Changes in the oral health-related quality of life in adult patients with intellectual disabilities after dental treatment under general anesthesia

Oral health of individuals with intellectual disabilities: a global cross-sectional study from the special olympics world games 2023

AIM

The aim of this study was to analyze the interrelationships between oral health status and dental visits among athletes participating in the Special Olympics World Games Berlin, Germany 2023.

METHODS

This cross-sectional study was conducted within the framework of the Healthy Athletes Program at the Special Olympics World Games Berlin 2023, where 2109 athletes with intellectual disabilities (ID) from all over the world participated in voluntary oral health screenings. Data were collected through interviews and clinical oral examinations, following a standardized protocol. Statistical analyses included descriptive statistics, logistic regression models, and chi-square tests to assess regional disparities, with significance set at p < 0.05.

RESULTS

From a total of 7500 athletes that participated during the Special Olympics World Games 2109 athletes (28.1%) with intellectual disabilities from 152 countries participated in the oral health screening at the Special Olympics World Games Berlin 2023. Untreated caries were present in 40.6% of the athletes (n = 856). If the dentist was visited at least once a year neither the occurrence of untreated carious lesions (OR 1.02; p = 0.868) nor the rate of untreated lesions (OR 1.10, p-value 0.630), the number of missing teeth (OR 0.65) or gingivitis (OR 1.076) was significantly reduced.

CONCLUSION /CLINICAL RELEVANCE

This study highlights an overall insufficient oral health status in athletes with ID. Even those who visited a dentist within the last year, treatment needs were not reduced significantly. More efforts compensating reduced oral hygiene capabilities and optimizing a barrier-free provision of dental care are needed.

Assessment of Oral Health Conditions Among Physically Disabled Patients in Saudi Arabia

OBJECTIVES

This study was undertaken to assess the oral health status among physically disabled Saudi patients.

METHODS

Recruitment took place in the Armed Forces Centre for Health Rehabilitation in Taif, Saudi Arabia. 124 patients living with a physical disability were enrolled and divided into three groups: hemiplegia, paraplegia and quadriplegia. Data was collected on demographics and different oral indices, including the Decayed Missing Filled Teeth (DMFT) index, the Mean Decayed Teeth score, the Community Periodontal Index (CPI), the Community Periodontal Index of Treatment Needs (CPITN), and the Simplified Oral Hygiene Index (OHI-S).

RESULTS

High DMFT was observed among the hemiplegia group (mean = 22.61; P-value = .008) with no difference in the Mean Decayed Teeth. All groups showed signs of gingivitis in the form of gingival bleeding. The most compromised periodontal health in the form of pockets 6 mm or deeper was found in the hemiplegia group (53.7%; P-value = .001). This was also reflected in the CPITN (39.0%; P-value = .001), indicating the need for complex treatments in the same group. Regarding oral hygiene, all groups showed a "fair" oral hygiene condition (OHI-S < 3.0), with significantly poorer hygiene (mean = 2.49; P-value = .042) and greater debris accumulation (mean = 1.52; P-value = .024) among the quadriplegia group. In the regression analysis, both age and gender had significant effects on some indices, while disability type showed borderline effects.

CONCLUSION

The findings indicate poor oral health in these individuals, mainly due to physical limitations, hindering effective self-care practices.

CLINICAL SIGNIFICANCE

Oral health is a critical aspect in people with physical disabilities, as it is intrinsically linked to overall health and well-being. Recognizing the clinical importance of oral health among physically disabled patients is essential to improve access and affordability of dental care for this vulnerable group of the population.

Impact of dental treatments under general anesthesia on oral health-related quality of life in children: a comprehensive meta-analysis

BACKGROUND

Children's oral health significantly impacts their overall well-being, daily activities, and social interactions. Dental treatments under general anesthesia are often required for extensive dental problems, special health care needs, or dental phobias, particularly in pediatric populations. The objective of this meta-analysis was to systematically review and synthesize existing research on how dental treatments under general anesthesia affect the oral health-related quality of life (OHRQoL) in children.

METHODS

The electronic databases such as PubMed, EMBASE, Ovid MEDLINE, Web of Science, and Scopus were systematically reviewed following PRISMA guidelines to identify studies evaluating OHRQoL changes after dental treatments under general anesthesia. Studies involving ECOHIS and COHRQoL scales in pre- and postoperative assessments were included. The mean differences between scale measurements before and after dental treatments under general anesthesia were reported as the standard mean difference (SMD), and effect sizes for Hedges' g were classified as follows: small effect (0.2), medium effect (0.5), large effect (0.8). All meta-analysis statistical computation was carried out using the Hartung-Knapp-Sidik-Jonkman method for the random effects model.

RESULTS

A total of 36 papers satisfied the inclusion criteria and were subsequently included in the investigation. In the pooled analysis, treatments under general anesthesia in children improved OHRQoL (ECOHIS) in the short term with a significantly large effect size (SMD = 1.66, 95% CI: 1.07-2.24, p < 0.001; τ2 = 2.18, I2 = 98.9, p < 0.001). Similarly, dental treatment under general anesthesia increased the COHRQoL score in children with a significantly large effect size (SMD = 1.32, 95% CI: 0.81-1.84, p < 0.001; τ2 = 0.78, I2 = 97.3, p < 0.001).

CONCLUSION

The findings of this meta-analysis suggest that there was evidence that OHRQoL of children receiving dental treatment under general anesthesia improves with a large effect size in the short-term following treatment.

A case-control study on oral health knowledge and dental behavior among individuals with developmental delays in Jordan: caregiver perspective

Aim

the aim of this study is to assess oral health knowledge and dental behavior among individuals with developmental delays intellectual and developmental disabilities (IDD) in comparison with individuals without (IDD) in Jordan.

Methods

A case-control study was conducted among 317 caregivers of individuals with IDD (n = 168) and control (n = 149) groups, which involved the completion of the questionnaire. A closed-ended, validated self-designed questionnaire was distributed. The questionnaire included questions addressing participants' oral health knowledge and behavior. Convenience sampling was used to select the caregivers from centers associated with IDD by collecting data from nearby locations. Using SPSS® software Version 22 with a 0.05 level of significance data were analyzed. A Chi-square test and contingency-table analysis were performed on the data.

Results

Caregivers for individuals with IDD in Jordan were less knowledgeable about different oral health aspects than control group (P value < 0.05). Fewer individuals in the IDD caregiver group brushed their teeth once or twice daily (83.2%), compared to the control group (93.3%). Only 22.6% of the IDD participants could brush their teeth without assistance. On the other hand, the IDD group consumed significantly less sugary foods and soda than the control group (P value < 0.05).

Conclusion

The lack of knowledge among IDD caregivers in Jordan is critical which can result in poor oral health outcomes for this vulnerable population. Increasing the knowledge level for the IDD caregivers on the specific needs for IDD individuals is highly important to enhance their understanding of oral health and improve their quality of life. Caregivers with IDD should receive training programs given by oral health professionals about the need for regular dental check-up and effective oral hygiene care reduce the risk of having dental problems and oral disease.

Perceptions of Parents/Caregivers About the Impact of Oral Conditions on the Quality of Life of Children and Adolescents with Autism Spectrum Disorder

PURPOSE

To investigate the perceptions of parents/caregivers about the impact of oral conditions on the oral health-related quality of life (OHRQoL) of children/adolescents with autism spectrum disorder (ASD) compared to the perceptions of parents/caregivers of children/adolescents without ASD.

METHODS

A comparative cross-sectional study was conducted involving 80 children/adolescents with ASD three to 16 years of age matched by sex and age with 80 children/adolescents without ASD and their parents/caregivers. Clinical examinations were performed for the diagnosis of dental caries experience (DMFT/dmft), clinical consequences of untreated dental caries (PUFA/pufa), visible plaque (VPI), bleeding on probing (BPI), malocclusion and traumatic dental injury (TDI). Parents/caregivers answered a questionnaire addressing sociodemographic characteristics and the Brazilian version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ), which measures OHRQoL from the perspective of parents/caregivers. Data analysis involved the Wilcoxon test, chi-squared test and Poisson regression.

RESULTS

Dental caries experience impacted OHRQoL in the group with ASD regarding the total P-CPQ score (p < 0.001) as well as the "oral symptoms" (p = 0.011) and "wellbeing" (p < 0.011) domains. No differences were found between the perceptions of parents/caregivers of children/adolescents with ASD and perceptions of parents/caregivers of children/adolescents without ASD (p = 0.721).

CONCLUSION

Dental caries experience can have a negative impact on the OHRQoL of children/adolescents with ASD.

Effectiveness of Oral Health Rehabilitation Under General Anaesthesia on Oral Health-Related Quality of Life in Children with Intellectual and Developmental Disabilities - A Prospective Study

CONTEXT/BACKGROUND

Children with intellectual and developmental disabilities may have compromised oral health and require oral health rehabilitation under general anaesthesia.

AIM

The present study aimed to evaluate the changes observed in the Child Oral Health Impact Profile (COHIP-14) and Family Impact scores (FIS-12) of children with severe behavioural disabilities and medically compromised conditions after oral health rehabilitation (OHR) under general anaesthesia (GA).

MATERIALS AND METHODS

Children with severe behavioural disabilities and medically compromised conditions were recruited, and OHR was done under GA. Teeth with fair prognosis were functionally restored, and teeth with poor prognosis were extracted after parents'/caregivers' informed consent. Pre-operative and post-operative COHIP-14 and FIS-12 questionnaires were filled out by the parents/caregivers. The pre-operative and post-operative values were compared with those of the Student t -test.

RESULTS

All responses for the COHIP-14 and FIS -14 had shown significant ( P ≤ 0.001) change after OHR under GA.

CONCLUSION

The oral and functional health of children with severe behavioural disabilities was improved after OHR under general anaesthesia. The family impact score was also improved in terms of activity and emotions; further financial concerns of the family were also reduced after OHR under GA.

The oral health status and treatment needs of adults with intellectual disabilities in Auckland

AIMS

Adults with intellectual disabilities (ID) are known to have poor oral health and complex dental needs requiring treatment under general anesthesia (GA). This retrospective chart review aimed to provide information on the oral health status and treatment needs of adults with ID in Auckland.

METHODS AND RESULTS

Data on 1075 adult patients with ID seen through the Auckland public dental service during the period June 2016 to April 2020 were drawn from electronic notes. Analyses focused on age group differences and the characteristics associated with the use of GA for dental treatment. More cumulative caries experience, poorer oral hygiene, and more missing teeth were observed among those who were older. About half (50.8%) of the patients used GA for dental treatment. This proportion was higher among those who were younger, less independent, non-verbal, with poorer oral hygiene, or who had active decay.

CONCLUSION

Adults with ID are a heterogeneous population with unmet dental treatment needs. Different age groups require consideration of distinct characteristics for dental care provision. It is important to be for public sector service provision to be developed to consider predictors for GA service use in patients who are younger, less independent, non-verbal, or have active decay.

Chairside oral prophylaxis for people with profound intellectual or multiple disabilities-a retrospective feasibility study

OBJECTIVES

People with severe intellectual or multiple disabilities (PIMD) have been receiving dental care in a specialized unit offering special care dentistry. For most of these adult patients, the initial consultation is complaint driven. In addition, the limited ability to cooperate due to their disabilities often means that dental treatment for these patients is usually carried out under general anesthesia (GA). Chairside treatment attempts are the exception rather than the rule. This retrospective study evaluated whether consistent practice of behavioral management principles and techniques embedded in a specific dental environment enables successful dental treatment of PIMD.

MATERIALS AND METHODS

The feasibility of chairside dental prophylaxis in PIMD (n=36) was analyzed: specific behavioral management techniques were applied, and professional tooth cleaning (PTC) was performed in the dental chair. Clinical data obtained from medical records and a questionnaire were analyzed.

RESULTS

All patients had severe intellectual or multiple disabilities and had previously undergone at least one dental treatment under GA. Of these patients, 55.6% never had their teeth professionally cleaned before. Applying different behavioral techniques, all patients were compliant with receiving PTC in the dental chair.

CONCLUSIONS

An individualized and disability-specific treatment strategy using various noninvasive and nonpharmacological behavioral guidance techniques resulted in a higher compliance rate in PIMD, which allowed chairside PTC and reduced the need for treatment under GA.

CLINICAL RELEVANCE

Consistent implementation of various behavioral guidance techniques and communication strategies in a supportive environment enabled all patients to receive chairside PTC and be involved in a lifelong recall program.

Effects of a disability-simulating learning unit on ableism of final-year dental students - a pilot study

OBJECTIVES

This study aimed to describe a disability-simulating learning unit (DSLU) to raise dental students' awareness of the special needs of patients with disabilities as well as to measure the effect of the DSLU on ableism.

METHODS

A DSLU among final-year undergraduate dental students (n = 33), was developed and evaluated. The students were randomly divided into two groups (Group I, n = 17; Group II, n = 16). Group II only received conventional teaching (control group), whereas Group I was additionally exposed to the DSLU (intervention group). In the DSLU, typical physical restrictions and the associated difficulties in attending dental appointments were simulated with the help of simulation suits. Four different stations offered the opportunity to experience typical signs of disability in a dental context. About 2 months after the DSLU, both groups were asked to answer the Symbolic Ableism Scale (SAS). An analysis was conducted to examine the participants' average total score and several subscores. The Mann-Whitney U Test was employed to control the differences between the study groups.

RESULTS

Overall, the students in the intervention group had a significantly (p = .001) lower mean SAS summary score (median = .37; IQR .32-.42) than the students in the control group (median = .50; IQR .39-.53). For the components "individualism" (p < .0001) and "excessive demands" (p = .002) significant group differences could be observed.

CONCLUSION

The DSLU is a potentially feasible and effective method for influencing students' ableism attitude.

OPERATIONALIZING ORAL HEALTH OUTCOME MEASURES TO IMPROVE THE ORAL HEALTH OF PERSONS WITH INTELLECTUAL DISABILITIES

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.

Education/Training Interventions to Improve Oral Health of Adults with Intellectual Disability

People with intellectual disability have poorer oral health outcomes and experience greater difficulties accessing dental services than the rest of the community. Interdisciplinary educational programs for those involved in oral health decision making for people with intellectual disability aim to improve their oral health. This scoping review explored education/training interventions related to the oral health of adults with intellectual disability. Interventions targeted dental health and non-dental health professionals, adults with intellectual disability, and their paid and unpaid supporters. Six electronic databases were searched using PRISMA guidelines and the Crowes critical appraisal tool. The search strategy, plus the application of the inclusion and exclusion criteria, presented in the body of the manuscript, led to the selection of 20 papers for inclusion into this review. The quality of undergraduate tuition relating to disability was reported to be poor, but students and dental health professionals expressed interest in expanding their knowledge in this area. Disability-support workers and primary carers of people with intellectual disability reported improved knowledge and attitude, but the oral health status of the people they supported was not impacted. No research was found that explored the perspectives of non-dental health professionals. Oral health training/education contributes to systemic barriers in general health, wellbeing, and social inclusion of people with intellectual disability. Revision of disability-related programs in general dentistry courses and longitudinal impact research is needed.

Association between General Anesthesia and Root Canal Treatment Outcomes in Patients with Mental Disability: A Retrospective Cohort Study

In the population of individuals with a disability, mental illness patients can be uncooperative during dental treatment; thus, general anesthesia has been widely applied during dental procedures. This study aims to investigate the association between general anesthesia and the outcomes of root canal treatment in patients with disability. Teeth treatment records of patients with disability from Kaohsiung Medical University Hospital Research Database and electronic database from January 2005 to December 2018 were used in this retrospective cohort study. The authors conducted analysis comparing root canal treatment outcomes under general anesthesia and non-general anesthesia, indicated by endodontic re-treatment or post-treatment teeth extraction. Over the 9-year follow-up period, root canal treatment outcomes representing a cumulative survival rate of 87.68% and 74.51% in the general anesthesia group and non-general anesthesia group, respectively, were found. After adjustment for potential confounders, the teeth with general anesthesia showed a substantially and significantly reduced HR of root canal treatment failure at 0.24 (95% confidence interval, 0.12 to 0.49). Our study supported the notion that root canal treatment with general anesthesia may entail substantial reduction of treatment failure in patients with disability.

The use of general anaesthesia in special care dentistry: A clinical guideline from the British Society for Disability and Oral Health

Background

General anaesthesia (GA) may be required to support the care of those seen in Special Care Dentistry (SCD) services for various reasons, such as enabling extensive dental care for people with severe learning disabilities or severe dental phobia. Guidance is needed for teams delivering SCD using GA due to the potential risks, implications, and costs of using GA to deliver dental care.

Aim

To present evidence‐based recommendations, where possible, for teams involved in providing GA for dental care for adults within SCD services.

Methods

A multidisciplinary working group, supported by a formal literature search and stakeholder involvement, iteratively produced and refined the recommendations presented.

Results

There was little evidence to inform the guidelines. Recommendations are therefore based mainly on the working group's expert consensus opinion. Clinical guidelines are presented as a set of overarching principles followed by six key sections reflecting patients' pathways from referral to dental services through to their care during and after GA.

Conclusion

Guidelines are presented to support those providing GA to provide SCD. The need for comprehensive and person‐centered assessment and planning is emphasized.

Risk factors for repeated general anesthesia for dental treatment of adult patients with intellectual and/or physical disabilities

AIM

Repeated dental treatment of patients with intellectual and/or physical disabilities under general anesthesia (GA) often becomes necessary. This study aimed to identify potential risk factors predictive of repeated dental treatment under general anesthesia.

MATERIALS AND METHODS

Data of adult patients with intellectual and/or physical disabilities receiving dental treatment under GA within a time period of 7 years were analyzed (n = 203, mean age: 41.0 ± 14.9 years). All patients received comprehensive dental treatment (professional tooth cleaning, periodontal therapy, composite restorations, and/or extractions); patients receiving extractions only for emergency dental care were not included as a second intervention for restorative treatment often followed. Demographic, anamnestic, oral health, and treatment factors were obtained from dental records. Duration of intervals without dental treatment under GA was assessed using Kaplan-Meier statistics. Potential predictive factors were tested using univariate and multivariate cox regression analyses.

RESULTS

Thirty-five patients (17.2%) received a second and five patients (2.5%) a third dental treatment under GA during that period. In the univariate analysis, patients' age, living situation, and nutrition were associated with repeated GA. In the multivariate Cox regression analysis, only nutrition remained significant. Risk for repeated treatment increased if patients were tube-fed (HR: 7.54, p = 0.001) or received pureed/liquid food (HR: 4.32, p = 0.007) compared to nutrition without limitation.

CONCLUSION

In adult patients with intellectual and/or physical disabilities, nutrition affects the risk for repeated dental treatment under GA.

CLINICAL RELEVANCE

Identification of risk factors making repeated dental treatment under GA of patients with intellectual and/or physical disabilities more likely is essential to adjust preventive measures.

Impact of dental treatment on the oral health-related quality of life of children and adolescents with Autism Spectrum Disorder

AIM

To evaluate the impact of dental treatment on the oral health-related quality of life (OHRQoL) of children and adolescents with Autism Spectrum Disorder (ASD), through the perception of caregivers.

METHODS AND RESULTS

A prospective longitudinal study was conducted on 115 individuals with ASD, 6-14 years of age, recruited from the referral centers for special needs individuals at Teresina, Brazil. A clinical examination was carried out and the OHRQoL was measured using the Brazilian version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ) before and 3 months after dental treatment. Data were analyzed using Kolmogorov-Smirnov, Levene, Mann-Whitney, Kruskall-Wallis, and Wilcoxon tests, and the Poison regression with backward method (P < .05). Treatment needs of children with ASD consisted of dental restorations (81.7%), oral prophylaxis (66.1%), endodontic treatment (10.4%), and tooth extractions (10.4%). The baseline P-CPQ total score varied from 1 to 33 (mean score = 13.2 [±6.4]), and at 3 months after treatment it ranged from 0 to 10 (mean score 3.4 [±2.2] (P < .001). The effect magnitude varied between 0.55 and 0.56.

CONCLUSION

According to the perception of the caregivers, dental treatment had a positive impact on the OHRQoL of children and adolescents with ASD.

Predictors of oral health-related quality of life in 2-5 year-old children in the South of Iran

Background

Dental and oral diseases can have negative impacts on children’s quality of life. The aim of this study was to determine the predictors of oral health-related quality of life (OHRQoL) in the children aged 2–5 years old.

Materials and methods

A total number of 288 children aged between 2 and 5 years were selected and stratified by gender from three community health centres located in the city of Jahrom, south of Fars Province, Iran. The data collection tool was a researcher-made questionnaire whose validity and reliability was confirmed. The questionnaire was completed by parents/caregivers of the children. A multiple linear regression analysis was performed with quality of life as the dependent variable and, based on covariance structural analysis, evaluated the goodness of fit of the resulting structural equations models.

Results

The results showed that predisposing factors with a coefficient of 0.0457 (p = 0.015) and reinforcing factors ones with a coefficient of 0.2748 (p < 0.001) were correlated with the oral health behaviours. Moreover, there was a relationship between such behaviours with a coefficient of 0.1612 (p < 0.001) and oral health status and the given status with a coefficient − 0.9714 was correlated with OHRQoL (p < 0.001). Based on the covariance structural analysis, the resulting model was found to exhibit a reasonable goodness of fit.

Conclusion

The predictors of the children’s OHRQoL included predisposing, strengthening, oral health behaviours and oral health status. Therefore, planning to enhance supportive family behaviours and to boost predisposing factors including knowledge, attitudes, perceived benefits, and self-efficacy in parents and their oral health behaviours is recommended.

Failure on all fronts: Qualitative analysis of the oral health care experience in individuals with intellectual disability

AIM

To explore the oral health care experience of individuals with intellectual disability and their families.

METHODS

A qualitative approach utilising face-to-face semi-structured interviews with parents of individuals with intellectual disability. All interviews were audio recorded and transcribed verbatim, and Qualitative Framework Analysis was used to present the results.

RESULTS

Twenty-six parents of 26 individuals with intellectual disability were interviewed. The interviewees were 10 males and 16 females, and their average age was 46.4 ± 11.2 years (range 28-66). The average age of individuals with intellectual disability was 17.9 ± 9.2 years (range 6-48), and there were 11 (42.3%) males and 15 (57.7%) females. The interviewees reported that challenges to oral health care do occur on multiple levels: (a) home environment; (b) primary dental care; (c) secondary dental care facilities; (d) health and education policies and systems; and (e) societal views on individuals with intellectual disability.

CONCLUSION

Individuals with intellectual disability and their families are being failed at multiple levels of oral health care, leaving parents feeling frustrated, isolated, and sometimes helpless. Collaborative efforts are needed to train families to prevent oral health disease at home, establish better primary and secondary oral health care systems, and overcome wider cultural, social, and economic barriers.

A Comprehensive Approach Limiting Extractions under General Anesthesia Could Improve Oral Health

Access to dental treatment could be difficult for some patients due to dental phobia or anxiety, cognitive or sensorial disabilities, systemic disorders, or social difficulties. General anesthesia (GA) was often indicated for dental surgery, and there is almost no available data on adapted procedures and materials that can be applied during GA for maintaining functional teeth on the arches and limiting oral dysfunctions. This study evaluates changes in oral health-related quality of life and mastication in a cohort of uncooperative patients treated under GA according to a comprehensive and conservative dental treatment approach. Dental status, oral health-related quality of life, chewed bolus granulometry, kinematic parameters of mastication, and food refusals were evaluated one month preoperatively (T0), and then one month (T1) and six months post-operatively (T2). One hundred and two adult patients (mean age ± SD: 32.2 ± 9.9 years; range: 18–57.7) participated in the preoperative evaluation, 87 were treated under GA of which 36 participated in the evaluation at T1 and 15 were evaluated at T2. Preoperative and postoperative data comparisons demonstrated that oral rehabilitation under GA helped increase chewing activity and oral health-related quality of life. The conditions for providing dental treatment under GA could be arranged to limit dental extractions in uncooperative patients.

Oral health-related quality of life after dental treatment in patients with intellectual disability

BACKGROUND

The influence of dental treatment on oral health-related quality of life (OHRQOL) has rarely been evaluated in patients with intellectual disability (ID) through validated questionnaires. The aim of this study was to estimate the changes on OHRQOL in patients with ID after the implementation of an institutional dental treatment program under general anesthesia using the Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire (FHCOHRQOL-Q).

MATERIAL AND METHODS

A prospective longitudinal study was conducted on 85 patients (mean age=24.85 years) classified according to DSM-V whose parents/caregivers completed the FHC-OHRQOL-Q. We analyzed the changes in the questionnaire's overall score and its dimensions from pre-treatment to 12-months of follow-up, considering effect sizes and minimal important differences estimated by the standard measurement error. The impact of clinical and therapeutic factors was evaluated using univariate and multiple linear regression analysis (p<0.05).

RESULTS

Significant improvement of OHRQOL was found after dental treatment in oral symptoms (p0.001), daily life problems (p=0.018), parent's perceptions (p=0.013) and FHCOHRQOL-Q´s overall score (p=0.001). OHRQOL changes exhibited an intermediate magnitude (0.38-0.21) as estimated by effect sizes. Changes in oral symptoms showed positive correlation with DMFT index (r=0.375, p=0.002), decayed teeth (r=0.244, p=0.036), dental extractions (r=0.424, p<0.001) and number of treatments (r=0.255, p=0.019). The improvement was greater in patients with 4 decayed teeth (p=0.049) and undergoing 2 dental extractions (p=0.002). Multiple regression analysis demonstrated that dental extractions (p<0.001) and DMFT index (p=0.028) were significantly related to oral symptom improvement.

CONCLUSIONS

Dental treatment under general anesthesia showed a positive effect on the overall FHC-OHRQOL-Q score and most of its dimensions. At 12-months of follow-up, the improvement of oral symptoms was significantly associated with DMFT index, decayed teeth, dental extractions and number of treatments. In our clinical setting, the implementation of a dental treatment program enhanced the OHRQOL of patients with ID.

A special needs dentistry study of institutionalized individuals with intellectual disability in West Sumatra Indonesia

People with intellectual disability have a higher risk of oral health problems. This study assessed the clinical oral health status and behaviors and treatment needs of people living in an institution in Padang, West Sumatra, Indonesia. We quantified oral health status of 65 individuals with intellectual disability using Oral Hygiene Index Simplified (OHIs), Angle’s classification of malocclusion, Community Periodontal Index and Treatment Need (CPITN), and decay index and also recorded their brushing behavior. We found that males had significantly lower OHIs (p < 0.001), more malocclusion (p < 0.001), greater caries number (p < 0.001), greater CPITN (p = 0.001) and higher need of dental treatment (p < 0.01) than females. Additionally, we found that high caries number was associated with poor OHIS, malocclusion, periodontal disease, and dependent brushing behavior (p < 0.001). The findings of this study imply that there is a gap in appropriate oral health care in individuals with intellectual disability. There should be a greater focus on providing appropriate oral health education to people with intellectual disability, improving the health literacy and quality of care of caregivers, and providing more dentists with specialized training in special needs dentistry.

Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review

BACKGROUND

People with intellectual and developmental disability (IDD) have poor oral health and need support to maintain optimal oral health outcomes. Little is known about how, when and where to intervene for this population. Thus the aim of this review was to summarise the existing evidence surrounding improving oral health outcomes for people with IDD.

METHODS

A scoping literature review was conducted focusing on 'oral health' and 'intellectual disability'. Systematic searches of five electronic databases were conducted in line with the study aims and two authors independently examined all records for relevance, with consensus achieved by a third author.

RESULTS

A small number of approaches and interventions were identified to support people with IDD to independently maintain optimal oral hygiene. Identified studies highlighted that caregivers play a vital role in the provision of oral health support, emphasising the effectiveness of educational interventions for caregivers. However, there was uncertainty regarding the efficacy of specific tooth brushing interventions for people with IDD. In cases of more severe IDD and/or dental-related behavioural problems, dental treatment under general anaesthesia was often both a necessary and effective method of oral health care provision. The findings also identified outreach and exclusive oral health services as successful strategies for increasing the limited access of people with IDD to oral care services.

CONCLUSIONS

A uniform approach to supporting oral health for people with IDD is unlikely to succeed. A system-based approach is needed to address the diverse needs of the population of people with IDD, their caregivers and service context. Further high quality evidence is required to confirm these findings.