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 treatment under general anesthesia for special‐needs patients: analysis of the literature

The aim of the present review was to identify the studies published on dental treatment under general anesthesia for special‐needs patients. A comprehensive search of the reported literature from January 1966 to May 2012 was conducted using PubMed, Medline, and Embase. Keywords used in the search were “dental treatment under general anesthesia”, “special‐needs patients”, “medically‐compromised patients”, and “children”, in various combinations. Studies published only on dental treatment under general anesthesia and in English were included. Only 10 studies were available for final analysis. Age range from 1 to 50 years, and restorative procedures, were most prevalent. Only two studies discussed repeated general anesthesia, with rates of 7.2% and 10.2%. Over time, the provision of general anesthesia for special‐needs patients has changed from dental clinics to general hospitals. The demand for dental treatment for special‐needs patients under general anesthesia continues to increase. Currently, there are no certain accepted protocols for the provision of dental treatment under general anesthesia.     

Dental health and treatment needs in institutionalized psychiatric patients in Italy

Abstract The caries prevalence, oral hygiene status, periodontal health and the treatment needs were assessed in a group of institutionalized psychiatric patients in Catanzaro, Italy. Of the total sample of 297 subjects, 165 (55.6%) were males, the mean age was 55.1 yr, the great majority (90.6%) was able to care for themselves, on average they had been institutionalized for 12.9 yr, and almost two-thirds were schizophrenic (65%). They did not receive any assistance in daily oral hygiene procedures, only 7.4% had visited a dentist and exclusively for emergency care. A total of 33 (11.1%) patients were edentulous, and the multiple logistic regression analysis showed a highly significant increase of edentulousness with increasing age (P < 0.001). No caries-free subjects were found and among the dentate the DMFT and DMFS scores for all age groups were respectively 15.5 and 88.6. The stepwise linear regression analysis showed that the mean DMFT index increased with age (t = 6.86; P < 0.00l), and in the partly or totally helpless patients it was significantly higher than in the self-sufficient patients (1=2.78; P= 0.006). Of the 264 dentate subjects, only 25 (9.5%) had no need of dental treatment: 213 (80.7%) required extractions with a mean number per person of 6.3 and the need for conservative dental care was recorded in 154 (58.3%) patients with a mean need for patient of 2.8. Mean OH1-S score was 4.2 and the stepwise linear regression analysis showed that it increased with age (t = 5.73; P < 0.01) and with the length of institutionalization (t =3.42; P < 0.001). Only 0.9% of the entire sample was found with healthy periodontal tissue; bleeding on probing or a higher score was found in 4.6% of examined sextants; calculus in 10.1%; shallow pockets and deep pockets in 19.6%. and 64.8% of all sextants. The results of the multiple logistic regression analysis indicated that the number of subjects with deep pockets as highest score increased with increasing age (P < 0.001), and with the increasing length of institutionalization (P=0.005). The findings of this study demonstrate high caries prevalence, poor oral hygiene and periodontal health, and extensive unmet needs for dental treatment. More coordinated efforts between the social and dental care sector must be maintained to serve adequately the need of this disadvantaged group.     

Bacteriology and antimicrobial susceptibility of gram‐positive cocci isolated from pus specimens of orofacial odontogenic infections

We recently reported the β‐lactamase production and antimicrobial susceptibility of anaerobic gram‐negative rods isolated from pus specimens of 93 orofacial odontogenic infections. In this report, we determine the bacteriology and antimicrobial susceptibility of bacteria other than anaerobic gram‐negative rods, mainly gram‐positive cocci, isolated from the same specimens. Streptococcus constellatus and Peptostreptococcus micros were frequent isolates from all types of infection examined. Peptostreptococcus prevotii, Corynebacterium species, and Eubacterium species were recovered only from dentoalveolar infections, while Gemella morbillorum was found more frequently in periodontitis than in the other infections. β‐Lactamase‐positive strains were detected only in staphylococci. Ampicillin, ampicillin/sulbactam, cefazolin, cefotaxime, imipenem, erythromycin, clindamycin and levofloxacin showed high susceptibility rates (≥77%) against viridans streptococci, Peptostreptococcus and Gemella. Minocycline showed a high MIC₉₀ value against viridans streptococci (32 µg/ml), and metronidazole was effective against Peptostreptococcus and Gemella. These results provide useful information for the treatment of orofacial odontogenic infections.     

Simultaneous adenomatoid odontogenic and keratocystic odontogenic tumours in a patient with Gorlin‐Goltz syndrome

Gorlin and Goltz described a syndrome in which multiple basal cell carcinomas, odontogenic keratocysts and bifid ribs occurred in combination. The jaw keratocysts are a consistent feature of ‘Gorlin‐Goltz’ or naevoid basal cell carcinoma syndrome. Central nervous system and ocular involvement occurred together with the fairly typical facial features of frontal bossing and hypertelorism. This case report documents the pathology associated with an impacted maxillary canine tooth in a boy with Gorlin‐Goltz syndrome. The patient presented for investigation of the failure of eruption of the right permanent maxillary canine tooth. Radiographic investigation showed the presence of a well circumscribed radiolucency located around the crown of an impacted right maxillary canine tooth. The patient's medical history revealed a medulloblastoma that was treated 13 years ago. The right maxillary canine tooth and associated peri‐coronal tissue were removed under general anaesthetic. A diagnosis of a keratocystic odontogenic tumour with an associated adenomatoid odontogenic tumour was made. The common differential diagnoses for a peri‐coronal radiolucency in the maxilla that need to be considered by dentists include a dentigerous cyst, follicular keratocystic odontogenic tumour and adenomatoid odontogenic tumour. A rare case of both keratocystic odontogenic tumour and associated follicular adenomatoid odontogenic tumour is described in a patient with naevoid basal cell carcinoma syndrome.     

Antimicrobial susceptibility of major pathogens of orofacial odontogenic infections to 11 β‐lactam antibiotics

In this study, we evaluated the current effectiveness of 11 β‐lactam antibiotics for treatment of orofacial odontogenic infections by determining the antimicrobial susceptibility of the major pathogens. The antimicrobial susceptibilities of viridans streptococci (n = 47), Peptostreptococcus (n = 67), Porphyromonas (n = 18), Fusobacterium (n = 57), black‐pigmented Prevotella (n = 59) and non‐pigmented Prevotella (n = 47) isolated from pus specimens of 93 orofacial odontogenic infections to penicillin G, cefmetazole, flomoxef, cefoperazone, cefoperazone/sulbactam, ceftazidime, cefpirome, cefepime, cefoselis, imipenem and faropenem were determined using the agar dilution method. Penicillin G, most cephalosporins, imipenem and faropenem worked well against viridans streptococci, Peptostreptococcus, Porphyromonas and Fusobacterium. Penicillin G and most cephalosporins, including fourth‐generation agents, were not effective against β‐lactamase‐positive Prevotella, though they were effective against β‐lactamase‐negative strains. Cefmetazole, cefoperazone/sulbactam, imipenem and faropenem expressed powerful antimicrobial activity against β‐lactamase‐positive Prevotella. In conclusion, penicillins have the potential to be first‐line agents in the treatment of orofacial odontogenic infections. Most of the other β‐lactam antibiotics, including fourth‐generation cephalosporins, were not found to have greater effectiveness than penicillins. In contrast, cefmetazole, cefoperazone/sulbactam, imipenem and faropenem were found to have greater effectiveness than penicillins.     

The Brisbane Statistical Division Survey of Adult Dental Health 1984. 3. Dental health status and treatment needs

Dental status and treatment requirements were investigated in 1504 subjects. Mean numbers of decayed, missing and filled (DMF) teeth for the various age groups were: 15–19 years, 6.2; 20–24 years, 10.6; 25–29 years, 15.8; 30–34 years, 18.1; 35–44 years, 20.4; 45–54 years, 23.0; 55–64 years, 26.2; and 65 years and older, 28.7. Total tooth loss did not occur in the 15–19 years or 20–24 years groups. In the 25–29 years group 2.6 per cent of subjects had lost all their teeth, 4.2 per cent in the 30–34 year group and 5.0 per cent in the 35–44 year group. The figures for the older age groups rose dramatically with almost 60 per cent of the 65 year and older age group having lost all their natural teeth. Treatment requirements for all age groups were low. In the 15–19 year age group 62.4 per cent of subjects had no treatment requirements. In other age groups the proportion was lower, ranging from 43.2 to 55.9 per cent. The periodontal condition of subjects was relatively good with only 3.3 per cent requiring complex treatment for severe forms of periodontal disease. A high proportion (over 50 per cent in all but the 15–19 year age group) required scaling and improved personal oral hygiene.     

Dental care needs,use and expenditures among U.S. children with and without special health care needs

BackgroundControversy exists in the literature about whether dental care needs, use and expenditures differ between children with and without special health care needs (SHCN).MethodsThe authors used data from the 2005 Medical Expenditure Panel Survey (MEPS) for children younger than 18 years. The MEPS questionnaire included the Children with Special Health Care Needs Screener, which defines a child as having SHCN if he or she meets at least one of five specific criteria. Using bivariate and multivariable regression analyses, the authors evaluated the effect of SHCN on unmet dental care needs, type of dental care received and average dental care expenditures.ResultsChildren with special health care needs (CSHCN) had an adjusted odds ratio (AOR) of 1.49 (95 percent confidence interval [CI] = 1.09–2.05) of having unmet dental care needs compared with children without SHCN, and CSHCN who met four or five screener criteria had an AOR of 2.2 (95 percent CI = 1.16–4.20). CSHCN used more dental care services and were more likely to receive only nonpreventive care. Average dental care expenditures were not statistically different between CSHCN and children without SHCN, and there was variability among CSHCN in unmet dental care needs and use.ConclusionsUnmet dental care needs are associated independently with SHCN status and complexity (based on the number of screener criteria the child met). The CSHCN populations in MEPS varied in their ability to obtain and use needed dental care services.Practice ImplicationsIt is important to consider the diversity of CSHCN when developing systems of dental care for this population.     

Dental caries and treatment needs in street children in Toluca, Mexico

OBJECTIVE: To assess dental caries (deft and DMFT) and treatment needs, in street children from the city of Toluca in Mexico. METHODS: After informed consent from their parents, guardian or legal representative, 310 street children, 0 to 17 years of age, from Toluca in the state of Mexico, were evaluated. Caries and treatment needs were recorded according to 1997 WHO criteria. The oral examination was carried out on site in daylight. RESULTS: For the population from which the sample was derived, the caries prevalence was 94.96%, the mean DMFT was 6.0 +/- 4.6 (5.8 decayed), while deft was 3.5 +/- 3.7 (3.4 decayed). Treatment needs in the deciduous dentition revealed that 43.9% of teeth did not require any treatment, 20% needed fissure sealants, 19% required one surface restoration and 13.19% needed restoration in two or more surfaces. In the permanent dentition, the treatment needs were as follows: 51.2% teeth did not need any treatment, 22.9% needed fissure sealants, 18.4% required one surface restoration and 5.3% needed restoration in two or more surfaces. CONCLUSIONS: These findings illustrate the high prevalence of caries in street children in the city of Toluca. There is an enormous need for dental treatment; sealant applications were the treatment most in need. The data can serve as a platform to implement preventive and restorative dental health programmes that meet the needs of Mexican street children,     

Dental health and treatment needs of 5-year-old children in the health area of Lambeth, Southwark and Lewisham, England

Abstract 865 children in their first year of full-time education in the health area of Lambeth, Southwark and Lewisham were examined for dental fitness and treatment requirements. Seventy-six percent of the subjects examined required treatment for dental caries and the mean dmft was 4.85. Sixteen percent of erupted permanent first molars were carious. 404 children had marginal gingivitis. All the treatment required for gingivitis and 82% for caries could be carried out by dental auxiliaries. The need for preventive measures is discussed.     

MMP‐13 expression in keratocyst odontogenic tumour associated with NBCCS and sporadic keratocysts

Oral Diseases (2010) 16 , 795–800 Objective: To investigate the matrix metalloproteinase (MMP)‐13 expression in associated and non‐nevoid basal cell carcinoma syndrome (NBCCS) Odontogenic Keratocysts (OCKs) in order to contribute to a better understanding of the differences in the growth pattern between them. Materials and methods: Thirty‐nine paraffin‐embedded blocks of OCKs, 26 sporadic OCKs and 11 NBCCS‐associated KCOTs were studied by immunohistochemistry to evaluate MMP‐13 expression both in epithelial and stromal layers. A semi‐quantitative scale was used to evaluate immunostaining. Obtained data were compared between the two groups, using Fischer’s exact test and the chi‐square test. Results: Only 13 of 26 sporadic OCKs showed a positive immunostaining, whilst 11 KCOTs resulted in positive labelling for MMP‐13 expression. Moreover, syndromic cysts displayed a more intense and diffuse MMP‐13 labelling of the stromal tissue. Instead, in non‐syndromic forms, the staining pattern of MMP‐13 in stromal tissue was completely absent. Fisher's exact test showed a statistically significant greater prevalence of KCOTs‐immunolabelled cysts with respect to sporadic OCKs. Conclusions: Results from this study point out that the biological behaviour of these cysts could be related not only to the epithelial layer but also to stromal tissue in that... MMP‐13 overexpression in stromal tissue of NBCCS‐associated KCOTs could clarify the higher aggressiveness of these cysts.     

Oral health and treatment needs among patients in psychiatric institutions for the elderly

Abstract – The purpose of the study was to assess oral health and treatment needs among elderly in psychiatric institutions in a Danish county. The study serves as baseline for the evaluation of a newly established oral health care program in the county. The study population comprised the residents in eight institutions ( n = 407). Two thirds of the residents were edentulous, 34% of the dentate had one or more root remnants, and 55% had untreated decay. The dentate with regular dental visiting habits had significantly less untreated decay than the irregular users. The oral hygiene was poor, but was not related to whether or not the elderly were assisted in daily oral hygiene. The evaluation of the program will show to what extent treatment takes place, and whether or not oral hygiene improves.     

Oral health attitudes and behaviours of final‐year dental students

Objectives: The objectives of this study of final‐year dental students in 10 classes (1997, 2001—2009) were to examine their self‐reported oral health attitudes and behaviours and describe any trends in these attributes. Participants and methods: Students were surveyed in final semester via an anonymous questionnaire (34 behaviour questions; eight attitude statements). Distributions, trends over time and attitude–behaviour associations were examined. Results: Of 583 students, 459 responded (79%). All tooth‐brushed with fluoride toothpaste; 80% brushed ≥2/day. Overall, 85% flossed; over time flossing behaviour increased significantly (P < 0.05), and those flossing 1—2/day increased (P < 0.005). Over time, significant decreases occurred in those taught toothbrushing (P < 0.001) and flossing (P < 0.05), and in use of mouth rinses (P < 0.05) and tooth cleansing sticks/picks (P < 0.001). Almost all (96%) had received a dental examination; 77% attended a dentist 1—3/year. Between‐meal snacking was common (84%); 71% chewed gum. Although 18% had ever smoked, 5% currently smoked. Most strongly agreed they expected to keep most of their teeth for all their life (76%); their future needs for fillings would be minimal (61%); smoking could adversely affect their teeth or gums (85%); and regular dental attendance was important for their dental health (51%). Congruent attitudes and behaviours favouring oral health were widely held concerning dental attendance, flossing and smoking. Conclusions: Final‐year dental students showed well established, favourable oral hygiene attitudes and behaviours, with evidence to suggest this knowledge was developed whilst in dental school. Despite many ceasing smoking, 5% still smoked. All dental students should receive training in motivational counselling and tobacco cessation to ensure this is included in patient care.     

Dental treatment needs and demands of an elderly population in England

A sociodental investigation was conducted among 254 elderly people living at home in Nottingham. A clinical assessment was made of the subjects' dental treatment needs and this was compared with the subjects' felt and expressed needs. Seventy-eight percent of the sample were clinically judged as needing denial treatment, mainly some form of prosthetic treatment. There was, however, a wide discrepancy between the normative and perceived needs of this elderly population. Only 42% of those who were clinically assessed as needing treatment felt that they required it and only 19% had actually tried to obtain it. Many of the elderly mentioned a number of barriers to obtaining dental care; these included the cost of treatment, fear of the dentist, immobility and the feeling that they should not “bother” the dentist.