It is important for special needs patients to select an appropriate toothbrush. In this study, we focused on the influence of toothbrush size, and evaluated the functionality of four kinds of toothbrush using the single half-cylinder model (SHC model) which was created for in vitro functional evaluation of toothbrushes.

Three of them were super tapered bristles with different head size, while the other had rounded bristles with a flat profile. We shot videos while the toothbrush was brushing the surface of the model, and measured the motion by an inertial sensor and evaluated the amplitude of motion.

It is suggested that super tapered bristles with a large toothbrush provides higher cleaning performance than rounded bristles or super tapered bristles with a compact head for special needs patients who are not good at controlling the brushing force.

At our hospital, we have established a treatment system that can provide intensive dental treatment under general anesthesia for disabled patients who have difficulty undergoing normal dental treatment and have a number of teeth affected by dental diseases. In principle, we have endeavored to continue oral cavity management of our patients through periodic maintenance after treatment in order to prevent the aggravation of dental diseases. However, there have also been cases where, due to aggravation of the dental disease, we have been forced to administer repeated intensive dental treatment under general anesthesia. Therefore, this retrospective study was conducted to clarify the factors leading to repeated intensive dental treatment under general anesthesia for disabled patients at our hospital.

The subjects included 72 patients who underwent intensive dental treatment under general anesthesia and continued maintenance for more than 3 years from April 1993 to August 2020 at our hospital. Forty-eight out of 72 patients underwent only one procedure, while the remaining 24 underwent multiple procedures.

The results of this study suggest that motor dysfunction, maintenance interruption for more than 1 year, fewer prosthetic treatments, endodontic treatments, extractions, more remaining molars, and more restorative treatments are all factors that influence the necessity of repeated intensive dental treatment under general anesthesia. These results suggest that it is important to consider the content of treatment according to the patient’s background and to educate patients and caregivers about the necessity of maintenance.

It is hard for people with intellectual disabilities (ID) to develop the lifestyle habit of brushing their teeth on a daily basis. We examined the changes in “voluntary participation behavior” and “cooperation with dental hygienists for finishing polishing” in the brushing group activity. Three hundred and two people with ID were divided into three groups, mild (Category 1 and 2), moderate (Category 3 and 4) and severe (Category 5 and 6), according to their disability support category. The voluntary participation behavior in brushing activities was evaluated on a 10-point scale, and the degree of cooperation among dental hygienists for finishing polishing was evaluated on a 5-point scale, and changes over time over 7 years were analyzed.

The level of voluntary participation in brushing activities differed and changed among the three groups according to severity, but none of them showed a significant improvement during the 7 years. On the other hand, the degree of cooperation by dental hygienists for finish polishing was different among the three groups from the beginning, but there was a clear tendency for improvement in all groups, and it improved significantly three years after the start of tooth-brushing support and management activities.

This findings show that, for a long period of time, dental hygienists’ tooth-brushing support and management activities have not changed the voluntary participation behavior of people with intellectual disabilities in oral hygiene activities, but it has become accepted that dental hygienists brush their teeth.

The first and second branchial arch syndrome is a congenital defect caused by abnormal development of the first and second branchial arches. In patients with this syndrome, hypoplasia of the maxilla, zygoma, and mandible, cleft profile, blessed ears, microtia, and closure of the external auditory canal tend to occur unilaterally. In this article, we report a case of an incisive canal cyst in a patient with the first and second branchial arch syndrome. The patient was a 29-year-old male with gnathic malformations and moderate intellectual disability. At the first visit for caries treatment, a bone expansion was observed around the root apex of the maxillary central incisor, but we suspected a maxillary malformation which is often noted in patients with the first and second branchial arch syndrome. However, swelling and pus drainage in the same area were identified during the regular checkup, and a cyst-like transmission image was detected around the root apex of 11, 21, and 22 by panoramic radiographs and dental radiographs. In addition, we diagnosed this lesion as an incisive canal cyst by CT and biopsy. The patient was then referred to an oral surgeon who performed cystectomy under general anesthesia. The first and second branchial arch syndrome presents various malocclusions, and the occlusal plane is often inclined. In this case, characteristic jawbone deformity with malocclusion and malocclusion of the maxillary anterior teeth were observed, masking the inflammatory lesion. Because of the continuous oral management, the incisive canal cyst was detected in the early stage of acute changes and could be removed before the inflammation spread. Since, in patients with this syndrome, the presence of oral lesions tends to be considered as one of the characteristic oral malformations, there is a risk of complications such as functional impairment if the lesion is not detected and diagnosed in time. Therefore, it is important to constantly monitor whether the lesion is malformed or progressive through continuous management in patients with the first and second branchial arch syndrome.

Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders defined by interpersonal relationship and communication problems and limited and repetitive behavioral patterns. It is characterized by a tendency to suffer because of even small environmental changes. In dental settings, these patients are not receptive to treatment due to their inability to adapt to environmental changes, which can worsen symptoms. Here, we report a case of an ASD patient with severe intellectual disabilities who developed an external dental fistula on the cheek, which was surgically removed along with the tooth responsible using intravenous sedation (IVS) and general anesthesia (GA). The patient was a 15-year-old male who visited our hospital in July 2017 with a chief complaint of swelling and pus discharge from the lower left cheek. At a different dental clinic, he had undergone four root canal treatments under IVS and took oral antibiotics, but no improvement was observed and the patient was referred to our hospital. At the initial examination, the patient strongly resisted sitting in the unit and it was difficult to persuade him to do so, which also made it impossible to perform an oral examination or obtain a panoramic X-ray. Because the external dental fistula of the left cheek could have caused jaw inflammation, we believed that an oral examination, diagnosis, and treatment needed to be performed without delay. First, an oral examination, digital X-ray, and computed tomography were performed under IVS. Based on the diagnosis that tooth extraction was indicated, the tooth responsible was removed on the same day. Although the external dental fistula healed without causing jaw inflammation, scarring and contraction of the fistula tract created a depression in the cheek. As the patient’s parents wanted the cheek depression fixed, fistulectomy was performed under GA. Removal of the fistula improved the depression, and the patient’s course has been uneventful since.

Purpose：Williams syndrome is a developmental disorder characterized by congenital heart disease, intellectual impairment, and dysmorphic facial features. It is caused by a hemizygous deletion of the elastin gene on chromosome 7q11.23. The prevalence of Williams syndrome is estimated to be 1 in 7,500 live births. In this case report, we present a patient with Williams syndrome with submucous cleft palate and multiple congenitally missing teeth, accompanied with dysarthria.

Case：The patient was a 9-year-old girl who came to our hospital with a complaint of unclear conversation. She had been diagnosed with Williams syndrome at another hospital.

On our examination, she was diagnosed with submucous cleft palate because she had the Calnan triad of clinical sign. In the panoramic radiography, permanent teeth numbered 15, 13, 12, 24, 25, and 45 were congenitally missing. Next, we evaluated the velopharyngeal closure and performed a developmental examination. As a result of snort mirror examination, no obvious cloudiness was observed at the time of blowing and articulation, so we diagnosed that her velopharyngeal closure had extremely mild deficiency. Her intelligence quotient was about that of a three-year-old. Because on our examination her velopharyngeal insufficiency was extremely mild, we decided not to perform palatoplasty but to prioritize language training. Although she had intellectual impairment and was unable to follow our instructions for language training well, when we gave her visual feedback on exhalation movements, her dysarthria improved.

Conclusion：We report the case of a patient with Williams syndrome with submucous cleft palate and multiple congenitally missing teeth, accompanied with dysarthria. Cleft palate has been reported in the literature in just a few cases as part of the multiple-disorder characteristic of Williams syndrome. We have not found any reports of Williams syndrome accompanied with submucous cleft palate in our search so far. From this report, it is undeniable that submucous cleft palate may become one of the phenotypes if cases of submucous cleft palate increase in the future. Even if normal speech treatment is difficult due to intellectual disability, the symptoms may improve depending on the training method. In addition, if the accompanying dysarthria becomes apparent as in this case, there may be an organic abnormality. Therefore, if the symptom does not improve through language training, it may be necessary to consult a speech pathologist from an early stage.

Dentatorubral-pallidoluysian atrophy (DRPLA) is a form of spinocerebellar degeneration, and patients may require behavioral adjustment for some problems such as myoclonus, psychiatric symptoms associated with intellectual disability, ataxia, and seizure during dental treatment. We report herein a case in which intravenous sedation was effective in the dental treatment of a patient with DRPLA.

The case was a 22-year-old woman. The patient visited our hospital with a complaint of toothache of the right mandibular second molar. At the age of 16, she was diagnosed with juvenile DRPLA, and at the age of 20, she could not talk and needed long-term care such as eating and changing clothes. When infiltration anesthesia was started as usual treatment to perform pulpectomy on the right mandibular second molar, the blood pressure increased to systolic blood pressure of 192mmHg, the heart rate became sinus tachycardia at 150 beats/minute, and myoclonus became remarkable. Therefore, systemic management was performed by applying intravenous sedation using midazolam (6mg+2mg). Since recovery was slow at this time, we changed to propofol (initial bolus administration of 40mg, continuous intravenous infusion of 5mg/kg/hour) from the second time onward, and behavioral control was good and recovery was quick.

Two and a half years after finishing the treatment, she returned to the hospital. A gastrostomy and a tracheostomy tube were indwelled. At the time of the examination, the blood pressure and heart rate suddenly increased and myoclonus became remarkable as in the previous examination. Therefore, we were able to perform safe and appropriate treatment by performing mental relaxation and behavioral adjustment again by intravenous sedation using propofol.

We report on the dental treatment with systemic management throughout the life of a patient with Down syndrome, who was diagnosed with Eisenmenger syndrome, where general anesthesia was determined to be difficult. The patient had had dental caries since childhood, and was receiving dental treatment under body restraint. However, with the progression of age and growth, treatment refusal and gag reflex became stronger, which rendered treatment without the use of general anesthesia difficult. After being diagnosed with severe Eisenmenger syndrome at the age of 20 years, the patient was refused treatment at numerous other facilities since dental treatment under general anesthesia posed a high risk, and hence the patient presented to our hospital. The patient expired at the age of 33 years due to heart failure. For eight years, between the ages of 25 and 33 years, the patient was treated 97 times. The patient had 96 dental treatments under administration of oxygen and monitoring, and one tooth extraction under intravenous sedation. SpO₂ under room air, which was measured during each treatment, was 80-89% in the beginning, but gradually decreased over time. During the last year, it was often 70-79%, which indicated poor general condition. Eisenmenger syndrome when complicated with Down syndrome has a short average lifespan of around 18 years due to pneumonia or infective endocarditis；however, this patient maintained quality of life until the age of 33, which is 1.5 times longer than the average lifespan. This increased lifespan was due to the dental treatments under systemic management, such as monitoring under oxygen administration and intravenous sedation. Providing the safest dental environment for high-risk patients for whom general anesthesia is impossible is the most important role of a team approach with a pedodontist and a dental anesthetist.

We report a case of leukoplakia-like white lesions on the tongue of a patient with autism spectrum disorder.

The patient was a 29-year-old male. He had regular dental examinations at a dental clinic for special needs. We found leukoplakia-like white lesions on the left lower tongue surface, and leukoplakia was suspected. We considered referring the patient to another hospital for a detailed examination, but could not find a hospital in the same prefecture that would accept people with disabilities.

We referred him to a university dental hospital in another prefecture, sharing information about the patient with the hospital. A biopsy and total excision were performed under general anesthesia at the hospital, and the pathological diagnosis was hyperkeratosis. His postoperative condition was favorable.

This case shows the importance of regular examinations for patients to detect diseases at an early stage. Cooperation between hospitals and clinics is also important. Since the number of tertiary medical institutions that can accept people with disabilities is still limited, it is necessary to strengthen the medical system in the future.

We work at a dentistry department in a social welfare facility for people with intellectual disabilities and provide dental treatments for both residents and outpatients. At our department, dental treatments are provided under general anesthesia (GA) for patients who are restless because of intellectual disabilities or other reasons. We provide patients who are difficult to treat at primary care facilities with treatments under intravenous sedation (IVS) and day treatment under GA, and we refer patients who require inpatient treatment under GA to tertiary medical care facilities. To share useful information for smooth collaborative dental treatment for people with disabilities, we conducted a survey on dental treatments provided under GA at our department for over 25 years. Of a total of 112,093 patients treated (70,884 residents and 41,209 outpatients), 368 were treated under GA (80 residents and 288 outpatients), with a mean annual number of 14.7 (6.7) patients. Patients aged 21-30 years accounted for the largest proportion (33.7%), and the majority were men (67.1%). Intellectual disabilities were the most common disabilities observed in these patients, and dental pulp treatment was the most common treatment provided. The mean treatment duration, GA duration, and time to recovery after GA were 94.5 (40.9) minutes, 139.5 (44.0) minutes, and 112.5 (37.5) minutes, respectively. Slow anesthesia induction accounted for 72.3% of all induction methods used. The most commonly used anesthetics for the intraoperative maintenance of GA were nitrous oxide–sevoflurane and propofol (135 cases, 36.7%). After the muscle relaxant was switched from vecuronium bromide to rocuronium bromide, the time needed for GA induction was shortened；the usage of nitrous oxide was ceased, but the time to arousal was unaffected by this change. Perioperative complications were observed in 18 cases (4.9%), but all of them improved without exacerbation.

For better collaborative dental treatment for people with disabilities, we need to choose safe day treatments under GA whenever possible primarily for outpatients referred from primary healthcare institutions. Hence, in the past 25 years we have made efforts to shorten the durations of treatment and anesthesia and ensure the availability of ample recovery time. Moreover, to provide day treatments under GA efficiently with a limited number of staff, it is important to call back patients who had received GA and evaluate their oral health and provide them with training so that they can receive dental treatments under IVS or in the standard setting.

We conducted a questionnaire survey among local member organizations in ordinance-designated cities of four organizations supporting people with disabilities throughout Japan, with the aim of understanding their opinions on dental health care in the event of major disasters. A total of 123 organizations responded (response rate, 62.8%).

Only 11.4% of the organizations “have a disaster preparedness manual,” and only 8.1% “have an individual evacuation plan for their members.” Although 52.8% of the organizations “have connections with local dental institutions,” only 19.5% “have discussions with dental institutions about dental health care during disasters.” Furthermore, 80.5% of the respondents answered that they “have problems with dental checkups even during normal times.” When asked about their concerns about their teeth and mouths in dental health care during disasters, 82.8% of the organizations responded that they “are worried about whether they would be able to provide oral care in a changing environment.” The most common answer for necessary information was “places that provide dental first aid” at 88.6%, and the most common answer for necessary support was “oral care in evacuation centers” at 83.6%. There were differences in the concerns and necessary dental support during disasters depending on the characteristics of the disability.

These results indicate that the disaster preparedness of organizations for people with disabilities is still inadequate. Especially in the area of dentistry, it became clear that there are many concerns during disasters and that support needs to be tailored to the characteristics of the disability, but there is a lack of information sharing with dental care providers. As a background, it was suggested that the local dental care system for people with disabilities was not fully functioning, with a low level of awareness that responding to disasters is an extension of responding in normal times.