Orthodontic Treatment for Disabled Children: A Survey
The parents of 60 disabled children (DCh) with physical, mental and/or sensory impairment undergoing OT were surveyed on attitudes to OT and the level of satisfaction with outcomes. All treatments were performed between 2010 and 2013 in the Special Needs Unit of the School of Medicine and Dentistry of the University of Santiago de Compostela in Spain. The mean age of patients was 13.8 ± 2.3 years (range, 9–18 years). All patients lived at home or in an institution and no overnight stays in our unit were required. All patients were able to tolerate dental procedures using only behavior modification techniques; a single session of deep sedation or general anesthesia was needed in only 4 DCh patients for long procedures requiring a high degree of collaboration (taking impressions and bracket adhesion). Patients with severe malocclusions requiring jaw surgery were excluded.
The orthodontic diagnosis was established in each patient based on the following variables: anteroposterior malocclusion (Angle's classification system), transverse malocclusion, and pre-treatment Peer Assessment Rating (PAR) index. The orthodontic treatment outcome was evaluated by using the difference between pre-treatment and post-treatment PAR index scores (absolute value and percentage), and the PAR nomogram (worse or no different, improved, greatly improved).
The medical diagnoses in the study group were Down's syndrome (13 cases), mental and/or psychomotor deficiency (12 cases), congenital malformations with craniofacial involvement (10 cases), cerebral palsy (7 cases), autistic spectrum disorders (4 cases), sensory deficiencies (4 cases) and other rare congenital disorders (10 cases).
The survey was based on previously validated questionnaires, and consisted of 23 questions grouped into 4 sections (Spanish version, see Additional file 1 http://www.biomedcentral.com/1472-6831/14/98/additional).
To establish a control group, the parents of 60 healthy children (HCh) undergoing OT at the Orthodontic Unit of the same institution and treated by the same orthodontists were also surveyed. HCh were matched with the DCh group for age, sex, anteroposterior malocclusion and pre-treatment PAR index score. All patients (DCh and HCh) were treated with both removable and fixed appliances.
The statistical analysis of the results was performed using R software, version 2.12.0 (R Development Core Team, Vienna, Austria). Differences between the responses of DCh and HCh parents were analyzed using the Fisher test with significance taken as a P value less than 0.05. The Kruskal Wallis test was used to analyse differences in the values of the qualitative variables between patients with different medical diagnoses.
The study protocol was approved by the Ethics Committee of the University of Santiago de Compostela (reference number 2010-1724B). Written informed consent was obtained from the parents or legal guardians, as applicable, of the involved disabled and healthy children undergoing orthodontic treatment . A copy of the written consent is available for review by the Editor of this journal.
Methods
The parents of 60 disabled children (DCh) with physical, mental and/or sensory impairment undergoing OT were surveyed on attitudes to OT and the level of satisfaction with outcomes. All treatments were performed between 2010 and 2013 in the Special Needs Unit of the School of Medicine and Dentistry of the University of Santiago de Compostela in Spain. The mean age of patients was 13.8 ± 2.3 years (range, 9–18 years). All patients lived at home or in an institution and no overnight stays in our unit were required. All patients were able to tolerate dental procedures using only behavior modification techniques; a single session of deep sedation or general anesthesia was needed in only 4 DCh patients for long procedures requiring a high degree of collaboration (taking impressions and bracket adhesion). Patients with severe malocclusions requiring jaw surgery were excluded.
The orthodontic diagnosis was established in each patient based on the following variables: anteroposterior malocclusion (Angle's classification system), transverse malocclusion, and pre-treatment Peer Assessment Rating (PAR) index. The orthodontic treatment outcome was evaluated by using the difference between pre-treatment and post-treatment PAR index scores (absolute value and percentage), and the PAR nomogram (worse or no different, improved, greatly improved).
The medical diagnoses in the study group were Down's syndrome (13 cases), mental and/or psychomotor deficiency (12 cases), congenital malformations with craniofacial involvement (10 cases), cerebral palsy (7 cases), autistic spectrum disorders (4 cases), sensory deficiencies (4 cases) and other rare congenital disorders (10 cases).
The survey was based on previously validated questionnaires, and consisted of 23 questions grouped into 4 sections (Spanish version, see Additional file 1 http://www.biomedcentral.com/1472-6831/14/98/additional).
Attitude and adaptation to OT: Patient attitude and parent capacity to help with oral care during treatment, frequency of daily toothbrushing, level of collaboration with oral hygiene procedures, adaptation to fixed and removable appliances and influence of treatment on activities of daily living.
Benefits derived from OT: Improvement in quality of life, social acceptance and integration, importance of aesthetic appearance and other reasons for seeking treatment.
Adverse effects associated with OT: Oral lesions, altered oral function, increased salivary secretion and nausea.
Level of satisfaction after completion of OT: Satisfaction with the outcome, improved self-image, reaction of family and friends, improvement in daily activities, changes in social life, and willingness to undergo orthodontic treatment again in the future should it be required.
To establish a control group, the parents of 60 healthy children (HCh) undergoing OT at the Orthodontic Unit of the same institution and treated by the same orthodontists were also surveyed. HCh were matched with the DCh group for age, sex, anteroposterior malocclusion and pre-treatment PAR index score. All patients (DCh and HCh) were treated with both removable and fixed appliances.
The statistical analysis of the results was performed using R software, version 2.12.0 (R Development Core Team, Vienna, Austria). Differences between the responses of DCh and HCh parents were analyzed using the Fisher test with significance taken as a P value less than 0.05. The Kruskal Wallis test was used to analyse differences in the values of the qualitative variables between patients with different medical diagnoses.
Ethics and Consent
The study protocol was approved by the Ethics Committee of the University of Santiago de Compostela (reference number 2010-1724B). Written informed consent was obtained from the parents or legal guardians, as applicable, of the involved disabled and healthy children undergoing orthodontic treatment . A copy of the written consent is available for review by the Editor of this journal.
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