Oral health education and promotion in special needs children: Systematic review and meta-analysis

Effectiveness of Oral Health Interventions Among Intellectually Disabled Children-A Systematic Review

AIM

This review aims to compare the effectiveness of various oral health interventions to improve the oral hygiene and oral health status of intellectually disabled children.

METHODS

A comprehensive literature search was performed and screened for articles in PubMed, Cochrane-CENTRAL, Google Scholar, EMBASE databases, and gray literature databases from January 2013 to December 2023. The search focused on randomized and clinical trials aimed at improving oral health status in children with intellectual disabilities were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data extraction was performed independently by two authors, involving 11 studies that met the inclusion criteria. The studies were assessed using the Cochrane Rob Tool. A descriptive summary of the significant findings was reported.

RESULTS

The studies used various oral health promotion strategies such as supervised tooth brushing, fluoride application, and oral health education interventions in reducing dental caries, gingival disease, and improving oral health among intellectually disabled children. All the included studies were of level 2 evidence.

CONCLUSION

This review highlights the effectiveness of fluoride applications, specialized toothbrushes, and caregiver training in improving the oral health of children with intellectual disabilities.

The evaluation of the effectiveness of conventional and pulsating toothbrushes on the oral health of healthy and mentally disabled pediatric patients

OBJECTIVES

Children, especially the mentally disabled, are generally incapable of obtaining adequate oral hygiene levels by manual brushing due to their lack of knowledge about oral hygiene and their limited motor skills. In order to handle those limited skills, different designs of manual and electric toothbrushes are developed and put on markets. The aim of this study was to evaluate the effectiveness of pulsating toothbrushes with easy-to-use properties, against conventional toothbrushes and to analyze their benefits on mentally disabled pediatric patients.

METHODS

Thirty-one healthy and 31 mentally disabled children (aged between 7 and 12) participated in this study. The effectiveness of three different toothbrushes (Oral-B Pulsar, Colgate 360° Micro Sonic Power, Oral-B Stages 3) was investigated with a cross-over study design. DMFT, dft, modified sulcus bleeding index (MOD-SBI), approximal plaque index (API) and Green and Vermillion simplified oral hygiene index (G&V OHI-S) measurements are performed to evaluate the oral hygiene status.

RESULTS

In the mentally disabled group the manual toothbrush for MOD-SBI, and Colgate 360° Micro Sonic Power for API showed the best results respectively.

CONCLUSION

The ability of tooth brushing was improved both in healthy and in disabled children during this 5 months study. Unfortunately, it was not obvious in disabled children. Persevering training for tooth brushing might be the most important regardless of the kind of toothbrush.

Oral Health Care for Children and Youth With Developmental Disabilities: Clinical Report

Oral health is an essential component of overall health for all individuals. The oral health of children and youth with developmental disabilities (CYDD) involves unique characteristics and needs of which pediatricians and pediatric clinicians can be aware. Risk for oral disease in CYDD is multifactorial and includes underlying medical conditions, medications, and ability to participate in preventive oral health care and treatment, and lack of access to providers is common for this population despite being eligible for Medicaid. Pediatric clinicians are uniquely positioned to support the oral health needs of CYDD and their families through the medical home. This clinical report aims to inform pediatric clinicians about the unique oral health needs of CYDD. It provides guidance on assessing caries risk and periodontal status using structured screening instruments; understanding dental trauma, the role of diet and caries risk, trauma prevention, and malocclusion; and providing anticipatory guidance on oral hygiene that includes tooth brushing, use of fluoridated toothpaste, assessing community water fluoridation, advocating for a dental home by 1 year of age, and transition to adult dental care as part of adolescent health care. It also highlights special considerations for dental treatment rendered under sedation or general anesthesia that CYDD may need. Pediatric clinicians can help reduce risk of CYDD developing dental disease by understanding the unique needs of their patients and their barriers to accessing oral health care in their community, communicating with the child's dental home, and advocating for safe and accessible dental procedures.

Effectiveness of Audio-Tactile Performance Versus Other Oral Health Education Methods in Improving Oral Health in Visually Impaired Children and Adolescents: A Systematic Review

The aim of this study was to compare the effectiveness of audio-tactile performance (ATP) versus other oral health education methods in improving the oral health status of visually challenged children and adolescents. The review was carried out based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was performed on the effectiveness of ATP in improving the oral health of visually impaired children. The search was conducted in Scopus, Google Scholar, PubMed, Embase, Lilacs, Web of Science, and Cochrane until December 2022. The risk-of-bias tool for randomized trials (RoB-2) was used to analyze the risk of bias. Meta-analysis was carried out for included studies that made similar comparisons and reported the same outcome measures. The initial search retrieved 368 records, of which nine studies were included for qualitative synthesis. Out of the nine included studies, five studies were included for quantitative synthesis. Two studies evaluating plaque index at 180 days (MD = -0.10; p = 0.0009; CI = -0.17 to -0.02) and five studies evaluating gingival index at 90 days (MD = -0.15; p < 0.00001; CI= -0.21 to -0.09) exhibited a significant mean difference favoring ATP. Three studies that evaluated gingival index at 30 days and 180 days showed significant mean differences (MD = -0.27; p < 0.000; CI = -0.40 to -0.15 and MD = -0.09; p = 0.01; CI= -0.15 to -0.02) favoring ATP. The ATP technique produced significant improvements in oral health when compared with other conventional techniques. However, the studies had high heterogeneity, and hence, the result must be inferred with caution.

Pediatric dentistry systematic reviews using the GRADE approach: methodological study

BACKGROUND

To assess the reporting of the certainty of the evidence using the GRADE approach in systematic reviews of interventions in pediatric dentistry.

METHODS

The inclusion criteria were systematic reviews of randomized clinical trials (RCTs) and non-randomized studies of interventions (NRSIs) in pediatric dentistry that reported the certainty of the evidence through the GRADE approach. Paired independent reviewers screened the studies, extracted data, and appraised the methodological quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) tool. The certainty of the evidence was extracted for each outcome. A descriptive analysis was conducted.

RESULTS

Around 28% of pediatric dentistry reviews of interventions used the GRADE approach (n = 24). Twenty reviews reported 112 evidence outcomes from RCTs and 13 from NRSIs using GRADE evidence profile tables. The methodological quality was high (16.7%), moderate (12.5%), low (37.5%), and critically low (33.3%), fulfilling the majority of the AMSTAR 2 criteria. The certainty of the evidence for outcomes generated from RCTs and NRSIs was very low (40.2% and 84.6%), low (33.1% and 7.7%), moderate (17.8% and 7.7%), and high (9.8% and 0.0%). The main reasons to downgrade the certainty were due to (for RCTs and NRSIs, respectively): risk of bias (68.8% and 84.6%), imprecision (67.8% and 100.0%), inconsistency (18.8% and 23.1%), indirectness (17.8% and 0.0%), and publication bias (7.1% and 0.0%).

CONCLUSION

The proportion of systematic reviews assessing the certainty of the evidence using the GRADE approach was considered small, considering the total initial number of published pediatric dentistry reviews of intervention. The certainty of the evidence was mainly very low and low, and the main problems for downgrading the certainty of evidence were due to risk of bias and imprecision.

REGISTRATION

PROSPERO database #CRD42022365443.

Anti-caries Streptococcus spp.: A potential preventive tool for special needs patients

INTRODUCTION

Probiotics are living microorganisms that act on the host-microbiome interface to restore the microbiota's physiological homeostasis. Numerous probiotics have been marketed with inhibitory activity against Streptococcus mutans and consequently with a potential anti-caries effect, mainly of the genera Lactobacillus and Bifidobacterium, whose main disadvantage is their limited ability to settle in the oral cavity.

METHODS

This narrative review describes the main Streptococcus spp. with probiotic anti-Streptococcus mutans activity, whose substantivity is greater than that of Lactobacillus spp. and consequently with anti-caries potentiality. We performed a literature review in the PubMed, Science Direct and Google Scholar databases of articles published in English (without time restriction) related to caries and probiotics.

RESULTS

The potential identified anti-caries probiotics included Streptococcus spp. A12, Streptococcus oralis (AJ3), Streptococcus oligofermentans, Streptococcus salivarius (K12, M18, JH, LAB813, 24SMB), Streptococcus spp. with arginolytic activity (S. sanguinis, S. gordonii, S. ratti, S. parasanguinis, S. intermedius, S. australis, and S. cristatus), Streptococcus rattus (JH145), Streptococcus dentisani and Streptococcus downii.

CONCLUSIONS

The possibility of using these Streptococcus spp. as probiotics that inhibit the growth of dental plaque and the development of carious lesions represents a potential tool of particular interest for individuals with physical or intellectual disabilities that impede the routine and effective application of mechanical dental plaque removal techniques.

Oral health characteristics in children and adolescents with Down syndrome

AIM

To compare oral health indicators of children/adolescents with Down syndrome (DS) with a group of children/adolescents without DS.

METHODS AND RESULTS

This cross-sectional study included 144 individuals with DS, ages 4 to 18 years, matched for age and sex with a group of 144 individuals without DS, and their parents/caregivers. Parents/caregivers completed a questionnaire regarding sociodemographic information and habits related to their children's oral health. Clinical examination of the children/adolescents evaluated dental caries experience (DMFT/dmft), bleeding on periodontal probing, presence of visible plaque, clinical consequences of untreated dental caries (PUFA/pufa), and malocclusion (DAI). The chi-square test, linear by linear test, and Mann-Whitney test were used to compare the variables between the groups (p < .05). Children/adolescents without DS brushed their teeth more times per day (p < .001) and had a higher frequency of daily sugar intake (p < .001). The children/adolescents in the DS group had a greater presence of gingival bleeding (p < .001) and had a greater number of cases of "severe malocclusion" and "very severe malocclusion" (p = .001). No difference was found in the prevalence of dental caries between the two groups.

CONCLUSION

The children/adolescents in the DS group had a greater presence of gingival bleeding during the clinical examination and had a greater need for orthodontic treatment.