Medical comorbidities associated with autism spectrum disorder and their impact on dental care.

Autism spectrum disorder is a neurodevelopmental disorder affecting communication, behavior, and socialization in a large number of children and adults. In addition to the classically considered features of autism, individuals with this disorder also often present with multiple significant medical comorbidities that affect dental treatment. This article discusses the most common of these neurologic, psychiatric, and gastrointestinal issues and explores their relevance to dental care. It is incumbent on dentists and members of the dental team to be familiar with the features and comorbidities of autism spectrum disorder and effectively use this knowledge to provide care for patients with autism.

Teledentistry: remote observation of patients with special needs.

While telemedicine has been adopted and is used increasingly in patient care, the dental profession is still in the relatively early stages of utilizing technology in similar ways. The number of patients with intellectual and developmental disabilities is increasing in number and complexity, calling for new approaches to assist with access to care. The current article outlines the benefits of new technology in the evaluation of all patients but particularly the more complex population that has been diagnosed with a disability. Three case examples illustrate the value of technology in remote patient observation and offer ideas for use and further research.

Nutritional and dental issues in patients with intellectual and developmental disabilities.

BACKGROUND: People with intellectual and developmental disabilities are among the most disadvantaged and underserved groups of dental patients. Considerable health care disparities for this population have been identified, particularly oral and dental health as well as access to dental care services. People with Down syndrome and cerebral palsy have a variety of nutritional and dental considerations. CONCLUSIONS: These people have a higher prevalence of untreated caries and periodontal disease than the general population and may have higher rates of obesity, edentulism, and chronic oral and systemic diseases. Diet choices may affect the oral health and may play an important role in the systemic health of these people. Suggestions to improve and affect dietary intake are provided. CLINICAL IMPLICATIONS: Health issues within this population require a holistic approach to care. Concerns about oral health and diet must be addressed to support optimal health.

Use of dental radiographic minipanel series in disabled adults in a university-based special care dental clinic.

OBJECTIVE: To compare the diagnostic efficacy of a minipanel series to a conventional 18-radiograph full-mouth series in a disabled adult population in a university clinic. METHOD AND MATERIALS: Eighty patients who attended the New Jersey Dental School special care services clinic between 2004 and 2006 were selected for a double-blind quasiexperimental study based on existing full-mouth series radiographs. A minipanel series consisting of eight radiographs from the 18-radiograph full-mouth series was used as a comparison against a matched pair of an 18-radiograph exam. The diagnostic efficacy of this eight-radiograph series was tested against the more conventional 18-radiograph full-mouth series to determine whether the minipanel series was an acceptable substitute for the full-mouth series in this population group. Traditionally, it is difficult to obtain full-mouth series radiographs in patients with disabilities. RESULTS: From the 80 studied patients, a total of 2,219 teeth were available for study. A median of 29 teeth per patient was found in the full-mouth series and 28 teeth per patient in the minipanel series category. The difference was statistically significant (P < .001). Of the patients evaluated, 78 (97.5%) had at least one problem detected when the full-mouth series was used. Of these 78 with at least one problem, 74 (94.8%) were identified using the minipanel series. The sensitivity for the minipanel series when compared to the gold-standard full-mouth series was 63% (95% confidence interval [CI], 59.2 to 68.0) for tooth-specific disease; the specificity was 92% (95% CI, 92.2 to 94.5). CONCLUSION: Prospective studies are needed for the acceptance and use of minipanel radiographic series in conjunction with a clinical examination.

A prospective study of bispectral index scoring in mentally retarded patients receiving general anesthesia.

STUDY OBJECTIVE: To determine whether degree of mental retardation (MR) affects bispectral index scale (BIS) scores during general anesthesia. DESIGN: Prospective clinical study. SETTING: University Hospital. PATIENTS: 80 ASA physical status I, II and III patients with varying degrees of MR, undergoing dental rehabilitation. INTERVENTIONS: Patients were grouped into mild, moderate, severe or profound degrees of MR, by an independent registered research nurse according to criteria by the American Psychiatric Association. MEASUREMENTS: All patients were given a standard sevoflurane in oxygen anesthetic with ASA standard monitoring. A research assistant who was blinded to study group assignment recorded the BIS scores continuously on a computer and compared the scores at the following time points: awake, induction of anesthesia, intravenous catheter placement, tracheal intubation, start of surgery, end of surgery, awakening to commands, and tracheal extubation. MAIN RESULTS: No significant differences in BIS scores existed among the study groups at any time point. No significant difference in slope of induction of anesthesia was noted among the study groups. However, the slope of emergence from anesthesia leading to tracheal extubation showed a significantly longer emergence time in the higher MR groups. CONCLUSION: MR does not affect BIS values during general anesthesia.

Oral health promotion among older persons and their care providers in a nursing home facility.

OBJECTIVES: To assess oral health status and oral health-related quality of life (OHRQoL) of residents in an extended care facility and to assess the care providers' oral health attitudes and knowledge. METHODS: Participants included 137 residents (58.1% female, age range 32-94 years, 91% African-American) and 22 care providers. Residents received an oral examination and completed the Oral Health Impact Profile (OHIP-14), an OHRQoL questionnaire. Care providers completed an oral health knowledge (OHK) questionnaire before and after the on-site geriatric oral health education and training programme. RESULTS: Oral examinations showed that 58% of the residents had extensive oral health needs. On the OHIP-14, the mean severity was 9.2 (SD=12.0), extent (number of items rated as 'fairly often' or 'often') was 1.2 (SD=2.6) and prevalence (participants rating at least one item at least 'fairly often') was 37.8%. Most prevalent negative impact items were about 'oral pain', 'appearance' and 'self-consciousness'. Regarding OHK, caregivers' knowledge improved following instruction from 65% correct on the pre-test to 90% correct on the post-test (p<0.05). Subsequent to the eight in-service workshops, providers reported that physical limitations, fear of getting bitten and time constraints were barriers to providing oral hygiene to their residents. CONCLUSION: Examination data showed a high level of dental needs among the majority of residents, accompanied by significantly reduced OHRQoL. Although care providers' OHK improved following the geriatric service programme, they reported specific barriers regarding their provision of oral hygiene care to the residents.