Oral health status and barriers to care in a multiethnic mixed disability center: Rethinking disability community dental services

Abstract

AimsThere are currently neither onsite services nor any known studies that addresses oral health of persons with special care needs (PSCN) within disability activity centers in Singapore. This study aims to report on the oral health status, disability‐related barriers, and assess how these barriers limit care pathways.Methods and Results29 PSCN from a multiethnic mixed disability day activity center were screened over two days. Their ages ranged from 18‐59 years old (mean: 31.3). Proportion of Chinese, Malay and Indian ethnicity was 69.6%, 26.7% and 10.3% respectively. 11 were female. Only three PSCN were dentally fit, the average required almost four treatments each. 65.5% had “poor” to “very poor” oral hygiene. The mean number of decayed, missing and filled teeth were 2.8 (95% CI: 1.3‐4.1), 1.9 (95% CI: 1.2‐3.1), and 1.9 (95% CI: 1.2‐3.1), respectively. DMFT had a moderate positive (Pearson's) correlation with age (rp = 0.4549, P < .05). The average British Dental Association (BDA) total banded score was 16.97, categorized as “moderate complexity.” 51.7% were wheelchair users, while 41.3% needed support. Pharmacological behavioral management had to be considered for 17.2%. The odds ratio was 10 and relative risk 5.26 for requiring additional behavioral modifications and requiring more than average treatment.ConclusionThis multiethnic cohort of mixed disabilities displayed considerable unmet dental needs and a conflux of barriers to care. Pathways to care and study limitations are discussed.

Special Care Patients and Caries Prevalence in Permanent Dentition: A Systematic Review

“…People with disabilities often have associated oral complications. This is related to the difficulty they can experience when eating, especially when chewing, and maintaining proper oral hygiene; which can increase the susceptibility of their teeth to decay and their gums to swelling [ 4 ].…”

“…Among the main factors that participate in the increased cariogenic risk, the following are worth mentioning: xerostomia, secondary to the consumption of anxiolytics and anticholinergic drugs; the consumption of drugs that incorporate sugary vehicles; special diets, including those that require frequent intakes; hypotonia of the cheeks, lips, or tongue; motor dysfunction of hands and arms; and demotivation due to the continuous perception of illness [ 4 , 9 ].…”

Disability and oral health in the Association of Southeast Asian Nations - A survey for conceptualisation and development

“…14 With the heterogeneous social constructs that persons with disabilities in developing nations face, a complex list of barriers to oral health exist - how do we improve sensemaking for such a phenomenon? 11 This was the starting point for our study. In order to forward ADF’s aim and improve DOH, 5 there is a need to conceptualise understanding of the difficulties and create a framework for development in ASEAN.…”

“…10 PWD face poorer dental health outcomes, more oral diseases, and poorer accessibility to oral health services than the average person. 11 A cross-sectional screening programme for 343 adults of mixed disabilities in Singapore revealed that the average PWD of 40 years and above would retain less than 20 teeth. 12…”

“…10 PWD face poorer dental health outcomes, more oral diseases, and poorer accessibility to oral health services than the average person. 11 A cross-sectional screening programme for 343 adults of mixed disabilities in Singapore revealed that the average PWD of 40 years and above would retain less than 20 teeth. 12 'Accessibility' is defined as the opportunity to reach and obtain appropriate health services, which enlists determinants that integrate demand and supply-side factors.…”