, were given a preventive treatment, repeated once every 2–3 months which included (1) instruction and practice in oral hygiene techniques and (2) meticulous prophylaxis. The patients were re-examined 3 and 6 years after the baseline examination. At the Follow-up examinations the parameters studied at the Baseline examination were recorded again. The findings demonstrated that a preventive program which stimulates individuals to adopt proper oral hygiene habits may resolve gingivitis and prevent progression of periodontal disease and caries. Traditional dental care, on the other hand, did not prevent the progression of caries and periodontitis in adults.     

Dental caries experience, oral health status and treatment needs of dental patients with autism

Objectives

Autism is a lifelong neurodevelopmental disorder. The aims of this study were to investigate whether children with autism have higher caries prevalence, higher periodontal problems, or more treatment needs than children of a control group of non-autistic patients, and to provide baseline data to enable comparison and future planning of dental services to autistic children.

Material and Methods

61 patients with autism aged 6-16 years (45 males and 16 females) attending Dubai and Sharjah Autism Centers were selected for the study. The control group consisted of 61 non-autistic patients chosen from relatives or friends of autistic patients in an attempt to have matched age, sex and socioeconomic status. Each patient received a complete oral and periodontal examination, assessment of caries prevalence, and caries severity. Other conditions assessed were dental plaque, gingivitis, restorations and treatment needs. Chi-square and Fisher''s exact test of significance were used to compare groups.

Results

The autism group had a male-tofemale ratio of 2.8:1. Compared to controls, children with autism had significantly higher decayed, missing or filled teeth than unaffected patients and significantly needed more restorative dental treatment. The restorative index (RI) and Met Need Index (MNI) for the autistic children were 0.02 and 0.3, respectively. The majority of the autistic children either having poor 59.0% (36/61) or fair 37.8% (23/61) oral hygiene compared with healthy control subjects. Likewise, 97.0% (59/61) of the autistic children had gingivitis.

Conclusions

Children with autism exhibited a higher caries prevalence, poor oral hygiene and extensive unmet needs for dental treatment than non-autistic healthy control group. Thus oral health program that emphasizes prevention should be considered of particular importance for children and young people with autism.     

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.     

Korean dental hygienists' knowledge and opinions about etiology and prevention of dental caries

Objectives: Because of their formal education Korean dental hygienists have the potential to be the primary source of information on caries prevention for patients and the general public, and inuence the use and adoption of caries preventive procedures. The purposes of this study were to determine the knowledge and opinions about caries etiology and prevention among Korean dental hygienists, and to describe associated factors. Methods: A pre-tested, 20-item questionnaire was mailed to 1120 dental hygienists selected by stratied d random sampling and allocated proportionately. A postcard reminder was sent to all dental hygienists after 1 week. Non-respondents were sent additional complete mailings after 3 and 7 weeks. The response rate was 77% (n=863). Results: Analysis of six factors thought to be related to knowledge about caries etiology and prevention showed that dental hygienists who were taught to provide oral health education and believe that it is desirable to practice oral health education during dental hygiene school and those employed in health centers were likely to be more knowledgeable about caries etiology and prevention than other hygienists (P < 0.05). In regression analysis of the perceived effectiveness of caries preventive procedures, hygienists who provided oral health education during their formal training tended to rate caries preventive procedures as being more effective than other dental hygienists (P < 0.05). Conclusions: Overall, the results of this study suggest that most dental hygienists do not have up-to-date information on the etiology and prevention of dental caries, mechanisms of action ofuoride e and effectiveness of preventive procedures. Efforts to increase the level of knowledge of Korean dental hygienists about caries prevention should focus on strategies to educate dental hygienists who have not been taught to provide oral health education, who do not have favorable opinions about the desirability of oral health education, and who had no experience with providing oral health education as part of their work, especially hygienists working in private clinics. Further, these efforts should include the revision of dental hygiene curricula and continuing education courses.     

Special oral hygiene and preventive care for special needs

Many dental patients have special preventive needs related to dental caries and periodontal disease, and most patients with intellectual or physical disabilities have specialized needs. This article suggests that these needs often go overlooked. To best care for patients with these needs, the dental practitioner should identify special oral hygiene needs among his or her patients, provide them with oral hygiene instruction and implement the specific oral hygiene preventive and treatment procedures described here.     

The dental status of 15-year-old South Australian students

An exploratory study of the dental health and habits of 15-year-old students from different socioeconomic levels revealed a generally low prevalence of caries experience (DMFT 3.3). Shallow periodontal pockets were found in an average of 0.4 sextants among 19.5 per cent of students, but gingivitis, calculus and overhanging margins of restorations were very common. The highest treatment needs were for oral health education (97.6 per cent) and scaling (69.6 per cent). Socioeconomic level was associated with the dental visit pattern and dental status; this confirmed other studies that found that the lower socio-economic groups were at a disadvantage. There were indications that some minority ethnic groups had higher caries experiences and lower dental service utilization.     

Periodontal disease incidence,progression and rate of tooth loss in a general dental practice: the results of a 12-year retrospective analysis of patient's clinical records

One of the main objectives of a general dental practice is to teach its patients how to reduce their oral bacterial load. In other words, by teaching good oral hygiene habits, it is possible to reduce the number of bacteria and hence the number of species of bacteria present in each patient's mouth. Thus by achieving a high level of oral hygiene, the dental team hope to reduce each patient's future risk of periodontal problems, and dental caries.     

Oral health in a long-term care institution equipped with a dental service

The oral health and medico-dental status of 250 mostly elderly residents of a long term care institution were assessed by examination and a review of medical records. In addition, attitudes to dental care, dental experiences, and demands for care were solicited from those who could participate in an interview. There were no dental complaints from 70% of those interviewed. The complaints most frequently reported were difficulties with mouth dryness, hygiene, and chewing. Natural teeth remained in at least one jaw in 30% of the 245 residents examined. Dental caries was present in 78% of this dentate group, with coronal and root lesions equally prevalent. Gingival bleeding was also common in this group and 29% had deep periodontal pockets. Nearly 50% of the mandibular dentures and 25% of the maxillary dentures examined were inadequate. Mandibular dysfunction occurred in 25% of the population and was more frequent in the dentate group. Oral mucosal pathoses were rare. No correlation was found between the systemic health and the oral health of the residents. There was a need to improve the oral hygiene of most of those examined. Less than 20% of the denture wearers would have benefitted from treatment and 10% of those with defective dentures were considered unsuitable for treatment. In contrast, 60% of those with natural teeth required restorations and 36% needed one or more teeth removed. Very few urgent needs were seen. An inter-examiner accumulative inconsistency of 11% was measured between the three examiners, and a third of the assessments made of periodontal status were contradictory.     

Effect of controlled oral hygiene procedures on caries and periodontal disease in adults

Abstract The present investigation was carried out to determine if the occurrence of caries and the progression of periodontitis can be prevented in adults, and maintained at a high level of oral hygiene by regularly repeated oral hygiene instructions and prophylaxis. An attempt was also made to study the progression of dental diseases in individuals who received no special oral hygiene instruction but regularly received dental care of a traditional type. Two groups of individuals from one geographic site were recruited in 1971-72 for the trial; 375 were assigned to a test and 180 to a control group. A baseline examination revealed that the socio-economic status, the oral hygiene status, the incidence of gingivitis and the caries experience were similar among the test and control participants prior to the start of the study. During the subsequent 3-year period, the control patients were seen regularly once a year and given traditional dental care. The test group participants, on the other hand, were seen once every 2 months during the first 2 years and once every 3 months during the third year. On an individual basis they were instructed in a proper oral hygiene technique and given a careful dental prophylaxis including scaling and root planing. Each prophylactic session was handled by a dental hygienist. A re-examination was carried out towards the end of the third treatment year. The results of the trial clearly showed that it is possible, by regularly repeated tooth cleaning instruction and prophylaxis, to stimulate adults to adopt proper oral hygiene habits. The findings also demonstrated that persons who utilized proper oral hygiene techniques during a 3-year period had negligible signs of gingivitis, suffered no loss of periodontal tissue attachment, and developed practically no new carious lesions. The control patients, who during the same period received merely symptomatic treatment, suffered from gingivitis, lost periodontal tisssue support and developed several new as well as recurrent, carious lesions. These results indicate that dental treatment is a highly ineffective means of curing caries and periodontal disease.     

Oral health status and practices of dentate Bhil adult tribes of southern Rajasthan,India

Aims : To assess the oral health status of the Bhil tribal population of Southern Rajasthan and to investigate the association of age, oral hygiene and dental visiting practices with oral health status. Design : A cross sectional study of Bhil tribal adults chosen by a multi stage stratified random sampling procedure. Participants : The total sample size was 1,590 male tribal dentate subjects aged 15–54 years. Methods : Clinical recordings of oral hygiene status (OHI ‐ S), caries status (DMFT and DMFS) and treatment needs, and periodontal status (CPI). The Chi square test was applied to discrete data and one way ANOVA for continuous data. Multivariate analyses were carried out to test the association of age, frequency of cleaning teeth, material used for cleaning teeth and dental visiting habits with caries and periodontal status. Results : Debris, calculus and oral hygiene index scores increased with age. The overall mean DMFT and DMFS scores were 5.34±6.48 and 18.94 ± 35.87 respectively. Extraction was the most required treatment (1.74 ± 3.66 teeth) followed by one surface fillings (1.34 ± 1.65 teeth). Shallow periodontal pockets were prevalent (40%) among the 35–44 years age group whereas deep pockets were most common (11.6%) in the oldest age group. More than half the sextants (3.15) were excluded amongst the oldest study group. All the independent variables namely age, frequency of cleaning teeth, substance used for cleaning teeth and visiting habits were statistically significantly related to caries and periodontal status. Conclusions : The study population was characterised by a lack of previous dental care, high treatment needs, high prevalence of periodontal disease and poor oral hygiene. Under these circumstances, the implementation of a basic oral health care programme for the Bhil population is a high priority.     

A longitudinal study of dental health and treatment need in Swedish teenagers

Ninety-seven teenagers were followed from the age of 14 1/2 to 19 yr. During that time they were given regular dental care by the Public Dental Service. Data concerning dental caries, gingival status, probing pocket depths, subgingival calculus, defective fillings, loss of attachment and additional preventive care were recorded. The prevalence and increment of caries were low and at 19 one-third of the subjects had still needed no proximal restorative care at all. However, in 26% of the 19-yr-olds subgingival calculus was diagnosed radiographically and during the study period gingival inflammation changed from being merely a result of poor oral hygiene to an indication of initial periodontal disease. There was a sex difference in dental health, which increased with age and was of clinical importance at 19. In spite of a good caries situation, most of the subjects were in need of individual care due to an initial periodontal problem. Furthermore, the change to a treatment strategy based on prevention requires regular check-ups, and an extension of intervals between dental examinations could not be justified in this study, especially as it seemed to be difficult for the regular dentist to predict future disease on a clinical basis.     

Periodontal considerations of the removable partial overdenture

1. An overdenture, whether complete or partial, is an excellent mode of treatment in the mutilated dentition for the preservation of the residual ridge. 2. Selection of patients for an overdenture should be based on past history of dental neglect, the status of the teeth and their periodontium, including present oral hygiene status, and patient motivation. The patients with a history of dental neglect, poor oral hygiene, and lack of motivation in having the teeth and the periodontium restored to health as well as strict compliance to a home-care regimen and recall schedule are not good candidates for treatment with an overdenture. 3. The choice of teeth or roots to serve as overdenture abutments must include their periodontal evaluation, which should consist of a detailed periodontal examination, diagnosis, prognosis, and treatment when this is indicated, including chemical protection (fluoride gel) and an oral hygiene regimen tailored to individual needs. 4. The knowledge and expertise in the selection and implementation of appropriate periodontal treatment modalities is of paramount importance in restoring optimum periodontal health to the overdenture abutments before overdenture fabrication. 5. The maintenance phase of the overdenture abutments as well as of the existing natural teeth is of critical importance in the preservation of health of these abutments and teeth. This maintenance phase should consist of periodic recalls based on individual needs; a detailed periodontal evaluation, including patient's motivation and status of oral hygiene and denture hygiene; and detection of caries. If necessary, appropriate periodontal and/or restorative therapy should be performed, and oral hygiene measures reinforced. This will ensure longevity of both abutment teeth or roots and of the existing natural teeth resulting in a long-term success of an overdenture. 6. Because there is evidence of high incidence of periodontal disease and dental caries in overdenture wearers, and because this evidence is attributed mainly to lack of motivation and compliance of adequate oral hygiene as well as to frequency of recall visits, patients should be made aware of the importance of their role in the maintenance phase of treatment and in the factors that lead to ultimate success of overdenture therapy. 7. With (a) proper selection of the patient and the abutment teeth, (b) adequate periodontal and restorative health and treatment to ensure optimum health prior to RPOD construction, (c) a well-designed home-care regimen and frequency of recalls, and (d) proper execution of maintenance care, changes for long-term success of overdenture therapy will be much improved.     

Oral hygiene status in relation to sociodemographic factors of children and adults who are hearing impaired,attending a special school

This study examined the oral hygiene levels and periodontal status in a group of children and adults with hearing impairment attending a special school in Udaipur, India. Oral hygiene status was assessed by the Simplified Oral Hygiene Index (OHI‐S) of Greene and Vermillion and periodontal status by the Community Periodontal Index. An analysis using a bivariate analysis revealed that all the oral hygiene variables varied significantly with age, economic status, and education of the parents. A multiple regression analysis showed that the education of the mother was the single best predictor for oral hygiene status and explained 92% of the variance. These findings show that children with hearing impairment have poor oral hygiene and high levels of periodontal disease. This may be due to a lack of communication; hence, appropriate oral health education should be tailored to the needs of these students with the support of their teachers and their parents.     

Oral health status and treatment needs in institutionalized psychiatric patients: one year descriptive cross sectional study.

BACKGROUND AND OBJECTIVES: Psychiatric patients are one of the special groups requiring attention as they are often neglected. Oral health is an major determinant of general health for psychiatric patients and may have a low priority in the context of mental illness. The present study was conducted to assess the oral health status and treatment needs of institutionalized psychiatric patients of Davangere. METHODS: 220 psychiatric patients admitted in two general hospitals of Davangere during the period of one year were included in the study. The oral health status was evaluated with respect to caries, oral hygiene, and periodontal status. RESULTS: Of the 180 examined with the response rate of 81.8%. 58.3% were males, mean age was 36.7 years, 57.8% had < 1 year of mental illness with a mean of 2.2 years, and 90% were self-sufficient. The multiple logistic regression analysis showed that the mean DMFT (0.92) increased with age, duration of mental illness, and irregularity of oral hygiene habits (P<0.001). Mean OHI-S score was 3.3 and multiple logistic regression analysis showed that the mean OHI-S score increased with age (P<0.001). The multiple logistic regression analysis showed that the CPI score increased with age, duration of mental illness, and degree of helplessness (P<0.001). INTERPRETATION AND CONCLUSION: The findings of this study demonstrates low caries prevalence, poor oral hygiene, and extensive unmet needs for dental treatment.