It is important to select appropriate toothbrushes for special needs patients. However, there is no objective functional index for toothbrush selection.

In this study, we used the SHC model which was created for in vitro functional evaluation of toothbrushes. The model consists of a semi-circular rod of diameter 8.0 mm fixed to a flat plate. We used three kinds of toothbrushes with four rows of tufts：super tapered-end bristles with flat profile, end-rounded bristles with flat profile, and raw and super tapered-end bristles in the same tuft. We measured brushing motion by an inertial sensor and evaluated the amplitude of brushing.

Our research showed that with larger amplitudes, the toothbrush head cannot touch the surface of the model or that the bristles of the toothbrush bend. The evaluation of the amplitude of toothbrush movement using the SHC model and inertial sensor could identify the proper load of each toothbrush. It is suggested that this could be used as a functional index for toothbrush selection for special needs patients.

Periodontal disease in individuals with Down syndrome (DS) develops early, rapidly, and extensively, but the mechanisms are not well understood. Previous studies indicated that interleukin (IL)-4 suppressed IL-1β-induced chemokines and matrix metalloproteinase in gingival fibroblasts and periodontal ligament cells. We studied the cellular response in gingival fibroblasts derived from individuals with non-DS (NGF) and fibroblasts derived from individuals with DS (DGF) stimulated with recombinant IL-1β (rIL-1β) and recombinant IL-4 (rIL-4) to assess the anti-inflammatory effect of IL-4 to DGF. There were four experimental groups : control, rIL-1β additive group, rIL-4 additive group, and the group in which rIL-β and rIL-4 were added simultaneously (rIL-1β/IL-4). We measured the production of IL-6 and IL-8 in supernatants using ELISA and analyzed those mRNA expressions using real-time PCR. In addition, phosphorylation of NF-κB p65 and STAT6, which are known as transcription factors, were detected by Western blotting. The protein productions and mRNA expressions of IL-6 and IL-8 in DGF with rIL-1β were significantly higher than those in NGF. However, phosphorylation of NF-κB p65 was weak in DGF with rIL-1β. The IL-6 and IL-8 production and mRNA expression were significantly lower in NGF with rIL-1β/IL-4 compared to that with rIL-1β. On the other hand, those in DGF with rIL-1β/IL-4 were significantly higher than those in DGF with rIL-1β. The phosphorylation of STAT6 was weak in DGF compared to NGF. It is considered that the enhancement of IL-6 and IL-8 expression in DGF with rIL-1β occurred via not only NF-κB but also other signal pathways and factors. In addition, it is considered that the weakness of the phosphorylation of STAT6 induced the enhancement of IL-6 and IL-8 in DGF with rIL-1β/rIL-4. IL-4 appears to play an anti-inflammatory role in NGF but not in DGF.

It is well known that individuals with Down syndrome (DS) have a high prevalence of severe periodontitis, but the reasons have not been clear. Porphyromonas gingivalis (P.g), which is known as the most important periodontopathic bacteria, is an asaccharolytic anaerobe that needs metabolic energy from peptides and amino acids. Therefore, P.g produces several types of proteolytic enzymes which cause periodontal tissue destruction. There are few reports about the effect of aminoacyl histidine dipeptidase, PepD. PepD is a proteolytic enzyme frequently of type Ⅱ P.g, which is detected in high amounts in patients with severe periodontitis. In this study, we examined whether PepD acts as a pathogen of severe periodontitis in DS or not. Gingival fibroblasts derived from Non-DS (NGF) and from DS (DGF) were stimulated with recombinant PepD (rPepD). After incubation, we measured the production of inflammatory mediators and analyzed their mRNA expressions. In addition, NGF and DGF were subjected to cell scratch assay for cell proliferation and migration. The productions of interleukin (IL)-6 and IL-8 in DGF stimulated with rPepD were significantly higher than those in NGF. The mRNA expressions of IL-6, IL-8 and chemokine (C-C motif) ligand 20 (CCL20) in DGF stimulated with rPepD were significantly higher than those in NGF. In addition, nuclear factor kappa B (NF-κB) p65 activity was observed strongly in DGF with rPepD compared to NGF. Therefore, it is considered that the high expressions of inflammatory mediators in DGF with rPepD were induced via the pathway of NF-κB. Cell proliferation and increase in growth factors such as Ki67, epidermal growth factor (EGF) and fibroblast growth factor (FGF) are necessary for termination of the inflammatory phase. DGF cell proliferation was found to be significantly faster than that of NGF. The mRNA expressions of Ki67, EGF and FGF in DGF with rPepD were significantly higher than those in NGF. Furthermore, EGF and FGF mRNA expressions were significantly higher in DGF without rPepD compared to NGF. It is considered that these phenomena induced the persistent inflammation via feedback regulation of those growth factors to the cells. Further studies are needed for clarification.

Patients with Down syndrome often have thyroid dysfunction. We report a case of Basedow disease discovered by screening for hyperthyroidism during dental treatment under general anesthesia.

The patient was a 24-year-old woman with Down syndrome who was undergoing caries treatment. Although she had been trained at a nearby dental clinic, she became frustrated and rejected dental treatment. Therefore, she was referred to our dental center. She had a history of surgery to repair a ventricular septal defect and double-chambered right ventricle. At the first visit, she was unable to sit on the dental treatment unit and we performed the examination in the attendant’s chair. Panoramic photographs were unclear because she moved during projection. As multiple dental caries were observed, we decided to perform treatment under general anesthesia. We were unable to perform the preoperative examination because of her strong aversion and instead obtained the physical data from a doctor of internal medicine. We confirmed with her doctor that general anesthesia was possible, and so blood examination, chest X-ray, and electrocardiography were carried out under general anesthesia. Although there was no medical history of thyroid disease, thyroid function was also examined according to a previous report. Her general condition was stable during general anesthesia. However, the examination results revealed that thyroid function was abnormal. Accordingly, she was introduced to the endocrinology department and was diagnosed with Basedow disease. She was immediately administered medication. As untreated hyperthyroidism has a high risk of developing into thyroid crisis during general anesthesia, we decided to postpone her dental treatment under general anesthesia for approximately three months. As a result of the drug treatment for Basedow disease, her irritation and aversion to dental treatment decreased, and she began cooperating with treatment. Her cavities were filled with cement and panoramic photographs were taken. This case suggests that it is important to perform a detailed examination as it may detect undiscovered diseases in patients with Down syndrome.

Pompe disease is an autosomal recessive disorder of glycogen metabolism caused by a deficiency of the lysosomal enzyme acid α-glucosidase. There are two forms of the disease：infantile-onset Pompe disease (aged <1 year) and late-onset Pompe disease (>1 year of age through to adulthood). The present case was a patient with the juvenile form of late-onset Pompe disease. Enzyme replacement therapy (ERT) improved the disease symptoms except for lingual weakness, dysarthria and velopharyngeal insufficiency.

Therefore, we applied a palatal lift prosthesis (PLP) to the patient. It was necessary to reduce or eliminate the gag reflex by systematic desensitization to fit the PLP, which took 7 months to get accustomed to. At present, the gag reflex is absent and the prosthesis is used in daily life, and has clearly improved the patient’s articulations, particularly /p/ and /s/.

In conclusion, PLP is a useful tool to improve the outcomes in patients with Pompe disease with dysarthria under ERT. Further long-term studies are necessary to confirm the application of PLP in patients with Pompe disease with dysarthria under ERT.

We conducted longitudinal dental management for a child with autism spectrum disorder who acquired adaptive behaviors through intervention with visual aids.

The patient was a boy who was 6 years and 11 months old. He had resisted dental preventive treatment due to being unable to understand verbal instructions for approximately two years. At 8 years and 10 months old, he began to engage in adaptive behaviors only after we started using visual aids by way of picture cards for dental preventive treatment. His inability to imagine the posture for undergoing the medical service or the treatment itself via current perceptions was considered one cause of his maladaptive behavior upon first experiencing dental treatment.

We believe that he failed to imagine the posture for undergoing the medical service or the treatment itself via auditory perception due to being unable to understand the verbal instructions during the treatment while being held down；furthermore, he was unable to imagine the posture for undergoing the medical service or treatment via visual perception as he was unable to see his own posture during the treatment. In addition, his somatic sensations (mainly proprioception) also failed to allow him to imagine his posture during the treatment. When he saw picture cards for dental preventive treatment, he was able to imagine the treatment or his body (posture) by integrating visual information and somatic sensations. As he became used to undergoing preventive treatment once a month and repeatedly experienced the integration of both visual information and somatic sensations, in addition to improved cognitive functions as the boy matured, when he heard cues which signified that it was time to undergo dental preventive treatment or when he saw medical specialists and other individuals working at the dental office, he was able to recall the posture for undergoing medical service or treatment. In this way, he became able to understand verbal instructions without using picture cards, allowing him to receive dental treatment.

Purpose：This study was performed to understand how members of the Japanese Society for Disability and Oral Health (JSDOH) are dealing with hyperesthesia in handicapped children and adults in the fields of clinical practice and education.

Subjects and Methods：We conducted a questionnaire survey of JSDOH members to gain an overview of the members, their understanding of tactile hypersensitivity, its treatment in clinical settings, and education on this issue. An e-mail was sent to each JSDOH member between August and October 2019, requesting participation in our questionnaire survey, and responses were collected through a web platform. Statistically significant differences in data were determined by the chi-square test and Fisher’s exact test using IBM SPSS Statistics.

Results：Responses were obtained from 448 (233 males and 215 females) of 5,102 members (response rate：8.8％). A total of 227 (62.7％) dentists and 59 (69.4％) dental hygienists had experienced patients with tactile hypersensitivity. This clinical experience among dentists was associated with whether or not they were qualified to provide dental treatment for handicapped patients (p＜0.0001), whereas no such association was confirmed among dental hygienists. Implementation of education on desensitization was significantly associated with professional career (p＝0.044) and presence/absence of qualification (p＜0.0001) among dentists. Similarly, a significant association with presence/absence of qualification was found among dental hygienists (p＝0.004).

Conclusion : To a question about the method of desensitization, many respondents reported that they massaged the hypersensitive site or touched the site from the distal to proximal parts, as well as touching it firmly. This suggested the need to verify the indications and methods for desensitization. A certain number of dentists or dental hygienists in university facilities (educational institutions) seemed to have performed desensitization according to the conventional method, indicating that appropriate education based on current information is required. Many oral care providers with a long professional career or with qualification have often received education on desensitization. This suggests that specialized knowledge and skills are necessary to understand the importance of tactile hypersensitivity.

Some patients with severe motor and intellectual disabilities also have horizontal gingival enlargement without drug-influenced gingival hyperplasia and genetic predisposition to hereditary gingival fibromatosis. Patients who were hospitalized in a facility for the severely disabled were examined, and the proportion and clinical characteristics of those patients with horizontal gingival overgrowth of 3.5mm or more were studied.

There were 73 hospitalized subjects with severe motor and intellectual disabilities. Age, sex, disease, ADL, medications, and oral intake/tube feeding were investigated from hospitalization records. Pocket depth, malocclusion, and oral hygiene status were evaluated using a mirror and LED light in the oral examination. Those not taking a drug that caused gingival overgrowth, having no genetic predisposition, and having horizontally enlarged gingiva of over 3.5mm were diagnosed as non-drug/non-hereditary gingival hyperplasia. These patients were examined for experience of taking phenytoin, a calcium channel blocker, and cyclosporine based on hospital records and interviews with parents.

The proportion of non-drug/non-hereditary gingival hyperplasia was 5.5％ in persons with severe motor and intellectual disabilities and 22.2％ in tube-fed individuals alone. Those who had non-drug/non-hereditary gingival overgrowth had a lower average age than those who did not, and there was a significantly higher proportion of tube feeding and open bite. The morphological characteristics of non-drug/non-hereditary gingival hyperplasia are horizontal hypertrophy inward of the upper anterior and upper and lower molars. This characteristic was different from the morphology of drug-induced gingival overgrowth and hereditary gingival fibromatosis. Four cases with idiopathic horizontal gingival hyperplasia had no history of oral intake.

This study examined the situation and issues of home visit dental treatment for children in Japan. We conducted a questionnaire survey on the situation of home visit dental treatment for children. The subjects were 206 dentists who were members of The Society of Home Dentistry for Children；responses were obtained from 130 dentists.

The number of dentists conducting home dental care for children was 51. The highest percentage of patients’ age was 0-4 years (46.5％). The percentage of medically dependent children with severe motor and intellectual disability was 39.1％. Requests for home dental care were received mainly from the families of patients (54.9％); requests from other occupations accounted for 11.8-27.5％. Many of the respondents (70.6％) answered that they felt “cooperation with other occupations” was an issue of home visit dental treatment for children.

The number of dentists considering conducting home dental care for children was 42. The main reason they did not do so was “no request” (85.7％).

The number of dentists not conducting home dental care but providing outpatient care for the disabled was 26. The percentage of respondents cooperating with home dental care for children was 30.8％, while 72.2％ of the respondents not cooperating with home dental care for children answered that they could cooperate in the future.

In order to consider concrete plans to expand home visit dental treatment, it is necessary to conduct further investigation and research.