S p e c Care Dentist 24(3): 132-17 6 , 2004
Editor’s Note: Missing numbers are intentionally omitted.
A method to control the reflex postural
movements of patients with cerebral palsy to
aid dental treatment.
“S.M.H.C.A.AGUIAR (School of Dentistry of Arqatuba -
UNESP - Universidade Estadual Paulista, Sao Paulo, Brazil)
There is an increasing demand in our dental school to treat patients
with cerebral palsy Because these patients cannot control some of their
reflexes (asymmetrical cervical tonic reflex, labyrinthine tonic reflex
and symmetrical cervical tonic reflex), their movements may interfere
with their dental treatment. We have developed some techniques that
will help the patient comfortably receive dental treatment without initi-
ating involuntary movements, which include inclining the dental chair
at a maximum 45-degree angle. This presentation will discuss cerebral
palsy, and by demonstrating specific techniques, which inhibit involun-
tary movements of the head, shoulders, knees and hips of patients with
cerebral palsy, we will show that these patients can receive dental treat-
ment.
An investigation of variations in oral health
problems by age in a population-based sam-
ple of Canadians with Down syndrome.
“PJ. ALLISON’ and H.P LAWRENCE2(’Faculty of Dentistry,
McGill University and ’Faculty of Dentistry, University of
Toront 0)
The study’s objective was to investigate oral health problems experi-
enced by people with Down Syndrome (DS) aged three and older. A
cross-sectional survey study design was used. A proxy measure of oral
health problems in people with DS was distributed to members of the
Canadian Down Syndrome Society. The questionnaire contained 20
items in four domains: communication, eating, oral parafunction and
oral symptoms. The possible range for each domain was 0-10, with
higher scores indicating greater problems. Subjects (parents of persons
with DS) completed the questionnaire twice: for their child with DS and
for the sibling closest in age without DS. Returned questionnaires
included 1219 people with DS and 950 siblings. Domain scores for age
categories 4-6, 7-12, 13-18 and > 18 years were generated for both cate-
gories. These scores were then compared for the group with DS and
their siblings using ANOVA. In the group with DS, the mean communi-
cation scores decreased from 4.5-1.8 with age; the mean eating scores
ranged from 4.8-4.0; the oral parafunction scores decreased from 4.8-
3.9 with age; and the oral symptoms scores increased from 1.8-3.0 with
age. In the sibling group the mean communication scores ranged from
0.3-0.5; the mean eating scores ranged from 0.3-0.6; the mean oral
parafunction scores decreased from 1.3-0.8 with age; and the oral symp-
toms scores ranged from 1.1-1.4. The domain scores differed signifi-
cantly with age between the DS and sibling groups (p<O.OOl). We con-
cluded that patterns of oral functional, parafunctional and symptomo-
logical problems in people with DS with increasing age differ by domain
and also differ from those of siblings without DS.
132 S p e c Care Dentist 2 4 ( 3 ) 2004
7
The patient with HIV and Osseointegrated
Dental Implants: A Review and Case Reports.
“AX. ARRIBAS and K. SHETTY (Louisiana State University
Health Sciences Center, New Orleans, USA)
The association between human immunodeficiency virus (HIV) infec-
tion and the success of osseointegrated dental implants is unknown.
Many questions have been raised about the feasibility and cost-effective-
ness of using dental implants in patients who are HIV positive. This
study investigated the success of osseointegrated dental implants in a
group of HIV positive and HIV negative individuals. The study popula-
tion consisted of 10 adult patients, seven male and three female (four
Caucasian and six African American). Four were HIV positive (study
group) and six were HIV negative (control group) with a mean age of
46 years (38-55 years). The mean CD4 count in the HIV group was 365
cells/mm3. Treatment planning, surgical placement, assessment of heal-
ing and osseointegration were conducted using a standardized protocol.
(Calcitek spline 3.75 mm implants were used for all patients.) Subjects
were evaluated six months after placement of implants. The outcome of
implant therapy success was measured by lack of pain, mobility, health
of the surrounding soft tissue and peri-implant radiolucency. When
short-term success was compared between the test and control group,
there was no difference in the rate of post-operative complications or
osseointegration of the implants. The results of the study showed that
implant surgery may be successfully carried out in patients with HIV
infection.
aCharacteristic oral and facial features in
patients with aspartylglucosaminuria.
“I! ARVIO‘, K. HURMERINTA’, M. ARVI03, S. PIRINEN’
(‘Lammi-Tuulos Health Care Centre, Lammi, Finland, ‘Institute
of Dentistry, University of Helsinki, Finland, and ’Piiujarvi
Centre, Lammi, Finland)
Aspartylglucosaminuria (AGU) is a recessively inherited lysosomal stor-
age disorder caused by a deficiency of aspartylglucosaminidase (AGA);
the main symptom is progressive mental retardation. Although the syn-
drome is clinically defined with distinct facial features, the cephalomet-
ric assessment of structural variation had not been evaluated before.
This study’s objective was to find out whether radiographic facial fea-
tures exist that are characteristic to AGU. A computer-based digital
examination from lateral cephalometric radiographs of 47 AGU patients
and 47 age- and sex-matched healthy controls was carried out. We per-
formed 28 linear and 12 angular measurements to describe the craniofa-
cia1 characteristics. Compared to control patients, a patient with AGU
had a higher lower face (p=0.008) as well as a more prognathic upper
and lower jaw (SNA and SNB, p<O.OOl). The tongue was larger
(p=0.002), the nose shorter (p<O.OOl), the upper incisors more pro-
truded (p<O.OOl), and the mandible was longer (p<O.OOl). Both the
frontal and sphenoidal sinuses were smaller than the controls
(p<O.OOl). We concluded that patients with AGU have characteristic
oral and facial structures. The large and prominent tongue may relate to
the prominence and length of the jaw and to the protrusion of the
upper incisors.
Abstracts

9 11
Oral problems in persons with physical hand-
icaps who have had cerebral vascular acci-
dents (strokes).
*V ATAM and H. RAM (King George’s Medical College,
Lucknow, Uttar Pradesh, India)
In developing countries, oral health in young persons who have suf-
fered from cerebrovascular accidents (stroke) is a major concern
because of high treatment costs. A lack of resources and care for the
patient may complicate the outcome of stroke and aggravate dental
problems, presumably because of improper care, poor diet and psycho-
logical factors. This study included 37 non-diabetic stroke patients,
aged 35-45 years, with nearly complete hemiparesishemiplegia (power
grade <3,upper limb) and 35 agdsex-matched controls. A dental exam-
ination was done during admission to the study during the first month
and at six months. Out of 37 stroke patients, 22 had hemorrhagic, 12
had thrombotic and 3 had embolic stroke. Twenty-six of the patients
had right-sided hemiparesis while 11 had left-sided hemiparesis. The
initial dental evaluation revealed that 6 patients had gingivitis and/or
periodontitis. During the first month follow-up of 30 patients (7 were
lost), 22 patients had gingivitis and/or periodontitis, 6 had oral candidi-
asis, and 4 had oral ulcers. Ten patients suffered from bilateral pneu-
monitis and 2 had right lower lobe pneumonitis within four weeks of
their stroke. These findings were significantly higher than for the con-
trol group. During the six-month follow-up of 26 patients (11 were
lost), 16 patients had gingivitis and/or periodontitis, 18 had increased
plaque and 4 had calculus, which was significantly higher than the con-
trol group. We concluded that oral problems were more common in
stroke patients than in the control group and persons with handicaps
cannot care for their oral health due to paralysis or rinse their mouth
because of facial muscular weakness. They lack resources, have poor
diets (vitamin deficiency), and have insufficient fluoridation. Poor oral
hygiene may aggravate gingival and periodontal problems and precipi-
tate lung infections, which may increase the mortality and morbidity in
stroke patients.
10
Ten years experience with dental mplants in
patients with disabilities.
*C. BACCI, E. VALESI-PENSO, L. GIROTTO, E. MARCHES, M.
GIROTTO (St. Lorenzo Hospital, Borgo Valsugana, Italy)
There are many ‘simplified protocols in the literature for people with
physical and/or psychological handicaps. Because dental implant proce-
dures are considered very challenging, people with disabilities generally
do not receive this oral rehabilitation. This presentation will report on
our review study of ten years of dental implant experience in patients
with disabilities. We will discuss the rate of implant success and suggest
special care in surgical and prosthetic procedures that are carried out
with general anesthesia, sedation or only local analgesia. This presenta-
tion will illustrate our belief that patients with physical and/or psycho-
logical disabilities can receive dental implants.
Abstracts
ABSTRACTS
Facial fractures and jaw c y s t s in patients
with disabilities.
*A.M. BAIETTI, N. CORNACCHIA, R. COCCHI (Maggiore
Hospital, Bologna, Italy)
The goal of this study was to clinically analyze traumatic fractures and detect
jaw cysts in a group of patients with disabilities,with a particular focus on treat-
ments needed for these special patients. The types of fractures in both were eval-
uated as well as the surgical treatment needed. Also noted was previous dental
treatment that was not well-performed and previous traumatic injuries to the
teeth. From 1997 to 2003, out of 164 facial traumatic injuries observed, 18
(10.9%)were affected by facial fractures and in particular, 12 involved the
mandible, 5 the zygomatic bone, 1 the orbit, and 1 the maxilla. These fractures
were attributed mostly to epileptic seizures not adequately controlled by medica-
tion or to lack of physical coordination. Out of 1256 patients, jaw cysts were
present in 32 cases (2.5%);these were difficult to diagnose because of little or no
clinical evidence. Inflammatorycystswere the most common clinical feature fol-
lowed by follicular cysts.The results of the study showed that patients with dis-
abilitiesare at high risk of traumatic injuries, in particular, facial. A good seizure
medication can greatly help prevent trauma. In the case of jaw cysts, a clinical
and radiological check up is important so an early diagnosis of cysts can be
made before there is an increase in bone loss. This presentation will give a clini-
cal analysis of facial trauma and jaw cysts in patients with disabilities;it will out-
line the risk of facial trauma in these patients and point out jaw cysts with par-
ticular reference to previously performed dental treatment. Based on the study’s
results, the presentation will give suggestionsfor treatment.
12
Clinical evaluation of oral pathologies in
young patients affected by insulin-dependent
diabetes: a 5-year screening.
*A.M. BAIETTI and N. CORNACCHIA (Department of Oral
Surgery, Maggiore Hospital, Bologna, Italy)
The goal of this study was to evaluate the oral pathologiesof a group of patients
with insulin-dependentdiabetes. Seventy-two patients aged 7-22 (38 male and
34 female) were examined and compared with a control group that was similar
in age. The patients were observed for a five-year period (1998-2003).A proto-
col was used to detect the most common pathologiesin patients with insulin-
dependent diabetes mellitus (IDDM). Each patient’s periodontal condition was
evaluated (plaque index, gingival index and pocket depth probing). The caries
rate was assessed by the DMFT index and compared to the control group. Other
medical parameters, such as metabolic control, duration of diabetes and therapy,
were analyzed and correlated to the periodontal findings.The study results
found that the DMFT index of the diabetic patients’group did not show any sig-
nificant difference compared to the control group. After the 6-month follow-up,
lower values of periodontal parameters were found and at the 12-month check
up, the values were significantly lower (p<0.05),demonstrating the efficacy of a
plaque control program. At the 24-month check up, periodontal values were not
significantly different to those at 12 months, demonstrating a good stable condi-
tion of the periodontal tissue. The periodontal values were statistically higher in
patients with poor metabolic control. The results of this study underline the
contributingrole of a plaque control program in preventing periodontal disease
and the importance of having good metabolic control in young patients with
IDDM. Early detection of oral pathologies will help minimize the need for
extensive dental treatment.
S p e c Care Dentist 24(3) 2004 133
ABSTRACTS
Maxillo-mandibular relations in children with
speech and hearing impairment.
*S. BHARADWA] (Bangalore Institute of Dental Sciences,
Hospital and Postgraduate Research Center, Bangalore, India)
The purpose of this study was to evaluate the dento-alveolar develop-
ment in children with speech and hearing impairment, compare this
development with normally developing children of similar ages and
determine treatment needs. The dento-alveolar development in 50 boys,
aged 6-10, with speech and hearing impairment was examined. The
boys were compared with normal children of the same age, using
dento-alveolar analysis, to determine the treatment needs for the devel-
oping malocclusion in children with speech and hearing impairment.
Study results indicated that the maxillary arch showed significantly
lower arch length, arch width and arch perimeter, while the mandibular
arch showed significantly lower arch width and arch perimeter. The
children with speech and hearing impairment showed a disturbed
dento-alveolar development, which would require an early treatment
intervention by interceptive guidance to occlusion based on the devel-
oping malocclusion. A function, which may be either tension or com-
pression, is the real stimulus for bone formation and growth. Children
with speech and hearing impairment may have decreased glossal and
circumoral muscle function because of a deficiency in one of the tongue
functions, i.e. speech, which may affect the dento-alveolar develop-
ment.
Interdisciplinary action in treating patients
with special needs who have mouth breathing
syndrome.
*S.B.O. BOACNIN,' S.E. DUAILIBI,'.3].A.U. SOUZA,l,zM.7.
DUAILIB11-3.('Universidade Camilo Castelo Branco,
'Universidade de Sdo Paulo, 'Universidade Federal de Sao Paulo,
Brazil)
This study reported the interdisciplinary action in a school clinic
between odontology and speech therapy when treating 20 patients with
special needs who had mouth breathing syndrome. Patients with mouth
breathing syndrome and several genetic syndromes from the Special
Need Patients Department, Unicastelo University, were assessed by the
interdisciplinary team. They were rehabilitated by applying functional
orthopedic appliances to the jaw and given oral-motor therapy exercis-
es. Most patients began nasal breathing after orthopedic treatment and
speech therapy with labial sealing being observed as a result. The
patients reached a balance (equilibrium) of the stomatognatic system.
Study results showed that odontological treatment and speech therapy,
combined with the rehabilitation of the jaw skeletal relationships of
these patients, were beneficial to treatment and consequently to the
patient. Results were reached sooner, which helped the school clinic
more efficiently meet the demand of patients.
134 Spec C a r e Dentist 24(3) 2004
15
Speech therapy and functional orthodontic
treatment of the jaw bone: interdisciplinary
care in treating a patient with mild cerebral
palsy - a case history.
*S.B.O. BOACNIN', S.E. DUAILIBI,'-', M.EP SANTOS', M.7.
DUAILIBI'.' Universidade Camilo Castelo Branco, 'Universidade
Federal de Sao Paulo, Brazil)
The objective of this paper was to report an important interdisciplinary
care plan used to treat a young patient with mild cerebral palsy, who
had orthodontic treatment in the Special Need Patients Department of
Unicastelo University. Functional orthopedic appliances were used
together with oral-motor therapy The patient was assessed using an
interdisciplinary approach and underwent rehabilitation utilizing func-
tional orthopedic appliances together with oral-motor therapy exercises.
The patient used the orthopedic appliances and did oral-motor therapy
exercises for 3 years and was able to develop a normal occlusion with a
balanced facial musculature and good speech articulation. An evalua-
tion of the results showed that the association of odontological treat-
ment and oral-motor therapy optimized the treatment and benefited the
bio-psycho-social life of this patient.
17
Differences in treatment carried out amongst
different groups of patients attending the
same unit.
*N. CAMPBELL (School 0fDentistr-y and Belfast City Hospital,
Belfast, United Kingdom)
The study measured differences in treatment carried out among a group
of people with learning disabilities. For two sessions per week, the Day
Procedure Unit at the Belfast School of Dentistry cares for patients with
learning disabilities and other patients, many who have been referred
for behavior management problems. These patients have been referred
for routine dental treatment with the help of intra-venous sedation or
general anesthesia. Appropriate records were collected and studied on
the day of treatment. Of 497 patients who had been treated in the unit
since 1996, 254 had a learning disability and 243 did not; 1477 extrac-
tions were completed, 13 of which required surgery There were 1811
restorations, 57 root fillings and 33 crowns completed. In the learning
disability group, the average number of completed extractions was 3.4
and the average number of restorations was 2.2. This compared with
2.5 extractions and 4.75 fillings for the other group. In the group with
learning disabilities, 39 patients had conservative treatment only, 88
had extractions only and 127 had a mixture of restorations and extrac-
tions. In the other group, 79 patients had conservative treatment only,
54 had extractions only and 109 had both restorations and extractions.
We found a clear disparity in treatment patterns between the two
groups. An evaluation of the results suggest that dentists who work in
special care dentistry should have oral surgery and restorative skills.
Specialists are needed because people with learning disabilities are more
likely to have teeth extracted and less likely to have teeth filled with the
help of sedation or general anesthesia than other groups of patients
who are also referred for dental treatment.
Abstracts

Two brothers with mental retardation, short
stature, hearing loss and dental anomalies: a new
syndrome of autosomal recessive inheritance?
*RG.E.C.CAINELS', G.R MORTIER', PJ. DE COSTER', L.C.M.MARTENS'
('Ghent University Hospital, PaeCaMeD Research, Ghent, Belgium, 'Dept. of
Medical Genetics)
The objective was to report the dental anomalies in two Turkish brothers with mental
retardation,proportionate short stature and sensorineuralhearing loss. Clinical and
radiographic dental examinationswere carried out. The parents were of Turkish origin
and First cousins. Both siblingshad mild mental retardation with a normal inale hry
otype in blood lymphocytes. Extensive metabolic work-up did not reveal any abnor-
malities and the MRI brain scan was normal. The two brothers also suffered from sen-
sorineural heanng loss. They were proportionatelyshort and radiographs showed
skeletal osteoporosis,mild platyspondyly and cone-shapedepiphyses (CSE) in the
hands. Dental evaluation of both boys revealed an amber discolorationwith severe
attrition, affecting both primary and permanent dentitions. An evaluation of the radi-
ographs showed bulbous crowns and straight long MXOW roots with progressive
obliteration.Eoth children at different ages showed similar features of odontoplasia
with signs of dentinogenesis imperfecta. During the previous 12 years of dental man-
agement of both boys the vertical dimension of occlusion was preserved by protecting
the posterior teeth from attrition using stainless steel crowns. For cosmetic reasons,
the anterior teeth were built up with composite resin. To our knowledge, the associa-
tion of all of these symptoms has not been reported before and may represent a new
syndrome. Because the parents are first cousins, this condition may have autosomal
recessive inheritance.Based on the type of anomalies, a structural defect of the con-
nective tissue is likely. Additional histologcal studies on the extracted abnormal teeth
of one of the boys will provide better insights into the pathogenesis of this disorder
Additional cases will confirm and more precisely delineate this syndrome.
19
Clinical evaluation of the plaque removing
ability of three different toothbrushes in
children with mental handicaps.
*ML. DOGAN', A. ALACAM', N. ASICP, M. ODABAS', G. SEYDAOGLUZ
(Schools of 'Dentistry and 'Medicine, University of Cukurova, Adana,
Turkey. 'School of Dentistry, University of Gad, Ankara, Turkey)
The study evaluated the efficacy of plaque removal of three different toothbrushes in
children with mental handicaps in two different age groups. A special toothbrush with
a triple head (SuperBrush/Dento-0-Care) was compared with a new manual tooth-
brush (Cross-ActiodOralB) and an electric toothbrush (Braun 3-D/OralB).Fifteen
children, aged 6-12 (Group A) and 15 children, aged 13-18 (Group B), with mental
handicaps participated in the single blind clinical study. To obtain a plaque-free condi-
tion at baseline, professional tooth cleaning was performed for each participant. After
instructions about using the toothbrushes, each group started the experiment with
electric toothbrushes. After one week of application,the Quigley-Hein plaque index
and the approximal plaque index were used to assess the oral hygiene status of each
participant. This was followed by a week of recess before each group switched to the
next type of toothbrush. The study lasted 5 weeks. In the 6-12 age group using the
Braun 3-D and SuperBrush, children did not have significantly different plaque scores
for any surfaces. Cross-Action resulted in the highest plaque scores in both groups
(P<0.001).In the 13-18age group, the use of the Braun 3-D and SuperBrush brush
were similar in the maxilla with regard to plaque removal, but had &Rerent results in
the mandible and in the buccal anterior and posterior surfaces. In addition, there were
no significant differences between the age groups. The study indicated that electric
toothbrushes remain the mot effective toothbrush for children with mental handicaps
whereas the SuperBrush could be a good alternative.
Abstracts
ABSTRACTS
20
The oral health status of street youth in
Adana, Turkey.
M.C. DOGAN', 'M.C. HAYTAC', 0. OZALI' (Schools of
'Dentistry and 'Medicine, University of Cukurova, Adana,
Turkey.)
The aim of this study was to compare the oral health status of a group
of street youth with urban children and evaluate the findings with cer-
tain socio-economic data. Forty male children, aged 5-15, from each
group, were clinically examined for malocclusion, periodontal status
(Community Periodontal Index of Treatment Needs - CPITN), and the
presence of (TMJ) disorders. Demographic data, which included educa-
tion and the professional level of parents, the educational level of chil-
dren, tooth brushing frequency, previous visits to the dentist, nutrition
type, and substance abuse (inhalation of solvents), were also recorded.
The results showed that the urban children had significantly higher
dmft and DMFT scores, which were mainly related to nutrition type.
On the other hand, the street youth had significantly higher CPITN
scores, which were correlated with inadequate oral hygiene and level of
education. Gingivitis around the anterior teeth was most commonly
found among street youth; this was presumably due to substance abuse.
The prevalence of malocclusion and TMJ disorders was also higher in
the street youth. In conclusion, street youth are more commonly faced
with oral health problems. Their special dental needs must be addressed
and supplemental health services and programs must be implemented
for this population.
21
A controlled survey of difficulty encountered
during routine hygiene and health care by
persons attending a Special Care dental clinic.
*I? COLLADO', M.N. MAZILLE', A.HERMAN', D. FAULKS', M.
HENNEQUlN'.' ('Dental Faculty of Clermont-Ferrand, France,
'University Hospital of Clermont-Ferrand, France)
The study evaluated the prevalence of difficulty with routine hygiene
and health care for persons attending a Special Care dental clinic com-
pared to control subjects. Data were gathered from 98 patients (mean
age 18 SD f 10.9 years) attending the clinic and 27 control subjects
(mean age 17.3 SD f 10.6 years) using a 19-item questionnaire. When
persons with disability could not complete the questionnaire them-
selves, parents or caregivers were solicited to reply. The patients were
divided into three groups: children under 5 years of age (n=10, mean
age 4.3 k 1.8 years), persons with disability (n=75, mean age 20.3 +
10.6 years) and dental phobics (n=13, mean age 20.4 * 8.6 years).
Patients were significantly (95% CI) more likely to report difficulty in
performing the following functions compared to controls: cleaning
teeth (Odds Ratio: 15.3), cleaning ears (OR 7.6), dental treatment (OR:
5.5), ear examination (OR: 3.8), dental examination (OR: 3.11, a blood
test (OR: 2 . 6 ) and swallowing a tablet (OR: 2.1). Difficulties encoun-
tered in accepting routine hygiene and health care could be used to
indicate the need for Special Care facilities for outpatient treatment.
This type of questionnaire, adapted for age, might be used as the basis
for defining the population in need of Special Care, in relation to the
activities domain of the International Classification of Functioning
(WHO).
S p e c Care Dentist 24(3) 2004 135
ABSTRACTS
The development of a home hygiene program
for persons w i t h developmental disabilities.
*B. COYLE', D. OLSON', W LARSON', M. HELGESON',J. CER-
NOHAUS' ('Mount Olivet Rolling Acres, Victoria, MN, USA,
'Apple Tree Dental, Minneapolis, USA)
Sixty persons were screened using a measurement-gathering tool devel-
oped for the project. Based on the screening results, 32 persons met the
inclusion criteria. Sixty-eight dental visits were conducted in their
homes as an alternative to the traditional dental office setting. The pro-
gram's effectiveness was measured by client outcomes, including servic-
es performed (complete visual exam, flossing, prophylaxis including
scaling and polishing), client behavior (fully, partially or non-coopera-
tive), and staff comments. Results showed outcomes were achieved and
staff comments were overwhelmingly favorable. An increase in all areas
of performed services was seen in the in-home visits compared to the
previous in-office visits. Behavior differed significantly from the in-
office visit compared to the in-home visit. The number of clients who
were listed as non-cooperative in the office setting (69%) was reduced
to 4% during the first in-home visit. Staff noted a dramatic change in
behavior, which allowed some dental procedures to be completed that
were never performed before. The study concluded that a home hygiene
program developed to provide preventive dental services to 32 children
and adult persons with developmental disabilities increased the quality
and number of services performed as well as improved client behavior
and cooperation. This presentation will focus on increasing dental
access and improving dental health for children and adult persons with
disabilities by providing in-home dental services. It will provide a
screening process, an individual dental care plan format, suggested
strategies for improving cooperation, and a data collection method for
evaluating effectiveness.
Special Care dental s e r v i c e s in Las Vegas.
*P CRADDOCK (Nevada Dental Association)
Las Vegas is one of the fastest growing cities in the United States.
Fourteen years ago there were no services available for the most diffi-
cult to treat of the population with special needs. To serve this popula-
tion, the community must be informed that such services are available,
medicavdental teams must be created to treat these patients, and both
the dental community and the dental educational community must be
educated about the need to train individuals who can offer services to
this segment of the population. Dentists who limit their practices to
Special Care patients, exposing dental assisting and hygiene students to
hospital dental care, offering referral sources for team dental care, and
requesting that Special Needs training and exposure to treating special
patients be part of our new dental school's curriculum, is an important
part of the process. Providing care for the invisible segment of the pop-
ulation, in a very healthy economy, has been a struggle. Most dentists in
the community provide cosmetic services and market their practices
with free bleaching trays. Educating the dental community and the pub-
lic has been a slow process but now the community has services, refer-
ral sources and an educational component.
136 Spec Care Dentist 24(3) 2004
24
Oral health and treatment needs of heritable
connective tissue disorders (HC TD) .
*PJ.A. DE COSTER', L.C.M. MARTENS', A. DE PAEPE'
('PaeCaMed Research, Ghent University, Ghent, Belgium, 'Centre
for Medical Genetics, Ghent University Hospital, Ghent, Belgium)
Different aspects of oral health are at risk in persons with heritable connective
tissue disorders (HCTD). Monogenic mutations in COLl, COL3 and COL5
may produce multi-system disorders with a variable phenotype. COLl muta-
tions may alter cranial bone structure, dentin, periodontal tissues and the liga-
ments of the TMJ. Many different COLl mutations have resulted in a wide
variety of clinical manifestations,such as vascular changes in soft tissue, thus
predisposing a person with HCTD to periodontal pathologies. How COL5
mutations affect oral health remains uncertain, although recent clinical data
suggest structural alterations in mucosa and dentin. FBNl or FBN2 mutations
may result in skeletal overgrowth, TMJ hypermobility and structural alter-
ations of vascular walls. Although treatment depends on the disorder's molec-
ular basis, clinical expression of oral features varies greatly Precautions must
be taken with asepsis, anesthesia and invasive surgery This presentation will
provide the practitioner with an overview of the most common heritable con-
nective tissue disorders (HCTD) and their oral manifestations, distinctive
aspects of oral health and treatment needs, and the molecular cause of the dis-
ease. We will propose guidelines for oral treatment strategies
Gene r a1i ze d j o i n t hyper m o b i 1it y and tempo r o -
mandibular disorders: inherited connective tissue
disease as a model with maximum expression.
*PJ.A. DE COSTER', L. VAN DEN BERGHE', L.C.M. MARTENS'
('PaeCaMed Research, Ghent University, Ghent, Belgium, 'Unit for
Orofacial Pain, Ghent University Hospital, Ghent, Belgium)
The objective was to study the relationshipbetween generalizedjoint hypermo-
bility (GJH) and temporomandibulardisorders (TMD) by assessing the preva-
lence and characteristics of TMD in a population with maximum expression of
GJH as a symptom of heritable connective tissue disease (HCTD). Diagnostic reli-
ability of a series of clinical signs indicatingTMJ hypermobility was also tested.
The study included 24 subjects with Matfan symdrome, 18 with Ehlers-Dados
syndrome (n=42), and 40 controls with normal peripheral joint mobility and
TMD. TMD dlagnoses were assigned to each subject according to the Research
Diagnostic Criteria for TMD (RDmMD).Seventy-one percent of the GJH sub-
jects were symptomaticfor TMD and 13%were seeking treatment.Sixty-nine
percent were diagnosed with myofacial pain, 86%were diagnosed with disk dislo-
cation with reduction, and 62%had TMJ arthralgia. Joint noises and recumng
mandibular subluxations (both P<O.Ol) were frequent findings in GJH, with
symptomaticsubjects presenting more and prolonged subluxation events
(P<O.Ol).High diagnosticreliability as clinical signs indicative of condylar hyper-
mobility was computed for a large endfeel distance in the absence of muscular
pain (sensitivity 92.9, specificity 88.0), large linear measurements of mandibular
border positions (sens. 90.5, spec. 92.0),reproducible 'jumps' during mandibular
movement (sens. 100, spec. 82.0), a preauriculardepression at the end of the
opening cycle (sens. 95.2, spec. 84.0), and recurrent mandibular subluxations
(sens. 97.6, spec. 90.0). These TMJ hypermobility signs were significantly more
expressed in GJH compared to patients with TMD and normal joint mobility The
study's conclusion was that GJH represents an important predisposing factor for
TMD development.The practitioner should be suspiciousof signs and symptoms
of TMD when treating patients with HCTD.
Abstracts

A Centre for Special Care in Dentistry at the
Ghent University Hospital, Ghent, Belgium: a
5-year report.
*S. DE TURCK, L.A.M. MARKS,J.K.M. APS, R.G.E.C.
CAUWELS, L.C. MARTENS [PaedCaMed Research, Ghent
University, Belgium)
The report presents an overview of the Centre for Special Care in
Dentistry (CBT) during the last 5 years. We established an Excel data-
base to record data on age, gender, medical history, caries experience
and oral hygiene. The following parameters were included: (1) Reason
for seeking care, (2) Source of referral, and ( 3 ) Major treatment carried
out after referral. An examination of the data showed that the majority
of patients who were treated at CBT were referred by their dentist. The
primary reason for referral was fear of dental treatment and association
with multiple caries lesions at a very young age, both leading to treat-
ment under general anesthesia (GA). Since the inception of data keep-
ing, the number of patients needing GA has continually increased
(n=320 in 2002). Treatment of ambulatory patients with disabilities
who were treated after being referred by an institution or private den-
tists also increased continuously Moreover, because the CBT dental
practitioners collaborate with 4 institutions outside Ghent, the patient
population has increased to more than 1500. For the patients who were
medically compromised or suffering from a syndrome, the physician,
especially the pediatrician or genetic specialist, played a major role in
referrals. An overview of all the syndromes we have seen at CBT will be
presented.
The dental-mental connection: what dental
professionals need to know about psychiatric
disorders.
*PE. DOYLE [private practice and University of Washington,
Seattle, USA)
Persons with chronic mental illness (CMI) have a greater need for den-
tal services than healthy persons but providing services to this group
has been neglected. This program will provide information about psy-
chiatric disorders and their oral health implications, both in patients
with CMI and patients with other disabilities. Participants will learn
how to take a mental health history; how to design an oral health care
program in community settings and private practice; how to work with
case managers in the community mental health system; the oral effects
of psychotropic medications; case study protocol; and how to facilitate
a mental health referral. A bio-psycho-social approach to oral health
care will be illustrated with case studies. Handouts will be provided.
Abstracts
ABSTRACTS
The dental-mental connection: dental care and
the mental health patient.
*PE. DOYLE [private practice; University of Washington
DECOD program, Seattle, USA)
Persons with chronic mental illness (CMI) exhibit a higher incidence of
oral health problems than a similar group of individuals without CMI.
Although oral health problems are common among mental health
clients, care is less accessible. This presentation illustrates an innovative
dental program, which provided needed dental care to persons with
CMI. Participants were severely mentally ill clients of Harborview
Mental Health Service, Outpatient Programs, who were treated at
Harborview Medical Center Dental and Oral Surgery Clinic. Harborview
is a county hospital in Seattle, Washington which also serves as a teach-
ing institution of the University of Washington. This program included
identifying and assessing dental needs, assistance in accessing dental
care providers and funding sources, treating dental fears, and providing
dental treatment. The dental hygienist worked with the clients, the
mental health case manager and the dental staff to facilitate care. Many
clients had a dual diagnosis of chronic mental illness and substance
abuse, along with other medical problems. The program served 166
mental health clients who received dental hygiene, restorative and oral
surgery care. Because of their disability, nearly one third completed the
treatment plan, but all participants benefited from the oral health care
provided. This program illustrated that oral health care can be part of
the total health care for mental health clients who are served in a com-
munity mental health system.
Aesthetic and functional rehabilitation of
patient with Crouzon’s Disease.
‘M.1 DUAILIBI’.2,X L . M . ROSA2, C.A. ROSA3,J.A.U. SOUZA’,2,
S.E. DUAILIB11.2(‘Universidade Camilo Castelo Branco,
2Universidade Federal de Sdo Paulo, 3Dentist)
This presentation reports on the surgical stabilization of the maxillary
bony structure of a patient with Crouzon’s Disease in order to restore
function and provide a more aesthetic appearance for the patient. The
patient was treated at UNICASTELO in the Dentistry for Special Need
Patients Department. After studying the clinical characteristics of both
the patient’s plaster cast and facial impressions taken with alginate and
the facial X-rays, we surgically moved the maxilla to a forward position,
which was then maintained with intra and extra oral appliances. This
surgical technique, along with the orthopedic forces produced by the
oral appliances, allowed the bone to stabilize and heal, and restored
function to the patient’s jaw as well as improving the appearance. From
this surgery we conclude that by using these therapeutic techniques, we
can stabilize bony structures in patients with Crouzon’s Disease and
restore the function of the jaws.
S p e c C a r e Dentist 2 4 ( 3 ) 2004 137
ABSTRACTS
Multidisciplinary approach to the patient
with first and second branchial arch malfor-
mations: a case history.
*M.T. DUAILIBI',*,M. SANTIAGO3,D.I. JARDIM', S.E. DUAILI-
BI',' ('Universidade Camilo Castelo Bvanco, 'Univevsidade
Federal de Sao Paulo, 3Plastic Surgery of Defeitos da Face
Hospital, 'Speech Pathologist)
This presentation reports on a 6-year-old female patient who presented
with multiple oral and facial deformities due to first and second
branchial arch malformation. The girl was treated using a multidiscipli-
nary approach to provide the best functional results and symmetrical
rehabilitation. The authors analyzed the benefit of the multidisciplinary
approach using surgical intervention and orthopedic appliances (bidi-
rectioned distractor and functional intra oral appliances). They
observed that using these techniques benefited the patient by decreas-
ing her facial deformities and alleviating her dental occlusion and aes-
thetic problems. The authors concluded that the multidisciplinary
approach may help establish a more aesthetic facial symmetry and
result in a more functional branchial arch.
31
Functional and aesthetic rehabilitation of
patients with congenital anhidrotic ectoder-
ma1 dysplasia.
*S.E. DUAILIBI',', VLM. ROSA',J.A.U. SOUZA',3,C.M. ORTE-
LAN', M.T. DUAILIBI'.' ('Universidade Camilo Castelo Branco,
'Universidade Federal de Sao Paulo, 3Universidade de Sao Paulo,
4Dentistf
This case history reports on the oral prosthetic rehabilitation of a 9-
year-old male patient who had anodontia, which was one of the clinical
characteristics of congenital anhidrotic ectodermal dysplasia syndrome.
The patient was examined by an interdisciplinary team and referred to
the Dentistry for Special Need Patients Department at UNICASTELO.
The authors proposed a prosthetic rehabilitation of the patient's maxilla
and mandible. After the prostheses were positioned, the mouth and
jaws functioned adequately.
138 Spec C a r e Dentist 24(3) 2004
33
Dental treatment o f a dentigerous cyst by
marsupilization in a patient with Cornelia de
Lange's Syndrome.
*S.E. DUAILIBI'.', A.L.A. BRONZO', J.A.U. SOUZA'', M.T.
DUAILIBI' ('Univevsidade Camilo Castelo Branco, ZUnivevsidade
Federal de Sao Paulo, 'Univevsidade de Sao Paulo)
The purpose of this paper was to describe the best approach to remov-
ing a pathologic lesion in the mandibular left premolar region in a
patient with Cornelia de Lange's Syndrome. After studying the patient's
clinical history, we proceeded using a surgical marsupilization tech-
nique of the dentigerous cyst to allow the eruption of the mandibular
left premolar and thereby preserving the dental dentition. Our choice of
surgical technique resulted in the continuing eruption of mandibular
left premolar and its preservation. We found that marsupilization was
the best approach to preserving the patient's erupting teeth.
34
Achieving an integrated oral health program
for adults with special needs and the frail
elderly in four community health sectors.
"E.D. ROSS (Halton Region Health Department, Oakville,
Canada)
We developed an oral health service delivery model within the Halton
region which targeted adults with special needs, including the frail eld-
erly in order to improve access to appropriate preventive oral health
care, dental treatment services and assistance with daily living. We sta-
tistically analyzed a sampling from our target group and presented the
results to the local government council. They directed the Public Health
department to resolve the disparity of services for this population. After
advocacy and lobbying by the task force, funding was approved for an
oral health coordinator and a dental educator. In 2002, due to contin-
ued reporting by the task force, government funding was approved for a
region-wide program, Dental Care Counts, for adults with special needs
who cannot afford dental treatment.
Abstracts

K.I.S.S. (Keep it Simple Staff)
*E. DUNCAN-ROSS (Halton Region Health Department, Halton,
Canada)
This skill-building workshop is for oral health care professionals who
are frustrated with the lack of improved oral care for individuals with
disabilities despite extensive attempts to educate caregivers. Participants
will learn how to gain insight into caregiver resistance, methodologies
for providing oral care for hard-to-serve clients, effective skill-building
and practical tools for oral care, and how a unique and easy method of
oral care for individuals with disabilities can be taught to nursing care
providers. Attendees will receive an outline that explains caregiver non-
compliance, a package of educational tools for various difficult clients,
a task sheet and grading sheet, and a brief description of the K.I.S.S.
process.
Oral rehabilitation with implant-supported
prostheses in patients with disabilities.
*A. EKFELDT (National Orofacial Resource Centre for Rare
Disorders, Goteborg, Sweden)
This study evaluated oral rehabilitation with implant-supported pros-
theses for patients with disabilities and documented a treatment proto-
col. The Mun-H-Center treated 14 patients, either with single-tooth,
partially edentulous or completely edentulous fixed implant-supported
prostheses; 11 patients had general anesthesia. All surgical and prostho-
dontic complications were noted. In all, 32 Nobel BiocarP implants
were placed. Three implants were lost before or during second stage
surgery and 2 implants were lost after loading. Implant failures and
other complications were observed in 2 patients, possibly due to tongue
thrusting or finger habits. One patient with Down syndrome had possi-
ble reduced resistance to infection. The other 12 patients had no major
complications. We concluded a strict regimen was required when
implants were placed in patients with disabilities. The patient’s caregiv-
er should be informed about maintaining good oral hygiene and the
increased risk of complications due to tongue thrusting or finger habits,
and the patient should have frequent recalls for checkups. Using a soft
splint to cover the operation area postoperatively was also found to be
valuable.
Abstracts
ABSTRACTS
Caries prevalence in elderly persons with
and without dementia.
*B. ELLEFSEN, L. VILSTRUP, I? HOLM-PEDERSEN (Royal
Dental College, Copenhagen, Denmark)
We compared coronal and root surface caries in community-dwelling
elderly individuals with dementia and without dementia. Subjects with
dementia (DSM-IV) were recruited from the dementia assessment clinic
at Bispebjerg University Hospital, Copenhagen, Denmark. The compari-
son group of non-demented persons (MMSE3 24) were matched to the
dementia group by age and gender. One examiner used the NIDCR
diagnostic caries criteria to conduct visual-tactile examinations on den-
tate subjects. To date, 58 individuals with dementia have received
examinations; 39 were dentate and 19 were edentulous. The compari-
son group had 115 individuals and 77 were dentate. The mean age of
the dementia group was 83 years and 85 years in the comparison group.
The mean number of teeth among dentate subjects was 16.6 * 8.2 in
the dementia group and 13.5 f 8.1 in the comparison group. The mean
DFS scores for participants with dementia were 32.9 + 21.7 and 8.5 r
8.0 for coronal and root caries. For the participants without dementia,
the mean DFS scores were 31.3 * 22.1 and 7.3 * 6.6. The mean DS for
the group with dementia were 3.5 * 4.8 for coronal and 3.6 k5.3 for
root caries. The DS scores for the group without dementia were 2.5 i
4.3 for coronal and 3.8 r 5.1 for root caries. We concluded that the
findings document that there is a substantial amount of dental caries
among older adults with newly diagnosed dementia and older adults
without dementia, and underscore the importance of continued caries
prevention and treatment for elderly adults.
Comparison of gingival and periodontal con-
ditions of healthy children and children with
cerebral palsy.
*I. ERDINC, I. TANBOGA, T. ARI (Marmara University Faculty
of Dentistv, Istanbul, Turkey)
Individuals with specific disabilities have more gingival and periodontal
disease compared to normal age-matched control groups. Following
informed consent, 106 healthy children and 106 children with cerebral
palsy (CP), with a mean age of 11.24 years, were randomly selected for
routine dental treatment from the patient population of the Pediatric
Dentistry Clinic of the Marmara University Faculty of Dentistry All
children were examined by two pediatric dentistry specialists in a regu-
lar dental chair, with a halogen lamp, and the teeth were dried with
compressed air. The World Health Organization criteria were used to
examine the teeth for caries, a dental mirror and a periodontal probe
were used to evaluate the gingival and periodontal conditions. The gin-
gival condition and dental plaque accumulation were evaluated on the
buccal surfaces of teeth #3 or J , #9 or F, and at the lingual surfaces of
teeth #19 or R. Analysis of the data showed a statistically significant
increase in plaque and gingival indices (p<0.05) in children with CP It
was concluded that children with cerebral palsy have a higher preva-
lence of periodontal disease than children without Cl?
S p e c C a r e Dentist 24(3) 2004 139
ABSTRACTS
40
A controlled pilot survey of difficulties with
routine hygiene and health care by persons
with Down syndrome.
‘D. FAULKS’, V COLLADO’, B. DE FREMIWILLE’, J.T. NEW-
TON4,M. HENNEQUIN’,’ (‘University Hospital of Clermont-
Ferrand, France, ’Dental Faculty of Clermont-Ferrand,
’University Hospital of Saint-Etienne, France, ‘GKT Dental
Institute, London, UK)
This study evaluated the prevalence and difficulty experienced by per-
sons with Down syndrome (DS) during routine hygiene and health care
compared to control subjects. Data were gathered from parents of per-
sons with DS in a cross-sectional survey using a 19-item proxy ques-
tionnaire. Nineteen responses related to a child with DS (mean age 16.7
SD 11.3 years) and 27 related to a control subject (mean age 17.3 SD
10.6 years) were collected. Parents reported greater difficulty (95%
C1) in performing the following acts for their child with DS compared
to their other children: cutting nails (Odds Ratio: 4.4), putting drops in
the eyes (OR: 4.4), cleaning teeth (OR: 8.9) and washing ears (OR
10.0).There was a tendency to express greater difficulty for the group
with DS for the following acts: a dental examination (OR: 3.1), an ear
examination (OR: 3.7), a blood test (OR: 3.8) and a gynecological
examination (OR: 9.5). (This pilot survey has been extended to a
national study of 400 families of persons with DS; its results will be pre-
sented at this conference.) The difficulty with routine hygiene and
health care could indicate the need for outpatient treatment at special
care facilities and may justify increased educational support for persons
with Down syndrome to achieve independence in daily living.
41
Enamel dentin junction (EDJ) and dentin
characterization in premature infants.
*M. FRASCHINI’, N. COFWACCHIA’, G. LUPOLI’, G. MASCO-
LO’, S. CICCIARELLP (‘University of Perugia, Italy, Department
of Restorative Dentistry, ’Maggiore Hospital, Bologna, Italy,
3BambinoGesu Pediatric Hospital, Rome, Italy)
This study observed ultrastructural variations in the dentin and enamel of
50 preterm subjects of very low birth weight and a gestational age
between 24-32 weeks. Many patients had deciduous teeth that were dilac-
erated, opaque or hypoplasic. When 50 teeth were analyzed with elec-
tronic paramagnetic resonance (EPR), ultrastructural defects in the
dentin and enamel were observed. We found that dentin was regular near
the pulp in morphology. Far from the pulp to enamel, we found the same
density of tubules but of a sinusoidal trend and finally, few tubules with
many lateral branches. At the enamel-dentin junction (EDJ), there were
sometimes no tubules or an ”anarchic” layer with few tubules and atubu-
lated dentin. These layers suggested stress affecting the dentin during the
initial stage of formation and dentin near the EDJ was similar to tertiary,
reactive dentin. More severe conditions at birth showed severe disorders
during the formation of dentin layers. Systemic defects in tooth formation
may occur prenatally, neonatally or postnatally, as a result of birth trau-
ma, infections, nutritional, metabolic or chemical disorders. Identifying
the structure of dentin and enamel in premature infants will facilitate
choosing the best restorative materials for defective dental enamel.
140 S p e c Care Dentist 24(3) 2004
42
Professional skills to empower you to work
with behaviors for patients with special
needs (follow-up of Autism Day).
*C. FRIEDMAN’, B. LOUISE‘ (‘University of Western Ontario,
London, Ontario, ’Certified Professional Co-Active Coach
(CPCC), Master Trainer of Chronic Disease Self-Management
ProgradStanford University)
The pre-congress seminar on autism will address overall concepts as
well as provide specific behavioral interventions related to treatment. A
major issue in addressing the behavior of patients with special needs is
being flexible, ‘getting in tune’ with patients and adjusting to their
needs. This half-day session will be interactive. We will use exercises
and discussion to highlight learning objectives: activities to enhance a
professional’s self-efficacy to change patient behavior; 10-minute lec-
tures on skills for listening, acknowledgement, and championing; brain-
storming and co-creating new ideas/perspectives for professional prac-
tice; problem-solving activities; and role-playing.
43
Comparison of mechanica plaque control
with modified toothbrush handles: a clinical
analysis.
*J.P GEORGE’,J.E LAZARUS’ (‘Rajas Dental College,
Bangalore, India, ’Dr MGR Medical University, Tamilnadu,
India)
Controlling dental plaque in patients with handicaps presents a major
challenge to patients, their relatives, and to the dentist. Children with
special needs have limited dexterity, which hampers their oral hygiene.
Several oral hygiene aids, mainly modified toothbrush handles, have
been suggested to increase the toothbrush handle’s bulk or tailor a
toothbrush handle to a patient’s grip, thus enabling children with dis-
abilities to assume responsibility for their own oral hygiene. We will
present literature reviews addressing modifications in toothbrush han-
dles and will also present a clinical study that compared mechanical
plaque control with and without using modified toothbrush handles in
children with mental handicaps. The toothbrush handle design used in
the study will be presented by the authors, who will also discuss its
commercial availability.
Abstracts

Osteopetrosis: a clinical study of orofacial
manifestations in two Mexican pediatric
patients.
“C. GIL-ORDUNA’.’, W SAN MARTIN-BRIEKE’, S. OCHOA
CACERES’,J.M. APARICIO RODRIGUEZ’.’, N. MACARTHY-
VELAZQUEZ’,J.A. CAO-ROMERO’, E. LANDINI-MALDONA-
DO3, C. F-SALINAS’ (‘Hospital para el Nino Poblano, Mexico
’Benemerita Universidad de Puebla, Mexico, 3Medical University
of South Carolina, Chavleston, USA)
We designed a program to treat two female patients, aged 7 and 3, with
osteopetrosis, a rare genetic disease with both inheritance patterns:
dominant (1:20,000) and recessive (1:200,000). It is characterized by a
deficient metabolic re-absorption into the bone and cartilage, resulting
in increased bone density. Predisposition is 1:1 and consanguinity is a
risk factor. Altered bone shape and a high fracture incidence have been
observed; clinical features include short size, anemia, microcephaly, an
increase in fronto-cranial bone, and exophthalmos, as well as slow orth-
odentition eruption, malformation and a high caries incidence.
Infections may result in osteomelitis. The 7-year-old female patient had
multiple bone fractures in both legs, short size and frequent headaches.
An intraoral examination revealed malocclusion and multiple caries.
She was treated under general anesthesia. Her younger 3-year-old sister
was diagnosed with growth retardation, exophthalmos, malocclusion,
and dental caries. We concluded that an early rehabilitation program for
osteopetrosis must be considered to increase the quality of life for
patients with this rare disorder.
Retrospective study of demographic data and
the oral and general clinical manifestation in
HIV positive patients or patients with AIDS
older- than 50- years.
“E.M. GIOVANI, N. TORTAMANO (School of Dentistry,
Universidade de Sao Paulo, Brazil)
This study’s objective was to identify how HIV affects the clinical and
immunological conditions of elderly patients with HIV and compare the
status of patients who use or do not use antiretroviral therapy. We stud-
ied the records of 115 HIV-positive patients, aged 50 and above, in
CAPE (Special Care Center) at the University of SHo Paulo College of
Dentistry. Oral lesions appeared in 82.22% of the patients. Lesions
included candidiasis (85.22%), pseudomembranous candidiasis
(36.52%), erythematous candidiasis (29.57%), angular cheilitis
(29.13%), periodontal pathologies (66.95%), conventional gingivitis
(24.25%), conventional periodontis (13.04%), gingival erythema
(2.61%), herpes simplex (18.26%), ulcers (18.29%) oral hairy leuko-
plakia (14.78%), aphthous ulcer (7.83%), Kaposi’s sarcoma (6.09%),
herpes zoster (2.61%), condyloma acuminatum (1.74%), and syphilis
(1.74%). We concluded that oral lesions were common and occurred
more frequently in persons over 50 who are HIV-positive. The more
prevalent infections included pneumonia (38.26%), tuberculosis (20%),
oral pharyngeal candidiasis (18.26%), and hepatitis B (17.26%). The
association of oral lesions with a low lymphocytes CD4 count suggests
that they are good predictors of immunosuppression and AIDS.
Abstracts
ABSTRACTS
46
The relationship between salivary flow and
oral manifestations in patients who are HIV-
positive.
‘E.M. GIOVANI, S. EGASHIRA, R.S. SOUZA, C.E. ALEGRETTI,
J.J. MELO, N. TORTAMANO (School of Dentistry, Universidade
Paulista, Sao Paulo, Brazil)
This study evaluated the relationship between salivary flow and the
occurrence of oral manifestations in patients with HI\! Ninety-six
patients at the Special Care Dentistry Center, School of Dentistry at the
University Paulista, SLo Paulo, Brazil, were enrolled in this study. All
patients used HAART (Highly Active Anti-Retroviral Therapy). Patients
were divided into two groups: Group I had 48 patients with clinical oral
lesions, which included pseudomembranous candidiasis (30%), can-
didiasis (20%), angular cheilitis (lo%), gingivitis (So/), periodontitis
(8%),hairy leukoplakia (8%), herpes simplex (6%),condyloma acumi-
natum (6%) and recurrent aphthous ulcer (4%). Group I1 had 48
patients who had no oral lesions. Saliva was collected after being stimu-
lated by having patients chew gum. Our results showed that Group 1
had 17 patients (38%) with normal salivary flow and 31 patients (62%)
with xerostomia. Twelve patients (38%) exhibited mild xerostomia, 11
patients (34%) had moderate xerostomia, and 9 patients (28%) had
severe xerostomia. Group 11 presented 35 patients (73%) with normal
salivary flow and 13 patients (27%) had xerostomia (7 patients had
mild xerostomia and 6 had moderate xerostomia). We concluded that
xerostomia is frequently seen in patients who are HIV-positive and that
it is directly related to oral manifestations.
47
The budget of a hospital public service for
oral health care in patients with disabilities.
“M. GIROTTO, C. BACCI, L. GIROTTO, E. VALESI-PENS0 (St.
Lorenzo Hospital, Borgo Valsugana, Italy)
During the last ten years, the regional public health service has devel-
oped a budget control system for departments in the county’s seven
hospitals. This system decides the initial annual budget of the Oral
Health Department, depending on the estimated population of persons
with disabilities who need special care in dentistry. A large amount of
autonomy, however, is given to the medical staff in distributing
resources to clinics. The authors analyzed expenses in relation to the
type of clinical management of patients with disabilities, to define the
average costs of a public dental service that could assure oral health for
persons with disabilities (1%-4%).
Spec Care Dentist 2 4 ( 3 ) 2004 141
ABSTRACTS
A new oral health screening protocol for peo-
ple with disabilities in Turkey.
I. TANBOGA, 1 ARI, *N.GULMAN (Marmara University
Faculty of Dentistry, Pediatric Dentistry Department, Istanbul,
Turkey)
Although screening people with disabilities is not easy, we designed a
detailed screening protocol, consisting of demographic data, medical
history, home care information, and dental findings, and examined 117
people with disabilities (75 mental, 42 physical). Dental findings
included DMFT, dft, periodontal status (gingival index and plaque
index), intra-extra oral pathologies, detailed occlusal conditions, trau-
ma, drooling, erosion, attrition, abrasion, bruxism, fluorosis and
hypoplasia. Each examination lasted * 3.54 minutes. Satisfactory levels
of agreement were indicated by Kappa values for the intra- (0.83) and
inter-examiner (0.78) reliability tests. The new standardized and
detailed oral screening form provides valuable information with high
sensitivity, specificity and predictive value and can be used to estimate
oral health treatment needs. It is easy to use and when it is extended to
other studies, aggregated data can be used to characterize the oral
health needs of people with disabilities, making it possible to make
comparisons over time, and among population groups with varying
characteristics.
Opinions of g u a r d i a n s on t h e use of
r e s t r a i n t s for various t y p e s of persons w i t h
disabilities.
*K. HAKADA, M. NISHINO, Y KORI, K. ARITA (School of
Dentistry, University of Tokushima, Tokushima, Japan)
Fifty-two persons with disabilities who were restrained during dental
treatment were randomly chosen. Subjects included 28 males and 12
females with an average age of 2 k 1 1 years old; 14 had autism, 21 had
mental retardation, 1 had Down Syndrome, and there were 4 in the cat-
egory ‘other.’ Caregivers’ opinions about using restraints were obtained
by questionnaire of which 76.9% were returned. Questionnaire recipi-
ents included the mother (85.0%),father (lO.O%), and staff in a home
(5.0%).After dental treatment using restraints, the opinion of the care-
takers was that (1) it was better than parental restraint (95.0%); (2)
caretakers did not want to use restraints (2.5%); and ( 3 ) ‘other’ (2.5%).
From the results we concluded that using restraints, following informed
consent, should be reserved for unmanageable persons with disabilities.
142 Spec Care Dentist 24(3) 2004
52
Oral functions in persons with Down syn-
drome: improving oral health, improving qual-
i t y of life.
“M. HENNEQUIN’, EI ALLISON’, G. DAHLLOF’, K. CARLST-
EDT3,A. MCALLISTER4, D. FAULKS’ (‘University of Auvergne,
Clermont-Ferrand, France, ‘McGill University, Montreal,
Canada, ’Karolinska institute, Huddinge, Sweden, 4Linkoping
University, Linkoping, Sweden)
Individuals with Down syndrome (DS) have a high incidence of abnor-
malities associated with the orofacial complex, including dysfunction
from poor neuromotor control, muscle weakness and dysmorphology.
Consequently, these individuals have many oral health problems, many
which do not improve with age. Problems with breathing, swallowing,
feeding and speech have been studied in children and adults. If these
problems are recognized, treated and monitored early, severe functional
difficulties could be minimized. The goal of this symposium is to sum-
marize information and discuss how to identify and prevent masticatory
problems within this population and explain how these problems affect
oral and general health as well as the social integration of persons with
Down syndrome. We will also discuss how palatal plate therapy
improves oral motor function, articulation and communication.
Mobile and portable dental c a r e systems:
options for p r i v a t e and public partnerships.
*L. HILL’, M. REED’, M. TEUTSCH3,M. HELGESOW, D.
BERKEY (‘Cincinnati Health Department, Cincinnati, USA,
’Mobile Dental Care, Dallas, USA, ’Mission Children’s Hospital
Dental Program, Asheville, USA, 4Apple Tree Dental,
Minneapolis, USA, ’University of Colorado School of Dentistry,
Denver, USA)
Mobile and portable dental care systems are rapidly increasing in the
U.S. New vadtruck design options, equipment, federal and state regula-
tions, reimbursement, as well as outreach and patient care logistics,
make it challenging to have a cost-effective, functional program. This
session will present resources for decision making and highlight pro-
gram models in the private and public sectors. A new online manual on
mobile and portable dental care systems will also be discussed. Dr. Hill
will present an overview of available resources to help programs make
decisions. Dr. Hill and Ms.Teutsch will present models using portable
vans. Drs. Berkey and Reed will discuss various models using portable
equipment. Dr. Helgeson will describe a hybrid model used by Apple
Tree Dental. There will be an interactive discussion on selected issues
or questions.
Abstracts
 ABSTRACTS

54
Postoperative swelling and pain prophylaxis
with intravenous injection of dexketoprofen
trometamol in dental surgery for patients
with disabilities.
"V HOLTHAUS', U . WAHNER' ('Department of Oral Surgeiy
and Dentistry for Disabilities, Bad Segeberg, Germany, 'Berlin-
Chemie, Research Centeu, Berlin, Germany)
A large number of dental patients with psychiatric, physical and mental
deficits, as well as patients who are pharmacologically compromised
due to a general disorder, are treated under sedation or intubation anes-
thesia. Intraoperative prophylaxis of swelling, postoperative medication
for pain and quality of life following the procedure, are important.
Dexketoprofen trometamol is an excellent analgesic and non-steroidal,
anti-inflammatory drug (NSAID). Its efficacy following oral administra-
tion was demonstrated in a 2003 survey The current study is evaluating
dexketoprofen trometamol in solution form for injection. The study
compares patients undergoing dental surgery who received 50 mg as a
bolus before the procedure with patients who received no intraoperative
prophylaxis. Results show that by using the intraoperative NSAID med-
ication dexketoprofen trometamol, postoperative analgesic and anti-
inflammatory medications can be reduced.
Anterior resin crowns in patients with spe-
cial needs.
"C. INGA (Texas Scottish Rite Hospital, Dallas, USA)
A retrospective chart review of Texas Scottish Rite Hospital patients
confirms that there is a high success rate of anterior resin crown reten-
tion in patients with special needs. We conclude that different types of
esthetic dentistry can be accomplished in patients with special needs.
57
Retrospective study of 10 years of operating
room dental cases in an academic medical
center.
*D.E. JOLLY (Ohio State University College of Dentistry,
Columbus, Ohio)
Our objective was to analyze a comprehensive database of operating
room patients treated in the operating room since 1992. Essential med-
ical history and demographic information 'was analyzed for disability
and medical conditions; dental treatment needs and other demographic
factors were summarized. Approximately 67% were patients with men-
tal retardation, other developmental disabilities, or who possessed relat-

55 ed diagnoses of various disabilities. Approximately 33% of all patients

treated in the operating room were medically frail without a diagnosis
Dental and oral surgery treatment of a of a 'classical' disability We concluded that an academic medical center
serves as a valuable community resource and a safe location for treating
patient with Seckel Syndrome: a case report a wide variety of patients, the majority who are patients with disabili-
ties, in a monitored setting.
of a very rare syndrome.
*V HOLTHAUS (Department of Oral Surgery and Dentistry for
Disabilities, Bad Segeberg, Germany)
Seckel Syndrome is characterized by intrauterine and postnatal growth
retardation, microcephaly, mental retardation and typical beak-like pro-
trusion of the midface. Craniofacial features include a highly arched or
cleft palate, crowded and hypoplastic teeth and malocclusion.
Approximately 70 cases of this syndrome have been reported in the
medical literature. This case report describes a male child with Seckel
Syndrome who has received medical and dental treatment since the age
of 5 years. All dental procedures have been done under general anesthe-
sia. It cannot be predicted when his deciduous and permanent teeth
will erupt. When the patient's crowded, irregular and hypoplastic teeth
appear, they must be removed because of periodontal inflammation.

Abstracts Spec C a r e Dentist 2 4 ( 3 ) 2004 143

ABSTRACTS
A comparative study of oral health in people
with disabilities and non-disabled patients
aged 35-44 in Germany.
*1. KASCHKE, K.R.JAHN, M. LlERE (School of Dentistry,
Charite, Humboldt-University, Berlin, Germany)
People with handicaps have a high risk for dental caries and periodon-
tal disease because of their physical andtor mental impairment. The
purpose of this study was to assess the oral health of institutionalized
people with disabilities, aged 35-44, in Berlin, compared with data from
healthy people of the same age that were taken from a 1999 Third
German Oral Health Study (DMS 111). In 2003 a dentist examined the
oral health of 100 institutionalized adults with disabilities, aged 35-44,
from Berlin. The examinations included evaluating the following index-
es, which were compared with the data from the DMS 111 study for
healthy people, aged 35-44: DMF-T/S, PBI, CPI. When the oral health
of patients with disabilities was compared with healthy people of the
same age, there were statistically significant differences in the patients
with disabilities: a higher rate of carious and missing teeth fewer
restorations, crowns and bridges, as well as removable dentures; poorer
oral health; and a greater unmet need for treatment. The survey and
data showed poor oral health and great treatment needs for patients
with serious disabilities. We concluded that the WHO health goals for
oral health in 2000 had not been achieved for patients with physical
and/or mental disabilities. This study clearly indicates an urgent
demand for nationwide dental programs for persons with disabilities.
59
Orthodontic treatment in patients with cere-
bral palsy: control of dental development by
means of modified serial extractions.
*I. KLAR, K. STAUFER, A.C. FISCHER, H. LANDMESSER
(Faculty of Dentistry, University of WittedHerdecke, Germany)
After completing dentofacial development, patients with cerebral palsy
often show marked oral deformities, which affect orofacial function;
muscular dysfunction is the most important etiologic factor. Although a
protracted orthodontic treatment is needed, most patients with cerebral
palsy do not accept it. An alternative treatment is an interceptive ortho-
dontic therapy. This presentation focuses on 22 patients with cerebral
palsy (12 femaldl0 male), with an average of 10.8 years, who were
evaluated. Orthodontic measures included moderate serial extraction
with reduction of the number of teeth in the upper jaw (deciduous
canine, first deciduous molar, first permanent premolar) and a reduced
treatment with removable appliances for maxillary transverse expansion
and mandibular sagittal development (not more than 16 months). The
main results included: in the maxilla: 6.5 mm (+/- 1.8 mm) of sagittal
reduction and 4.5 mm (+/- 1.5mni) of transverse expansion of the den-
tal arch; mandible: 3.2 mm (+-/ 1.6 mm) increase of the sagittal arch
length; and reduction of the overjet. We concluded that correcting the
malocclusion should begin in the early mixed dentition in order to
reduce the negative effects of malocclusion and dysfunction. The inter-
ceptive therapy takes advantage of the biological response and is toler-
ated by most patients with cerebral palsy.
144 S p e c C a r e Dentist 2 4 ( 3 ) 2004
60
Dental treatment of patients with disabilities
who have prosthetic demands.
*S. KLAR, I! CICHON (Department of Special Care in Dentistry,
University of WittedHerdecke, Germany)
Dental prostheses can improve the quality of life, especially for patients
with disabilities, by providing an adequate masticatory function, chewing
comfort, coherent speech and aesthetics. Even patients with very advanced
caries and a greatly reduced number of teeth can be cared for with fixed or
combined dental prostheses following tooth extraction, periodontal or con-
servative treatment. In the past, the dental treatment of choice for patients
with disabilities was of teeth extraction due to lack of oral hygiene. Recent
studies show that restorative and prosthodontic treatment is possible even
in this group of patients. Patients with disabilities can be successfully treat-
ed with fixed and removable prostheses over a long period, depending on
their degree of disability and dental care following oral rehabilitation. The
number of anchor teeth and the type of disability should be considered
when planning treatment for patients with disabilities who require den-
tures. In most cases, restorative treatment using endotracheal anesthesia is
necessary for these patients. Because of severe dental destruction due to
cariogenic, periodontal, traumatic, and dysgnathic reasons, treating patients
with disabilities with fixed or removable dentures is very difficult under
general anesthesia. When planning prosthetic treatment for patients with
disabilities, it should be noted that most of these patients depend on a care-
giver for oral hygiene and denture care; a conscientious aftercare program is
a prerequisite for successful dental treatment.
Development of a new material to suppress
bacterial adhesion to the denture base.
*M. KOBAYASHI', R. HAYASHI', K. UMEZAWA', K. NAKAZATO',
M. HIRASAWA', T. KUBOTA', f . MEGA' ("ihon University Schoot
of Dentistry at Matsudo,lapan, 'Faculty of Engineering, Ibaraki
University,Japan)
The purpose of this study was to prepare a new copolymer containing fluo-
roacrylic monomer and assess its ability to prevent bacterial adhesion. The
physical properties and surface characteristics of synthesized resins were ana-
lyzed. We also examined the adherence of Candida albicans (C. albicans) and
Streptococcus mutans (5. mutans) to the resin composed of perfluoro-
hexylethyl methacrylate (C6F) and methylmethacrylate (MMA). Copolymer
beads composed of 75% MMA and 25% C6F were prepared by dispersion
polymerization. Test specimens (C6FA) were obtained by heat polymeriza-
tion. The distribution of fluorine concentration in specimens was measured
by electron spectroscopy for chemical analysis (ESCA), and polymerization
characteristicswere also measured by differential scanning calorimetry
(DSC). Knoop hardness and tensile strength were measured to analyze the
physical properties of test samples. Bacterial adherence was examined by
using C. albicans and S. mutans as described by Otake et al. (Caries Research,
1991). ESCA indicated the maximum value of F/C atomic ratio at 0.3 mm in
depth from the surface of the C6FA. DSC showed two glass tradition temper-
atures in the low and high temperature region. This result indicated that C6F
and MMA did not compete alternately Knoop hardness and tensile strength
of C6FA were slightly lower than those of PMMA. The numbers of adhered
C. albicans and S. mutans to C6FA were significantly lower than those of
PMMA. These results indicated that the adherence of both C. albicans and S.
mutans to C6FA was significantlysuppressed when compared to that of
PMMA, although the physical properties of C6FA failed slightly
Abstracts

A survey of Ontario general dentists and
dental specialists to determine attitudes
towards providing care for persons with dis-
abilities.
*W9. LOEPPKY, M.J. SIGAL (Faculty of Dentistry, University of
Toronto, Ontario, Canada)
Persons with disabilities find it difficult to receive appropriate dental care
and often cite the attitudes of dentists as a contributing factor. The goal
of this study was to identify the kinds of dental services that are provided
to persons with disabilities in Ontario and to determine attitudes of
Ontario dentists about providing dental care for persons with disabilities.
A mail survey, following a variation of Dillman's Total Design Method,
was conducted in Ontario. Questionnaires were mailed to a random sam-
ple of 1000 dentists and to all pediatric dentists licensed to practice in
Ontario in 2002. A total of 524 general dentist surveys (52%) were
returned and a total of 83 pediatric dentist surveys (90%) were returned.
A total of 466 (89%) of general dentist respondents reported treating per-
sons with disabilities of all ages. All responding pediatric dentists (100%)
reported treating persons with disabilities. A majority of both general and
pediatric dentists (ranging from 74% to 94%) reported treating persons
with disabilities whose dental care is paid through various government
programs. In general, both groups of respondents reported positive atti-
tudes toward providing care for persons with disabilities but negative atti-
tudes toward the time and effort required to treat these patients, the low
payment rates, and administrative requirements. We concluded that
Ontario general and pediatric dentists are interested in providing a full
range of dental services to persons with disabilities and, in general, hold
favorable attitudes toward providing care for this group.
Innovations in health care and education to
enhance quality of life in old age: findings
from the ELDER Group.
*M. MACENTEE,J. WALTON, R. BRYANT, M. BRONDANI, S.
KHATAMI, M. PRUKSAPONG, N. HUI (University of British
Columbia, Vancouver)
The impact of oral health on quality of life (QoL) in old age is unclear,
as are the methods used in dental education to prepare dentists for serv-
ing elderly populations. The ELDERS Group is exploring multiple
aspects of these two issues to explain: (1) why relatively healthy elders
select various prosthodontic treatments; (2) how the conflicting priori-
ties of long-term care (LTC) influence acceptance of dental treatment
by frail elders; and (3) educating dentists for geriatric care. For exam-
ple, elderly patients do not necessarily accept implant treatment, even
when offered without charge for edentulous mandibles, probably
because they prefer to adapt and cope with conventional dentures. Oral
health is surprisingly poor in LTC despite educational programs about
oral health care offered to nursing staff, probably because of distractions
from conflicting priorities of care. Moreover, dentists are generally
reluctant to provide comprehensive care to institutionalized frail elders,
undoubtedly because their education does not adequately prepare them
for this service. Combinations of quantitative and qualitative research
methods are in progress to identify more clearly how oral health can be
managed effectively to enhance QoL in old age.
Abstracts
ABSTRACTS
Special Olympics: the first experience of the
Special Smiles project in Belgium.
"L.A.M. MARKS',J.K.M.APS', R.G.E.C. CALJWELS', D. DE
CLERCK', C.H. PILIPILI', L.C. MARTENS' ('Ghent University,
P a d d e d Research, Gent, Belgium, 'Catholic University of
Leuvevl (KUL), 'Universite Catholic de Louvain (UCL), Brussels,
Belgium)
The Special Olympics is a worldwide organization that promotes sports for
athletes of all ages who are mentally disabled (www.specialolympics.org).
We report on the first Special Smiles (SpS) project, which was organized in
Brussels, Belgium, during the 22nd Special Olympics (SpO) in May 2003.
There were 2800 athletes with mental disabilities; 253 athletes (go/,) were
screened. The project included SpS as an oral health screening enterprise
and was a collaboration by the Centre of Special Care in Dentistry of
Ghent University. There was also logistical support of WETAG, the
Flemish working group on disability and oral health. Calibration of volun-
teer screeners (n=47) was completed according to the guidelines devel-
oped by the SpS international project. Ten parameters were examined on
every athlete to find out the treatment need and urgency level: mainte-
nance, non-urgent treatment, and urgent necessary treatment. After the
oral screening, athletes and caregivers received oral health education and
instruction on oral hygiene. The screening results indicated that 40% of
this group needed dental treatment and of those, 10% needed urgent den-
tal treatment. Further refined analysis of the data is expected by Special
Olympics International. These results confirm the worldwide finding of a
clear treatment need in persons with disabilities. These findings should be
used to convince healthcare professionals that accessible dental care for
persons with disabilities needs to be improved.
The MONRETT project: set-up and initial data
on oral symptomatology and oral hygiene
habits of children with RETT syndrome.
E BOONEFAES, L. MARKS, R. CALJWELS, "L. MARTENS
(PaeCaMedD Research, Ghent University, Gent, Belgium)
Rett Syndrome (RS) is a progressive neurological disorder estimated to affect
1:10,000- 1:15,000 live female births. The disorder leads to a complete social
withdrawal and loss of motor shlls. Although there have been other studies, oral
signs were only reponed in two surveys. We conducted a study known as the
MONRETT project (MP), which was supported by the Belpn self-aid group on
Rett Syndrome. The study had access to 72 recognized children who were suffer-
ing from RS. The MP project inventoried oral health and related problems within
the national RS population and consisted of three major parts: (1) a questionnaire
on oral habits, such as bruxism, fingersucking and oral hygiene habits; (2) an
oral screeningdetermining canes experience (DMF) and plaque accumulation;
and (3) impressionswere made to evaluate the palate. From the entire FS popula-
tion (n=72),42 parents (58%) answered the questionnaireand reported that their
children suffered from drooling (65%),tongue thrusting (44O/,), mouthbreathing
(79%), wringing hands (72%),pushing hands in the oral cavity (58%),epilepsy
(77%),bleeding gums (53.5%),foetor ex ore (46.5%)and regurgitation (21%).
From these preliminary results we concluded that patients with RS need extra
oral health care. The clear discrepancy between the parents' idea of oral hygiene
and their reported complaints indicates that parents need oral hygiene education.
S p e c Care D e n t i s t 24(3) 2004 145
ABSTRACTS
A case-controlled s t u d y of intravenous proce-
d u r a l sedation for dental treatment in autis-
tic spectrum disorder.
*A.R. MILNES, G. MAUPOME (Okanagan Pediatric Dental
Services, Inc., Kelowna, British Columbia, Canada)
Autistic specmm dmrder is a dunnic, non-progmsive developmental dmbility with a
classic triad of impaiment in social interaction, communication and behavior. Providing
outpatient dental treatment for cluldren with autism is Cllmcult.T ~ study
E compared the
outcome of intravenous procedural sedation (IVPS) between children with autism (experi-
mental) and healthy but uncooperative children (conml). each of whom required dental
mtment. Thuty children were recruited 15 children with autism who needed dental
mtment were matched for age, type of required treatment, and length of procedure to 15
healthy but uncooperativechddren. Using a time-based sedation record, physiologic,
behavioral, treatment delivered,and drug dosage data were collected. Informed consent
was obtained from a parent before treatment. Sedation was administeredaccodng to
American Academy of Pediatric Dentishy (AAPD) guideha. Descriptive statisticswere
calculated for each group and groups were compared using unpaired T-tests and one-way
ANOVA. AU treatment was completed for each chdd in both groups. There were no seda-
tion failures or adverse sedation even&in either group. AAPD sedation levels of 2 or 3
were achieved in each cbdd. There were no statistically s i e c a n t diferences between
groups in midazolam,droperidol and lidocaine dosages. A sigmficantly higher dose of na-
buphine was admuustered to children in the control group (p-0.042).Parental acceptance
of the sedation technique was tugh. We concluded that intravenous procedural sedation,
when adnunistered to children with autism for dental mtment. wa5 overwhelmingly suc-
cessful and was also positively received by parents With appropriate mining and educi-
tion, IVPS can be safely administeredby pediatric dentists so that dental care can be safely
and compassionately provided to children with autism.
The situation of removable denture use and
factors related to t h e a b i l i t y of using den-
t u r e s in disabled elderly patients.
*S. MINAKUCHI, S . TAKAOKA, H . UEMATSU (Graduate
School, Tokyo Medical and Dental University, Tokyo, Japan)
Although elderly people with disabilities need to wear dentures in order to restore
masticatory functions, they often cannot use their dentures. The purpose of this
study was to survey elderly patients who wear dentures and identify factors that
enabled them to use their dentures. We surveyed the dentists and caregivers of
145 patients in a special nursing home about the patients' oral status (caries,
missing teeth, and status of restorations); the status of their denture wearing;
Activities of Daily Living or ADL (transferring, eating, toileting, bathing, dress-
inglundressing, grooming, communication, mobility; the ability to gargle; and the
degree of dementia). The data analyses were done by using SPSS 10.0 for
Windows. The initial evaluations used frequency distribution tables followed by
chi-square tests of independence. A multiple logistic regression analysis was used
to determine the variable independently associated with the use or nonuse of den-
tures. Ninety percent of the subjects needed dentures and 60% of them were not
using dentures. Bivariate analysis for the relationship between surveyed items and
denture use identified that nonuse of dentures was associated with the ability to
gargle, the degree of care, the degree of dementia, and ADL. A multiple stepwise
logistic regression analysis showed that the nonuse of dentures had a significant
association with eating (p<0.05),bathing (p<0.01), the ability to gargle (p<0.01),
and the number of remaining tooth crowns (p<O.Ol).We found that nonuse of
dentures was related to the number of remaining tooth crowns and the ability to
use the hands and the mouth in ADLs.
146 S p e c Care Dentist 2 4 ( 3 / 2 0 0 4
71
Teaching oral health: a self-learning module.
*J.MORREALE (Mohawk College, Hamilton, Ontario, Canada)
My objective is to demonstrate a self-learning module in CD format,
which can be used to teach oral hygiene to nurses, registered practical
nurses, and caregivers. With this primer course in dentistry, people can
teach themselves as quickly and as m u c h as they wish to learn. The
course can also be used as a basis for continuing education and as a
manual for groups. There are other self-learning modules for geriatric
dentists and hygienists and any other allied professional who wants to
learn about oral health and maintaining a quality of life for the patient.
I will use a lap top computer to show the actual programs Dentistry and
Oral Health and Oral Health and the Elderly. Participants will learn to
identify oral diseases, ill-fitting dentures, caries, etc., as well as learn
preventive dental techniques. This self-learning method of continuing
education for staff can be taught as a group o r individually. Tests follow
each section to help participants evaluate their understanding of the
section before continuing to the next module.
72
A Protocol for dental treatment in patients
w i t h C1-INH deficiency.
*M. NARCISO, E . RAIMONDO, D. SAVINI, A. DE CUNTIS
(S.I.O.H. Calabria, Cetraro Hospital, Cosenza, Italy)
The purpose of this work was to create a protocol for dental treatment
of patients affected by C1-INH quantitative o r qualitative deficiency,
which causes a disease called hereditary angioedema. The reduced
serum level o r the reduced activity of C1-INH leads to a n uncontrolled
activation of complement, which causes the production of vasoactive
mediators and consequent edema. Hereditary angioedema is character-
ized by recurrent skin, intestinal and laryngeal edema. Laryngeal
edema can lead to death by asphyxiation. Angioedema is diagnosed by
laboratory examinations and familial history. In order to treat a patient
with a recurring history of laryngeal and skin edema attacks, along
with laboratory findings of C1-INH deficiency, we performed a broad
review of the literature with inclusion criteria AI-A2. Preventing
angioedema i n patients includes avoiding traumas. Dental treatment
may precipitate a n attack of angioedema, which can be fatal. In most
cases, this complication can be avoided with preventive pharmacologi-
cal therapy of C1-INH.
Abstracts

13
Framework for undergraduate dental educa-
tion in special care dentistry.
*J. NU”’, S. THOMPSON2,A. DOUGALL’, J. GRIFFITHS3
(‘School of Dental Science, Trinity College, Dublin, Ireland,
2South Warwickshire Primary Care Dental Services, UK,
’University Dental Hospital, Card$, UK)
The British Society of Oral Health and Disability convened a Teachers
Group in 2002 to develop a generic undergraduate curriculum in spe-
cial care dentistry The educational goals were to fulfill the criteria for
undergraduate education exemplified in the First Five Years: A
Framework for Undergraduate Dental Education (General Dental
Council, UK) to meet the benchmarking academic standards of the
Quality Assurance Agency in the UK and those in Europe (DentEd).
One of education’s goals is a seamless transition from undergraduate to
postgraduate education that is consistent with the philosophy of life-
long learning. Future dental teams should be familiar with, have knowl-
edge of, and be competent in, the different areas of special care den-
tistry This presentation will explain the current status of teaching in
special care dentistry in the UK and Ireland: (1) the overall perspective
of education in special care dentistry; (2) the early undergraduate years;
(3) and the clinical years and postgraduate education; and (4) the edu-
cation of professionals complementary to dentistry We will discuss the
use of innovative educational methods including Disability and Equality
Training by service users; using actors and ‘role play;’ ‘instant’ aging
workshops; specialized options and outreach teaching; modular dis-
tance learning; and the Special Interest Group and the British Society of
Disability and Oral Health study days in postgraduate education. The
importance of interdisciplinary teamwork will be emphasized through-
out the educational process.
Surgical interventions for prevention, restora-
tive care, orthodontic care, and preventing
malnutrition in very rare patients.
*B.L. NUSSBAUM’.’, R.I. DECIDUE,’ (‘Pediatric and Special
Needs Dentistry, Cherry Hill, USA, 2ThomasJefferson University
Medical School, Philadelphia, USA)
Patients who are unable to open their mouths are very rare. The
authors reviewed twelve patients they treated who had Fibrodysplasia
Ossificans Progressiva and describe the steps taken, including dentistry,
oral surgery, and anesthesia, to treat such rare patients. Fibrodysplasia
Ossificans Progressiva, which occurs in one in two million live births,
causes all striated muscles and tendons to turn to bone and renders the
patients helpless because they are encased in a cast of their own bone.
In particular, the jaws fuse shut, causing potential malnutrition. The
authors review the characteristics of patients with Fibrodysplasia
Ossificans Progressiva based on examinations of 120 patients with the
disease. Office procedures that can prevent jaw fusion as well as restora-
tive care are also detailed.
Abstracts
ABSTRACTS
Optimal target concentraton of intravenous
sedation with a target-controlled infusion
(TCI) system in elderly dental outpatients.
*I OHWATARI, H. FUKAYAMA, H. UEMATSU, M. UMINO
(Graduate School, Tokyo Medical and Dental University, Tokyo,
Japan)
A target concentration of TCI was started at 0.3 micrograms/ml adjust-
ed in steps of 0.1 micrograms/ml to maintain a sedation level 3
(Wilson’s sedation score). The mean age of the patients was 74.5 years
(SD: 3.9). The mean optimal target concentration was 0.78 (SD: 0.22)
micrograms/ml and its range was from 0.50 to 1.40 micrograms/rnl.
One complication was slight delirium in two patients. Mean VAS scores
for the surgeon’s satisfaction was 80.4 (SD: 12.2) mm and 92.4 (SD:
9.2) mm for patients. Amnesia in patients was found after local anes-
thesia (75%) and dental treatment (79.2%). We concluded that intra-
venous sedation with propofol TCI can be safely used in elderly dental
outpatients; its optimal target concentration may be 0.8 micrograndml.
76
Oral findings and 18-month follow-up treat-
ment in two siblings with Autistm.
*EA. OREDUGBA (College of Medicine, University of Lagos, Idi-
Araba, Nigeria)
Autism is marked by extreme abnormal emotional, social and speech
development. Dental management is therefore most challenging for
pediatric dentists. This presentation highlights some significant oral
findings and treatment challenges in two male siblings with autism,
aged 11 and 9 years (A and 3 respectively). Their physician referred the
siblings to the pediatric dental outpatient clinic for oral care. Their
medical, dental and family histories were taken and general physical
and oral examinations were completed. Findings showed severe halito-
sis, poor oral hygiene, generalized marginal gingivitis and DMFT of 0 in
both patients-Sibling A: S-OHI=4.1, Overjet=bmm and a mobile maxil-
lary primary second molar; Sibling B: S-OHI=2.5. Initial treatment
included extracting the mobile tooth in A and oral prophylaxis in both
patients. An intensive oral care regimen including routine professional
prophylaxis and parental counseling was designed for both patients.
Over the following 18 months, oral hygiene improved significantly We
concluded that the oral health of children with autism can be controlled
by regular professional care, supported by parents and caregivers. Such
a program can prevent gingivitis and periodontitis when instituted early
and continued through adult life.
S p e c Care Dentist 24(3) 2004 147
ABSTRACTS
Dental abnormalities in an adolescent with
the HbSC genotype.
“FA. OREGUGBA (College of Medicine, University of Lagos, ldi-
Araba, Nigeria)
Individuals with the HbSC genotype present a variant of Sickle Cell
Disease (SCD), which has a lower prevalence and fewer severe clinical
symptoms than the homozygous state (HbSS). Dental abnormalities
such as hypoplasia, hypodontia and delayed eruption of teeth have been
associated with HbSC. This report presents a case history of a 15-year-
old female adolescent patient with HbSC who has retained primary
teeth, oligodontia and transposition of a permanent tooth. She arrived
at the pediatric dental outpatient clinic with a toothache and swelling
on the left side of her face. After a history was completed, oral and radi-
ographic examinations showed a carious, mobile mandibular left first
permanent molar; roots of maxillary and mandibular right second pri-
mary molars; retained mandibular left second primary molar and maxil-
lary right primary canine; and the maxillary permanent canine trans-
posed to the position of the missing lateral incisor. Carious and mobile
teeth were extracted under antibiotic cover and oral hygiene and dietary
programs were initiated. A panoramic radiograph showed missing sec-
ond premolars, maxillary right lateral incisor, and left third molar. A
removable prosthesis and conversion crowns were planned for the
patient after receiving patient and parental consent and taking cost into
consideration. We concluded that treatment planning for the patient
with SCD, especially when dental rehabilitation is indicated, can be
complicated by the frequent crises experienced by the patient.
Preventive care should begin as soon as SCD is diagnosed.
78
Identification of oral candida colonization in
elderly patients from South Texas.
‘M.N. PARTIDA, S. DIRKS, S. REDDING, B. COCO, W KIRK-
PATRICK, 1 PATTERSON (University of Texas Health Science
Center at Sun Antonio, USA)
Candida glabrata has emerged in recent years as a common cause of
systemic fungal infection, especially in the elderly Reports of oral infec-
tion with this organism are increasing. Studies done in Iowa and Japan
have shown that oral colonization with C. glabrata increases as people
age. The purpose of this pilot study was to determine the epidemiology
of oral colonization with C. glabrata in elderly patients from South
Texas. Fifty patients > 70-years-old from the Senior Care Geriatric
Dental Clinic at the UTHSCSA Dental School were evaluated. The
patients had no oral manifestations of candidiasis. To determine oral
colonization, fungal cultures were obtained using both an oral swab and
a swish saline sample. Samples were plated on CHROMagar Candidam
chromogenic media and species confirmed by characteristic color of
colonies. Sixty percent of patients were colonized with Candida, 52%
with C. albicans, 24% with C. glabrata and 14% were mixed with both
species present. We concluded that C. glabrata is a common oral colo-
nizing organism in elderly patients living in South Texas. It is common-
ly mixed with C. albicans but does occur alone. This organism’s role in
oral infection in the elderly needs to be explored further.
q48 S p e c C a r e D e n t i s t 24(3) 2004
79
Conscious sedation for special care patients.
“N. ROBB’, S. THOMPSON’, C. PENNELL’, L. BREMNER’, L.
MCARTHUR’ (‘University Central Hospital, CardijJ Wules,
‘Glasgow Dental School, Scotland)
Conscious sedation (CS) is a technique taught within the dental under-
graduate curriculum in most dental schools across the UK and Ireland.
CS is one of many management strategies used by the dental team to
manage pain and anxiety in patients. This workshop will include: (1)
A n overview of conscious sedation (CS) defined and described as it is
practiced within the UK and Europe, including the techniques currently
advocated; (2) Using CS techniques for special care patients along with
case studies highlighting different techniques that are useful for anxiety
control; ( 3 ) Training for the dental team, which will focus on the
knowledge, skills and clinical training required for ’competency’ in CS
techniques for dental surgeons. A parallel session will examine the
training requirements for the NEBDN (National Examining Board for
Dental Nurses) Certificate in Dental Sedation Nursing that is the ‘gold
standard for the second appropriately trained person.
80
The New York Taskforce in Special Dentistry:
meaningful improvement in oral health for
individuals with developmental disabilities.
“M. ROMER’, N. DOUGHERTY’ (‘Albert Einstein College of
Medicine, Bronx, USA, ’New York University College of
Dentistry, USA)
The New York State Office of Mental Retardation and Developmental
Disabilities (OMRDD) estimates that over 120,000 individuals with
developmental disabilities currently reside in New York State. Although
New York enjoys an abundance of dental providers, many people with
developmental disabilities continue to experience difficulties in access-
ing appropriate dental care. To respond to this problem, OMRDD in
February 2003 convened the first meeting of a “Taskforce in Special
Dentistry.” Taskforce members have been charged with exploring a
number of issues including funding, education, behavior management,
and quality of care. The objective of the Taskforce is to improve the
oral health care of all individuals with disabilities in New York. The
information presented about the taskforce will include: the mission of
the taskforce; its formation by the state; its composition in terms of
involved personnel; its organizational structure; how to keep communi-
cation flowing between meetings; and a summary of taskforce accom-
plishments to date.
Abstracts

Clinical restoration of totally abraded teeth
in a 26-year-old female patient with autism:
a case report.
*G. ROMHILD (Charite Humboldt-University, Dental School,
Berlin, Gemany)
A 26-year-old female patient with autism ground her teeth in an abnor-
mal behavior. Because of a lack of previous dental treatment, she has a
significant loss of tooth structure worn down to the gingiva level as
well as an open bite. A s a result, the patient was unable to bite properly
or chew food. Without restorative treatment together with splint thera-
py, her bruxism could not be controlled or even reduced. Because the
patient was not able to cooperate during treatment, general anesthesia
was necessary while we rebuilt her teeth with composite resins. A rub-
ber dam was needed to achieve a good outcome. After restoration, elas-
tomeric impressions were made to fabricate bite-guard splints. The
treatment enabled the patient to have improved biting and chewing,
which improved her nutritional intake
Mobile dental health care treatment and
training in homes for pat ents with special
needs.
*G. ROMHILD, I. KASCHKE, K.-R. JAHN (Charite Humboldt-
University, Department of Operative and Preventive Dentistry,
Dental School, Berlin, Germany)
Better education is needed to provide dental treatment in homes for
patients with special needs. Our objective was to organize a portable
unit with the dental tools and equipment needed to treat patients with
special needs. We also developed programs to train and better educate
medical attendants working in homes, and to provide solutions to den-
tal problems and provide new ideas for treatment and dental prophylax-
is in homes for patients with special needs.
Abstracts
ABSTRACTS
83
LADD syndrome.
*C.E SALINAS, R.E. TAYLOR (Medical University of South
Carolina, Charleston, South Carolina)
LADD (Lacrimo-Auriculo-Dento-Digital) syndrome is an unusual genet-
ic disorder of autosomal dominant inheritance with variable expressivi-
ty The objectives of this presentation are to describe the clinical charac-
teristics of LADD syndrome, to discuss the results of a comprehensive
dental treatment approach, and to review the literature about the syn-
drome. Our case report involves one female who exhibited the main
characteristics of the disorder: hypoplasia of the lacrimal puncta, peg-
shaped teeth, generalized enamel hypoplasia of the permanent teeth
and preaxial digital anomalies. The patient’s father also has LADD syn-
drome and recently the patient gave birth to a daughter who was also
affected. The patient was examined by one of the authors and referred
for a genetic evaluation where a diagnosis of LADD syndrome was
given. From the dental point of view, severe enamel hypoplasia has
affected all of her permanent dentition. In addition, her lower mid-face
appeared prominent. Dental treatment consisted of constructing porce-
lain crowns for all affected teeth. As a result, an excellent occlusal rela-
tionship was achieved as well as nearly eliminating the lower mid-face
deficiency effect. Dentists treating patients with special health care
needs should be aware of the significance of dental findings that are
related to complex syndromes.
Improving dental access to special patients:
the South Carolina experience.
*C.E SALINAS, R.A. BELL (Medical University of South
Carolina, Charleston, South Carolina)
At the Medical University of South Carolina, we developed a comprehen-
sive approach to address the oral-dental needs of children with special
health care needs. Our program’s objectives are: (1) to provide a state
referral service for diagnosing and treating children with special needs;
(2) to empower the patient’s parents to become effective managers of the
childs dental needs; ( 3 ) to provide educational experience for the dental
students and residents and develop Annual Continuing Education cours-
es for dentists and their teams; (4) to develop a statewide Web-based net-
work of dentists; (5) to foster dental research studies in this population;
and (6) to develop outreach activities such as Special Olympics Special
Smiles. As a result, over 4,000 patients are seen annually; 230 are seen
under general anesthesia. Eleven courses for dental students and resi-
dents are taught with topics related to diagnosis and treatment of patients
with special needs. During the last five years an Annual Continuing
Education Course has trained free of charge 1,000 dental health profes-
sionals in the state. In outreach, the Special Olympics Special Smiles pro-
gram has been carried out since May 2001. Students and residents have
participated in research topics related to special patients. Our results have
demonstrated the overwhelming need for a program that includes service,
teaching, research, and outreach activities is valid and viable. The pro-
gram’s activities have effectively decreased the disparities observed in den-
tal access for patients with special needs.
S p e c Care Dentist 2 4 ( 3 ) 2004 149
ABSTRACTS
Down syndrome with additional multiple sys-
temic pathology: report of a clinical case.
“G. SCAGNET, T. FERRARY, E GRISOLIA, L. KRIEGER, M.
MARCANTONI, MJ. GIGLIO (Oral Clinical and Pathology I,
CLAPAR 11, Dentistry School, Buenos Aires University, Argentina)
We optimized dental treatment for a female patient, aged 34, with Down
syndrome, Type 1 diabetes, hyperthyroidism and inborn cardiomyopathy
(ASA 111). A clinical examination detected severe periodontitis and atypi-
cal swallowing. We used the following parameters: OLeary’s plaque
index; bleeding on probing; probing pocket depth; probing attachment
level; Ramjord index; and mobility Dental treatment was based on the
patient’s medical risk. We used antibacterial prophylaxis as per the stan-
dard of the American Heart Association, sedation before dental treatment,
controlled blood glucose levels before and after dental appointments and
also checked blood pressure. We removed teeth with a mobility=III,
scaled and root planed the teeth, and performed subgingival irrigation
with antibacterial compounds. A new prosthetic device, coiisisting of
molar bands to support the anterior teeth, was developed in our laborato-
ry. After three months of therapy, we detected a gradual decrease in the
periodontal and plaque indices with values of 20% and 40% less than
baseline. There was improved masticatory function and a decrease in
blood glucose levels (180-220 mg/dl). In this clinical case, specific
actions were carried out to improve dental care and prevent infection,
which was essential for a Type 1 diabetic patient. Fitting a prosthesis
helped restore masticatory function and allow better feeding. The treat-
ment also resulted in a decrease in the patient’s blood glucose level.
Protocol of dental care for patients with
hy p e r- I g E sy n dr o me (HIE S ) .
*G. SCAGNET’, M. ARMADA’, S. KRASOVEC’, M. OLEASTRO’
(‘Special Patients Service, Quinquela Martin Hospital of
Pediatric Dentistry, ’Immunology Service, J.€!Garrahan National
Pediatrics Hospital, Buenos Aires, Argentina)
Hyper-IgE syndrome (HIES) includes several alterations of the dentition.
Treating this illness is based on supportive therapy and focuses on preventing
oral infection. Dental care is an essential part. The purpose of this study was to
develop a dental care protocol for 32 Argentinian patients with HIES who were
reported to the Latin American Group of Immunodeficiency(LAGID) Registry
as of September 2002. Sixteen were treated in the Immunology Service of the
Pediatric Hospital Garrahan; all were diagnosed with buccal candidiasis. Since
June 2003, dental care has been provided for 2 of the 16 patients and this expe-
rience has resulted in the design of a dental care protocol for patients with HIES.
Treating systemic and oral malformations by attaining and maintaining oral
health, included preventing and/or treating infections to avoid systemic disease.
We detected and treated dental anomalies early by: (1)Working with immunol-
ogists; (2) Completing clinical and radiographic diagnostic assessments;(3)
Working with the patient and hidher family to reduce anxiety; (4) Creating a
dental rehabilitation plan that emphasized prevention; (5) Treating oral candidi-
asis; (6) Using antibiotic prophylaxis during procedures that could result in bac-
teremia; (7) Avoiding drug interactions with medical prescriptions; (8)Using
oral prostheses to prevent dental malformations. Our conclusion from develop-
ing this interdisciplinaryprotocol was that it is important to correctly treat
patients with HIES and avoid systemic complications caused by dental proce-
dures. With this protocol it will also be feasible to document the incidence of
dental disorders in the Argentinian population of patients with HIES.
150 S p e c C a r e Dentist 2 4 ( 3 ) 2 0 0 4
87
The role of information technology in primary
health care (PHC) and the medical library.
*A. SHAMS (Isfahan University and Medical Sciences, College of
Management and Medical Information, Isfahan, Iran)
From the beginning of history, the human mind has strived to prevent
disease and promote health. According to the World Health
Organization (WHO), health is defined in physical, psychological and
social dimensions and hygiene is the science of maintaining and pro-
moting health. WHO has also defined technology as the use of science
in every field, especially in library science. The latest WHO program,
PHC (primary health care) emphasizes promoting hygiene to the public
and the importance of organizational participation in hygiene promo-
tion. As a health manager in the Chaharmohal province health system,
the author prepared a learning method for health promotion by taking
photographs of unhygienic locations in the local village, preparing
slides and showing them in the village mosque after midday prayer,
which enabled him to discuss different aspects of hygiene. This style of
health promotion was educational for participating villagers and helped
change their attitudes and health behaviors. In a similar way, the new
digital world with companies like Yahoo, Google and Microsoft have
changed the concept of libraries and library information so that pro-
moting hygiene and health can be more easily accomplished with the
increased use of computer technology and libraries.
Dental management of the pediatric HIV
patient.
“K. SHETTY (Louisiana State University Medical Centev, New
Orleans, USA)
Pediatric HIV disease has changed significantly over the last few years
with the vast majority of new pediatric HIV cases resulting from perina-
tal transmission of the virus. In the United States there are approxi-
mately 1,400 to 2,200 HIV-infected infants born each year. Children
exhibit significant differences in oral manifestations, as well as different
virologic and immunologic responses to the virus, when compared to
adults, such as infections of the teeth, mucosa, gingival and periodontal
tissues, and oral lesions, which cause pain and discomfort, compromise
function, interfere with oral hygiene, and may negatively affect the
patient’s general health. Children with untreated or poorly controlled
HIV may suffer from poor nutrition because of carious teeth and a
painful dentition or they may have untreated soft ’tissue problems,
which result in an inability to chew properly The effects of HIV infec-
tion on the pediatric patient and the patient’s family may alter the
provider’s approach to dental treatment. Preventive measures provided
by the caregiver and the medical-dental team are critical for a child with
HIV infection. This presentation will address the natural history of HIV
disease in children, offer diagnostic techniques for oral lesions; and dis-
cuss appropriate therapeutic and preventive interventions in dental
management.
Abstracts

Oral health status of school children with
mental retardation and visual impairment.
*SJ. SIM (Dental Clinic, National Rehabilitation Centeu, Seoul,
Korea)
We surveyed the oral health of 345 school children with mental retarda-
tion and 230 children with visual impairment, between 6 and 24 years
old, to develop an oral health promotion program. The children, who
attended five special schools in Seoul, Korea, were examined using the
dft index, dt rate, ft rate, DMFT index, DT rate, MT rate, and FT rate.
The DMFT index for all the children was 3.53k3.73 (n=575); the
DMFT index of children with mental retardation was 3.41+3.41
(n=345), and the DMFT index of children with visual impairment was
3.72k4.17 (n=230). There was no difference in the DMFT index
between children with mental retardation and visual impairment
(p0.05) and no significant difference in the two groups (p>0.05).
However, the boys’ DMFT index was significantly lower than the girls’
( ~ ~ 0 . 0and
5 ) the DMFT index increased with age (p<O.Ol). While a
dental clinic had provided oral health care for 3 years to children at one
of the five schools (group Oii), the children at the other schools did not
have dental care (group O f ) . The DMFT index of group Ou was
3.11*3.81 while that of group Of was 3.60+3.71, so there was no sig-
nificant difference (p>0.05). The DT rate of group Ou, however, was
significantly lower than that of group O T (p<O.Ol). We concluded chil-
dren with mental retardation and visual impairment have a significant
need for an oral health promotion program.
Oral microbiota of patients with handicaps
and mouthbreathing during orthopedic treat-
ment.
*J.A.U.SOUZA’,’,M.A.A. SANTOS’, S.B.O. BOACNIN’, S.E.
DUAlLIBIZ,’,M. T. DLJAILIBIZ,’(‘Microbiology Department of
Universidade de Sao Paulo, ’Dentistry for Special Need Patients
Department of UNICASTELO - Universidade Camilo Castelo
Branco, ’Otorhinolaryngology Department of UNIFESP -EPM-
Universidade Federal de Sao Paulo)
We studied the oral microbiota of 20 patients with handicaps and
mouthbreathing during orthopedic treatment in the clinic at the
Dentistry for Special Need Patients Department of UNICASTELO.
Saliva for microbiological analysis was collected using a sterilized swab,
transferred to a tube with 9 ml of phosphatase saline solution and incu-
bated in appropriate medium at 37 degrees C for 1 to 7 days. We found
fungi contamination (loo%), staphylococcus sp and anaerobic gram +
cocci (SO%), and aerobic gram + cocci (90%).We conclude that oral
microbiota are found in the orthopedic functional appliances of patients
with handicaps who mouthbreathe.
Abstracts
ABSTRACTS
91
Orthodontic treatment a s a prerequis te for
successful orofacial rehabil tation of patients
with cerebral palsy.
*K. STAUFER, r. KLAR,J. HAGEMANN, H. LANDMESSER
(Department of Orthodontics, University of WittenlHerdecke,
Germany)
Severe malocclusion impedes the progress of therapeutic physiological
exercise programs. Our goal was to determine which type of malocclu-
sions were most likely to affect dentition development, at what point
during development it is likely to occur, and how the progression of
intra- and extraoral deformities could be prevented. We examined mal-
occlusion in 42 children with cerebral palsy (average age 11.2, 22 male
and 20 females). The children were examined by using cast analysis,
categorizing malocclusion according to Klink-Heckmann, and evaluat-
ing space using Lundstromk segmented arch analysis. We found the
prevalence of severe overjet was 79%, posterior crossbite was 48%, and
spacing in the upper jaw was 45%, including an extreme protrusion of
the upper incisors. Thirty-three percent of the patients had an open bite
and 31% of the patients had severe crowding in the manidbular arch.
We found that reducing the overjet was needed to improve oral func-
tion because the early mixed dentition was susceptible to malocclusion,
severe sagittal extension and transvers compression of the maxilla.
Orthodontic treatment should be completed before myofunctional exer-
cise programs are begun.
Interdisciplinary care plan for patients with
cerebral palsy who have airway problems.
*I ARI, I. TANBOGA (Marmara University Faculty of Dentistry,
Istanbul, Turkey)
Cerebral palsy (CP) causes chronic childhood disability in 1.4-2.7% live
births. To prevent respiratory complications, a multidisciplinary team of
speech pathologists, a pediatric dentist and an ear-nose-throat specialist
created individual programs for these patients. The dental program used
an individually designed removable maxillary expansion appliance for 7
physically able patients with CP, aged 7-13 years, to increase breathing
and swallowing. The children were encouraged to use the appliance for
one hour daily and gradually increase the time to 6-10 hours daily. Six
months later, the children were evaluated and their cephalometric
analysis was done. The mean treatment time for each appliance was 5.5
months; all patients had a statistically improved airway passage/width
(p<0.005). Our results showed that maxillary expansion appliances may
help patients with CP who have compromised pulmonary function.
Spec C a r e D e n t i s t 2 4 ( 3 ) 2 0 0 4 151
ABSTRACTS
Laryngeal mask airway in dental procedures
for patients with mental disabilities.
*V SCIGEL, I! MICHALEK (Dental Department for Patients at
Risk, Institute of Clinical and Experimental Medicine, Prague,
Czech Republic)
General anesthesia is needed in many dental procedures for patients
with mental disabilities (MD). During 30 months (2001-2003), we eval-
uated the safety of using a laryngeal mask airway (LMA) with general
anesthesia during dental treatment of 27 patients with MD. Depending
on the type and extensiveness of the treatment plan, increased risk of
aspiration, and expected risk of complications, various methods of air-
way management were used. Six patients with spontaneous ventilation
needed no additional airway management, orotracheal intubation was
used for 9, and LMA was used for 12 patients. There were no periopera-
tive complications using LMA and patients had a faster, less traumatic
postoperative recovery of psychomotor function compared to patients
who had undergone standard intubation. We concluded that the LMA is
a suitable alternative for patients with MD during short outpatient den-
tal procedures, which require general anesthesia.
The oral health condition of children with
severe mental retardation (4-12 years) in
Dutch daycare centers.
"C.M.H.H. VAN HOUTEM, A. DE JONGH, D.L.M. BROERS, M.
VAN SCHOOF, G.H.B. RESIDA (ACTA, Academic Centre for
Dentistry Amsterdam, Netherlands)
We evaluated the oral health and dental treatment needs of 128 chil-
dren with severe mental retardation attending 7 different daycare cen-
ters in the Netherlands. During the children's oral examination, both
their parents and their dentists completed several questionnaires.
Thirty-seven children, aged 4-12 years, 65% male, had a mean plaque
index of 52% and a mean bleeding index after brushing of 21%. Ten
peirent of the teeth were decayed, 19% were restored, 2% had el-osion
and 14% had signs of abrasion. Ninety-one percent of the children
received help with brushing. Although 70% of the parents (n=128)
thought their children's oral hygiene could be improved, only 13%were
dissatisfied with their children's dental health, even though 32% of the
children received n o dental care. Forty-eight percent of the dentists felt
that treating children with severe mental retardation was more compli-
cated than treating normal patients and 26% were dissatisfied with their
own delivery of care. We concluded there was insufficient preventive
dental care in Dutch daycare centers and there was a significant need to
provide dental care to children with severe mental retardation.
169 T n e r r a r e nentist 74/,?11 2004
Nutritional status and oral related quality of
life in complete denture wearers.
"J.L. VEYRUNE', M. BESSADET', C. LASSAUZAY', B.
LESOURD' ('Dental Faculty and 'University Hospital of
Clermont-Ferrand, France)
We evaluated the relationship between the nutritional status of 26 com-
plete denture wearers who had been edentulous for more than a year
and their oral quality of life. Fifteen women (mean age 69.4 years *9.7)
and 11 men (mean age 70.7 years 27.7), with an ovcrall age of 70.0
years k8.8, were assessed for nutritional status using the Mini
Nutritional Assessment to determine body mass index. We used the
Global Oral Health Assessment lndex (GOHAI) to determine the
impact of oral status on quality of life and completed the statistical
analysis by using the Mann-Whitney test and Pearson's test. Our results
showed that 8% of the patients had malnutrition and a BM1 under 21
kg/m2. Forty-six percent of the patients were overweight, with 67%
moderately overweight and 33% obese. Patients had a low daily energy
intake (22 Kcal/g/joule) and lacked vitamins in their diet, particularly
vitamin D. The GOHAI score showed a statistically significant correla-
tion between the patients' oral status and their choice of soft foods.
Overall, the patients' nutritional intake was good despite choosing food
that is easy to chew.
Improving quality of life without lifting a
handp ie c e m
*C.A. WATKINS (Wake Forest University Baptist Medical
Center, Winston-Salem, North Carolina)
Special Care Dentistry (SCD), a North Carolina program, uses portable
equipment to provide comprehensive oral care to nursing home resi-
dents who are screened annually. A dentisthygienist team screened 429
residents in three nursing facilities; each facility was screened within a
one-week period. Screening data included treatment status, dentate sta-
tus, oral prescriptions, and initial diagnosis of oral lesions. A triage
process defined emergency needs (range: 2.8-4.6%) as pain or related
behavior reported by the patient or nurse. Urgent needs (range: 9.8-
16.4%) were defined as problems that could become painful within
months. Oral conditions treated with prescriptions included candida or
angular cheilitis (72%), severe xerostomia (13%), advanced
gingivitis/stomatitis (12%), lichen planus (2%), and oral herpes (1%).
One resident resumed eating after receiving anti-fungal treatment and
was removed from hospice care. In all, the screening data showed that
9 8 patients had urgent oral needs and 60 patients were treated for oral
conditions.
Abstracts

Palliative care dentistry: bridging the gap
between restoring quality of life issues and
oral care.
*M. WISEMAN’, A. BOCCIA’ [‘Faculty of Dentistry McGill
University, Montreal, Canada, ’St. Joseph’s Health Centre,
Toronto, Canada)
Palliative care or end-of-life patients have significant oral problems due
to medications or the effect of disease on the oral cavity. A palliative
care team should include a dentist, who is an expert in treating oral
conditions. Poor oral conditions will often result in opportunistic infec-
tions, xerostomia, and problems with nutrition and speech. By improv-
ing a patient’s ability to eat food, a palliative care dentist can restore the
patient’s dignity and improve hisher quality of life. This symposium
will present examples of oral conditions and outline techniques for
treating these conditions in palliative care patients.
The benefits of mentoring in dental educa-
tion.
*A. WONG,]. DOWER,]. PARK, N. NGUYEN [University of the
Pacific School of Dentistry, San Francisco, USA)
The goal of our one-year program was to transfer the skills and abilities
of the director of local anesthesia to an A.E.G.D. resident who would
gain the experience needed to become a local anesthesia course instruc-
tor for continuing education courses. Through mentorship, the resident
observed the director’s teaching techniques, demonstrated those tech-
niques to the director, and assumed teaching responsibilities under
daily review by the director. After three years, one resident was now
employed as faculty with the following schedule: a local anesthesia
course instructor (one day), clinical faculty in restorative dentistry (one
day), provides care in Hospital Dentistry (one day), and privately prac-
tices (two days). A second resident has just completed the mentorship
program and is currently a preclinical instructor in operative dentistry, a
local anesthesia block instructor, and is preparing to instruct a post-
graduate course in local anesthesia. A third resident has just begun the
mentorship program. This program increases the clinical and teaching
skills of residents and produces quality dentists and educators.
A b s tra cls
ABSTRACTS
100
Predictors of dental treatment in an elderly
long-term care population.
*C.C.L. WYATT [Faculty of Dentistry, University of British
Columbia, and Centre for Aging and Health, Providence Health
Care, Vancouveu, British Columbia)
We studied 831 elderly residents (mean age: 84.2 years) of 7 long-term
care (LTC) hospitals who had access to a comprehensive dental care
program. Resident data (hospital, gender, age, medical conditions and
medications) was gathered using the CODE assessment (Clinical Order
Disorders in Elders). This data along with the CODE scores, which pro-
vided dental conditions, were used to predict dental treatment using
Chi-square analysis and Cox & Snell logistic regression analysis. We
recommended treatment for 535 residents; 240 consented to dental
care. Residents who were more likely to receive treatment included
females (p=0.002), patients younger than 86 years (p=O.OI5), patients
with a nervous system disorder (p=O.O18), patients who took more than
5 medications per day (p=O.OOl) or who took medications with possi-
ble xerostomic side effects (p=0.007), and patients who were partially
or completely dentate (p<O.OOl). The CODE oral health assessment
accurately predicted which residents received treatment. We found poor
oral health and substantial treatment needs in elderly residents of LTC
hospitals. Partially edentulous residents desire dental treatment and oral
hygiene services.
101
Characteristics of lower-jaw-position sensa-
tion with respect to oral-jaw functions in
patients with cerebral palsy.
*M. YOSHIDA, I. NAKAJIMA, A. UCHIDA, T. YAMAGUCHI, H.
YOSHIDA, S. NAKAMURA, M. IWASAKI, T. NONAKA, Y. KIJI-
MA [Department of Pediatric Dentistry, Nihon University School
of Dentistry, fokyo,]apan)
We studied the effect of a vibration stimulus applied to the lower jaw
muscle of 8 patients with cerebral palsy (CP) and 8 healthy adults.
Subjects held a reference stick between their central incisors for 5 sec-
onds followed by a test stick with a smaller diameter for 5 seconds.
Both groups were then asked whether the test stick diameter was “larg-
er” or “smaller” than the diameter of the reference stick. They were
tested both before and after applying the vibration stimulus. When the
healthy adults’ ability to discriminate was compared before and after
using the stimulus, the rate of error (RME) was significantly higher
after the stimulus application when the test stick diameter was smaller
than the reference stick diameter. When the discrimination ability of
the patients with CP was compared before and after the stimulus was
used, the RME was significantly lower after the stimulus application
when the test stick had a smaller diameter than the reference stick
diameter. We found that because the patients with CP have a decrease
in motor-neuron activity, the results for these patients differed from the
results of the healthy patients.
Spec Care D e n t i s t 24(3/ 2004 153
ABSTRACTS
103
How Swedish dental professionals should
approach and meet their patients with dis-
abilities: a project to increase quality in
caret aking.
‘B. AHLBORG’, B. ALBORN’, J. NORDERYD’, E. WALLENIUS3
(’Mun-H-Center, Goteborg, ’Swedish section of IADH, Jonkoping,
’The Swedish Association of Rare Disorders, Sundbyberg,
Sweden)
The present project was a government-supported collaboration between
dental professionals and patient organizations to educate dental profes-
sionals about the difficulties people with disabilities experience in the
Swedish dental care system. Dental clinic staff and people with disabili-
ties and their families were invited to 14 meetings throughout Sweden.
Experiences, observations and reflections were documented and ten
main points from the material were used to create a short book, which
has been sent to all Swedish dental clinics free of charge, to improve the
relationship between dental professionals and patients with disabilities.
104
Clinical application of an injection needle
that can be inserted and safely recapped
outside of the patients’ view.
*I AKASAKZ‘, H. ISHIGURO’ (‘Medical Corporation Dental
Clinic Hamille, Aichi Prefecture, Handa City, Japan, ’Dentistiy,
Aichi Prefectural Colony Central Hospital, Kasugai City, Japan)
We studied how effectively an injection needle with a slide-cap prevented
needle sticks and provided relief and safety for 39 patients with mental
disabilities (age: 2.8-42) and 30 healthy patients (2.0-9.9).We explained
that the injection needle was a “special anesthetic” then carried out infil-
tration anesthesia in the gingivobuccal sulcus without surface anesthesia.
The new needle was “effective” in 44 subjects, “partially effective” in 13,
and ‘‘not effective” in 12. Among the 51 subjects with previous anesthesia
experience, 32 reported that this needle was “effective,” 9 “partially effec-
tive,” and 10 said it was “not effective.” Among the 18 subjects with no
anesthesia experience, 12 reported that it was “effective,” 4 “partially
effective,” and 2 “not effective.” Our new injection needle with a slide-
cap is useful for patients who are cautious or fearful and provides relief
and safety for them and for health professionals.
154 Spec Care Dentist 24(3) 2004
105
Retrospective evaluation of delayed healing
after simple extractions in patients with HIV
*M.E.A.EALVES, G. WEI, M. RISTY, M.C.E ALVES (University
of Illinois at Chicago HIV/AIDS Dental Program)
Alveolar osteitis is a potentially serious condition in immunosuppressec
persons but it is unclear whether being HIV-positive increases the risk
of not healing. The goal of our retrospective pilot study was to deter-
mine whether immunosuppression could increase the risk of complica-
tions following routine tooth extraction. We randomly selected 100
patient charts from the UIC-COD Ryan White Dental Clinic. We found
the following from evaluating specific variables: from 150 simple dental
extractions, 20 had delayed healinddry sockets (13%); 11 females
(55%) and 9 males (45%) did not heal well. We found no significant
difference with gender, race and age. The median CD4 for patients who
did not heal normally was 523, CD8 was 563, and viral load was unde-
tectable (less that 400/ml). Despite this limited small study sample, the
results suggest that patients with HIV seem to have more delayed heal-
ing than that which has been reported in the literature for the general
population.
106
Island in the sun: experiences from Agrenska
and Mun-H-Center.
*J.ANDERSSON-NORINDER’, A. OLAUSSON’, L. GUSTAFS-
SON’, I? DORNERUS’, M. ZELLMER’, A. CARLSSON’ (‘Mun-H-
Centev, Goteborg, Sweden, ’Agrenska, HovAs, Sweden)
This symposium discusses how the Mun-H-center, a Swedish national
orofacial center, and Agrenska, in HovAs, Sweden, collaborated using
multiprofessional teams to provide information and programs for
patients, their families, and oral health professionals. The Mun-H-center
offers consultation, advisory and examination services, tests and treat-
ment of dental and orofacial problems, aids and prostheses, and con-
ducts research and development. Agrenska provides programs for fami-
lies of children with rare disabilities, such as orofacial and dental health
impairment, and offers information to health care professionals. Both
facilities work multiprofessionally to ensure that patients with rare dis-
orders receive better treatment and an improved quality of life.
Abstracts

107
Neurocranial, dentofacial and dental pheno-
type in persons with Williams syndrome.
5.AXELSSON, K. STORGHAUG (TAKO-Centre, Resource
Centre for Oral Health in Rare Medical Conditions, Oslo,
Norway)
The purpose of this study was to describe the neurocranial, dentofacial
and dental characteristics found in Williams syndrome (WS), a rate
congenital disorder. We examined 25 males and 37 females with WS
(age range of 4.7 to 44.4 years) using lateral cephalograms, orthopanto-
mograms, and dental casts, which were analyzed and compared to a
control group. The group with WS showed more deviant neurocranial
morphology than the controls. The neurocraniuni was shorter in height
but longer because of a larger occipital bone. The anterior and posterior
cranial base was shorter in length and we found that the sella turcica
was smaller with more dysmorphology. The maxilla was shorter and
more rotated anteriorly. The chin was severely deficient with a high
plane angle. For the group with WS who were older than 10 years,
41.5% had agenesis of one or more permanent teeth while 12.2% had
agenesis of more than 6 permanent teeth. Compared with the control
group, the dimensions of permanent tooth crowns in subjects older
than 12 years were significantly smaller and there was altered tooth
morphology. We concluded that there are aberrations in the cranium
and permanent dentition of individuals with WS, which may compli-
cate orthodontic and prosthodontic treatment and affect dental esthet-
ics.
108
A study of oral conditions in elderly people
us in g smear c y t olo gym
*M. ENDOH, H. OKADA, T. MATSUMOTO, K. UMEZAWA,J.H.
CHO, H. YAMAMOTO, J. MEGA (Nihon University Graduate
School of Dentistry at Matsudo, Japan)
The purpose of our study was to determine whether smear cytology,
which is used to screen gynecological diseases, may also be effective for
screening for oral mucosal conditions. We examined 14 elderly special
nursing home residents and collected samples from the gingiva, cheek,
palate and tongue by using a brush (CytobrushB Plus). Papanicolaou
(Pap) and periodic acid-Shiff (PAS) stainings were done and observed
under light microscopy. Inflammatory cells, including leukocytes, were
found in 11 subjects (78.6%); candida-like cells were found in 8 sub-
jects (64.3%); and 12 subjects (85.7%) were classified as class I1 (Pap).
We concluded that smear cytology is useful in evaluating the condition
of oral mucosa in elderly persons.
Abstracts
ABSTRACTS
109
Evidence-based dentistry: how does one evalu-
ate a published paper or review a manuscript?
*R. ETTINGER', C. WATKINS', J. CHALMERS' ('University of
Iowa College of Dentistry, Iowa City, Iowa, 'Wake Forest
University Baptist Medical Centeu, North Carolina, 'Australian
Research Centre for Population Oral Health, Dental School,
University of Adelaide, Australia)
We are overwhelmed by information that we receive from many
sources, especially published literature, but we have no way to critically
appraise the information. How does a clinician decide what information
to incorporate into hist'her clinical practice? We have all heard of evi-
dence-based dentistry, which is the ability to access, summarize and
apply information from the published literature. This workshop will use
published papers to help participants assess the validity of the papers
by evaluating their component parts. Questions to be asked include: (1)
Does the title reflect the paper's contents? (2) In the Introduction, do
the authors review the relevant literature and are the citations current?
(3) Is there a hypothesis or experimental question? Does it logically fol-
low from the literature review? (4) Is there an adequate experimental
design to answer the question asked? (5) Are the appropriate statistical
methods used to determine potential differences? (6) Are the results
presented in a way that relates to the hypothesis? (7) Does the discus-
sion suggest a reasonable explanation of the results? (8) Do the conclu-
sions reflect the findings of the study? (9) Does this paper add signifi-
cantly to the body of knowledge in this area? At the end of this pro-
gram, the participants will be able to identify the component parts of a
research paper and be able to evaluate whether such a paper is scientifi-
cally valid and applicable for clinical decision making. This symposium
will include a question and answer period.
110
Special care oral health advocacy: what
works, what doesn't.
*G. FOLSE (Private practice, Lafayette, Louisiana, and
Louisiana State University School of Dentistry, USA)
Advocacy efforts are gaining momentum to assure access to oral health
for adult patients who are elderly, blind or who have disabilities. This
workshop discusses the history, current status, and future hopes of
these advocacy efforts including a summary of Good, Bad and Ugly
Advocacy Techniques: What Works and What Doesn't. Participants will
learn about the presenter's goals and techniques used for special care
advocacy and be able to apply these goals and techniques to improve
dental treatment for patients with special needs.
Spec Care Dentist 2 4 ( 3 ) 2004 155
ABSTRACTS
111
Frail elder denture care: real world situations.
*G. FOLSE (Private practice, Lafayette, Louisiana and Louisiana
State University School of Dentistry, USA)
Difficult denture patients, especial frail elderly, need unique treatment
approaches for successful outcomes. The goal of this workshop is to
discuss and demonstrate new, modified and effective denture techniques
(denture and partial treatment; modified impression and border-mold-
ing; occlusal rim procedures; and patient-specific occlusal schemes) as
well as to present philosophies about the entire denture process.
Attendees will learn to promote patient satisfaction with these tech-
niques while simultaneously increasing their own professional, personal
and spiritual gratification.
112
Prevalence of oral lesions regarding sero-pos-
itive patients: follow-up a f t e r 18 months.
*M. FRASCHINI’, E NOVELLI‘, I. CALVANESE’, M. TERRANO-
VA’, G. CLARICH‘ (‘University of Perugia, Department of
Restorative Dentistry, Perugia, Italy, *Civile Hospital of Narni,
Italy, ’University of Catania, Department of Restorative
Dentistry, Catania, Italy, ‘Burlo-Garofolo Hospital, Trieste, Italy)
We studied 31 recovering drug addicts who were sero-positive, in the
Operative Unit of Odontostomatology at the Hospital of Narni. The
patients ranged in age from 27 to 52 years and the male-female ratio
was 3.4 to 1. Forty-five percent of the patients had HIV virus, 39% had
Hepatitis C and 16% had HIV, HBV and HCV. During the first visit, each
of the 31 patients received an oral screening and personalized oral
hygiene instruction and a demonstration of how to carry out oral
hygiene. During the second visit six months later, 20 patients received
dental treatment and encouragement. Eighteen months later, the
remaining 16 patients received the same dental treatment and data were
collected. (The number of patients declined due to death, transfer,
incarceration, or leaving the program.) There was an average of 3 oral
lesions (mucocutaneous) per patient during the first visit, 2.35 lesions
per patient during the second visit, and 2.25 lesions per patient during
the third visit. We concluded that the decline in oral lesions was a
result of dental treatment and oral hygiene instruction, which improved
their oral health.
156 Spec Care Dentist 24(3) 2004
113
Access t o oral health s e r v i c e s for people
w i t h special needs: a global perspective.
*P. GLASSMAN’, G. SEKIGUCHI’, A. DEAN’, J.P. O’KEEFE’
(‘Associate Dean, University of the Pacific School of Dentistry,
President, Special Care Dentistry, ‘President, American Dental
Association, ’President, Canadian Dental Association,
‘Federation Dentaire International)
Access to oral health services is a worldwide problem for people with
special needs. During this symposium, leaders in the dental profession
from developed and developing countries will present multiple views of
this issue. We will explore barriers encountered by people with special
needs, solutions, and current and future initiativcs for cooperation
between countries.
114
Utilizing “health visitors” to provide c a r e
information and research access t o a n at-risk
group: pregnant women and caregivers of 0-5
i n f a n t s and children.
* M . HABIBlAN (School of Dentistry, University of Southern
California)
Thirty-nine British registered nurses, or Health Visitors (HVs), partici-
pated in an oral health education program for pregnant women and
mothers. A two-hour training session included thc epidemiology, etiolo-
gy, clinical features, and prevention of early childhood caries (ECC),
along with an informational package describing the goalshethods of
the study, and another package with information sheets and consent
forms that HVs could use to recruit patients. Forty-four percent of 1380
parents were recruited by HVs, 52% by mail and 4% by the author, who
attended clinics held by the HVs. Seventy-two percent of the parents
reported they received oral health information from HVs (68%),den-
tists (ll%),media (9%),friends ( 5 % ) , family members (4%) and others
(3%).Their information included how to clean their babies’ teeth
(77%), fluoride supplements ( 5 8 % ) , and nutrition and feeding (82%).
Ninety-two percent of the parents began cleaning their infant’s teeth at
mean 8.1 (2.1) months of age and, as a result, children had no caries at
12 months of age although 18%had visible plaque. The study found
that non-dental primary health care providers can effectively prevent
ECC by educating parents and by recruiting parents and their children
to participate in studies about ECC.
Abstracts

115
Oral conditions of children with cerebral
palsy treated at Guarulhos University before
and after parents receive oral hygiene
instruction.
*A.S. HADDAD, D.G. CAKVALHO, M. MOREIRA (Guarulhos
University, ABENO, Sdo Paulo, Brazil)
The goal of our program was to improve the quality of oral hygiene care
given by the parents of children with cerebral palsy Thirty-one male
and female children, between 1-7 years of age, were evaluated at the
Physiotherapeutic Sector of Guarulhos University in S2o Paulo, Brazil.
The children were examined during three stages (day 1, day 20 and day
50) and their bacterial plaque was evaluated using the index of Greene
and Vermillion (1964). The children received professional preventive
treatment and an application of fluoride varnish. The parents answered
a questionnaire about how frequently they brushed their children’s
teeth, whether the child had already seen a dentist, and whether the
family had received information about oral health techniques and about
diet and nutrition that can precipitate caries. We found that 23 patients
(74%) needed help maintaining their oral health.
116
The Oral Health Practitioner Model: Expanded
Functions for Hygienists in Alternative-
Settings.
C. BRICKLE’, *M. HELGESON2,D. OLSON’, K. THOMAS3, D.
JACOBP (“ormandale Community College, Bloomington,
Minnesota, ’Apple Tree Dental, Minneapolis, 30MNII Oral
Pharrnaceu ticals)
Oral health practitioners include hygienists who provide preventive and
diagnostic services, education and outreach in community settings. This
symposium presents the Oral Health Practitioner Model, which address-
es the need for primary care services for people with special needs who
cannot receive dental office care. Attendees will learn how to imple-
ment this more effective and less expensive model by creating a new
educational curriculum to meet patient demand, utilizing new diagnos-
tic technology, improving public policy and funding, and understanding
how the Oral Health Practitioner Model works.
Abstracts
ABSTRACTS
117
Communication skills for general dentistry
residents who treat patients with special
needs: an educational intervention.
*L. KAGIHARA (University of Southern California, Los Angeles,
USA)
Interpersonal skills are essential for a successful dental practice.
However, the average dental education curriculum devotes only four
instructional hours to patient motivation and compliance issues or
behavior changes in patients who are elderly or medically compro-
mised. Although most dental students lack the skills to interact with
these patients, a UK study found that training dental practitioners in
interpersonal problem-solving skills is beneficial. During this interactive
seminar, participants will complete several exercises in self-awareness,
trust building and empathy, and develop an educational module of exer-
cise to use in their home institutions.
118
Evaluation of dry mouth in older persons and per-
sons with disabilities using a saliva wet tester.
*Y KAKINOKI’, K. SHIBWA’, T. NISHIHARA3 (’National
Minami-Fukuoka Hospital, Fukuoka, Japan, ’The Lion
Foundation for Dental Health, Tokyo, Japan, and ’Kyushu
College, Kitakyushu, Japan)
Bedridden older persons and persons with disabilities often suffer from dry
mouth, which is a factor in caries, periodontal disease, fungal infections,
masticatory dysfunctions, and impaired dentures. In this study we meas-
ured the moisture in the oral mucosa of 455 elderly patients (aged 65-99)
by using the L-SALIVOa wet tester to measure tongue dorsum moisture
after 10 seconds. Xerostomia was diagnosed using Kakinoki’s method
(grade 0-3).Using the Saliva Wet Tester, it was easy to measure the tongue
dorsum moisture, which averaged 3.850.2mm (meankSEM) when the
patients’ dry mouth grade was 0, 1.9+0.22mm when it was grade 1,
1.71i0.37mm when it was grade 2, and 0.8+0.20mm when it was grade 3.
The average moisture related to a feeling of dry mouth was 3.6i0.23mm
when a subject reported hdshe did not have a dry mouth, 2.6k0.25 when
dry mouth was felt sometimes, and 1.6t0.15mm when dry mouth was felt
all the time. The Saliva Wet Tester value showed a positive co-relationship
with the clinical diagnosis grade (p<0.05). There was also a positive rela-
tionship between the L-SALIVOB value and the feeling of dry mouth. The
results suggest that the Saliva Wet Tester can evaluate the grade of oral dry-
ness and diagnose dry mouth in older persons or persons with disabilities.
S p e c C a r e Dentist 2 4 ( 3 ) 2 0 0 4 157
ABSTRACTS
119
Comparing dental t r e a t m e n t in p a t i e n t s w i t h
severe mental retardation a n d mental disor-
d e r s and p a t i e n t s w i t h moderate mental
retardation and mental disorders.
*H. KARIBE', Y. UMEZU', Y. HASEGAWA', E . OGIHARA', S.
WARITA', M. SHINOHARA' ("ippon Dental University
Hospital, Tokyo, Japan, 'Sodegaura Social Welfare Centev, Chiba,
Japan.)
Patients with mental retardation sometimes experience mental disorders,
including disturbances in behavior, which can interfere with dental treat-
ment. This study compared the characteristics of mental disorders combined
with mental retardation in patients with dental diseases, and behavior man-
agement during dental treatment. Twenty-five dental patients with mental
retardation and more than one mental disorder (I 1 males, 14 females; aver-
age age, 33.8 years) were divided into two groups: severe mental retardation
(SMR) and moderate mental retardation (MMR). Patients' charts were stud-
ied for dental diagnoses and behavior management and the data for the two
groups were compared using the chi-square test. There was no significant
difference in the distribution of mental disorders, dental diseases and behav-
ior management between the two groups (P-0.114, 0.099, and 0.093). The
SMR group, however, had more patients with attention-deficit-hyperactivity-
disorder, than the MMR group and more teeth injuries resulting from a
higher trauma rate than the MMR group. Physical restraints were used more
often in the SMR group during dental treatment than in the MMR group.
The results suggest that patients with severe mental retardation and mental
disorders experience more behavioral disturbances than patients with mod-
erate mental retardation, which may affect dental treatment.
120
A pilot s t u d y t o a s s e s s t h e difficulties and
awareness about oral hygiene in children
with disabilities.
* S . KARKARE (M.G.V Dental College, Nashik, India)
Over 100 families of children with disabilities answered a pilot study
questionnaire that assessed oral hygiene practices, associated problems
and remedies, and documented what professional dental care the chil-
dren had received. The results showed that many parents had difficulty
brushing their children's teeth, many had never seen a dentist and were
unaware of special dental care, and some were refused dental treatment.
We concluded that community programs should be created to educate
parents and caregivers about oral hygiene maintenance, dental care
should be made more accessible to children with disabilities, and exer-
cises to improve orofacial muscle tone in these children should be
implemented.
158 S p e c C a r e Dentist 2 4 ( 3 ) 2004
121
Prevalence of drug-induced gingival over-
growth in individuals taking antiepileptic
d r u g s a t a dental clinic for patients with
special needs.
"R.K. KIMURA',J. MURAKAMI', S. AKIYAMA', A. ATSUO', I.
MORISAKI' ('Osaka University Dental Hospital, Japan, 'Osaka
University Graduate School of Dentistry, Japan)
In special care dentistry, many patients with epilepsy are treated with
anticonvulsant drugs. A common side effect of phenytoin (PHT), is
severe gingival overgrowth. Other anticonvulsant drugs such as carba-
mazepine (CBZ) and valproic acid (VAL) have fewer reports of
drug-induced gingival overgrowth. Using a questionnaire and clinical
survey, we studied the incidence and severity of drug-induced gingival
overgrowth in patients taking PHT, CBZ and VAL. Of 459 subjects, 397
(84.5%) were prescribed one or more anticonvulsant drugs. Gingival
overgrowth was found in 151 patients taking one anticonvulsant, with
an incidence of 52.9% (PHT), 11.6% (CBZ) and 11.3% (VAL). For
patients taking a combination of these drugs, PHT and VAL induced
gingival overgrowth more severely We concluded that other anticonvul-
sant drugs can also induce gingival overgrowth and a combination of
these drugs results in more severe gingival overgrowth than one drug.
122
Generation of reactive oxygen species (ROS)
involvement from gingival fibroblast in
p a t i e n t s with Down syndrome: possible
mechanism in e a r l y severe periodontitis.
*I KOMATSU, A. MIYAGI, E. KUBOTA, M.C. LEE (Kanagawa
Dental College, Yokosuka, Japan.)
Down syndrome (DS) is one of the most frequent genetic disorders in
humans. Over expression of Cu, Zn superoxide dismutase is found in
persons with Down syndrome and reactive oxygen species (ROS) may
be associated with various abnormalities (neurodegenerative and
immunopathological), including early periodontitis or aging, although
currently no evidence exists. The nature of interaction of ROS with
MMP-2 activity on DS gingival fibroblasts (GF) remains unclear. The
goal of this study was to determine the characterization of the ROS
species generated from DS-GE Using 10% fetal bovine serum, we isolat-
ed DS-GF on DME12 from patients with Down syndrome. After the
8th or 9th passages, the DS-GF were cultivated with DMF/12 added 6
factors for 24 hours without Interleukin-lbeta (IL-lbeta). ROS generat-
ed from DS-GF were verified by electron spin resonance (ESR) spec-
troscopy and the spin trap 5-dimethyl-I-pyrroline-N-oxide(DMPO).
From our results we identified the DMPO-OH spin adducts, indicating
ROS, especially hydroxyl radical (HO.) generated from DS-GE DS-GF
treated IL-lbeta enhanced the signal intensity of the DMPO-OH spin
adduct compared to the untreated DS-GE The effects of H202 scav-
enger, catalase, and iron chelator, desferal, significantly inhibited
DMPO-OH spin adduct from DS-GE These results gave us the first
direct evidence of a HO. generation from DS-GF using the ESR spin
trap technique. They may be involved in the pathological status, includ-
ing early severe periodontitis, of patients with DS.
Abstracts

123
Expanded role for pediatricians in reducing
oral health dispar ties among children with
special needs.
*D. KROL’,J. BALZERL(‘Columbia University, New York, New
Yovk, ’Association of State and Territorial Dental Directors,
Santa Crup, California)
Because pediatricians are more likely to meet new mothers and their
children, it is essential that they learn the risk factors of early childhood
dental caries and promote oral health. The recent American Academy of
Pediatrics policy, Oval Health Risk Assessment Timing and Establishment
of the Dental Home, describes expanding the role of the pediatrician to
includes activities such as oral health education, anticipatory guidance,
risk assessment, referral, and support for the concept of the “dental
home.” The presenters, a pediatrician and dentist, will describe why the
pediatrician’s role should be expanded, policy issues related to increased
physiciaddentist collaboration, how pediatricians can promote oral
health in patients with special needs, and collaborate more effectively
with dentists.
124
Dental management of patients with organ
transplants: two case studies.
*M. LEE, E. TO,]. ZHANG (Advanced Education in General
Dentistry, University of Southern California, USA)
The goal of this presentation is to develop the skill and knowledge of
dental practitioners and increase the number of competent clinicians
who are willing to treat patients with organ transplants. We will present
two case studies of patients with liver and kidney transplants, discuss
diagnosis, risk assessment and medicavdental treatment planning
(including number/length of appointments and treatment modalities),
antibiotic prophylaxis, dental drug pharmacology (including local anes-
thetics), and immunosuppressive treatment.
Abstracts
ABSTRACTS
125
Development of antioxidant drugs and foods
for patients with dysphagia using electron
spin resonance (ESR) spectroscopy.
“M.C. LEE, T. KOMATSU, A. MIYAGI (Kanagawa Dental
College, Yokosuka, Japan)
Free radical reactions are associated with oxidative stress-mediated
alterations under pathophysiological conditions like stroke, brain
tumor, and amyotrophic lateral sclerosis (ALS). Weakening muscles can
result in dysphagia and impair a patient’s ability to eat. This study
examined two nitroxyl compounds, blood-brain-barrier (BBB)-perme-
able 3-methoxycarbonyl-2,2,5,5-tetramethyl-pyrrolidine- 1-yloxy (MC-
PROXYL) and BBB-impermeable carbamoyl-PROXYL, as spin probes for
in vivo ESR technique. Using ESR spectroscopy, we observed a rapid
decay of MC-PROXYL in isolated spontaneously hypertensive rat
(SHR)-brain and stroke-prone spontaneously hypertensive rat (SHRSPI-
brain compared to Wistar-Kyoto rats (WKYs), who are a normoteusive
reference strain. Using L-band ESR non-invasively, we found a faster
decay rate constant of MC-PROXYL in live SHRs and SHRSPs than in
live WKYs. Our results suggest that in vivo ESR could be used to assess
the antioxidant effects on oxidative stress in the brain of animal disease
models like SHR and SHRSP Using the in vivo ESR technique, we will
be able to develop antioxidant foods and supplements for patients with
dysphagia.
126
A classification of treatments under dental
general anesthesia.
*].I! LOYOLA-RODRIGUEZ, N.V ZAVALA-ALONSO, N.
PATINO-MARIN (Dental Research Center, San Luis Potosi
University, San Luis Potosi, Mexico)
We developed criteria for dental procedures completed under outpatient
dental general anesthesia (DGA). The study, conducted from May 1997
to July 2002, included 84 male and female patients with disabilities,
aged 4-25 years old, who needed dental treatment. Patients were
included if they had a medical diagnosis, were uncooperative, or ASA 1-
111 and classified as negative or definitive negative (Frankl’s scale). The
pre-anesthetic evaluation, medicavdentistry clinical history, dental treat-
ment under DGA, and postoperative management occurred in our clin-
ic. When we compared our classification of DGA procedures with other
classifications, there was a significant statistical difference (p < 0.05).
We concluded that in order to safely provide dental treatment for
patients with special disabilities, dental care providers must maintain
the oral health of these patients, collaborate with different dental spe-
cialists to provide a wide range of treatments, and provide a safer DGA
procedure.
S p e c Care Dentist 2 4 ( 3 ) 2 0 0 4 159
ABSTRACTS
127
Working together to improve the oral health
of seniors: Nova Scotia Action Plan.
“M. MCNALLY, R. LYONS, I? MAGEE, E. TAIT, S. CROWELL
(Faculty ojDentistry, Atlantic Health Promotion Research
Centre, Dalhousie Universify, Halifax, Canada)
The goal of our study was to enhance oral health care for seniors living
in Nova Scotia We collected data from focus groups, interviews and a
practice scan and presented the findings at a provincial forum of 75
professional, community and government attendees Using the data, we
devcloped an action plan to improve the oral health of seniors with a
definitive program, which includes policy development, education, pre-
vention and promotion strategies, and research initiatives
128
Development of a n e w examination in Special
Care Dentistry.
“S. MASTER (East Elmbridge and Mid Surrey Primary Care
Trust, London, UK)
Raising standards of care for persons with special disabilities has been
strongly debated All health professionals must continually improve
their knowledge, skills and experience This new distance learning
modular examination was developed to meet the needs of health profes-
sion& who work in special care dentistry It is divided into Parts A and
B Part A includes a self-directed learning program with seven modules
A resource package helps access the required information Required
assignments are continually assessed Part B involves submitting com-
pleted case histories, oral examinations and a short paper with answers
to clinical scenarios Participants must submit a portfolio with educa-
tion and experience in SCD, which includes reflective learning This
“user friendly” examination was reviewed favorably by candidates who
appreciated the distance learning and modular aspects of the examina-
tion The presentation will outline new evaluation in special care den-
tistry Participants will learn about the self-directed learning program
and alternative methods of assessment
160 S p e c C a r e Dentist 2 4 ( 3 ) 2004
129
Overcoming sensory sensitivities in children
w i t h Autistic Spectrum Disorder b y utilizing
hypnotherapy as an alternative care modality.
“S. MASTER (East Elmbridge and Mid Surrey Primavy Care
Trust, London, UK)
Nearly 40% of children with autism have an abnormal sensory sensitivi-
ty (ASD), sometimes to taste, texture or smell These sensitivities can
complicate oral care A case history is presented here where hypnother-
apy was used as part of an acclimatization program to help a 5-year-old
child with ASD overcome oral hypersensitivity and better tolerate oral
examinations, tooth brushing and dental treatment as well as to enjoy
more types of foods Hypnotic techniques given during four visits
helped the child consume a wider range of foods and undergo oral
examinations This case history demonstrates that hypnotherapy can be
utilized to help children with ASD overcome oral hypersensitivity
130
Ten year results of a training program
designed to increase knowledge and willing-
n e s s of providers to care for HIV/AIDS
patients in the community.
“R.A. MULLIGAN’, H. SEIRAWAN’, V GREENE’, S. LEMME’
(Schools of ‘Dentistry and ’Medicine, University of Southern
California, Los Angeles, USA)
The Pacific Aids Education and Training Center established a training
program in 1994 to increase the number of community dentists treating
patients with HIV/AIDS We analyzed the program’s success to deter-
mine whether course changes have affected the outcomes Didactic and
clinical experiences in small group settings with topics including epi-
demiologic trends, medical management, oral manifestations, infection
control, clinical experiences, risk assessment iiiteiviewb, diid Internet
searching for HIV resources were offered We evaluated the program’s
effectiveness by pre (time 0) and post training (up to six months after)
Questionnaires assessed the knowledge, attitudes and behaviors of 91
dentists or dental hygienist trainees Thirty-five statements on a scale
from 1 to 7 (disagree - agree) were assigned point values from -3 to +3
(incorrect answer - correct answer) Explanatory variables included
academic degree, type of practice, sex, age and race Participants
demonstrated a significant (p< 0001) increase in post test scores (60 9)
over pretest scores (50 4) The test’s three subparts (knowledge, attitude
and behavior) all changed in a positive direction with attitude and
behavior changing the most 29%, (p< 001) and 95% (p< 0001) Using
a linear regression model, this change could not be explained by any
independent factors (e g , gender, race, age, type of practice or degree)
other than the program itself Nor was there any linear trend across
time based on quartile measurements We concluded that programs
using different teaching methodologies can effectively educate dental
care providers about caring for patients with HIV/AIDS and increase
their willingness to treat these patients
Abstracts

131
Treatment modifications and clinical guide-
lines for dental care of patients with HIV.
C. BORRERO, L. DANIALIAN, “P MUNDL, V GREENE
(University of Southern California School of Dentistry)
The ambiguity and controversy among physicians and dentists about
treating patients with HIV impedes good clinical decisions by dentists
and standardized instruction by physicians. Standardizing clinical
guidelines would reduce potential health risks to patients with HIV
who are undergoing dental treatment. We reviewed current
literatureh-eports to determine what relevant information about the
patient’s HIV status and laboratory data the dentist needs to deliver the
best and safest treatment. Our presentation compares and contrasts cur-
rently available protocols on dental management of patients with HI\!
Our findings show that implementing clinical guidelines for treatment
modifications will benefit providers and patients and reduce the risk of
unnecessary delays, ambiguity of clinical decisions and potential
adverse events or over-medication during dental treatment to patients
with HIV
132
Invasion of porphylmonas gingivalis into gin-
gival cells derived from Down syndrome.
*J. MURAKAMI’, R.K. KIMURA’, A, AMANOl, I. MOIUSAKI’
(‘Osaka University Dental Hospital, ’Osaka University Graduate
School of Dentistry, Osaka, Japan)
Persons with Down syndrome (DS) are susceptible to early-onset as
well as severe adult periodontitis, which is caused Porphylmonas gingi-
valis, the most relevant pathogen found in periodontal disease. While
gingival fibroblasts and epithelial cells act as a barrier against pathogen-
ic microorganisms, including €? gingivalis, few studies have examined
the relationship between DS gingival epithelial cells and P. gingivalis
infection. We compared the difference in susceptibility to €? gingivalis
infection or morphology of gingival fibroblasts and epithelial cells
between subjects with and without DS and by treating samples of gingi-
val tissue from both groups with dispase and trypsin to separate the
epithelial cells. The cells were seeded with human keratinocyte media
and gingival fibroblasts recovered from connective tissue were cultured
in the alpha-MEM medium. After the epithelial cell cultures were
infected with [3-H]-€?gingivalis, the adherencdinvasion rate was meas-
ured. Quantitative and morphological observations of P. gingivalis infec-
tion and gingival fibroblasts/epithelial were performed using phase con-
trast and confocal laser microscopes. We found that the adherencdinva-
sion efficiency of [3-H]-F! gingivalis to DS epithelial cells was signifi-
cantly greater than to normal cells (P<O.O5);Microscopic observation
also confirmed this. However, no difference was found microscopically
between the epithelial cells and fibroblasts derived from normal sub-
jects and subjects with DS. We concluded that gingival epithelial cells
and fibroblasts in patients with DS are more susceptible to I? gingivalis
infections and results suggest that the periodontal tissue defense mech-
anism is altered in patients with DS compared with control subjects.
Abstracts
ABSTRACTS
133
An exploration of the relationship between
special care dentistry in developed and
developing countries: a review of information
and models o f patient care.
*A. NARVEY’, C. ZED’, D. BEDARD’, C. MILLER4, S. NEIL’
(‘Alberta Children’s Hospital, Calgaiy, Canada, ‘University of
British Columbia Dental School, Vancouvei; Canada, -’Universityof
Alberta, Alberta, Canada, ‘University of the Pacific, Sun Francisco,
USA)
This all-day program will address several issues involving special care
dentistry in developing nations: (1) an example of a symbiotic relation-
ship between a Canadian university related hospital program and a clin-
ic in Vietnam; (2) a review of oral pathology and oral medicine as it
relates to the needs of people with less access to health care; (3) a
lunchtime round table discussion related to providing care in develop-
ing countries; (4) prevention-oriented ideas and active models for com-
munities with less access to health care; ( 5 ) a presentation and discus-
sion on recognizing and avoiding medical emergencies with patients
who have limited, if any, medical history.
134
Stressless intravenous sedation in an autistic
patient: a combination of training, nitrous oxide
sedation and lidocaine iontophoresis.
“T. OGASAWARA, T. WATANABE, K. HOSAKA, H. KASAHARA
(Department of Special Patients and Oral Care, Matsumoto
Dental University, Nagano, Japan)
Patients with autism have enhanced sensations so dental care is often unsuc-
cessful. Using restraints is not recommended and intravenous sedation can be
painful. To avoid pain during dental treatment, we developed a “stressless
intravenous sedoanalgesia” that uses training, nitrous oxide sedation and pain-
less venipuncture using lidocaine iontophoresis. This case history presented
here is a patient with autism who had undergone a painful venipuncture,
which was given without iontophoresis and so made subsequent venipuncture
procedures difficult. We were unable to provide dental treatment due to
patient noncompliance but later we were able to do a pulpectomy on the first
maxillary left molar using the stressless intravenous method. During the treat-
ment, we attempted a venipuncture without the iontophoresiasticmethod
because no electrode was available,but the patient was noncompliant because
the use of a tourniquet resulted in a fearful response. We concluded that a
stressless intravenous sedoanalgesia using nitrous oxide sedation and lidocaine
applied with iontophoresis together with training can be extremely useful in
providing dental treatment to patients with autism. A video will illustrate the
difficulties of treating patients with autism and the technique of providing this
painless special intravenous sedation.
S p e c C a r e D e n t / s t 24(3/ 2004 161
ABSTRACTS
135
Correlation of progression of disease and the
oral environment in patients with
Amyotrophic Lateral Sclerosis.
A. OGATA‘, E MUKAI’, E OHTSUKA‘, A KLJROKflWA’, N.
MURATA’, R. ISHIDA4,N. SUGIHARA’, E MAKIJ,5(‘School of
Dentistry, Showa University, Tokyo,Japan, 2NutionalSanatorium
Chibu-Higashi Hospifut, Dentistry, Chibu,fapun, ’The Lion Foundation
for Dental Health, Tokyo,Jupan, ‘Okayanla University, Hospital of
Dentistry, O k u y a m Japan,
~ ’Tokyo Dental College, Chiba,Japan)
There are many studies on the progression of Amyotrophic Lateral Sclerosis
(ALS), but few reports on oral hygiene and oral care for patients with ALS.
Our goal was to design an oral support program for patients with A S . We
examined 29 patients who were either hospitalized or receiving care for ALS.
A neurosurgeon assessed the general progression of the disease using the
ALS Functional Rating Scale (ALSFRS, Japanese version). Oral hygiene
assessments were made evaluating DMF; CPI, salivary secretion rate, pH, sali-
va buffer capacity, S. Mutans, L. Bacillus, Rdtest, Candida, etc. The correla-
tion of ALSFRS (total score with salivation) and oral hygiene was assessed by
Spearman’s correlation coefficients (Stat View 5.0). An evaluation of the
results showed that indices of carious teeth and periodontal disease were not
correlated in this study The ALSFRS total score was correlated with salivary
secretion rate (r=0.502), L. Bacillus (r=0.485),jaw opening ability (r=0.624),
amount of jaw opening (r=0.619), and ability to chew gum (r=0.580). The
ALSFRS salivation score was correlated with saliva at pH (r=0.502), buffer
capacity (r=0.480),jaw opening ability (r=0.492), amount of jaw opening
(r=0.535), ability to chew gum (r=0.825) and maximum occlusal pressure
(r=0.371). We concluded that patients with ALS have inadequate oral care
and need special oral care based on disease progression and synchronous
changes in salivary pH, buffer capacity, change in bacteria and oral function.
136
Assessments of the development of feeding
functions in low birth weight infants.
*M. OKOCHI’, Y MUNETA’, M. INOUE’, M. TOTANI’, K.
ITABASHI’, Y MUKAI’ (‘School of Dentistry, Showa University,
Tokyo, Japan, ‘Graduate School of Human Life Science, Showa
Women’s University, ’School of Medicine, Showa University)
The goal of our study was to establish an assessment of feeding function in
low birth-weight infants. After observing the movements of the infants’ oral
region, 117 low birth weight infants were divided into four groups according
to the developmental stages of feeding function and on birth weight: under
lOOOg, lOOOg, 1500g, 2500g. According to the results reported by the moth-
ers, low birth weight infants had a greater number of milk feedings than full-
term infants, while both groups of infants had the same frequency of feedings
with solid foods. We found that the lower the birth weight of the infant, the
longer was the delay in the disappearance of the primitive feeding reflex. We
found no significant difference in the development of feeding behaviors dur-
ing the early stage of weaning. However, during the later stages of weaning in
the lower birth weight infants, the development of feeding with solid foods
was delayed, although the difference was not significant.We concluded that
compared with full-tern infants, the development of feeding functions in the
low birth-weight infants was delayed. Further study of low birth weight
infants is needed to understand psychological and physical development, oral
growth and development and nutritional needs.
162 S p e c C a r s Dentist 24(3) 2 0 0 4
137
The development of a screening tool to assess
the suitability of persons with disabilities for
oral care in primary or secondary care services.
*N. PRABHU’,J. NUNW (‘Westmead Centre for Oral Health,
Sydney, Australia ‘Trinity College, Dublin, Ireland)
The goals of our study were to: (1) examine the use of general anesthetic
services by persons with disabilities; (2) develop a tool for screening
patients who have surgical needs and who need dental care; and (3) apply
the tool to different groups of patients who need comprehensive oral care,
to test the tool’s usefulness. Data for 124 patients with disabilities were
collected from: (1) a questionnaire for patients and their parentdcaregivers
to evaluate patientkaregiver satisfaction; (2) a clinical flow chart (“the
tool”) that was completed by the clinicians during the initial visit; and (3)
a questionnaire for clinicians and anesthetists, which was completed after
treatment. We concluded that the flow chart’s management strategy was
appropriate for 94 of 100 patients. Modifications suggested by users were
incorporated into the tool. The major reasons given for referring these
patients to the hospital were either a lack of adequate sedation facilities or
inadequate experience with behavior management of these individuals.
There was little agreement between parents, anesthetists and clinicians on
behavior assessment. However, there was a high rate of parendcaregiver
satisfaction. We concluded that using clinical flow charts helped direct
patients to appropriate dental care settings. However, because parents have
different expectations of their childs behavior in a dental setting than do
clinicians, this issue must be addressed so that patients with disabilities
receive optimal care and are encouraged to use alternative anesthesia tech-
niques, when appropriate, for behavior management.
138
Facilitating patients with special needs into
practice during consultation.
*M. PREVETTE (Pediatric Oral Health and Dentistry, London,
Ontario, Canada)
The presentation will discuss using an intake coordinator during con-
sultation to facilitate incorporating patients with special needs into a
private practice. An interactive format will be utilized to explain how
non-dental personnel can be most effectively used and how they can
create a unique dental experience. Participants will learn effective alter-
native methods, including risk assessment, to incorporate patients with
special needs into the private practice setting.
Abstracts

139
A model for enabling the development of cul-
ture competence and social responsibi ity in
pre-clinical dental students.
*R.W RUBZN (University of Pittsburgh, School of Der ul
Medicine and UCLZD Centev, University of Pittsburgh)
The goal of this study was to find an effective and verifiable method for
dental students to develop cultural competence and social responsibili-
tx particularly in the field of special care dentistry. Sixty-one freshmen
participated in 40 hours of non-dental community service and kept per-
sonal journals, which were completed after two years. Competency out-
comes were measured by selecting key words and phrases relating to
compassion, righteousness, propriety and wisdom that were found in
individual journals. We found that individual experiences were rarely
limited to fewer than three of the four mentioned categories. We con-
cluded that this project effectively engaged pre-clinical dental students
in broad-based community health service and also helped develop cul-
turally competent, community-minded and reflective dental health pro-
fessionals.
140
Variation in normal physiology of sequential
swallowing of a liquid.
*Y. SHIMIZU, Y KANEKO, T. YASUZ (School ofDentistvy,
Meikai University, Sakado,Japan)
Although textbooks describe only one normal physiological mechanism
of swallowing liquid after drinking from a cup or straw (K type in this
study), we examined other variations of sounds made during sequential
swallowing of liquid and classified them. We examined 98 healthy
adults (49 males, 49 females) with a mean age of 24.8 years who had
no history of dysphagia. Each subject was instructed to swallow 150 ml
of water in hisher usual manner while one of the authors listened to
breathing and swallowing sounds using a stethoscope (Littman infant
type) that was placed on the neck. Three main sounds were heard: (1)
respiration (expiration and inspiration); (2) single swallow initial dis-
crete sound (IDS) and final discrete sound (FDS); and ( 3) bolus transit
sound (BTS). The sound patterns were classified as S (45.9%), K
(39.8%),and M (14.3%). The sound pattern of the S type was repeated
single swallow sounds while the larynx moved up and down. The pat-
tern of the K type was the sequence of IDS, repeating BTSs, and FDS
while the larynx remained steady at the elevated position before FDS.
The M type was a mixture of S and K. We found there were 3 distinct
types of sound patterns during sequential liquid swallowing by healthy
adults. This evaluation is essential for evaluating sequential drinking
from a cup by a patient with dysphagia when a stethoscope is used at
bedside.
Abstracts
ABSTRACTS
Radiographs for sedated patients.
*S. SOBEL (University of Southern California School of
Dentistvy, Los Angefes, USA)
Making radiographs, which are essential for diagnosis and treatment
planning, is usually routine. Some patients, however, present challenges
such as an exaggerated gag reflex, sensitivity, or difficulty holding films
in the mouth. Many patients with disabilities or who are medically
compromised must be sedated for dental treatment and so obtaining
diagnostic quality radiographs can be especially challenging. This pres-
entation will describe successful techniques that will provide good qual-
ity radiographs for sedated patients and discuss what supplies are need-
ed and the vendor sources. We will demonstrate positioning for the
patient, the film and collimator, and describe how to achieve diagnostic
quality results with film.
142
Kyphosis and dental occlusion.
"PA. STONE (University of Southern California School of
Dentistiy, Los Angeles, USA)
Success of newly placed dental restorations and prostheses depends
upon maintaining a relaxed, normal, head-torso position. Patient com-
fort also depends on the same relaxed position. This presentation will
discuss kyphosis, an exaggerated curvature of the spine that is most
commonly found in the elderly, and its effects on dental occlusion and
patient comfort during dental procedures. Photographs will illustrate
relaxed and strained head-torso positions while standing and sitting in
the dental chair. Newton imaging will show occlusal discrepancies,
which develop when there is no head support. Participants will be able
to personally experience the physical changes caused by kyphosis by
simulating the condition through verbally directed exercises. The pres-
entation will demonstrate the importance of understanding kyphosis for
patient comfort and for restorative and prosthetic success.
Spec Care Dentist 24(3) 2004 163
ABSTRACTS

143 145
Postgraduate training in disability and oral Taurodontism in Klinefelter syndrome: a case
care using PBL and distance education prin- report.
ciples: the Norwegian model. *I TURK (IPSE, an organization for people with disabilities,
*K. STORHAUG (TAKO-Centre, Lovisenberg Hospital, Oslo, Woubrugge, Netherlands)
Taurodontism is a symptom found in as many as 40% of persons with
Norway) Klinefelter Syndrome. This presentation presents a case history of a 25-
The purpose of this program is to provide information about oral care year-old patient with Klinefelter syndrome who had teeth, which
issues in rare medical conditions among public dental health teams in a showed taurodontism. Personal information was gathered as well as a
sparsely populated country.
medical and dental history, dental radiographs of all four quadrants
In order to establish "satellite" teams who were knowledgeable about
were made. Evaluation of the literature showed that taurodontism had
oral health issues regarding rare medical conditions, 10 dental teams, 2
no clinical implications on normal dental treatment. The discussion will
from each health region in Norway, were offered a four-week postgradu-
focus on the patient's root canal treatment and the maxillary central
ate course in the fall of 2002. The course was successful and teams incisors where a retrograde apical seal was used to improve the seal of
wanted to continue with more training. Because travel is costly and the endodontic treatment, possibly due to the patient's enlarged pulp
time-consuming, three e-learning modules were developed at the chamber.
National Resource Centre for Oral Health In Rare Medical Conditions
(TAKO-Centre), which comprised descriptions of and treatment for
ectodermal dysplasias, osteogenesis imperfecta, and drooling. The mod-
ules were available for 3 months on Internet for the teams. Chat groups 146
and other channels of communication were established between partici-
pants and teachers. Teams presented treatment plans and solutions to
A newly developed toothbrush with irrigation
relevant problems in PBL-based tests. Results showed that participants and suction in g c a p a b i li t i e s (e -Brush@).
were better informed about the issues presented in the modules and
there was good cooperation between teams with problem solving. All "T. YAMAZAKI', Y. YAMAZAKI', H. MIZUTANI', Y HIGUCHI',
participants wish to continue their post-graduate training using dis- H. SENPUKUj ('Tokyo Medical and Dental University, Tokyo,
tance education methods, which are cheap and viable for big countries Japan 'National Institute of Infectious Disease, Japan)
with small populations. The purpose of this study was to develop a new manual toothbrush
with a small head (e-Brush"), which combines both irrigation and
suctioning functions. Using advanced technology, we improved the
144 e-Brush@by changing the regular head size to a smaller one. As a
result, the toothbrush now has a smaller brush head and is smaller and
Clinical management of a patient with chro- weighs less. It can clean teeth more quickly and is easier to handle.
This e-Brush@is useful for patients with dysphagia because it prevents
mosome trisomy 22 who has rampant caries: water from leaking into the pharynx and this makes it safe to use.
a case report.
*A. TAKAHASHI, Y. HOZUMI, K. MIZUTA, N. GOTO, T.
SAITO, H. MAYANAGI (Tohoku University Dental Hospital,
Sendai, Japan)
This study describes dental management of a 6-year-old Japanese female
with mental and physical retardation and heart disease. At 7 days of age,
an echocardiogram showed an atrial septa1 defect and valvular pul-
monary stenosis. At 5 years of age the patient underwent intracardiac
surgery, which improved cardiac function. Until her referral to Tohoku
University Dental Hospital, she had received little dental care. All of her
primary teeth were decayed and nearly all of the caries had reached the
pulp. Because the girl was noncompliant, general anesthesia was
required to provide treatment or to extract the carious teeth. At 7 years
of age, all primary teeth had been extracted except the maxillary second-
ary primary molars that had received preformed metal crowns under
general anesthesia. At that time, all permanent first molars had not
reached the occlusal plane and maxillary central incisors and mandibu-
lar lateral incisors had not erupted, although the mandibular central
incisors had erupted. Since this treatment, the girl's oral hygiene has
improved with continuous home dental care and occasional professional
dental care. We concluded that the parents were more cooperative about
maintaining better oral health for their daughter after her successful
heart surgery. Unfortunately, we diagnosed delayed eruption of the girl's
permanent dentition, which may be diagnostic of trisomy 22.

164 S p e c C a r e Dentist 2 4 ( 3 ) 2 0 0 4 Abstracts


141
Case report of a modified oral screen appli-
ance for preventing self-inflicted oral trauma
in a child with cerebral palsy.
*EM. YASUI, A. KAWAMURA, R.K. KIMURA, S. AKIYAMA, I.
MORISAKZ (Division of Special Care Dentistry, Osaka
University, Osaka, Japan)
Dental management of self-inflicted oral trauma depends on the
patient’s medical history, etiology of behavior, and the severity or fre-
quency of the injury We present a case history of a 10-month-old
female infant with cerebral palsy who had self-inflicted oral trauma. She
was suffering from a feeding disorder, oral trauma and bleeding caused
by tonic biting following the eruption of the mandibular and maxillary
primary central incisors. The traumatic lesions were on the ventral and
dorsal sides of the tongue tip and on the lower lip mucosa. Although
the patient’s wounds had initially been treated with a topical medication
and the incisal tooth edges protected with a mouth splint, these proce-
dures were ineffective because of uncontrolled tonic oral muscle move-
ments. We then tried an oral screen made of acrylic resin, which fit the
infant’s oral vestibule according to Cheney (1963). This was more effec-
tive except for its stability We fabricated a modified oral screen using a
flexible material, extended the appliance laterally and placed holes in
the body to prevent it from being blown out of her mouth. The new
appliance significantly reduced oral trauma and was not difficult for the
mother to remove or insert. We found that the newly designed oral
screen was the most effective of five treatment strategies in preventing
self-inflicted oral trauma in a child with cerebral palsy.
148
Dental treatment needs of children with spe-
cial needs seen at the Paediatric Institute,
Huala Lumpur Hospital.
*N.N.N. YUNUS (Paediatric Institute, Kuala Lurnpur Hospital,
Malaysia)
Advances in medicine and pediatric care have resulted in children with
chronic diseases surviving longer. The goal of our four-year study was
to determine if preventive efforts and early referral of children with spe-
cial needs to the dentist had affected the oral health and treatment
needs of these children. A total of 1180 children with special needs
were seen between 2000-2003. The incidence of caries decreased from
84.4% in 2000 to 51.4% in 2003. The severity of periodontal disease,
however, fluctuated over the years; the highest rate was 8.4%. Of the
group, 842 children needed dental treatment. Most (79%) were treated
in the dental clinic under local anesthesia with or without sedation.
Only 134 (21%) of the children were treated under general anesthesia.
We concluded that prevention is important for managing caries and
periodontal disease. Parental involvement and an early referral to the
dentist will assure that children avoid pain and discomfort and improve
their quality of care. This presentation will focus on the dental treat-
ment needs of children with disabilities who attended a pediatric dental
clinic. It will cover their oral health status, treatment modalities and
preventive aspects of managing their oral health.
ABSTRACTS
149
A new Internet resource for dental treatment
protocols and management of organ trans-
plant patients.
*J. ZHANG’, M. LEE’, E. TO’,J. MILLER’ (‘Advanced Education
in General Dentistry, University of Southern California School of
Dentistry, ‘University of Californiu, Los Angeles, School of
Medicine, USA)
Organ transplant patients have unique medical and dental needs, but
because these patients are relatively rare, clinicians may not be familiar
with the special protocols. Our goal was to provide Internet resources
about dental treatment guidelines for patients with organ transplants.
We conducted an Internet search using 3 major search engines with a
number of key phrases that would produce a comparison of medical vs.
dental links about treatment protocols. Key phrases included combina-
tions of words in four groups: MedicaVDental; Management of,
Treatment of, Protocol for, Diagnosis of, Drug Therapy for; Organ,
Heart, Kidney, Pancreas, Liver Transplant; Management of Medically
Compromised Patients. Although the numbers of dental links found for
each key phrase was only 0 -2, these links were PDF files, books, and
articles. There were nearly 245 medical links but because there were no
Web sites dedicated to dental treatment protocols for patients wlth
organ transplants, we concluded it would be beneficial to establish one.
We established the “Dental Protocols in Treatment & Management of
Organ Transplant Patients” Web site, which provides links to various
Web materials and serves as an interdisciplinary site for physicians and
dentists who wish to access information about this topic.
150
Botulinum toxin, pain, spasm and the patient
with special needs.
“ G . 1 CLARK’, Z. VANEK’, A. STILES’, M.JOG‘, D. NIXDORF’
(‘University of Southern California, School of Dentistv, Los
Angeles, USA, ‘UCLA, Los Angeles, USA, -’ThornasJefferson
University, Philadelphia, USA, ‘London Health Science Centeu,
University of Western Ontario, London, Canada, ’University of
Minnesota, Minneapolis, USA)
This symposium will focus on the use of botulinum toxin, a long-lasting
locally injectable paralytic agent that also has pain-inhibitory properties.
This agent derives from a toxin produced by the anaerobic bacterium
Clostridium botulinum and when used for spasticity, it can block motor
nerve conduction from 8 to 16 weeks. Most recently it has been used to
treat triptan-resistant migraine headaches, muscle spasticity-associated
head and facial pain, and it is also being evaluated as a long-lasting pain
reduction agent for local neuropathic pain. Treatment is only palliative
except perhaps for some headache disorders when chronic headache
pain may diminish substantially. The five speakers, who are experienced
with this agent, will discuss the multiple uses of botulinum toxin in the
orofacial area and will present several case histories to show how this
agent can help patients with special needs. Topics will include a tutorial
series, how and when to use it for orofacial spasticity, headache pain,
various oro-bucco-lingual disorders or for myofascial pain. The sympo-
sium will include a question and answer period.
ABSTRACTS
151
Oral cancer and the management of medically
complex older adults.
“N.L. RHODUS’, S. SILVERMAN’ (‘University of Minnesota,
Minneapolis, USA, ‘University of California, San Francisco,
USA)
The average age for diagnosing oral cancer is 63 years. Older adults typ-
ically exhibit various medical-systemic conditions during dental care,
which predispose them to oral cancer. This symposium, sponsored by
the American Academy of Oral Medicine, will discuss the dental man-
agement of older adults with common medically compromising condi-
tions as well as detecting, preventing and managing oral cancer.
152
Buffer capacity, pH and flow rate in saliva
of children aged 2 to 60 months with Down
syndrome.
“WL. SIQUEIRA’, PR. BERMEJO’, 2. MUSTACCHI’, J. NICO-
LAU’ (‘Oral Biology Research Centel; Faculty of Dentistry,
University of Scio Paulo, Brazil, ’Darcy Vargas Children’s
Hospital, Scio Paulo, Brazil)
The goal of this study was to measure the flow rate, pH and buffer
capacity of saliva from 25 children with Down syndrome, aged 2-60
months, and compare the results with 21 children without Down syn-
drome. Whole saliva was collected under slight suction. The pH and
buffer capacity were determined using a digital pHmeter. The buffer
capacity was measured by titration with 0.01 N HCI. We found that the
group with Down syndrome showed a higher buffer capacity in inter-
vals of pH 6.9-6.0, pH 5.9-5.0 and pH 4.9-4.0 than the control group.
The group with Down syndrome had a low flow rate. The buffer capaci-
ty was higher in boys with Down syndrome (pH 6.9-6.0, pH 5.9-5.0
and pH 4.9-4.0) than the boys from the control group, while the only
difference in buffer capacity between the girls in both groups was the
range of pH 1-pH 7.0 in the girls with Down syndrome. Our results
suggest that persons with Down syndrome have a better buffer capacity,
which supports several studies that found low dental caries in persons
with Down syndrome.
166 S p e c Care D e n tis t 2 4 ( 3 ) 2004
153
Some variables in the saliva of adolescents
with cerebral palsy.
“M.T.B.R.SANTOS’, WL. SIQUEIRA’, J. NICOLAU’ (‘School of
Dentistry, University Cruzeiro do Sul, ‘Faculty of Dentistry,
University of Sao Paulo, Brazil)
The goal of this study was to evaluate the flow rate, pH and buffer
capacity in the saliva of 24 adolescents with cerebral palsy (CP). The
adolescents with CP were compared with 18 adolescents without CF’,
aged around 12 years. Whole saliva was collected under slight suction
and the pH and the buffer capacity were determined using a digital
pHmeter. The buffer capacity was measured by titration with 0.01 N
HCI. The results showed that the flow rate was low in the group with
CP who demonstrated lower buffer capacity in intervals of pH 6.9-6.0
than the control group. Boys and girls from the group with CP showed
lower buffer capacity in the range pH 6.9-6.0 than boys and girls from
the control group. Although there was no difference in the buffer capac-
ity between boys and girls from the control group, the girls with CP
presented nearly a 55% lower buffer capacity than boys in the intervals
(pH 6.9-6.0 and pH 5.9-5.0). The salivary pH was lower in boys with
CP while the girls from the group with CP showed no difference com-
pared with the control group. The results suggest that adolescents with
cerebral palsy present low flow rate, pH and buffer capacity and there-
fore have a greater risk for oral disease.
154
Ectodermal dysplasia and management of the
associated dental problems.
“J.R. GOODMAN (Eastman Dental College, University College
London Hospitals Trust, London, UK)
Ectodermal dysplasia occurs in many forms of varying severity and can
result in several problems. Hypodontia is one feature of the condition
and its management requires a multidisciplinary approach. In particu-
lar, the timing of treatment is important for the psychological wellbeing
of the patients and their caregivers. This presentation will show partici-
pants how to recognize the features of ectodermal dysplasia, how to rec-
ognize and manage hypodontia, and what treatment options to consider
as well as timing the options.
Abstracts

155
Ethics: intervention for people unable to
comply with routine oral health care.
S. GREENING’, T. TURK’,J. NORDERYD’, T. ARP, S. SPATER5
(‘GwentHealthcare NHS Tmst, and British Societyfor Disability
and Oral Health, CardqJ UK, ’Netherlands, ’National Oral
Disability Centre, Institute for Postgraduate Dental Education,
Sweden, ‘Marmara Univeristy, Turkey, Yoseph Samuels Dental
Clinic, Rhode Island Hospital, USA)
Dr. Greening will present the most recent BSDH (British Society for
Disability and Oral Health) policy document entitled “Principles of
Interveiition Unable to Comply with Routine Oral Health Care.”
Following Dr. Greening’s presentation of the guidelines, panelists will
respond to these guidelines by giving the viewpoint of their respective
countries. Following their response, there will be open discussion. The
goal of this presentation is to create a forum for discussion and educate
communities about the issues involved with this controversial topic.
156
lasertherapy in the repair o f ulcerations
caused by bullous epidermolysis.
M.T.B.R. SANTOS, L.A.S. MERLI, WJ. GENOVESE (University
Cruzeiro do Sul, Sao Paulo, Brazil)
Recessive dystrophic bullous epidermoloysis (DEB), or Hallopeau-
Siemens disease, is a bullous disease with an autosomal recessive pat-
tern, which has a poor prognosis with no spontaneous remission. It is
characterized by the appearance of lesions from birth, which evolve to
erosions, synechial scars and inilium. The skin involvement by
synechial scars result in poor oral hygiene and microstomy The goal of
this study was to evaluate the efficacy of low-potency laser use on skin
ulcerations caused by rupturing bullous lesions in patients with DEB.
Three trunk ulcerations from 3 different patients with DEB were select-
ed due to the following characteristics: average size (3x5 cm), infection,
delayed healing, difficult to control, spontaneous bleeding resulting in
anemia, and non-responsive to antibiotic therapy A KC-611 laser from
Dentoflex was used, with 50mV potency and density of energetic depo-
sition of 9 J/cm2 in scanning. There was a 7-day interval between treat-
ments. Abundant granulation tissue was noticed in the three ulcerations
7 days later at the first re-evaluation. There was no secondary infection
or spontaneous bleeding. At the second re-evaluation 14 days later,
there was a significant clinical difference in healing compared to the
non-irradiated ulcerations. We found that a low-potency laser effective-
ly treated ulcerations in individuals with DEB by speeding the healing
process and reducing secondary contamination.
Abstracts
ABSTRACTS
Oral health status of patients with disabili-
ties in two localities in the Czech Republic.
*A. PILINOVA’, E. LENCOVA’, E. MATEJlCKOVA2,E. VOJTE-
CHOVA’ (’Institute of Dental Research, 1st Faculty of Medicine
and General Faculty Hospital, Charles University, Prague, Czech
Republic, ’Private Physiotherapy Practice)
In 2003, a project supported by the Ministry of Health Grant Agency of
the Czech Republic was started to validate a preventive program for
persons with disabilities and to facilitate dental treatment. Ninety-five
children (59 boys and 36 girls, mean age 11.79 years) with mental dis-
abilities, from three day care facilities, were examined. Using three
indices (DMFT, DI-OHI, PMA), their oral health was evaluated, includ-
ing the functional impairment of their oro-facial complex according to
the concept describes by Castillo Morales. The mean DMFT for the
group was 11.31, mean number of decayed teeth was 2.60, and inissing
teeth was 4.21. These results showed that decayed teeth were either
untreated or extracted. The mean number of treated teeth was as low as
4.50 per person. Two thirds of all the examined teeth were covered with
dental plaque; gingival inflammation (papillitis or marginal gingivitis)
was found in 50% of the children. Orofacial dysfunctions were found in
all of the children. These findings confirm the need of a dental preven-
tive program, including a home care program, nutrition and an efficient
office oral hygiene and restorative dental treatment program. Using a
physiotherapist in the dental office would also improve the oro-motor
function and improve swallowing, mouth opening and breathing.
158
An alternative to conventional dental hygiene
care for patients with special needs.
*H.JACKSON (POHD, London Ontario)
Our current dental care system does not address the needs of patients
with special needs. The goal of this project is to present an alternative
to conventional dental hygiene care for patients with special needs and
to implement a community-based oral hygiene program in other com-
munities. A dental hygienist visits homes and work centers to train
both the patients and caregivers in an individualized oral hygiene pro-
gram. Routine care is provided to these individuals in a familiar and
safe environment. Because this is a new project, results will be collected
over the next few months.
S p e c Care Dentist 2 4 ( 3 ) 2004 167
ABSTRACTS
159
Oral risk assessment tools for the nursing
profession.
*J.GRIFFITHS (Department of Adult Dental Health, University
Dental Hospital, Heath Park, Wales)
The dental profession has considerable concern about the nursing pro-
fession’s Lack of knowledge and training in oral care. In recent years
oral health and hygiene have been receiving a higher profile in nursing.
The goals of this workshop are to help participants gain a better under-
standing of the different types of oral risk assessment tools for patients
with special needs and to improve oral care for these patients and pro-
vide them with an appropriate dental service. Participants will gain a
better understanding of the different types of oral risk assessment tools
for patients with special needs and will learn how to develop assess-
ment tools relevant to their own area of practice.
168
Risk factors for modifications to standard
oral health care.
*O.R. SUAREZ-SANCHEZ,3. CHASTEEN, M. MARTIN, J.
SHERMAN (University of Washington Oral Medicine
Department, Seattle, Washington)
We studied modifications to standard oral health care (SOHC) in a clin-
ic for adult patients with disabilities by examining dental records of 200
patients to identify classify and quantify the types of SOHC modifica-
tions. We also wanted to determine if self-reported functioning and dis-
ability (SRFD) or self-reported health status (SRHS) can predict the risk
for modification from SOHC, or identify other risk factors for modifica-
tions to SOHC. Group A was composed of 100 patients with reported
SOHC modifications and Group B had 100 controls. We found that
SRHS was not correlated to the need for SOHC modification (P=.529);
SRFD displayed marginal significance (P=.100). Few SRFD variables
(“sitting tolerance,” “communication,” and “bowel control”) were sig-
nificantly associated with needing SOHC modification (P<.05). Other
significant predictors included age, time exposed to the disability, need
for assistance, current prescriptions (yesfno), and number of prescribed
medications (P<.05). The results suggest that not all previously consid-
ered risk factors carry the same weight and perhaps they can be valu-
able when predicting a need for modifying SOHC.
168 S p e c Care Dentist 24(3) 2 0 0 4
172
Special Olympics Special Smiles: experiences
and opportunities.
*S. PERLMAN’, C.E SALINAS’, L.A.M. MARKS’, S.
ESTUPINAN4(‘Special Olympics Global Directov, U.S., ’Medical
University of South Carolina, Charleston, USA, ’Ghent
University, Ghent, Belgium, 4RegionalAdvisov, Pan American
Health Organization (PAHOE)
Special Olympics Special Smiles is currently the world’s largest oral
health initiative for children and adults with intellectual disabilities. In
2004, although there will be over 100 programs, only a fraction of the
1.3 million Special Olympic athletes from 160 countries will benefit
from the initiative. In this session, two programs will be highlighted,
each with its own start-up and/or growth perspectives. The viewpoint of
the Special Olympics athlete will be shared and strategies to expand
worldwide collaborative efforts will be discussed.
173
Special needs dental care fund.
“S. Zwetchkenbaum (Univevsify of Michigan Medical Centev,
Ann Arbov, USA)
In 2003, because the Michigan legislature eliminated Medicaid coverage
for adult dental services (except for extractions), over 1300 people with
developmental disabilities in Washtenaw County no longer had cover-
age for preventive, restorative or prosthetic dental care. I n response, we
began to develop the Special Needs Dental Care Fund and seek funding
from individuals, organizations and grants. Treatment plans have been
developed and patients can apply to have their payments drawn from
this fund. We concluded that if private funding for dental care is need-
ed, with proper support private funding can be successful. This presen-
tation will review the inception, development, and implementation of a
fund to support dental care for patients with special needs.
Abstracts

114
The ever-changing world o f medicine: an
update in n e w advances and how they impact
dent is t r y.
*B.JOHNSON, 0. BEIRNE (University of Washington, Seattle,
USA)
This session will review and educate participants about new advances
in the medical world, discuss how the advances might be applied to
medical treatment, and how these advances may or may not affect den-
tal therapy Topics will include human stem cell transplant; medication
impregnated cardiac stentshalves; immuno-modulation and approaches
to HCV infection; gene therapy; prophylaxis for individuals with
catheters; aspirin resistance; and gamma knife radiotherapy.
116
laryngeal mask and deep sedation in
dent is t r y.
*G. GOMEZ-MORENO, C. ARANA, A. CUTANDO (Facultad de
Odontologia, Universidad de Granada, Spain)
Deep sedation allows many patients to be safely treated during dental
procedures. However, sedation can lead to depressed breathing,
decreased deglutition and cough reflex. We present several case histo-
ries of dental treatment under sedation with a laryngeal mask for
patients with disabilities. Using deep sedation, the patient’s subglottic
space is not invaded and tracheal intubation is not necessary. The den-
tist can work without interference because the laryngeal mask is situat-
ed behind the pharyngeal bridges in front of the glottis.
Abstracts
ABSTRACTS
177
The impact of sugar consumption on caries
in people taking psychiatric medications.
*A. PAPAS, M. SINGH, J. CALVO, DJ. LEE, j . ZIMMERMAN
(Tufts University School of Dental Medicine, Boston, USA)
The goal of this study was to compare the frequency of sugar intake and
caries in a healthy group (n=74) and a group with psychiatric medica-
tions (n=185). Root and coronal caries were measured in two groups
who were 40-80 years old (mean age=63.7 years; 57% female), commu-
nity dwelling Boston residents. Both groups received a modified Block
Food Frequency Questionaire to determine the frequency and types of
sugars consumed. We found that coronal caries were significantly high-
er in the P group (P=3.73+3.24 vs. H=2.27&5.94) p=0.007). Root caries
were also higher in the P group (P=1.65+2.59 vs. H=0.98r1.74,
p=0.008). Although the brushing habits and dental visits were similar
in the two groups, the P group flossed more often (p=O.OOO),the P
group consumed sugar more frequently per week (P=56.80 + 40.66 vs.
H=37.41+/- 26.49 MW, p=O.OOO). We found this was true for all types of
sugars and total consumption. We concluded that people on psychiatric
medications have a greater risk for caries because their salivary flow is
low and their sugar consumption is significantly higher than healthy
controls. Because brushing and flossing do not sufficiently control
caries, patients on psychiatric medications should receive early preven-
tive intervention and nutritional counseling to prevent caries.
178
Melatonin in plasma and s a l i v a and
lymphocyte subpopulations in periodontal
patients.
*A. CUTANDO, G. GOMEZ-MORENO, C. ARANA, J.
BOLANOS, D. ACUNA-CASTROVIEJO (Universidad de
Granada, Granada, Spain)
Melatonin is secreted in saliva but its role in the mouth remains
unknown. Periodontal disease is an inflammatory disorder. We com-
pared the degree of periodontal disease and lymphocyte subpopulations
with melatonin concentrations in plasma and saliva among 46 patients
with different degrees of periodontal disease, along with 26 age- and
sex-matched controls. We compiled a dental and medical history using
World Health Organization criteria. Periodontal status was evaluated
using the Community Periodontal Index (CPI). Plasma and salivary
melatonin levels were determined using radioimmunoassay and lyin-
phocyte subpopulations were studied by flow cytometry. We found that
the patients had plasma and saliva melatonin levels of 8.5 + 3.18 and
2.57 + 0.99 pg/ml, respectively These values were lower (p < 0.001)
than in the controls (14.33 * 4.05 and 4.22 + 0.87 pg/ml, respectively.
Patients with periodontal disease showed a biphasic response in plasma
and salivary melatonin concentrations. Melatonin decreased in patients
with CPI = 2, and increased to maximum levels in patients with CPl =
4. We found an inverse relation between melatonin and the percentage
CD4+ T cells in patients with periodontal disease, with higher mela-
tonin levels with low CD4+ counts. We concluded that as periodontal
status worsened, there was increased plasma and salivary melatonin,
which suggests that increased salivary melatonin excretion may have a
periodontal protective function.
Spec Care D e n t i s t 2 4 ( 3 ) 2 0 0 4 169
ABSTRACTS
179
Oral status of patients with cerebral palsy.
I. TANBOGA, * P KARATABAN, Z ARI, S . ALTINTAS (Marmara
University, Istanbul, Turkey)
The goal of our study was to evaluate the frequency of dental diseases
and dental treatment needs of 71 patients (39 boys, 32 girls) with dif-
ferent types of cerebral palsy (Spastic, Ataxic, Athetoid and Mixed) in
Turkey who were admitted to the Metin Sabanci Rehabilitation Center.
The mean age of the study group was 26.34 (2.5-15.5 years). We
designed a new questionnaire, including dental habits, home care, intra-
and extra-oral pathologies, orthodontic needs, gingival and plaque
indices, DMF-T and df-t values. One examiner gave all of the examina-
tions and every measurement was done twice. We found that 70.4% of
the patients with cerebral palsy (CP) were Spastic, 9.9% were Athetoid,
1.4% were Ataxic, 4.2% were mixed and 14.1% had a hypotonic type of
CP Twenty-two percent of the patients also had epilepsy We found that
39.4% of the patients had mild gingivitis, 46.5% had moderate, and
11.2% had serious gingivitis. Twenty-one percent of the patients had
enamel hypoplasia and 17% had tooth erosion. Thirty percent of the
patients had open-bite and 12% had bruxism. The mean DMF-T value
was 2.5 and df-t was 4.02. The results show that patients with CP have
a higher frequency of dental problems compared with the normal popu-
lation.
180
Increasing access to dentat care can improve
the periodontal health of a population with
special needs.
*M. SHOAIB, M.]. BAIG, N. YAZDANIE (de’Montmorency
College of Dentistry/Punjab Dental Hospital, Lahore, Pakistan)
The purpose of this survey was to assess the periodontal status and fre-
quency of dental visits by a population with special needs in Lahore.
We surveyed 400 persons with special needs and 100 control subjects,
aged 6 to 20 years. Among the 500 children and young adults of both
groups, there were 327 boys (65.4%) and 173 girls (34.6%), with a
mean age of 12.7. Eight examiners used a questionnaire to determine
the frequency of dental visits and used an intra-oral examination to
assess the periodontal status on selected tooth surfaces according to cri-
teria of the Periodontal Index (PI). PI scores were calculated for both
the children and young adults with special needs (SNC and YA) as well
as for the healthy control subjects. There was a significantly higher pro-
portion of SNC and YA with irreversible periodontal disease than the
control group (p<O.OOl). The proportion of SNC and YA who never vis-
ited the dentist was significantly higher than for the control group
(p<O.OOL). By cross-tabulating the frequency of dental visits with peri-
odontal status, we found that persons who visit dentists frequently had
improved periodontal status. We concluded that the periodontal status
of SNC and YA was significantly poorer compared with that of the con-
trol subjects and that their periodontal status might be improved by
regular dental visits.
170 Spec C a r e Dentist 24(3) 2004
182
Stepping Stones in the United Kingdom.
*V BROOKES,]. FISKE ooint Advisory Committee in Special
Care Dentistry and the British Society of Disability and Oral
Health)
The Joint Advisory Committee in Special Care Dentistry OACSCD) was
established in 2000 as a freestanding committee to (1) promote and
oversee the introduction of training programs; (2) develop curricula;
and (3) develop training standards and the assessment process in spe-
cial care dentistry (SCD). The JACSCD membership met on a regular
basis to develop a case of need for a specialty in special care dentistry
and a training pathway. In 2003 JACSCD produced a proposal for a spe-
cialty in special care dentistry, which is based on demographic trends
and literature on oral health needs. The proposal includes examples of
good practice and identifies challenges faced by caretakers of individu-
als with special needs. It also outlines specific roles and future chal-
lenges, including creating a specialist list that will be held by the
General Dental Council and subsequent training programs with the
National Health Service. JACSCD also produced a document, Training
in Special Care Dentistry, which details the knowledge, skills and com-
petencies required in a three-year training program in SCD. From these
activities, we conclude that JACSCD has taken a leading role in devel-
oping the need for a specialty and three-year training program in spe-
cial care dentistry.
184
Clinical Care Delivery for HIV Dental
Patients: Recent Findings of Relevance to
General Practice.
*V GREENE’, E. GIOVANI’, A. ARRIBAS’, K. SHETTY’, M .
ALVES’, R. MULLIGAN’ (‘University of Southern California, LOS
Angeles, USA, ‘University of Sdo Paulo, Brazil, ’Lousiana State
University, New Orleans, USA, +University of Illinois, Chicago,
USA)
HIV infection is now recognized as a chronic disease that affects all lev-
els of society, therefore health care providers and individuals seeking
care should familiarize themselves with specific problems that are com-
mon to oral management of HIV/AIDS. Patients with HIV commonly
have unmet dental needs and may have a limited understanding of how
to reduce or prevent transmission. Dental providers know that reviewing
a patient’s health history and evaluating the clinical signs or symptoms
of disease often reveal risk factors that may be linked to clinical findings.
Dentists, therefore, may provide a key role in risk assessment and dis-
ease prevention while managing problem-based cases. As primary care
providers, general dentists may be able to influence their patients’ behav-
ior while managing their dental care needs. This symposium will high-
light research findings from different countries and offer challenges in
clinical diagnosis and treatment of unusual manifestations of oral disease
associated with HIV/AIDS. This session will also address alternative ther-
apies and common treatment modalities as well as demonstrate out-
comes of targeted AIDS educational training for dental providers and
associated staff. We will discuss the results of a longitudinal study which
investigated trends among selected risk groups and the implications for
broader prevention and treatment considerations of patients with HIV.
Abstracts

185
North Carolina Family Physicians’ Oral Cancer
Knowledge, Practices & Opinions.
*L.LPATTON, R.P STRAUSS,J.H. SOUTHERLAND,J.R. ELTER,
R. MUMFORD (University of North Carolina, Chapel Hill, USA,
and North Carolina DHHS, Raleigh, USA)
Oral cancer is often detected in advanced stages, despite opportunities
for periodic examination by medical and dental providers. The goal of
our survey was to assess North Carolina (NC) family physicians’ knowl-
edge of risk factors/signs for oral cancer and practices/opinions about
oral cancer examinations (OCEs). In 2002 we mailed a 34-item pre-test-
ed survey three times to a random sample of 1058 NC family physicians.
There were 272 respondents (27% response rate). Data were entered and
summarized using EPIINFO 2002. Of these respondents, 62% felt they
didn’t have current knowledge about oral cancer, 62% thought high risk
could result from poor oral hygiene and 33% thought high risk could
result from poor fitting dentures. Thirty-seven percent did not know the
two most common sites of oral cancer, 39% did not know oral cancer
usually appears as a painless, red area; and 53% did not know the major-
ity of oral cancers are diagnosed at age 60+. Thirty-five percent felt they
were inadequately trained to examine patients for oral cancer and only
17%always examined their adult patients for oral cancer. Another 17%
rarely or never examined their patients’ mouths. We found that NC fam-
ily physicians feel they are inadequately trained and practiced to detect
oral cancer. We concluded that there needs to be increased education
and practices that may lead to early detection of oral cancer.
186
Outcome of a mainstreaming policy imple-
mented at a specialist HIV dental clinic.
*J.GRAY’, N. KUMAR‘, D.R. MOLES’, S. PORTER’ (‘Oral Health
Sewice, Christchurch Hospital, New Zealand, ‘Eastman Dental
Institutefor Oral Health Care Sciences, UCL, University of
London, Dental Clinic, Mortimer Market Centre, Camden PCT,
London)
The goal of this study was to assess the outcome of a mainstreaming
policy that was implemented in a London specialist HIV dental clinic.
Of 92 discharged patients with HIV, 36 patients - a response rate of 39%
- agreed to participate in the study. A semi-structured telephone inter-
view was conducted with these patients. Four patterns of utilizing oral
health services following their discharge from the specialist clinic were
identified: (1) Twelve participants transferred to a general dental practi-
tioner. (2) Three participants transferred to another specialist oral
health care provider. ( 3 ) Eleven participants relied on emergency oral
health care at Mortimer Market Centre and had irregular dental treat-
ment. (4) Ten participants no longer received any oral health care.
Twelve (33%) of the participants had the perception that general dental
practitioners could not provide the same quality of oral health care as a
specialist at the HIV dental clinic. Four participants (11%) were refused
oral health care because of their HIV-infected status. Ten participants
(2S0/) did not plan to disclose their HIV-infected status to a new oral
health care provider. We concluded that the attitudes and behavior of
both patients and oral health care providers are barriers to effectively
mainstreaming dental treatment for individuals with HIV.
Abstracts
ABSTRACTS
187
Dental status of the residents in long-term
care institutions.
*S.-S. TSAI‘, S.-T. HUANG’, S.-Y HSIAO’, S:C. HONG’, I!-H.
YANG’, W-C. HU’ (’Sen-Kong-Ma Nursing Home Institute,
Kaohsiung Medical University, Kaohsiung, Taiwan, ’College of
Dental Science, Kaohsiung Medical University, Kaohsiung,
Taiwan)
The purpose of this study was to investigate the oral health of 601 eld-
erly nursing home residents, with an average age of 72.81+12.99, from
four randomly selected nursing homes in Kaohsiung, Taiwan. The
DMFT index for these residents was 21.29k8.27. The decayed index (D
index), missing index (M index) and filling index (F index) were
3.3424.67, 14.81+10.19 and 3 .0 4 4 .1 2 . Of these patients, 20.13% were
edentulous and only 36.8% had more than 20 teeth. We concluded that
these elderly patients were susceptible to poor oral health and needed
dental treatment. Professional oral hygiene care should be added to
healthcare in long-term care institutions to improve the oral health of
these residents.
188
Periodontal status and its relative factors for
the residents of long-term care institutions.
*S.-Y HSAIO’, S.-S. TSAI’, S.-T. HUANG’, C.-C. CHEN’, H.-S.
CHEN’ (‘College of Dental Science, Kaohsiung Medical
University, Taiwan, ’Sen-Kong-Ma Nursing Home Institute,
Kaohsiung Medical University, Kaohsiung, Taiwan, ’Graduate
Institute of Oral Health Science, Kaohsiung Medical University,
Kaohsiung, Taiwan)
The purpose of this study was to examine the periodontal status of 485
residents in four long-term care institutions. We performed oral exami-
nations to record the dental plaque, attachment loss and periodontal
pocket depth of residents and used questionnaires to determine their
dietary habits, oral health habits and status of daily activities. We found
a statistical difference between the plaque index and sex or age of the
residents (p<0.05). The same result was found between the Community
Periodontal Index of Treatment Needs (CPITN) and attachment loss. A
resident’s level of education, years of hospitalization or cognitive state
substantially affected hidher history of periodontitis. Elderly residents
who were more active showed healthier gingiva and, according to the
CPITN index, exhibited no plaque. We concluded that most long-term
care residents have limited activities and cannot maintain their oral
health. Clinical oral health guidelines should be created and caregivers
should be educated about monitoring and maintaining the oral health
of these residents.
Spec Care Dentist 24(3) 2004 171
ABSTRACTS
189
Prosthetic status and needs of residents in
long-term care institutions.
*C.-C. CHEN’, S.-S. TSAI’, S.-T. HUANG’, S.-Y. HSAIO’, C.-H.
WU’ (‘College of Dental Science, Kaohsiung Medical University,
Kaohsiung, Taiwan, ‘Sen-Kong-Ma Nursing Home Institute,
Kaohsiung Medical University, Kaohsiung, Taiwan, ’Graduate
Institute of Oral Health, Kaohsiung Medical University,
Kaohsiung, Taiwan)
Oral health can greatly affect the general health of long-term care residents.
As residents age, their rates of edentulous increase and oral health care
becomes more important. The goal of this study was to investigate the pros-
thetic status and estimate the prosthetic needs of 485 residents from four
different long-term care institutions. We examined the residents and record-
ed their dental plaque, attachment loss, and periodontal pocket depth. A
questionnaire determined their dietary habits, oral health habits and the sta-
tus of daily activities. We found a substantial difference between age and
prosthetic status in the upper and lower arches of these residents. As their
age increased, the percentage of residents with complete dentures also
increased. According to the prosthetic needs in both arches, there was a sta-
tistical difference according to age, education level and cognitive status
(p<0.05).in residents aged 45 year or younger, 48.5% needed partial den-
tures in the lower arch and 36.6% of residents aged 85 years and older need-
ed complete dentures in the upper arch. We found that partial or full eden-
tulousness reduced food intake, chewing function, digestion, influenced oral
and general health, their facial profile and interpersonal relations. it is
important to address the prosthetic status and needs of long-term care resi-
dents in order to provide them with suitable prostheses and good oral care.
190
The dental status and treatment needs of
residents in long-term care institutions.
*H.-Q. WONG’, S.-S. TSAI’, S.-T. HUANG’, W-C. HU’, L.-C.
HONG’ (‘College of Dental Science, Kaohsiung Medical
University, Kaohsiung, Taiwan, ’Sen-Kong-Ma Nursing Home
Institute, Kaohsiung Medical University, Kaohsiung, Taiwan,
’Graduate Institute of Oral Health Science, Kaohsiung Medical
University, Kaohsiung, Taiwan)
Although oral health affects quality of life and may be associated with several
important systemic diseases, the dental health of long-term care residents
receives little attention compared to other general health care. This study
examined the dental treatment needs of 485 long-term care residents from
four institutions. We examined each resident for dental plaque, periodontal
attachment loss and pocket depth, and provided a questionnaire to determine
diet, oral hygiene habits, lifestyle behaviors, Barthek score and the Kamofsky
scale. We found that 83 (17.11%) of the residents had received dental treat-
ment during the past year and 402 residents (82.89%) had received no dental
treatment. The Community Periodontal index of Treatment Needs (CPITN)
was higher for patients not receiving dental treatment than for those who
received dental treatment. Independent residents were more cooperative with
dental examinations than residents who needed help with daily activities.
These residents chose local dental clinics because of convenience, the dentist’s
professional technique, and the attitude of the staff. We found that residents
who visited the dentist had a healthier CPITN index than those who had not
visited the dentist. This finding suggests that dental consultation might be
beneficial to the oral health of residents in long-term care institutions.
172 Spec Care Dentist 24(3) 2004
191
Satisfaction of removable dentures in resi-
dents of long-term care institutions.
*P-Z.CHENG’, S.-S. TSAI’, S.-T. HUANG’, C.-W CHEN’, W-H.
HUANG’ (‘Kaohsiung Municipal Ming-Shen Hospital, Kaohsiung,
Taiwan, ’Sen-Kong-Ma Nursing Home Institute, Kaohsiung
Medical University, Kaohsiung, Taiwan, ’College of Dental
Science, Kaohsiung Medical University, Kaohsiung, Taiwan)
As the edentulous rates increases for aging persons, their oral hygiene
care becomes more important. This study examined how satisfied 485
long-term care residents were about their removable dentures. Each res-
ident was given an oral examination and questionnaire. There were
51.14% residents who had never had removable dentures, 41.86% had
removable dentures and 84.58% of those had both upper and lower
removable dentures. Of these residents, 23.78% were very satisfied with
their upper dentures, 20.12% were satisfied, and 31.71% had no opin-
ion. For lower dentures, 24.84% were very satisfied. Loose dentures
were the most common complaint. We concluded that half of the resi-
dents with dentures were satisfied with them. The reasons for dissatis-
faction included loose dentures, gingivitis and pressure sores.
192
The relationship between oral health HAP of
caregivers and the oral health status of chil-
dren with disabilities in Kaohsiung County,
Taiwan.
*H.-C. CHEN’, S.-T. HUANG’, Y-S. GUO’, SY : HSIAO’, Y-H.
YANG‘. (‘College of Dental Science, Kaohsiung Medical
University, Kaohsiung, Taiwan, ‘The Health Bureau of Kaohsiung
County Government, Kaohsiung, Taiwan)
The goal of our cross-sectional survey of 526 children with disabilities
was to determine their oral health status and the ielationship between
oral health knowledge, attitude, practice and socio-demography (age,
social class of the father’s occupation, mother’s educational level) of the
caregivers. We gave the children, who were aged 12 and younger, a den-
tal examination and their parents completed a questionnaire. The exam
revealed that the caries prevalence was 79.09%. Fewer caries were seen
in children whose parents helped them brush their teeth, whose moth-
ers were more highly educated, and whose parents had a higher socio-
economic status. The number of fillings was significantly associated
with routine dental examinations, the types of disabilities, and the den-
tal care habits of their parents. We concluded that the oral health status
of children with disabilities was related to the oral health knowledge,
practice and socio-demography of the caregivers.
Abstracts

193
Dietary and oral cleaning habits of children
with disabilities in Kaohsiung County, Taiwan.
*Y.-S. GUO’, H.-C. CHENL,S.-T. HUANG’, M.-L. LIN’, C.-C.
CHEN’ (‘The Health Bureau of Kaohsiung County Government,
Kaohsiung, Taiwan, ’College of Dental Science, Kaohsiung
Medical University, Kaohsiung, Taiwan)
Children with disabilities have difficulty maintaining their oral hygiene
because of the level of disability, type of diet, educational level, and atti-
tude and habits of caregivers. This study’s goal was to investigate
dietary and oral cleaning habits of 526 children with disabilities in
Kaohsiung County, Taiwan. A questionnaire was distributed to 314 boys
and 212 girls with a mean age of 7.44k2.89 years. The survey showed
that 27.76% of the children rarely ate sweets, 25.47% ate sweets less
than once a day, and 42.97% ate sweets more than once a day. Nearly
88% of the children routinely had oral cleaning: 57.67% could clean
their mouth and teeth by themselves, 23.54% were partially dependent,
and 18.58% were totally dependent on caregivers while .22% never
cleaned their teeth. The survey also found that the more severe the dis-
ability was, the higher the percentage of children who depended on
their caregivers for oral health care. Our results showed that the dietary
and oral cleaning habits of children with disabilities was associated with
their caregivers’ habits. To improve their oral health, it is important to
teach the children and their caregivers about good dietary and oral
hygiene habits.
194
Dental caries of children with disabilities in
Kaohsiung County, Taiwan.
J.-Y ZHAN’, *H.-C. CHEN‘, S.-T. HUANGL,Y-S. GUO’, H.-S.
CHEW (‘Tom-Ling Children’s Dental Clinic, Taizhong, Taiwan,
’College of Dental Science, Kaohsiung Medical University,
Kaohsiung, Taiwan, ’The Health Bureau of Kaohsiung County
Government)
Children with mental retardation, physical disabilities and multiple dis-
abilities have poor oral hygiene than children in the general population.
The goal of this study was to survey the prevalence, rate and severity of
dental caries in children with disabilities in Kaohsiung County, Taiwan,
and establish baseline data to develop a caries prevention program. We
examined 526 children with disabilities (314 boys, 212 girls), whose
mean age was 7.44k2.89 years. The prevalence of caries was 79.09%,
the mean caries were 5.16k4.67 (dft+DMFT), 1.1522.08 (DFMT) and
4.01k4.52 (dft), and the mean filling rate was 19.68%+30.87.Most of
the caries were due to the high d/D components (d:3.19/D:0.82). The
results showed a low filling rate and high d/D components in children
with disabilities. We hope to establish a training system for dentists
treating persons with disabilities and to encourage preventive dental
treatments and routine examinations to improve the oral health of chil-
dren with disabilities.
Abstracts
ABSTRACTS
195
Oral health status and treatment needs of
persons with disabilities in Taoyuan County,
Taiwan.
*I.-E! CHIU and S . - I HUANG (Graduate Institute of Oral Health
Science, Kaohsiung Medical University, Kaohsiung, Taiwan)
The goal of this study was to assess the oral status and treatment needs
of 811 people with disabilities (466 men and 345 women) in Taoyuan
County, Taiwan. The prevalence of caries was 86.96% and the mean
DMFT index was 9.00 (SD7.61). Among teeth with caries, only 25%
had received treatment. The incidence of gingivitis was 33.21%. Among
this group, 32.59% of them needed prosthetic treatment in the upper
jaw and 36.17% needed prosthetic treatment in the lower jaw. Among
the group, 54.20% needed orthodontic treatment. We concluded that
the high prevalence of caries and gingivitis and low filling rate indicated
poor oral hygiene and unmet dental treatment among the persons with
disabilities. The dental health care system should provide dental service
for people with disabilities and the discrepancy of dental resources
between urban and rural areas should be reduced. An oral health educa-
tion program should be implemented for caregivers and the Bureau of
National Health Insurance should provide extra financial support to
dentists who treat people with disabilities.
196
Dental status of the population with mental
retardation in Taiwan.
*S.-T. HUANG, H.-Y. LIU, S.-C. HONG, W-C. HU, H.-Q. WONG
(Kaohsiung Medical University, Kaohsiung, Taiwan)
Mental retardation is the most common disability in persons with dis-
abilities. We believe that before oral health education is introduced, the
oral dental status of Taiwan should be analyzed. We studied the dental
status of 841 persons with mental retardation, with a mean age
24.80+10.83, who were randomly selected by a stratified multi-stage
cluster sampling method. We found that the population of persons with
severe mental retardation was highest compared to moderate and
extreme severe mental retardation. Caries prevalence was
91.08+28.52%, DMFT index was 8.93k6.94, D index was 4.2k4.83, M
index was 2.66+4.85, F index was 2.08k3.23, and filling rate was
26.42k33.51°h. We found that the dental status of persons with mental
retardation is worse than that of the general public in Taiwan. Lack of
educational courses, dental treatment or prevention programs, and
insufficient oral health promotion are urgent problems that must be
solved.
Spec C a r e Dentist 24(3) 2004 173
ABSTRACTS
Oral health-related quality of life in a n eld-
erly v e t e r a n institute.
*S.-L. LIOU, 1-Y. SHIEH, Y-H. YANG, S . - I HUANG, L.-E.
ZHEN (Graduate Institute of Oral Health Science, Kaohsiung
Medical University, Kaohsiung, Taiwan)
The purpose of this study was to examine the effect of tooth loss on the
quality of life of 220 elderly with a mean age of 79 years, who were liv-
ing in a veteran institute. We used an oral examination and a question-
naire, which included the Barthel index; OHIP 49 or oral health impact
profile; systemic disease; betel drinking; and smoking, to collect data
for a cross-sectional survey. We found that participants had a high rate
of tooth loss (mean number of remaining teeth=12), one or more
chronic medical conditions, and they were taking prescription medica-
tions. The disability rate in the long-term center was 15.7%. The results
suggest that promoting oral health for the elderly can influence the
wellbeing and quality of life for this population. Oral treatment services
and oral health education for the elderly are an important component
for promoting oral health. Our goal is to prevent tooth loss and pro-
mote oral health for elderly living in long-term care centers.
198
The relationship between oral health and
quality of life among elderly nursing home
residents.
*M.-Y KUO', L.-Y CHI', P-J. CHANG', C.-S. CHANG', Y-C.
CHIV ('Chia-Yi City Chung Jean Vocational High School of
Nursing and Mid-Wifery, Taiwan, 'National Yang-Ming University,
Taipei, Taiwan, 'National Taipei Nursing College, Taiwan, 4Taiwan
Family Dental Association, 5TaiwanDental Association)
We studied the relationship between oral health and quality of life
(QOL) among 123 elderly nursing home residents aged 65 and over.
Using a cross-sectional correlation design, we gathered data by inter-
views and oral examinations. Questionnaires included the short
portable mental status questionnaire (SPMSQ), resident oral health
assessment, World Health Organization Quality of Life-BREF (WHO-
QOL-BREF) and oral health impact profile (OHIP). The results showed
(1) Oral health status: DMF: 2 3 4 . 5 , MT: 20.61+10.19. Edentulous sub-
jects with one or more dentures (47.2%) had significantly better QOL
than edentulous subjects without any denture or partial denture
(36.6%), and the same with oral function and mouth care. (2) There
was a significantly positive correlation between mouth care and oral
function (r=0.58, p<0.001), and quality of life (r=0.21-0.41, p<0.001).
(3) Oral function was a significant predictor in the four domains of
WHO QOL-BREF and the OHIP total score. We concluded that there
was a significantly positive correlation between mouth care and QOL.
Edentulous subjects with one or more dentures had a significantly bet-
ter QOL than edentulous subjects without dentures.
174 S p e c C a r e Dentist 24(3) 2004
199
Satisfaction w i t h complete dentures provided
by Kaohsiung City Government for the elderly.
*K.-H. Wang', H.-C. CHIUL, Y-S. CHEN' ('Dental Department of
Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan,
'Graduate Institute of Public Health, Kaohsiung Medical
University, Kaohsiung, Taiwan)
The four objectives of this study were (1) to evaluate how satisfied the
elderly were who received subsidized denture service; (2) to identify fac-
tors that influence denture satisfaction; (3) to assess the pros and cons of
the free denture policy for the elderly; and (4) to make policy recom-
mendations for future dental programs. We used a survey questionnaire
to collect information from 1,684 randomly selected elderly in four
municipal districts in Kaohsiung. After trained personnel conducted
home interviews with 954 patients and an oral hygiene examination was
completed, only 393 respondents were included in the statistical analysis
because of incomplete questionnaires and proxy responses. The results
showed that age, gender and location of residence were not statistically
significant to explain varying patient satisfaction with complete den-
tures. Three statistically significant factors that contributed to customer
satisfaction were financial status, location where the denture treatment
occurred, and whether or not the patient continued to use the denture.
Patients who had a better financial status, who received dentures from
higher levels of dental clinics, and those who continued using the den-
tures were more satisfied with free denture service. We found five factors
that contributed to customer satisfaction: financial status, health condi-
tion, ability to chew, the fit and functionality of the complete denture,
and knowledge about, and attitudes toward, complete dentures.
200
Building bridges w i t h our health colleagues:
a c a s e of s a l i v a r y duct relocation.
*M. TJEUU: L. MUGAYAR (Westmead Centrefor Oral Health,
Westmead Australia)
This retrospective case history highlights the need to collaborate with
other health professionals. A 15-year-old female with autism and an
intellectual disability had rampant caries. At 8 years she had surgery to
relocate both sublingual salivary ducts for the treatment of sialhorrea.
She lived with her patients, which was an eight-hour drive from our
Special Needs Unit at Westmead Centre for Oral Health. The examina-
tion was very limited due to limited patient compliance. A preventive
program included diet counseling, daily concentrated fluoridated tooth-
paste (5000ppm) and 0.2% chlorhexidine gel. Although the revised
treatment plan recommended more extractions, her parents were not
willing to accept anterior extractions. Under general anesthesia (GA),
21 surfaces were found to be carious. Restoration, endodontics, and
extractions were required under three long (2 1/2 hours each) GA ses-
sions over several months. We decided that in other similar scenarios,
we would collaborate with otolaryngologist surgeons on a protocol for
salivary duct relocation and dental follow-up, particularly in people
with special needs.
Abstracts

20 1
Paving the way towards better care: cerebral
palsy.
*M. T J E W L. MUGAYAR [Westmead Centre for Oral Health,
Westmead, Australia)
The purpose of this retrospective study was to demonstrate a range of
dental problems associated with cerebral palsy (CP) and treatment
options available using the facilities at Westmead Centre for Oral
Health. We examined five patients aged 16 to 35 who had a range of
dental needs associated with CP Patient A was compliant, demonstrated
good oral hygiene, and because no intervention was required, a preven-
tive program was issued. Patient 8 had trauma of the maxillary anterior
teeth, which resulted in lost maxillary central incisors. We treated
Patient B by constructing a maxillary removable partial denture to
replace the lost central incisors. Patient C had repeated trauma to the
lower lip, which resulted in recurring ulcers. Patient C received injec-
tions with botulinum toxin administered under general anesthesia.
Patient D exhibited signs of bruxism with worn and fractured amalgam
restorations. We replaced Patient D’s worn restorations with amalgam
restorations then administered an occlusal splint. Patient E also exhibit-
ed signs of bruxism with heavy wear and loss of vertical dimension of
occlusion. Patient E was treated under general anesthesia with a full-
mouth reconstruction with onlays, injections with botulinum toxin and
the use of an occlusal splint. We concluded that a wide range of treat-
ment options can be provided for patients with CP when they are given
intra-venous sedation and general anesthesia.
202
Dental management of a patient w i t h multi-
ple malignancies.
*M. FEEG [Westmead Centre for Oral Health, Sydney,
Australia)
The goal of this presentation is to review a case history of a 44-year-old
male patient who was treated at the Medically Compromised Clinic,
Special Care Unit, at Westmead Centre for Oral Health in Sydney. His
medical history included Lupus Erythematous, multiple malignancies,
bowel cancer, leukemia, and cancer of the tongue. The patient had
received the maximum allowed dosage of chemotherapy and radiothera-
py for bowel cancer. Although he had excellent oral hygiene and no
active caries, he had a reduced dentition, and lacked occlusal stability,
which resulted in limited masticatory function. This presentation will
discuss a treatment plan, treatment alternatives, and treatment out-
come, which improved the quality of life for this patient with multiple
malignancies and reduced dentition.
Ab s tra cts
ABSTRACTS
203
A huge leap backwards, then small steps for-
ward: profile of children seen at a Rett
Syndrome multidisciplinary management clinic.
*E.E.JAY, L. MUGAYAR, B. GUTIERREZ,]. THOMPSON, C.
ELLAWAY, B. TODD, T. JUAREZ, G. KONTOLEON, L. MOP-
PETT (Westmead Centre for Oral Health and the Children’s
Hospital, Westmead, Australia)
Rett Syndrome is a rare and severe neurodevelopmental disorder, which
results in progressive loss of intellectual function, fine and gross motor
skills, deceleration of head growth, and the development of stereotypic
hand movements. Current treatment is symptomatic and supportive
and focuses on maximizing each patient’s abilities. This poster will pres-
ent a brief overview of Rett Syndrome, patient case histories, and the
structure, roles and responsibilities of the Rett Syndrome
Multidisciplinary Management Clinic team, which consisted of a geneti-
cist, genetic counselor, pediatrician, dentist, occupational therapist,
speech pathologist, dietician, physiotherapist and music therapist. It
will also illustrate how health professionals collaborate to solve prob-
lems in a holistic manner.
204
Dental management protocol for juvenile ideo-
pathic arthritis: report from a workshop.
“1.NORDERYD’, B. BERGENDAL’, L. OLSON’, B. ANDERS-
SON-GARE’ (‘The Institute for Postgraduate Dental Education,
Jonkoping, Sweden, ‘Ryhov County Hosiptal, Jonkoping, Sweden)
Juvenile idiopathic arthritis (JIA) denotes arthritis in children that per-
sists for at least 6 weeks and has no known cause. In a Swedish study,
the incidence was estimated to be 11/100,000 children and adolescents
up to 16 years of age (Andersson-Gare 1992). New knowledge and clin-
ical experience necessitated the revision of a 1992 dental management
protocol. In 2003 Scandinavian dental and medical specialists on JIA
participated in a workshop to create new dental guidelines for treating
children with JIA. The protocol enables the early diagnosis and treat-
ment of temporomandibular disorders to prevent pain, decreased func-
tion, destruction and growth disturbances. Because JIA includes periods
of no symptoms and periods of flare-ups, the guidelines focus on recog-
nizing disease activity early. Temporomandibular disorders are common
in JIA and dental diagnosis may result in medical intervention. The
consensus of workshop participants was: (1) Each Swedish county
council should have a dental management coordinator; (2) A dental
specialist should examine all children and adolescents with JIA; (3)
Early treatment of arthritis is important; (4) Because scientific data is
sparse, more studies are needed.
Spec C a r e Denfisf 24(3) 2004 175
ABSTRACTS
205
Angelman Syndrome: dental treatment.
*M.S.A. CORREA’, R.O. ROCHA’, E N 2 CORREA’, A.S. HAD-
DAD’ (‘School of Dentistry, University of Cruzeiro do Sul
(UNICSUL), Sao Paulo, Brazil; ‘School of Dentistry, University
of Suo Paulo, Brazil)
Angelman Syndrome is a neuro-genetic disorder that occurs in approxi-
mately 10 in 20,000 births. The syndrome’s main characteristics include
intellectual disability, behavioral alterations, and delayed neuropsy-
chomotor development Physical manifestations include small head size,
hypo-pigmented skin, a protruding mandibular, tongue thrust and
widely-spaced teeth. We report on a 13-year-old white male patient
with Angelman Syndrome and discuss the preventive and orthodontic
treatment, including photographs and radiographs that were used to
treat the boy’s mandibular and dental problems.
206
Klippel-Trenaunay-Weber Syndrome: a case
report.
*A. SABBAGH’, LA., M. MOREIRA’, M.A. LOTULO’, E.Q.
ASSIS‘ (‘Brazil Oral Association; ‘Guarulhos University, Sao
Paulo, Brazil)
Klippel-Trenaunay-Weber syndrome is characterized by vascular nevi,
venous varicosity and hyperplasia of soft tissues and possibly bone in
the affected areas. Hemihypertrophy, macrocephaly, limb abnormalities
and macrodactyly is also observed. Orofacial manifestations include
facial asymmetry, jaw enlargement, malocclusion, premature tooth erup-
tion, teeth that may be significantly larger than normal, malformed, or
pedunculated, and severe gingival hypertrophy Most of these are the
result of mutations or may occur due to a dominant or recessive autoso-
ma1 pleiotropic gene. We report on a 12-year-old male patient with
craniofacial hemihypertrophy of the right side, cutaneous syndactyly,
early tooth eruption of the permanent teeth and jaw hypertrophy of the
left side with asymmetry associated with malocclusion. After examining
this patient, we concluded that oral surgeons and dentists must remain
aware of potentially serious complications of dental and/or surgical pro-
cedures in such patients.
176 S p e c C a r e Dentist 2 4 ( 3 ) 2004
210
Development of a community-based oral
health promotion program for African
American elders: Take Charge of Your Oral
Health.
*A. SLAUGHTER’, L. TAYLOR’, X SMITH’, L. EVANS’
(‘University of Pennsylvania School of Dental Medicine,
Philadelphia, USA; ’Center of Excellence for Diversity in Health
Education and Research, University of Pennsylvania,
Philadelphia, USA; 3Multidisciplinary Center on Aging, Lincoln
University, Philadelphia, USA; ‘University of Pennsylvania
School of Nursing, USA)
African American elders experience a disproportionate level of oral dis-
ease and utilize dental services less often than others in the general
population. Our goal was to better understand the oral health beliefs of
community-residing African American elders, who were primarily
female and whose mean age was 76 years, in order to develop a cultur-
ally sensitive health promotion program. Our target population attend-
ed six senior centers in West Philadelphia. Using the Health Belief
Model and Social Cognitive Theory, we conducted a survey of four
focus groups (n=24) at two centers. Oral screenings (n=147) were con-
ducted at six centers to compare the clinically assessed dental care need
to the perceived dental care need. We found that 61% of the partici-
pants needed dental care and that participants did not know that plaque
bacteria caused dental decay and gum disease; that tooth loss from gum
disease was not inevitable; that dental providers could prevent gum dis-
ease; and that flossing was beneficial. Although those who reported
dental pain were 4 times more likely to perceive a dental problem, only
9% reported oral pain, and only 9% rated their general health status as
poor. Based on these findings, we developed an educational program to
present the preventive benefits of brushing teeth and to increase aware-
ness of non-painful oral signs and symptoms as well as the effects of
plaque-related diseases towards overall health.
211
Mirroscope: a revolutionary visualization tool
in dentistry.
*M. RAKOCZ’, Z. RAKOCZ’ (‘Division of Pediatric 6 Hospital
Dentistry, The Chaim Sheba Medical Centev, Tel-Hashomer,
Israel; ’Private Practice, Tel-Aviv, Israel)
Our objective is to describe a new technology that integrates a high-
tech miniature video camera with the traditional 30-degree intraoral
mirror, thus allowing the dentist or dental hygienist to have a magnified
working field, which can be viewed on a computer or TV screen. The
advantages of this technology include being able to use the tool during
any type of procedure; having a magnified image of the operating area;
allowing dentists to maintain a normal position most of the time, which
avoids back strain; and not requiring an “adjustment” of intuitive hand-
eye coordination. The presentation will include a video demonstration
of the clinical use of this technology on different types of patients.
Abstracts