Down syndrome （DS） often results in immature oral function, and mothers of DS children experience increased parental stress from the weaning period. We quantified and compared the anxiety of mothers of children with DS before and after the start and end of support using the STAI Form JYZ, with the aim of clarifying whether providing support for the development of feeding and swallowing function in children with DS reduces maternal anxiety.

The subjects were 33 mothers of children with DS who had completed support for the development of feeding and swallowing function at the pediatric dental clinic of Osaka Dental University Hospital, with the pre-support group as the positive control group and the post-support group as the intervention group. In addition, 32 mothers of typically developing children were examined as the negative control group, analyzed for state anxiety and trait anxiety, and statistically examined.

The results showed that there were no significant differences between the mothers of healthy children and the mothers of （pre-support） DS children on the total scale scores, but the （post-support） group of mothers of DS children had significantly lower scores on both state and trait anxiety. On the subscales, the （post-support） group of mothers of DS children scored significantly lower than the （pre-support） group on the anxiety-absent scale （A scale） for state anxiety and anxiety-present scale （P scale） for trait anxiety. Furthermore, when comparing the pre- and post-support scores of mothers of DS children classified by age at the child’s first visit, the 0-1 year group （15 mothers） had significantly lower post-support scores on the P scale for state and trait anxiety and the 2-year group （9 mothers） on the A scale for state anxiety, but there were no differences for children aged 3 and over.

These results suggest that initiating support for the development of feeding and swallowing function for DS children by the age of 2 years may reduce trait anxiety in mothers of DS children.

Oral moisturizers are commonly utilized in the management of patients presenting with membranous substances to facilitate their softening and removal. However, conventional oral moisturizers often present challenges in removal procedures and may induce bleeding during the process. To address these limitations, we evaluated the efficacy of hydrogels made from pectin, a natural polysaccharide and hydrocolloid, in removing membranous substances.

This study employed a crossover design involving consenting tube-fed patients allocated into two groups. The protocol was initiated with comprehensive oral examinations to document the presence and morphology of palatal deposits, followed by minimal sample collection for pathological examination. Subsequently, oral mucosal care was administered, with one group receiving palatal mucosal care using the pectin gel while the other group received care with a glycerin-containing moisturizer. Observations and the mucosal care were conducted at predetermined intervals, documenting both the duration required for palatal mucosal care and the incidence of post-care bleeding. Following the completion of the initial phase and a subsequent washout period, the protocol was repeated with reversed group assignments.

Pathological specimens were analyzed to determine membranous substances, with morphological classification into four categories：none, mucous, viscous, and dry substances, based on a visual assessment. Statistical analyses comprised the Mann-Whitney U test for comparing care duration across different morphological types between the two oral care products, while Fisher’s exact test was employed to analyze bleeding incidence rates.

The results demonstrated that the pectin gel group required significantly less time for palatal mucosal care in cases with dry deposits （p＜0.05）. Furthermore, this group exhibited a significantly lower incidence of bleeding episodes （p＝0.039）. These findings suggest that the pectin gel is an effective alternative for the removal of membranous deposits in oral care procedures.

This study was conducted to understand the current situation regarding access to dental care for people with disabilities in Japan, by asking parents with disabled children, “Have you ever looked for a dental clinic that performs oral examinations and dental treatment for people with disabilities?” The results may serve as information to help improve the dental care environment for people with disabilities in the future.

The survey was conducted using Google Forms. The survey was conducted by four national disability organizations, and we also invited relevant local disability organizations to participate in the survey. The survey period was from December 1, 2023 to February 20, 2024. There were a total of 1,080 participants in this study.

It was revealed that 86.3％ of parents with children with disabilities had been unable to immediately find a dentist to undergo an oral examination. Over 70％ of parents with disabled people aged between 10 and 40, were looking for a dental clinic that would examine their children. Both parents of disabled children over 40 years old and parents of disabled children under 10 years old had been looking for dental clinics that would examine their disabled children. This suggests that it may be difficult to know which dental clinics perform oral examinations for disabled children, both now and over 40 years ago. The percentage of people who have searched for a dental clinic for dental treatment was 80.6％, slightly lower than the 86.3％ who have searched for a dental clinic for oral examinations. Specialists certified by the Japan Dental Specialist Board are allowed to advertise themselves, which helps people choose where to visit. We believe that by producing a large number of high-quality specialists in dentistry for people with disabilities, we will be able to meet the needs of parents with children with disabilities.

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

In this study, we investigated the effects of bristle stiffness on cleaning efficiency and critical stroke using a flat model among four kinds of wide flocking toothbrush：bristle stiffness was “hard,” “regular,” “soft,” or “extra soft.”

Cleaning efficiency increased in the order of bristle hardness, with significant differences among toothbrushes （p＜0.05）.

Critical strokes were shorter in the order of bristle hardness. Significant differences were found between “hard” and other toothbrushes and between “regular” and “extra soft” toothbrushes （p＜0.05）. It is suggested that hard toothbrushes are more efficient in cleaning, while soft toothbrushes require longer brushing strokes.

Person with special needs often cannot continue to move their toothbrushes widely, suggesting that bristle stiffness should be considered when selecting a toothbrush.

Introduction：The SCERTS model is an educational model that takes a comprehensive approach to autism spectrum disorder （ASD） with social communication, emotional regulation （consisting of self-regulation and mutual-regulation）, and transactional support. In the present case, we observed an improvement in acceptance of dentistry in a child with ASD as a result of medication adherence management and emotional regulation of dental anxiety. Written consent was obtained from the patient for this report.

Case：A 7-year-old boy, Disability：ASD, Developmental age：4 years, Chief complaint：Treatment of tooth decay, Current condition：10 dental caries, height 120cm, weight 21kg.

Treatment and progress：At the time of the first visit, the patient refused to enter the room, so we conducted an oral examination in the waiting room and planned dental treatment under general anesthesia. After taking the sedative drug midazolam, anesthesia was introduced, and the progress was good. In the post-treatment training, pictures were shown to the patient as a form of self-regulation and he was asked to select what he could do, which was positioned as “what to do today.” Among the pictures that he judged to be unacceptable, the dental hygienist proposed to the patient to try some of them that were considered to be acceptable. Then, a picture that the patient agreed to was positioned as “the next thing to do.” Gradually, acceptance of dentistry improved. One year later, it was possible to extract milk teeth using the ordinary method.

Discussion and Summary：Oral administration of midazolam may be effective for reducing stress as premedication for children with ASD who refuse an injection. The SCERTS model of emotional regulation is a technique using realistic desensitization, and is thought to be useful for children with ASD.

Introduction：Japan is an aging society, and the aging of patients with cerebral palsy （CP） is no exception, as advances in medical technology extend life expectancy. CP complicates routine care and dental treatment due to impaired mobility and posture；however, long-term oral care can reduce the risk of dental caries and periodontal disease while improving quality of life. We report the case of an elderly CP patient who maintained 21 teeth after approximately 42 years of dental care.

Case：The patient was a 94-year-old man with cerebral palsy, certified as requiring nursing care for 5. He first visited our clinic at the age of 52 for treatment of periodontal disease and caries. He received 24-hour support from caregivers, including home-visit treatments, nursing care, and rehabilitation. Upon initial examination, the patient presented with numerous caries requiring treatment and significant occlusal attrition.

Progress：At his initial visit, the patient had 30 remaining teeth. After one year of treatment, the number of remaining teeth was reduced to 23. After the treatment was completed, some teeth were extracted due to periodontal disease, but at the age of 94, he still had 21 teeth. At age 87, we provided thorough instruction on posture and eating habits, as the position of the head was found to affect aspiration, as seen in a swallow angiogram. Since then, aspiration pneumonia has not recurred. Respecting the patient’s wishes, we continued to provide care with an emphasis on oral hygiene, feeding, and swallowing function.

Conclusion：We have approximately 42 years of experience in the oral management of patients with CP. As dentists who work in the community where their patients live, we sought to maintain a safe practice and oral environment. Consequently, many teeth were maintained. This case is an example of comprehensive community care in which dental professionals, family members and caregivers, and medical professionals were all involved.

We report our experience in the general anesthesia and perioperative management of patients with intellectual disabilities （IDs） and cyanotic congenital heart disease （CCHD） for dental treatments, and discuss the indications and management of these patients in dental facilities.

Case 1：An 8-year-old ID male with Fontan circulation was scheduled for general anesthesia. The mean pulmonary artery pressure （PAP） was 11mmHg and the mean upper and lower vena cava pressure was 11mmHg. Anesthesia was slowly introduced with midazolam and sevoflurane with fentanyl, and was maintained with sevoflurane. Initially, artificial respiration was performed in a pressure-controlled ventilation （PCV） mode with 6l/min of oxygen and 1％ sevoflurane, resulting in a percutaneous oxygen saturation （SpO₂） of 97％ and a partial pressure of end-tidal carbon dioxide （etCO₂） of 50mmHg. After the ventilation volume was increased, pulmonary blood flow decreased by an increased intrathoracic pressure, resulting in a decrease in SpO₂ of 88％. Then, when assisted ventilation was employed, SpO₂ （92-96％） and etCO₂ （37-44mmHg） were maintained under 35％ oxygen.

Case 2：A 25-year-old female with ID and Fontan circulation was scheduled for general anesthesia. The mean PAP was stable at 11mmHg and pulmonary vascular resistance was in the normal range （1.48 units/m²）. The awake intubation was performed with midazolam and fentanyl, and anesthesia was maintained with sevoflurane. Initially, artificial respiration was performed by PCV with 6l/min of oxygen and 1％ sevoflurane, resulting in a SpO₂ of 87％. After the ventilation volume was lowered, the SpO₂ was 95％ and the etCO₂ was 75mmHg. Then, when assisted ventilation was used, SpO₂ （95-100％） and etCO₂ （35-43mmHg） were maintained under 35％ oxygen.

Case 3：A 17-year-old male with Down syndrome who had a history of intracardiac repair for tetralogy of Fallot was scheduled for general anesthesia. Due to the high right ventricular （RV） pressure caused by pulmonary valve stenosis, general anesthesia was scheduled after the RV pressure was improved by pulmonary valve replacement. Anesthesia was slowly induced with midazolam and sevoflurane with remifentanil, and maintained using sevoflurane and remifentanil uneventfully.

When preoperative evaluation and management are performed in patients with ID after repair of CCHD, it is important to evaluate whether pulmonary hypertension is absent, pulmonary blood flow （pulmonary/systemic blood flow balance） is stable, and heart failure is mild. In anesthesia management, oxygenation can be controlled through assisted ventilation.

CHARGE syndrome is a syndrome of multiple malformations caused by gene mutations, and is often associated with functional disorders such as feeding problems and swallowing disorders, as well as anorexia and sensory deviations around the mouth, which make oral intake insufficient. We report two cases in which patients showed no anorexia or sensory deviations from infancy, and were able to wean themselves off artificial nutrition and start oral intake.

The cases were an 11-month-old boy （Case 1） and a 1-year-old girl （Case 2） at the first visit. They were referred to the feeding clinic with the main complaint of not progressing to weaning food. Immediately after birth, they showed feeding difficulty and received formula milk through a nasogastric tube. However, their refusal to drink bottles and anorexia improved quickly and the gastric tube was removed within 3 months of birth. Based on their feeding function at the first visit, Case 1 was diagnosed as having acquired swallowing function and Case 2 was diagnosed as having acquired lip-closing function. Neither child refused to eat using utensils or weaning food and they were able to drink formula milk from a bottle. Therefore, we provided their guardians with instructions on how to assist with the spoon and on the contents of the food, and decided to progress with the weaning food stage in line with the development of feeding function.

In Case 1, feeding function development was relatively smooth, with grinding and self-feeding functions being acquired by the age of 2 years. As a result, he was able to eat regular food at 2 years and 6 months of age. In Case 2, lateral movement of the mandible was observed in the second year of age, however, bolus formation and transport function were insufficient. In both cases, oral intake was continued without the use of alternative nutrition, but because acceptance of oral intake and development of feeding function differ between cases, continued multidisciplinary support is considered to be necessary.

Children with trisomy 13 often have severe complications and difficulty with oral intake. We report a case in which oral sensory acceptance was good and oral intake was improved through feeding function therapy.

The patient was a 1-year-1-month-old girl who was referred to our department by a nearby dental clinic with the main complaints of poor progress in weaning and the need for a Hotz plate for cleft lip and palate surgery. She had a cleft lip and palate （CLP） and ventricular septal defect, and gross motor function was undetermined. She was fed infant formula using a feeding bottle for cleft lip and palate, and was eating early weaning food. Her baby teeth had not yet erupted, there was no hypersensitivity in the mouth, and oral sensory acceptance was good. She also accepted the Hotz plate well. When eating weaning food, tongue protrusion was observed, and food transport was difficult. We diagnosed her with adult swallowing failure, and the treatment plan was to continue infant formula and early weaning food and increase the amount of weaning food per meal. At 1 year and 10 months of age, the patient underwent surgery for lip reconstruction, soft palate reconstruction, and lingual frenectomy. The use of a Hotz plate was discontinued. At the age of 2 years, fluid intake training was instructed using jaw support. At the age of 3 years, the amount of baby food intake increased. Although acquisition of adult swallowing was insufficient, weak crushing and grinding movements were observed.

From the first consultation, oral sensory acceptance was good, and dental intervention improved feeding and swallowing function, such as maintaining oral intake and increasing the intake of baby food. In diseases in which progress of oral intake is difficult, earlier dental intervention may be able to promote oral sensory acceptance and improve feeding and swallowing function.

Systemic amyloidosis is a refractory disease characterized by the abnormal deposition of amyloid substances, composed mainly of unique fibrous proteins with a β-structure, in the extracellular spaces of various organs throughout the body, causing functional impairment. The patient was a 79-year-old male. His chief complaint was dysphagia. Due to the enlargement of tongue and poor tongue mobility, he was referred to our department and visited us. He was 169.2cm tall, weighed 49.9kg, and had poor nutritional status with TP at 6.2g/dl and albumin at 3.4g/dl. A tongue biopsy revealed eosinophilic fibrous material in the subepithelial connective tissue of the tongue, and immunostaining confirmed a diagnosis of amyloidosis. Therefore, a full-body examination was conducted. The full-body examination revealed carpal tunnel syndrome as a neurological symptom, and amyloid deposits were also found in bone marrow tissue and a skin biopsy, leading to a diagnosis of systemic amyloidosis. Due to the progressive and refractory nature of the disease, a dramatic improvement was not expected, but our department aimed to do its best to enhance the patient’s QOL as much as possible. Indirect training, such as oral care, articulation training, lip and cheek massage, and exercises to strengthen the tongue muscle, led to improved swallowing function, allowing the patient to enjoy consuming food orally. Additionally, professional oral care by a dental hygienist was frequently performed to prevent aspiration pneumonia. However, due to the restricted range of motion of the tongue and poor hyoid bone movement, despite all possible interventions, the patient’s overall condition deteriorated, and he passed away nine months after diagnosis. In cases presenting with non-neoplastic macroglossia, tongue movement disorders, and dysphagia, it is necessary to consider amyloidosis as a differential diagnosis.

Introduction：In Japan, reports of oral health management in residential disability support facilities without routine dental interventions are limited. It is essential to understand the oral conditions of residents in such facilities. This cross-sectional study investigated the relationship between oral health management and duration of stay in a residential disability support facility in Sapporo city.

Materials and Methods：This study included 27 residents of a residential disability support facility, which was established in 1993, in Sapporo city. Demographic and clinical data were collected from July 2023 to December 2024. The facility had not previously received routine dental interventions from specific dental clinics. Participants were classified into two groups based on duration of stay：≥11 years and ≤10 years. Key variables included the number of remaining teeth, periodontal status, and the time since the last dental attendance.

Results：Eleven residents （41％） were male, and their median age was 71 ［61-73］ years old. The median duration of stay was 30 ［29-30］ years, with a median age at admission of 44 ［39-56］ years old. The median number of remaining teeth was 20 ［14-24］, and 15 residents （56％） had severe periodontitis. The median time since the last dental attendance was 28 ［5-29］ years. Residents in the longer-stay group （≥11 years） had fewer remaining teeth （17 ［9-21］ vs. 25 ［24-29］, p＜0.01）, were older （71 ［68-75］ vs. 56 ［46-73］ years old, p＝0.03）, and had a longer duration since their last dental attendance （28 ［18-29］ vs. 4 ［3-5］ years, p＜0.01） than those in the shorter-stay group （≤10 years）.

Discussion：These findings suggest that the longer the duration of stay, the more insufficient oral health management tends to be. The study underscores the importance of strengthening social support systems and introducing appropriate dental interventions in residential disability support facilities to improve oral health management.

The aim of this study was to establish a home medical care system that aligns with the background lives of patients with children （adults） requiring medical care and children （adults） with severe motor and intellectual disabilities （SMID）, and their families.

The subjects were 58 patients （mean age 9.03±11.02 years） with children （adults） requiring medical care, and SMID who received home dental care provided by the Yokohama City Center for Oral Health of Persons with Disabilities from September 2018 to March 2024.

We investigated basic information, presence and type of requiring medical care, types of health care and nursing care services, medical consultation status, dental consultation details and dental consultation history, and outcome items by extracting information from the patients’ medical records. We then analyzed the characteristics of the patients and trends.

The age range of the patients was mainly infants and children. The most common patient diseases were central nervous system diseases and peripheral nerve diseases. Forty-six （79.3％） were children （adults） requiring medical care and 12 （20.7％） were SMID children （adults）. In terms of daytime activities, 60％ of patients attended school or daycare. Most patients also received medical and nursing care services. Based on our findings, the age distribution of patients suggests that there may be latent need for dental examinations among patients aged above 15, and it was considered necessary to collaborate with physicians and dentists at hospitals in secondary and tertiary medical care to identify these needs and to recommend dental examinations to these patients. As children requiring medical care transition to the community, it is important to collaborate with local dentists to enable smooth consultation in accordance with the lifestyles of patients and their families. In the future, it will be essential to establish an integrated system of cooperation from the general practitioner or family dentist to secondary and tertiary medical care.