A R T IC L E S
The Lincoln dental caries study: a three-year evaluation of dental caries in persons with various mental disorders Arnold D. Steinberg, DDS, MS, Chicago Stuart Zim m erm an, PhD, Houston
An evaluation o f three-year incremental caries scores in
institutionalized persons with various mental disorders indicated that in a DMFS evaluation o f caries increment, the group with Down syndrome had significantly few er caries than many o f the other groups compared. No such significant difference was found in an evaluation of DMFT. The caries increments did not differ significantly from one another in all other mentally subnormal groups. The carious lesions in the group with Down syndrome appeared to be limited to the occlusal surface.
T
M he m ajority of reports agree that the prevalence of dental caries among m entally subnorm al (MS) per sons is low er than am ong normal persons. A lthough G u llik son 1 re ported high er caries scores in re tarded ch ild ren than in norm al c h il dren, the m ajority of studies have re ported a low er prevalence of caries for both institu tion alized and non institu tionalized M S persons than for norm al persons of sim ilar ages.2'6 W ithin the M S population, several in vestigation s7'9 have show n low caries scores in those w ith Down syndrome. However, Sw allow 10 re ported an overall caries sim ilarity be tw een those w ith Down syndrom e and M S persons w ithout Down syn drome. A ll of the studies reported caries
scores from a single exam ination. T h ey w ere not based on yearly in crem ental caries scores that provide a m ore accurate appraisal o f caries. In a previous in vestig ation ,11 we ob served that the overall incid ence of caries (based on one-year increm en tal caries scores) in an in stitutionalized M S population w ith out Down syndrom e was not sig n ifi cantly different from the caries in c i d ence of a noninstitutionalized, norm al population of sim ilar age. W hen one exam ination of prevalence of caries (DF and DMF) was made, the prevelance was significantly lower in the M S population; this supports the data o f other investigators.2'6 In the previous stud y,11 we inves tigated the d ifferences betw een an institu tionalized M S population and
a noninstitu tionalized norm al popu lation. No attem pt was made to inves tigate possible differences in in ci den ce of caries betw een the sub groups (arranged according to m en tal disorder) of the M S population. As it is possible that those w ith a sp ecific disorder may have a low in cid en ce of caries even though the overall M S population does not, we evaluated the in cid en ce of caries in institu tionalized persons w ith vari ous m ental disorders based on three-year increm en tal scores.
Study methods A total of 250 M S, institu tion alized , m ale and fem ale persons (who formed the control group for a bottled-beverage study cond u cted at the L in co ln State S ch oo l in L inco ln, 111) w ere exam ined in itia lly .12 T h eir ages ranged from 10 to 21 years, w ith a m ean age of 16.8 years, and they w ere exam ined at six-m onth inter vals for three years. T he in stitu tion classified the patients according to m ental disorder, and we retained this classificatio n . The entire in stitutionalized population was de fined as m entally subnorm al (M S). T hose patients who prim arily had a defect in in tellig en ce existing sin ce birth, w ithout an organic brain dis order of know n prenatal cause, were subclassified as m entally retarded. JADA, Vol. 97, December 1978 ■ 981
A R T IC L E S
Another subclassification, chronic brain disorders, was defined as or ganic brain disease, usually of known causes. Any classification with fewer than eight subjects re maining at the end of three years was not considered so that a meaningful base for statistical evaluation could be provided; nine groups were eval uated in this report. As control sub jects in the bottled-beverage study, each person included drank 12 oz of water each day under supervision, besides the water that was normally consumed. The fluoride concentra tion of this water was 0.4 ppm. A detailed account of examination and recording procedures and other related information has been pub lished previously.12All data were ob tained from both oral and radiographic examinations and statisti cally evaluated by analyses of vari ance. Differences between means were determined by the Duncan Multiple Range procedure. In an effort to better assess factors
Table 1 tion.
responsible for teeth lost during the course of the study, every tooth that was extracted during the three-year period was noted, and records were checked for indications of caries at the examination immediately before extraction. If the tooth was carious on two or more surfaces or severely cari ous on one surface, the loss was at tributed to caries. If the tooth had no active caries or (as in a few instances) had only slight caries involvement of a single surface, it was considered lost because of other causes. The data presented in Table 1 for our threeyear increment DMF scores are based on only those teeth believed lost be cause of dental caries.
Results At the first examination, the group with Down syndrome, who were sig nificantly younger, had fewer teeth and more unerupted teeth than the other groups (P
The Lincoln dental caries study: a three-year evaluation of dental caries in persons with various mental disorders Arnold D. Steinberg, DDS, MS, Chicago Stuart Zim m erm an, PhD, Houston
An evaluation o f three-year incremental caries scores in
institutionalized persons with various mental disorders indicated that in a DMFS evaluation o f caries increment, the group with Down syndrome had significantly few er caries than many o f the other groups compared. No such significant difference was found in an evaluation of DMFT. The caries increments did not differ significantly from one another in all other mentally subnormal groups. The carious lesions in the group with Down syndrome appeared to be limited to the occlusal surface.
T
M he m ajority of reports agree that the prevalence of dental caries among m entally subnorm al (MS) per sons is low er than am ong normal persons. A lthough G u llik son 1 re ported high er caries scores in re tarded ch ild ren than in norm al c h il dren, the m ajority of studies have re ported a low er prevalence of caries for both institu tion alized and non institu tionalized M S persons than for norm al persons of sim ilar ages.2'6 W ithin the M S population, several in vestigation s7'9 have show n low caries scores in those w ith Down syndrome. However, Sw allow 10 re ported an overall caries sim ilarity be tw een those w ith Down syndrom e and M S persons w ithout Down syn drome. A ll of the studies reported caries
scores from a single exam ination. T h ey w ere not based on yearly in crem ental caries scores that provide a m ore accurate appraisal o f caries. In a previous in vestig ation ,11 we ob served that the overall incid ence of caries (based on one-year increm en tal caries scores) in an in stitutionalized M S population w ith out Down syndrom e was not sig n ifi cantly different from the caries in c i d ence of a noninstitutionalized, norm al population of sim ilar age. W hen one exam ination of prevalence of caries (DF and DMF) was made, the prevelance was significantly lower in the M S population; this supports the data o f other investigators.2'6 In the previous stud y,11 we inves tigated the d ifferences betw een an institu tionalized M S population and
a noninstitu tionalized norm al popu lation. No attem pt was made to inves tigate possible differences in in ci den ce of caries betw een the sub groups (arranged according to m en tal disorder) of the M S population. As it is possible that those w ith a sp ecific disorder may have a low in cid en ce of caries even though the overall M S population does not, we evaluated the in cid en ce of caries in institu tionalized persons w ith vari ous m ental disorders based on three-year increm en tal scores.
Study methods A total of 250 M S, institu tion alized , m ale and fem ale persons (who formed the control group for a bottled-beverage study cond u cted at the L in co ln State S ch oo l in L inco ln, 111) w ere exam ined in itia lly .12 T h eir ages ranged from 10 to 21 years, w ith a m ean age of 16.8 years, and they w ere exam ined at six-m onth inter vals for three years. T he in stitu tion classified the patients according to m ental disorder, and we retained this classificatio n . The entire in stitutionalized population was de fined as m entally subnorm al (M S). T hose patients who prim arily had a defect in in tellig en ce existing sin ce birth, w ithout an organic brain dis order of know n prenatal cause, were subclassified as m entally retarded. JADA, Vol. 97, December 1978 ■ 981
A R T IC L E S
Another subclassification, chronic brain disorders, was defined as or ganic brain disease, usually of known causes. Any classification with fewer than eight subjects re maining at the end of three years was not considered so that a meaningful base for statistical evaluation could be provided; nine groups were eval uated in this report. As control sub jects in the bottled-beverage study, each person included drank 12 oz of water each day under supervision, besides the water that was normally consumed. The fluoride concentra tion of this water was 0.4 ppm. A detailed account of examination and recording procedures and other related information has been pub lished previously.12All data were ob tained from both oral and radiographic examinations and statisti cally evaluated by analyses of vari ance. Differences between means were determined by the Duncan Multiple Range procedure. In an effort to better assess factors
Table 1 tion.
responsible for teeth lost during the course of the study, every tooth that was extracted during the three-year period was noted, and records were checked for indications of caries at the examination immediately before extraction. If the tooth was carious on two or more surfaces or severely cari ous on one surface, the loss was at tributed to caries. If the tooth had no active caries or (as in a few instances) had only slight caries involvement of a single surface, it was considered lost because of other causes. The data presented in Table 1 for our threeyear increment DMF scores are based on only those teeth believed lost be cause of dental caries.
Results At the first examination, the group with Down syndrome, who were sig nificantly younger, had fewer teeth and more unerupted teeth than the other groups (P
