Skip to main content

Advertisement

Log in

Dental health and odontogenic infections among 6- to 16-year-old German students with special health care needs (SHCN)

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

This cross-sectional study aimed to assess dental health and odontogenic infections in students with special health care needs (SHCN) in the Free State of Thuringia, Germany.

Methods

From 1283 students with SHCN aged 6–16 years, 66.0 % (n = 848 of whom are 35.7 % females and 64.3 % males) with intellectual/learning disabilities (ID/LD), physical disabilities (PD), and sensory disorders (SD) participated after informed consent in oral examinations according to WHO standards. Dental caries was assessed by dmft/DMFT, odontogenic infections by pufa/PUFA. Fissure sealants (FS) were scored in permanent molars. Data were compared to regional and national reference data and analysed by t test and age-adjusted logistic regression models.

Results

Students with SHCN revealed 41.2 % caries prevalence in permanent and 31.7 % in primary teeth. Highest prevalence/experience of caries and odontogenic infections in primary teeth was recorded in 6–11-year-olds with PD (65.1 %/2.3 dmft; 14.0 %/0.3 pufa). Most affected permanent teeth were observed in students with ID/LD (12–16-year-olds 59.6 %/2.4 DMFT; 6–11-year-olds 2.8 %/0.03 PUFA). All odontogenic infections in 12–16-year-olds occurred in males; n = 9 students revealed n = 9 teeth with pufa/PUFA. Students with ID/LD aged 6–11 years exhibited lowest prevalence of FS (29.0 %) and mean of 0.8 FS. Students with SHCN suffered more than twice as frequent from untreated dental caries and benefited up to 29.0 % less from FS than peers without disabilities.

Conclusion

This first study investigating odontogenic infections of German students with SHCN revealed highest prevalence in primary teeth and in males. Oral health among students with SHCN is reduced, and FS are underutilized compared to German students without disabilities.

Clinical relevance

Reinforcing the application of FS in students with SHCN might contribute to reducing disparities in oral health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. UN-Convention on the Rights of Persons with Disabilities (2011) Retrieved from: http://www.behindertenbeauftragter.de/SharedDocs/Publikationen/DE/Broschuere_UNKonvention_KK.pdf. Accessed 16 Oct. 2015

  2. American Academy of Pediatric Dentistry (2012) Definition of special health care needs. Retrieved from: http://www.aapd.org/media/Policies_Guidelines/D_SHCN.pdf. Accessed 16 Oct. 2015

  3. Federal Statistical Office (Statistisches-Bundesamt) (2013) Statistics on severely disabled people (Statistik der schwerbehinderten Menschen). Retrieved from: https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/BehinderteMenschen/SchwerbehinderteKB.html. Accessed 16 Oct. 2015

  4. Al-Allaq T, DeBord TK, Liu H, Wang Y, Messadi DV (2015) Oral health status of individuals with cerebral palsy at a nationally recognized rehabilitation center. Spec Care Dentist 35:15–21. doi:10.1111/scd.12071

    Article  PubMed  Google Scholar 

  5. Anders PL, Davis EL (2010) Oral health of patients with intellectual disabilities: a systematic review. Spec Care Dentist 30:110–117. doi:10.1111/j.1754-4505.2010.00136.x

    Article  PubMed  Google Scholar 

  6. Leroy R, Declerck D (2013) Objective and subjective oral health care needs among adults with various disabilities. Clin Oral Investig 17:1869–1878. doi:10.1007/s00784-012-0879-x

    Article  PubMed  Google Scholar 

  7. Shetty V, Kumar J, Hegde A (2014) Breaking the sound barrier: oral health education for children with hearing impairment. Spec Care Dentist 34:131–137. doi:10.1111/scd.12042

    Article  PubMed  Google Scholar 

  8. van Schrojenstein Lantman-de Valk HM, Walsh PN (2008) Managing health problems in people with intellectual disabilities. BMJ 337. doi:10.1136/bmj.a2507

  9. Sari M, Ozmen B, Koyuturk A, Tokay U (2014) A retrospective comparison of dental treatment under general anesthesia on children with and without mental disabilities. Niger J Clin Pract 17:361–365. doi:10.4103/1119-3077.130243

    Article  PubMed  Google Scholar 

  10. German-CRPD-ALLIANCE (BRK-ALLIANZ) (2013) Alliance of German non-governmental organizations on the UN Convention on rights of persons with disabilities. Retrieved from: http://lib.ohchr.org/HRBodies/UPR/Documents/Session16/DE/JS4_UPR16_DEU_S16_2013_JointSubmission4_E.pdf. Accessed 16 Oct. 2015

  11. Glassman P, Caputo A, Dougherty N, Lyons R, Messieha Z, Miller C, Peltier B, Romer M (2009) Special Care Dentistry Association consensus statement on sedation, anesthesia, and alternative techniques for people with special needs. Spec Care Dentist 29:2–8. doi:10.1111/j.1754-4505.2008.00055.x

    Article  PubMed  Google Scholar 

  12. Mansell J (2010) Raising our sights: services for adults with profound intellectual and multiple disabilities. Tizard Learning Disability Review. pp 1–40. Retrieved from: https://kar.kent.ac.uk/24356/1/DH_2010_Raising_our_sights.pdf. Accessed 16 Oct. 2015

  13. Roberto LL, Machado MG, Resende VLS, Castilho LS, Abreu MHNG (2012) Factors associated with dental caries in the primary dentition of children with cerebral palsy. Braz Oral Res 26:471–477

    Article  PubMed  Google Scholar 

  14. Gurbuz T, Tan H (2010) Oral health status in epileptic children. Pediatr Int 52:279–283. doi:10.1111/j.1442-200X.2009.02965.x

    Article  PubMed  Google Scholar 

  15. Peltier B (2009) Psychological treatment of fearful and phobic special needs patients. Spec Care Dentist 29:51–57. doi:10.1111/j.1754-4505.2008.00062.x

    Article  PubMed  Google Scholar 

  16. Abanto J, Carvalho TS, Bönecker M, Ortega AO, Ciamponi AL, Raggio DP (2012) Parental reports of the oral health-related quality of life of children with cerebral palsy. BMC Oral Health 12:15. doi:10.1186/1472-6831-12-15

    Article  PubMed  PubMed Central  Google Scholar 

  17. de Nova García MJ, Gallardo-López NE, Martín-San Juan C, Mourelle-Martínez MR, Alonso-García Y, Carracedo-Cabaleiro E (2007) Criteria for selecting children with special needs for dental treatment under general anaesthesia. Med Oral Patol Oral Cir Bucal 12:E496–E503

    PubMed  Google Scholar 

  18. Edelstein BL (2007) Conceptual frameworks for understanding system capacity in the care of people with special health care needs. Pediatr Dent 29:108–116

    PubMed  Google Scholar 

  19. Heinrich-Weltzien R, Wagner A, Micheelis W (2013) Knowledge and subjective strain of dental treatment of children with special needs—results of a representative questioning of Thuringian dentists (Fachwissen und subjektive Belastung der zahnärztlichen Behandlung von Kindern mit Behinderungen-Eine Befragung der Thüringer Zahnärzteschaft). Oralprophylaxe Kinderzahnheilkd 35:81–85

    Google Scholar 

  20. Guay AH (2004) Access to dental care: solving the problem for underserved populations. J Am Dent Assoc 135:1599–1605

    Article  PubMed  Google Scholar 

  21. Bissar AR, Kaschke I, Schulte AG (2010) Oral health in 12-to 17-year-old athletes participating in the German Special Olympics. Int J of Paediatr Dent 20:451–457. doi:10.1111/j.1365-263X.2010.01065.x

    Article  Google Scholar 

  22. Schulte A, Kaschke I, Bissar A (2011) Oral health in adult athletes with intellectual disabilities in Germany (Mundgesundheit erwachsener Athleten mit geistiger Behinderung). Gesundheitswesen 73:e78–e83. doi:10.1055/s-0030-1254170

    Article  PubMed  Google Scholar 

  23. Monse B, Heinrich-Weltzien R, Benzian H, Holmgren C, van Palenstein HW (2010) PUFA—an index of clinical consequences of untreated dental caries. Community Dent Oral Epidemiol 38:77–82. doi:10.1111/j.1600-0528.2009.00514.x

    Article  PubMed  Google Scholar 

  24. Monse B, Duijster D, Sheiham A, Grijalva-Eternod CS, van Palenstein HW, Hobdell MH (2012) The effects of extraction of pulpally involved primary teeth on weight, height and BMI in underweight Filipino children. A cluster randomized clinical trial. BMC Public Health 12:725. doi:10.1186/1471-2458-12-725

    Article  PubMed  PubMed Central  Google Scholar 

  25. Murthy A, Pramila M, Ranganath S (2014) Prevalence of clinical consequences of untreated dental caries and its relation to dental fear among 12–15-year-old schoolchildren in Bangalore city, India. Eur Arch Paediatr Dent 15:45–49. doi:10.1007/s40368-013-0064-1

    Article  PubMed  Google Scholar 

  26. Oziegbe E, Esan T (2013) Prevalence and clinical consequences of untreated dental caries using PUFA index in suburban Nigerian school children. Eur Arch Paediatr Dent 14:227–231. doi:10.1007/s40368-013-0052-5

    Article  PubMed  Google Scholar 

  27. Kumar A, Puranik MP, Sowmya K (2015) Relationship between untreated dental caries and dental neglect among mentally handicapped children: a cross-sectional study. J Indian Assoc Public Health Dent 13:126–132

    Article  Google Scholar 

  28. Lewis C, Robertson AS, Phelps S (2005) Unmet dental care needs among children with special health care needs: implications for the medical home. Pediatrics 116:e426–e431

    Article  PubMed  Google Scholar 

  29. DAJ (Deutsche Arbeitsgemeinschaft für Jugendzahnpflege e.V.) (2010) Epidemiological accompanying examination on group prophylaxis 2009 (Epidemiologische Begleituntersuchung zur Gruppenprophylaxe 2009). Retrieved from: http://www.daj.de/fileadmin/user_upload/PDF_Downloads/Studie_Korrektur.pdf. Accessed 16 Oct. 2015

  30. Micheelis W, Schiffner U (2006) Fourth German Oral Health Study (Vierte Deutsche Mundgesundheitsstudie) (DMS IV). Deutscher Zahnärzte Verlag, Köln

    Google Scholar 

  31. World Health Organization (1997) Oral health surveys: basic methods (4th ed.). World Health Organization, Geneva Retrieved from http://apps.who.int/iris/handle/10665/41905#sthash.nltBJXcI.dpuf. Accessed 10 Aug. 2010

  32. Altun C, Guven G, Akgun OM, Akkurt MD, Basak F, Akbulut E (2010) Oral health status of disabled individuals attending special schools. Eur J Dent 4:361–366

    PubMed  PubMed Central  Google Scholar 

  33. Avasthi K, Bansal K, Mittal M, Marwaha M (2011) Oral health status of sensory impaired children in Delhi and Gurgaon. Int J Dent Clin 3:21–23

    Article  Google Scholar 

  34. de Jongh A, van Houtem C, van der Schoof M, Resida G, Broers D (2008) Oral health status, treatment needs, and obstacles to dental care among noninstitutionalized children with severe mental disabilities in the Netherlands. Spec Care Dent 28:111–115. doi:10.1111/j.1754-4505.2008.00022.x

    Article  Google Scholar 

  35. Jain M, Mathur A, Sawla L, Choudhary G, Kabra K, Duraiswamy P, Kulkarni S (2009) Oral health status of mentally disabled subjects in India. J Oral Sci 51:333–340

    Article  PubMed  Google Scholar 

  36. Solanki J, Gupta S, Chand S (2014) Comparison of dental caries and oral hygiene status among blind school children and normal children, Jodhpur City Rajasthan, India. Univ Res J Dent 4:22–25

    Article  Google Scholar 

  37. Dougall A, Fiske J (2008) Access to special care dentistry, part 1. Access. Br Dent J 204:605–616. doi:10.1038/sj.bdj.2008.457

    Article  PubMed  Google Scholar 

  38. Hennequin M, Moysan V, Jourdan D, Dorin M, Nicolas E (2008) Inequalities in oral health for children with disabilities: a French national survey in special schools. PLoS One 3:e2564. doi:10.1371/journal.pone.0002564

    Article  PubMed  PubMed Central  Google Scholar 

  39. Klingberg G (2014) Children with disabilities. In: Wright GZ, Kupietzky A (eds) Behavior Management in dentistry for children. 2nd edn. Wiley, New Jersey, pp. 93–105

    Chapter  Google Scholar 

  40. Gizani S, Kandilorou H, Kavvadia K, Tzoutzas J (2014) Oral health care provided by Greek dentists to persons with physical and/or intellectual impairment. Spec Care Dentist 34:70–76. doi:10.1111/scd.12011

    Article  PubMed  Google Scholar 

  41. Martens L, Marks L, Goffin G, Gizani S, Vinckier F, Declerck D (2000) Oral hygiene in 12-year-old disabled children in Flanders, Belgium, related to manual dexterity. Community Dent Oral Epidemiol 28:73–80

    Article  PubMed  Google Scholar 

  42. Vellappally S, Gardens SJ, Al Kheraif A-AA, Krishna M, Babu S, Hashem M, Jacob V, Anil S (2014) The prevalence of malocclusion and its association with dental caries among 12-18-year-old disabled adolescents. BMC Oral Health 14:123. doi:10.1186/1472-6831-14-123

    Article  PubMed  PubMed Central  Google Scholar 

  43. Chand BR, Kulkarni S, Swamy NK, Bafna Y (2014) Dentition status, treatment needs and risk predictors for dental caries among institutionalised disabled individuals in Central India. J Clin Diagn Res 8:ZC56–ZC59. doi:10.7860/JCDR/2014/9940.4861

    PubMed  PubMed Central  Google Scholar 

  44. Oredugba FA, Akindayomi Y (2008) Oral health status and treatment needs of children and young adults attending a day centre for individuals with special health care needs. BMC Oral Health 8:30. doi:10.1186/1472-6831-8-30

    Article  PubMed  PubMed Central  Google Scholar 

  45. Grund K, Goddon I, Schüler IM, Lehmann T, Heinrich-Weltzien R (2015) Clinical consequences of untreated dental caries in German 5-and 8-year-olds. BMC Oral Health 15:140. doi:10.1186/s12903-015-0121-8

    Article  PubMed  PubMed Central  Google Scholar 

  46. Benzian H, Monse B, Heinrich-Weltzien R, Hobdell M, Mulder J, van Palenstein HW (2011) Untreated severe dental decay: a neglected determinant of low body mass index in 12-year-old Filipino children. BMC Public Health 11:558. doi:10.1186/1471-2458-11-558

    Article  PubMed  PubMed Central  Google Scholar 

  47. Heinrich-Weltzien R, Monse B, Benzian H, Heinrich J, Kromeyer-Hauschild K (2013) Association of dental caries and weight status in 6-to 7-year-old Filipino children. Clin Oral Investig 17:1515–1523. doi:10.1007/s00784-012-0849-3

    Article  PubMed  Google Scholar 

  48. Liu C-j, Zhou W, Feng X-s (2016) Dental caries status of students from migrant primary schools in Shanghai Pudong New Area. BMC Oral Health. 16:28. doi:10.1186/s12903-016-0187-y

    Article  PubMed  PubMed Central  Google Scholar 

  49. Zhang S, Liu J, Lo EC, Chu C-H (2014) Dental and periodontal status of 12-year-old Bulang children in China. BMC Oral Health 14:32. doi:10.1186/1472-6831-14-32

    Article  PubMed  PubMed Central  Google Scholar 

  50. Lukacs JR, Largaespada LL (2006) Explaining sex differences in dental caries prevalence: saliva, hormones, and “life-history” etiologies. Am J Hum Biol 18:540–555

    Article  PubMed  Google Scholar 

  51. Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Mäkelä M, Worthington HV (2013) Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev. doi:10.1002/14651858.CD001830.pub4

    PubMed  Google Scholar 

  52. Heinemann F, Ifland S, Heinrich-Weltzien R, Schüler I (2015) Influence of fissure sealants on dental health of elementary school children in Weimar—a longitudinal observational study under real-life conditions (Einfluss der Fissurenversiegelung auf die Zahngesundheit von Weimarer Grundschülern–Eine longitudinale Beobachtungsstudie unter Alltagsbedingungen). Gesundheitswesen. doi:10.1055/s-0035-1564180

    PubMed  Google Scholar 

  53. Micheelis W, Schiffner U (2016) Fifth German Oral Health Study (Fünfte Deutsche Mundgesundheitsstudie) (DMS V). Deutscher Zahnärzte Verlag, Köln

    Google Scholar 

  54. Peretz B, Spierer A, Spierer S, Rakocz M (2012) Dental treatment of patients with systemic diseases compared to patients with developmental disabilities under general anesthesia. Spec Care Dentist 32:21–25. doi:10.1111/j.1754-4505.2011.00226.x

    Article  PubMed  Google Scholar 

  55. Gizani S, Declerck D, Vinckier F, Martens L, Marks L, Coffin G (1997) Oral health condition of 12-year-old handicapped children in Flanders (Belgium). Community Dent Oral Epidemiol 25:352–357

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the support of the headmaster and teachers of all schools during the clinical examination of the children.

Authors’ contributions

IMS and RHW conceptualized and reviewed the paper for content, including the final version of the manuscript. RHW developed the study design. KL, SI and IG organized and conducted the clinical examinations in the different regions. MD collected the data, performed the statistical analysis, conducted the literature research and authored the major portion of the manuscript. IMS and TL contributed towards statistical analysis and data handling. IMS contributed to the writing of the manuscript. All authors have read and approved the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marco Dziwak.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The work was not supported by any funding.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. The Ethics Committee of Jena University Hospital approved the present study (processing number 2930-09/10).

Informed consent

Written informed consent was obtained from all students with SHCN and/or their parents included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dziwak, M., Heinrich-Weltzien, R., Limberger, K. et al. Dental health and odontogenic infections among 6- to 16-year-old German students with special health care needs (SHCN). Clin Oral Invest 21, 1997–2006 (2017). https://doi.org/10.1007/s00784-016-1988-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-016-1988-8

Keywords

Navigation