Unmet oral health needs among persons with intellectual disability
Introduction
It has been reported that the number of persons with intellectual disabilities (ID) is increasing and the reasons are: population growth, increased reporting, aging of the population and more accurate methods and models of detection and diagnosis (Nunn & Murray, 1987).
Reports on the oral health of persons with an ID have identified problems such as poor oral hygiene, untreated caries and high prevalence of periodontal disease. In addition to poorer general health, individuals with ID experience more difficulty obtaining dental care than the general population (Glassman et al., 2003) with a higher proportion of extracted teeth and increased prevalence of traumatic dental injuries (Gallagher & Fiske, 2007; Anders & Davis, 2010; Waldman, Perlman, & Swerdloff, 2001).
Good oral health is an important component of general health, and oral health promotion can reduce the burden of oral diseases (Glassman and Miller, 2009, Oredugba, 2007), but it has been reported that dental caries, gingivitis and periodontal disease are among the top ten secondary conditions in persons with ID that cause limitations in their daily actives (Owens, Kerker, Zigler, & Horwitz, 2006).
Living arrangements significantly affect both general and oral health, particularly in developing countries. The policy of deinstitutionalization, integration and increased independence for persons with ID has been accepted in the developed countries, and no indications of a corresponding influence on oral health in individuals with could be observed (Gabre, Wikstrom, Martinsson & Gahnberg, 2001). (Glassman & Folse, 2005). The oral health of many people with ID is largely dependent on the knowledge, attitudes and practices of their family or care providers (Cumella, Ransford, Lyons, & Burnham, 2000).
There are strong recommendations that interaction between general and oral health in persons with ID should be investigated and understood (Batista, Moreira, Rauen, Corso, & Fiates, 2009). The effect of co-occurring developmental disorders (DDS) on oral health and dental visits has been documented (Kancherla, Van Naarden Braun, & Yeargin-Allsopp, 2013). Physical access to treatment, as well, is significant issue that must be addressed given that many people with ID also have motor impairments (Pradhan, Slade, & Spencer, 2009).
Finally, one systematic review confirmed that there was a significant gap in oral health care among people with ID within different age groups (Anders & Davis, 2010). In many countries and in Serbia as well, full dental coverage is terminated when a person attains 18 years of age. This has already been identified as one of the key limiting factors oral health care delivery among intellectually disabled (Kancherla et al., 2013).
The aim of this study was to examine the factors affecting oral health status among intellectually disabled individuals in Serbia.
Section snippets
Method
The study protocol was revised and approved by the Research Ethical Committee of the Faculty of Dental Medicine, University of Belgrade and was in accordance with the World Medical Association’s Declaration of Helsinki. All participants/parents/caregivers gave their informed consent to participation.
The study was carried out at the Pediatric and Preventive Dentistry Department, Dentistry Clinic of Vojvodina, University of Novi Sad and at the Pediatric and Preventive Dentistry Clinic, Faculty of
Results
In total, 1000 respondents were initially included in the study. Despite the referral for treatment and consent from the caregivers, complete clinical examination could not be completed in 95 participants due to lack of cooperation. These patients were excluded from the preparation of the epidemiological profile, but were not excluded from the study, recorded that 9.5% of the patients did not tolerate dental examination. All epidemiological parameters were analyzed in 905 patients who had
Discussion
According to the International Classification of Functioning, Disability and Health (ICF), current concept of disability is based primarily on social models, in which the disability is described in terms of functional limitations experienced by a person because of environmental and social barriers (WHO, 2001). Based on this model, a person with a disability has been defined as anyone who has or has had an impairment causing a long term adverse effect upon his or her ability to perform daily
Conclusions
The results from the present investigation show that caries and advanced forms of gingivitis with the high proportion of tooth loss is present in all groups of individuals with ID. In addition to that, age, institutionalization, co-occuring impairments contribute to even more unfavourable epidemiological profile. Targeting oral health services to individuals with ID is encouraged and may help to reduce overall negative effect on oral and general health associated with delayed treatments,
What this paper adds
This paper adds in depth examination of the factors affecting oral health status among intellectually disabled individuals in Serbia. It has been recorded that caries was significantly more prevalent among adult persons with ID, and in persons with co-occurring DDS. Institutionalization and co-occurring disabilities has been found to be significantly associated with a higher probability of developing gingivitis.
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