|
|
ORIGINAL ARTICLE |
|
|
|
| Year : 2005 | Volume
: 23
| Issue : 2 | Page : 71-73 |
| |
Dentofacial changes and oral health status in mentally challenged children
Rahul Bhowate1, A Dubey2
1 Dept. of Oral Medicine and Radiology, Sharad Pawar Dental College, Wardha (MS), India
2 Dept. of Pedodontics and Preventive Dentistry, Govt. Dental College and Hospital, Raipur, India
Correspondence Address:
Rahul Bhowate
9B, Asara, Akanksha Vihar, Manor-Manglya Lane, Old Bye Pass Road, Amravati - 444 605
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-4388.16445
 Abstract | | |
The study was carried out on 69 mentally challenged individuals. They were subjected to detailed clinical evaluation for dentofacial abnormalities and oral health status. Of the 69 mentally handicapped individuals 27 had Downs syndrome and 42 had cerebral palsy. Characteristic facial abnormalities were seen in children with Downs syndrome. In cerebral palsy, fracture maxillary anteriors were more evident. All the Downs syndrome cases had abnormal TMJ movements but in cerebral palsy only 35.7% of individuals had abnormal TMJ movements. In both the groups, submandibular lymph adenopathy was reported. Present study revealed dental caries in 56.0% of the individuals. Fair clinical level of oral hygiene in 60% of the individuals was seen.
Keywords: Mentally challenged, oral health status
How to cite this article:
Bhowate R, Dubey A. Dentofacial changes and oral health status in mentally challenged children. J Indian Soc Pedod Prev Dent 2005;23:71-3 |
How to cite this URL:
Bhowate R, Dubey A. Dentofacial changes and oral health status in mentally challenged children. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2023 Feb 6];23:71-3. Available from: http://www.jisppd.com/text.asp?2005/23/2/71/16445 |
Normal facial morphology and its components are necessary for harmony and aesthetic of the craniofacial complex.[1] Oral and dental anomalies are a frequent accompaniment of mentally challenged, leading to improper functioning of stomatognathic complex. Many published studies have reported relatively poor oral hygiene and high level of periodontal disease in challenged children.[2],[3] Dental diseases and its treatment present several problems in this group of patients. As large percentage of children with Down syndrome have a heart defect, dental caries or infection of the gingival or periodontal tissues may lead to bacterial endocarditis.[4] Simple dental procedures such as conservative or endodontic treatment may pose a serious risk and any form of surgery can create problems. Anesthesia, either local or general may require special facilities and care. Several agents including ketamine and enflurane have been found to induce seizures and are therefore contraindicated in cerebral palsy.[5]
The prevention and treatment of the early stages of periodontal disease lie in the provision of self-care but this may be difficult for the challenged. In India there is little data available relating to dental health in mentally challenged.[6],[7],[8],[9] The aim of this study was to know the various dentofacial abnormalities and oral health status in mentally challenged individuals.
| Materials and Methods | |  |
The present study was carried out in 69 mentally challenged individuals from Thakur Hari Prasad Institute of Rehabilitation for mentally challenged children, Hyderabad, for assessing Dentofacial abnormalities. To assess oral health status (dental caries and oral hygiene), 65 challenged children from the same institution were included in the study. All the subjects were in 10-14 years of age group. Out of 69 subjects, 27 had Downs Syndrome and 42 had Cerebral Palsy. Medical history and relevant information were obtained from individual files. Clinical levels of oral hygiene were assessed using Simplified Oral hygiene index[10] and caries detection was carried out according to WHO, caries recording criteria.[8]
| Results | | |
All the mentally challenged individuals had one or other form of dentofacial abnormality. Prevalence of various dentofacial abnormalities revealed amongst Downs Syndrome and Cerebral palsy are presented in [Table - 1] and [Table - 2]. Abnormal speech was present in 36 (52.0%) and 12 (17.0%) were not speaking at all. Bitten fingernail, cold clammy hands and callused digits were seen in 53 (76.0%) of the individuals as these individuals are more nervous [Table - 3]. 37 (56.00%) of the individuals were affected with dental caries. Out of 65 individuals, 39 (60%) had fair level of hygiene [Table - 4].
| Discussion | | |
In present study, most of the individuals with Downs Syndrome had hypertelorism (92.5%) and flat bridge of nose (96.2%), this is due to mid-face hypoplasia. Fissured tongue (66.6%) and macroglossia (62.9%) in the present study is also a consistent finding in Cohen[11] and Ardran[12] study. High arched palate was present in (88.8%) but in the Gullikson[13] study of cephalometric analysis, palatal anomalies were present in 64% of the individuals. Malocclusion was present in 37.03% of Downs Syndrome and 30.9% of Cerebral Palsy patients. Patel et al[6] and Tondon et al.[14] showed 44.3 and 60.0% malocclusion in mentally retarded children, respectively. Malocclusion in the Downs Syndrome is due to retardation of the growth of the maxillae and mandible and both are placed anteriorly to the cranial base. In Cerebral Palsy, primary cause may be disharmonious relation between intra oral and peri oral movements. Uncoordinated and uncontrolled movements of jaws, lips and tongue are observed frequently in-patients with cerebral palsy.[15] Microdontia was present in 40.7% of Downs Syndrome and 4.7% of cerebral palsy patients in the present study while Patel et al[6] observed Microdontia in 80.3% of the subjects with mental retardation. Delayed eruption of permanent teeth was present in 14.8% with Downs Syndrome and 71.4% with cerebral Palsy. Abnormal movements of TMJ were present in all the individuals with Down syndrome and in 35.7% of individuals with cerebral Palsy. Abnormal movements of TMJ in Down Syndrome are mostly due to hypotonia and hyper extensibility of joints, but in Cerebral Palsy it is due to uncoordinated and uncontrolled movements of jaw.[5] Fractured maxillary anterior teeth were present in 21.4% of the individuals with cerebral palsy, as they are more susceptible to trauma. Submandibular lymphadenopathy was observed to be a consistent finding in Down Syndrome (77.7%) and Cerebral Palsy (61.9%), this was thought to be due to the high prevalence of gingival disease and un-treated carious teeth in mentally challenged individuals.
Adequate oral cleansing in most individuals is heavily dependent on effective brushing. This may be even more so in the mentally challenged in whom natural cleansing by the oral musculature may be impaired. Decayed teeth were present in 56.9% of the individuals. Increased caries incidence in mentally challenged has also been reported by Gupta[8] and Bhavsar. [9]
The most important aim of dental care for this group of children is to prevent dental disease, thus avoiding the problems associated with the disease and the need for operative treatment. It is necessary to educate the parent so that they understand the importance of dental health for their child and its relation ship to his medical condition. Aspects of preventive care include dietary counseling, provision of any necessary fluoride supplements and oral hygiene instructions.
It is important that these children should be provided with dental care as soon as their medical condition has been diagnosed and pediatricians should be encouraged to make the appropriate referral and advice the parents on the importance of dental health.
| References | | |
| 1. | Ingervall B, Helkimo E. Masticatory muscle force and facial morphology in man. Arch Oral Biol 1978;23:203.  [PUBMED] |
| 2. | Brown JP, Schodel DR. A review of controlled surveys of dental disease in handicapped persons. J Dent Child 1976;43:313. [PUBMED] |
| 3. | Tesini DA. Age, degree of mental retardation, institutionalization and socio-economic status as determinants in the oral hygiene status of mentally retarded individuals. Community Dent Oral Epidemiol 1980;8:355-9. [PUBMED] |
| 4. | Brown RH, Cunningham WM. Some dental manifestations of mongolism. Oral Surg 1961;14:664-76. |
| 5. | Frassica JJ, Miller EC. Anesthesia management in pediatric &special needs patient under going dental and oral surgery. Int Anesthiol Clin 1989;27:109. [PUBMED] |
| 6. | Patel AK, Boghani Co. Dental manifestation of Down's syndrome J Indian Dent Asso 1985;57:97-9. |
| 7. | Dinesh RB, Arnitha HM, Munshi AK. Malocclusion and orthodontic need of handicapped individuals in South Canara, India. Int Dent J 2003;53:13-8. |
| 8. | Gupta DP, Chowdhary R, Sarkar S. Prevalence of Dental caries in handicapped children of Calcutta. J Indian Soc Pedod Prev Dent 1993;11:23-7. |
| 9. | Bhavsar JP, Damle SG. Dental caries and oral hygiene among 12-14 years old handicapped children of Bombay, lndia. J Indian Soc Prev Dent 1995;13:1-3. |
| 10. | Green JC, Vermillion JR. The Simplified Oral Hygiene Index. J Am Dent Assoc 1964;68:7. |
| 11. | Cohen MM Sr, Cohen MM Jr. The oral manifestations of trisomy G (Down's syndrome). Birth Defects 1971;7: 241-51. |
| 12. | Ardran GM, et al. Tongue size in Downs syndrome. J Ment Defic Res 1966;16:160-6. |
| 13. | Gullikson-John. Oral status of mentally retarded children. J Dent Child 1969;36:133-6. |
| 14. | Tondon P, et al. Orodental pattern in mentally retarded. Indian J Psychiat 1990;32:185-7. |
| 15. | Weddllga JA, Vash BC, Jones VJE, Lynch TR. Dental Problems of the disabled child. In: McDonald RE, Avery DR, editors. Dentistry for child and adolescent, 5th Ed. CV Mosby Company; 1987. p. 618-21. |
Tables
[Table - 1], [Table - 2], [Table - 3], [Table - 4]
| This article has been cited by | | 1 |
Effect of cerebral palsy and dental caries on dental plaque index, salivary parameters and oxidative stress in children and adolescents |
|
| C. P. Malta, R. C. S. Barcelos, H. Z. Rosa, M. E. Bürger, L. W. Bento | | European Archives of Paediatric Dentistry. 2021; 22(1): 21 | | [Pubmed] | [DOI] | | | 2 |
A scoping review of oral health outcomes for people with cerebral palsy |
|
| Karen Lansdown, Michelle Irving, Kimberly Mathieu Coulton, Hayley Smithers-Sheedy | | Special Care in Dentistry. 2021; | | [Pubmed] | [DOI] | | | 3 |
Health of intraoral soft tissues in children with cerebral palsy and associated factors |
|
| Esra TUNALI, Seniz KARAÇAY, Arda TABANCALI, Büsra Seda IMAMOGLU, Ersin YILDIRIM, Turgay ARIK | | Mucosa. 2021; 4(2): 41 | | [Pubmed] | [DOI] | | | 4 |
Implications of Down's syndrome on oral health status in patients: A prevalence-based study |
|
| EV. Soma Sekhar Goud, Saakshi Gulati, Akriti Agrawal, Pooja Pani, K Nishant, SamarjeetJ Pattnaik, Shivam Gupta | | Journal of Family Medicine and Primary Care. 2021; 10(11): 4247 | | [Pubmed] | [DOI] | | | 5 |
Oral health status of Down's syndrome patients in Aseer, Saudi Arabia |
|
| NC Sandeepa, SaraAli Al Hagbani, FatmahAbdulrahman Alhammad, AmalSaeed Al Shahrani, SaraEid Al Asmari | | Journal of Pharmacy And Bioallied Sciences. 2021; 13(5): 656 | | [Pubmed] | [DOI] | | | 6 |
Oral hygiene negligence among institutionalized mentally disabled children in Mysore city—A call for attention |
|
| Darshana Bennadi, Vinayaka Konekeri, M Maurya, Veera Reddy, G Satish, CV. K Reddy | | Journal of Family Medicine and Primary Care. 2020; 9(4): 2045 | | [Pubmed] | [DOI] | | | 7 |
Association between intelligent quotient and oral health conditions among 13–15 year old intellectually disabled children |
|
| Jagadeeswara Rao Sukhabogi, Dolar Doshi, Sankepalli Shwetha, Hariprasad Gone, Kandadi Vasavi, Pandi Shulamithi | | International Journal of Adolescent Medicine and Health. 2020; 0(0) | | [Pubmed] | [DOI] | | | 8 |
Test–retest reliability of electromyographic variables of masseter and temporal muscles in patients with cerebral palsy |
|
| Lilian Chrystiane Giannasi,Miriam Yumi Matsui,Fabiano Politti,Sandra Regina F Batista,Bruna F. Caldas,José Benedito O. Amorim,Luis Vicente Franco de Oliveira,Claudia Santos Oliveira,Monica Fernandes Gomes | | Archives of Oral Biology. 2014; 59(12): 1352 | | [Pubmed] | [DOI] | | | 9 |
Dentofacial and Cranial Changes in Down Syndrome |
|
| Deepika Shukla,Deepika Bablani,Aman Chowdhry,Raveena Thapar,Puneet Gupta,Shashwat Mishra | | Osong Public Health and Research Perspectives. 2014; | | [Pubmed] | [DOI] | | | 10 |
Dental status, periodontal condition and oral hygiene of patients suffering from cerebral palsy [Stan uze{ogonek |
|
| Jankowska, K. and Kaczmarek, U. | | Dental and Medical Problems. 2012; 49(4): 495-501 | | [Pubmed] | | | 11 |
Assessment of dental trauma among cerebral palsy individuals in Udaipur city |
|
| Jalihal, S. and Nagarajappa, R. and Sharda, A. and Asawa, K. and Tak, M. | | Dental Traumatology. 2012; 28(6): 448-451 | | [Pubmed] | | | 12 |
Evaluation of status of cerebral palsy patientæs masticatory system [Ocena stanu narza{ogonek |
|
| Jankowska, K. and Kaczmarek, U. | | Dental and Medical Problems. 2012; 49(3): 358-362 | | [Pubmed] | | | 13 |
Dentition status, treatment needs and dental aesthetic index scores of individuals attending special schools |
|
| Shenoy, R.P. and Hegde, V. and Shenai, P.K. | | Indian Journal of Community Medicine. 2011; 36(4): 301-303 | | [Pubmed] | | | 14 |
Assessment of dental trauma among cerebral palsy individuals in Udaipur city : Dentral trauma among cerebral palsy patients |
|
| Sagar Jalihal, Ramesh Nagarajappa, Archana Sharda, Kailash Asawa, Mridula Tak | | Dental Traumatology. 2011; : no | | [VIEW] | [DOI] | | | 15 |
Dental assistance for children with cerebral palsy and tecnological perspectives for rehabilitation [Assistência Odontológica em Crianças com Paralisia Cerebral e Perspectivas Tecnológicas de Reabilitação] |
|
| Ferraz, M.J.P.C. and Gomes, M.F. and Matsui, M.Y. | | Arquivos de Medicina. 2010; 24(2): 59-64 | | [Pubmed] | | | 16 |
Severity of malocclusion in patients with cerebral palsy: Determinant factors |
|
| Miamoto, C.B. and Ramos-Jorge, M.L. and Pereira, L.J. and Paiva, S.M. and Pordeus, I.A. and Marques, L.S. | | American Journal of Orthodontics and Dentofacial Orthopedics. 2010; 138(4): 394.e1-394.e5 | | [Pubmed] | | | 17 |
Severity of malocclusion in patients with cerebral palsy: Determinant factors |
|
| Cristina Batista Miamoto,Maria Letícia Ramos-Jorge,Luciano José Pereira,Saul Martins Paiva,Isabela Almeida Pordeus,Leandro Silva Marques | | American Journal of Orthodontics and Dentofacial Orthopedics. 2010; 138(4): 394.e1 | | [Pubmed] | [DOI] | | | 18 |
Oral health status of Chinese teenagers with cerebral palsy |
|
| Chu, C.H., Lo, E.C.M. | | Community Dental Health. 2010; 27(4): 222-226 | | [Pubmed] | | | 19 |
Caries experience in individuals with cerebral palsy in relation to oromotor dysfunction and dietary consistency |
|
| Santos, M.T.B.R., Guare, R.O., Celiberti, P., Siqueira, W.L. | | Special Care in Dentistry. 2009; 29(5): 198-203 | | [Pubmed] | | | 20 |
Dysfunctions and parafunctions of the stomatognathic system in special-care schoolchildren - A questionnaire parental study [Wystepowanie dysfunkcji i parafunkcji narzadu żucia u dzieci ze szkół specjalnych - Badanie ankietowe rodziców] |
|
| Gerreth, K. and Borysewicz-Lewicka, M. | | Dental and Medical Problems. 2009; 46(1): 75-82 | | [Pubmed] | |
|
|
|
|
|
|
|
|
