Our study aimed to elucidate whether the level of activities of daily living (ADL) of patients recovering from stroke causes differences in oral health condition and nutritional status. The subjects included 166 stroke patients in the recovery stage at admission in rehabilitation hospitals between October 1, 2016 and March 31, 2018. The ADL of the subjects was evaluated using the Functional Independence Measure (FIM) and the patients were divided into three groups based on their level of FIM. Oral health condition was evaluated using the Japanese version of the Oral Health Assessment Tool (OHAT-J).
The OHAT-J score of the group with a low ADL at admission was significantly high, the nutritional status was poor, and the rate of dental intervention was also high. FIM at admission (exercise items), Alb at admission, and oral ingestion were the factors associated with OHAT-J at admission.
Poor oral health condition and marked malnutrition were noted in patients with low activity and eating orally at the time of hospitalization, suggesting that oral management and nutritional support by multiple types of workers are important.
Objectives：Appropriate management of the diseases of dental patients with disabilities is important for maintaining and enhancing quality of life. In this study, we conducted a retrospective survey and statistical analysis on patients who had a history of dentist visits for 15 years or more in order to elucidate the relationship between visits and changes in the number of sound teeth, which is an indicator of dental health.
Subjects and Methods：We conducted the following survey on patients of University “A” Special Needs Dentistry with routine or intermittent dental visits for 15 years or more. We examined the following：
a. Dental visits (number of visits, use of anesthesia (intravenous anesthesia or general anesthesia), period of discontinued visits (one year or more))
b. Number of healthy teeth (at the initial visit and 15 years after the initial visit)
c. Relationship with the number of healthy teeth lost during 15 years from the initial visit, number of dental visits, period of discontinued visits, rate of anesthesia usage during dental visits
With the number of healthy teeth lost being the median or more as the primary outcome, we performed a multinomial logistic regression analysis. The significance level of the statistical analysis was 5%.
Results：There were 121 subjects with a median age of 22 years at the initial visit. The median number of healthy teeth at the initial visit was 17.
The median number of dental visits during 15 years was 95. The median rate of anesthesia usage during treatments was 2.3%. Sixty-three (52.1%) subjects had a period of discontinued visits of one year or more.
The median number of healthy teeth lost during 15 years was five.
The factor that had the most impact on the number of healthy teeth lost over 15 years was the period of discontinued visits. The odds ratio was 3.34. This was followed by the rate of anesthesia usage with an odds ratio of 2.30.
Conclusions：The median number of healthy teeth lost over 15 years from the initial dental visit for patients at University “A” Special Needs Dentistry was five. The factor that had the most impact on the number of healthy teeth lost was long-term discontinuation of dental visits, followed by rate of anesthesia usage.
Adaptation to tooth brushing is more difficult for certain children with autism spectrum disorder (ASD) than for children with typical development. Some ASD children are partial to sweets and insist on such foods. Therefore, it is often difficult to prevent dental caries. In this study, we investigated the relationship between the incidence of dental caries and factors related to dietary and tooth brushing habits for 4- or 5-year-old ASD children. As a result, the incidence of caries was found to be associated with the number of times of eating between meals, presence of eating after dinner, regularity of eating between meals, frequency of eating sweet food, insistence on foods, partiality toward sweets because of insistence on foods, adaptation to tooth brushing, and sensitivity to touch stimulation (Kruskal-Wallis test). Moreover, by the Type II Quantification Method using these items as explanatory variables, the incidence of caries was highly correlated with number of times of eating between meals, and the severity of dental caries was highly correlated with adaptation to tooth brushing, number of times of eating between meals, and insistence on foods. These results suggest that the management of eating between meals is important to prevent dental caries in ASD children as well as children with typical development. Furthermore, measures to prevent the progression of dental caries, such as shortening the periods between examinations, are needed when ASD children have difficulty adapting to tooth brushing or insist on foods.
In order to determine the frequency of oral care for bedridden elderly patients who easily form membranous substances, we clarified the formation process of membranous substances on the palate in relation to time and the time required for oral care. Among the elderly requiring long-term tube feeding, 17 patients who were diagnosed with first-degree or more of the clinical diagnostic criteria（Kakinoki）for xerostomia were investigated. Age, disease, nutrition intake（central parenteral nutrition, tube feeding）, and bedridden degree（Ministry of Health, Labor and Welfare in 1991）were examined from hospitalization records. The level of awareness（Japan Coma Scale）, the presence or absence of communication, the possibility of speech, and the frequency of nurses assisting with oral hygiene focusing on membrane care were also examined. The membranous substances on the palate were observed and collected at 3, 6, 12, 24, and 48 hours after dental brushing and mucosal care were performed by dentists. When deposits included epithelial components, HE sections prepared by ordinary procedures were pathologically diagnosed as “exfoliated epithelial membrane”. They were observed pathologically to assess the presence of the epithelial component and to measure the percentage of the epithelial area. Those in which the epithelial component was observed were diagnosed as membranous substances, and the formation state of membranous substances was classified into four categories of “none”, “mucus substances”, “viscous substances” and “dry membranous substances”. The oral care time by dental hygienist or dentist was measured. The median epithelial area ratio of “dry membranous substances” was the largest（84.2%）, the second largest area was “viscous substances”（45.0%）, and the least was “mucus substances”（0%）. A significant difference was recognized for each. At 3 hours after mucosal care, 52.9% of patients were observed to have “mucus substances”. After 6 and 12 hours, 35.3% of patients had “viscous substances”. Those observed with “dry membranous substances” were 11.8% after 6 hours, 23.5% after 12 hours, 47.1% after 24 hours, and 52.9% after 48 hours. The median formation time of “dry membranous substances” was 12 hours, “viscous substances” was 6 hours, and “mucus substances” was 3 hours. The formation time of “dry membranous substances” and “viscous substances” was found to be significantly longer than that of “mucus substances”. It was judged that it is appropriate to perform oral care once every 6 to 12 hours for elderly patients requiring long-term nutrition with tube feeding.
Introduction：Partial trisomy 7p syndrome is an autosomal genetic disease caused by an extra chromosome 7. Approximately 50 cases of this syndrome have been reported. The general condition is characterized by serious congenital heart disease, mental retardation and brain malformation, big forehead, telecanthus, and a short stature. We herein report the dental treatment of an adult patient with partial trisomy 7p syndrome.
Case report：The patient was a 24-year-old male, 138 cm tall and 38 kg in weight, with severe mental retardation and epilepsy. He initially visited our hospital for the treatment of dental caries. The oral findings showed a microstomia, a high palate, a maxillary molar with a small radial curvature and an enlarged medullary chamber. After caries treatment, we performed periodontal disease management for six years, but he ultimately lost four teeth.
Discussion：The present patient was mentally retarded, and it was difficult to manage his behavior. In addition, his lips and cheeks were strongly strained, and his family was unable to perform home care. There was crowding of anterior teeth in the microstomia along with morphological problems. In addition, the maxillary molar teeth had a small tooth root curvature. The clinical crown width of maxillary canine teeth, maxillary first premolar teeth, maxillary second premolar teeth, maxillary first molar teeth, mandibular canine teeth and mandibular first molar teeth were smaller than the standard deviation. These findings suggest that oral care should be thoroughly conducted in patients with partial trisomy 7p syndrome to prevent the development of severe periodontal disease.
Japan is changing to a super-aging society in which one in three individuals are expected to be elderly in the near future. Consequently, the establishment of an integrated community care system is being promoted, and so dentistry is required to engage in multidisciplinary collaboration to provide appropriate dental care to patients. While there have been recent reports on the efficacy of perioperative oral care at the ward level, these have mostly come from large hospitals with dental departments. Medical-dental partnerships are urgently needed in hospitals that do not have dental departments. Our objective was to promote cooperation between medical and dental hospitals, centered around oral care and dysphagia rehabilitation provided by dentists and dental hygienists. We evaluated the launch of this project between May 2017 and April 2019 and investigated policies to further promote medical-dental cooperation.
We retrospectively examined 180 patients aged 26-101 years （70 men, 110 women, mean age 72.1±15.5 years） who were admitted to hospitals without dental departments. Requests for care were predominantly received from the departments of oncology and internal medicine. The most common primary disease was malignant neoplasm （82 patients, 45.6%）. A total of 666 treatment interventions were provided：oral care was the most common at 265 interventions （39.8%）, followed by 127 conservative dental treatments （19.1%）, and 122 cases of dysphagia rehabilitation （18.3%）. Although there was some variation in the monthly change, the number of interventions was gradually increased during the first year and leveled off in the second year. In spite of many requests from medical departments, we could not collaborate enough as we were short-staffed in the second year.
We collaborated with a hospital that did not have a dental department to provide care to inpatients at that hospital via on-site visits. The interventions primarily consisted of oral care and dysphagia rehabilitation by dentists and dental hygienists, which promoted medical collaboration between a medical hospital and a dental hospital. Care visits to a medical hospital without a dental department appear to have a major impact and will become even more essential in the future.
Objective：We conducted a survey to determine the reasons for tooth extraction in disabled patients.
Materials and Methods：The study sample consisted of patients with intellectual, physical, mental, and developmental disorders who visited our clinic from April 2015 to March 2018. Patients who experienced tooth extraction （except third molars and supernumerary teeth） during the investigation period were selected from these subjects. Age, sex, diseases causing disability, and diagnoses of extracted teeth were identified from clinical records. Diagnoses of extracted teeth were divided into three groups：（1） dental caries, including intense tooth decay and apical periodontitis, （2） periodontal disease, and （3） others, including tooth fracture and trauma to the teeth. Statistical analyses were performed using the chi-square and Kruskal-Wallis tests using SPSS 25.0 for Windows （IBM Japan）.
Results：During the investigation period, 897 disabled patients visited our clinic, of which 242 patients were under age 20, 438 patients were aged 20–39, 177 patients were aged 40–59, and 40 patients were over age 60. The diseases causing disability included intellectual disability （n＝361）, 21-trisomy （n＝90）, autism spectrum disorder （ASD, n＝238）, developmental disorders other than ASD （n＝25）, physical disorders （n＝138）, and mental disorders （n＝45）. The number of patients with diseases causing disability who experienced tooth extraction during the investigation period was as follows：intellectual disability 51/361 patients （14%）, 21-trisomy 7/90 （8%）, ASD 15/238 （6%）, developmental disorders other than ASD 6/25 （24%）, physical disorders 17/138 （12%） and mental disorders 18/45 （40%）. In total, 114 patients experienced single or multiple tooth extraction；67 were male and 47 were female. In patients with intellectual disability, 21-trisomy, ASD, or developmental disorders other than ASD, 161 teeth were extracted due to dental caries；19 teeth due to periodontal disease；and 14 teeth due to other reasons. In patients with physical and mental disorders, 49 teeth were extracted due to dental caries；22 teeth due to periodontal disease；and 8 teeth due to other reasons.
Conclusion：With regard to intellectual disability, 21-trisomy, ASD, developmental disorders other than ASD, teeth tended to be removed more due to dental caries, compared to patients with physical and mental disorders. These results may be explained by the lower mean age of patients with intellectual disability, 21-trisomy, ASD, developmental disorders other than ASD, compared to the older age of patients with physical and mental disorders. Because disabled patients lose more teeth than healthy people, we consider that public efforts are needed to prevent caries in this population.