Pressure pain threshold of masticatory muscles in children and adolescents with and without intellectual disability: a pilot study.

PURPOSE: Pain is considered a stressful experience, related to real or possible tissue damage with emotional, sensory, social and cognitive components. The aim of the study was to evaluate and compare, using a digital algometer, the pressure pain threshold of temporal and masseter muscles of children and adolescents with and without intellectual disability. METHODS: A cross-sectional study was conducted. Data regarding gender and age were collected from the caregiver of children and adolescents with and without intellectual disability. The evaluations followed this sequence: pressure pain threshold of the masseter and temporal muscles, evaluation of pain on touch using the visual analog scale and signs and symptoms of Temporomandibular disorder. The χ2 test, the Kolgomorov-Smirnov test, Student t test and Mann-Whitney test were performed. The significance level was set at 5%. RESULTS: Two homogeneous groups by gender (P = 0.258) and age (P = 0.727) were evaluated, of which 25 children and adolescents presented intellectual disability and another 25 did not have intellectual disability. No significant difference was observed between groups on the pressure pain threshold of the masseter and temporal muscles, nor pressure average or exam time (P > 0.05). Regarding Temporomandibular dysfunction, no difference in signs or symptoms frequency was found (P > 0.05). However, the range of maximum mouth opening was smaller in the intellectual disability group (P = 0.006). CONCLUSION: Children and adolescents with intellectual disability and preserved basic functionalities do not present alterations in pain perception when evaluated with computerized pressure algometer and visual analog scale. They present similar threshold of pain to pressure as those reported by normative children and adolescents. These results emphasize the importance to treat these children and adolescents with intellectual disability with respect to their pain threshold.

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.

A controlled study comparing salivary osmolality, caries experience and caries risk in patients with cerebral palsy.

BACKGROUND: Cerebral palsy (CP) is a permanent neurological disorder accompanied by secondary musculoskeletal masticatory disorder, with repercussion on chewing and deglutition functions. In these conditions, the liquids ingestion is compromised resulting in salivary osmolality alteration. The objective of this study was to compare salivary osmolality, caries experience and caries risk between normoreactive individuals and patients with CP. MATERIAL AND METHODS: The participants were 4-20 years old: 52 patients with CP treated at a reference rehabilitation centre (study group, SG), and 52 normoreactive individuals (control group, CG). Saliva was collected for five minutes using cotton rolls. Following centrifugation, salivary osmolality was determined by freezing point depression osmometry. Evaluations included caries experience (DMFT index), and caries risk based on a caries-risk assessment tool (CAT). Descriptive and inferential statistics (Chi square and Student t tests) were used to compare the groups. Receiver operating characteristic (ROC) analyses were performed and the area under the ROC curve (Az) was calculated. The level of significance was set at 5%. RESULTS: The groups were homogeneous for sex (p=0.843) and age (p=0.128). In the SG, spastic type CP was the most prevalent (80.8%), and patients showed significantly higher salivary osmolality values compared with the CG (p<0.001). No significant differences in caries experience (p=0.159) or caries risk (p=0.297) were observed. ROC curve analysis determined a salivary osmolality cutoff point of >74 for the SG and >54 for the CG in the presence of dental caries. A significant correlation was verified between salivary osmolality and the DMFT index for the SG (p≤0.05). CONCLUSIONS: Although patients with CP showed higher salivary osmolality values, higher caries experience and caries risk were not observed compared with normoreactive individuals.

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.

Association between anticonvulsant drugs and teeth-grinding in children and adolescents with cerebral palsy.

The relation between teeth-grinding and the use of drugs acting on the central nervous system of cerebral palsy (CP) patients has not yet been described. The aim of this research was to evaluate the presence or absence of teeth-grinding (sleep and/or awake periods) in normal and in CP children and adolescents, as well as the association of teeth-grinding and use of anticonvulsant drugs. The sample consisted of 207 children and adolescents, divided into three groups: G1, individuals with CP who did not take anticonvulsant drugs; G2, individuals with CP administered medications on a regular basis; and CG, normal individuals. Logistic regression analyses were performed to evaluate the association of teeth-grinding with some variables. No significant statistical differences were observed regarding the presence or absence of teeth-grinding when G1 and G2 were compared. However, compared with the CG, a statistically significant difference was determined, with the CG showing fewer children presenting teeth-grinding (P < 0·001). Among those children/adolescents prescribed drug therapy, the barbiturate group showed a greater frequency of teeth-grinding. CP children and adolescents show a greater and significant presence of grinding of the teeth compared with normal individuals. Subjects taking barbiturate drugs showed greater presence of teeth-grinding, than those who were taking medications from the other groups of anticonvulsant drugs.

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.

Assessment scale of the oral motor performance of children and adolescents with neurological damages.

Among the conditions that classify individuals as special needs patients are those resulting from neurological sequelae, particularly cerebral palsy (CP), which is a disorder of high prevalence. Innumerable alterations can be found in individuals with CP but the inability to control striated muscles, due to damages suffered by the central nervous system, should be emphasized. Changes in tonus, speed and strength of oral muscles, reduction of mandibular mobility amplitude and difficulty to passively seal the lips are characteristics observed in such individuals. Categorization of the individual's mastication pattern is important in order to establish diagnosis and treatment protocols and prognosis. The aim of this study was to develop an Oral Motor Assessment Scale (OMAS) and evaluate its performance in terms of construct validity and reliability in a cohort of 53 children and individuals with CP. Two dentists examined the same patients on two different occasions. Good interexaminer (kappa > 0.85) and intra-examiner (kappa > 0.90) agreement was obtained for the majority of the OMAS items. This study shows that the OMAS is an accurate and valid method of assessment of oral motor skills in children and adolescents with neurological damages.

Infantile reflexes and their effects on dental caries and oral hygiene in cerebral palsy individuals.

The aim of this study was to evaluate the presence of pathological primitive reflexes and their effects on dental caries and oral hygiene in cerebral-palsied individuals. A group of 124 non-institutionalized patients (57 males) attending Lar Escola Sao Francisco Rehabilitation Center, who had a medical diagnosis of spastic CP (age range 3-17 years, mean+/-s.d.=8.6+/-4.3) were selected for dental clinical evaluation according to WHO (Oral health surveys: basic methods, WHO, Geneva, 1997) and oral hygiene using the oral hygiene index proposed by Greene and Vermillion (J Am Dent Assoc, 1964, 68, 7). The presence/absence of the pathological primitive oral reflexes of rooting, suckle-swallow, biting and gagging was evaluated by observing patients' reaction after a stimulus. Results were statistically analysed by Fisher's exact, Chi-square and Kruskal-Wallis tests. A significantly higher percentage of the biting reflex in patients with quadriplegia was observed, and also the absence of this reflex in patients with hemiplegia (P=0.006). Patients with hemiplegia presented significantly lower DMF index values. Kruskal-Wallis test showed no statistical difference (P=0.335; 0.677; 0.202) for OHI-S among the quadriplegia, diplegia and hemiplegia for all dentitions. Our data suggest that the more severe the neurological damage is, the more frequent is the presence of the biting reflex and consequently, the higher is the risk of oral diseases in this population due to the difficulty to perform an adequate oral hygiene.