The oral health of people with intellectual disability participating in the UK Special Olympics

Oral health characteristics of patients living with intellectual disability at transition phase from pediatric dental service to adult dental service: A systematic review

AIM

A systematic review was conducted to evaluate the available literature to ascertain the oral health characteristics of patients living with intellectual disability when they transfer from pediatric dental service to adult dental service.

MATERIAL AND METHODS

The electronic search was performed between June 2020 and July 2020 using the following databases: MEDLINE and EMBASE. Cochrane database, gray literature, and Google Scholar were also searched. References of articles obtained from the electronic searches were scanned through. Journals and regulation agency websites were also hand searched. This systematic review used a defined search strategy keywords for all the electronic databases. The strength of evidence in these studies was evaluated using the British Medical Journal quality assessment tool.

RESULTS

The search process identified 45 eligible articles. Of these, 35 studies were excluded, and 10 observational studies were included.

CONCLUSION

It seems that a considerable percentage of patients living with intellectual disability in their transition phase, aged between 18 and 25 years, have a high prevalence of dental caries, gingivitis, and periodontal disease when compared to the general population.

The Top 50 Most Cited Articles on Special Olympics: A Bibliometric Analysis

The Special Olympics was established in 1968 to "provide year-round sports training and athletic competition in a variety of Olympic-type sports for children and adults with intellectual disabilities". It has gained recognition in the field of sports and healthcare of persons with intellectual disability, with a large number of dedicated researchers and institutions all over the world. However, there is an urgent need to analyze the progress and current status of this research field to identify knowledge gaps and develop this discipline. The aim of this study was to analyze the scientific production of the Special Olympics and report the bibliometric characteristics of the top 50 most cited Special Olympics publications. A systematic search was conducted on the Scopus database and bibliometric data were extracted and analyzed. The top 50 publications received 1632 citations. A total of 138 authors (63 female and 75 male) contributed to these publications. The two main areas of study were the physical health of Special Olympics athletes (n = 27) and the psycho-social health of athletes (n = 12).

Oral health needs of athletes with intellectual disability in Southern Europe: Greece, Italy and Spain

AIMS

The population with intellectual disabilities (ID) has been reported to be a vulnerable population in terms of oral health. The aims of this study were to evaluate the oral condition and treatment needs of Special Olympics (SO) athletes from Greece, Italy and Spain.

METHODS AND RESULTS

A cross-sectional study was performed with data collected in annual SO events held in Greece, Italy and Spain, between 2010 and 2012. The recorded parameters were the presence/absence of edentulism, untreated decay, filled or missing teeth, sealants, tooth injury and signs of gingival disease. Among the main findings, the prevalence of untreated decay was 57.0% in Greece, 48.8% in Italy and 41.7% of the Spanish athletes. The prevalence of signs of gingival disease was 61.1% in Greece, 60.6% in Italy and 66.1% in Spain. While the majority of the athletes were in need of dental treatment.

CONCLUSIONS

Oral disease is an unresolved problem among athletes with ID in these Mediterranean countries. Therefore efforts should be directed to meet their treatment needs and to prevent oral disease.

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.

Dental attendance, restoration and extractions in adults with intellectual disabilities compared with the general population: a record linkage study

BACKGROUND

Oral health may be poorer in adults with intellectual disabilities (IDs) who rely on carer support and medications with increased dental risks.

METHODS

Record linkage study of dental outcomes, and associations with anticholinergic (e.g. antipsychotics) and sugar-containing liquid medication, in adults with IDs compared with age-sex-neighbourhood deprivation-matched general population controls.

RESULTS

A total of 2933/4305 (68.1%) with IDs and 7761/12 915 (60.1%) without IDs attended dental care: odds ratio (OR) = 1.42 [1.32, 1.53]; 1359 (31.6%) with IDs versus 5233 (40.5%) without IDs had restorations: OR = 0.68 [0.63, 0.73]; and 567 (13.2%) with IDs versus 2048 (15.9%) without IDs had dental extractions: OR = 0.80 [0.73, 0.89]. Group differences for attendance were greatest in younger ages, and restoration/extractions differences were greatest in older ages. Adults with IDs were more likely prescribed with anticholinergics (2493 (57.9%) vs. 6235 (48.3%): OR = 1.49 [1.39, 1.59]) and sugar-containing liquids (1641 (38.1%) vs. 2315 (17.9%): OR = 2.89 [2.67, 3.12]).

CONCLUSION

Carers support dental appointments, but dentists may be less likely to restore teeth, possibly extracting multiple teeth at individual appointments instead.

Role of family caregivers regarding sexual and reproductive health for women and girls with intellectual disability: A scoping review

BACKGROUND

While people with intellectual disability (ID) face disparities relating to sexual and reproductive health (SRH) services, little is known about the role of family caregivers who assist women and girls with ID access SRH services. This scoping review examined the findings of studies to elucidate the role of family caregivers with regard to SRH for women and girls with ID.

METHOD

We used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to evaluate identified sources. We searched three electronic databases, six ID journals and reference lists in full-text articles. Inclusion criteria included (1) primary and secondary source research studies in peer-reviewed journals; (2) published in English; (3) all research methodologies (i.e. qualitative, quantitative, mixed methods and systematic reviews or commentaries); (4) published between 2000 and 2016; and (5) studies from any country.

RESULTS

The search yielded 2062 studies; 57 articles met inclusion criteria. Most studies employed purposive, convenience or criterion sampling. Participants included people with ID, family caregivers, paid caregivers and health-care professionals. Findings were summarised thematically: (1) menstruation and menopause; (2) vaccinations and preventive screenings; (3) supporting sexuality and healthy relationships; (4) coordinating with health-care providers and (5) contraception and sterilisation.

CONCLUSIONS

Findings from this scoping review underscore the need for more and better-quality research, including how family caregivers assist women and girls with ID access perinatal and preventive SRH services and sexual abuse education. Family caregivers, women and girls with ID and health-care providers need increased access to information about SRH.

Oral health of adults with intellectual disabilities: a systematic review

BACKGROUND

There have been several past reports that adults with intellectual disabilities experience poor oral health (tooth loss, periodontal health and untreated dental caries). Loss of a functional dentition has serious consequences, including problems with chewing, swallowing, nutrition, speech, temporomandibular joint osteoarthritis and pain and systemic health conditions. Poor oral health is largely preventable through proactive oral care support. In recent years, social care provision for adults has changed, with deinstitutionalisation and home-based personalised care now being the typical provision in high income countries. Hence, oral health inequalities might be reducing. However, there is limited recent evidence-synthesis on the topic. We aimed to address this.

METHOD

PROSPERO registration number: CRD42018089880. We conducted a preferred reporting items for systematic reviews and meta-analyses systematic review of publications since 2008. Four databases were searched with a clear search strategy, strict inclusion criteria for selection of papers, double scoring (two raters), systematic data extraction and quality appraisal of included papers.

RESULTS

A total of 33/3958 retrieved articles were included, of which 14 were drawn from dental service users and 10 from Special Olympic athletes, therefore not necessarily being representative of the wider population with intellectual disabilities. Despite this limitation, adults with intellectual disabilities were still shown to experience poor oral health. High levels of poor oral hygiene and gingivitis were found, with many also affected by periodontitis and untreated dental decay. There is clear unmet need relating to both periodontal (gum) and tooth health, leading to tooth loss.

CONCLUSIONS

Despite reports in the past of poor oral health amongst adults with intellectual disabilities, and despite it being preventable, there remains a high burden of poor oral health. This highlights the need to raise awareness, and for polices on effective daily oral care, and appropriate service provision. The importance of oral health and its possible negative sequelae needs to be elevated amongst carers and professionals.

Oral health status of the disabled compared with that of the non-disabled in Korea: A propensity score matching analysis

Background

There are many types of disabilities, and each type has a variety related to socioeconomic factors. Such factors affect to many health problems of the disabled. However, surveys of the oral health status of the disabled in Korea are rare.

Objective

The purpose of this study was to estimate oral health disparity through comparing oral health status of the disabled to the non-disabled, adjusted for the net effect of the disability on oral health status.

Methods

A cross-sectional study was conducted among the disabled in urban and suburban areas in Korea from June to September 2016. People with physical, mental, and multiple disabilities took part in this survey. The clinical examinations were carried out by trained dentists. Statistical analysis was performed to quantify the association between oral health and socioeconomic status after restricting the analysis using a propensity score matching method.

Results

The disabled had more DMFT, DT, and MT, fewer FT, and fewer teeth than the non-disabled based on entire groups (P<0.01). No difference in the ratio of periodontitis was observed. The subjects with mental disabilities (MD) scored 3.09 (95% CI, 1.07–8.97), and those with multiple disabilities scored 4.37 (95% CI, 1.16–16.37) for edentulous status. The MD had an odds ratio of 1.34 (95% CI, 1.03–1.74), and those with multiple disabilities had an odds ratio of 1.75 (95% CI, 1.11–2.76) for the DMFT index.

Conclusions

These results represent poor oral health status of the disabled compared to the non-disabled. Consequentially, we can verify that not only the existence of disability but also the type of disability has a decisive effect on oral health condition. This comparison is necessary to widen our approach to evaluate the actual status condition of the disabled.

Global oral health status of athletes with intellectual disabilities

Background

The aim of this study is to identify the oral health status and treatment needs of Special Olympics athletes with intellectual disabilities from 181 countries by the assessment of oral health parameters and differences between world regions.

Material and methods

Data were collected through interview and oral examinations within the Healthy Athletes Screening. These data were analysed with descriptive statistics of oral health parameters of athletes from Africa, Asia Pacific, East Asia, Europe/Eurasia, Latin America, Middle East North Africa (MENA) and North America. Mean differences of untreated visible dental caries, gingival signs and missing teeth were tested between regions by one-way ANOVA test and between age groups (8–11, 12–18, 19–39 and 40+) by chi-square tests for multiple comparisons with Hochberg-adjusted p value. The level of significance for all tests was set at a p value < 0.05.

Results

A total of 149,272 athletes with intellectual disabilities were screened. More than 80% of the athletes reported that they cleaned their mouths at least once a day. Athletes in Europe/Eurasia, Latin America, and MENA presented higher rates of signs of gingival disease than other regions. The prevalence of untreated dental caries was significantly higher in Latin America and the group of 8–11-year-olds from Latin America, Europe/Eurasia and Asia Pacific.

Conclusions

The data provided by this study demonstrate that continuous efforts for preventive and restorative oral health care are needed for the oral health of these athletes with ID especially in Latin America, MENA and Europe/Eurasia regions.

Prevalence of and factors associated with fewer than 20 remaining teeth in Taiwanese adults with disabilities: a community-based cross-sectional study

OBJECTIVES

To examine the prevalence of and the factors associated with a number of remaining teeth (NRT) <20 among adults with disabilities.

DESIGN

A community-based, cross-sectional descriptive study.

SETTING

This study was part of a health promotion programme designed for community-dwelling adults with disabilities.

PARTICIPANTS

A total of 549 adults with disabilities, aged 20-80 years, living in the community in Chiayi County in Taiwan.

OUTCOME MEASURES

Various parameters, including NRT, oral health behaviours (ie, oral hygiene, dietary habits and substance use), comorbidities, disability classification and capability for performing activities of daily living, were measured. Data were statistically analysed using descriptive statistics and multivariate logistic regression analysis.

RESULTS

The mean NRT was 18.1 (SD=10.9); 44.8% of participants had NRT <20 (including 13.7% edentulous participants). Most participants had poor oral hygiene: 83.4% reported seldom using dental floss, 78% did not undergo regular 6-monthly dental check-ups and 77.4% seldom brushed their teeth after meal. After adjusting for potentially confounding variables, the intellectual disability group had a significantly higher risk of an NRT <20 than the physical disability group (OR 2.30, 95% CI 1.30 to 4.08). Additionally, the rare use of dental floss and hypertension significantly increased the possibility of an NRT <20 (OR 1.73-2.12, 95% CI 1.15 to 3.71).

CONCLUSIONS

An NRT <20 and edentulism were highly prevalent among adults with disabilities, who displayed poor oral hygiene behaviours. Adults with intellectual disabilities had a greater likelihood of having an NRT <20 than did those with physical disability. In addition to unmodifiable factors, the poor use of dental floss was significantly associated with an NRT <20.

Oral Health Status of Institutionalized Individuals with Intellectual Disabilities in Lebanon

OBJECTIVES

To assess the dental status of institutionalized intellectually disabled individuals in Lebanon and the role of background and behavioural determinants.

MATERIAL AND METHODS

Oral health was recorded for 652 individuals (6, 12, 15 and 35 - 44 years old) using the decayed, missing and filled teeth/decayed and filled teeth (DMFT/dft) index. Data collected was statistically analysed with statistical significance set at P = 0.05.

RESULTS

Overall, mean DMFT index score was 5.86 (SD 6); composed of 3.64 (SD 4.05) decayed (D) teeth; 1.71 (SD 4.38) missing (M) teeth; 0.87 (SD 2.51) filled (F) teeth. DMFT was highest in adults (12.71 [SD 7.43]) and had a large component of missing (6.24 [SD 7.02]) and filled (3.31 [SD 4.56]) teeth. DMFT scores ranged between 3.5 (SD 4.44) at 6 years and 4.8 (SD 4.52) at 15 years and the decayed component was the main contributor. In multivariate analyses, governorate of residence was statistically significantly (P ≤ 0.040 and P ≤ 0.044) associated with D and DMFT, the degree of disability and caretaker educational level were statistically significantly (P = 0.009 and P = 0.008) associated with D, oral hygiene practices were statistically significantly (P ≤ 0.017; P < 0.001; P ≤ 0.017; P < 0.001) associated with D, M, F and DMFT and sugar consumption was statistically significantly (P ≤ 0.03 and P ≤ 0.019) associated with D and DMFT.

CONCLUSIONS

In Lebanon, preventive and treatment programs to improve the oral health status of institutionalized intellectually disabled subjects are needed.

Thriving in Youth with Autism Spectrum Disorder and Intellectual Disability

Most research on mental health in individuals with autism spectrum disorder (ASD) and intellectual disability (ID) has focused on deficits. We examined individual (i.e., sociocommunicative skills, adaptive behavior, functional cognitive skills) and contextual (i.e., home, school, and community participation) correlates of thriving in 330 youth with ID and ASD compared to youth with ID only, 11–22 years of age (M = 16.74, SD = 2.95). Youth with ASD and ID were reported to thrive less than peers with ID only. Group differences in sociocommunicative ability and school participation mediated the relationship between ASD and less thriving. Research is needed to further elucidate a developmental-contextual framework that can inform interventions to promote mental health and wellness in individuals with ASD and ID.

Treatment needs and impact of oral health screening of athletes with intellectual disability in Belgium

BACKGROUND

Special Olympics Special Smiles (SOSS) is an initiative created for oral health data collection and education in oral hygiene for athletes with an intellectual disability. The aims of this study were to evaluate treatment needs of participants of Special Olympics in Belgium 2013 in comparison with those from 2008 and to assess the impact of screening and referral within the SOSS in a group of athletes who participated in two consecutive events, 2012 and 2013.

METHODS

Data were collected following a standardized protocol developed by the U.S. Centres for Disease Control and Prevention, Division of Oral Health. Oral hygiene habits, treatment urgency and reports of oral pain, gingival signs, sealants, untreated caries, missing and filled teeth were recorded. Data analysis of data from 2013 consisted in descriptive statistics followed by the analysis of the data by univariable and multivariable logistic regression. This data was compared with data from 2008 published by Leroy et al., 2012 using Chi square tests. Data from athletes who participated in both Special Olympics events (2012 and 2013) were compared using Exact McNemar's test and Chi-square test for homogeneity of proportions. The level of significance for all tests was set at a p-value < 0.05.

RESULTS

A total of 627 athletes with intellectual disability participated to the SOSS program in 2013, while 132 athletes met the inclusion criteria of being a participant at both SO Belgium 2012 and 2013. The prevalence of gingival signs was 44.3 % in 2013, slightly higher than in 2008 (42.4 %). The burden of untreated decay affected 27.1 % of the population showing a net increase in comparison to 2008 (20.9 %). McNemar's test and Chi-square test revealed that there were no statistically significant differences in the proportions of all compared parameters between 2012 and 2013.

CONCLUSION

Special Olympics results from 2013 indicate a considerable unmet treatment need among Belgian Special Olympics Athletes, persistent from 2008 to 2013. Moreover, SO intervention had no impact in the oral health of athletes who participated in 2012 and 2013 events. Continuous efforts for preventive and restorative oral health care are needed for this population.

Oral cleanliness and gingival health among Special Olympics athletes in Europe and Eurasia

Background

Special Olympics athletes, as well as the general population of people with intellectual disabilities, are expected to have poorer gingival health. The aim of the study is to explore the prevalence of gingival signs of inflammation and its relationship to oral cleanliness and age among Special Olympics athletes from Europe and Eurasia.

Material and Methods

A retrospective longitudinal study was performed with data collected through standardized oral from 15.941 athletes from annual Special Olympics events held in 49 countries, from Europe and Eurasia between 2007 and 2012. The data was analysed descriptively, with One-Way ANOVA test and Chi-Square test.

Results

The level of significance was predetermined at a p value < 0.05. A total of 7,754 athletes presented with gingival signs (48.64%). There were no significant differences (p= 0,095) in mean gingival signs between age groups, however the association between mouth cleaning and age, was statistically significant.

Conclusions

The data suggests that there is a high prevalence of gingival signs among individuals with special needs; over 50% in more than 20 countries. Therefore, there is a serious need for education and preventive programs for the patients, their parents and caregivers.

Key words:Gingivitis, prevalence, hygiene, disability, Special Olympics.

Global initiative of the special olympics movement for people with intellectual disabilities

The mission of the Special Olympics is to provide year-round sports training and competition in a variety (33) of Olympic-type sports for children and adults with intellectual disabilities, giving them continuing opportunities to develop physical fitness, demonstrate courage, experience joy, and participate in sharing of gifts and friendship with their families, other athletes, and their communities. The Special Olympics movement often goes beyond the sports competition formula. During the last few years, the movement has developed many new global initiatives, which expand its former sports activities. They include:

Coaching excellence and the coaching model

Partnerships with international (regional) sports federations

Sports Resources Teams (SRT)

Extended quota for high level athletes

Athletes Leadership Program (ALPS)

Young Athletes Program

Youth volunteer initiatives

Unified Sports Program

Motor Activity Training Program

Healthy Athletes Program

These initiatives fulfill and expand the existing program, which was launched in 1968 and is the largest sports organization for people with disabilities worldwide, with very important new social, marketing, and developmental aspects of life, going far beyond activities met in other sports organizations.

Sexual and reproductive health care for women with intellectual disabilities: a primary care perspective

Adults with intellectual disabilities (ID) face multiple health disparities and challenges to accessing health care. Little is known about sexual health care of this population and about how to optimize women's reproductive health care for women with intellectual disabilities. Women with ID face important barriers to care, including lack of provider training and experience, hesitancy to broach the topic of sexual health, a lack of sexual knowledge and limited opportunities for sex education, disability-related barriers, higher prevalence of sexual abuse and assault, often underreported, lack of dialogue around this population's human right to consensual sexual expression, undertreatment of menstrual disorders, and legal and systemic barriers. We conducted a limited literature review related to six aspects of sexual health care of women with ID, including barriers to sexual health care, sex education, sexual abuse and consensual sexuality, contraception, screening for sexually transmitted infections and cervical cancer, and pregnancy and parenting. After providing background information about each topic, we suggest practice recommendations for primary care clinicians, using a rights-based framework.

Is There Anything to Smile about? A Review of Oral Care for Individuals with Intellectual and Developmental Disabilities

Individuals with intellectual and developmental disabilities (I/DD) are at risk for dental disease and face substantial challenges in accessing both routine and preventive dental services. In terms of unmet needs it ranks third, following residential services and employment opportunities for this particular group of people. Poorer oral health status negatively impacts overall health and one's quality of life. Factors contributing to this problem include significantly higher rates of dental caries, periodontal disease, poor oral hygiene, low expectations, fear of treatment, and lack of awareness among individuals and carers. Additional factors include problems accessing dental care or denial of services because of inadequate education and clinical training, inappropriate bias, or inadequate levels of compensation to providers. Strategies to improve service delivery include individualized and coordinated care services, education of individuals, carers, and providers, including both classroom and clinical experiences with special needs patients in dental programs.