ORAL HEALTH OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS

Approximately 9.3 American million children (nearly 13%) have special health care needs, including developmental disorders, systemic disorders and sensory impairments. These children have more oral disease and greater unmet dental needs than the general pediatric population. Petrova et al from the University of Minnesota studied the relationship between these children’s level of functioning and their oral health. In addition to giving demographic information, parents of 154 children aged 2 to 16 years completed a 39-question version of the Survey Interview Form of the Vineland Adaptive Behavior Scales (SIFVABS) designed to measure the children’s level of functioning across 6 domains:

• listening and understanding
• talking
• daily living
• relating to others
• playing and using leisure time
• physical activity

The children’s oral hygiene was evaluated on a 3-point scale (poor, fair, good); their gingival health was evaluated on a 4-point scale (within normal limits, mild gingivitis, moderate gingivitis, severe gingivitis).

Most of the children had ≥1 developmental disorder, with epilepsy/seizure disorder (36%), cerebral palsy (31%) and autism spectrum disorder (25%) the most common. The most frequent systemic health issues included gastroesophageal reflux disease and the pres-ence of a gastrostomy tube (41%), asthma (18%) and cardiovascular disease (13%); 18% of the children had been diagnosed with attention deficit hyperactivity dis-order, while 7% had cleft lip and/or palate.

Higher levels of talking skill correlated with better lev-els of oral hygiene and gingival health. Higher levels of listening and understanding correlated to better parental perception of children’s oral health state and better lev-els of oral hygiene. Children with special health care needs face problemswith oral health care as well, including higher levels of dental caries, malocclusion and broken teeth. Education of the parents of these children can help meet their needs.

Petrova EG, Hyman M, Estrella MRP, Inglehart MR. Children with special health care needs: exploring the relation-ships between patients’ level of function-ing, their oral health, and caregivers’ oral health-related responses. Pediatr Dent 2014;36:233-239.

Oral Health of Children with Congenital Cardiovascular Disease

Cardiovascular diseases are the leading cause of death from congenital malformations. The 3 most common congenital cardiovascular diseases are ventricular septal defect, aortic valve stenosis and coarctation of the aorta. Children with congenital cardiovascular diseases are less likely to receive quality dental care and more likely to have poorer oral health.

Many studies have noted a link between periodontal and cardiovascular diseases; some have suggested that periodontal disease is an independent risk factor for coronary disease. Children with congenital cardiovascular diseases must receive special dental care because of their susceptibility to infective endocarditis associated with dental and periodontal infections. Nosrati et al from Indiana University evaluated the gingival condition of children with congenital cardiovascular diseases to determine whether an association exists between congenital cardiovascular diseases and gingivitis and periodontal disease.

A group of 25 children aged 7 to 13 years old with congenital cardiovascular disease (6 with ventricular septal defect; 14 with aortic valve stenosis; 5 with coarctaion of the aorta, n = 5) was recruited from a pediatric cardiology department at a children’s hospital; an age- matched control group included 25 systemically healthy children. Parents completed a questionnaire about their children’s past and present systemic health status and dental health history.

Because periodontal probing may cause bacteremia and is therefore contraindicated in patients with congenital cardiovascular disease, modified techniques were used to measure the presence of gingivitis and dental plaque. Levels of recession were also measured. The children with congenital cardiovascular disease had significantly higher scores on the modified gingival index (GI) and the modified plaque index (PI) and higher levels of recession than did the control group (Figure 1). No differences were detected among the 3 subgroups defined by type of congenital cardiovascular disease. While 20% of the children with congenital cardiovascular disease had ≥1 site with recession >0, none of the control children had any sites showing recession. The study also showed that these 25 patients and their parents had received encouragement from their pediatrician, pediatric cardiologist and parents’ dentist to arrange dental visits for the children, and the children had more recent visits to the dentist than did the control group. Nevertheless, children with congenital cardiovascular disease showed a greater incidence of periodontal disease, perhaps due to less-than-adequate oral hygiene habits. These children need to receive regular dental check-ups on a more frequent basis than do their systemically healthy peers.

Nosrati E, Eckert GJ, Kowolik MJ, et al. Gingival evaluation of the pediatric cardiac patients. Pediatr Dent 2013;35:456-62.

Maternal Taste Preferences and Early Childhood Caries Incidence

Dietary habits, especially a high daily intake of sugars, correlate with caries experience in pre-school and school-age children. A genetic component, based on the ability to taste the bitterness of the chemical 6-n-propylthiouracil (PROP), enters into certain food preferences. People with the ability to recognize PROP (known as supertasters) tend to dislike sweet tastes, preferring weaker tastes, while those who cannot recognize PROP (known as nontasters) prefer sweeter and stronger tastes.

Previous studies of children and adolescents show that nontasters have significantly more dental caries than do supertasters. However, their mothers’ food preferences may affect the decisions of what foods to offer their children. Alanzi et al from Kuwait University examined whether an association exists between mothers’ taste perceptions and their children’s early childhood caries prevalence.

The study originally included 60 children (aged 24–36 months) who presented to the pediatric clinic at the University of Maryland School of Dentistry. Their mothers were tested for PROP sensitivity; 18 mothers were nontasters, 20 were supertasters. (The children of 22 medium-taster mothers were excluded from the study.) Orally administered questionnaires recorded the moth-ers’ demographic information and oral health status, along with the children’s oral hygiene and dietary practices. Each child was examined by mouth mirror and fixed dental unit light for early childhood caries based on decayed, missing and filled surfaces (dmfs) score.

The oral examinations showed that 45% of the children (n = 17) had caries (defined as a dmfs >1). Of these children, 71% (n = 12) had mothers who were non-tasters, a statistically significant difference (p = .009). Children of nontaster mothers had significantly higher dmfs scores in their maxillary teeth than did children of supertaster mothers (p = .04; Figure 2). Children whose mothers had active dental caries had significantly higher dmfs scores than did children whose mothers did not have active dental cares (3.9 ± 5.3 vs 0.5 ± 1.2; p = .04).

Children of PROP nontaster mothers who shared a home with grandparents had significantly higher levels of caries than did similar children in homes without grandparents. This could reflect a genetic predisposition passed from generation to generation. Based on the results of this study, PROP screening for mothers may help identify children at risk for early childhood caries.

Alanzi A, Minah G, Romberg E, et al. Mothers’ taste perceptions and their preschool children’s dental caries experiences. Pediatr Dent 2013;35:510-514.