A comparative study of oral health amongst trisomy 21 children living in Riyadh, Saudi Arabia: Part 1 caries, malocclusion, trauma.

BACKGROUND: Trisomy 21 (T21) is a genetic disorder stemming from a chromosomal abnormality and characterized by general and mental retardation. Depending on the population, T21 is known to affect 1 in every 600-2000 live births. The current literature provides a mixed view on the oral health status of T21 individuals. AIM: To establish the prevalence of dental caries, malocclusion, and trauma amongst children with T21 compared with non-T21 children in Riyadh, Saudi Arabia. METHODS: This cross-sectional study recruited non-T21 and T21 children between the ages of 7-15 years who were studying at the Saut Society. After informed consent was obtained from parents and both groups were matched by age and gender, trained examiners screened children at the dental clinic of King Saud University to record the presence of dental caries, malocclusion, and trauma in both groups. RESULTS: While there was no statistical difference between the two groups with regard to the mean decayed, missing, and filled teeth (DMFT) index (2.66 for T21 versus 3.11 for controls), T21 children had a higher prevalence of incisal fractures compared to the control group (24.73% versus 4.95%, respectively) and that was statistically significant (P < 0.05). There were also highly significant group differences concerning the prevalence of malocclusion. Therein, 45% of T21 children had a Class III incisor relationship compared with 8% of control children, and 50% of T21 children had a Class III molar relationship compared with 8% of control children. CONCLUSIONS: While there was no significant difference in the incidence of caries between children with and without T21, practitioners should be aware of the disparities in malocclusion and trauma in this vulnerable population.

Comparative study of oral health among trisomy 21 children living in Riyadh, Saudi Arabia: Part 2, gingival condition.

BACKGROUND: Trisomy 21 (T21) is a congenital disorder characterized by triplication of Chromosome 21 components. Patients with T21 have an increased risk of acquiring periodontal disease due to their inability to maintain good oral hygiene. Consequently, it is important to determine an approach for disease prevention in this population. AIM: The purpose of the study was to assess the periodontal health, through the prevalence of gingivitis and plaque, among children with T21 living in Riyadh, Saudi Arabia. SUBJECTS AND METHOD: This study included 93 children with T21 and 99 age- and gender-matched children without T21 between the ages of 7 and 15 years. Parents were informed about the study and provided informed consent. Trained examiners using standardized tools assessed the prevalence rates of gingivitis and plaque in all children. RESULTS: Gingivitis prevalence was elevated among T21 children (46.9%) compared to controls (34%) in all arch sextants except the mandibular middle (P < 0.01). Comparing the two groups, the prevalence of plaque was higher in the maxillary right sextant of the T21 group and the mandibular middle sextant of the control group (P < 0.05). CONCLUSION: T21 children have significantly elevated plaque levels, resulting in greater prevalence of gingivitis, compared to healthy children. Preventive measure, such as oral health awareness programs, should be delivered early to parents and continued at school to encourage and motivate children.

Traumatised permanent teeth in 11-16-year-old Saudi Arabian children with a sensory impairment attending special schools.

- The aim of this study was to determine the prevalence of traumatised permanent teeth among sensory (visual (VI) and hearing (HI)) impaired children attending special schools in Riyadh, Saudi Arabia. All the dental injuries involved incisor teeth, and trauma was noted in 33 (6.7%) children attending government schools (control group) compared to 7 (9%) VI children and 24 (11.4%) HI children. Differences in the dental trauma only reached statistical significance between the HI and control group (P < 0.05). Gender differences were only apparent in the HI group, with males having higher levels of traumatised teeth. In addition, HI children aged 11-12 years were more prone to trauma than children in the control group of the same age (P < 0.05). In conclusion, sensory impaired children do have a tendency for more dental trauma. However, this was only statistically significant for HI children. Whereas a gender difference was most noticeable for the HI group, with males having higher levels of trauma, this was noticeable by its absence among VI children.

Attitudes of dentists, working in Riyadh, toward people with a sensory impairment.

This study was conducted to determine the attitudes of dentists, working in Riyadh, toward people with a sensory impairment (SI), according to the Scale of Attitude Towards Disabled Persons (SADP). The SADP scale was modified to focus solely upon sensory impairment. The modified scale was pre-tested and then incorporated into a self-administered questionnaire. This was then administered to 600 dentists (response rate, 73.7%) working in the city of Riyadh, Saudi Arabia. The modified scale showed itself to be reliable, with a Chronbach's coefficient alpha 0.616 and four-factor analysis, which accounted for 38.5% of the variance. Ninety-four percent of the dentists were generally positive toward SI in the society. There were, however, significant variations in attitudes, with a more positive score for dentists who had worked for 30 years or more (p < 0.005), were specialists (p < 0.005), received little or no undergraduate training in this subject (p < 0.05), and who received their undergraduate training in Europe/North America (p < 0.001). However, in a stepwise regression model, all these variables were significant except for the years of practice. The modified SADP showed dentists, working in Saudi Arabia, having a positive attitude toward people with SI.

The development of a tactile graphic version of IOTN for visually impaired patients.

The Index of Orthodontic Treatment Need (IOTN) is a visual-based index and has been widely used. This paper describes the development and evaluation of tactile graphics representing the aesthetic component (AC) of IOTN for the use of visually impaired patients (VI). Four tactile graphics were produced corresponding to IOTN photographs 1 (graphic 1, no treatment - mild need), 5 (graphic 2, moderate need), 8 (graphic 3, severe need; increased overjet) and 10 (graphic 4, severe need). Nine (30-50 years) expert consumers from the Royal National Institute for the Blind (RNIB) and 13 VI schoolchildren (11-16 years) evaluated the graphics. The evaluation was in terms of design features, complexity of information and ease of use. Each individual was asked to arrange the graphics in order of severity of malocclusion. The procedure was repeated after 30 min to test individual reliability (www.clinorthodres.com/cor-c-084/). The consumer group was able to identify the main features in each graphic and found them easy to use. Six had arranged the graphics correctly at the first attempt and five on their second. The children were able to distinguish the different oral features, except the overjet presentation in graphic 2. Nine children arranged the graphics correctly at the first attempt, but only six at the second. The confusion centred for both groups on presenting an increased overjet with graphic 2. A modification was undertaken to enhance the anterior-posterior nature of the image. Fifteen VI schoolchildren reassessed the modified graphics, 14 arranged them correctly at the first attempt and 13 at the second. The study concluded that IOTN tactile graphics were well accepted and showed a good reliability.

The development of a tactile graphic version of IOTN for visually impaired patients.

The Index of Orthodontic Treatment Need (IOTN) is a visual-based index and has been widely used. This paper describes the development and evaluation of tactile graphics representing the aesthetic component (AC) of IOTN for the use of visually impaired patients (VI). Four tactile graphics were produced corresponding to IOTN photographs 1 (graphic 1, no treatment - mild need), 5 (graphic 2, moderate need), 8 (graphic 3, severe need; increased overjet) and 10 (graphic 4, severe need). Nine (30-50 years) expert consumers from the Royal National Institute for the Blind (RNIB) and 13 VI schoolchildren (11-16 years) evaluated the graphics. The evaluation was in terms of design features, complexity of information and ease of use. Each individual was asked to arrange the graphics in order of severity of malocclusion. The procedure was repeated after 30 min to test individual reliability (http://www.clinorthodres.com/cor-c-084/). The consumer group was able to identify the main features in each graphic and found them easy to use. Six had arranged the graphics correctly at the first attempt and five on their second. The children were able to distinguish the different oral features, except the overjet presentation in graphic 2. Nine children arranged the graphics correctly at the first attempt, but only six at the second. The confusion centred for both groups on presenting an increased overjet with graphic 2. A modification was undertaken to enhance the anterior-posterior nature of the image. Fifteen VI schoolchildren reassessed the modified graphics, 14 arranged them correctly at the first attempt and 13 at the second. The study concluded that IOTN tactile graphics were well accepted and showed a good reliability.

Changes on storage of polyacid-modified composite resins.

Two polyacid-modified composite resins, Dyract and Compoglass, have been studied for water-uptake on storage in three aqueous media, namely pure water, 0.9% NaCl and 1 M NaCl at 37 degrees C, and the results compared with those of a conventional composite resin, Pekafill. The equilibrium water-uptake of Dyract and Compoglass varied depending on time of cure and ionic strength of the storage medium. This latter finding contrasted with that for Pekafill, where equilibrium water content showed almost no variation with ionic strength of the storage medium. Uptake of water was always greater in Dyract and Compoglass than in Pekafill, reflecting the role of water in promoting the later neutralization reaction in these materials and its further role in hydrating the ionic products of that reaction. Despite this and other evidence of neutralization, specimens of Dyract and Compoglass stored in wet conditions (0.9% NaCl) showed no change in compressive strength on storage from 24 h to 30 days, a result similar to that reported previously for Dyract alone for flexural strength for times up to 1 year. By contrast, specimens of Dyract and Compoglass stored in dry air at 37 degrees C, and therefore unable to undergo any neutralization, showed an increase in compressive strength of between 40 and 70 MPa by 30 days that was significant at P < 0.01.