Unmet oral health needs among persons with intellectual disability

doi:10.1016/j.ridd.2016.09.020

Research in Developmental Disabilities

Volume 59, December 2016, Pages 370-377

https://doi.org/10.1016/j.ridd.2016.09.020 Get rights and content

Abstract

The aim of this study was to examine the factors affecting oral health status among intellectually disabled individuals in Serbia. The sample population was categorized according to age, sex, living arrangements, general health and the level of intellectual disability (ID). The diagnosis of dental caries was performed using the DMFT/dmft criteria. The oral hygiene and gingival health were assessed with the plaque index (Silness&Löe) and gingival index (Löe&Silness), respectively. Descriptive analysis, step-wise and logistic regression were performed to analyze related influential factors for caries presence, number of extracted teeth, teeth restored, the oral hygiene level and the extent of gingival inflammation. Odds ratios for caries were significantly higher among adult persons with ID, in persons with co-occurring developmental disorders (DDS) and increased with the level of ID. Group with DDS was associated with a 1.6 times greater odds of untreated decay, while the institutionalization was associated with 2.4 times greater odds of untreated decay. Institutionalization and co-occurring disabilities have been found to be significantly associated with a higher probability of developing gingivitis. Targeting oral health services to individuals with ID are encouraged and may help to reduce overall negative effect on oral and general health associated with delayed treatments, chronic dental pain, emergency dental care, tooth loss and advanced periodontal disease.

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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Citation Excerpt :
While inadequately studied, there is no reason to believe that such inadequacies do not exist in dentistry.7 Individuals with ID face several challenges in accessing preventive services that include basic activities such as brushing teeth and dietary control to more interactional care such as receiving professional dental care.8-10 At the same time, there is inadequate data on the difference in prevalence rates of dental diseases, often due to challenges in collecting such data from the most vulnerable populations in this cohort.
Individuals with intellectual disability (ID) face significant challenges in preventing oral diseases. They also lack access to high-quality oral health care in professional settings. To understand the effects of oral conditions on their lives and health, it is necessary to assess their oral health outcome measures. For those with mild ID, who possess adequate linguistic and cognitive abilities, accessibility features should be incorporated in the dental patient reported outcome (dPRO) measures. But many other individuals often lack the linguistic and cognitive ability to self-report through dPRO measures. While self-reported measures are preferable, requiring dPROs in this population would result in a high amount of missing data and the inability to assess interventions for improving their dental health. Thus, there is a need to use proxy-reported outcome (ProxRO) measures, observer reported outcome (ObsRO) measures, and clinician reported outcome (ClinRO) measures among those with ID. This is also a common approach taken by other specialties that work closely with those with ID, where the measures for activities of daily living and adaptive behavior measures use reporting by caregivers. ProxRO measures in dentistry that were created for infants and young children provide a structure for appropriate adaptations and the creation of relevant outcome measures. Including input from the intensely multidisciplinary teams that provide supports for those with ID is key to creating high-quality measures and oral health interventions for those with ID.
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View all citing articles on Scopus

View full text

Unmet oral health needs among persons with intellectual disability

Abstract

Introduction

Section snippets

Method

Results

Discussion

Conclusions

What this paper adds

Access to dental care in Alabama for children with special needs

The Journal of the American Dental Association

Oral health of patients with intellectual disabilities: A systematic review

Special Care in Dentistry

Oral health and nutritional status of semi-institutionalized persons with mental retardation in Brazil

Research in Developmental Disabilities

Problems of persons with cerebral palsy in obtaining dental care

Australian Dental Journal

For debate: Problems with the DMF index pertinent to dental caries data analysis

Community Dentistry and Oral Epidemiology

A survey of the availability of dental services to developmentally disabled persons residing in the community

Special Care in Dentistry

Public health approach to the study of mental retardation

American Journal on Mental Retardation

Medications' impact on oral health

The Journal of the American Dental Association

Transition planning/coordinating interventions for youth with disabilities: A systematic review

Career Development and Transition for Exceptional Individuals

Needs for oral care among people with intellectual disability not in contact with Community Dental Services

Journal of Intellectual Disability Research

Ethnic variation in service utilisation among children with intellectual disability

Journal of Intellectual Disability Research

Dental health and dental care in severely mentally retarded children

Swedish Dental Journal

Move of adults with mental retardation from institutions to community-based living: Changes in the oral microbiological flora

Journal of Dental Research

Special care dentistry: A professional challenge

British Dental Journal

Social supports and prevention strategies as adjuncts and alternatives to sedation and anesthesia for people with special needs

Special Care in Dentistry

Practical protocols for the prevention of dental disease in community settings for people with special needs: The protocols

Special Care in Dentistry

Oral health status of mentally disabled subjects in India

Journal of Oral Science

Assessment of dental trauma among cerebral palsy individuals in Udaipur city

Dental Traumatology

Dental care among young adults with intellectual disability

Research in Developmental Disabilities

Periodontal disease in pregnancy I: Prevalence and severity

Acta Odontologica Scandinavica