{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T19:11:48Z","timestamp":1793646708854,"version":"4.5.1"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002383","name":"King Saud University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002383","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002839","name":"Charit\u00e9 - Universit\u00e4tsmedizin Berlin","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002839","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Paediatr Dent"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Children with special healthcare needs (SHCN) often experience poorer oral health due to limitations in self-care, behavioral challenges, medical conditions, and reduced access to specialized dental services. This study aimed to assess and compare oral health behaviors, risk factors, and caries experience between children with SHCN and healthy controls, and to identify predictors of poor oral health outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>In this cross-sectional study, 300 children (150 SHCN, 150 controls) underwent clinical examinations. Caries experience was assessed using the decayed, missing, and filled teeth (dmft\/DMFT) indices, while oral hygiene status was evaluated with the Plaque Index and Gingival Index. Occlusal characteristics, dental trauma, and oral habits were also recorded. Behavioral assessment was performed using the Frankl Behavior Rating Scale (FBRS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Children with SHCN demonstrated higher resistance to toothbrushing (42.7% vs. 6.7%, p\u2009=\u20090.001), more frequent swallowing of toothpaste (32.0% vs. 0%, p\u2009=\u20090.001), and a greater prevalence of habits such as mouth breathing (30.7% vs. 8.7%, p\u2009=\u20090.001). Interestingly, the control group showed significantly higher mean dmft scores (5.07\u2009\u00b1\u20093.56) compared to SHCN children (2.64\u2009\u00b1\u20094.22, p\u2009=\u20090.001). Regression analysis identified group (B\u2009=\u20092.44, p\u2009&lt;\u20090.001) and age (B\u2009=\u2009\u2212\u00a00.125, p\u2009=\u20090.002) as significant predictors, explaining 12.2% of the variance. SHCN children exhibited distinct behavioral risk factors, while younger age was associated with higher caries experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Children with SHCN exhibited significantly poorer oral health behaviors, including resistance to brushing, swallowing toothpaste, and abnormal oral habits, compared to controls. Interestingly, despite these behavioral disadvantages, caries experience was higher in the control group, underscoring the multifactorial and complex nature of caries development. Group type and age emerged as significant predictors of dmft.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40368-025-01139-x","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T19:24:29Z","timestamp":1763148269000},"page":"159-169","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Oral health disparities among children with special healthcare needs: a comparative cross-sectional study"],"prefix":"10.1007","volume":"27","author":[{"given":"R. A.","family":"Rajeevan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Aparna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. G.","family":"Elenjickal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. G.","family":"Valliaveettil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Joseph","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"John","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. G.","family":"Varghese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Kunnaiah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Naik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Vellappally","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. A.","family":"Abdulah Al kheraif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. K.","family":"John","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. G.","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Saleh Al Harbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Schmalz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Chopra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"issue":"01","key":"1139_CR1","doi-asserted-by":"publisher","first-page":"54","DOI":"10.53294\/ijfstr.2024.6.1.0029","volume":"6","author":"EP Adeghe","year":"2024","unstructured":"Adeghe EP, Okolo CA, Ojeyinka OT. Optimizing dental screening protocols for children with special healthcare needs: enhancing access and prevention. Int J Front Sci Technol Res. 2024;6(01):54\u201361. https:\/\/doi.org\/10.53294\/ijfstr.2024.6.1.0029.","journal-title":"Int J Front Sci Technol Res"},{"issue":"19","key":"1139_CR2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11195557","volume":"11","author":"H Alamri","year":"2022","unstructured":"Alamri H. Oral care for children with special healthcare needs in dentistry: a literature review. J Clin Med. 2022;11(19):5557. https:\/\/doi.org\/10.3390\/jcm11195557.","journal-title":"J Clin Med"},{"issue":"1","key":"1139_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4034\/pboci.2019.191.127","volume":"19","author":"JOS Alkhabuli","year":"2019","unstructured":"Alkhabuli JOS, Essa EZ, Al-Zuhair AM, Jaber AA. Oral health status and treatment needs for children with special needs: a cross-sectional study. Pesqui Bras Odontopediatria Clin Integr. 2019;19(1):1\u201310. https:\/\/doi.org\/10.4034\/pboci.2019.191.127.","journal-title":"Pesqui Bras Odontopediatria Clin Integr"},{"issue":"3","key":"1139_CR4","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1111\/j.1754-4505.2010.00136.x","volume":"30","author":"PL Anders","year":"2010","unstructured":"Anders PL, Davis EL. Oral health of patients with intellectual disabilities: a systematic review. Spec Care Dent. 2010;30(3):110\u20137. https:\/\/doi.org\/10.1111\/j.1754-4505.2010.00136.x.","journal-title":"Spec Care Dent"},{"issue":"1","key":"1139_CR5","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1367\/1539-4409(2002)002<0038:icwshc>2.0.co;2","volume":"2","author":"CD Bethell","year":"2002","unstructured":"Bethell CD, Read D, Stein REK, Blumberg SJ, Wells N, Newacheck PW. Identifying children with special health care needs: development and evaluation of a short screening instrument. Ambul Pediatr. 2002;2(1):38\u201348. https:\/\/doi.org\/10.1367\/1539-4409(2002)002%3c0038:icwshc%3e2.0.co;2.","journal-title":"Ambul Pediatr"},{"issue":"3","key":"1139_CR6","first-page":"355","volume":"21","author":"L Bowen","year":"2012","unstructured":"Bowen L, Bharathi AV, Kinra S, Destavola B, Ness A, Ebrahim S. Development and evaluation of a semi-quantitative food frequency questionnaire for use in urban and rural India. Asia Pac J Clin Nutr. 2012;21(3):355\u201360.","journal-title":"Asia Pac J Clin Nutr"},{"issue":"2","key":"1139_CR7","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1111\/j.1754-4505.2004.tb01679.x","volume":"24","author":"C Bradley","year":"2004","unstructured":"Bradley C, McAlister T. The oral health of children with Down syndrome in Ireland. Spec Care Dent. 2004;24(2):55\u201360. https:\/\/doi.org\/10.1111\/j.1754-4505.2004.tb01679.x.","journal-title":"Spec Care Dent"},{"issue":"5","key":"1139_CR9","first-page":"378","volume":"41","author":"M Frank","year":"2019","unstructured":"Frank M, Keels MA, Qui\u00f1onez R, Roberts M, Divaris K. Dental caries risk varies among subgroups of children with special health care needs. Pediatr Dent Am Acad Pediat Dent. 2019;41(5):378\u201384.","journal-title":"Pediatr Dent Am Acad Pediat Dent"},{"key":"1139_CR10","unstructured":"Frankl S N. Should the parent remain with the child in the dental operatory? J Dent Child. 1962; 29: 150\u2013163. Available from: https:\/\/ci.nii.ac.jp\/naid\/10010634934\/"},{"issue":"1","key":"1139_CR11","doi-asserted-by":"publisher","first-page":"33","DOI":"10.4103\/jisppd.jisppd_214_17","volume":"36","author":"A Gadiyar","year":"2018","unstructured":"Gadiyar A, Gaunkar R, Kamat A, Tiwari A, Kumar A. Impact of oral health-related behaviors on dental caries among children with special health-care needs in Goa: a cross-sectional study. J Indian Soc Pedod Prev Dent. 2018;36(1):33. https:\/\/doi.org\/10.4103\/jisppd.jisppd_214_17.","journal-title":"J Indian Soc Pedod Prev Dent"},{"key":"1139_CR12","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e37728","author":"SS George","year":"2024","unstructured":"George SS, Elenjickal MG, Naik S, Thomas NG, Vellappally S, Varghese N, et al. Oral health status and dental treatment needs in children with autism spectrum disorder. Heliyon. 2024. https:\/\/doi.org\/10.1016\/j.heliyon.2024.e37728.","journal-title":"Heliyon"},{"issue":"1","key":"1139_CR13","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1186\/1471-2458-9-433","volume":"9","author":"E Kralikova","year":"2009","unstructured":"Kralikova E, Kozak JT, Rasmussen T, Gustavsson G, Le Houezec J. Smoking cessation or reduction with nicotine replacement therapy: a placebo-controlled double blind trial with nicotine gum and inhaler. BMC Public Health BioMed Central. 2009;9(1):433. https:\/\/doi.org\/10.1186\/1471-2458-9-433.","journal-title":"BMC Public Health BioMed Central"},{"issue":"6","key":"1139_CR27","doi-asserted-by":"publisher","first-page":"533","DOI":"10.3109\/00016356408993968","volume":"21","author":"H L\u00f6e","year":"1963","unstructured":"L\u00f6e H, Silness J. Periodontal Disease in Pregnancy. I. Prevalence and Severity. Acta Odontol Scand 1963;21(6):533\u2013551. https:\/\/doi.org\/10.3109\/00016356309011240","journal-title":"Acta Odontol Scand"},{"issue":"4","key":"1139_CR14","doi-asserted-by":"publisher","first-page":"410","DOI":"10.3390\/healthcare9040410","volume":"9","author":"V Ningrum","year":"2021","unstructured":"Ningrum V, Bakar A, Shieh T-M, Shih Y-H. The oral health inequities between special needs children and normal children in Asia: a systematic review and meta-analysis. Healthcare. 2021;9(4):410. https:\/\/doi.org\/10.3390\/healthcare9040410.","journal-title":"Healthcare"},{"issue":"1","key":"1139_CR15","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/1472-6831-8-30","volume":"8","author":"FA Oredugba","year":"2008","unstructured":"Oredugba FA, Akindayomi Y. Oral health status and treatment needs of children and young adults attending a day centre for individuals with special health care needs. BMC Oral Health. 2008;8(1):30. https:\/\/doi.org\/10.1186\/1472-6831-8-30.","journal-title":"BMC Oral Health"},{"issue":"11","key":"1139_CR16","doi-asserted-by":"publisher","first-page":"e48139","DOI":"10.7759\/cureus.48139","volume":"15","author":"I Pandiyan","year":"2023","unstructured":"Pandiyan I, Arumugham M, Prabakar J. Assessment of oral health status and treatment needs of institutionalized children with special needs in Poonamallee, Chennai: a cross-sectional study. Cureus. 2023;15(11):e48139. https:\/\/doi.org\/10.7759\/cureus.48139.","journal-title":"Cureus"},{"issue":"4","key":"1139_CR17","doi-asserted-by":"publisher","first-page":"433","DOI":"10.5005\/jp-journals-10005-2419","volume":"15","author":"D Patidar","year":"2022","unstructured":"Patidar D, Sogi S, Patidar DC. Oral health status of children with special healthcare need: a retrospective analysis. Int J Clin Pediatr Dent. 2022;15(4):433\u20137. https:\/\/doi.org\/10.5005\/jp-journals-10005-2419.","journal-title":"Int J Clin Pediatr Dent"},{"issue":"6","key":"1139_CR18","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1111\/j.1754-4505.2010.00160.x","volume":"30","author":"BM Purohit","year":"2010","unstructured":"Purohit BM, Acharya S, Bhat M. Oral health status and treatment needs of children attending special schools in South India: a comparative study. Spec Care Dentist. 2010;30(6):235\u201341. https:\/\/doi.org\/10.1111\/j.1754-4505.2010.00160.x.","journal-title":"Spec Care Dentist"},{"issue":"2","key":"1139_CR19","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1111\/scd.12658","volume":"42","author":"J Puthiyapurayil","year":"2022","unstructured":"Puthiyapurayil J, Anupam Kumar TV, Syriac G, Maneesha R, Raseena KT, Najmunnisa N. Parental perception of oral health related quality of life and barriers to access dental care among children with intellectual needs in Kottayam, central Kerala\u2014A cross sectional study. Spec Care Dent. 2022;42(2):177\u201386. https:\/\/doi.org\/10.1111\/scd.12658.","journal-title":"Spec Care Dent"},{"issue":"1","key":"1139_CR20","doi-asserted-by":"publisher","first-page":"4","DOI":"10.4103\/jiaphd.jiaphd_138_17","volume":"16","author":"B Sabbarwal","year":"2018","unstructured":"Sabbarwal B, Puranik M, Uma S. Oral health status and barriers to utilization of services among down syndrome children in Bengaluru City: a cross-sectional, comparative study. J Indian Assoc Public Health Dent. 2018;16(1):4. https:\/\/doi.org\/10.4103\/jiaphd.jiaphd_138_17.","journal-title":"J Indian Assoc Public Health Dent"},{"issue":"6","key":"1139_CR21","first-page":"430","volume":"42","author":"LI Stein Duker","year":"2020","unstructured":"Stein Duker LI, Richter M, Lane CJ, Polido JC, Cermak SA. Oral care experiences and challenges for children with down syndrome: reports from caregivers. Pediatr Dent. 2020;42(6):430\u20135.","journal-title":"Pediatr Dent"},{"issue":"1","key":"1139_CR26","doi-asserted-by":"publisher","first-page":"121","DOI":"10.3109\/00016356408993968","volume":"22","author":"J Silness","year":"1964","unstructured":"Silness J, L\u00f6e H. Periodontal disease in pregnancy. II. correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964;22(1):121\u2013135. https:\/\/doi.org\/10.3109\/00016356408993968doi:.","journal-title":"Acta Odontol Scand"},{"issue":"2","key":"1139_CR22","doi-asserted-by":"publisher","first-page":"236","DOI":"10.4103\/ijdr.ijdr_809_18","volume":"32","author":"P Vishnu","year":"2021","unstructured":"Vishnu P, Mahesh R, Madan Kumar P, Sharna N. Oral health status and treatment needs of children with sensory deficits in Chennai, India\u2013a cross-sectional study. Indian J Dent Res. 2021;32(2):236\u201342. https:\/\/doi.org\/10.4103\/ijdr.ijdr_809_18.","journal-title":"Indian J Dent Res"},{"issue":"3","key":"1139_CR23","doi-asserted-by":"publisher","first-page":"292","DOI":"10.3109\/13668250.2017.1409596","volume":"44","author":"NJ Wilson","year":"2019","unstructured":"Wilson NJ, Lin Z, Villarosa A, George A. Oral health status and reported oral health problems in people with intellectual disability: a literature review. J Intellect Dev Disabil. 2019;44(3):292\u2013304. https:\/\/doi.org\/10.3109\/13668250.2017.1409596.","journal-title":"J Intellect Dev Disabil"},{"key":"1139_CR24","unstructured":"World Health Organization. Oral health surveys: basic methods. World Health Organization; 2013."},{"issue":"4","key":"1139_CR25","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1016\/j.pec.2019.11.030","volume":"103","author":"B Xiang","year":"2020","unstructured":"Xiang B, Wong HM, Perfecto AP, McGrath CPJ. The effectiveness of behavioral interventions to improve oral health in adolescents at different periods of follow-up: a systematic review and meta-analysis. Patient Educ Couns. 2020;103(4):725\u201333. https:\/\/doi.org\/10.1016\/j.pec.2019.11.030.","journal-title":"Patient Educ Couns"}],"container-title":["European Archives of Paediatric Dentistry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40368-025-01139-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40368-025-01139-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40368-025-01139-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T11:53:05Z","timestamp":1772711585000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40368-025-01139-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,14]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["1139"],"URL":"https:\/\/doi.org\/10.1007\/s40368-025-01139-x","relation":{},"ISSN":["1818-6300","1996-9805"],"issn-type":[{"value":"1818-6300","type":"print"},{"value":"1996-9805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,14]]},"assertion":[{"value":"9 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}