Special Care in Dentistry最新文献

Aims: Malnutrition is common among individuals with intellectual disabilities, and behavioral resistance may limit access to routine oral care. This study examined the association between refusal of oral care and poor nutritional status.

Methods: In this cross-sectional study, conducted between February and March 2025, we assessed 55 adults with intellectual disabilities living in two designated residential support facilities for persons with disabilities in Fukuoka, Japan. Nutritional status was evaluated using the Mini Nutritional Assessment-Short Form. Oral care refusal was identified from staff records. Functional and body composition data were obtained using the Functional Independence Measure, Barthel Index, and bioelectrical impedance analysis.

Results: The at-risk/malnourished group had significantly lower BMI, fat mass, and functional scores, and a higher rate of oral care refusal (p = 0.007). Logistic regression showed that oral care refusal [OR = 9.23 (95% confidence interval (CI): 1.10-77.33], lower fat mass [OR = 0.78 (0.66-0.92)] were independently associated with poor nutritional status (FIM-Eating [OR = 0.86 (0.53-1.39)], gender [OR = 0.44 (0.08-2.27)], age [OR = 0.96 (0.90-1.02)]). AUC was 0.90 (0.81-0.98).

Conclusion: Oral care refusal may indicate increased risk of malnutrition among adults with intellectual disabilities. Larger, longitudinal studies are needed to confirm these findings.

Background: Social workers in interprofessional dental teams play a critical role in making oral healthcare more equitable and accessible, especially for individuals with special health care needs (SHCN). Social workers are specifically trained to identify the connections between oral health, mental and physical well-being, socioeconomic status, history of trauma, and access to resources. Their work supports whole-person care and helps mitigate social determinants of health (SDoH) that produce systemic barriers to access to proper dental care. This narrative review explores four core domains that synthesize and highlight previous seminal research on the intersectional contribution of social workers to interprofessional dental teams.

Methods: Through a narrative review, we identified articles that discussed social work's role in supporting adults with SHCN in dentistry across the following four core domains: (1) addressing SDoH barriers, (2) mental health support, (3) care coordination, and (4) community engagement within dental settings.

Results: Across 34 peer-reviewed studies, the four core domains demonstrated the role of social workers in reducing barriers to care, supporting whole-person approaches, and improving patient communication. Ten gray literature sources further identified emerging trends, including trauma-informed care (TIC), legislative analyses, and ethical frameworks shaping practice.

Conclusions: This review highlights the multidimensional contributions of social work to dental settings across the domains of SDoH, mental health, care coordination, and community engagement. Evidence from peer-reviewed and gray literature indicates that integrating social work can reduce barriers to care, promote whole-person approaches, and inform emerging practices such as TIC. For individuals with SHCN, social work integration is particularly important in addressing heightened risks of unmet social and behavioral needs. These findings suggest that social work holds significant promise for advancing patient-centered, equitable dental care for special care populations.

Objectives: This study aimed to examine the association between oral health factors and Mild Cognitive Impairment (MCI), evaluating their independent effects after adjustments for sociodemographic, medical, and behavioral confounders.

Methods: A cross-sectional analytical study was conducted among 248 older adults aged 60 years and above. Cognitive status was assessed using the Montreal Cognitive Assessment-Thai version (MoCA-T). Demographic, medical, and behavioral data were collected through structure interviews. Oral health assessments included active dental caries, periodontal disease, number of natural teeth, number of posterior occluding pairs, and masticatory performance, all measured through clinical examination. A multivariate logistic regression analysis was performed using the enter method, with statistical significance set at p < 0.05.

Results: The mean age of participants was 68.7 years, and 73% were female. Of the 248 participants, 73 (29.4%) were identified as having MCI. After adjusting for age, marital status, education, occupation, income, hypertension, functional, and nutritional status, only periodontal disease remained significantly associated with MCI (adjusted OR = 2.01, 95% CI: 1.05-3.84, p = 0.035).

Conclusion: Among the oral health factors examined, periodontal disease emerged as the only factor independently associated with MCI after adjustment for demographic, medical, and behavioral confounders.

Background: Patients with systemic lupus erythematosus (SLE) may exhibit increased oral health vulnerabilities. This study aimed to compare salivary pH, dental and periodontal health, and salivary Streptococcus mutans and Porphyromonas gingivalis counts between SLE patients and healthy controls.

Materials and methods: A case-control study included 20 SLE patients and 20 healthy controls matched for age, sex, socioeconomic status, and geographic region. All SLE patients had at least one year since diagnosis and met the Lupus Low Disease Activity State (LLDAS) definition (SLEDAI ≤4, no major organ activity, PGA ≤1, prednisone ≤7.5 mg/day, and no recent flare). Medication profiles were not systematically recorded, although patients maintained standard-of-care therapies as per their rheumatologists' prescriptions. Participants brushed at least once daily; smokers and individuals with xerostomia were excluded. Dental (DMFT) and periodontal (GBI, CAL) indices and plaque index were assessed. Unstimulated saliva was collected to measure pH and quantify S. mutans and P. gingivalis counts using PCR.

Results: No significant differences were observed in overall DMFT, decayed or filled teeth, GBI, CAL, or P. gingivalis counts (p > 0.05). Within the limits of the sample size, SLE patients had a higher number of missing teeth and significantly increased S. mutans counts (p < 0.05). Salivary pH was significantly lower in the SLE group (p < 0.05).

Conclusion: Tooth loss in SLE may be related to caries rather than periodontal disease, potentially influenced by lower salivary pH and elevated S. mutans levels. Altered salivary composition may contribute to increased caries risk even in the absence of xerostomia.

Clinical relevance: These findings emphasize proactive caries prevention in SLE. Strategies such as hydration guidance, pH-regulating mouthwashes, and xylitol-containing products may be beneficial, although their efficacy in SLE populations was not tested.

The landscape of dental education and clinical practice has undergone significant evolution in recent decades, driven by increasing recognition of health disparities and the evolving needs of diverse patient populations. Central to this transformation is the role of the Commission on Dental Accreditation (CODA) in establishing rigorous postdoctoral standards for dental education. Concurrently, General Practice Residency (GPR) programs have emerged as pivotal training models that prepare dental practitioners to deliver high-quality, comprehensive oral health care-especially for persons with disabilities and medically complex conditions. This article examines CODA's historical and current influence on dental education, highlights the critical training components of GPR programs, and discusses how these initiatives contribute to enhanced care for underserved populations, improving access and quality of oral health care for vulnerable populations.

Aim: To design and evaluate an animated educational application to improve oral health among children with hearing impairment.

Methods: A feasibility pilot pre-post study was conducted over 2 months with 26 children with hearing impairment. The intervention consisted of application-based animations and questionnaires, developed through focus group input. Knowledge changes in children were assessed using a visual questionnaire, while behavioral changes and application satisfaction were evaluated via online questionnaires completed by mothers, both before and after the intervention.

Results: Significant improvements were observed in children's overall oral health knowledge and behavior following the intervention (p < 0.05). While individual items were not statistically analyzed, descriptive data indicated positive trends. Children showed increased awareness of healthy food choices, proper brushing and flossing techniques, and the importance of regular dental visits. Mothers reported behavioral changes, including more frequent toothbrushing and flossing, reduced sugary snack consumption, and increased intake of fruits and milk. High satisfaction among mothers reflected strong acceptability and usability of the intervention.

Conclusion: This pilot study demonstrates the feasibility and acceptability of using animation-based applications to promote oral health among children with hearing impairments.

Dental clearance prior to radiotherapy (RT) can extend pretreatment timelines in head and neck cancer (HNC). However, its specific contribution to delays is rarely quantified, and no timing benchmarks exist for patients treated with RT without prior surgery. We conducted a retrospective descriptive study at a Canadian tertiary center, including all adults referred for pre-RT dental evaluation between January 1 and December 31, 2022. Delay metrics were defined as days from consultation to surgery, surgery to clearance, and consultation to RT start. Analyses were descriptive, with complete-case calculations. Among 463 patients scheduled for RT, 356 dentate or partially dentate individuals were referred for dental assessment. Of these, 29 (8.2%) required extended healing or multiple follow-ups. Median consultation-to-surgery delay was 6 days (range 0-31), surgery-to-clearance 22 days [8-119], and consultation-to-RT 28 days [15-133]. Six patients (20.7%) experienced delays extending beyond a 42-day period, used here as a contextual benchmark for exploratory comparison rather than as a formal standard. Follow-up was inadequate in 15/29 (51.7%). One patient (3.4%) developed osteoradionecrosis. This study provides the first descriptive quantification of dental clearance-related delays on RT-only patients in a Canadian tertiary center. Although most achieved clearance within expected timelines, a minority experienced clinically meaningful delays linked to prolonged healing and inadequate follow-up, highlighting dental clearance as a modifiable bottleneck in pretreatment planning and supporting the need for standardized reassessment intervals, structured recall systems, and improved cross-disciplinary coordination. Future multicenter studies are warranted to establish operational benchmarks and evaluate targeted quality-improvement strategies.

Objectives: Hypomineralized Second Primary Molars (HSPM) are qualitative enamel defects that typically involve one to four second primary molars. Although widely investigated, their etiology remains unclear. This review synthesizes current evidence on potential etiological factors.

Materials and methods: The design of this systematic review complied with the 2020 PRISMA guidelines. The research was conducted using five databases. Study quality and bias were assessed using the Newcastle-Ottawa Scale.

Results: Nine articles met the inclusion criteria, underscoring the limited evidence base. Prenatal factors were most frequently associated with HSPM, particularly epigenetic markers in blood (DNA hypermethylation and hypomethylation, p < 0.05), maternal smoking (p = 0.001), and maternal illness (p < 0.001). Though effect sizes varied, and methodological heterogeneity limited comparability. Perinatal factors such as preterm birth (p = 0.024) and delivery complications (p = 0.032) were also reported, but evidence was less robust and often confounded by small sample sizes. Postnatal factors, including recurrent childhood illnesses (asthma, otitis media, episodes of fever, and eczema) were significantly linked to HSPM, yet causality remains uncertain given the dependence on retrospective designs and parent-reported data.

Conclusions: Current evidence suggests that HSPM is likely multifactorial with contributions from prenatal, perinatal, and postnatal exposures. However, the overall level of evidence is moderate, constrained by small study numbers, variable quality, low response rate, and the retrospective nature of the studies. Stronger conclusions will require large-scale, prospective studies with standardized diagnostic criteria and rigorous control of bias.

Aim and background: Addressing oral hygiene in children with autism remains a critical concern for dental professionals and caregivers. These challenges make routine toothbrushing difficult and increase the risk of oral health problems. Recognizing the urgent need for practical solutions, this investigation was undertaken to evaluate three structured toothbrushing teaching interventions and their effectiveness among autistic children.

Materials and methods: This study evaluated the effectiveness of three instructional methods-visual posters, video demonstrations, and caregiver modeling to improve oral hygiene in autistic children aged 7-15 years. Sixty participants were randomly divided into three groups. Toothbrushing skills, cooperation (Frankl Scale), and oral hygiene (OHI-S) were assessed over 3 months.

Results: All groups showed significant improvement. Parent Modeling (15.55 ± 1.23) was highly superior to both Video and Poster groups (p < 0.001). A statistically significant difference (p = 0.024) was also found favoring the Video (12.80 ± 1.20) over the Poster (10.75 ± 2.49) group.

Conclusion: Caregiver modeling was the most effective method for teaching toothbrushing to children with ASD, promoting better outcomes in both oral hygiene and behavioural cooperation.

Trial registration: CTRI/2025/03/083547.

Introduction: Many studies reported on the existence of a relationship between tooth loss and hearing loss. However, only few studied the new relationship between dental implants and hearing loss.

Aims: To report the effect of a single implant-retained removable complete overdenture in the mandibular jaw on hearing loss of completely edentulous first-time denture wearers with sensorineural hearing loss.

Methods: This study is a case series that reports on the hearing thresholds of four completely edentulous patients at the ages between 55 and 62 years, which were tested before the insertion of a removable complete denture (RCD) and after loading the implant, through pure tone audiometry (PTA) for air and bone conduction in the Audiology Department at Almouwasat Hospital, from 2022 to 2024.

Results: Improvements of 5-10 dB in bone conduction thresholds were observed in some of the frequencies. A transition from minimal hearing loss to normal hearing was noted in the right ear of the second patient.

Conclusion: This experiment supports the new insight into the enhancement in hearing after loading the implant-retained removable complete overdentures, which suggests that placing dental implants improves hearing ability.

Clinical trial registration: Cases in this case series are part of a clinical trial approved by ClinicalTrials.gov Protocol Registration and Results System (PRS) with the approval number NCT05744830.