Mental Retardation |
It is a disorder that has an important impact on the life of an individual, his family and society. Mental retardation was defined by the American Mental Deficiency Association as a significant decrease in the intellectual function along with a deficit of re-adaptative behavior that manifests during development [6[6] American Association on Mental Retardation. Mental retardation. Definition, classification and systems of supports. Washington, DC: American Association on Mental Retardation, 1992.]. |
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As for the degree of severity, it is generally accepted that mental retardation is mild when the IQ is 50-55 to 70, moderate when the level is 35-40 to 50-55; serious from 20-25 to 35-40 and deep if it is less than 20-25 [7[7] Battaglia A, Carey JC. Diagnostic evaluation of developmental delay/mental retardation: An overview. Am J Med Genet C Semin Med Genet 2003; 117C(1):3-14. https://doi.org/10.1002/ajmg.c.10015
https://doi.org/10.1002/ajmg.c.10015...
]. |
Cerebral Palsy |
Fundamentally, they have a characteristic motor impairment caused by brain malformations or injuries during a stage of maturation prior to three years of age; if occurred in later stages, it is referred to as brain trauma or damage [8[8] Silvestre Donat FJ, Plaza Costa A. El Paciente de Riesgo Médico en la Clínica Odontológica. In: Silvestre Donat FJ, Plaza Costa A. Odontología en Pacientes Especiales. Valencia: Universitat de Valencia, Servei de Publicacions, 2007. pp. 15-26.]. |
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According to the International Classification of Functioning, Disability and Health of the World Health Organization (WHO), in 2009, CP constitutes: "A group of disorders in movement and posture development, which cause limitation in activity and they are attributed to non-progressive alterations that occur in the developing brain of the fetus or young child [9[9] Gimenez-Prats MJ, Lopez-Jimenez J, Boj-Quesada JR. An epidemiological study of caries in a group of children with cerebral palsy. Med Oral 2003; 8(1):45-50.]. |
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Common causes include Hypoxia, advanced age of the mother, recurrent history of abortions, intrauterine infections, fertility and multiple pregnancy problems, abnormal fetal presentation [8[8] Silvestre Donat FJ, Plaza Costa A. El Paciente de Riesgo Médico en la Clínica Odontológica. In: Silvestre Donat FJ, Plaza Costa A. Odontología en Pacientes Especiales. Valencia: Universitat de Valencia, Servei de Publicacions, 2007. pp. 15-26.,10[10] Malagon Valdez J. Cerebral palsy. Medicina 2007; 67(6/1):586-92.,11[11] Bax M, Goldstein M, Rosenbaun P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 2005; 47(8):571-6.]. |
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Degree of motor impairment: Mild: total autonomy; Moderate: patient has autonomy or needs some assistance at the most; Severe: almost zero autonomy; Very severe / Profound: zero autonomy [8[8] Silvestre Donat FJ, Plaza Costa A. El Paciente de Riesgo Médico en la Clínica Odontológica. In: Silvestre Donat FJ, Plaza Costa A. Odontología en Pacientes Especiales. Valencia: Universitat de Valencia, Servei de Publicacions, 2007. pp. 15-26.,9[9] Gimenez-Prats MJ, Lopez-Jimenez J, Boj-Quesada JR. An epidemiological study of caries in a group of children with cerebral palsy. Med Oral 2003; 8(1):45-50.,12[12] Cuesta US, Navas IC, Escribano AM, Goig MR. Epidemiological study of dental health in patients with cerebral palsy. Rev Clín Méd Fam 2008; 2(5):206-9.]. |
Down Syndrome |
It is a genetic disorder in which a person has three copies of chromosome 21. The presence of an extra chromosome causes a genetic imbalance and is responsible for the phenotypic manifestation proper to Down syndrome, and in turn causes alterations in organs and systems development and function. The nervous system is the most affected, especially the brain, which is why people with Down syndrome have a variable degree in intellectual disability [13[13] Bancalari S C, Oliva M P. Biological risk of caries in children between 12-17 years with Down syndrome of Cavime, Concepción, Year 2010. Int J Odontostomatol 2012; 6(2):221-4.]. |
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There are three types of trisomies that cause Down syndrome: regular trisomy, which is approximately 95% of cases, translocation trisomy (3-4%) and mosaic trisomy [14[14] Demicheri AR, Batlle A. La enfermedad periodontal asociada al paciente con síndrome de Down. Odontoestomatologia 2011; 13(18):4-15. [In Spanish]]. |
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Regular Trisomy: This is the result of a genetic error that occurs in the process of cell reproduction. During the formation of the male or female gamete there is no disjunction of pair 21 and then one of the two gametes contains 24 chromosomes instead of 23. When the gamete bearing the extra chromosome joins that of the opposite sex, the result is a zygote with 47 chromosomes [15[15] Alba JG, Antonio J, Pérez JAP, Otero FD. Aspectos neuropsicológicos y hemodinámicos en el síndrome de Down. Nuevas aportaciones. Rev Síndrome Down 2010; 27(107):149-58.]. |
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Down syndrome is the most frequent genetic disease. Its incidence rate is estimated in one case per every 660 live births. |
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The Down syndrome has been related to risk factors as varied as genetic, physical, chemical, immunological, infectious and social agents, but only there are currently considered as probable etiologic agents of trisomy 21: They are chromosome abnormalities of parents capable of inducing secondary meiotic disjunction, maternal, zygotic exposure to ionizing radiations, and advanced maternal age. The first two, while important, are responsible, in practice, for a minority of cases of Down syndrome, while it has been shown that there is a close relationship between this codition and the maternal age [16[16] Nazer HJ, Cifuentes OL. Congenital malformations in Latin America in the period 1995-2008. Rev Med Chil 2011; 139(1):72-8.
[17] Al-Biltagi M, Serag AR, Hefidah MM, Mabrouk MM. Evaluation of cardiac functions with Doppler echocardiography in children with Down syndrome and anatomically normal heart. Cardiol Young 2013; 23(2):174-80. https://doi.org/10.1017/S1047951112000613
https://doi.org/10.1017/S104795111200061...
-18[18] Nazer J, Aguila A, Cifuentes L. Vigilancia epidemiológica del síndrome de Down en Chile, 1972 a 2005. Rev Med Chile 2006; 134:1549-57. [In Spanish]]. |