Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

The Oral Health of 6-15 Year Old Special Needs Children in Baghdad

S.M Yahya Hanoush, Bashar Helail*

Post Graduate, Dip Bristol England

Abstract: Objectives: To provide a critical review of the current evidence that implicates special needs as a risk factor for dental caries, relating to different special needs types and their effect on oral hygiene. Design: qualitative research. Setting: Mainly hospital-based patients or subjects. Outcome measures: The relationship between special needs and dental caries and gingivitis. Results: The prevalence of dental caries and oral hygiene status were assessed in 496 special needs children aged 6-15 years, attending 7 special needs institutes in Baghdad. The effect of different types of special needs condition or oral hygiene and dental caries was also evaluated. On the basis of the finding, it was concluded that a high proportion of carious lesion were untreated in all ages the F component was less than 20%. The prevalence of gingivitis was high, over 85% of the children were affected, with poor level of oral hygiene increasing by age. The only significant trends to emerge from the different handicap types were that those with impaired hearing and communication problems had much better oral hygiene. Conclusion: The relationship linking dental caries and gingivitis with poor oral hygiene and in special types of special needs children is relatively strong.

Keywords: the oral health of 6-15 year

Citation: S.M Yahya Hanoush, Bashar Helail, The Oral Health of 6-15 Year Old Special Needs Children in Baghdad. International Journal of Dental Sciences and Research, 4 (5). 79-84. January 2016. doi:10.12691/ijdsr-4-5-1

1. Introduction

In the recent years there has been an increasing awareness of the problem of special needs as a challenging group from dental aspect which lies in their physical disability to keep proper oral hygiene, with the difficulty in receiving adequate dental care in general dental practice [16,17,22].

Although studies carried out on the prevalence of dental caries suggested that very little difference exist between the prevalence of dental decay seen in special needs children and normal controls, there is definitely a much higher level of untreated dental diseases that have been reported. Special needs children tend to have more decayed and missing teeth [16,18,20].

On the other hand, most investigators noted a significantly poor level of oral hygiene with a higher incidence of gingival and periodontal disease amongst special needs children [7,16,17], which varies considerably with the degree and type of special need [6].

However, studies on the prevalence of the dental caries and periodontal diseases in Iraqi children (with no special needs) have been published for many years but probably none have dealt with special needs children.

Therefore, this study was organized to ascertain more about the dental state of special needa children to provide basic information for future dental services to be planned. In addition, the affect of different types of special needs on these parameter has been investigated.

2. Setting up the Health Service for Special Needs

On June 28th, 1980, the law of Social Welfare was issued in Iraq, in which the State takes the responsibility to provide health services (including dental services) for those with special needs, with the corporation of the various ministries and health departments.

The welfare and rehabilitation doctorate were established which direct (51) special institute and schools for various types of need throughout the country towards the regulations of rehabilitation

The total number of the special needs is not exactly well known as not all the special needs registered at the welfare department, but at the time of this study there were 4425 children officially registered at 17 special institutes in Baghdad and 34 institute distributed in other cities around the country.

Most of the children lived at home and none of them were institutionalized on a permanent basis.

3. Material and Methods

A sample of 496 special needs children aged 6 to15 years, attending 7 special needs institutes were included in the study.

They represent the three main groups of special needs (deaf & deaf-mute, blind& physically special needs).

The Mental special needs children were excluded from this study.

A stratified sample of 194 deaf & deaf-mute children were selected randomly from five institutes out of nine deaf and deaf- mute special needs institutes distributed in the Baghdad province.

Since there was only one physically and one blind institute in Baghdad, so all the 303 children were examined. Table 1 shows the distribution of the children according to their age and need.

Table 1. Distribution of the study sample according to age group and main special needs

Permission was given from the welfare department to carry out the dental examination at the institutes, and all the head-masters of each institute involved were approached personally prior to the examination.

All the examinations were performed by the first author so initial training and calibration of the examiner was followed by a pilot study to finalize the diagnostic criteria.

A reproducibility study was carried out at one of the deaf-mute institutes with a 4 weeks interval.

Differences recorded between data was not found to be statistically significant (P>0.05).

All the dental examination were carried out at the respective institutes in a classroom. Each child sat on an upright chair except for those with severely physically special needs as they had to be examined on their chair; day light was a constant source of light. The examination took place using a No.4 plain mouth mirror and sickle probe.

4. Diagnostic Criteria

4.1. Dental Caries

The diagnostic criteria selected for the assessment of dental caries were used following the WHO oral health surveys basic methods 1977.

4.2. Gingival Condition and Oral Hygiene Status

The criteria for measuring both gingival and hygiene condition were kept as simple as possible in order to keep the duration of examination to a minimum.

Both conditions were assessed using the good, fair, poor index of James et al 1960.

The data processing was carried out using the following statistical test.

Quantitative data = t-test.

Quantitative data= X² test.

5. Results

• Dental caries prevalence

The caries experiences for both sexes’ were found to be similar, so the results have been presented in combined form.

A total of 496 children were examined for dental caries.

The results are presented in three age groups

6-9 year olds; 10-12year olds, and 13-15 year olds.

Caries experience in the deciduous dentition are shown in Table 2.

Table 2. Caries experience among special needs Deciduous Dentition

• The mean DMF of 6-9 year olds group was 3.9 teeth, and 24%were caries free.

• While in age 10-12 year olds. The mean DMF was 5.1, and only 19% were caries free. 63% of carious lesion remain untreated.

Table 3. Caries experience among S.N permanent dentition

The prevalence of dental caries in permanent dentition is recorded in Table 3,

• The percentage of caries decrease from 31% at age 6-9 years old to16% by age of 13-15yr.

• The mean DMF increases from 3.3 in 6-9 years old to 7.4 by age of 13-15 years.

The breakdown of the:-

• DMF value showed 77% of carious lesions were untreated and only 11% were filled at age 6-9 years.

• In the 13-15 year old group 83% of carious lesions were untreated and only 4% had been filled.

• Caries experience by Special needs condition

When the caries experience of the special needs children was analyzed according to their special need condition Table 4 it was clear there is a difference in the prevalence of the dental caries between the three groups. Deaf and deaf-mute shows the least DMF value in all age groups, while the blind children show a significantly greater value of DMF compared to the other two groups. (P<0.05).

Table 4. Caries experience among S.N. by their major special need type

• Dental cleanliness and gingival condition

The dental cleanliness and gingival health of 496 children were recorded, Table 5 shows the proportion in each group with good, fair, and poor gingival condition which illustrate that the gingival health deteriorated with increasing age, in the 6-9 years old group only 10% had poor gingival condition and only 2% had good gingival condition.

Table 5. Gingival condition and dental cleanliness among Special needs children

Similarly the plaque scoring obtained shows that in the age 6-9 years old group, 25% of children were in good oral hygiene, while in the 13- 15 years old group, 3% had good oral hygiene.

On the other hand, there were significant differences in oral hygiene standards and gingival health among the three major special needs groups. Table 6 shows that blind and physically special needs had the worst condition, 47% had poor condition, while the deaf and deaf-mute was the least, only 29% with a bad oral hygiene.

Very little differences exist between the physically special needs children and blind children.

Table 6. Oral hygiene and gingival health among H.C. by Special need category

6. Discussion

The results obtained from this study showed a relatively high dental caries level among special needs children, which confirms the finding of other investigators [16,17,21].

• The mean DMF calculated for deciduous dentition in Table 2 ranged from (3.9) at 6-9 years of age to (5.7) at 10-12 years, which was relatively higher compared to the normal Iraqi children (Virgin 1982).

• The special needs children tended to have more missing and decayed teeth.

This may be attributed to a number of associated factors. There is a tendency from the parents to keep the feeding bottle for much longer than is wise, there is frequent intake of soft sugary foods given to the children to pacify them at time of stress, together with neglected oral hygiene procedures, all of which leads to considerable tooth destruction and advanced stage of dental caries end with multiple extraction of the teeth. In permanent dentition Table 3 the mean DMF ranged from:

• (3.34) at 6-9 years.

• (4.64) at age of 10-12 years.

• And (7.45) at age of 13-15 years respectively.

The caries prevalence was related to age difference, with the older aged children having more permanent teeth at risk, and this is in agreement with a great number of reports that concluded that dental caries are strongly and positively associated with age [5,9].

The D&M component combined form over 80% of the DMF in all age groups, and restorative component was less than 20%, which means high percentage of carious lesion were untreated, this emphasises the fact that special needs children are still receiving less dental care and when treatment is provided, there more likely to have extractions rather than restorative as has been shown to be the case in other studies [11,16,17,22].

When the caries experience of the special needs children was analyzed by the three major special needs condition, the blind and physically special needs children showed the highest

DMF value in every age groups Table 4, while the deaf and deaf-mute group showed relatively lower caries prevalence.

This would perhaps be anticipated for the first two groups, either because of a difficulty in keeping good oral hygiene, or a lack of co-operation and a difficulty in the management of those children during treatment which ends in most cases by simple treatment of the child.

The current investigation has also confirmed the poorer levels of oral hygiene and greater prevalence of gingival conditions in special needs children, which agree with other studies [4,17,20].

Both conditions get worse with increasing of age, as might be expected from previous data on normal and special needs children [12,14,16,17].

The comparison of the oral hygiene and gingival conditions within different groups shows that the incidence of these conditions varies considerably with the type of condition Table 6.

The blind group scored lowest in terms of "good" oral hygiene, and most of them required periodontal treatment. Children with impaired hearing and communication problems had much better oral hygiene, and this is agree with other studies [17].

The scrutiny of the component of carie index (Figure 4) and gingival status (Figure 5) indicated poor dental health of many special needs children with consequent inadequacy of dental care provision, there are a number of factors that can explain this. Firstly most of the special needs institutes are not visited by a dentist on a regular basis, with no routine dental examination offered for the special needs childre which may be due to insufficient manpower.

Figure 1.

Figure 2.

Secondly most of those the dental profession are reluctant to provide dental treatment to those with special needs, either because they have a personal fear of inadequacy to cope with the situation, which lead to the child refusing the treatment [10], or because they do not have the time or the treatment equipment, or even because they do not consider it to be economical.

Whatever the reason, the results emphasise the need for good quality dental services together with establishing a comprehensive preventive measure at an early stage for special needs children which includes oral hygiene instruction with much effort placed on the methods of teeth brushing to suit the individual requirements, dietary adviceabout reducing sugar containing foods, fluoride supplements, and a regular check up with a dental professional.

Figure 3. Dental cleanliness among Special needs children

Figure 4. Figure Percentage of caries free in the permanent dentition

Figure 5. Gingival condition among Special needs children

However, many authors have emphasised the importance of a preventive approach whether to patients, or parents or the dentists [8,19,23].

Therefore the present investigation stress the vital importance of preventive measures of dental diseases for special needs patients and they should receive absolute priority. In fact, after the general well-being of the child the prevention of dental disease is the most important aspect of any treatment program.

7. Summary

The prevalence of dental caries and oral hygiene status were assessed in 496 special needs children; aged 6-15year olds. On the basis of the findings it was concluded that a high proportion of carious lesions were untreated, in all ages. The F component was less than 20%.

The prevalence of gingivitis was high, over 85% of the children were affected, by a poor level of oral hygiene which increase by age.

This study stresses the importance of preventive measures to improve the dental health for this group in the community.

References

[1]   | Baghdady V.S. & Ghose L.J. 1982 Dental caries prevalence in schoolchildren of Baghdad province. Iraq Community Dent, oral Epidemiology 10:148-151.
[2]   | Barmes D.E. Oral health in Iraq. Assignment report IRQ/DNH/001 WHO, Geneva.
[3]   | Berman & Slock 1972 Dental caries in English school children a longitudinal study. Br. Dent j 1972 133:529-38.
[4]   | Brown J.P.1980 The efficacy and economy of comprehensive dental care for special needs children int, Det.J.30:14-27.
[5]   | Brunelle J. & Pcanlos J. 1982Changes in the prevalence of dental caries in V.S. school children 1961-1980. J. Dent. Res. 61-special issue.
[6]   | Claycomb C.K., Summers G.W., Hall W.B. and Hart R.W. 1970 Gingival collagen biosynthesis in mongolism. J.Periodont Res 5:30.
[7]   | Cutress TW. 1971 Periodontal disease &oral hygiene in trisomy Arch oral Biology 16: 1345-55.
[8]   | Franks A.S.T., Winter G.B. 1974 Management of the special needs and chronic sick in the dental practice Br. Dent. J. 136:62-7.
[9]   | Greene J. & Suomi J. 1977 Epidemiology and public health aspects of caries and periodontal disease. J. Dent. Res. special issue C. 56:c20-c25.
[10]   | Gurney N-L. & Alcorn B.C. 1979 The concept of attitudes. In dentistry for the special needs patient. Postgraduate dental handbook series. PP:1-9 John Wright PSG Inc. Boston.
[11]   | Horowitz HS, Greek WJ.Hoag OA.1965 A study of the provision of dental care for special needs children. J. An. Dent. Assoc 71: 1398-1410.
[12]   | Hugoson A.Kock, G. Hallonsten, A.1980 Dental health 1973 and 1978 in individuals ages 3-20 in Jonkoping sweden. Swedish Dent. J. 4: 217-29.
[13]   | James P.M.C. et al. 1960 Gingival health& dentalcleanliness English school children. Arch oral Biology 3: 57-66.
[14]   | Loe, H. Anerud, A. Boysen, H. And Smith M. 1978 The natural history of periodontal disease in Man. J. and periodontal Res. 13: 550-60.
[15]   | Modeer T., Dahilof G. And Theorell K. 1986 Oralhealth in non-institutionalized epileptic children with special reference to phenytoin medication. Commun. Dent. Oral Epidemiology 14: 165-8.
[16]   | Murray J.J., Mcleod J.P. The dental condition of severly subnormal children in three London boroughs. Br. Dent.J. 1973; 134: 380-385.
[17]   | Nunn J.H., J.J. Murray The dental health of special needs children in Newcastle and Northumberland. Br. Dent. J. 1978; 162: 9-14.
[18]   | Pali T., Hausen H., Alvesalol, Heinonen O.P. Dental health of 9-10 year old mentally retarded children in Eastern Finland. Community Dent. Oral Epidemiology 1982; 10: 86-90.
[19]   | Pool D. 1981 Dental care of the special needs Br. Dent. J. 151: 267-70.
[20]   | Pleper K., Dirks B., Kessler P. Caries, oral hygiene and periodontal disease in special needs adult. Community Dent oral Epidemiol 1986; 14:28-30.
[21]   | Svatun B., Holeo LA. Dental status and treatment needs among in stitutionalised mentally subnormal persons in Norway. Community dent oral Epidemiol 1975; 93:208-13.
[22]   | Swallow J.N. The dental management of the physically special needs children.Br. Dent.J. 1966; 120:35-39.
[23]   | Stephen K.W. Macfadyen E.E.1977 Three years of clinical caries prevention for cleft palate patients Br.dent.J. 143:111-16.
[24]   | World health organization Oral health survey, basic methods, 2nd ed. Geneva, World health organization 1977.