Introduction：The novel coronavirus pandemic has had a great impact on all fields around the world. However, there have been no reports on the status of dental visits by special needs patients during the pandemic, and the background of patients who postponed or continued dental visits. Therefore, in this study, we conducted a survey of patients who were scheduled to visit our dental clinic for special needs patients during the declaration of a state of emergency for the pandemic, and aimed to clarify the factors related to deciding whether to visit or not.

Subjects and Methods：We conducted a questionnaire survey by mail of 320 patients and their guardians who were scheduled to visit our dental clinic during the period when the state of emergency was declared nationwide. Of the 198 subjects who responded, 185 were analyzed （approved by E-2067, Hiroshima University Epidemiological Research Ethics Committee）.

Results：According to the questionnaire survey, about 70% of patients postponed dental visits. There was a significant difference in the presence or absence of anxiety about the oral cavity between the three groups：“the group that postponed on their own judgment,” “the group that postponed due to communication from the university,” and the “continued consultation group.” In addition, there was a significant difference between “with anxiety about the oral cavity” and “postponing dental visits for special needs patients during the declaration of a state of emergency.”

Discussion and Conclusion：It was suggested that postponing dental visits increased anxiety about the oral cavity among patients and guardians. In the future, it is important to create a system that does not interrupt dental visits for special needs patients.

It has been reported that abused children have a high prevalence of dental caries. In this study, we analyzed dental caries by tooth type with the aim of further clarifying the characteristics of the status of dental caries in abused children. 534 children aged 2–19 years old who were taken into temporary care shelters were included. Of these, 323 children whose reason for placement was “child abuse” were grouped by age into 2–5 and 6–9 years for the analysis of primary teeth, and into 5–9, 10–14, and 15–19 years for permanent teeth, and were then compared with the results of the Survey of Dental Diseases in Japan. The mean number of decayed teeth per person was significantly higher in the abused group for both primary and permanent teeth, and the mean number of decayed and filled teeth per person for permanent teeth was significantly higher in the abused group in all age groups. On the other hand, there were no findings specific to the abused group in terms of caries prevalence by tooth type, and it was considered that the abused children had a higher percentage of caries in areas that are generally more susceptible to caries occurrence. The abused children had caries at an early stage after the eruption of permanent teeth. The mean number of decayed and filled teeth per capita showed that 25% of the abused children had no decayed and filled teeth as the controls, while some of the abused children had very high numbers of decayed and filled teeth. This may have increased the number of decayed teeth per person of caries in abused children.

Congenital insensitivity to pain with anhidrosis (CIPA) is an autosomal recessive inherited disease characterized by an absence of thermal sensation and pain, anhidrosis and intellectual disabilities. The dental problems in cases with CIPA are bite wounds on the tongue, lips, buccal mucosa and finger tips ; osteomyelitis of the upper and lower jaws ; and pathological fracture of the jawbone. In infancy, protective plates are applied to the patient to prevent severe bite wounds, but they are difficult to make and use.

In this study, we report a patient who underwent long-term oral management from infancy to adulthood, and the dentition model measurements at the time of 2 years and 7 months, 5 years and 1 month, and 27 years and 6 months.

1. In infancy, protective plates were used to prevent bite wounds on the tongue and buccal mucosa from 10 months of age for the mandible and from 1 year for the maxilla, to 4 years and 8 months.

2. The use of protective plates from the early stage of eruption of deciduous teeth is an effective method to prevent early tooth extraction and tooth loss before the roots are formed completely, and to prevent bite wounds.

3. In model analysis, there was no evidence of dental arch narrowing in both the upper and lower jaws in the permanent dentition, and the use of protective plates in the deciduous dentition phase had no obvious effect on the permanent dentition.

4. In the permanent dentition, sudden mobility of the maxillary bilateral first and second molars occurred, and the left first and second molars were extracted because they were difficult to preserve. The right first and second molars, with sequestrum, fell out as a single mass which was presumed to be due to osteomyelitis resulting from periodontitis.

Some autistic spectrum disorder (ASD) children have difficulty using a dental chair for their dental treatment. There are many possible treatments in dental check-ups that are possible without a dental chair such as toothbrushing instruction, dietary counseling, oral examination, fluorine coating, silver diamine fluoride treatment, and temporary sealing with dental cements. In our dental office, we perform dental check-ups using a mat designed to transition children to using a dental chair for dental check-ups. In the present study, we investigated the progress of adapting to dental check-ups by 9 years of age. The subjects were 43 ASD children aged 3 to 5 years who could not tolerate toothbrushing instruction and oral examination in the supine position in a dental chair at the first visit to our dental office. At their second visit, eight of these children could receive toothbrushing instruction and oral examination on the mat, whereas none of the children could do so in the supine position in a dental chair. At 6 years of age, 13 children could receive toothbrushing instruction and oral examination on the mat, and five children could do so in the supine position in a dental chair. At 9 years of age, 25 children could receive toothbrushing instruction and oral examination in a dental chair. Thus, some children who struggled with dental check-ups in a dental chair were able to receive dental check-ups on the mat relatively early. Therefore, dental check-ups on the mat are useful until ASD children are ready to have dental check-ups in a dental chair.

General anesthesia performed in Tsurumi University for the disabled has been based on perioperative management during hospitalization for three days, however, three years have passed since the outpatient general anesthesia system was started in December 2018. We conducted a statistical study on the patient background, treatment contents, method of general anesthesia, and complications in cases where outpatient general anesthesia was performed.

There were 73 cases of outpatient general anesthesia, 43 men and 30 women, of whom 39 were children or persons with disabilities. As for the contents of the procedure, wisdom tooth extraction was the most common；only 13 cases were for preservation and prosthetic treatment. The general anesthesia method is mainly inhalation of anesthetic with sevoflurane. No major complications or problems have occurred so far. By using outpatient general anesthesia rather than management during hospitalization for three days, the options for treatment methods of dentistry for the disabled may be expanded.

This paper summarizes and considers the home-visit dental care for a child who has needed constant medical care provided by a local private dental clinic for the past 35 years. The clinic has provided home-visit dental care to a total of 48 children living in Amagasaki City and nearby cities in Hyogo Prefecture. More than half of them lived within a 4 km radius, and even the furthest one was less than 12 km from the clinic. Since 2011, the number of home-visit dental care trips has increased until the end of March 2022. Regarding the patients’ age at the first visit, the majority were 1 year old, followed by 2 and 4 years old in order. The patients suffered from a wide variety of diseases and disorders; of the 27 kinds of diagnoses, the most common was cerebral palsy or hypoxic encephalopathy. Many patients had respiratory and/or nutritional problems and were controlled by, for example, using a ventilator and/or parenteral nutrition, mostly a gastrostoma (PEG). The most common reason for requesting home-visit dental care from their caregiver was for an examination or consultation on the patient’s oral condition, followed by dental calculus removal and swallowing dysfunction in order.

Although many dental clinics provide home-visit dental care for older adults at home, few do so for children who need constant medical care. Amid the declining birthrate in society, the relative number of children requiring intensive and continuous medical care is increasing, so it is necessary to increase the number of dental clinics providing home-visit dental care for such children.

Older people often have multiple diseases and take a large number of medications. Nursing home residents also often have feeding and swallowing difficulties. We provide feeding and swallowing instructions to residents in nursing homes, and so surveyed such instructions in nursing homes.

Between April 2017 and March 2020, 241 people underwent feeding and swallowing evaluation and were enrolled in the study. The participants were divided into a control group (taking 5 or fewer medications) and a polypharmacy group (taking 6 or more medications), and a Chi square test was performed to analyze whether there was a significant difference in the presence of suspected dysphagia between the two groups.

The mean ages were 86.4±6.7 years in the control group and 85.6±5.4 years in the polypharmacy group. Dementia was the most common underlying disease in both groups. Most participants ate a dysphagia diet, and only a few participants ate regular food. Suspicion of dysphagia at all stages was significantly higher in the polypharmacy group than in the control group.

Although many nursing home residents have feeding and swallowing difficulties and are prescribed multiple medications, difficulties in swallowing medications have not been addressed. Based on our results, we believe that nursing home residents have some medication difficulties.

A psychological support program was implemented for parents of school-aged children with special needs who visited the Special Care Dentistry, Osaka University Dental Hospital. This multidisciplinary parent support program was named “Parent Raising Class” and was organized once a month. Eight 120-minute sessions consisting of lectures and philosophical dialogues were conducted.

Four mothers with school-aged children participated in the program. Lectures were held in the first half. The themes of the lectures were set based on the evaluation of the participants’ emotional expressions and the topics that the participants wanted to discuss. Specialists in social welfare, special care dentistry, and pediatric nursing provided parents with information useful for parenting. Philosophy dialogues were held in the second half. The facilitator set the theme based on the contents of the lecture. Each participant talked about their troubles, anxieties, and questions. Participants’ health related QOL and parenting stress varied before and after the program. On the other hand, caries activity and salivary buffer capacity did not change. From the participant questionnaire, there were many positive opinions about the Parent Raising Class, and there were opinions that similar efforts are necessary at special care dentistry in the future.

These findings showed the importance of practicing parent support in special care dentistry, taking advantage of the characteristics that involve parents and children for a long period of time. The provision of psychological support to parents in the field of special care dentistry may improve the living difficulties of parents and indirectly maintain the oral health of persons with special needs. In addition, staff can deepen their understanding of parents’ mental care needs and support system. These findings are significant in reinforcing and improving the quality of special care dentistry.