Longitudinal study of dental caries, tooth mortality and interproximal bone loss in adults with intellectual disability

Abstract

The investigation focused on longitudinal changes of oral health in a group of adults with intellectual disability. A number of 124 individuals, aged 21-40 yr in 1990, were followed during 8.5 yr. The incidence and prevalence of caries, incidence of tooth mortality, and interproximal bone loss were registered from clinical examinations and bite-wing radiographs. The subjects visited the dental clinic for preventive dental care on average every third month during the period. The caries incidence was low, on average 0.51 new lesions per yr. Persons with mild intellectual disability experienced more caries than other subjects. During the 8.5 yr, the subjects had lost on average 1.82 teeth, with periodontitis dominating as the reason for tooth mortality. Individuals who cooperated poorly with dental treatment had lost the most teeth. The average annual bone loss in all subjects was 0.03 mm. Subjects with Down syndrome had a higher bone loss compared to those with other diagnoses of intellectual disability. Thus, the major part of the persons with intellectual disability showed satisfactory oral health. However, subjects with poor ability to cooperate with dental treatment and subjects with Down syndrome showed an increased risk for impaired oral health.

Dental Treatment for Patients with Physical or Mental Disability under General Anesthesia at Tokyo Dental College Suidobashi Hospital

“…In recent years, the rate of extensive caries requiring pulp treatment or extraction among P/MD patients has reportedly been decreasing, indicating a decline in the severity of caries 2,3,9) . According to Morisaki 8) , the clinical polarization of patients is becoming apparent, with some, albeit few, patients presenting with advanced, severe caries affecting several teeth.…”

The implications and management of acute odontogenic infection in association with Down and Eisenmenger syndromes and schizophrenia in a rural setting

“…5 A number of recent studies have demonstrated that individualized preventive dental care, performed regularly using generally available methods and assistance with maintaining adequate oral hygiene are effective for suppressing the severity and progression of periodontal disease in Down syndrome patients. [18][19][20][21] However, as is evident from this case study, the wide variance in the degree of intellectual impairment and the development of complex medical histories may present significant barriers to achieving and maintaining oral health. 19 Severe odontogenic infection is potentially a lifethreatening event and "management is primarily surgical with skilled anaesthetic airway management".…”

“…However, the prevalence of dental caries among Down syndrome individuals is generally considered to be low compared to different control groups, with those individuals residing in institutions generally having a lower caries experience than those residing at home. [15][16][17][18] The reasons for this observed lower caries rate are varied and may include low levels of S. mutans found in the saliva, genetic or environmental factors. 16,17 The increased prevalence of periodontal disease among people with Down syndrome compared to age matched groups of both non-Down syndrome and other people with intellectual disability is well documented.…”

Oral Health in Individuals with Down Syndrome

“…Recently, it has been shown that a different salivary environment of electrolytes and pH is manifested in DS children, leading to the lower reported caries rate (Davidovich et al, 2010) 3.2 Periodontal disease DS individuals usually present with poor oral hygiene and manifested as marginal gingival inflammation, acute and subacute necrotizing gingivitis, advanced chronic periodontitis, loss of attachment in form of gingival recession and increased pocket depth, alveolar bone loss, suppuration or even abscesses, furcation involvement in the molars, increased tooth mobility, and even loss of teeth (Shaw & Saxby, 1986) (Figures 5B & 6). DS individuals had a prevalence of 60 to 90% percent and increased severity of periodontal disease compared with normal age-matched controls and subjects with other mental disabilities of similar age (Cutress, 1971b;Orner, 1976;Barnett et al, 1986;Reuland-Bosma & van Dijk, 1986;, Modeer et al, 1990;Shapira et al, 1991;Ulseth et al, 1991;Desai, 1997;Gabre et al, 2001;Lopez-Perez et al, 2002;Sakellari et al, 2005;Cheng et al, 2007;Khocht et al, 2010). Obviously the severity of periodontal disease among DS individuals is milder in recent years' reports as better dental care have been employed to take care of them early in their life.…”

“…Low prevalence of dental caries or tooth decay in both primary and permanent dentitions of DS individuals has been widely reported (Cutress, 1971a;Orner, 1975;Barnett et al, 1986;Vigild, 1986;Ulseth et al, 1991;Gabre et al, 2001;Bradley & McAlister, 2004;Cheng et al, 2007;Dellavia et al, 2009;Davidovich et al, 2010). Cutress (1971a) examined 416 DS subjects and found lower prevalence of dental caries than normal population, but after adjusting the age of teeth eruption, there were only small and no significant difference between 2 groups.…”