Oral parafunction and bruxism in Rett syndrome and associated factors: An observational study

Access to Oral Healthcare in Individuals With Rett Syndrome: A Qualitative Study of Parent Perspectives

BACKGROUND

Intellectual and developmental disabilities (IDD) are varied in their nature and presentation. Barriers to oral healthcare are reported in studies of general populations with IDD but these may not reflect the barriers experienced by individuals with rare disorders such as Rett syndrome (RTT). There are also few peer-reviewed studies in the Australian context exploring barriers to dental care access for patients living with a disability. This qualitative study explored caregivers' perceptions and experiences regarding oral health and access to dental care for those with RTT in Australia.

METHODS

Parents of 31 individuals with a confirmed MECP2 mutation were sampled purposively from the Australian Rett Syndrome Database. Interview questions were based on earlier studies used in other disability populations and queried identification and management of dental pain and influence of other comorbidities in their child's oral care. Interviews were audio-recorded, transcribed and analysed using NVivo (Version 12 Plus). Directed content analysis was used to code data to a framework constructed from a literature review of factors affecting access to professional oral healthcare systems and factors affecting access to optimal at-home oral care in disability.

RESULTS

The most frequently cited barriers to professional dental care were dentist-related, while caregiver related financial barriers were cited by a minority of families. Dentist-related financial barriers were not present in these data. Most factors affecting access to optimal at-home oral care coded to the existing framework, with further enablers identified under training for the caregiver or parent.

CONCLUSIONS

The findings of this study provide a point of reference to understand factors affecting provision of at-home dental care and professional services to enable optimal oral health in RTT. Future research could explore the provision of targeted oral health information on RTT to carers and clinicians.

Exploring Oral Health Related Quality of Life in Rett Syndrome Using Directed Content Analysis

No validated oral health-related quality of life (OHRQOL) instrument currently exists for those with severe intellectual and developmental disabilities and who communicate non-verbally. This qualitative study aimed to explore the domains that were important to the oral health-related quality of life in individuals with Rett syndrome (RTT). In 2021, following purposive sampling, recorded interviews were conducted with parents of individuals with a confirmed MECP2 mutation in the Australian RTT database (n = 31). Interview questions covered experiences of oral problems, the impacts of their daughter's oral health on other aspects of her life and on the lives of others, and on the family's quality of life. Directed content analysis was conducted. Seven domains were identified around the impacts of oral health on the child- discomfort, pain, eating, activities of daily living, emotional well-being, social well-being, and provision of services- affecting impacts on the patient. Five domains related to impacts on the family- emotions, activities, family function, conflict, and morale and self-efficacy to facilitate oral healthcare. The findings of this study pave the way for developing targeted OHRQOL measures for patients with RTT to understand and measure oral health impacts.

qPCR assay optimisation for a clinical study comparing oral health risk in Rett syndrome

PURPOSE

This study aimed to validate qPCR assays for specific microbiota, for use on dental plaque samples stored on Whatman FTA cards to compare relative oral health risk in Rett syndrome.

METHODS

Supragingival dental plaque samples were collected, using a sterile swab, (COPAN FLOQswab™) swabbed onto Whatman FTA™ cards. DNA extraction was performed using a modified Powersoil™ protocol. Where published assays were unsuitable, species-specific qPCR assays for caries-associated, gingivitis-associated and oral-health-associated bacteria were designed using multiple sequence alignment, Primer3Plus and PrimerQuest. Assays were run using absolute quantification. Limit of detection (LOD) and limit of quantification (LOQ) were calculated, and PCR products verified by Sanger sequencing.

RESULTS

Most assays allowed detection using real-time qPCR with high specificity on samples collected on FTA cards. Several assays showed low or even single gene copy numbers on the test samples.

CONCLUSION

Assays were optimised for detection and evaluation of oral health risk in dental plaque samples stored on FTA cards when cold storage is not feasible, except for F. nucleatum. Several assays showed gene copy numbers less than the LOQ or outside the range of the standard curve, so there is merit in optimising these assays using digital droplet PCR.

Prevalence of Oral Parafunctional Habits in Children and Related Factors: An Observational Cross-sectional Study

Aim

Parafunctional habits cause movements indicating their effect as functional and structural disorders such as malocclusion and temporomandibular joint changes in the oral and dental organs. This cross-sectional study was conducted to investigate the prevalence and factors associated with parafunctional habits in 6-12-year-old children in Qom, Iran.

Materials and methods

This analytical cross-sectional study was performed on 403 6-12-year-old schoolchildren of Qom, Iran. Data collection tools included a demographic questionnaire and a checklist prepared along with a clinical examination. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), with chi-square and analysis of variance (ANOVA) tests.

Results

The mean age of children was 8.9 ± 2.03 years. Bruxism was more common than other parafunctional habits (22.6%). There was a significant relationship between oral habits with children's gender and age (p <0.001). However, there was no significant relationship between oral habits and other variables such as underlying disease, economic status and parent's smoking (p >0.05).

Conclusions

Given the relatively high prevalence of parafunctional habits in children, it seems that children should be investigated for the presence of such habits in order to provide the necessary education to parents and perform dental interventions to prevent complications from oral habits. Dental interventions at a younger age are easier to conduct and have a more effective preventive role.

How to cite this article

Mehdipour A, Aghaali M, Janatifar Z, et al. Prevalence of Oral Parafunctional Habits in Children and Related Factors: an Observational Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(2):308-311.

Challenges in the Dental Management of Rett Syndrome under General Anesthesia: A Rare Disease

Rett syndrome is a neurodevelopmental genetic X-linked disorder. It is predominantly found in females with a prevalence rate of 1 : 9000. Rett syndrome patients are usually healthy the first months of their lives. The syndrome goes into a deceleration phase where motor, behavioral, and cognitive skills are impaired. Regarding their oral health, bruxism is one of the common oral manifestations found among Rett syndrome patients. We present a case of an 8-year-old patient with Rett syndrome who presented to the dental clinic for oral rehabilitation. The patient was evaluated and treated under general anesthesia with multiple extractions, restorations, and crown installments. Oral rehabilitation of Rett syndrome is important for those patients, and proper evaluation and treatment are the most efficient when performed under general anesthesia.

Enablers and barriers in dental attendance in Rett syndrome: an international observational study

AIMS

Intellectual and developmental disabilities are heterogeneous in aetiology and presentation, and one cannot make assumptions about the oral health barriers of those with Rett syndrome (RTT) based on findings from generic studies. This study investigated caregivers' perceptions regarding access to dental care for those with (RTT), and associations of dental treatments received by those with RTT with their caregivers' perceived value of oral health and perception of their own as well as their daughter's dental anxiety.

METHODS AND RESULTS

Retrospective observational data of a subset of individuals with confirmed MECP2 mutations in the InterRett database (n = 216) were used to explore caregiver-related factors and their relationships with longitudinal data on dental service utilisation, using negative binomial regression. The main reported barriers to dental care access for individuals with RTT were primarily dentist-related in nature, regardless of dental service history. Those with reported dental nonattendance were of older age. Increasing levels of caregiver-reported dental fear were associated with less frequent dental check-ups or for any appointments for affected individuals.

CONCLUSIONS

Dentist-related barriers and caregiver-reported anxiety may both adversely affect dental attendance for those with RTT. Future research should explore caregivers' beliefs and oral health literacy.