In our previous studies on fixed prostheses in patients with cerebral palsy, we found that the survival rate of the fixed partial denture was lower than that of a single crown, however, this survival rate includes the risks of debonding, removal, and tooth extraction, and may differ from the risk of tooth extraction alone, which is an irreversible failure. In this study, we investigated the tooth extraction risk factors for the abutment teeth of a fixed prosthesis. The study examined 268 abutment teeth of 35 patients with cerebral palsy who visited the Special Dental Comprehensive Treatment Department from 1984 to 2017 and in whom a fixed prosthesis was set. The data (sex, age, number of teeth, tooth type, type of prosthesis, anesthesia, disease, etc.) were collected and shared frailty analysis was performed using a mixed effect model with patient ID as random effect. The significance level was 5%. During the observation period, 22 of the 268 abutment teeth were extracted. The 10-year survival rate of the abutment teeth was 92.1% and the 20-year survival rate was 78.1%. As a result of shared frailty analysis, the survival rate of abutment teeth in a single crown was lower than that of a fixed partial denture, and the hazard ration of the fixed partial denture was 0.35, using the single crown as a reference. When we set a fixed prosthesis for patients with cerebral palsy, the fixed partial denture was often detached or removed, while the single crown was considered to be more likely to eventually lead to tooth extraction. Patients with cerebral palsy have their peculiar mandibular activity, which tends to cause a high stress load on their teeth. When a single crown is used, the occlusal force is not distributed and root fracture is likely to occur.

These results showed that selecting a fixed partial denture for prostheses in CP patients is useful for preserving the teeth.

It is important to select appropriate toothbrushes for persons with special needs. However, there is no objective functional index for toothbrush selection. In this study, we evaluated cleaning ability used an interproximal model for evaluating the function of the toothbrush. We used three kinds of toothbrushes : DS : flat profile with rounded-end bristles, SY : slim head with super-tapered bristles, and GR : large head with super-tapered bristles.

According to the results, the bristle tip angle of all toothbrushes was almost twice each head angle. As the head angle increased, the cleaning performance on flat areas decreased when brushing with DS, but the results were the opposite with SY and GR. In interproximal areas, the cleaning performance and distance of penetration were improved by increasing the head angle with all toothbrushes.

It is suggested that the type of bristle ends and toothbrush size should be considered when selecting a toothbrush for persons with special needs who have low brushing skills.

With the number of children receiving treatment at home increasing, various initiatives for pediatric home dental care are gradually being implemented. However, the actual status of provision of dental care has not been fully understood. Therefore, we identified issues and examined future initiatives to understand the actual status of pediatric home dental care and problems in the current situation at primary medical institutions in Kanagawa Prefecture that provide dental care for the handicapped.

Responses were obtained from 220 of the 753 targeted primary medical institutions (response rate : 29.2%). Few primary medical institutions were able to provide pediatric home care. 85.5% of the institutions responded that multidisciplinary collaboration was necessary, and the most common institutions with which they should collaborate were medical institutions (department of medicine), followed by welfare and health centers, with physicians and visiting nurses as the most common job categories with which information should be shared. The most common dental care that could be provided in pediatric home dental care was “oral care” (185 cases, 84.1%), and feeding and swallowing therapy (103 cases, 46.8%). The most frequently cited problems in implementation were “insufficient manpower” and “concerns about response to unforeseen situations and liability issues.” 65.9% of the respondents wished to participate in the workshop.

It was considered necessary to clarify the procedures that should be provided in pediatric home dental care, to hold training sessions to enhance the necessary expertise and disseminate techniques, and to create a system that facilitates collaboration among multiple professions.

Public health centers play a major role as a window and keystone for collaboration among the many professions involved in dental care in the community. However, the actual status regarding their involvement in pediatric home dental care is not clear. Therefore, in order to grasp the actual status of coordination and provision of pediatric home dental care, we identified issues and examined future initiatives at public health centers/health and welfare offices (public health centers, etc.) in Kanagawa Prefecture.

Responses were obtained from 23 of the 32 targeted public health centers/health and welfare offices (public health centers, etc.) (response rate : 71.9%). Public health nurses provided the largest number of consultations regarding pediatric home dental care, and the most common organization to collaborate with was the welfare and public health center. Public health nurses were the most frequently asked to share information. As a problem in cooperating with dentistry in pediatric home dental care, many institutions (73.9%) responded that it was difficult to grasp the actual situation. 82.6% of the institutions responded that training sessions were needed, and all institutions indicated that they would like to utilize a list of dentists who can provide pediatric home dental care.

These results suggest that there is an urgent need to share and provide detailed information on the provision of pediatric home dental care, to develop a system of collaboration between local health centers and dental institutions, and to train personnel to provide pediatric home dental care.

It is important for children receiving treatment at home to not only live at home but also to connect with society and broaden the scope of their activities in terms of their growth and development. Accordingly, the disability welfare services at developmental support facilities for children with disabilities have been enhanced. However, the actual status of dental support by dental professionals at developmental support facilities for children with disabilities is not fully understood. Therefore, in order to understand the dental problems of users and the needs for pediatric home dental care at developmental support facilities for children with disabilities, we conducted a survey of such facilities to identify issues related to dental support at these facilities and to identify the needs for pediatric home dental care, taking into consideration the results of the first and second reports. Future efforts needed to provide dental care were discussed.

Responses were obtained from 106 of the 510 targeted developmental support facilities for children with disabilities (response rate : 20.8%). The most frequent consultation from users was about “eating functions” (72 cases, 67.9%), which was inconsistent with the medical care that could be provided in the first report. Regarding the participation in the guidance tours and workshops, 62 respondents (57.5%) answered that they “would like to participate,” and many respondents wished to utilize a “list of dentists who can provide pediatric home dental care” and the consultation service.

Based on the results of the survey at primary medical institutions, health centers, and developmental support offices for children with disabilities, it is necessary to clarify the procedures that should be provided in pediatric home dental care, and to hold training sessions to enhance the necessary expertise and disseminate the techniques. Therefore, it is considered necessary to establish a network system that enables everyone, including multidisciplinary professionals and patients, to grasp and share necessary and detailed information.

Methyl CpG binding protein 2 (MECP2) duplication syndrome is a rare genetic disorder caused by duplication of the chromosomal region containing the MECP2 gene. This genetic disease is characterized by early-onset hypotonia, progressive spasticity, severe intellectual disability, recurrent respiratory infections, and refractory epilepsy. Here, we report an experience of daily dental treatment and perioperative management for tooth extraction in a patient with MECP2 duplication syndrome for 6 years from the age of 12. Because he was uncooperative with dental treatment, we focused on training and oral hygiene instruction to improve his acceptance of dental practice. However, because of his strong resistance to dental treatment, we performed psychosedation or intravenous sedation. At the age of 18, extraction of a right impacted third molar under general anesthesia was scheduled. He showed intractable epilepsy, mental retardation, autism disorder and hypoplasia in the middle to lower face, which were characterized by MECP2 duplication syndrome. In addition, he had a history of anaphylaxis to various allergens including foods and drugs. Therefore, we planned to minimize the use of drugs in the perioperative period, and did not use muscle relaxants as much as possible according to previous reports and his medical history. Moreover, we prepared for the possibility of transfer to the intensive care unit in cooperation with the emergency department in case of emergency. In conclusion, we performed the dental treatment using psychosedation or intravenous sedation, because we could not obtain the patient’s cooperation with the dental treatment. If surgical treatment is required, sufficient preparation to prevent perioperative complications is needed for safety management.

Clinical characteristics of Williams syndrome have been reported to include elf-like facial features, intellectual impairment, and cardiovascular lesions, which are primarily supravalvular aortic stenosis and peripheral pulmonary arterial stenosis. In addition, hyperacusis and anxiety/phobia are also considered to be characteristic of this syndrome. Occlusal guidance was performed for the management of ectopic eruption of left mandibular second molar in a child with this syndrome. The clinical course is reported.

The patient was a 10-year 3-month-old girl who presented with intellectual impairment, micrognathia, supravalvular aortic stenosis, ventricular septal defect, pulmonary valve stenosis, and elf-like facial features. She visited our clinic with the primary objectives of caries treatment and milk teeth extraction, and was treated under restriction of body movements and nitrous oxide inhaled anesthesia. Thereafter, she was followed up with periodic oral care. Since ectopic eruption of left mandibular second molar was observed 1 year and 4 months after the first examination, fenestration of left mandibular second molar and extraction of left mandibular third molar were performed under oral sedation in collaboration with the departments of dental anesthesia and oral surgery of our hospital. Lingual arches were placed about 1 year after fenestration, and left mandibular second molar was moved distally using an elastic chain. Then, brackets were applied and the appliances were removed after about 10 months. Presently, no relapse of left mandibular second molar or new caries is observed, and a satisfactory intraoral condition is maintained.

Occlusal guidance is occasionally difficult in patients with intellectual impairment because of poor cooperation. In the present case, however, continuation of regular oral care is considered to have mitigated the fear of dental treatment resulting in the management of ectopic eruption of left mandibular second molar by the use of simple appliances.

We provided dental treatment under general anesthesia to a patient with severe intellectual disability who was living independently. For the provision of dental treatment under general anesthesia, the consent of the patient is required ; in this case, the patient made the decision to consent. However, questions remained as to how decision-making by patients with severe intellectual disability should be evaluated when a decision cannot be made by the patient.

An adult guardian had been designated for the patient by the Family Court and was managing their assets, including the medical contract between the medical institution and the patient. However, as this guardian did not have the authority to make decisions on the nature of medical treatment, which is a matter of physical guardianship, they were unable to consent to or refuse the provision of treatment under general anesthesia. A support meeting was required to make a decision in this case. Patient decision-making support meetings require the attendance of not only medical staff but also the adult guardian as well as family members and welfare service representatives. In practice, such meetings consist mainly of the one-sided provision of medical information, making a lively exchange of views difficult.

By working in partnership with welfare services, we were able to obtain their cooperation in managing this severely disabled patient who lived alone before and after treatment under dental anesthesia. This case illustrated the need for an understanding of welfare services on the part of dental staff about decision-making support for adult disabled patients, as well as the necessity of training dental staff capable of coordinating collaboration with welfare services to enable the dental treatment of patients.

Mowat-Wilson syndrome (MWS) is a genetic disease which simultaneously exhibits various clinical symptoms including characteristic facial features such as external ear malformation, widely spaced eyes, thick and dense eyebrows, pointed chin, elongated face, and prominent nasal bridge, mild to moderate intellectual disabilities, microcephaly, Hirschsprung disease, tapered fingers, hypoplastic corpus callosum, hypospadias, and epilepsy. Regarding characteristic intraoral features, there have been only a few reports on delayed eruption of teeth, high arched palate, cleft uvula, submucous cleft palate, and malalignment, but there is no report describing the morphological characteristics of teeth.

In this study, we performed dental treatment of two patients with MWS and found shared morphological characteristics of teeth. The patients were a 17-year-old male and a 23-year-old male. Neither patient could cooperate in dental treatment because of intellectual disabilities and both were difficult to treat by conventional methods. We measured the size of teeth on CT images and dental radiograms obtained during oral examination and dental treatment under general anesthesia or using extracted wisdom teeth. Even taking into account the error of measurement, the molars of both patients showed greater overall lengths than the Japanese average and, in particular, mild radiculomegaly. In addition, histopathological examination of extracted wisdom teeth revealed that the cause of radiculomegaly was cement hyperplasia. In the present study, radiculomegaly was observed in both patients, which may be an intraoral finding characteristic of MWS.

A child with intellectual disabilities visited our dental office for one-day general anesthesia treatment for tooth luxation. The patient was an 8-year-old boy with autism spectrum disorder. He was 123cm tall and weighed 23kg. One evening, he fell and completely dislocated the bilateral maxillary central incisors. He was taken to the emergency department of a general hospital while crying and excited, however, he could not be treated because no oral surgeon was present. Therefore, the patient’s parents were introduced to our dental clinic where general anesthesia can be performed, and we were contacted by telephone from the hospital. After confirming the condition of the child’s dislocated teeth, the patient’s physical condition, and when and what he had eaten prior to the accident, we instructed that the teeth be immersed in milk and that the child come to our clinic as soon as possible. The patient was unable to cooperate with the treatment, and it was judged that reduction and fixation of teeth using general anesthesia was necessary. With the consent of the parents, preanesthetic examination was performed and then general anesthesia was performed immediately. Slow induction was performed using oxygen, nitrous oxide, and sevoflurane (GOS), muscle relaxation was obtained with rocuronium bromide, and right nasal endotracheal intubation was performed. Anesthesia was maintained with GOS. The surgery was alveolar debridement and teeth reduction and fixation. General anesthesia is rarely carried out in dentistry; on the other hand, luxation of teeth in non-cooperative patients is recommended for early teeth reduction and fixation. However, in order to safely perform emergency general anesthesia in the clinic, it is important to obtain information from the hospital regarding the physical and neurological status of the patient. Therefore, close collaboration between the hospital and local clinic is necessary.

The purpose of this study was to analyze the percentage of guardians who were seeking consultation regarding tactile hyperesthesia development in their children with disabilities and applying these findings for hyperesthesia therapy.

In this study, which was supported by dental clinics and hospital dentistry departments, 62 individuals with children with disabilities suffering from tactile hyperesthesia were enrolled. The study-specific questionnaire was filled out anonymously. The study population was divided into four categories based on the evaluation of gross movement and communication ability in their children : mild disability (n = 9), physical disability (n = 10), intellectual disability (n = 2), and multiple disabilities (n = 41). Overall, the results showed that 42/62 guardians (67.7%) would seek consultation regarding this problem, with 50.0% (4/8) with mild disability, 62.5% (5/8) with physical disability, 50.0% (1/2) with intellectual disability, and 58.3% (14/24) with multiple disabilities being the responders in the different categories.

The results indicated that psychological dislike should also be included as an option in this questionnaire as the survey was based on the guardians’ assessment. Furthermore, it was found that guardians perceived the terms “desensitization” and “tactile hyperesthesia” in different ways. The main reason behind this could be the lack of awareness regarding consultation. Therefore, based on these findings, it is concluded that easy access to information on topics such as “desensitization” and “tactile hyperesthesia” is needed in order to introduce medical institutions with which we could consult.