Studies of Dental Health for the Severely Multi-Handicapped

Dental health control and health education are often difficult in severely multi-handicapped children because of their intellectual and physical disabilities. This study surveyed 57 male and 61 female children institutionalized in an institution for the severely multi-handicapped in order to study the relationship between their oral condition and the systemic evaluation. The results are summarized below.1. The following mean values were obtained: dft, 5.5; DMFT, 9.4; f ratio, 2 percent; F ratio, 3 percent; OHI-S, 1.86; and PMA-I, 18.69.2. When examined by age group, the dft increased until the age of 8 years and then decreased thereafter. The DMF was found to increase with age. The PMA-I value increased until the ages of 15 to 19 years and continued to be high thereafter. The OHI-S value increased with age. This was shown to be attributable to the increase in the CI-S value.3. Compared to the values obtained in the survey of dental diseases conducted in 1981, the incidence of caries was low for the molar teeth but high for the lower anterior teeth among the deciduous teeth, and low for the lower molar teeth among the permanent teeth.4. When the children were classified by Ohshima's classification for the severely multi-handicapped, the dft, DMFT, PMA-I, and OHI-S values tended to be higher in groups 5 to 9 than in the other groups.5. With regard to the relationship between IQ, degree of behavioral disturbance, and the oral condition, the DMFT, unlike the dft, tended to be higher in the children with higher IQs and only slight behavioral disturbances. The PMA-I and OHI-S values were higher in the group with IQs of 0 to 25 than in the other groups, but they were lower than in the patients classified as“able to walk”by degree of behavioral disturbance.6. With regard to the relationship between the classification of growth and function and the oral condition, it was found that the DMFT tended to be higher in the children who showed higher levels of growth and function with regard to tooth brushing, eating, and type of diet. The PMA-I value was high in the children who showed poor growth and function with regard to tooth brushing and those who required partial help when eating. The OHI-S value was high in those patients who showed poor growth and function.From these results, this study suggests that it is inadequate to evaluate dental caries and gingivitis in severely multi-handicapped children by examining the oral condition only, and that it is necessary to take into consideration such systemic factors as the patient's daily activities, intellectual disability, and motor function disorders.