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jSY eGUKW: OiaI and gingivaI nicioliaI fIoia, MenlaI ielaidalion, D, Saii

#%)"!/.*)#!%

MenlaI ielaidalion (MR) is a geneiaIized
disoidei, vhich appeais lefoie aduIlhood and is
chaiacleiized ly inpaiinenl in cognilive aliIily
and deficils in lvo oi noie adaplive lehaviois
(1). The pievaIence and seveiily of denlaI caiies,
gingivilis and peiiodonlaI infeclion aie high in
palienls vilh nenlaI ielaidalion. Suifaces of
leelh and gun aie coIonized ly a dense
popuIalion of nicioles, caIIed pIaques, vhich is
lhe nain facloi foi denlaI caiies. Consideiing lhal
denlaI caiies and gingivaI diseases occui eaiIiei
in nenlaIIy ielaided palienls lhan in noinaI
peopIe, il is noie pievaIenl in lhese palienls due
lo lheii nenlaI and physicaI disaliIilies and
inaliIily lo effecliveIy liush lheii leelh and
piopeiIy and ieguIaiIy use noulhvashes (2-3-4).
In addilion lo lhese faclois, nenlaI disaliIilies
and noloi skiII disoideis such as oiaI liealhing,
Iip seaI, lhe diel causing denlaI caiies, difficuIly
in cheving and svaIIoving, alnoinaI slielch of
face nuscIes, ieduclion of saIiva fIov and effecls
of nedicines shouId le nenlioned (2). Washing
lhese peopIes leelh ly nuises aIso invoIves nany
piolIens and palienls have IillIe coIIaloialion in
lhis iegaid (5). Thus, conducling lhis sludy seens
necessaiy foi physicaIIy disalIed peopIe.





36




NoinaI oiaI fIoia (lhe fIoia vilh piopei hygiene
in lhe noulh) can le consideialIy changed.
Weak hygiene of lhe noulh Ieads lo incieased
niciooiganisns and lheii palhoIogicaI lypes in
oiaI fIoia. This shifl lovaid sickness incieases
noilaIily due lo seplicenia, pneunonia and
endocaidilis (5). In addilion lo lhe nenlioned
piolIens, il has leen iepoiled foi nenlaIIy
ielaided palienls lhal lheii lacleiiaI iesislance of
noulh lo lhe convenlionaI anliliolics used in
denlisliy is diffeienl fion lhal of noinaI peopIe
(6).
Diffeienl sludies have leen conducled lo sludy
oiodenlaI hygienic condilion and pievaIence of
denlaI caiies, gingivilis and peiiodonlaI infeclion
in nenlaIIy ielaided peopIe (7&8). Diffeienl
sludies have leen conducled lo invesligale lheii
nicioliaI fIoia of gingivaI and denlaI pIaques
and ils diffeience fion lhal of heaIlhy peopIe
aIong vilh ils ieIalionship vilh iespiialoiy
infeclions. Sone olhei sludies have leen done lo
conpaie anliliolic sensilivily in highIy pievaIenl
niciooiganisns in denlaI caiies of nenlaIIy
ielaided peopIe vilh lhal in heaIlhy peopIe. In
lhe piesenl ieseaich, foi lhe fiisl line, oiodenlaI
hygienic condilion and pievaIence iale of denlaI
caiies veie sludied in nenlaIIy ielaided peopIe
in iehaliIilalion cenleis in lhe cily of Saii and
oiaI lacleiiaI fIoia of lhese peopIe vas
invesligaled.

2&)+"#&'9 &%/ 2+)k!/9
This desciiplive cioss-seclionaI sludy vas
conducled in 2O11 on nenlaIIy ielaided palienls
in iehaliIilalion cenleis in lhe cily of Saii.
SanpIing of nenlaIIy ielaided peopIe in lhese
cenleis vas iandon. Consideiing lhe facl lhal lhe
piesenl sludy vas conducled foi lhe fiisl line,
aiound 5O (138 peopIe) veie slalislicaIIy
sanpIed. The dala veie iecoided in lhe ieIaled
queslionnaiie, vhich incIuded queslions on lheii
denogiaphics such as gendei, age and educalion
and lhose foi lheii paienls and sone queslions
aloul lheii oiodenlaI hygiene condilion such as
daiIy loolh liushing, denlaI caiies, loolh
exliaclion, noulh uIceis and hisloiy of oiaI
suigeiy, aII of vhich veie noninaI quaIilalive
vaiialIes. Queslionnaiies veie fiIIed ly ieseaich
lean nenleis vhiIe exanining lhe palienls, ly
lhe assislance of lhe cenlei aulhoiilies using lhe
dala iecoided in lhe cenleis, and ly lhe
coopeialion of lhe denlisl of lhe ieIaled cenlei.
The sanpIes veie diieclIy laken fion lhe noulh
(and gun) of lhe pailicipanls using a sleiiIe
sval, pIaced in Iiquid lianspoil nediun (Anies)
and liansfeiied lo lhe Ialoialoiy of Saii IacuIly
of Medicine. Aflei lhe sanpIes veie liansfeiied
lo lhe Ialoialoiy, lhey veie cuIluied in LM and
lIood Agai nedia. Then coIonies veie gian
slained aflei 24 h of inculalion al 37C, in case
lhe isoIaled lacleiia veie gian posilive cocci,
calaIase lesl vas peifoined on lhen. The
posilive calaIase coIonies veie idenlified as
slaphyIococcus and coaguIase lesl vas
peifoined on lhen. In case of posilive coaguIase
lesl, lhe ieIaled coIony vas idenlified as
slaphyIococcus auieus and, in case of negalive
lesl, novoliocin disc vas pIaced. The coIonies
sensilive lo novoliocin veie iecognized as
slaphyIococcus epideinidis and iesislanl
coIonies veie consideied slaphyIococcus
sapiophylicus. Ioi negalive calaIase coIonies
vhich indicaled lheii slieplococcus piopeily,
henoIylic lesl vas peifoined. Ioi lhe coIonies
vilh aIpha lype henoIysis, oplochin disc vas
used and lhe coIonies sensilive lo oplochin veie
idenlified as pnuenococcus vhiIe iesislanl ones
veie iecognized as viiidans slieplococcus. Ioi
lela lype henoIylic coIonies, laciliacin disc and
SXT veie used. The coIonies sensilive lo
laciliacin and SXT iesislanl coIonies veie
idenlified as slieplococcus pyogenes vhiIe SXT
and laciliacin iesislanl coIonies veie idenlified
as slieplococcus sp. In case lhe isoIaled lacleiia
veie gian negalive lacciIus, lhey veie cuIluied
on speciaI enleiolacleiiaceae nedia and species
of lhe consideied lacleiia vas idenlified aflei
conpaiison vilh lhe enleiolacleiiaceae chail.
One of lhe Iinilalions of lhis piojecl vas faiIuie
lo sludy olIigale anaeioles.
Resislance and sensilivily of lhe isoIaled lacleiia
lo anpiciIIin, anoxiciIIin, gaianycin, peniciIIin,
vanconycin and liinelhopiin suIfanelhoxazoIe
veie invesligaled foi gian posilive lacleiia. The
sane vas exanined using cifixin, cefliiaxon,
leliacycIine, jenlanycin, liinelhopiin-
suIfanelhoxazoIe, cipiofIoxacin and cefazoIin foi
gian negalive lacleiia. Anliliogian vas
peifoined in MoIIei Hinlon nediun using
Kiily-auei nelhod accoiding lo O.O5 McIaiIand
slandaids. The avaiIalIe dala veie anaIyzed in
SISS soflvaie (veision 17) using Chi squaie lesl
and ANOVA.


"+9.')9

In lhis sludy, oul of 138 nenlaIIy ielaided
palienls (48 palienls) in lhe cily of Saii, 31.4
veie in Iaidis Cenlei and 21.7 (3O palienls)

37

". 6D6@7BD

Iiequency disliilulion of isoIaled lacleiia vas

caIcuIaled fion lhe noulh sanpIes of lhe
nenlaIIy ielaided palienls in lhis sludy as
foIIovs:
Inuenococcus 37.7 (52 palienls), L#coIi 16.7
(23 palienls), niseiiasp 45.6 (63 palienls),
slieplococci sp 18.8 (26 palienls), slaphyIococci
sp 1.4 (2 palienls), pseudononas O.7 (1
palienl), saInoneIIa 8.69 (12 palienls), pioleus
3.6 (5 palienls), diphlheioid 4.2 (6 palienls).
In lhe peifoined sludy lased on Chi-squaie lesl,
lheie vas a significanl ieIalionship lelveen
fiequency of isoIaled lacleiia fion lhe noulh
sanpIes of lhe sludied nenlaIIy ielaided
palienls and lhe foIIoving cases veie found:
iehaliIilalion cenleis (p=O.OOO, df=45), gendei of
palienls (p=O.OOO and df=15), using loolhliush
(p=O.25 and df=15), denlaI caiies (p=O.O3 and
df=15), loolh exliaclion (p=O.OO9 and df=15),
noulh uIceis (p=O.O5 and df=15) and daiIy
anliliolic use (p=O.O1 and df=15), hovevei, il had
no significanl ieIalionship vilh oiaI suigeiy (p=5,
df=15).
Anliliolic iesislance lo lhe lesled anliliolics on
gian posilive lacleiia vas as foIIovs: anpiciIIin


38
veie in each of Mehiegan, Sina and Ieidovsi
Cenleis. The sludied peopIe veie cIassified inlo
lhiee age gioups of leIov 2O, 2O lo 4O and alove
4O. In lhis sludy, I<O.O5 vas consideied
significanl. The sludied peopIe incIuded 68.8
(95 palienls) fenaIes and 31.2 (43 palienls)
naIes. Mean and slandaid devialion of lhe
sludied peopIes age veie 28.28 and 12.O5,
18.5 (15 palienls), anoxiciIIin 5O.6 (41
palienls), jenlanycin 12.3 (1O palienls),
peniciIIin 67.9 (55 palienls), vanconycin 11 (9
palienls), liinelhopiin-suIfanelhoxazoIe 65.4
(53 palienls).

The anliliolic piofiIe foi gian negalive lacleiia
vas as foIIovs: genlanycin O, leliacycIin 2.6
iespecliveIy. 4.3 (6 palienls) veie Iileiale and (1 palienl), ceflazidine 13.1 (5 palienls),
95.7 (132 palienls) veie iIIileiale.

36.2 (5O palienls) used loolhliush and 63.8
(88 palienls) did nol use il. 65.9 (135 palienls)
had denlaI caiies and 34.1 (3 palienls) did nol.
5O.97 (7O palienls) had a hisloiy of loolh
exliaclion lul 49.3 (68 palienls) had no iecoid.
1O.979 (15 palienls) had noulh uIceis lul 89.1
cipiofIoxacin O, cefliiaxone 5.3 (2 palienls),
cepholaxin 42.1 (16 palienls), cefixin 36.8 (14
palienls), liinelhopiin-suIfanelhoxazoIe 5.3 (2
palienls).

ased on Chi-squaie lesl (p=O.OO and df=6O),
lheie vas a significanl ieIalionship lelveen
iesislance lo lhe lesled anliliolics on gian
(123 palienls) did nol. 5.1 (7 palienls) had posilive and negalive lacleiia and lhe
iecoid of oiaI suigeiy vhiIe 94.9 (131 palienls) iehaliIilalion cenleis. ased on ANOVA
had no such iecoids. 13.18 (19 palienls) used
anliliolics eveiy day lul 86.2 (119 palienls) did
nol. D index vas eslinaled in lhiee age gioups
slalislicaI lesl, lheie vas a significanl ieIalionship
lelveen age gioups and fiequency of isoIaled
lacleiia (p=O.OO9) and anliliolic iesislance
in aII of lhe sludied palienls, vhich vas as
(p=O.OO1).

foIIovs: leIov 2O (54), 2O lo 4O (76.2), alove
4O (73.3), lolaI (69.5). ased on Chi squaie
slalislicaI lesl, lheie vas a significanl ieIalionship
lelveen denlaI caiies and age (
/#9*.99#!%

The piesenl ieseaich shoved lhal lhe pievaIence
of denlaI caiies anong 138 nenlaIIy ielaided
palienls in Saii iehaliIilalion cenleis (D ) vas
69.5. The eslinaled D vas highei lhan lhe
vaIue iepoiled ly Maicia H. Tanaka el aI. (2OO9)
in iaziI |2j, in vhich D vas equaI lo O. In
lhe peifoined slalislicaI sludy in lhis ieseaich,
D vas aloul 63 in lhe age gioup of 7-12 yeais
oId, vhich vas Iovei lhan lhe one iepoiled ly
AIghahlani and Vien (2OO4) in Saudi Aialia |3j,
iepoiled as 1OO. In lhis sludy, D vas aloul
7O in lhe age gioup of 3-3O yeais oId, vhich
vas in Iine vilh lhe one iepoiled ly Rao el aI.
(2OO1) in India (18) as 71.5.

In lhis sludy, lhe pievaIence of pnuenococcus
anong nenlaIIy ielaided peopIe vas 37.7,
vhich vas highei lhan ils pievaIence in oiaI fIoia
of noinaI peopIe (25) accoiding lo lhe
InleinalionaI Refeience (15).

In lhis sludy, lhe pievaIence of slieplococcus (sp)
anong nenlaIIy ielaided peopIe vas 18.8,
vhich vas highei lhan ils pievaIence iepoiled ly
W. }. Losche el aI. (1972) (8) as 37.8 and lhe iale
iepoiled ly SaIaco (2OO7) in Kuvail (6) as 39.
The eslinaled pievaIence of slieplococcus
nulans in oiaI fIoia of lhe nenlaIIy ielaided
palienls in lhis ieseaich vas nol significanlIy
diffeienl fion ils pievaIence in oiaI fIoia of lhe
noinaI peopIe in lhe sludy ly SaIaco (6).


llCu8L 1: l8LCuLnC? Cl lSCLA1lCn Cl ulllL8Ln1 8AC1L8lA l8CM C8AL SAMLLS


8AC1L8lAL lSCLA1L

uSL Cl An1l8lC1lCS

?LS ()




nC ()

1C1AL

()

neumococcl

6 (11.3)

46 (88.3)


32 (100)

L.coll

16 (69.6)

7 (30.4)


23 (100)

nelsserla spp.

13 (30.6)

30 (79.4)


63 (100)

SLrepLococcl

7 (27)

19 (73)


26 (100)

SLaphylococcl

0 (0)

2 (100)


2 (100)

seudomonas 1 (100) 0 (0) 1 (100)

lungl

3 (37.3)

3 (62.3)

8 (100)

ulphLherla

3 (30)

3 (30)

6 (100)

Salmonella spp.

0 (0)

12 (100)

12 (100)

roLeus spp.

0 (0

3 (100)

3 (100)

Ioi lhe diffeience lo le significanl, p=O.O1 Df=15

Accoiding lo lhe InleinalionaI Refeience, iale in noinaI oiaI fIoia of noinaI peo pIe ($%5)
pievaIence iale of lhis niciooiganisn in noinaI
fIoiaI of lhe noinaI peopIe vas 1OO (15).

In lhis ieseaich, pievaIence iale of L.coIi vas
16.7 and lhal of pioleus vas 3.6 vhiIe
sludying enleiolacleiiaceae faniIy and lhe
pievaIence iale of lhese lacleiia vas highei in
noinaI fIoia of lhe noinaI peopIe, each of vhon
had 25 of noinaI fIoia. IievaIence iale of
saInoneIIa vas 8.7 vhich did nol exisl in
noinaI peopIes noulh fIoia and lhis inpoilanl
facl indicaled fecaI-oiaI conlaninalion due lo Iov
hygienic IeveI in lhese peopIe.

IievaIence iale of Neisseiia vas 44 in lhis
sludy. In noinaI peopIes fIoia, lhe pievaIence of
Neisseiia sp and Neisseiia neningilides vas 25
(15). This incieased iale vhich vas found in lhe
piesenl sludy vas due lo Iack of sepaialion of ils
diffeienl species.

IievaIence of pseudononas aeiuginosa in lhe
piesenl ieseaich vas O.7 vhich vas equaI lo ils
(15).

IievaIence of slaphyIococci sp in lhis sludy vas
1.4, lhis iale vas aloul 1OO in noinaI oiaI
fIoiaI of noinaI peopIe in leins of
slaphyIococcus epideinidis (15). AIso, il vas 25
foi slaphyIococcus auieus (15).

The pievaIence iale of diphlheioids in lhis sludy
vas 3.5, vhich vas Iess lhan ils pievaIence iale
in noinaI oiaI fIoia of noinaI peopIe as 25
(15).

Duiing slalislicaI sludies in lhis ieseaich,
anliliolic sensilivily and iesislance of gian
posilive cocci lo six anliliolics of anoxiciIIin,
anpiciIIin, jenlanycin, peniciIIin, vanconycin
and liinelhopiin-suIfanelhoxazoIe veie
sludied vhich veie 5O.6, 18.5, 12.3, 67.9,
1O and 65.4, iespecliveIy. The highesl and
Iovesl iesislance vas lo peniciIIin (67.9) and
vanconycin (11), iespecliveIy. In addilion, in
lhe sludy ly SaIaco el aI. in Kuvail, lhe highesl

39
iesislance vas lo anoxiciIIin (43), vhich vas
Iovei lhan lhal ollained in lhis sludy in lvo
gioups of heaIlhy and nenlaIIy ielaided peopIe
and lhe Iovesl iesislance vas lo vanconycin
(12), vhich vas in Iine vilh lhe iale ollained in
lhe piesenl voik.

The piesenl ieseaich shoved lhal oiaI and
gingivaI lacleiiaI fIoia of lhe sludied nenlaIIy
ielaided peopIe vas significanlIy diffeience fion
oiaI lacleiiaI fIoia in lhe noinaI peopIe
(accoiding lo lhe iecoided scaIe in InleinalionaI
Refeiences), vhich is juslified consideiing lheii
cIinicaI diffeiences and lheii inaliIily lo nainlain
lheii oiaI hygiene.

Highei pievaIence of pneunococcus in lhese
peopIe lhan lhal in noinaI peopIe incieases iisk
of lacleiiaI iespiialoiy infeclions and denlaI
pIaques such as saInoneIIa, vhich aie nevei
found in oiaI fIoia of noinaI peopIe, veie found
in lhese peopIe due lo lheii oiaI-fecaI
conlaninalion, lolh of lhe nenlioned pIaques
couId cause seveie infeclions, especiaIIy in case of
innunodeficiency. In lhis sludy, pievaIence of
lacleiiaI oiaI fIoia had a significanl ieIalionship
vilh oiaI hygiene of lhese peopIe.

&[PLGe\SK_SJSLXW

We appieciale lhe esleened ieseaich depuly of
Univeisily and IacuIly of Medicine foi financing
lhis piojecl. We aIso appieciale esleened
aulhoiilies of foui iehaliIilalion cenleis foi
nenlaIIy ielaided (Iaidis, Sina, Ieidovsi and
Mehiegan) in lhe cily of Saii foi lheii sinceie
coopeialion.












































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"+,+"+%*+9

!1.Maicia H. Tanaka, Kaiina ocaidia, Kalha
Yukaii kishinolo, IauIa }acques, Denise
MadaIena IaIonaii SpoIidoiio, LIisa Maiia
Apaiecida Ciio .DMIT index assessnenl and
niciolioIogicaI anaIysis of slieplococcus nulans
in inslilulionaIized palienls vilh speciaI
needs.iaz }oiaI Sci.2OO9,8(1):9-13

2.AI-Qahlani Z, vyne AH. Caiies expeiience and
oiaI hygiene slalus of lIind, deaf and nenlaIIy
ielaided fenaIe chiIdien in Riyadh, Saudi

Aialia(als).OdonloslonaloI Tiop. 2OO4, 27(1O5):
37-4O

3.OiaI hygiene,gingivaI and peiiodonlaI slalus in
Dovns syndione. Ioi lhe degiee of naslei of
denlaI suigeiy, The TaniIandu Di.M.C.R.
nedicaI univeisily.Ieliuaiy 2OO5.

4. }anes Day, , MichaeI D. Mailin, Mae Chin.
Lfficacy of a sonic loolhliush foi pIaque ienovaI
ly caiegiveis in a speciaI needs popuIalion. SCD
SpeciaI Caie in Denlisliy. 1998, 18 (5).

5.SaIako NO,Rolini V,IhiIip L, el aI. The
pievaIence and anliliolic sensilivily of oiaI
Viiidans slieplococci in heaIlhy chiIdien and
chiIdien vilh disaliIilies in Kuvail.Spec Caie
Denlisl.2OO7 Mai-Api,27(2):67-72.

6. Hovaid K. Kuianilsu, Xuesong He& Renale
Lux. Inleispecies Inleiaclions vilhin OiaI
MicioliaI Connunilies. MiciolioIogy and
MoIecuIai ioIogy Revievs. Decenlei 2OO7,
71(4) : 653-67O.

7.W.}.Loesche, R.N.Hockell and S.A.Syed.The
piedoninanl cuIlivalIe fIoia of loolh suiface
pIaque ienoved fion inslilulionaIized suljecls.
Aichs OiaI ioI.1972,17:1311-1325.
8. }ack D. Rosenleig. Cingivilis. Cun disease,
IeiiodonlaI disease. IulMed HeaIlh, Lasl
ievieved: Ieliuaiy 22, 2O1O

9.}. M. Haidie & C. H. ovden. acleihaI fIoia of
denlaI pIaque. i. Med. uII. 1975,. 31 (
2).avaiIalIe al lnl.oxfoidjouinaIs.oig

1O.S Saini, Apaina, N gupla,el aI.MicioliaI fIoia
in oiodenlaI infeclions.Indian }ouinaI of MedicaI
MiciolioIogy.2OO3,21(2):111-114.

11. I. Calie, M Wikslion, T. Mailinsson and L.
Cahnleig. Move of AduIls vilh MenlaI
Relaidalion fion Inslilulions lo Connunily-
lased Living: Changes in lhe OiaI
MiciolioIogicaI IIoia. } Denl Res. 2OO1, 8O(2):421
-426.

12. CIudio Mendes Iannuli
I
,Roleilo Iiaga
Moieiia Lolufo
I
,SiIvana Cai, Maiia da Conceio
Saiaiva, Nvea Maiia de Iieilas, DaniIo IaIsi
.
Lffecl of a O.5 chIoihexidine geI on denlaI
pIaque supeiinfecling niciooiganisns in
nenlaIIy handicapped palienls. Iesqui. OdonloI.
ias. }uIy/Sepl 2OO3, 17(3) .

13.inkIey.C.}.,Haugh.C.S.,Kilchens.D.H. OiaI
nicioliaI and iespiialoiy slalus of peisons vilh
nenlaI ielaidalion/inleIIecluaI and
deveIopnenlaI disaliIily: an olseivalionaI cohoil
sludy.OiaI Suigeiy,OiaI Medicine,OiaI
IalhoIogy,OiaI RadioIogy and LndodonloIogy.
2OO9 ,1O8 ( 5) :722-731.

14. Rao D, Hegde A M l, MunshI A K c and
MangaIoie. Caiies pievaIence anongsl
handicapped chiIdien of Soulh Canaia disliicl,
KainalakaD (} Indian Sol Iedo Iiev Denl 2OO1,
19:2:67-73)
15.Kennelh Todais(2O11).The noinaI lacleiiaI
fIoia of hunans.
In:hllp/vvv.lexllookoflacleiioIogy.nel/noina
IfIoia.













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