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Özel Bakım Gereksinimi Olan Bireylerde Ağız-Diş Bulgularının Değerlendirilmesi

Yıl 2020, Cilt: 10 Sayı: 3, 331 - 337, 21.09.2020
https://doi.org/10.33631/duzcesbed.678638

Öz

Amaç: Özel bakım gereksinimi olan çocuklarda ağız sağlığı problemleri, genel sağlık sorunlarına ek olarak ortaya çıkan büyük bir sağlık sorunudur. Bu çalışmanın amacı, İstanbul ilinde özel eğitim veren okullarda muayene edilen özel bakım gereksinimi olan bireylerin ağız-diş sağlığı verilerinin değerlendirilmesidir.
Gereç ve Yöntemler: Bu kesitsel çalışma İstanbul Üniversitesi Diş Hekimliği Fakültesi Pedodonti Anabilim Dalı ile İstanbul Üniversitesi Diş hekimliği Fakültesi Engelsiz Gülüşler Öğrenci Kulübü sosyal sorumluluk projesi olarak İstanbul ili içerisinde özel eğitim veren okullarda gerçekleştirildi. Ağız ve diş sağlığı taramaları için her bir tarama öncesi özel olarak izin alındı. Ağız muayenesi gün ışığında tek kullanımlık ayna, sond ve presel yardımı ile yapıldı. Muayenede çocukların yaşları, engel durumları, ilaç kullanıp kullanmadıkları, diş çürüğü varlığı, dental travma varlığı, diş sıkma ve maloklüzyon durumları kaydedildi. Verilerin değerlendirilmesinde uygun istatistiksel testler/analizler kullanıldı ve anlamlılık düzeyi 0,05 olarak belirlendi.
Bulgular: 42’sinde otizm, 111’inde mental retardasyon ve 10’unda Down sendromu olmak üzere 163 özel bakım gereksinimi olan bireyin ağız içi muayenesi yapıldı. Her üç grubun DMFT ve dft ortalamaları arasında istatistiksel olarak anlamlı bir fark bulunmadı (p>0,05). Down sendromlu bireylerde nötral oklüzyon görülme oranı, otizmli bireylerden daha düşük bulundu (p<0,05). Sınıf II maloklüzyon için gruplar arası fark görülmezken, Sınıf III maloklüzyon görülme oranının zihinsel engellilerde otizmlilere göre daha yüksek, Down sendromlu bireylerde hem zihinsel engelli bireylerden hem de otizmli bireylerden daha yüksek olduğu görüldü (p<0,05).
Sonuç: Özel bakım gereksinimi olan bireylerin diş çürükleri, maloklüzyon, dişlerde aşınma, bruksizm, dental travma ve ağız-diş sağlığı açısından takip edilmeleri ve ağız-diş sağlığı açısından yakından takip edilmeleri gerekmektedir.

Destekleyen Kurum

Yoktur

Kaynakça

  • Saravanakumar MS, Vasanthakumari A, Bharathan R. Oral health status of special health care needs children attending a day care centre in Chennai. Int J Students’ Res. 2013; 3(1): 12.
  • Tufan İ, Arun Ö. Türkiye bilimsel ve teknik araştırma kurumu Türkiye özürlüler araştırması. 2. baskı. Ankara: DİE Matbaası; 2006.
  • Owens PL, Kerker BD, Zigler E, Horwitz SM. Vision and oral health needs of individuals with intellectual disability. Ment Retard Dev Disabil Res Rev. 2006; 12(1): 28–40.
  • Setiawati AD, Suharsini M, Budiardjo SB, Indiarti IS, Widyagarini A. Assessment of dental anxiety using braille leaflet and audio dental health education methods in visually impaired children. J Int Dent Med Res. 2017; 10(Special Issue): 441–4.
  • Petersen P, Baez R, Ramon J, World Health Organization. Oral Health surveys: basic methods. 5th edition. Geneva: WHO Press; 2013.
  • Angle EH. Classification of malocclusion. Dent Cosmos. 1899; 41: 350–75.
  • Beange HP. Caring for a vulnerable population. Med J Aust. 1996; 164(3): 159–60.
  • Gordon SM, Dionne RA, Snyder J. Dental fear and anxiety as a barrier to accessing oral health care among patients with special health care needs. Spec care Dent. 1998; 18(2): 88–92.
  • Shore S, Lightfoot T, Ansell P. Oral disease in children with Down syndrome: causes and prevention. Community Pract. 2010; 83(2): 18–22.
  • Deps TD, Angelo GL, Martins CC, Paiva SM, Pordeus IA, Borges-Oliveira AC. Association between dental caries and Down syndrome: a systematic review and meta-analysis. PLoS One. 2015; 10(6): e0127484.
  • Jaber MA. Oral Health Condition and Treatment Needs of a Group of UAE Children with Down Syndrome. Ibnosina J Med Biomed Sci. 2010; 2(2): 62–71.
  • Corder JP, Al Ahbabi FJS, Al Dhaheri HS, Chedid F. Demographics and co-occurring conditions in a clinic based cohort with Down syndrome in the United Arab Emirates. Am J Med Genet Part A. 2017; 173(9): 2395–407.
  • Moreira MJS, Schwertner C, Jardim JJ, Hashizume LN. Dental caries in individuals with D own syndrome: a systematic review. Int J Paediatr Dent. 2016; 26(1): 3–12.
  • Robertson MD, Schwendicke F, de Araujo MP, Radford JR, Harris JC, McGregor S, et al. Dental caries experience, care index and restorative index in children with learning disabilities and children without learning disabilities; a systematic review and meta-analysis. BMC Oral Health. 2019; 19(1): 146. doi: 10.1186/s12903-019-0795-4.
  • Macho V, Coelho A, Areias C, Macedo P, Andrade D. Craniofacial features and specific oral characteristics of Down syndrome children. Oral Heal Dent Manag. 2014; 13(2): 408–11.
  • Ghaith B, Al Halabi M, Khamis AH, Kowash M. Oral health status among children with Down syndrome in Dubai, United Arab Emirates. J Int Soc Prev Community Dent. 2019; 9(3): 232–9.
  • Altun C, Guven G, Akgun OM, Akkurt MD, Basak F, Akbulut E. Oral health status of disabled individuals attending special schools. Eur J Dent. 2010; 4(4): 361–9.
  • Fakroon S, Arheiam A, Omar S. Dental caries experience and periodontal treatment needs of children with autistic spectrum disorder. Eur Arch Paediatr Dent. 2015; 16(2): 205–9.
  • Vellappally S, Gardens SJ, Al Kheraif A-AA, Krishna M, Babu S, Hashem M, et al. The prevalence of malocclusion and its association with dental caries among 12-18-year-old disabled adolescents. BMC Oral Health. 2014; 14(1): 123–9.
  • Du RY, Yiu CKY, King NM, Wong VCN, McGrath CPJ. Oral health among preschool children with autism spectrum disorders: A case-control study. Autism. 2015; 19(6): 746–51.
  • Kuter B, Guler N. Caries experience, oral disorders, oral hygiene practices and socio-demographic characteristics of autistic children. Eur J Paediatr Dent. 2019; 20(3): 237–41.
  • Naidoo M, Singh S. The Oral health status of children with autism Spectrum disorder in KwaZulu-Nata, South Africa. BMC Oral Health. 2018; 18(1): 165–74.
  • Kaufman L, Ayub M, Vincent JB. The genetic basis of non-syndromic intellectual disability: a review. J Neurodev Disord. 2010; 2(4): 182–209.
  • Seirawan H, Schneiderman J, Greene V, Mulligan R. Interdisciplinary approach to oral health for persons with developmental disabilities. Spec Care Dent. 2008; 28(2): 43–52.
  • Chiurazzi P, Pirozzi F. Advances in understanding–genetic basis of intellectual disability. F1000Research. 2016; 5: 1–16.
  • Makkar A, Indushekar KR, Saraf BG, Sardana D, Sheoran N. A cross sectional study to evaluate the oral health status of children with intellectual disabilities in the National Capital Region of India (Delhi‐NCR). J Intellect Disabil Res. 2019; 63(1): 31–9.
  • Scalioni F, Carrada CF, Abreu L, Ribeiro RA, Paiva SM. Perception of parents/caregivers on the oral health of children/adolescents with Down syndrome. Spec Care Dent. 2018; 38(6): 382–90.
  • Fontaine-Sylvestre C, Roy A, Rizkallah J, Dabbagh B, dos Santos BF. Prevalence of malocclusion in Canadian children with autism spectrum disorder. Am J Orthod Dentofac Orthop. 2017; 152(1): 38–41.
  • Rao D, Hegde S, Naik S, Shetty P. Malocclusion in individuals with mental subnormality—a review. Oral Heal Dent Manag. 2014; 13(3): 786–91.
  • Hyder M, Tanboga I, Kalyoncu I, Arain H, Marks L. Are Down syndrome children more vulnerable to tooth wear? J Intellect Disabil Res. 2019; 63(11): 1324–33.
  • Önol S, Kırzıoğlu Z. Evaluation of oral health status and influential factors in children with autism. Niger J Clin Pract. 2018; 21(4): 429–35.
  • Ella B, Ghorayeb I, Burbaud P, Guehl D. Bruxism in movement disorders: a comprehensive review. J Prosthodont. 2017; 26(7): 599–605.
  • Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus CL, Vaughn B V. assm.org [Internet]. Illinois: The American Academy of Sleep Medicine; 2012 [Updated: 2015; Cited: 2020 Apr 24] Avaliable from: https://aasm.org/resources/pdf/scoring-manual-preface.pdf
  • Stores G, Stores R. Sleep disorders and their clinical significance in children with Down syndrome. Dev Med Child Neurol. 2013; 55(2): 126–30.
  • Manfredini D, Serra-Negra J, Carboncini F, Lobbezoo F. Current concepts of bruxism. Int J Prosthodont. 2017; 30(5): 437–8.
  • Miamoto CB, Pereira LJ, Ramos-Jorge ML, Marques LS. Prevalence and predictive factors of sleep bruxism in children with and without cognitive impairment. Braz Oral Res. 2011; 25(5): 439–45.
  • Aşıcı N, Doğan C, Odabaş ME, Alaçam A. Zihinsel Engelli Çocuklarda Diş Erozyonu ve DMFT Değerlendirilmesi-Pilot Çalışma. Acta Odontol Turcica. 2003; 20(2): 15–20.
  • Marcenes W, Zabot NE, Traebert J. Socio‐economic correlates of traumatic injuries to the permanent incisors in schoolchildren aged 12 years in Blumenau, Brazil. Dent Traumatol. 2001; 17(5): 218–22.
  • Ferreira MCD, Guare RO, Prokopowitsch I, Santos MTBR. Prevalence of dental trauma in individuals with special needs. Dent Traumatol. 2011; 27(2): 113–6.
  • Bagattoni S, Sadotti A, D’Alessandro G, Piana G. Dental trauma in Italian children and adolescents with special health care needs. A cross-sectional retrospective study. Eur J Paediatr Dent Off J Eur Acad Paediatr Dent. 2017; 18(1): 23–6.

Evaluation of Oral-Dental Findings in Individuals with Special Care Needs

Yıl 2020, Cilt: 10 Sayı: 3, 331 - 337, 21.09.2020
https://doi.org/10.33631/duzcesbed.678638

Öz

Aim: Oral health problems in children with special care needs are a major health problem that occurs in addition to general health problems. The aim of this study is to evaluate the oral and dental health data of individuals with special care needs examined in schools providing special education in Istanbul.
Material and Methods: This cross-sectional study was carried out at Istanbul University Faculty of Dentistry Department of Pedodontics and Istanbul University Faculty of Dentistry Disable-Free Smile Student Club as a social responsibility project in schools providing special education in Istanbul special permissions were obtained before each screening for oral and dental health. Oral examination was done with the help of disposable dental mirror, explorer probe and cotton plier in daylight. In the examination, the ages of the children, their disability, whether they used drugs, the presence of dental caries, the presence of dental trauma, bruxism and malocclusion were recorded. Appropriate statistical tests/analyzes were used to evaluate the data and the level of significance was set to be 0.05.
Results: Intraoral examination of individuals with 163 special care needs including 42 autism, 111 mental retardation and 10 Down syndrome was performed. There was no statistically significant difference between the DMFT and dft averages of all three groups (p>0.05). Neutral occlusion rate was lower in individuals with Down syndrome than in individuals with autism and people with intellectual disabilities (p<0.05). There was no statistically significant difference between Class II occlusion rates of all three groups (p>0.05). It was found that the frequency of Class III relationship was higher in individuals with Down syndrome than individuals with mental retardation and autism. Also it was higher in individuals with mental retardation than individuals with autism (p<0.05).
Conclusion: Individuals with special care needs should be followed in terms of dental caries, malocclusion, erosive tooth loss, bruxism and dental trauma and should be followed closely for oral and dental health.

Kaynakça

  • Saravanakumar MS, Vasanthakumari A, Bharathan R. Oral health status of special health care needs children attending a day care centre in Chennai. Int J Students’ Res. 2013; 3(1): 12.
  • Tufan İ, Arun Ö. Türkiye bilimsel ve teknik araştırma kurumu Türkiye özürlüler araştırması. 2. baskı. Ankara: DİE Matbaası; 2006.
  • Owens PL, Kerker BD, Zigler E, Horwitz SM. Vision and oral health needs of individuals with intellectual disability. Ment Retard Dev Disabil Res Rev. 2006; 12(1): 28–40.
  • Setiawati AD, Suharsini M, Budiardjo SB, Indiarti IS, Widyagarini A. Assessment of dental anxiety using braille leaflet and audio dental health education methods in visually impaired children. J Int Dent Med Res. 2017; 10(Special Issue): 441–4.
  • Petersen P, Baez R, Ramon J, World Health Organization. Oral Health surveys: basic methods. 5th edition. Geneva: WHO Press; 2013.
  • Angle EH. Classification of malocclusion. Dent Cosmos. 1899; 41: 350–75.
  • Beange HP. Caring for a vulnerable population. Med J Aust. 1996; 164(3): 159–60.
  • Gordon SM, Dionne RA, Snyder J. Dental fear and anxiety as a barrier to accessing oral health care among patients with special health care needs. Spec care Dent. 1998; 18(2): 88–92.
  • Shore S, Lightfoot T, Ansell P. Oral disease in children with Down syndrome: causes and prevention. Community Pract. 2010; 83(2): 18–22.
  • Deps TD, Angelo GL, Martins CC, Paiva SM, Pordeus IA, Borges-Oliveira AC. Association between dental caries and Down syndrome: a systematic review and meta-analysis. PLoS One. 2015; 10(6): e0127484.
  • Jaber MA. Oral Health Condition and Treatment Needs of a Group of UAE Children with Down Syndrome. Ibnosina J Med Biomed Sci. 2010; 2(2): 62–71.
  • Corder JP, Al Ahbabi FJS, Al Dhaheri HS, Chedid F. Demographics and co-occurring conditions in a clinic based cohort with Down syndrome in the United Arab Emirates. Am J Med Genet Part A. 2017; 173(9): 2395–407.
  • Moreira MJS, Schwertner C, Jardim JJ, Hashizume LN. Dental caries in individuals with D own syndrome: a systematic review. Int J Paediatr Dent. 2016; 26(1): 3–12.
  • Robertson MD, Schwendicke F, de Araujo MP, Radford JR, Harris JC, McGregor S, et al. Dental caries experience, care index and restorative index in children with learning disabilities and children without learning disabilities; a systematic review and meta-analysis. BMC Oral Health. 2019; 19(1): 146. doi: 10.1186/s12903-019-0795-4.
  • Macho V, Coelho A, Areias C, Macedo P, Andrade D. Craniofacial features and specific oral characteristics of Down syndrome children. Oral Heal Dent Manag. 2014; 13(2): 408–11.
  • Ghaith B, Al Halabi M, Khamis AH, Kowash M. Oral health status among children with Down syndrome in Dubai, United Arab Emirates. J Int Soc Prev Community Dent. 2019; 9(3): 232–9.
  • Altun C, Guven G, Akgun OM, Akkurt MD, Basak F, Akbulut E. Oral health status of disabled individuals attending special schools. Eur J Dent. 2010; 4(4): 361–9.
  • Fakroon S, Arheiam A, Omar S. Dental caries experience and periodontal treatment needs of children with autistic spectrum disorder. Eur Arch Paediatr Dent. 2015; 16(2): 205–9.
  • Vellappally S, Gardens SJ, Al Kheraif A-AA, Krishna M, Babu S, Hashem M, et al. The prevalence of malocclusion and its association with dental caries among 12-18-year-old disabled adolescents. BMC Oral Health. 2014; 14(1): 123–9.
  • Du RY, Yiu CKY, King NM, Wong VCN, McGrath CPJ. Oral health among preschool children with autism spectrum disorders: A case-control study. Autism. 2015; 19(6): 746–51.
  • Kuter B, Guler N. Caries experience, oral disorders, oral hygiene practices and socio-demographic characteristics of autistic children. Eur J Paediatr Dent. 2019; 20(3): 237–41.
  • Naidoo M, Singh S. The Oral health status of children with autism Spectrum disorder in KwaZulu-Nata, South Africa. BMC Oral Health. 2018; 18(1): 165–74.
  • Kaufman L, Ayub M, Vincent JB. The genetic basis of non-syndromic intellectual disability: a review. J Neurodev Disord. 2010; 2(4): 182–209.
  • Seirawan H, Schneiderman J, Greene V, Mulligan R. Interdisciplinary approach to oral health for persons with developmental disabilities. Spec Care Dent. 2008; 28(2): 43–52.
  • Chiurazzi P, Pirozzi F. Advances in understanding–genetic basis of intellectual disability. F1000Research. 2016; 5: 1–16.
  • Makkar A, Indushekar KR, Saraf BG, Sardana D, Sheoran N. A cross sectional study to evaluate the oral health status of children with intellectual disabilities in the National Capital Region of India (Delhi‐NCR). J Intellect Disabil Res. 2019; 63(1): 31–9.
  • Scalioni F, Carrada CF, Abreu L, Ribeiro RA, Paiva SM. Perception of parents/caregivers on the oral health of children/adolescents with Down syndrome. Spec Care Dent. 2018; 38(6): 382–90.
  • Fontaine-Sylvestre C, Roy A, Rizkallah J, Dabbagh B, dos Santos BF. Prevalence of malocclusion in Canadian children with autism spectrum disorder. Am J Orthod Dentofac Orthop. 2017; 152(1): 38–41.
  • Rao D, Hegde S, Naik S, Shetty P. Malocclusion in individuals with mental subnormality—a review. Oral Heal Dent Manag. 2014; 13(3): 786–91.
  • Hyder M, Tanboga I, Kalyoncu I, Arain H, Marks L. Are Down syndrome children more vulnerable to tooth wear? J Intellect Disabil Res. 2019; 63(11): 1324–33.
  • Önol S, Kırzıoğlu Z. Evaluation of oral health status and influential factors in children with autism. Niger J Clin Pract. 2018; 21(4): 429–35.
  • Ella B, Ghorayeb I, Burbaud P, Guehl D. Bruxism in movement disorders: a comprehensive review. J Prosthodont. 2017; 26(7): 599–605.
  • Berry RB, Brooks R, Gamaldo CE, Harding SM, Marcus CL, Vaughn B V. assm.org [Internet]. Illinois: The American Academy of Sleep Medicine; 2012 [Updated: 2015; Cited: 2020 Apr 24] Avaliable from: https://aasm.org/resources/pdf/scoring-manual-preface.pdf
  • Stores G, Stores R. Sleep disorders and their clinical significance in children with Down syndrome. Dev Med Child Neurol. 2013; 55(2): 126–30.
  • Manfredini D, Serra-Negra J, Carboncini F, Lobbezoo F. Current concepts of bruxism. Int J Prosthodont. 2017; 30(5): 437–8.
  • Miamoto CB, Pereira LJ, Ramos-Jorge ML, Marques LS. Prevalence and predictive factors of sleep bruxism in children with and without cognitive impairment. Braz Oral Res. 2011; 25(5): 439–45.
  • Aşıcı N, Doğan C, Odabaş ME, Alaçam A. Zihinsel Engelli Çocuklarda Diş Erozyonu ve DMFT Değerlendirilmesi-Pilot Çalışma. Acta Odontol Turcica. 2003; 20(2): 15–20.
  • Marcenes W, Zabot NE, Traebert J. Socio‐economic correlates of traumatic injuries to the permanent incisors in schoolchildren aged 12 years in Blumenau, Brazil. Dent Traumatol. 2001; 17(5): 218–22.
  • Ferreira MCD, Guare RO, Prokopowitsch I, Santos MTBR. Prevalence of dental trauma in individuals with special needs. Dent Traumatol. 2011; 27(2): 113–6.
  • Bagattoni S, Sadotti A, D’Alessandro G, Piana G. Dental trauma in Italian children and adolescents with special health care needs. A cross-sectional retrospective study. Eur J Paediatr Dent Off J Eur Acad Paediatr Dent. 2017; 18(1): 23–6.
Toplam 40 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Yelda Kasımoğlu 0000-0003-1022-2486

Cansu Akay 0000-0001-9174-2162

Özgecan Çaynak 0000-0002-1353-5472

Zeynep Aytepe 0000-0002-5938-0007

Mine Koruyucu 0000-0002-2077-5095

Yayımlanma Tarihi 21 Eylül 2020
Gönderilme Tarihi 22 Ocak 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 10 Sayı: 3

Kaynak Göster

APA Kasımoğlu, Y., Akay, C., Çaynak, Ö., Aytepe, Z., vd. (2020). Özel Bakım Gereksinimi Olan Bireylerde Ağız-Diş Bulgularının Değerlendirilmesi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 10(3), 331-337. https://doi.org/10.33631/duzcesbed.678638
AMA Kasımoğlu Y, Akay C, Çaynak Ö, Aytepe Z, Koruyucu M. Özel Bakım Gereksinimi Olan Bireylerde Ağız-Diş Bulgularının Değerlendirilmesi. DÜ Sağlık Bil Enst Derg. Eylül 2020;10(3):331-337. doi:10.33631/duzcesbed.678638
Chicago Kasımoğlu, Yelda, Cansu Akay, Özgecan Çaynak, Zeynep Aytepe, ve Mine Koruyucu. “Özel Bakım Gereksinimi Olan Bireylerde Ağız-Diş Bulgularının Değerlendirilmesi”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10, sy. 3 (Eylül 2020): 331-37. https://doi.org/10.33631/duzcesbed.678638.
EndNote Kasımoğlu Y, Akay C, Çaynak Ö, Aytepe Z, Koruyucu M (01 Eylül 2020) Özel Bakım Gereksinimi Olan Bireylerde Ağız-Diş Bulgularının Değerlendirilmesi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10 3 331–337.
IEEE Y. Kasımoğlu, C. Akay, Ö. Çaynak, Z. Aytepe, ve M. Koruyucu, “Özel Bakım Gereksinimi Olan Bireylerde Ağız-Diş Bulgularının Değerlendirilmesi”, DÜ Sağlık Bil Enst Derg, c. 10, sy. 3, ss. 331–337, 2020, doi: 10.33631/duzcesbed.678638.
ISNAD Kasımoğlu, Yelda vd. “Özel Bakım Gereksinimi Olan Bireylerde Ağız-Diş Bulgularının Değerlendirilmesi”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10/3 (Eylül 2020), 331-337. https://doi.org/10.33631/duzcesbed.678638.
JAMA Kasımoğlu Y, Akay C, Çaynak Ö, Aytepe Z, Koruyucu M. Özel Bakım Gereksinimi Olan Bireylerde Ağız-Diş Bulgularının Değerlendirilmesi. DÜ Sağlık Bil Enst Derg. 2020;10:331–337.
MLA Kasımoğlu, Yelda vd. “Özel Bakım Gereksinimi Olan Bireylerde Ağız-Diş Bulgularının Değerlendirilmesi”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, c. 10, sy. 3, 2020, ss. 331-7, doi:10.33631/duzcesbed.678638.
Vancouver Kasımoğlu Y, Akay C, Çaynak Ö, Aytepe Z, Koruyucu M. Özel Bakım Gereksinimi Olan Bireylerde Ağız-Diş Bulgularının Değerlendirilmesi. DÜ Sağlık Bil Enst Derg. 2020;10(3):331-7.