BACKGROUND:Older adults residing in long-term care facilities often depend on caregivers for daily oral care. Inadequate caregiver training may contribute to poor plaque control and denture hygiene. METHODS:A six-month parallel-arm cluster randomized controlled study was conducted in selected long-term care facilities in Northern India. Two old age homes were randomly selected, with one allocated to the intervention group and the other to the control group. A total of 150 older adults and 46 caregivers participated. Caregivers in the intervention group received a structured caregiver oriented oral health education. Clinical assessments were performed at baseline, 3 and 6 months. Outcomes included Debris Index, Turesky-Gilmore-Glickman Plaque Index, Denture Plaque Index and Denture Stomatitis Index. Caregiver knowledge and practice were evaluated using a validated questionnaire. RESULTS:Caregiver knowledge and practice scores improved significantly in the intervention group at 3 and 6 months. Significant differences were observed in Debris Index (DI), Plaque Index (PI), and Denture Plaque Index (DPI) in the intervention group over the six-month follow-up (p < 0.001). The Debris Index decreased from 2.76 ± 0.07 at baseline to 1.54 ± 0.05 at 6 months. Plaque Index scores declined from 3.26 ± 0.06 to 1.85 ± 0.08, and Denture Plaque Index scores reduced from 3.22 ± 0.03 to 1.74 ± 0.05. Denture Stomatitis Index improved over time; however, intergroup differences were not statistically significant. CONCLUSION:Structured caregiver-focused oral health education significantly improved oral hygiene among institutionalized older adults over six months, supporting integration of caregiver training within routine long-term care.
BACKGROUND:Thalassemia is a well-recognized hereditary blood disorder with systemic complications. However, its craniofacial and orthodontic alterations remain incompletely characterized. Current evidence is fragmented, and no comprehensive synthesis has been published hitherto. AIMS:To map and synthesize craniofacial and orthodontic alterations in individuals with thalassemia by identifying morphological patterns and associated clinical factors. METHODS:This scoping review included cross-sectional studies, cohort studies, and clinical trials retrieved from four databases and gray literature. Data were analyzed descriptively. RESULTS:Twenty-six studies (comprising 2,353 participants) published between 1964 and 2025 were included. Common findings included a Class II skeletal pattern, mandibular retrusion, maxillary protrusion, increased lower facial height, and thalassemic facies. Orthodontic anomalies included Class II malocclusion, anterior open bite, crowding, incisor protrusion, and transverse constriction of the arches (narrow skeletal arches). Greater severity was associated with chronic anemia, splenectomy, and delayed transfusion. Only one study evaluated functional appliance therapy, demonstrating improved mandibular advancement and facial esthetics. CONCLUSION:Thalassemia is associated with clinically relevant dentoskeletal alterations that affect function and esthetics. Early orthodontic evaluation and timely interceptive treatment should be prioritized, as they may attenuate deformity progression and improve craniofacial development, reducing the future need for complex orthognathic surgery.
BACKGROUND:Physiological changes during pregnancy can increase the risk of oral diseases in women, which may directly affect the health status of their newborns. This cross-sectional study aims to assess the oral health knowledge, attitudes, and practices of pregnant women in South China, as well as their associated factors. METHODS:A cross-sectional survey on oral health was carried out between June 2016 and June 2017. The study involved 517 pregnant women recruited from the First Affiliated Hospital of Guangxi Medical University and Hospital of Stomatology, Guangxi Medical University during their visits for either routine prenatal care or dental services. RESULTS:According to the survey, while over 90% of pregnant women recognized the importance of regular brushing and gargling, only approximately half were aware of the benefits of pit and fissure sealants (50.3%) and fluoride treatments (48.4%). Moreover, merely 9.3% had undergone routine dental check-ups before pregnancy. In terms of daily oral hygiene, 87.2% reported brushing at least twice daily, yet the proportions incorporating flossing (17.8%) and gargling (43.7%) were considerably lower. Multivariate analysis showed that older age, urban residency, nulliparity, higher education and dental insurance were factors potentially associated with better oral health knowledge, attitudes, and practices (all p < 0.05). Of note, education and method of dental payment consistently exhibited positive effects across multiple models. CONCLUSIONS:In conclusion, while the majority of pregnant women possessed satisfactory oral health knowledge, their practical implementation of specific oral hygiene measures and routine dental attendance were insufficient. Education and dental payment method may play a pivotal role in shaping oral health knowledge, attitudes and practices.
AIM:To assess the effect of an educational intervention on nursing professionals' knowledge of hospital oral hygiene and associated factors. METHODS:A single-group quasi-experimental study was conducted in a hospital in southern Brazil, including 138 nursing professionals (mean age: 35.46 ± 9.49 years). The intervention comprised three stages: a pre-test, a protocol-based educational session delivered by two dental surgeons, and a post-test. Data were analyzed using descriptive statistics, McNemar's test, and Pearson's chi-square test (α = 0.05). RESULTS:Before the intervention, 19.6% of participants had never received academic instruction on oral hygiene, 59.4% had not received institutional training, and 37.7% were unaware of an institutional protocol. After the intervention, correct answers reached ≥95% in 15 of 19 items and 100% in four items (p < 0.001). The greatest improvements were observed for oral hygiene before bathing intubated patients (43.5% to 85.5%), and toothbrush use in hospital settings (52.9% to 85.5%). Higher baseline knowledge was associated with the presence of an institutional oral hygiene protocol (p < 0.05). CONCLUSION:The educational intervention improved nursing professionals' knowledge of hospital oral hygiene. Institutional protocols were associated with higher baseline knowledge, reinforcing the importance of continuing education and standardized protocols to support safe, evidence-based care.
Amniotic Band Syndrome (ABS) is a congenital disorder which is caused by the entrapment of fetal parts in fibrous amniotic bands while in utero. It is found in 1 in 1200 to 15000 live births. There is no gender or ethnic predisposition. Abnormalities can involve the cranium, face, trunk, abdomen, and extremities. Extremities are the most frequently affected parts, which appear as absence of digits, abnormally developed extremities, or amputations. The prognosis depends on the severity of manifestations, ranging from mild to lethal abnormalities. The purpose of this report is to discuss a rare case of a patient with ABS, a profound intellectual disability, and associated craniofacial abnormalities such as the congenital absence of the nose and upper lip, which introduced significant challenges to dental anesthesia for a comprehensive dental examination and management. A preoperative anesthesia assessment must consider the patient's medical diagnosis, daily medication regimen, physical and airway status, PONV risk, prior anesthetic interventions, and other factors related to the patient's condition. Therefore, we must consider the extent of physical abnormalities present and any reconstruction reported when selecting the type of anesthesia and supporting airway devices.
AIMS:This study aimed to qualitatively evaluate the awareness, knowledge levels, and clinical approaches of dental residents regarding the dental management and characteristics of individuals with Autism Spectrum Disorder (ASD). METHODS AND RESULTS:Using a phenomenological qualitative design, data were collected through semi-structured, in-depth interviews with dental residents at a public university in Istanbul, Türkiye. Transcripts were analyzed via ATLAS-ti software to identify themes and sub-themes. Residents recognized key ASD traits such as repetitive behaviors, sensory sensitivities, and communication barriers. The theme "Experience During Examination" highlighted significant challenges, including patients' difficulty following instructions and fear of the clinical setting. Results indicated that residents utilize behavioral management strategies, such as providing isolated, low-stimulus environments and using visual aids or relaxing music. While some managed difficulties through adapted interactions, others reported a need to refer patients for conscious sedation or general anesthesia for invasive procedures. CONCLUSION:Although dental residents demonstrate a foundational awareness of ASD, they face practical challenges in clinical examination and treatment. Enhancing specialized training in behavioral management and providing low-stimulus clinical settings are essential to improve oralhealthcare outcomes for patients with ASD.
OBJECTIVES:To assess the knowledge and preparedness of dental students regarding Cleft lip and palate (CLP) and to utilize qualitative inquiry in Phase II to explain the educational factors influencing clinical competency (measured via theoretical management skills) and knowledge retention (measured via etiology recall). METHODS:A sequential explanatory mixed-methods study was conducted at Umm Alqura University, Makkah, Saudi Arabia. Phase I involved a cross-sectional survey of 129 clinical dental students and interns to assess demographics, theoretical knowledge, and attitudes toward CLP care. Phase II involved semi-structured interviews with a stratified purposive sample to explore barriers to learning and confidence. Quantitative data were analyzed using descriptive statistics and inferential tests (Chi-square and independent t-tests), while qualitative transcripts were analyzed using thematic analysis. RESULTS:Quantitative findings showed that while 85.2% of students recognized clinical features, significant deficits existed in etiology; only 35.9% correctly identified smoking as a risk factor. Students with clinical exposure achieved higher knowledge scores (7.94 ± 3.70) compared to non-exposed students (7.14 ± 2.89) yet demonstrated high variance in performance. Qualitative analysis explained these disparities through five emerging themes: (1) "knowledge decay" of pre-clinical sciences not reinforced in later years; (2) clinical exposure often limited to "passive observation" rather than active engagement; (3) anxiety regarding patient counseling due to a lack of practical communication training; (4) uncertainty regarding treatment sequencing and the optimal timing for interventions; and (5) ambiguity regarding the general dental practitioner's specific role and responsibilities within a multidisciplinary cleft palate team. CONCLUSION:Current educational models relying predominantly on isolated didactic instruction and passive observation may not be entirely sufficient for fostering complete CLP competency. The findings suggest a curriculum revision emphasizing vertical integration and active, case-based learning.
AIM:The present umbrella review aims to assess the association between periodontitis and mild cognitive impairment(MCI), Alzheimer's disease and dementia. METHODS AND RESULTS:MEDLINE(via PubMed), Scopus, EMBASE, Google Scholar, and Cochrane Library was searched. Risk of Bias(ROB) was performed using Risk of Bias in Systematic Reviews (ROBIS) tool. Metaumbrella software was used for performing quantitative analysis, evidence stratification and GRADE analysis. 12 of the 14 included studies were judged to have a high ROB, while two systematic reviews and meta-analyses (SRMAs) demonstrated a low ROB. Individuals with periodontitis had a 1.651 times higher risk of developing MCI (95% CI = 1.391 to 1.96; I2 = 0%; P < 0.001), a 1.525 times higher risk of Alzheimer's disease (95% CI = 1.149 to 2.023; I2 = 85.877%; P < 0.001), and a 1.535 times higher risk of dementia (95% CI = 1.119 to 2.107; I2 = 82.972%; P < 0.001), all supported by Class IV evidence. Furthermore, severe periodontitis was associated with a 2.138 times higher risk of MCI (95% CI = 1.59 to 2.875; I2 = 0%; P < 0.001), while moderate or severe periodontitis was associated with a 2.048 times higher risk of dementia (95% CI = 1.45 to 2.893; I2 = 0%; P < 0.001), supported by Class IV and Class III evidence, respectively. Despite these associations, the certainty of evidence for all outcomes was rated as very low according to the GRADE assessment. CONCLUSION:A significant association was found between periodontitis and MCI, Alzheimer's disease and dementia with a "very low" evidence certainty.
AIMS:This systematic review and meta-analysis assessed whether individuals with Parkinson's disease (PD) have higher dental caries rates than those without PD. METHODS:Seven electronic databases and gray literature sources were systematically searched for observational studies comparing dental caries between individuals with and without PD. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses of continuous data were performed, reporting mean differences (MD) with 95% confidence intervals (CI). The strength of evidence was appraised using the GRADE framework. RESULTS:Of 389 retrieved records, 10 studies were included, comprising 1726 individuals (573 with PD; 1153 controls). All studies employed a cross-sectional design with a control group and exhibited a moderate risk of bias. Meta-analyses revealed no significant differences in the decayed, missing, and filled teeth (DMFT) index (k = 5) (MD = -0.30; 95% CI = -5.18-4.57) or untreated dental caries (k = 4) (MD = 0.73; 95% CI = -1.66-3.12). The strength of evidence was classified as low. CONCLUSION:To date, very-low-certainty evidence does not demonstrate a statistically significant difference in dental caries experience between older adults with and without PD. These findings should be interpreted cautiously and should not be taken as evidence that PD is unrelated to current or future dental caries susceptibility.
Mucopolysaccharidosis type VI (MPS VI), a rare metabolic disorder, results from glycosaminoglycan accumulation in tissues, frequently leading to hyperplastic gingival alterations that necessitate comprehensive intervention. An 11-year-old male patient diagnosed with MPS VI required hospitalization due to complications associated with a ventriculoperitoneal shunt (VPS) valve. A dental evaluation identified bone malformation in the maxillomandibular complex accompanied by pronounced gingival hyperplasia. The surgical team performed a gingivoplasty in the operating room under general anesthesia, employing a combined technique involving manual scalpels and a diode laser to excise hyperplastic gingival tissue and cauterize bleeding sites. The patient exhibited an uneventful postoperative recovery, with no hemorrhagic or infectious complications. The diode laser demonstrated safety and efficacy in removing gingival tissue in this patient with MPS VI, facilitating local tissue repair, enhancing the aesthetic and functional profile, and ultimately improving the patient's oral health and quality of life.
AIMS:Developmental delay with gastrointestinal, cardiovascular, genitourinary, and skeletal abnormalities (DEGCAGS) syndrome (OMIM #619488) is a rare autosomal recessive disorder caused by pathogenic variants in ZNF699 and characterized by developmental delay and multisystem involvement. Although several systemic and craniofacial manifestations have been described, oral findings have not yet been reported. This case report describes the craniofacial and oral features of a patient with DEGCAGS syndrome, contributing to the expansion of its phenotypic spectrum. METHODS AND RESULTS:A 10-year-old girl with a homozygous pathogenic variant in ZNF699 was referred for dental evaluation. Clinical examination revealed hair thinning, dolichocephaly, retromicrognathia, synophrys, smooth philtrum, thin upper lip, increased overjet, and deep bite. Intraoral findings included generalized spacing, gingivitis, active carious lesions, hypomineralization of primary molars, talon cusps on the maxillary central incisors, erosive tooth wear, and signs consistent with sleep bruxism. Radiographic evaluation revealed taurodontism, particularly in teeth 16 and 26, shortened roots in the mandibular incisors, and increased pericoronal space associated with developing teeth. CONCLUSION:These findings expand the oral phenotype of DEGCAGS syndrome and highlight the importance of dental evaluation in patients with rare genetic disorders. Further reports are needed to better characterize the oral manifestations associated with this condition.
BACKGROUND:Platelet Storage Pool Deficiency (PSPD) is a rare qualitative defect involving impaired granule secretion, often presenting with normal routine coagulation profiles. This case highlights the challenges of dental debridement in a young adult with special health care needs where functional platelet failure outweighs numerical counts. CASE DESCRIPTION:An 18-year-old required dental debridement under general anesthesia. Despite a multidisciplinary preoperative protocol involving desmopressin and antifibrinolytics, the patient encountered refractory postoperative hemorrhage. The bleeding exceeded the capacity of local hemostatic measures, necessitating an emergent blood transfusion for stabilization. PRACTICAL IMPLICATIONS:This case underscores that pharmacological management of PSPD can be unpredictable. It reaffirms the necessity of the hospital-based "Medical Home" for special care populations, ensuring immediate access to blood products and interdisciplinary expertise. Practitioners must look beyond standard lab values when planning invasive procedures for patients with qualitative platelet dysfunction.
BACKGROUND:Hormonal changes during pregnancy increase susceptibility to gingival inflammation and periodontal disease, which may adversely affect maternal and fetal health. Effective oral health education during pregnancy is therefore essential. Visually engaging educational tools such as animated videos may improve understanding and adoption of preventive oral hygiene practices. AIM:To compare the effectiveness of a customized animated video-based oral health education intervention with conventional model-based education on oral hygiene status, behavioural practices, and selected pregnancy outcomes among pregnant women. METHODS:This single-blind, parallel-group randomized controlled trial included 92 pregnant women in their second trimester attending a tertiary care hospital between June 2024 and March 2025. Participants were randomly assigned to either an experimental group receiving customized animated video-based education or a control group receiving conventional model-based education. Clinical parameters including Plaque Index (PI), Gingival Index (GI), and Modified Periodontal Screening Score (mPESS), along with oral hygiene practices assessed through a validated questionnaire, were recorded at baseline, three months, and six months. Delivery outcomes were obtained postpartum. Statistical analysis included repeated-measures ANOVA or Friedman tests for within-group comparisons and Mann-Whitney U or chi-square tests for between-group comparisons. Analysis of covariance (ANCOVA) was additionally performed to adjust for baseline gingival index differences. RESULTS:Seventy-one participants completed the six-month follow-up (experimental = 26; control = 31). Both groups showed significant improvements in GI and PI, and oral hygiene practices over time (p < 0.001). At six months, the experimental group demonstrated significantly lower GI (p < 0.001) and PI scores (p = 0.011) compared with the control group. Behavioural improvements were also greater in the experimental group. No statistically significant differences were observed in preterm birth, delivery type, or infant birth weight. CONCLUSIONS:Within the limitations of the present study, customized animated video-based oral health education demonstrated greater improvement in gingival health, plaque control, and oral hygiene behaviours compared with conventional model-based education among pregnant women. TRIAL REGISTRATION:The study was submitted to the Clinical Trials Registry-India (CTRI) under Reference No. REF/2026/02/125268.
OBJECTIVE:This systematic review and meta-analysis aimed to assess the effectiveness of audio and audio-visual (AV) distraction techniques on dental anxiety in children and adolescents with intellectual disability (ID). METHODS:A thorough search was conducted up to December 2025 following the PRISMA 2020 guidelines by two independent researchers in seven databases, supplemented by hand search and grey literature search. Data extraction was performed using predetermined criteria. Risk of bias of selected studies was assessed using Cochrane collaboration's risk of bias tool for randomized trials (RoB2) and risk of bias in non-randomized studies of interventions, version 2 (ROBINS-I V2). Meta analysis of included studies was performed using pooled odds ratio and its corresponding 95% confidence intervals. RESULTS:Out of 1622 total studies identified, twelve studies were included. Nine studies were included in the meta-analysis. Audio-visual distraction generally showed improvements in children's behavior and physiological responses. Statistically significant values were observed in electrodermal activity and Venham's behavior rating scale. CONCLUSION:Audio-visual distraction may help to reduce dental anxiety in children with intellectual disability. However, there is inconsistent evidence, and further well-designed studies need to be conducted to establish their effectiveness more clearly.
BACKGROUND:CHARGE syndrome is a rare congenital genetic disorder caused by variants in CHD7 gene. The acronym "CHARGE" represents its primary features: coloboma of the iris or retina, heart defects, choanal atresia, retardation of growth and development, genital anomalies, and ear anomalies including hearing loss. Craniofacial and oral abnormalities are a significant component of its clinical spectrum and often complicate conventional dental care, necessitating reliance on pharmacological behavior management techniques. CASE REPORT:We report the case of a 4-year-old boy with CHARGE syndrome who underwent full-mouth dental rehabilitation under general anesthesia. Owing to extensive dental disease, anticipated airway difficulty, and multiple systemic comorbidities, comprehensive multidisciplinary planning and specialized anesthetic management were undertaken. Treatment was completed successfully, with improved oral function and quality of life at follow-up. CONCLUSION:This case underscores the importance of meticulous treatment planning, specialized airway management, and perioperative monitoring, as well as the value of an interdisciplinary team in ensuring safe and effective care. To our knowledge, this is one of the few reports detailing the dental and anaesthetic considerations and management strategies for a child with CHARGE syndrome.
Moyamoya disease (MMD) is a rare cerebrovascular occlusive disorder involving Internal carotid arteries, which may present in association with Down syndrome (Trisomy 21). These patients are at increased risk of intraoperative complications such as hyperventilation, transient ischemia, stroke and cerebral haemorrhage. This case report describes the dental management of an 8-year-old female patient with MMD and associated Down syndrome (DS) receiving antiplatelet therapy, along with a comprehensive literature review. The patient presented with dental pain in the upper right quadrant and multiple carious teeth. The child was cognitively impaired but potentially cooperative, and behavior management was achieved through desensitization and audiovisual distraction techniques. Dental treatment was performed in staged, short appointments and included selective caries excavation and restoration of teeth (#11, #21, #53, #55, #63, #65, #83, #85) using glass ionomer cement. Extraction of decayed teeth (#54, #64, #75 root stumps) was carried out under local anaesthesia (LA) without discontinuation of aspirin therapy. Patient was monitored intraoperatively for SpO2 and postoperatively for extraction-site bleeding, which was effectively controlled using cold application and local pressure. Acetaminophen was prescribed for analgesia. Over a one-year follow-up period, the patient demonstrated significant improvement in oral health, pain reduction, and overall quality of life. This case highlights that the choice of anaesthesia and management protocol should be individualized based on the patient's level of cooperation, extent of dental treatment needs, and associated comorbidities, including bleeding risk and airway considerations.
BACKGROUND:Children with Down Syndrome (DS) are at heightened risk for oral diseases due to their distinct physiological and immune characteristics. Matrix metalloproteinases (MMPs), particularly MMP-8 and MMP-9, are key mediators of periodontal tissue breakdown. Probiotics may provide a novel, well-tolerated alternative to conventional antiseptics by modulating these biomarkers. METHODS:This single-center, parallel-arm, randomized, single-blind pilot trial compared a sugar-free microencapsulated probiotic oral rinse against a 0.2% chlorhexidine digluconate rinse in children with DS. A total of 118 participants aged 6-14 years were enrolled; following attrition after oral rehabilitation, 40 children (20 per group) were allocated to intervention, and 15 participants per group completed all assessments. After individualized oral rehabilitation and oral health education, participants were randomized (1:1). Group 1 received probiotic rinse and Group 2 chlorhexidine rinse, both administered twice daily for two weeks. Primary outcomes were salivary MMP-8 and MMP-9 levels (enzyme-linked immunosorbent assay). Secondary outcomes were plaque index (PI), gingival index (GI), oral hygiene index-simplified (OHI-S), and bleeding on probing (BOP). Outcomes were assessed at baseline prior to oral rehabilitation (T0), two weeks after completion of oral rehabilitation (T1), two weeks following completion of the rinse protocol (T2), and six months post-rinse (washout period, T3) by blinded examiners. RESULTS:All 30 randomized participants completed the trial (15 per group). Both groups showed significant within-group reductions in MMP-8, MMP-9, PI, GI, OHI-S, and BOP at follow-up (p < 0.05). Between-group comparisons showed no significant differences in MMP levels, PI, GI or OHI-S at any interval. At six months, the probiotic group demonstrated a greater reduction in BOP compared with chlorhexidine (median difference -6.0; 95% CI [-9.0, -3.0]; p = 0.001). Given the two-week duration of rinsing, this isolated 6-month difference should be interpreted cautiously. HARMS:No systemic side effects or gastrointestinal symptoms were reported. Mild tooth staining occurred in two participants in the chlorhexidine group; no adverse effects were reported in the probiotic group. CONCLUSION:Both rinses demonstrated within-group improvements, although no significant between-group differences were observed in the primary biochemical outcomes. The probiotic rinse showed comparable short-term efficacy and better tolerability, but due to underpowering and design limitations, findings remain exploratory. Larger, adequately powered studies are required to determine true clinical effectiveness. TRIAL REGISTRATION:This study was a registered clinical trial with the Clinical Trials Registry of India (CTRI/2023/04/051447). The trial was prospectively registered, adhering to the WHO standards for clinical trial registration to ensure transparency and integrity in reporting health-related outcomes.
