Caries experience and salivary aspects in individuals with fragile X syndrome.
TL;DR: The experience of dental caries in individuals with FXS was correlated with salivary parameters, poor oral hygiene, lower socioeconomic status and an increased count of S. mutans in saliva.
Abstract: Fragile X syndrome (FXS) is the most common cause of hereditary mental retardation, but studies on the oral health condition of these patients are rare. The aim of this study was to determine the experience of dental caries in individuals with FXS, by examining the saliva profile, oral hygiene, socioeconomic characteristics and use of controlled drugs in these patients. Dental health was estimated using the decayed, missing and filled teeth index (DMF-T) and sialometry, and the pH value and buffering capacity of the saliva, colony forming units of S. mutans (CFU/mL), visible biofilm index, and socioeconomic status were all examined. The sample, comprising 23 individuals, had an average age of 17.3 ± 5.6 years, a DMF-T index of 5.5, a diminished salivary flow (78.3%), and a low (73.9%) saliva buffering capacity. Most (52.2%) individuals presented with a high abundance (CFU/mL) of S. mutans. The experience of caries was correlated with salivary parameters, poor oral hygiene, lower socioeconomic status and an increased count of S. mutans in saliva.
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TL;DR: Fragile X syndrome (FXS) is the leading inherited form of intellectual disability and autism spectrum disorder, and patients can present with severe behavioural alterations, including hyperactivity, impulsivity and anxiety, in addition to poor language development and seizures as mentioned in this paper.
Abstract: Fragile X syndrome (FXS) is the leading inherited form of intellectual disability and autism spectrum disorder, and patients can present with severe behavioural alterations, including hyperactivity, impulsivity and anxiety, in addition to poor language development and seizures. FXS is a trinucleotide repeat disorder, in which >200 repeats of the CGG motif in FMR1 leads to silencing of the gene and the consequent loss of its product, fragile X mental retardation 1 protein (FMRP). FMRP has a central role in gene expression and regulates the translation of potentially hundreds of mRNAs, many of which are involved in the development and maintenance of neuronal synaptic connections. Indeed, disturbances in neuroplasticity is a key finding in FXS animal models, and an imbalance in inhibitory and excitatory neuronal circuits is believed to underlie many of the clinical manifestations of this disorder. Our knowledge of the proteins that are regulated by FMRP is rapidly growing, and this has led to the identification of multiple targets for therapeutic intervention, some of which have already moved into clinical trials or clinical practice.
514 citations
TL;DR: The collected data provide information for the health professionals and guardians to guide the monitoring of patients with FXS as well as to create strategies to improve oral hygiene.
Abstract: OBJECTIVES To relate the oral health of individuals with fragile X syndrome (FXS) with their oral characteristics, habits, and difficulties in terms of oral hygiene and the perception of oral health of the guardians. METHODS AND RESULTS This observational transversal study included 31 volunteers who belong to the Portuguese Fragile X Syndrome Association. A questionnaire was presented to guardians, and a head and neck and oral examination was performed to the individuals: decay, missing and filled teeth index (DMFT) = 4.65, gingival index (GI) = 1.01, and simplified oral hygiene index (OHI-S) = 2.26 and Malocclusion Class Angle II (61.3%) with dental aesthetic index 34.90. A high-arch narrow palate (71%), accentuated gagging reflex (45.2%), and bruxism (22.6%) were the most common oral characteristics. There was a negative correlation between the several behaviors, attitudes, and habits reported by the guardians and all the indexes of oral health, with significance to the DMFT (P = .032), missing teeth (P = .032), and GI (P = .04). CONCLUSION There was a variability in oral characteristics, and these can represent a difficulty in performing oral hygiene. The collected data provide information for the health professionals and guardians to guide the monitoring of patients with FXS as well as to create strategies to improve oral hygiene.
3 citations
TL;DR: The MMC individuals, in the majority, have shown cognitive impairment and anxious behavior, use of controlled drugs, convulsion, CSF shunt use, and latex allergy, and the presence of periodontal tissue damage was higher in patients with MMC.
Abstract: The aim was to analyze systemic and oral aspects of patients with myelomeningocele (MMC), relevant for their dental treatment. Dental treatment of these individuals requires the dentist's extensive knowledge and careful information to determine the dental treatment plan. Thirty participants aged 3 to 16 years were divided into 2 groups: study group (15 MMC individuals) and control group (15 healthy subjects). All patients were evaluated for: systemic conditions, use of medications, sequela of the underlying pathology, oral hygiene, diseases, convulsion, cerebrospinal fluid (CSF), allergy, behavior, learning, and mouth physical examination to assess the oral conditions. The study group presented: higher percentage using drugs (P < 0.05), 40% had convulsions (P < 0.05), 86.67% using CSF shunt, 53.33% presented latex allergies (P < 0.05), 53.33% were classified as anxious and with cognitive deficit (P < 0.05), showed more gingivitis (P < 0.05). The MMC individuals, in the majority, have shown cognitive impairment and anxious behavior, use of controlled drugs, convulsion, CSF shunt use, and latex allergy. The presence of periodontal tissue damage was higher in patients with MMC.
2 citations
TL;DR: The need for treatment is shown for children with CMPA or LI, who had the worst caries prevalence and severity rates, and children's intake of replacement foods did not pose any risk for the development of carious lesions.
Abstract: Dental caries in 5-to-8-year-old children with cow's milk protein allergy (CMPA) and lactose intolerance (LI), their treatment needs, and the consumption of milk-based products and milk derivatives by these patients were investigated A cross-sectional study was undertaken with 200 children in southern Brazil in 2017 The clinical examination was based on the World Health Organization criteria and a questionnaire was sent to parents or legal guardians to collect information on the children's food intake, pre-existing systemic diseases, medication use, and CMPA and LI Standardization was performed to verify concordance among examiners (kappa = 096) Caries prevalence was 6750% in children with CMPA or LI, but 3437% in those without these conditions The mean dmft (decayed, missing, and filled teeth) index in children with CMPA or LI was 175 ± 184, significantly higher than among non-allergic or lactose-tolerant children (083 ± 160) (p < 0001) In children with CMPA or LI, the mean for treatment needs was 158 ± 150 Lactose-free milk was the most frequently consumed food among allergic/intolerant children (6500%), with a mean dmft of 200 ± 208, higher than that obtained for those without CMPA/LI (082 ± 087), showing no significant difference (p = 0129) Although dental caries and treatment needs in primary dentition were associated with CMPA or LI, children's intake of replacement foods did not pose any risk for the development of carious lesions Statistically significant differences were obtained for the prevalence and severity of dental caries This shows the need for treatment of children with CMPA or LI, who had the worst caries prevalence and severity rates
2 citations
TL;DR: A literature review was carried out in the following databases: Virtual Health Library (VHL) –MEDLINE– PubMed, SciELO and in the Capes database Journals.
Abstract: The objective of this study was to carry out a literature review in order to elucidate general and oral physical aspects, behavioral disorders, medical considerations and discuss considerations about the dental approach in individuals with Fragile X Syndrome (FXS) as well as to provide surgeons dentists with greater care clarification towards these patients. A literature review has been carried out in the following databases: Virtual Health Library (VHL) –MEDLINE– PubMed , SciELO and in the Capes database Journals. The descriptors used were: Fragile X Syndrome, Oral Health, Systemic Condition, Behavioral Disorders. The main phenotypic characteristics found in the literature were: prominent ears, elongated face, strabismus, hyperextensible joints , macrorchidism , mitral valve prolapse, seizures. Fragile X Syndrome oral characteristics are: mandibular prognathism, atresic and deep palate, enamel hypoplasia, malocclusion, presence of biofilm due to unestablished hygiene habits, caries, calculus and gingivitis. Cognitive deficit, autism spectrum disorder, anxiety disorder and hyperactivity are behaviors found in FXS which bring difficulties for these patients to undergo a dental approach. The dental surgeon must be up-to-date and aware of the medical and behavioral conditions of FXS individuals and, thus, offer an adequate and safe dental approach. Systemic, behavioral and oral abnormalities require an initial dental treatment planning.
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TL;DR: A selective medium was developed for the isolation of Streptococcus mutans from human dental plaque with maximum inhibition of the balance of the streptococcal flora normally encountered on this medium.
1,009 citations
Journal Article•
[...]
TL;DR: Fragile X syndrome (FXS) is the leading inherited form of intellectual disability and autism spectrum disorder, and patients can present with severe behavioural alterations, including hyperactivity, impulsivity and anxiety, in addition to poor language development and seizures as mentioned in this paper.
Abstract: Fragile X syndrome (FXS) is the leading inherited form of intellectual disability and autism spectrum disorder, and patients can present with severe behavioural alterations, including hyperactivity, impulsivity and anxiety, in addition to poor language development and seizures. FXS is a trinucleotide repeat disorder, in which >200 repeats of the CGG motif in FMR1 leads to silencing of the gene and the consequent loss of its product, fragile X mental retardation 1 protein (FMRP). FMRP has a central role in gene expression and regulates the translation of potentially hundreds of mRNAs, many of which are involved in the development and maintenance of neuronal synaptic connections. Indeed, disturbances in neuroplasticity is a key finding in FXS animal models, and an imbalance in inhibitory and excitatory neuronal circuits is believed to underlie many of the clinical manifestations of this disorder. Our knowledge of the proteins that are regulated by FMRP is rapidly growing, and this has led to the identification of multiple targets for therapeutic intervention, some of which have already moved into clinical trials or clinical practice.
514 citations
TL;DR: Methods for collection and stimulation of whole mouth saliva were compared and Gustatory and masticatory stimuli induced significantly higher salivary flow compared to resting levels but the between- and within-subject variances were also higher.
Abstract: Methods for collection and stimulation of whole mouth saliva were compared. Resting salivary flow values were roughly equivalent for draining, spitting, suction, and swab collection techniques, but the swab technique was less reliable. Gustatory and masticatory stimuli induced significantly higher salivary flow compared to resting levels, but the between- and within-subject variances were also higher. Stimulation produced a fairly constant addition of saliva whether individual resting flow levels were low or high.
490 citations
TL;DR: Considerably more research is required to investigate the transition of tooth surfaces from being intact and sound to the white spot lesion stage and a combination of conventional and molecular approaches are required to elucidate the involvement of an individual taxon and of microbial populations with particular traits in the caries process.
Abstract: The involvement of the oral biofilm in the caries process requires re-evaluation. The essential role of mutans streptococci (Streptococcus mutans and Streptococcus sobrinus) in the caries process is not proven. Acid production by dental plaque is not dependent upon the presence of mutans streptococci; caries occurs in the absence of these species and their presence does not necessarily indicate caries activity. Other oral bacteria, non-mutans streptococci, Actinomyces spp. and Bifidobacterium spp., are acidogenic and aciduric. They outnumber mutans streptococci in dental plaque, and there are data which support a role for these bacteria in the initiation and progression of caries. Molecular studies demonstrate the great diversity and complexity of the flora associated with caries. Many taxa identified have not been cultured and the role of these taxa is not known. We have, in mutans streptococci, good markers of disease but not necessarily the aetiological agents of the disease. Considerably more research is required to investigate the transition of tooth surfaces from being intact and sound to the white spot lesion stage. A combination of conventional and molecular approaches are required to elucidate the involvement of an individual taxon and of microbial populations with particular traits in the caries process.
346 citations
Journal Article•
TL;DR: Methods for the identification and enumeration of mutans streptococci and lactobacilli in saliva and plaque material have been developed and the combination of factors which are important contributors to the pathogenesis of dental caries is obtained.
126 citations