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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2005  |  Volume : 23  |  Issue : 2  |  Page : 71-73

Dentofacial changes and oral health status in mentally challenged children

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
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-4388.16445

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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 Top

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 Top

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 Top

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 Top

1.Ingervall B, Helkimo E. Masticatory muscle force and facial morphology in man. Arch Oral Biol 1978;23:203.  Back to cited text no. 1  [PUBMED]  
2.Brown JP, Schodel DR. A review of controlled surveys of dental disease in handicapped persons. J Dent Child 1976;43:313.  Back to cited text no. 2  [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.  Back to cited text no. 3  [PUBMED]  
4.Brown RH, Cunningham WM. Some dental manifestations of mongolism. Oral Surg 1961;14:664-76.  Back to cited text no. 4    
5.Frassica JJ, Miller EC. Anesthesia management in pediatric &special needs patient under going dental and oral surgery. Int Anesthiol Clin 1989;27:109.  Back to cited text no. 5  [PUBMED]  
6.Patel AK, Boghani Co. Dental manifestation of Down's syndrome J Indian Dent Asso 1985;57:97-9.  Back to cited text no. 6    
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.  Back to cited text no. 7    
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.  Back to cited text no. 8    
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.  Back to cited text no. 9    
10.Green JC, Vermillion JR. The Simplified Oral Hygiene Index. J Am Dent Assoc 1964;68:7.  Back to cited text no. 10    
11.Cohen MM Sr, Cohen MM Jr. The oral manifestations of trisomy G (Down's syndrome). Birth Defects 1971;7: 241-51.  Back to cited text no. 11    
12.Ardran GM, et al. Tongue size in Downs syndrome. J Ment Defic Res 1966;16:160-6.  Back to cited text no. 12    
13.Gullikson-John. Oral status of mentally retarded children. J Dent Child 1969;36:133-6.  Back to cited text no. 13    
14.Tondon P, et al. Orodental pattern in mentally retarded. Indian J Psychiat 1990;32:185-7.  Back to cited text no. 14    
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.  Back to cited text no. 15    


[Table - 1], [Table - 2], [Table - 3], [Table - 4]

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