Effects of treatments for drooling on caries risk in children and adolescents with cerebral palsy.

BACKGROUND: Neuromuscular impairment makes individuals with cerebral palsy (CP) more prone to drooling. Among the treatment options, there are procedures that interfere with saliva production. It is imperative to evaluate the effect of the different modalities since the reduction in salivary flow rate/production may exacerbate the risk of dental caries. MATERIAL AND METHODS: The aim of this study was to compare the effects of different treatments for drooling on caries risk and salivary parameters in children and adolescents with CP. STUDY DESIGN: A total of 142 children and adolescents with CP, aged 6 to 18 years, were assigned to groups based on the different treatments they had received for drooling: G1-anticholinergic drugs (n = 18), G2-botulinum toxin injection (n = 16), G3-salivary glands surgery (n = 16), G4-no treatment (n = 42), and G5-non-drooling subjects (n = 50). All participants were evaluated on the Simplified Oral Hygiene Index, and for the prevalence of dental caries (decayed, missing, and filled teeth index and white spot lesions). Unstimulated whole saliva was collected, and salivary flow rate and osmolality were measured. Chi-square, ANOVA and Poisson regression were calculated. Prevalence ratios and their respective 95 % confidence intervals were obtained. The significance level was fixed at 5%. RESULTS: No differences were found in the decayed, missing, and filled teeth index (p = 0.128) and Simplified Oral Hygiene Index (p = 0.674) among the different groups. G3 presented significantly higher percentages of WSL (p < 0.001), lower values of salivary flow rate (p < 0.001), and higher values of osmolality (p < 0.001). The white spot lesion prevalence ratio was higher only for G3 (Prevalence ratio = 14.36; IC 95% = 4.64-44.40; p < 0.001). CONCLUSIONS: Children and adolescents with CP who had received surgical treatment for drooling exhibited higher number of white spot lesions because of the reduced salivary flow rate and higher salivary osmolality.

Salivary parameters in Brazilian individuals with cerebral palsy who drool.

BACKGROUND: Although drooling of saliva is considered abnormal in a child over 4 years of age, it has been estimated to occur in approximately in 10-37% of children with cerebral palsy. AIM: The aim of this study was to evaluate the flow rate, pH and buffering capacity in saliva of Brazilian individuals with cerebral palsy who drool. METHODS: Cross-sectional assessment of saliva from 139 individuals with cerebral palsy (3-16 years old) enrolled in a specialized rehabilitation centre in Sao Paulo, Brazil, divided into two groups, according to the presence (G1) or absence (G2) of drooling and controls (G3): G1 consisted of 63 individuals who drool; G2 consisted of 76 who do not drool; and G3 consisted of 47 individuals with no neurological damage of similar age and sex. Unstimulated whole saliva was collected and salivary flow rate (mL/min), initial pH and buffering capacity, by titration of saliva with a constant amount of 0.01 N HCl, were evaluated. The results from G1, G2 and G3 were compared by one-way anova and the χ(2) -test. RESULTS: A higher percentage of severe drooling (60.3%) was observed compared with moderate (27.0%) and mild (12.7%) in the cerebral palsy individuals who drool and the prevalence of drooling was highest among children and adolescents with spastic quadriplegia. Significant reductions in salivary flow rate, initial pH, buffering capacity of whole saliva in pH range 6.0-6.9 and total buffering capacity occurred in G1 and G2 compared with G3. CONCLUSION: All individuals with cerebral palsy present lower flow rate, pH and buffering capacity of saliva, which increases the risk of oral diseases.

Some factors associated with dental caries in the primary dentition of children with Down syndrome.

AIM: It is well reported in the scientific literature that there is a high level of periodontal disease and lower caries prevalence in Down Syndrome (DS) individuals, when compared with age-matched non DS individuals. This study was conducted to investigate the process of dental caries in DS children. MATERIALS AND METHODS: In this study the following parameters were considered: oral hygiene habits, levels of Streptococcus mutans (SM) and Lactobacillus spp. (LB), Modified Gingival Index (MGI), and Simplified Oral Hygiene Index (OHI-S). A case group with DS children (n=69) and a control group of non DS children (n=69) were formed to perform this study. Dental caries severity was determined using the DMFT index. Samples of non-stimulated saliva were collected to determine the Lactobacillus spp levels. For SM levels, MSB agar plates were used. RESULTS: The findings revealed that the case group attended dental check-ups more frequently, brushed their teeth more times per day, flossed less, and also more frequently had SM levels classified as high count. The MGI was higher and the OHI-S was lower than the control group (p<0.001). CONCLUSION: No significant differences were found between the DMFT indexes of children from the two groups (p=0.345). The logistic regression analysis showed that in the case group, age, MGI, and SM count were positively related to dental caries (p<0.05).

Risk factors for anterior traumatic dental injury in children and adolescents with autism spectrum disorders: a case-control study.

AIM: This was to assess and compare risk factors for traumatic dental injury (TDI) among children/adolescents with and without autism spectrum disorders (ASD). METHODS: The study consisted of 122 children and adolescents (98 males, 24 females), 61 with ASD (study group) and 61 without ASD (control group, CG). Dental injuries were determined according to Andreasenss classification. The cause, location and type of activity at the time of trauma were recorded from patient/carer recollection. RESULTS: Subjects with ASD presented higher percentages of TDI in routine activities (P = 0.003), falling while walking and episodes of self-harm (P = 0.007) in the individual's own residence (P = 0.036). TDI prevalence in the ASD group was higher (39.3%) than in the CG (26.2%) though not significant, (P = 0.123). Girls with ASD presented a significantly higher TDI percentage (50.0%) compared with girls from the CG (8.3%) (P = 0.024). Enamel fracture was the most frequent type of TDI for both groups (P = 0.292). The teeth most commonly affected were #11 and #21 for both groups. CONCLUSIONS: Children and adolescents with ASD exhibit different risk factors for TDI compared with those without ASD, and girls with ASD are more prone than boys.

Effectiveness of Fluorescence-based Methods in Monitoring Progression of Noncavitated Caries-like Lesions on Smooth Surfaces.

Although there has been a significant decrease in caries prevalence in developed countries, the slower progression of dental caries requires methods capable of detecting and quantifying lesions at an early stage. The aim of this study was to evaluate the effectiveness of fluorescence-based methods (DIAGNOdent 2095 laser fluorescence device [LF], DIAGNOdent 2190 pen [LFpen], and VistaProof fluorescence camera [FC]) in monitoring the progression of noncavitated caries-like lesions on smooth surfaces. Caries-like lesions were developed in 60 blocks of bovine enamel using a bacterial model of Streptococcus mutans and Lactobacillus acidophilus . Enamel blocks were evaluated by two independent examiners at baseline (phase I), after the first cariogenic challenge (eight days) (phase II), and after the second cariogenic challenge (a further eight days) (phase III) by two independent examiners using the LF, LFpen, and FC. Blocks were submitted to surface microhardness (SMH) and cross-sectional microhardness analyses. The intraclass correlation coefficient for intra- and interexaminer reproducibility ranged from 0.49 (FC) to 0.94 (LF/LFpen). SMH values decreased and fluorescence values increased significantly among the three phases. Higher values for sensitivity, specificity, and area under the receiver operating characteristic curve were observed for FC (phase II) and LFpen (phase III). A significant correlation was found between fluorescence values and SMH in all phases and integrated loss of surface hardness (ΔKHN) in phase III. In conclusion, fluorescence-based methods were effective in monitoring noncavitated caries-like lesions on smooth surfaces, with moderate correlation with SMH, allowing differentiation between sound and demineralized enamel.

Floating-Harbor syndrome: case report and craniofacial phenotype characterization.

Floating-Harbor syndrome is a rare genetic disorder of unknown aetiology. It was described for the first time in 1973. The syndrome is characterized mainly by short stature, delay in speech development and characteristic facial features. This article describes a report of a case of the syndrome and emphasizes the oral aspects, including descriptions of soft tissues, teeth, occlusion, stage of dental development and findings on examination of the temporomandibular joint. The treatment provided and its outcome is also described. Hopefully this information will be compared with findings from other patients in the future to assist in clarifying the phenotype of the Floating-Harbor syndrome.