Bruna Lavinas Sayed Picciani

Aims: To map the evidence on oral health‐related quality of life (OHRQoL) in children and adolescents with Trisomy 21 (T21) and their families, identifying associated factors and impact of dental interventions. Methods and Results: This review was registered on the Open Science Framework. Five databases (MedLine/PubMed, Web of Science, Embase, Scopus, LILACS) and the grey literature were searched, without language or year restrictions. Two independent reviewers screened records and extracted data on study characteristics, instruments, clinical conditions, and findings. Of 618 records, eight studies met the eligibility criteria. Children and adolescents with Down syndrome (T21) had a high prevalence of caries, periodontal disease, and malocclusion associated with worse OHRQoL; untreated caries, plaque, malocclusion, and poorer periodontal indices were the strongest determinants. 30%–46% of caregivers reported negative effects on their own quality of life, amid socioeconomic vulnerability and low education. Two exploratory studies with small samples and limited or no appropriate control groups suggested possible benefits of full‐mouth rehabilitation under anesthesia and orthodontic aligner treatment. Conclusion: Children and adolescents with Down syndrome bear a substantial burden of oral disease affecting OHRQoL, with possible effects on family members. Despite methodological limitations, these findings support incorporating OHRQoL assessment into routine care and developing inclusive oral health protocols.

Aim: To evaluate the safety and efficacy of a conscious intramuscular (IM) sedation protocol combined with inhalational sedation in children with autism spectrum disorder (ASD) undergoing outpatient dental treatment, based on clinical data and dentists’ perceptions. Methods and results: Thirty‐seven sedation appointments in 28 patients with ASD were analyzed. Patients received an IM protocol of midazolam 0.1 mg/kg, ketamine 0.7 mg/kg, dexmedetomidine 0.5 mcg/kg, and promethazine 0.3 mg/kg. Data collection included demographics, support needs, use of central nervous system (CNS) depressants, procedures performed, adverse events, sedation time, clinicians’ assessments, and vital signs. Most patients were males (68%); aged 3–12 years and 65% required Level III support. CNS depressants were routinely used in 66% of cases. Surgical procedures occurred in 46% of appointments, and mean sedation time was 40 min. Only five (14%) adverse events were observed, and clinicians rated sedation as excellent in 62% of cases. Vital signs showed minimal variation throughout sedation. No statistically significant association were found between CNS depressant use and adverse events or between sedation success and sex, age, support level, or procedure characteristics. Conclusion: This IM sedation protocol appears safe and effective for outpatient dental care in individuals with ASD. Further research is needed to expand equitable access to sedation‐based care.

Objective: To evaluate the clinical changes and primary caregivers' perceptions regarding the habitual posture of the lips and tongue in children with Trisomy 21 (T21) after using the Palatal Memory Plate (PMP). Material and Methods: The sample consisted of children diagnosed with T21 and their respective caregivers. Data collection included demographic and clinical questionnaires, extra and intraoral physical examinations, questionnaires assessing primary caregivers' perceptions of habitual lip and tongue posture, video recordings evaluating habitual lip and tongue posture, scanning, and PMP fabrication. After four months of PMP use, the questionnaires and video were repeated. Results: Fifteen children were evaluated, aged 8-43 months. Initially, 60% of caregivers observed an "open lips" posture, which decreased to 40% showing a "semi-open lips" posture. Tongue posture also improved, with "between the teeth" decreasing from 40% to 27%, and "mouth floor " becoming prevalent in 73%. The median time for the "open lips" category decreased from 92 seconds to 53 seconds, while "mouth floor " increased from 62 seconds to 86 seconds. Conclusion: The palatal memory plate effectively improves habitual lip and tongue posture in children with Trisomy 21. Both caregivers and professionals observed the benefits of the palatal memory plate.

Background: The global increase in the population older than 80 years has led to a paradigm shift centered in the hospital environment, with the inclusion of domiciliary oral health actions improving quality of life. This review evaluates the effects of domiciliary dental care and oral health promotion in nursing homes of older adults. Methods: Seven databases were searched without date restrictions from 15 September to 21 November 2024. A manual search was also performed in the reference lists of the included articles. This research included studies evaluating older adults aged ≥80 years, regardless of sex, who received domiciliary dental care associated or not with oral health promotion, evaluating periodontal condition, dental caries, and the dental and denture plaque index. Regarding data collection and analysis, a risk of bias assessment was performed using RoB 2.0 and RoB 1.0, according to the study design. The level of evidence was assessed using the GRADE tool. Results: Of the 2415 studies found, 5 met the eligibility criteria. After quality assessment, one randomized clinical trial presented a moderate risk of bias, and one presented a low risk. Also, two non-randomized studies presented a high risk and one a low risk. The certainty of evidence was classified as low for all outcomes assessed. One study demonstrated a reduction in the caries level of participants. Regarding periodontal and gingival conditions, although the occurrence of deep pockets (greater than 3.5 mm) decreased over time, there was no significant difference between the control and intervention groups. The level of dental and denture plaque showed a slight reduction. Conclusion: There is limited evidence that domiciliary dental care in nursing homes for older adults can lead to a reduction in caries levels and that oral health programs can reduce dental and denture plaque in evaluations conducted over periods of up to two years. Although the results show a limited magnitude, this does not diminish the importance of promoting domiciliary oral health care.

People with Trisomy 21 (T21) have generalized hypotonia, also manifesting in oral structures. The palatal memory plate (PMP) is a removable appliance to improve tongue and lip posture. The evidence of research elucidates an improvement in oral motor function in children with T21 up to the age of 2 who received PMP-based therapy, with only limited, scanty reports in the literature concerning older children. Therefore, the aim of this study is to evaluate the effects of modified PMP on an oral motor function in patients over 2 years old. Two patients with T21, aged 4 and 3, with absence of lip seal and tongue malposition, were subjected to PMP-based therapy for 6 months. The patients were evaluated for an extra and intra oral exam; their parents answered a questionnaire about their children's habitual tongue and lip position. Two-minute footage to record orofacial motor functions was performed monthly, during follow-up appointments to assess the changes. The substantial improvement of tongue and lip posture was observed after 6 months of plate regular use. PMP has proved to be clinically effective in children over 2 years old, presented with T21, leading to improvement of lip and tongue posture, observed by parents and professionals.

Background: Behçet’s disease (BD) is a rare chronic auto-inflammatory systemic disease with non-specific oral manifestations, categorised as generalised variable vessel vasculitis that requires an interdisciplinary approach to diagnose due to its phenotypic heterogeneity. Whilst the oral lesions that reoccur in BD underpin the complex diagnostic process, the crucial role of dental professionals is highlighted in a case report summarised herein. We present a case of a 47-year-old male referred to the Oral Medicine Department by a rheumatologist after previous hospitalization for thrombosis of the iliac vein and inferior vena cava. He had elevated inflammatory C-reactive protein biomarker and an increased erythrocyte sedimentation rate. Recurrent episodes of folliculitis, oral and genital ulcers were reported. Clinical examination revealed multiple ulcerations in the oral mucosa. The complementary, histopathological analysis performed to rule out other disorders, based on excisional biopsy, showed non-keratinised stratified squamous epithelium with areas of exocytosis and ulceration. The connective tissue presented an intense mixed inflammatory infiltrate, congested blood vessels, haemorrhage, vasculitis, and HLA-B genotyping identified the expression of HLA-B15, further supporting the BD diagnosis. Treatment was initiated with colchicine, prednisolone, and weekly subcutaneous administration of methotrexate and resulted in the complete remission of oral lesions and no recurrence of other manifestations. Conclusions: This BD case report emphasizes the importance of a multidisciplinary approach in diagnosing BD, including the use of histopathological assessment and genetic profiling. It highlights the significance of thorough intraoral assessment and referral to a multidisciplinary team for diagnosis. The oral manifestations of BD as the primary symptoms often indicate underlying major systemic pathologies. The authors stress the need for a structured diagnostic algorithm to facilitate timely and effective management of BD.