Rare diseases with oral components: care course and quality of life

AIM

To describe links between the care course of individuals suffering from rare diseases and socio-behavioural risk factors and to ascertain the impact of dental conditions on the quality of life.

DESIGN

A cross-sectional comparative study involving self-reported questionnaire was performed. Care course was evaluated using predisposing, enabling and needs factors. The impacts of dental conditions on quality of life were measured with the OHIP 14 questionnaire. Proportions were compared by Chi-square test. Logistic regression for multivariate analysis assessed statistical association between variables.

RESULTS

Responses were received from 355 subjects (mean age 36.9 years, 67.6% females). Thirty-three rare diseases were recorded. Respondents were classified as group A, individuals suffering from rare diseases with a dental component (n=207, 58.3%), and group B, without dental component. Group A reported earlier diagnosis, more positive attitude toward dentists, functional limitation and higher prosthetic treatment needs. Only 17.4% of subjects having fewer than 20 teeth wear prosthetics. A higher percentage of individuals claiming pain, physical disability, psychological discomfort and social disability, was found among group B (p<0.001). Logistic regression analysis retained two impact factors: psychological disability (Exp(B)=8.66; 95% CI 1.86-40.34) and social wellbeing (Exp(B)=0.06; 95% CI 0.02-0.215).

CONCLUSION

Rare diseases with a dental component benefited from earlier identification of symptoms. Dentists could contribute to patients' quality of life by helping in early diagnosis, reducing functional limitation and improving social wellbeing.

Carbamide-containing polyol chewing gum and prevention of dental caries in schoolchildren in Madagascar

The objective of this investigation was to evaluate the effect on dental caries experience of using carbamide polyol chewing gum as a supplement to standard oral hygiene procedures for schoolchildren in a developing country (Madagascar). In 1994, grades 1 and 4 children of demonstration schools were allocated to experimental and control groups; all children participated in a school-based oral health education programme, including daily toothbrushing supervised by the classroom teacher. At grade 1, the test group (n = 125) also used chewing gum (V6: 55.5 per cent sorbitol, 4.3 per cent xylitol, 2 per cent carbamide) three times a day. At grade 4, one test group (n = 177) had chewing gum three times a day and an additional test group (n = 74) had chewing gum five times a day. The control groups included 117 children at grade 1 and 209 at grade 4. Dental caries was registered in 1994 and 1997 according to the Recording System for the Danish Child Dental Services. In grade 1 children, the preventive effect of the total DMFS was not statistically significant except for occlusal caries (-0.65 DMFS, P < 0.01). In the grade 4 test groups, non-significant reductions of dental caries experience were found when compared with controls. The present community trial indicates that the use of polyol chewing gum may be considered a supplement to the control of occlusal dental caries in young primary schoolchildren, particularly in developing countries with limited resources for dental care.

Oral health status of children and adults in Madagascar

The present national study was undertaken in order to describe the oral health situation of the population in Madagascar. The WHO pathfinder sampling procedures were applied to obtain representative samples of the following age groups: 6 years (n = 1866); 9 years (n = 1905); 12 years (n = 1992); 15 years (n = 1130); 18 years (n = 792), and 35-44 years (n = 1809). Data were collected in 1993 according to the methods recommended by WHO, including dental caries, dental treatment need, and CPITN. In 6-year-olds, 85 per cent had caries in primary teeth and a mean of 3.1 DMFT was observed among the 12 year-olds; the 35-44-year-olds had an average of 13.1 DMFT. Differences in dental caries prevalence were found according to sex, urbanisation, region, and ethnic group. Ninety-one percent of individuals at age 18 and 72 per cent at age 35-44 had maximum CPITN score 2 (gingival bleeding and calculus). In an African perspective, the oral health status of the Malagasy population is extraordinary poor, and the implementation of community-based oral health promotion and prevention is urgently needed.