Myofunctional therapy using twin block appliance in a class II Malocclusion patient with ADHD

@#A 9-year-old male ADHD patient with class II dentoskeletal malocclusion came to the Pediatric Department of Universitas Airlangga, Surabaya, with a chief complaint of a protrusive look. The patient had a behavior disorder of ADHD (Attention Deficit Hyperactivity Disorder), in which its symptoms may be challenging in dental treatment since it heavily depends on the patient’s obedience and case selection. References and similar studies of myofunctional therapy in Class II Malocclusion Patients with ADHD are still scarce. Most patients with class II malocclusion present with hyperactive perioral muscle and altered tongue position. Hence, myofunctional appliance is a reliable treatment choice. A special rule where the patient was asked to focus on the operator’s instruction for 10 minutes and then a 5-minute break, was applied to this patient to overcome ADHD symptoms as a behavior management strategy. This is in line with a theory stating that children with ADHD are prone to distraction, causing them to have a shorter duration of focus, limited sustained attention span, poor impulse control, and motor overactivity compared to normal children. This strategy gave a positive result in maintaining the cooperation of the patient using the twin block for 6 months which is lead to positive progress in malocclusion correction.

Parents' behavior related to caries status of children with Down Syndrome in Surabaya

Background@#Down syndrome (DS) is a chromosome disorder due to the presence of all or part of a third copy of chromosome 21 (trisomy 21) caused by a failure in chromosome segregation. Following Riset Kesehatan Dasar (RISKESDAS) in 2013, the number of people with DS in Indonesia increased compared to 2010, with an estimated 924 children with DS in Surabaya. Data regarding caries status in children with DS in Surabaya is limited. @*Objective@#To evaluate parents’ behavior (predisposing, enabling, and reinforcing factors) related to the caries status of children with DS. @*Methods@#This observational analytic cross-sectional study included children aged ≤18 years with DS and parents who were members of the Parents' Association of Children with Down Syndrome (POTADS). Caries status were measured using the DMF-T/def-t score, and parents were asked to fill out a questionnaire. Data were analyzed using Spearman’s correlation test. @*Result@#We included 46 children with DS in this study. The DMF-t / def-t index of children with DS (7.2) was categorized as very high according to WHO. There was a significant relationship between lack of knowledge of parents and caries status in children with DS. Enabling factors and reinforcing factors were not significantly correlated with caries status. @*Conclusion@#Parents' behavior is correlated with the caries status of children with DS. All combination of three factors behavior, including predisposing, enabling and reinforcing, are needed to reduce the number of caries in children with DS.