Oral health-related quality of life of Portuguese adults with mild intellectual disabilities

Exploring Oral Health Related Quality of Life in Rett Syndrome Using Directed Content Analysis

No validated oral health-related quality of life (OHRQOL) instrument currently exists for those with severe intellectual and developmental disabilities and who communicate non-verbally. This qualitative study aimed to explore the domains that were important to the oral health-related quality of life in individuals with Rett syndrome (RTT). In 2021, following purposive sampling, recorded interviews were conducted with parents of individuals with a confirmed MECP2 mutation in the Australian RTT database (n = 31). Interview questions covered experiences of oral problems, the impacts of their daughter's oral health on other aspects of her life and on the lives of others, and on the family's quality of life. Directed content analysis was conducted. Seven domains were identified around the impacts of oral health on the child- discomfort, pain, eating, activities of daily living, emotional well-being, social well-being, and provision of services- affecting impacts on the patient. Five domains related to impacts on the family- emotions, activities, family function, conflict, and morale and self-efficacy to facilitate oral healthcare. The findings of this study pave the way for developing targeted OHRQOL measures for patients with RTT to understand and measure oral health impacts.

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.

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.

The Correlation Between Odontogenic Infection and Total Spectrum of Dental Caries with Oral Health Related Quality of Life in Children with Intellectual Disabilities

Objective

: Children with Intellectual Disabilities (ID) have a higher rate of untreated caries and often progress to caries with pulpal involvement or odontogenic infections. This can be assessed using the Caries Assessment Spectrum and Treatment (CAST) index and the Pulp Ulcer Fistula Abscess (PUFA) index. Dental problems often have an impact on quality of life, so Oral Health-Related Quality of Life (OHRQoL) assessment is needed for ID children.

Purpose

To identify and analyze the correlation between odontogenic infection, the total spectrum of caries, and OHRQoL in ID children.

Methods

: The subjects of the research were 70 ID children who attended Special Needs Schools (SNS) Type D of the Foundation for the Development of Disabled Children (FDDC). This research uses an analytical survey using questionnaires and interviews to assess OHRQoL. The sampling technique, namely Total Sampling, obtained 43 ID child subjects who met the inclusion criteria. The data were tested statistically using the Spearman Correlation non-parametric test and the t-test.

Results

: The average value of odontogenic infection in the population was 1.79, including in the poor category, and the total spectrum of dental caries was 51.16%, including severe morbidity. Multivariate analysis showed a significant correlation between odontogenic infection, total spectrum of caries, and OHRQoL; odontogenic infection with total dental caries spectrum was significantly associated with each p-value = 0.0000, while the correlation between OHRQoL and both odontogenic infection and total caries spectrum had p-values > 0.05, respectively, so it is considered not significant.

Conclusion

: Odontogenic infection in ID children is a poor category. The total spectrum of dental caries in ID children mostly includes severe morbidity. There is a correlation between odontogenic infections, the total spectrum of dental caries, and OHRQoL, as well as between odontogenic infections and the total spectrum of dental caries.

Factors Related to Regular Dental Check-Ups in Adults With Intellectual Disabilities in Japan

BACKGROUND

We investigated the factors associated with regular dental check-ups among adults with intellectual disabilities in Japan, with the aim of increasing the attendance rate of regular dental check-ups, which are important for maintaining the oral health of persons with intellectual disabilities.

METHODS

A questionnaire survey focused on oral health was conducted with 971 adults with intellectual disabilities in Japan. The survey included questions related to disability diagnosis, severity of intellectual disability, residence type, and several oral-health factors, including proxy-reported number of teeth, presence of a family dentist, frequency of regular dental check-ups, tooth-brushing habits, and availability of a dental hygienist at a facility. Logistic regression analysis was used to determine the association between regular dental check-ups (dependent variable) and independent variables. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

RESULTS

In a multivariate analysis, sex, diagnosis of disability, severity of intellectual disability, residence type, and the presence of a family dentist were significantly associated with regular dental check-ups. The ORs for nonregular dental check-ups were significantly higher for adults with Down syndrome, those with mild disability, and those living at home with family; the respective mean ORs (95% CIs) were 2.3 (1.2-4.4), 3.3 (1.3-8.4), and 1.8 (1.1-3.0). The absence of a family dentist had a particularly strong association with a lack of regular dental check-ups, with a mean OR (95% CI) of 15.0 (8.7-26.0).

CONCLUSIONS

Regular dental check-ups among adults with intellectual disabilities in Japan were associated with sex, diagnosis of disability, severity of disability, type of residence, and the presence of a family dentist.

Differences in Oral Health According to the Presence of Hearing Loss: Data from the 2021 Korea National Health and Nutrition Examination Survey

BACKGROUND

The prevalence of hearing loss is increasing annually and has a strong relationship with oral health. However, existing research on hearing loss is limited to children, making it necessary to expand the analysis to adults. Therefore, this study aims to identify differences in oral health-related factors according to hearing loss in adults over 40 years of age using the Korea National Health and Nutrition Examination Survey.

METHODS

This study analyzed survey data from 2021. The study participants were divided into 1738 individuals in the nonhearing loss group and 1384 in the hearing loss group. Complex sample chi-square and complex sample independent t-tests were performed to determine differences in the sociodemographic characteristics, systemic diseases, hearing loss-related factors, and oral health status between the two groups.

RESULTS

Compared to the nonhearing loss group, the hearing loss group was older and had lower income and education levels. In terms of oral health, the hearing loss group had fewer existing natural teeth, poorer prosthesis conditions, and a higher number of implants than the nonhearing loss group. The hearing loss group also experienced comparatively more problems with chewing and speaking (P < 0.05).

CONCLUSIONS

Individuals with hearing loss exhibited poorer oral health status than those without hearing loss. Therefore, dental professionals in clinical practice should develop their communication skills to interact effectively with patients with hearing loss and strive to improve their oral health.

Supporting the oral health of people with intellectual disability: A survey of disability staffs' knowledge, perceptions, disability service barriers, and training

BACKGROUND

People with intellectual disabilities experience poorer oral health outcomes, which can negatively impact their quality of life. Disability support staff who support peoplewith an intellectual disability have the potential to assist with oral hygiene. However, there is limited understanding of the current practices of disability support staff around oral health, particularly in Australia.

OBJECTIVE

To describe disability support staff knowledge about oral health, explore their practice perceptions when supporting people with intellectual disabilities around oral health and their experiences of oral health training.

METHODS

A national cross-sectional survey was undertaken with 156 disability support staff across Australia. Recruitment was via publicly available websites of disability services and social media.

RESULTS

Disability staff were generally knowledgeable about appropriate oral hygiene practices and risks to oral health. They were less knowledgeable about the links between poor oral health and chronic diseases (<40%) and the importance of oral care for individuals who are fed enterally. Most participants (>80%) felt oral health was an important part of their care and were interested in further oral health training. Staff in semi-assisted living felt they had more time for oral health tasks compared to home-based living and residential facilities (p = 0.007). Lack of oral health training programs was the main barrier cited (44%), with only a quarter receiving any training in this area.

CONCLUSIONS

Disability support staff are receptive to promoting oral health. More training around oral health and intellectual disability is needed for this workforce to support them in undertaking this role.

The oral health-related quality of life for individuals with fetal alcohol spectrum disorder - a cross-sectional study

BACKGROUND

The oral health status of an individual can dramatically influence quality of life. Most individuals in Canada report having good oral health, however, this is not true for individuals with developmental disabilities such as fetal alcohol spectrum disorder (FASD). The purpose of this study is to compare the oral health-related quality of life (OHRQoL) of individuals with FASD and the general population in Saskatoon, Saskatchewan. Additionally, it aims to suggest ways to improve the oral health status and OHRQoL of these individuals.

METHODS

For this cross-sectional study, the Oral Health Impact Profile-14 (OHIP-14) survey was used to assess the impact that oral health related problems can have on an individual's quality life. This study used a cross-sectional cohort study design with a survey methodology. The sample population compromised of 154 individuals with FASD along with a separate control group of 154 otherwise healthy adults.

RESULTS

The results of the study showed that most of the individuals in the FASD group experienced pain in the past month. In both groups, cost was most frequently cited as a barrier to accessing care. The majority of individuals in the control group experienced a low impact across all OHIP-14 domains except for physical disabilities. However, in the FASD group, most individuals experienced higher impact scores in some of the categories including functional limitation, psychological discomfort, psychological disability and handicap.

CONCLUSION

The findings clearly demonstrate that there is a discernible effect on an individual's quality of life if they have poor oral health. In conclusion, further research is required to determine the most effective methods to improve the OHRQoL of individuals with disabilities.

Correlation of dental pain and pain catastrophizing with oral health status among physically disabled

Background

Physical disability results in impaired mobility, leading to increased dependency on others and may also have a negative impact on ones general and oral health. Moreover, such individuals could be at a greater risk of being prone to chronic pain conditions. A person's ability to cope with pain is a consistent and one of the most important predictors of clinical outcome. Catastrophization is known to be a maladaptive coping behaviour that could negatively influence such outcomes.

Material and Methods

A cross-sectional study was conducted among 229 physically disabled individuals at Home for Disabled, Bansilalpet, Secunderabad. Extent of Physical disability was measured using Barthel index of Activities of Daily Living (ADL), type and severity of dental pain was assessed using the short form McGill Pain Questionnaire and catastrophizing using the Pain Catastrophizing Scale (PCS). Dentition status and periodontal status were assessed using the World Health Organization assessment form.

Results

Caries prevalence of the population was 39.7% with a mean DMFT score of 2.8±4.09. Pain catastrophizing showed positive significant (p<0.05) correlation with sensory pain(r=0.182), visual analog scale(r=0.168), pain severity(r=0.161) and DMFT (r=0.4). It had significant negative correlation with ADL and bleeding gums.

Conclusions

In this study it was apparent that irrespective of the dependency levels, dentition status had a significant effect on pain catastrophizing level of the individuals. Key words:Disability, Oral Health, Catastrophizing.

Reduced lip seal strength and missing teeth are associated with poorer masticatory performance in young adults with intellectual disabilities: a cross-sectional analytical study

BACKGROUND

Alterations in oral health have a negative impact on the quality of life of persons with intellectual disabilities (PwIDs). Chewing is a process that influences and determines optimal oral health. However, little is known about how intellectual disability (ID) affects masticatory performance. This study aimed to analyse the differences in masticatory performance between young adults with IDs, young adults without IDs and older adults without IDs.

METHODS

A cross-sectional analytical design was used. The masticatory performance was evaluated with a chewing gum validated instrument. In addition, the labial and tongue strength was assessed with the Iowa Oral Performance Instrument. We compared the masticatory performance between groups using one-way analysis of covariance. Body mass index, muscle mass, missing teeth, lip strength and tongue strength were included as separate covariates. A multivariate regression analysis was performed to identify which independent variables could explain masticatory performance in each group.

RESULTS

Thirty-two PwIDs, 31 young adults without IDs and 32 older adults without IDs were recruited. PwIDs showed poorer masticatory performance compared with older adults (mean difference: -3.06, 95% confidence interval: -3.87 to -2.26) and healthy controls (mean difference: -2.38, 95% confidence interval: -3.19 to -1.57). The analysis of covariance showed significant difference between groups in the masticatory performance (F = 47.35, P < 0.001, η_p ²  = 0.507). Missing teeth (P < 0.001), right lip strength (P = 0.025) and tongue strength (P = 0.007) as covariables showed a significant interaction with the model. In the PwID group, lip strength and lack of teeth explained 58% of the variance in masticatory performance (R²  = 0.580, standard error = 1.12, P < 0.001).

CONCLUSIONS

Persons with intellectual disabilities have a poorer masticatory performance than adults without IDs. Our findings indicate that the primary determinants of optimal masticatory function in PwIDs are the strength of the lip seal and the number of missing teeth.

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.

Impact of disability diagnosis on dental care use for adults in the United States

BACKGROUND

Approximately 25% of adults in the United States have a disability that limits function and independence. Oral health care represents the most unmet health care need. This population has been found to have decreased oral health outcomes compared with the general population.

METHODS

The authors used the 2018 adult National Health Interview Survey to assess the association between disability status and dental care use (dental visit within or > 2 years). Disability status was categorized as adults with an intellectual, acquired, or developmental disability (IADD) that limits function, other disability that limits function, or no disability, on the basis of diagnoses of birth defect, developmental diagnosis, intellectual disability, stroke, senility, depression, anxiety, or emotional problem, all causing problems with function.

RESULTS

Adults with an IADD with functional and independence-limiting disabilities experienced higher crude odds of going 2 years or more without a dental visit than adults without disabilities (odds ratio [OR], 2.29; 95% CI, 1.96 to 2.67). This association was part of a significant interaction and was stronger among those with IADDs who could afford oral health care (OR, 1.73; 95% CI, 1.47 to 2.14) than among those who could not afford oral health care (OR, 1.21; 95% CI, 0.88 to 1.67; P value of interaction <.01).

CONCLUSIONS

Adults with IADDs have decreased access to oral health care compared with adults with other disabilities or without disabilities. The inability to afford oral health care lessens the impact of disability status.

PRACTICAL IMPLICATIONS

Dentists can use this study to understand the implications of IADD diagnoses on dental care use and make efforts to facilitate care for these patients.

Enablers and barriers in dental attendance in Rett syndrome: an international observational study

AIMS

Intellectual and developmental disabilities are heterogeneous in aetiology and presentation, and one cannot make assumptions about the oral health barriers of those with Rett syndrome (RTT) based on findings from generic studies. This study investigated caregivers' perceptions regarding access to dental care for those with (RTT), and associations of dental treatments received by those with RTT with their caregivers' perceived value of oral health and perception of their own as well as their daughter's dental anxiety.

METHODS AND RESULTS

Retrospective observational data of a subset of individuals with confirmed MECP2 mutations in the InterRett database (n = 216) were used to explore caregiver-related factors and their relationships with longitudinal data on dental service utilisation, using negative binomial regression. The main reported barriers to dental care access for individuals with RTT were primarily dentist-related in nature, regardless of dental service history. Those with reported dental nonattendance were of older age. Increasing levels of caregiver-reported dental fear were associated with less frequent dental check-ups or for any appointments for affected individuals.

CONCLUSIONS

Dentist-related barriers and caregiver-reported anxiety may both adversely affect dental attendance for those with RTT. Future research should explore caregivers' beliefs and oral health literacy.

Empirically supported psychological treatments: The challenges of comorbid psychiatric and behavioral disorders in people with intellectual disability

This paper reviews the current state of knowledge on psychological interventions with empirical evidence of efficacy in treating common psychiatric and behavioral disorders in people with intellectual disability (ID) at all stages of their life. We begin with a brief presentation of what is meant by psychiatric and behavioral disorders in this population, along with an explanation of some of the factors that contribute to the increased psychosocial vulnerability of this group to present with these problems. We then conduct a review of empirically supported psychological therapies used to treat psychiatric and behavioral disorders in people with ID. The review is structured around the three generations of therapies: Applied behavior analysis (e.g., positive behavior support), cognitive behavioral therapies (e.g., mindfulness-based cognitive therapy), and contextual therapies (e.g., dialectical behavior therapy). We conclude with some recommendations for professional practice in the fields of ID and psychiatry.

Oral health care and service utilisation in individuals with Rett syndrome: an international cross-sectional study

BACKGROUND

There is a dearth of literature available on the comparative oral health status of those with Rett syndrome (RTT) despite diurnal bruxism being a supportive diagnostic criterion for the disorder. This study was designed to investigate the dental experiences of individuals with RTT in terms of perceived at-home and professional dental care.

METHODS

Using data in the InterRett database, provided by English-speaking families of individuals with a confirmed MECP2 genetic mutation, the study investigated relationships between dental problems, oral care, child factors including bruxism and use of gastrostomy, and socioeconomic indicators. The study also explored relationships between dental presentations and socioeconomic, child, and family-related factors.

RESULTS

Individuals with RTT exhibiting bruxism were more likely to access dental treatment. Those who had full oral feeding had a higher incidence rate of dental treatment than those with full tube feeding. A conservative (under) estimation of the overall dental caries progression rate revealed that this may be similar to that of the normal population.

CONCLUSIONS

Drivers for dental treatment in RTT include bruxism as well as dental caries. Those who have full oral feeding experience more dental treatment than those with full tube feeding. A higher maternal education level may confer a protective effect for oral health outcomes in those with RTT. Nevertheless, families generally tended to value the importance of oral health despite reported difficulties in day-to-day mouth care.

Concerns with oral health care services for adults with cognitive and intellectual disabilities

It is of interest to document data on oral health care services for adults with cognitive and intellectual disabilities. Hence, a study protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) with registration number: CRD42020150759. We used PubMed, Science Direct, LILACS and SCIELO to collect data from known literature using keywords containing MESH (Medical Subject Headings) terms. The risk of bias rating for the collected data was calculated using the Newcastle-Ottawa assessment Scale. The AHRQ (Agency for Healthcare, Research and Quality) was used for classifying the level of evidence in the collected data. Analysis of available data shows that there is a lack of dentists with adequate skills to treat people with disabilities resulting in high cost for dental treatment. Thus, we conclude that inconvenient location of dental clinic, lack of dentists willing to treat people with disabilities and attitude of dental staff towards people with learning disabilities were considered as barriers and challenges faced for dental health service utilization in this context.

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.

Gingival health and oral hygiene practices among high school children in Saudi Arabia

BACKGROUND

Gingivitis is a site-specific inflammatory condition initiated by dental biofilm accumulation. The accumulation of dental plaque on the gingival margin triggers inflammatory effects that can become chronic. In addition to its local effect, gingival inflammation has recently been suggested to have an impact on general health.

OBJECTIVE

Determine the prevalence of gingivitis and its relationship to oral hygiene practices in high school children in Saudi Arabia.

DESIGN

Cross-sectional.

SETTING

High schools from different regions in Saudi Arabia.

PATIENTS AND METHODS

Periodontal examinations were conducted on a randomly selected sample of high school children between the ages of 15 and 19 years. Gingival and plaque indices, probing depth, clinical attachment level, oral hygiene practices and sociodemographic characteristics were recorded. Data were analyzed using descriptive statistics, chi-square and the independent t test.

MAIN OUTCOME MEASURE

Prevalence of gingivitis as defined by mean gingival index.

SAMPLE SIZE

2435 high school students.

RESULTS

Twenty-one percent of the sample had slight gingivitis, 42.3% had moderate, and 1.8% had severe. Gender, toothbrushing, tongue brushing, plaque index, and the percentage of pocket depth (PD) ≥4 mm showed a significant relationship with the severity of gingivitis. Almost 39.3% of females had a healthy periodontal status when compared to males (30.7%). Thirty-five percent (35.5%) of students who brushed their teeth had a healthy periodontium compared to 26.9% who did not brush. The mean plaque index was significantly higher in students with severe gingivitis when compared to students with healthy periodontium (2.4 vs. 0.79, respectively).

CONCLUSION

Gingivitis prevalence was high compared with Western countries in a nationally representative sample of high school students in Saudi Arabia and was influenced by oral hygiene practices.

LIMITATIONS

The half-mouth study design may underestimate disease prevalence. Data on oral hygiene practices was self-reported and may thus have been affected by social desirability bias.

CONFLICT OF INTEREST

None.

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.

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.

Characterization of oral health in a Portuguese population with mild intellectual disability

AIMS

This study aims to characterize the hygiene habits, the self-perception of the need for treatment and the oral condition of a population with a disability.

METHODS AND RESULTS

This research is part of an observational, cross-sectional epidemiological study on oral health and quality of life of people with mild intellectual disabilities living in (or attending) institutions of the Central Region of Portugal that were affiliated with HUMANITAS (Portuguese Federation for Mental Disability) in 2016. A sociodemographic and oral health questionnaire, applied on the form of an interview to 240 individuals aged between 18 and 64 years, was used. Statistical analyses were performed using SPSS version 22.0. It was verified that 32.9% of the individuals had less than 20 teeth. Only 15% of all individuals used removable prosthesis. About 21% didn't do oral hygiene daily. Only 28.4% of the sample visited the dentist in the last 6 months. Note that 75.2% of the sample stated their need for dental treatment and less than half (37.4%) described their oral condition as good or superior.

CONCLUSION

Dental care among adults with intellectual disability is one of the most unattended health needs. Evidence suggests that inadequate oral health habits are more prevalent in the studied population than in the Portuguese population.

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

OBJECTIVES

This study aimed to assess self- and proxy-rated changes in the oral health-related quality of life (OHRQoL) in adult patients with intellectual disabilities after dental treatment in general anesthesia.

METHODS

The OHRQoL in 52 adult patients with intellectual and developmental disabilities was assessed prior to dental treatment in general anesthesia (t0), 2 to 3 (t1) and 12 weeks (t2) postoperatively. Therefore, patients and primary cargivers were surveyed using either the 5-item short form of the Oral Health Impact Profile translated into easy language (OHIP-G5-easy, self-rating, n = 27) or the 14-item short form of the Oral Health Impact Profile (OHIP-G14, proxy-rating, n = 51), respectively. OHIP-G5-easy and OHIP-G14 summary scores were statistically analyzed with non-parametric mixed effects models and spearman correlation (p < 0.05). Additionally, the effect of demographic, anamnestic, oral health and treatment factors on QHRQoL or on changes of OHRQoL were analyzed using univariate and multivariate ordinal logistic regressions (p < 0.05).

RESULTS

Self- (t0: 5.8 ± 4.6, t1: 4.3 ± 5.9, t2: 2.0 ± 3.9) and proxy-ratings (t0: 18.8 ± 11.6, t1: 10.1 ± 11.2, t2: 2.7 ± 5.3) revealed a significant improvement of OHRQoL after dental treatment in general anesthesia. Data showed a moderate correlation (p < 0.001, r_Sp = 0.43). OHRQoL at baseline was affected by the etiology of cognitive impairment and by the periodontal status (OHIP-G14). Improvement of OHRQoL was associated with the etiology of cognitive impairment (OHIP-G14) and the extent of dental treatment (OHIP-G5-easy).

CONCLUSION

Self- and proxy-ratings revealed a significant improvement of OHRQoL in patients with intellectual disabilities after dental treatment in general anesthesia.

CLINICAL RELEVANCE

Assessment of OHRQoL promotes patient-centred care of adults with intellectual disabilities.

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.

Effects of dropping out of dental treatment on the oral health-related quality of life among middle-aged subjects using web research

Objective

The oral health-related quality of life has recently been reported to be a rather important aspect of general health. Dropping out of dental treatment has long been a problem plaguing oral health. However, the relationship between dropout for dental treatment and the oral health-related quality of life is unclear. The purpose of this study was to investigate the oral health-related quality of life in patients who dropped out of dental treatment.

Materials and methods

We conducted a questionnaire-based investigation using web research. The participants were allocated to two groups (dropout group and maintenance group). The dropout group included participants who had stopped visiting their dental office in the past and had not revisited in the last decade. The maintenance group included patients who visited their dental office continually for a regular checkup. We analyzed the General Oral Health Assessment Index (GOHAI) as an indicator of the oral health-related quality of life and assessed the background characteristics of the subjects.

Results

We analyzed 225 people in the dropout group and 236 people in the maintenance group. The score of GOHAI was significantly different between the 2 groups (dropout group:47.07, maintenance:48.97, p = 0.035), and the more frequent dropouts brought the less GOHAI score (p = 0.012). Furthermore, the results of a logistic regression analysis showed that dropping out of dental treatment was significantly associated with the GOHAI score (p = 0.002).

Conclusion

A relationship was demonstrated between the oral health-related quality of life and dental treatment dropout. Furthermore, dental treatment dropout seemed to have negative effects on the oral health-related quality of life.