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

Abstract

Previous research has found an unmet need for oral care among people with intellectual disability. The key factors which have been indicated are low expectations, fear of treatment, lack of awareness among carers and problems in accessing dental services. The withdrawal of many general dental practitioners (GDPs) from the National Health Service (NHS) may have exacerbated the latter problem in the UK. The aims of the present study were: (1) to assess the extent of unmet clinical needs in a group of adults with intellectual disability living in the community who were not in contact with the Community Dental Service (CDS); and (2) to explore their perceptions of teeth and contact with dentists to identify how oral care can be improved. Interviews were completed with subjects and/or carers and a dental examination was completed. There were higher levels of untreated caries (decay), and gingival or periodontal (gum) problems among the sample than in either the general population, or in a previous survey of CDS users at day centres and residential facilities. The subjects were largely unaware of dental problems, and used the appearance and absence of pain to judge the condition of their teeth. They depended greatly on their carers for decision-making and support with regard to visiting the dentist and tooth-brushing. Carers requested training in oral care and the use of dental services, and support in dealing with clients who have problems tolerating tooth-brushing. The subjects had experienced a wide variation in the treatment provided by dentists, but had not found it difficult to access a dentist despite recent reductions in the availability of NHS dental care. They expressed a particular need for a good relationship with their dentist and for their dentist to have personal skills in relating to people with an intellectual disability. Dental screening checks and oral care training for carers should be made easily available. Care plans should include tooth-brushing and dietary issues for all clients who have their own natural teeth. There are significant training issues for dentists in developing personal skills in total communication, disability awareness and attitudes which value people with intellectual disability.

A cascade of disparities: Health and health care access for people with intellectual disabilities

“…People with ID were more likely to have missing or decayed teeth and less likely to have fillings than the general UK population [Cumella et al, 2000], with concerns about high turnover and less awareness of dental needs in direct care staff. Lewis and colleagues [2002] noted higher rates of "poor" and lower rates of "good" oral health for persons with ID living in community care facilities in the United States compared with those living with family or friends or living in their own homes.…”

“…Lewis and colleagues [2002] noted higher rates of "poor" and lower rates of "good" oral health for persons with ID living in community care facilities in the United States compared with those living with family or friends or living in their own homes. Poor oral hygiene is implicated as a primary cause, along with lack of preventive care [Cumella et al, 2000;Lewis et al, 2002].…”

Influencia del nivel de educación sanitaria de los padres o apoderados en el estado de salud e higiene bucal del niño con retardo mental

“…Por lo que se puede concluir que estos niños no están recibiendo el apoyo correspondiente de sus familiares, tal como lo mencionan CUMELLA y col. 6 y MARTENS y col.…”

“…Los resultados hallados se deberían también a que las personas con discapacidad mental, como manifiestan CUMELLA y col. 6 , ignoran acerca de los problemas dentales, la relación entre el dolor y la condición de salud de sus dientes, ya que ellos dependen mucho de las personas que los cuidan, quienes a su vez no tienen conciencia de la importancia de brindarles cuidados especiales, por otro lado manifiestan tener problemas para acceder a los servicios dentales; por lo que recomiendan, que es necesario que se entrenen a los cuidadores, para que además mantengan una relación más estrecha con éstos y les brinden apoyo en los cuidados de su salud bucal, dieta y cepillado dental, pues presentan cierta resistencia a éste último. Así mismo MARTENS y col. 18 , realizaron un estudio epidemiológico en una población de niños discapacitados, observando que todos los grupos en término medio presentaron placa y cálculos dentales, aún los que tenían ciertas destrezas, esto se debió a que les faltó instrucciones adecuadas de higiene bucal, recomendando que es necesario instalar programas de entrenamiento dirigidos a sus padres y educadores.…”

Oral health impact on quality of life among adults with disabilities: carer perceptions

“…2 The most widely reported reason for dental visits is when a carer suspects that the care recipient might be experiencing pain by noting changes in behaviour particularly at mealtimes, followed by secondary reasons including halitosis, drooling and aspiration of food and/or liquids. 3 It is the carer who is best placed to note small changes in behaviour and detect any problem.…”