By Guest Blogger John Morgan, DDS, Associate Professor, Department of Public Health and Community Service at Tufts University School of Dental Medicine
What many people consider fairly routine – brushing their own teeth and going to the dentist – can be a major obstacle for people with physical and/or intellectual disabilities.
Research points to a high prevalence of oral diseases for those with a variety of disabilities. In a study that colleagues at Tufts University and I recently published in The Journal of the American Dental Association, we found that people with intellectual and developmental disabilities (IDD) are more likely to have periodontal disease, untreated tooth decay and missing teeth than the general population. Specifically, in our review of the electronic dental records of more than 4,700 people with IDD who received regular dental care, we found:
- More than 80 percent of all patients had periodontitis (gum disease)
- 1 in 3 had untreated cavities
- 10.9 percent of all patients did not have any teeth
- Those who were 40 years and older had the highest number of decayed, missing and filled teeth
Regular access to comprehensive dental treatment and daily oral home care are vital to promote good oral health, but can be difficult for many people with disabilities to achieve. For example, one of the occupational therapists in a school system where we have an oral health outreach program, brought to our attention that one of the fifth grade students was having a problem with his oral hygiene. He had a progressive muscular disease and a mild intellectual disability.
One of our dental hygienists spoke with the boy and found he wanted more independence as he grew older and no longer wanted help from his mother brushing his teeth. Unfortunately, he was unable to move his arm in the required motion to brush his own teeth. Working together with the hygienist, the occupational therapist designed an extender on an electric toothbrush which allowed him to brush his teeth effectively, live more independently and improve his self-esteem. This simple solution was transformational for him.
When I mentioned this to a colleague of mine who is an occupational therapist, she mentioned her experience over many years of treating patients with neurological involvement or injuries that affect hand or leg function. She saw how these factors could affect her patients’ ability to brush and floss their teeth and go to the dentist. Mobility and command of basic activities of daily living may take priority over oral health needs for patients with disabilities undergoing rehabilitation. Adapting home environments to facilitate tooth brushing, flossing and mouth rinsing often proves challenging for patients and therapists alike.
Oral health is a fundamental part of overall health and well-being, but the challenges to achieving good oral health present a variety of complexities. Speaking, eating, overall health, social interaction (including employability) and quality of life require a healthy mouth and smile. Many factors associated with disabilities contribute to an increased risk for oral disease and impact oral health. Cognitive, physical and behavioral limitations can make it difficult to perform daily oral care and visit a dental office.
Further impacting this complicated picture, many dental offices are not equipped to provide care to patients with disabilities, in large part because they lack specialized training required to provide care for this population. Often dental insurance benefits are not available to those with disabling conditions. In our study, we also found that even with excellent care provided by dentists who are highly trained to treat people with intellectual and developmental disabilities, there remains a high prevalence of disease, signaling the need for additional support and education among caregivers.
My colleagues and I are now looking at ways to assist caregivers in promoting preventive oral health care at home, as well as how and when to access professional dental care. Our research team has just completed more than 800 surveys of paid and family caregivers, and conducted focus groups of key stakeholders to determine the best ways to prevent oral disease and remove barriers to a healthy mouth for adults with disabilities. This information, combined with advances in dental science and the current emphasis on redefining the roles of the health professional, patient and caregiver in promoting oral health, could shape how we manage oral diseases for people with disabilities.
Particularly, as our population ages and lives longer with more disabilities, and our caregiver resources dwindle, the findings of our research could contribute significantly to improving the health of a deserving and vulnerable population.
John Morgan, DDS, is Associate Professor in the Department of Public Health and Community Service at Tufts University School of Dental Medicine. The Tufts Dental Facilities Serving People with Special Needs (TDF) is a network of Massachusetts dental clinics that provides oral health care to people with disabilities through a collaboration between Tufts University, the Massachusetts Department of Developmental Services and Department of Public Health.