Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
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


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.

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;23:71-73

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Bhowate R, Dubey A. Dentofacial changes and oral health status in mentally challenged children. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2021 Jan 19 ];23:71-73
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Full Text

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]


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].


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.


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