This study was conducted to investigate the relationship between periodic dental visits and the relevant factors for Down syndrome patients and their families according to their experiences during previous visits. Data were collected using semi-structured interviews with patients and their families, and were analyzed by qualitative research methods.
The process of deciding whether or not to visit the dentist periodically involved the following stages：pre-consultation, initial consultation, determinants for periodic dental care, and decision on whether to visit. Experiences from the initial visit and subsequent visits resulted in factors that either promoted or suppressed the need for periodic dental visits. Each factor was related to a decision on whether to：continue periodic dental visits, cease or suspend periodic dental visits, or switch to another clinic for dental care. Time or distance also caused cessation/suspension of periodic dental visits or switching to another dental clinic though they continued periodic dental visits. Some families were hesitant and ceased or suspended their periodic dental visits. When families were required to switch to another dental clinic, they followed the same aforementioned selection process （i.e., pre-consultation, initial consultation, determinants for periodic dental care, and decision on whether to visit）.
This study reaffirmed the need for patients to continue periodic dental visits by receiving supportive correspondence from dental clinics and suggested that positive experiences of patients and their families were factors that promoted periodic dental visits.

View full abstract

The purpose of this study was to investigate the usability of a lip and cheek retractor with soft material （LR-soft） in special needs dentistry.
In adult volunteers, the characteristics of the intraoral visual field by using LR-soft and the lip retractor were evaluated by an imaging study.
The size of area was shown to be smaller with LR-soft. The oblateness was shown to be significantly lower with LR-soft. The mobility of the lip, when the lip was pulled to the right side, was measured by the difference in horizontal length on the right and left sides independently, and the length was shown to be significantly longer with LR-soft （right p＜0.01, left p＜0.05）.
The impression of using LR-soft and the lip retractor was evaluated by using the modified Visual Analogue Scale （VAS）. Upon comparing the feeling when applied, soreness, and impression after using for 5 minutes, LR-soft showed significantly fewer complaints （p＜0.01）.
The degree of gaining the visual field by using LR-soft when tooth brushing was done by disabled persons was compared, using criteria for the difficulty of retracting the lips in the case of using LR-soft and by finger. Significantly less difficulty was shown when using LR-soft （p＜0.01）. The area where brushing was not performed due to the difficulty of retracting the lips was smaller with LR-soft.
Based on these findings, LR-soft provided a sufficient intraoral visual field and resulted in fewer complaints. Therefore, it is considered that LR-soft is suitable for disabled persons who present with ridged mouth closure in whom it is difficult to carry out treatment or oral care.

View full abstract

Oral bacteria are implicated in certain systemic diseases such as coronary heart disease, stroke, diabetes mellitus, atherosclerosis and aspiration pneumonia. Porphyromonas gingivalis （P. gingivalis）is strongly associated with severity of aspiration pneumonia for immunocompromised hosts and the elderly with oral dysfunction. P. gingivalis is an asaccharolytic bacterium that relies on fermentation of amino acids for the production of metabolic energy. Various proteinases produced by P. gingivalis play a role in the growth and virulence of P. gingivalis. According to a previous study, P. gingivalis fimA genotype II was detected at the highest frequency in patients with severe periodontal disease. In addition, aminoacyl-histidine dipeptidase （PepD）was strongly expressed in P. gingivalis fimA genotype II. However, there are few reports that focused on PepD of P. gingivalis fimA genotype II. Therefore, we studied the effectiveness of PepD on bronchial epithelial cells, BEAS-2B cells, and the usefulness of Bestatin, an aminopeptidase inhibitor, as antibacterial therapy. The production of IL-6 and IL-8 from BEAS-2B cells was enhanced by PepD. Furthermore, PepD was a target enzyme of Bestatin. These results suggested that PepD plays a role in not only the metabolism but also the virulence of P. gingivalis and may represent a target for molecular targeted therapy.

View full abstract

It is well known in many nursing homes that swallowing exercises promote the maintenance of swallowing function. Using swallowing exercises, we evaluated the antioxidant activity of saliva against reactive oxygen species such as HO and O₂^•−, in individuals from different generations.
Subjects：Individuals who provided informed consent, had normal levels of repetitive saliva swallowing, and did not perform swallowing exercises every day were eligible for this study. The following groups were investigated separately：group A：subjects aged 20-49 years；group B：subjects aged 50-70 years；group C：subjects aged 80 years and over.
Method：After collecting general information such as any possible complicating factors, resting saliva was collected before and after the swallowing exercises. The ability of the saliva to scavenge HO^• and O₂^•− was measured using the X-band electron spin resonance spin trap method.
Result：There was no significant inter-group difference between antioxidant values for resting saliva before and after the swallowing exercises, although there were large individual differences. It was further observed that group C had an increased O₂^•− antioxidant capacity, and an increased HO^• antioxidant capacity, generated from the Fe^2＋/H₂O₂ system. This was considered to be owing to the effects of aging or of general disease. In the comparison between saliva before and after swallowing exercises, the HO^• scavenging ability of the saliva was significantly elevated after swallowing exercises compared with before swallowing exercises in group A, but not in groups B or C.
The above results suggest that swallowing exercises can be used in group A for the activation of muscle function related to swallowing, and also to activate the defense mechanisms of the oral antioxidant system. However, there were no significant effects of swallowing exercises in groups B and C in this study. Thus, we would like to assess the antioxidant effects of adequate exercise, which is involved in the maintenance and improvement of swallowing/oral muscular functions, and the continuous effects of swallowing exercises in these groups.

View full abstract

Background：HDR syndrome （hypoparathyroidism, sensorineural deafness, and renal anomaly syndrome） is quite a rare disease caused by haploinsufficiency of the GATA3 gene, located on chromosome 10p15 and encoding the GATA3 transcription factor.
Case presentation：The patient was a 15-year-old girl who had been diagnosed with HDR syndrome by genetic testing at 1 year old. She had double ureter, hypoparathyroidism, sensorineural deafness. She had severe intellectual disability.
Oral and facial manifestations：Her neck was short and wide, and her mouth, nostrils, and external auditory foramens were small. Both right and left mandibular canine teeth were absent, presumably congenitally. Angle I malocclusion was evident. Infraversion, labioversion, and rotation were observed in both maxillary canine teeth, and 14 teeth showed enamel dysplasia. Radiologically, the size of pulp chambers, shape of roots, and the thickness of lamina dura were within normal ranges. Dimensions of the palate, tongue, and gingiva were also within normal ranges.
Dental treatment：On the first visit, the patient was agitated. But, resin filling and tooth extraction were successfully performed under behavior-modification techniques such as the “Tender Loving Care” and “Tell-Show-Do” methods. Her teeth were being effectively brushed by her mother, and no gingivitis was observed visually.
Conclusion：In this case of HDR syndrome, caries teeth, malocclusion and enamel dysplasia were observed. Dental treatments were successfully performed under behavior-modification techniques.

View full abstract

In this report, we describe the case of a dysphagic patient who had difficulty following instructions, and who had been fed by nasogastric tube for three years and returned to total oral intake through intensive training under hospitalization and continued the training program after discharge. The patient was a 52-year-old male, who had intractable epilepsy onset at age of 5, and was later diagnosed as having mental retardation. Since he developed aspiration pneumonia when he was 49 years old, a nasogastric tube was placed for nutrition management. He was referred to our department from the medical department. The ADL at the first medical examination was five points on the Barthel Index. The cognitive function at the first medical examination was two points on the HDR-S. At the initial visit, there was no finding of aspiration with yogurt or jelly on videofluorographic examination （VF）. Because there was no evidence of aspiration during VF, direct training was started using jelly at the residential facility. However, aspiration pneumonia developed shortly after training started, and so an intensive swallowing training program under hospitalization was implemented. The training during hospitalization was conducted in the presence of his family as often as possible. To make sure the training would be performed in the same way after being discharged from the hospital, the training methods and care methods were instructed to the patient’s family. Also, the training scenes were video-recorded, and handed over as a DVD at discharge so the residential facility staff could understand the training method accurately. After leaving the hospital, there was no notable change in physical condition including development of fever. Thus, the amount of oral intake was increased in consultation with an attending doctor and the facility staff. After a month, the patient returned to total oral intake, and in consultation with the doctor, the nasogastric tube was removed. The foods currently served are rice and chopped diet. Since the problem of food stuffing was observed, a normal diet is eaten only in the presence of the family. No change in overall condition including development of fever has been observed for a year since returning to total oral intake. It is suggested that a good training effect can be acquired for patients who have difficulty following instructions by providing intensive training under hospitalization and instructions to family and care workers.

View full abstract

A dental hygienist intervened for an autistic child who was maladjusted to tooth brushing or dental treatment. The purpose was to teach tooth brushing behavior. The result of the intervention is reported.
The Treatment and Education of Autistic and related Communication handicapped Children （TEACCH） program was performed once a month.
Picture cards were lined up in turn to show the structure of the schedule. A picture card was shown, the patient carried out the contents on the picture card, then the card was put in a ‘finish box’ for each picture card. When all cards had been put in the box, the procedure ended. This approach was repeatedly performed.
The maladaptation to tooth brushing gradually improved. However, tooth brushing behavior did not change.
On the other hand, when the child entered a special support school, educational guidance using the picture exchange communication system （PECS） started to be also performed at the school. From that time, the child showed voluntary behavior. Then, our clinic started to perform part of the PECS, and produced a change in tooth brushing behavior. This result suggests that tooth brushing behavior can be acquired by an autistic person using two kinds of visual support method and through bidirectional communication.

View full abstract

Oral malignant tumor is often incidentally found during ordinary dental management. Here we report an incidental finding of a suspected lesion of paranasal-oral malignant tumor （cytodiagnosis：Class ⅢB） in an elderly patient with dementia by visiting dental management.
A 94-year-old woman was bedridden and being treated as an inpatient with severe heart failure, paroxysmal supraventricular tachycardia, pneumonia and dementia. Her attending physician in the adjacent acute hospital and her family referred her for visiting dental treatment. In the initial oral inspection, we found an aphtha-like lesion on the upper left posterior region of her palate. We diagnosed the lesion as an aphtha caused by ill-fitting of her denture, and adjusted the denture by carving an appropriate region with a portable dental engine. When we visited her again one week later for follow-up, the aphtha-like lesion had changed in appearance and was rough, swollen, and twice the size in diameter. We suspected it as a tumor, and referred her to the department of oral surgery in our hospital. The oral surgeons immediately checked her oral lesion by computed tomography and cytodiagnosis. They diagnosed suspected malignant lymphoma of the left maxillary sinus （Class ⅢB）, and referred her again to the otolaryngologist in our hospital. The otolaryngologist checked the lesion by magnetic resonance imaging, but abandoned a biopsy because of her general condition, age and progression of the malignant tumor, and recommended to her family that she should be treated by palliative care. As part of the palliative care, we continued providing oral care until she was transferred to a hospice facility. This experience shows the importance of continual follow-up in visiting oral treatment, not only to maintain the oral environment, but also to detect oral malignant lesions at an early stage.

View full abstract

Purpose：The purpose of this study was to clarify the actual conditions of epilepsy and the control of epileptic seizures of dental patients with special needs.
Subjects and Methodology：The subjects were special needs dental patients from University Hospital “A”, and the questionnaire survey was performed from November 2013 to December 2014. We requested the guardians of the patients to answer the survey questions in a face-to-face interview. The questions included：1）whether the patient had been diagnosed with epilepsy；2）at what age the patient was diagnosed；3）the frequency of the patient’s epileptic seizures；4）the symptoms of the patient’s seizures；and 5）whether the patient had suffered any grand mal seizures （convulsions and loss of consciousness with their seizures）within the last year.
Results：During the survey period 188 subjects were sampled （mean age 28.6 years, SD 10.9）. Of these, 106 patients （56.4％）had been diagnosed. The group of patients with severe motor and intellectual disabilities （SMID）and those with mental retardation （MR）represented a significantly higher proportion than the group with autistic spectrum disorder （ASD）and Down’s Syndrome （DS）disabilities.
Those diagnosed with epilepsy had a mean age of 5.7 years （SD 6.1）, and there were 60 subjects （60.0％）who had been diagnosed by the age of four years old. There were significant differences by disability, with the SMID and MR groups diagnosed at a younger age, and the ASD and DS groups diagnosed at an older age.
There were 15 patients who were currently experiencing more than one seizure per day and they accounted for 14.2％ of those with epilepsy. At the other end of the spectrum, there were 11 patients who had never had even one seizure. In other words, there were 95 patients who had epilepsy, because the ILAE defines that epilepsy patients must have had at least one epileptic seizure.
The most frequent symptom （multiple answers allowed）was tonic-clonic seizure （54 patients, 50.9％）.
There were 26 patients who had experienced seizures with convulsions and loss of consciousness, and they accounted for 13.8％ of all subjects. Of those, there were four patients who had not been diagnosed with epilepsy.

View full abstract

It would be useful to establish a therapeutic regimen based on a simple evaluation of oral health status because it is not easy to work with disabled patients and evaluate their status during dental treatment. We quantified the factors correlated with oral hygiene status, the severity of periodontal diseases, and the risk of dental caries in patients under general anesthesia. We recorded the number of decayed, missing, and filled teeth （DMFT）, the average periodontal pocket depth, and the number of bacteria on the tongue and on the mandibular teeth and the level of pH decrease.
We carried out correlation analysis and obtained the following results.
1. The number of bacteria on the tongue （γs＝0.241 （p＝0.019）） and the mandibular teeth （γs＝0.334 （p＝0.011）） correlated with the average periodontal pocket depth.
2. The ability of acid production and pH decrease correlated closely with the number of DMFT （γs＝0.581, （p＜0.001））.
3. The number of bacteria on the tongue and the mandibular teeth did not correlate with DMFT （number of bacteria on the tongue：γs＝－0.019 （p＝0.848）；number of bacteria on the mandibular teeth：γs＝－0.088 （p＝0.519））, nor with the ability of acid production （number of bacteria on the tongue：γs＝－0.168 （p＝0.145）；number of bacteria on the mandibular teeth：γs＝0.100 （p＝0.539））.
We conclude that the number of bacteria can be used to evaluate the oral hygiene status, but not the ability of acid production or number of teeth contracting dental caries. The number of bacteria had no relation with contracting dental caries.
We will be able to establish a therapeutic regimen for evaluating oral hygiene status by measuring the number of bacteria, and the number of teeth contracting dental caries by the ability of acid production.

View full abstract