Oral health of adults with intellectual disabilities: a systematic review

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.

Educational strategies for oral assistance for the disabled and their effects on dentistry students' formation: A systematic review

AIMS

This systematic review aimed to analyze the influence of educational strategies for oral health care for Persons with disabilities (PwDs) on the technical, ethical, and social training of undergraduate dental students.

METHODS AND RESULTS

An extensive search was performed in the following databases: Cochrane, Embase, PubMed, Scopus, Web of Science, LILACS/BBO and OpenGrey database. Observational, nonrandomized, and quantitative comparisons before and after some type of educational strategy in undergraduate dentistry was included. The risk of bias was assessed using the risk of bias in nonrandomized intervention studies (ROBINS-I) tool. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Nine were included and suggested that a significant improvement was observed in the technical training of undergraduate dental students although there was no consensus on the acquisition of ethical/social competences after the application of educational strategies. The included studies presented a moderate to serious risk of bias, and the certainty of evidence for both, technical and ethical/social evaluative constructs, as very low.

CONCLUSION

Although studies show that awareness regarding PwD significantly increases technical skills in dental students, the evidence is poor due to the high risk of bias and inconsistency observed in both the technical and ethical/social constructs; further studies on this topic are therefore essential. Prospero: (CRD42021288463).

Understanding oral health from the point of view of adults with disabilities and/or complex medical conditions: A scoping review

AIM

This study aimed to review the qualitative scientific literature investigating experience of the mouth and oral health amongst adults with disabilities and/or complex health conditions.

METHODS

A scoping review methodology was applied in accordance with the methodological framework of Arksey & O'Malley and the PRISMA-SCR checklist. Electronic searching was performed using the databases Pubmed, Embase, and PsychInfo.

RESULTS

Thirty articles were included in the final selection. The populations included in the selected studies were very varied in terms of health conditions and disabilities. Three major themes relating to the experience and understanding of the mouth, oral health, and function were highlighted in the review: the representation of oral health, the influence of oral health on the participant's life, and the influence of the socio-environmental context on oral health. No study explicitly described the functional, social, and psychological roles of the mouth in a comprehensive manner.

CONCLUSIONS

Perception of the mouth and oral health differs depending on the individual and their health condition. Oral health is described as dependent on the socio-environmental context, however, outside of the experience of dental care services, this context is not investigated in the literature. This scoping review demonstrated that exhaustive understanding of the dimensions of the mouth and oral health has not been explored in published research for this population.

Oral Health Promotion among Individuals with Intellectual Disabilities: A Systematic Review

People with disabilities experience inferior health and poor access to good quality health services as compared with the general population. Optimum oral health is associated with improvement in the quality of life in such patients. As oral diseases are largely preventable, good oral health education can have a positive impact on individuals with disabilities. So, the aim of the study was to review the effectiveness of oral health promotion among individuals with intellectual disabilities (IDs). Seven electronic databases were searched using keywords like intellectual disability/mental retardation/learning disability AND dental health education/health promotion. All records that were identified electronically from this search were subjected to a preliminary review to identify eligible papers. Identified studies were grouped into oral health promotion directed at individuals with IDs, and those aimed at caregivers of people with IDs. Interpretation of the outcomes included the effects on oral health knowledge, attitudes, and behaviors (either observed or self-reported). Eventually, 16 studies were included in the review including five studies that were randomized controlled trials, while the remaining 11 studies were pre-post single group oral health promotion studies. Critical appraisal of each study was conducted with the 21-item criteria by Kay and Locker (1997) to provide a numerical quantification and ranking of the evidence. Positive changes in the behaviors and attitudes were observed, while other studies reported a considerable improvement in the knowledge of caregivers for oral healthcare of individuals with IDs. However, such activities need to be done over a long period of time with constant monitoring.

A call for trauma-informed dental care for individuals with intellectual disabilities

People with intellectual disabilities are at increased risk of dental anxiety and poor oral health. In addition, people with intellectual disabilities are at increased risk of potentially traumatic experiences, such as violence and sexual abuse, and appear to be more vulnerable to developing trauma-related disorders following such experiences. While psychological trauma is associated with poor oral health and dental anxiety in the general population, the potential link between dental anxiety, poor oral health and psychological trauma is yet to be explored in people with intellectual disabilities. In this conceptual paper, we provide an overview of recent findings concerning the relationships between oral health and intellectual disabilities, psychological trauma and intellectual disabilities, as well as between psychological trauma and oral health, and discuss the relevance of these findings related to dental care for people with intellectual disabilities. We conclude that psychological trauma is likely to contribute to dental anxiety and poor oral health also in people with intellectual disabilities. Implications include an urgent need for research exploring how trauma affects oral health and experiences of dental care for people with intellectual disabilities, as well as the importance of individualized and trauma-informed dental care for these individuals.

Oral hygiene status in individuals with hearing difficulties: A systematic review and meta-analysis

OBJECTIVES

Most studies focusing on oral hygiene status in hearing impaired individuals are cross-sectional and focus on specific populations. A comprehensive literature search and evidence-based analysis was carried out to assess the oral hygiene status in this special group of population.

METHODS

Searches were conducted in four databases with no restriction on publication date. Cross-sectional and comparative cross-sectional studies assessing the oral hygiene status and periodontal status of hearing impaired individuals using standardized evaluation criteria were included. Study selection, data extraction, and assessment of bias were carried out by four reviewers and oral hygiene, plaque, and gingival status were assessed. The risk of bias assessment was carried out by New Castle Ottawa Quality Assessment Scale. 29 relevant publications that fulfilled the eligibility criteria were included in the systematic review whereas six studies each assessing oral hygiene and plaque status and five studies evaluating the gingival status were included in the Meta-analysis.

RESULTS

Eight thousand eight hundred and ninety (8890) potentially relevant references were identified in the systematic literature search. The overall analysis of the included studies revealed a mean oral hygiene index score of 1.60 (95% CI 0.91-2.30), Gingival Index scores 1.27 (95% CI 1.02-1.51), and Plaque Index score 0.99 (95% CI 0.75-2.30) among the hearing impaired individuals.

CONCLUSION

The present study reported fair oral hygiene, fair plaque status, and moderate gingivitis among the hearing impaired individuals.

Home-based oral health program for adults with intellectual disabilities: An intervention study

BACKGROUND

Poor oral health is common in adults with intellectual disabilities leading to risk of mouth and lung infections. Yet, little is known about the benefits of preventative oral health programs.

OBJECTIVE/HYPOTHESIS

This prospective longitudinal experimental mixed methods study evaluated the efficacy of an oral health program aimed at improving knowledge and behaviours in adults with intellectual disabilities living in supported housing.

METHODS

A 90-min training session was provided to residents and their staff at 12 houses (56 residents; 67 staff). Follow-up training sessions (at 1 week, 1,2,3 months) were tailored to the learning abilities, behavioural/physical challenges, and independence of residents. Outcome measures were collected pre, 1, 2 and 3 months (n = 36): dental exam, plaque index, gingival signs, tongue coating index and behavioural rating scale. At 3 months, support workers (n = 10) and residents (n = 19) were interviewed. Residents' interviews were supported by Talking Mats®.

RESULTS

Most residents (94%) required support for oral cares; with 63% fully dependant on their support workers. 24 (63%) residents had significantly improved plaque scores at 3 months (p < .001). Resident interviews were restricted by communication competency but supported interviews indicated positive responses to 3-sided toothbrush 91%, interdental brush/flosser 60%, and mouthwash 100%. Support worker interviews revealed perceived health and social benefits including fresher breath and benefits of routines.

CONCLUSIONS

Oral health programs for adults with intellectual disabilities living in supported housing are well received by staff and residents, leading to changes in oral care routines and measurable changes in oral health.

Management of auto-immune blistering disease in an older patient with severe intellectual disability

Management of chronic oral mucosal diseases might be challenging in older individuals with intellectual disability because of associated comorbidities, variable clinical presentations, and various barriers imposed by the intellectual disability. This report describes the presentation and management of pemphigus vulgaris in an older female with severe intellectual disability.

Brazilian special olympics athletes: Oral health problems

AIMS

The people with intellectual disabilities have been reported to be a vulnerable population in terms of oral health. This study was carried out to determine the oral health condition and treatment needs of Special Olympics athletes in Brazil.

METHODS

This study is a retrospective review of oral health data collected from athletes participating in Healthy Athletes Program Special Olympics in Brazil, between the years 2015 and 2019. About 1241 athletes from the Brazil Special Olympics program were screened in the cities of São Paulo, Jundiai and Belo Horizonte (located in southeastern Brazil) and Recife (in northeastern Brazil). At each of these events, volunteer dental professionals performed an oral health screening for each athlete, All oral health assessments were done visually; and extra lighting were available if needed. The examinations were performed with the aid of a wooden spatula of the tongue depressor type and under natural light. The following parameters were recorded: mouth pain, untreated tooth decay, missing teeth, gingival signs, urgency and mouth hygiene habits. Data was analyzed using the STATA 14.0 program. Frequency tables were used for descriptive analyses. Categorical variables were compared between the different years of the event using the Chi-Square or Fisher's Exact test. Continuous variables were compared between different event years using the Kruskal-Wallis test followed by Dunn's post-hoc analyses. Simple logistic regression was used to assess the effect of age on dental assessment results. For all tests, a p-value was considered significant when less than or equal to .05.

RESULTS

No statistically significant differences were observed in the frequencies of Mouth Pain and Missing Teeth over the years (p > .05). In relation to Untreated Tooth Decay, there is a higher frequency in the years 2016 and 2018 and a lower frequency in the year 2015 (p = .048). Regarding Gingival Signs of inflammation, there is a higher frequency in the years 2016 and 2018 and a lower frequency in the year 2017 (p < .001). In relation to cases of urgency (in need of treatment (Urgent treatment need, Non-Urgent or Maintenance)), there was a higher frequency (no urgency) in 2016 (p = .007). Finally, in relation to mouth hygiene habits, there is a higher frequency of participants with irregular habits in the years 2017 and 2019 (p < .001).

CONCLUSION

The dental condition of Brazilian athletes Special Olympycs Brazil reported in this study from 2015 to 2019 showed us that athletes have a high prevalence of dental diseases and these needs could contribute to health damage. The athletes have many unmet dental treatment needs and these needs are similar in different regions of the country and in the years reported.

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.

Periodontal disease in down syndrome: Predisposing factors and potential non-surgical therapeutic approaches

BACKGROUND

Periodontal diseases (PDs) have been documented to be significantly more prevalent and severe in patients with Down syndrome (DS). Different immunological and microbiological factors contributed to predisposing these patients to progressive and recurrent PDs.

AIM

The aim of this review was to investigate the altered immunological responses and oral microbiota disorders as well as focus on adjunctive non-surgical methods for the treatment of PDs and its applicability in patients with DS.

MATERIAL AND METHODS

A literature review was conducted addressing the following topics: (1) the altered immunological responses, (2) orofacial disorders related to DS patients, (3) oral microbiota changing, and (4) adjunctive non-surgical treatment and its efficacy in patients with DS.

RESULTS

Due to the early onset of PDs in children with DS, the need for prompt and effective treatment in these patients is essential.

DISCUSSION AND CONCLUSION

So, investigating underlying factors may open a new window to better understand the pathology of PDs in DS people and thus, find better strategies for treatment in such group. Although non-surgical treatments such as photodynamic therapy and probiotic consumption represented acceptable outcomes in different examined patients without DS, data about the application of these convenience and no need for local anesthesia methods in patients with DS is limited.

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.

A five-year cohort study on German dental students: Self-assessment in regard to previous experience and attitude toward patients with different types of disability

AIMS

In Germany, a curriculum in special care dentistry (SCD) is not mandatory. As a result, very little is known about dental students' attitudes toward interacting with people with disability (PwD). The study´s aim was to assess this among dental students at Witten/Herdecke University (UW/H).

MATERIAL AND METHODS

In the academic years 2016-2017 to 2020-2021, dental students in the 7th semester (UW/H) were asked to complete a self-assessment questionnaire. Prior to its start, the study had obtained a positive vote from the ethics committee of the UW/H (#174/2016).

RESULTS

Out of 199 students 166 persons on average 24.5 years old completed the questionnaire. Nearly all participants had already had previous experience with PwD in various domains of life prior to dental school (89.2%). Three-quarters indicated not having reservations about interacting with PwD. The proportion of persons without previous experience in interacting with a PwD was almost twice as high in the group with reservation (16.2%) as it was in the group without reservation (8.7%). Almost all surveyed students (92.8%) affirmed that they would like to learn more on the topic of "Professional Interaction with PwD."

CONCLUSION

Most of the respondents did not have reservations about interacting with PwD. Almost all the participants indicated a high level of interest in topics related to SCD. Also, the authors like to encourage the curriculum committees of dental schools at other universities to integrate courses on SCD, based on the iADH recommendations, into their dental curricula.

Effectiveness of sensory adaptive dental environments to reduce psychophysiology responses of dental anxiety and support positive behaviours in children and young adults with intellectual and developmental disabilities: a systematic review and meta-analyses

BACKGROUND

People with Intellectual and developmental disabilities (IDDs) experience oral health inequality due to myriad of risk factors and complex needs. Sensory processing difficulties, maladaptive behaviours and dental anxiety contribute to difficulties in receiving preventive and routine dental treatments. This study aimed to systematically review the evidence on the effectiveness of sensory adaptive dental environments (SADE) for children and young adults (up to the ages 24 years) with IDD to address cooperation and dental anxiety.

METHODS

This review was reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE (Ovid), The Cochrane Library, Embase, Google Scholar, Web of Science and OT Seeker were searched using appropriate terms to identify Randomised Control Trails (RCTs) that matched inclusion criteria. Screening was conducted by two reviewers after de-duplication based on titles and abstracts followed by full text retrieval. Quality of the included studies was assessed using Cochrane Risk of Bias (ROB)-2 for crossover trials and data extracted by two reviewers. The details of the interventions and effectiveness were compared and discussed narratively, and comparable outcomes were included to meta-analyses using R software.

RESULTS

A total of 622 articles were identified and five articles met eligibility for inclusion. Three studies used multi-sensory adaptations and one used single sensory adaptation of music. Narrative synthesis showed some evidence of SADE reducing magnitude and duration, although, questionable for reducing the number of maladaptive behaviours. Two studies demonstrated conflicting evidence of the effect of SADE on cooperation. Three studies demonstrated significant positive impact of SADE on psychophysiological outcomes. Despite an overall tendency to favour SADE, no statistically significant difference of maladaptive behaviours was found between SADE and regular dental environment (RDE) (Standardised mean change (SMC) = 0.51; 95% Confidence Interval (CI) -0.20 to 1.22; p = 0.161). SADE was superior to RDE (SMC -0.66; 95% CI -1.01 to -0.30; p =  < 0.001) in reducing psychophysiological responses of dental anxiety.

CONCLUSION

Current evidence suggests that adapting visual, tactile, and auditory aspects of the dental environment in a single or multi-sensory approach demonstrates small positive effects on psychophysiological responses and maladaptive behaviours of dental anxiety for people with IDD.

TRIAL REGISTRATION

The title of this review was registered with PROSPERO (CRD42022322083).

Keep My Teeth: An evaluation of multi-disciplinary training in mouth care for people with intellectual developmental disorders

AIM

To evaluate a modular didactic training intervention called Keep My Teeth designed by special care dentists, for a range of healthcare students to provide oral homecare for people with intellectual developmental disorders (PwIDD).

METHODS

To evaluate the intervention a one-group pre-test post-test pre-experimental research design was utilized. The intervention was delivered by virtual platforms or face-to-face, with a sub-sample of participants also receiving practical training. Healthcare students included Speech and Language Therapy (SLT), Registered Nurse Intellectual Disability (RNID), Dental Science (DS), Dental Nursing (DN), and Dental Hygiene (DH).

RESULTS

Sixty-three of the 147 trainees completed all surveys. A significant change in perspective on barriers was seen for most groups post-training, with an increase in confidence in delivering oral care to PwIDD across disciplines; 67% of DH/DN students who took part in the practical training felt that the didactic training was just as effective without the practical training, while 42% of the DS students felt that was true.

CONCLUSIONS

The training interventions provided seem to have increased the awareness of study participants in relation to barriers to care, and increased their self-efficacy towards, and intention to perform, oral homecare behaviors.

Qualitative Insights from A Novel Staff-Led Oral Health Champions Program Within a Residential Service For People With Intellectual and Developmental Disability

The oral health of people with intellectual and developmental disability is poorer than that of the general community. Any solution for people with intellectual and developmental disability living in residential services needs to include disability support workers (DSWs). Previous studies have used either didactic or train-the-trainer approaches to enhance DSW knowledge and skills. Taking a different approach, a novel program used DSWs as embedded oral health champions. This model provided educational opportunities for DSWs to learn about good oral health and then share with peers and provide benefits to people with intellectual and developmental disability that they support. Interviews with a sample of these champions were conducted and analysed using content analysis. Findings suggest that DSWs are capable of affecting change with the right type and depth of training, management and organisational support. A DSW-led champions model has merit, however requires ongoing expert support to help maintain and sustain benefits over time.

Powered or manual toothbrushing for people with physical or intellectual disabilities - A systematic review

AIMS

The aim of this systematic review is to compare the effectiveness of a powered (PTB) and a manual (MTB) toothbrush in the hands of people with physical (PD) or intellectual (ID) disabilities or in the hands of a caregiver on parameters of plaque and gingival inflammation.

METHODS

MEDLINE-PubMed, Cochrane-CENTRAL and EMBASE databases were searched from initiation up to February 2022. The inclusion criteria were clinical trials conducted in people with PDs or IDs and comparing the effect of toothbrushing with a PTB to an MTB on plaque removal and gingival health. Data were extracted from the eligible studies and analyzed in four subgroups based firstly on the person performing the toothbrushing, either the participants or a caregiver, not a dental professional, and secondly on the main disability of the participants, either PD or ID. Heterogeneity and risk of bias were assessed, data were extracted from the eligible studies, and a descriptive analysis was performed.

RESULTS

The search yielded 294 unique papers; after selection 16 eligible publications describing 25 comparisons were included: 12 self-brushing and 13 caregiver-brushing comparisons. Considerable clinical and methodological heterogeneity was present; together with limited numerical data, not allowing for a meta-analysis. The descriptive analysis showed, in the majority, no statistically significant difference between PTB and MTB. This applied to self-brushing and caregiver-brushing in both disability groups.

CONCLUSION

This review demonstrates with a low level of evidence that a PTB compared to an MTB in the hands of people with PD or ID or in the hands of their caregivers results in no clinical difference in effectiveness on parameters of plaque and gingival inflammation.

Analysis of Health Profile and Treatment Needs of Patients with Special Health Care Needs at a Malaysian Teaching Hospital: A 6-Year Observation

Aims and Objectives

Special care dentistry (SCD) provides oral health care to disabled individuals in an environmental, cultural or social setting that supports their oral health. This study aimed to analyze the profiles of patients managed at an SCD clinic in a teaching hospital based on their sociodemographic background, medical condition or disability, dental diagnosis and treatment provided.

Materials and Methods

This retrospective audit study included patients seen from the clinic's inception in January 2017 until June 2022, retrieved from the faculty's record management system. The pattern of patients seen was arranged on an Excel sheet and analyzed using SPSS. Quantitative data were analyzed via descriptive analysis (frequency) and chi-square test (P < 0.05).

Results

A 220% surge in the number of patients treated between January 2017 and June 2022, from two to 91 years old, with more male patients seen. Most patients had an intellectual disability (49.7%), followed by medical compromised (16.4%) and genetic conditions or syndromes (12.0%). 43% of had caries, which is more prevalent in women, and 31.6% had periodontal disease, with the majority being between the ages of 21 and 40. Periodontal treatment accounted for most of the dental treatment (76.1%). Even though only a small percentage of endodontic therapy was performed (2.4%), a significant association was found between the treatment, gender and age group of patients seen in the clinic.

Conclusion

Considering their health profile, oral diagnosis and therapy, this study demonstrated the varied sorts of patients encountered in an SCD specialist clinic. This useful information will be beneficial in the development of a comprehensive care dentistry center for this community.

Qualitative inquiry from multiple perspectives of barriers and facilitators of oral health care for adults with disabilities

AIMS

Adults with special health care needs (ASHCN) face significant disparities in access to oral health care and subsequent health outcomes, resulting from several etiologies. This study investigated perspectives of patients, caregivers, and providers to better understand care barriers and facilitators for ASHCN.

METHODS

We conducted 26 semi-structured interviews with a purposive sample from an academic clinic specializing in oral health care for ASHCN with disabilities [patients (N = 4), caregivers (N = 8), and providers (N = 14)], and thematically analyzed transcripts for care barriers and facilitators.

RESULTS

Three overarching themes that encompassed overlapping barriers and facilitators of oral health care for ASHCN emerged: relational aspects, provider training/experience, and infrastructure aspects. Themes include intersecting perceptions of factors that hinder or help oral health care and management of ASHCN.

CONCLUSIONS

Building relationships with patients, inherent empathetic provider characteristics, and accommodating clinical infrastructure are imperative to facilitate oral health care for ASHCN. The primary themes revealed in this study are facilitators to care when they are present, and barriers to care when they are absent. No individual theme stands alone as a single contributor to quality care, and the provision of care for ASHCN relies on coordination of providers, patients, caregivers, and the overarching infrastructure.

Use and risk of side effects of antiresorptive medication in people with intellectual disabilities

Background

Recent studies show that adults with intellectual disabilities (ID) have high incidence of major osteoporotic fracture, especially hip fracture. In those ≥ 50 years, women and men with ID have an approximately two and four times higher rate of hip fracture than women and men without ID. Increased awareness of osteoporotic fracture risk in ID may lead to wider use of antiresorptive drugs (bisphosphonates and denosumab) in this population. We aimed to compare, between people with and without ID, the incidence of 1) major side effects, namely medication related osteoporosis of the jaw (ONJ) and oesophagitis; 2) oral pathology, which can be a risk factor for ONJ.

Methods

Exploratory study investigating safety of first line osteoporosis medication within the population of a previous study comparing fracture incidence in people with and without ID in the GOLD database of the Clinical Practice Research Datalink 1998-2017.

Results

The percentage of people on antiresorptive drugs was identical in the ID and non ID group (1.4%). The number of individuals who developed ONJ and oesophagitis during the study was too low to allow an accurate estimate of incidence of the events and a comparison between the two groups. The incidence of any oral pathology was 119.31 vs 64.68/10000 person year in the ID vs non ID group.

Conclusions

Medication related ONJ and oesophagitis are rare in people with and without ID. There is no reason based on our findings to use antiresorptives differently in people with ID as in the rest of the population. However, the potential for side effects of antiresorptives will inherently increase with wider use of these drugs. Given the higher incidence of oral pathology in people with ID, which could put them at higher risk of ONJ, precautions should be taken to prevent this complication by attention to oral health.

Preliminary Results of an Interdisciplinary Behavioral Program to Improve Access to Preventative Dental Care for Adults With Intellectual and Developmental Disabilities

Adults with intellectual and developmental disabilities (AIDD) experience significant oral health disparities, partially due to perceived behavioral issues. This article describes the preliminary outcomes of a developing interdisciplinary (dental, medical, behavioral) program involving a behavioral intervention for AIDD previously receiving preventative dental care with sedation, general anesthesia, or protective stabilization (SAS). After a baseline assessment, a board-certified behavior analyst implemented increasingly complex behavioral interventions during simulated dental visits. Prior to COVID-19 pandemic-related restrictions, there were 32 active participants; 15 (46.9%) successfully completed a focused, real dental exam with simple behavioral interventions and 17 (53.1%) remain in treatment. These preliminary results suggest that many AIDD previously receiving SAS may participate in a preventative dental exam with minimal behavioral supports, if given the opportunity.

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

Due to the increase in the population with special needs and the significant difficulty in their dental management, it is essential to analyze the caries prevalence in this group of patients. The systematic review was conducted following the PRISMA statement. A search was performed on 9 May 2022 and updated on 5 June 2022, in three databases: Pubmed, Scielo, and Cochrane library. Studies involving the analysis of caries in permanent teeth in patients with special needs were included. A total of 1277 studies were analyzed and 21 studies were selected. Quality assessments were performed using an adapted version of the STROBE guidelines. Among the analyzed groups (intellectual disabilities, human immunodeficiency virus infection, schizophrenia, down syndrome, drug addicts, adult heart transplant, kidney disease, diabetic, autism, psychiatric patients, cerebral palsy, and hemophilia), the highest prevalence of caries was observed in patients with intellectual disability, without differences between genders. However, there is a need for more studies with standardized methods for caries diagnosis to further investigate the prevalence of caries in permanent teeth in patients with special needs.

Oral health experiences and perceptions of children with disabilities in the Kingdom of Saudi Arabia

BACKGROUND

The clinical focus on oral health means there is a scarcity of evidence from the perspectives of children with disabilities because of the continuing exclusion of their views from oral health research. This study takes a rights-based approach, aiming to give disabled children a voice by exploring their oral health perspectives and experiences. In order to do this, innovative and inclusive methods are needed.

AIM

The aim was to include the voices of children with disabilities by representing their perspectives and experiences of oral health.

DESIGN

An ethnographic study employed a purposive sample of 10 children between the ages of 9 and 15 years with a range of intellectual disabilities and physical impairments attending special centres in Riyadh, Saudi Arabia. All children in the sample were female. Pluralistic methods enabled the inclusion of children in the research. Thematic analysis was used to analyse the data.

RESULTS

The study describes different inclusive methods to enable children's voices on oral health. Main themes were children's knowledge, and their oral health practices and experiences of visiting dental clinics. Children also described the physical barriers they experienced and their positive and negative feelings about oral health.

CONCLUSIONS

The study highlights that including children with disabilities in oral health research is possible, but that researchers need to be creative and be able to work in tandem with children. One goal for dental research is to include all children as active participants, working with them as collaborators. This would help transform services and reduce children's oral health inequalities.

Impact of the special care dentistry education on Malaysian students' attitudes, self-efficacy and intention to treat people with learning disability

INTRODUCTION

Special Care Dentistry (SCD) education has been introduced in Malaysia, but there are limited number of studies about its impact to students. Thus, this study aimed to explore the level of students' readiness to treat people with learning disability (PWLD) based on their attitudes, self-efficacy and intention to treat.

METHODS

A questionnaire was developed based on the Dental Student Attitude to the Handicapped Scale, Scale of Attitudes to the Disabled Persons and Health Action Process Approach. The self-administered, validated questionnaire was tested for reliability (Cronbach's alpha = .71-.81), before being distributed to clinical dental students of both genders from two universities (University A, n = 176 and University B, n = 175). Quantitative data were analysed via t test and ANOVA (p < .05) using the SPSS software.

RESULTS

There was no significant difference in mean total attitude score between the universities, although dental students from University A, who mostly reported having received hands-on clinical experience in SCD and exposure to Disability Equality Training (DET), showed significantly higher individual mean attitude score for 5 (out of 24) attitudinal items. The mean total self-efficacy score and individual mean self-efficacy score for 1 (out of 5) self-efficacy items were also significantly higher amongst University A dental students. The intention to treat PWLD was not significantly influenced by university, gender or year of study.

CONCLUSION

Incorporation of SCD education in the undergraduate curriculum, with hands-on clinical experience and exposure to DET, is recommended to equip students to be efficient oral healthcare providers for PWLD.

The Effectiveness of Sensory Adaptive Dental Environments to Reduce Corresponding Negative Behaviours and Psychophysiology Responses in Children and Young People with Intellectual and Developmental Disabilities: A Protocol of a Systematic Review and Meta-Analysis

People with Intellectual and Developmental Disabilities (IDDs) are disproportionately vulnerable to poorer oral health due to their complex needs specifically sensory processing difficulties. This leads to increased maladaptive behaviours and psychophysiology responses of dental anxiety amplified by the overstimulating aspects of the dental environment. Although, there is a growing body of evidence to suggest that sensory adaptions are an effective strategy for individuals with IDDs in a wide range of settings, there is a lack of high-quality evidence detailing the effectiveness in a dental setting. The objective of this review is to assess the effectiveness of sensory adaptive dental environments (SADE) to reduce dental anxiety, corresponding negative behaviours and psychophysiology responses in children and young people with IDDs. The systematic review will include all Randomized Controlled Trials (RCTs) that investigate the effectiveness of SADE compared to control (no intervention), waitlist or usual care (regular dental environment) to reduce dental anxiety and the corresponding negative behaviours and psychophysiology responses in children and young people (upto the ages of 24 years) with IDDs. This review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases including MEDLINE (Ovid), The Cochrane Library, Embase, Google Scholar, Web of Science and OT Seeker will be searched using appropriate keywords. Additionally, citation searching will be conducted. Screening based on titles and abstracts will be done after de-duplication, followed by full-text reading for selection based on the inclusion criteria. Data extracted from the included studies will be tabulated and assessed for risk of bias. If applicable, a meta-analysis of the pooled data will be conducted. The review is registered with PROSPERO (CRD42022322083).

Oral Health Care of People with Down Syndrome in Germany

BACKGROUND

Due to a dearth of information on preventive and supportive oral care for people with Down Syndrome (PDS) in Germany, caregivers of PDS were surveyed on the topic.

METHODS

An anonymized questionnaire was sent to the 610 members of the German Down Syndrome Association. The study was approved by the ethics committee of Witten/Herdecke University (# 165/2017).

RESULTS

The parents/caregivers of 207 PDS responded. These PDS were between 1 and 55 years old (mean age 24.4 years) and included 111 males and 96 females. At their first dental appointment, 40.7% (n = 82) had been younger than three years. Although 78.3% (n = 162) tooth brushed twice daily, only 30.9% (n = 64) brushed for 2-3 min; 84.0% (n = 135) did not use other dental hygiene products apart from toothbrushes. Age-specific differences were found: Although only 30.8% (n = 12) of PDS < 18 years (n = 39) independently performed dental self-care; this was 67.3% (n = 113) for PDS ≥ 18 years (n = 168). A statistically significant (p < 0.001; Chi-Square-Test) difference in toothbrush preferences emerged: While PDS < 18 years mainly used manual toothbrushes, PDS ≥ 18 years preferred electric toothbrushes. In contrast to 72.6% of PDS ≥ 18 years, only 51.3% of PDS < 18 years accepted most types of toothpaste.

CONCLUSIONS

Age-dependent differences in tooth brushing behaviour became evident within the group of PDS in Germany. Hence, better age-specific, inter-professional dental prophylaxis concepts need to be developed and offered for all age groups of PDS. These concepts should include personalized check-up intervals and hands-on instruction in dental hygiene procedures by dental practitioners.

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.

Oral Hygiene Practices among Adults with Intellectual Disabilities-A Pilot Study

It is known that the oral health status of people with intellectual disabilities (IDs) is likely to be compromised as compared with the general population. Until recently, the trend of oral hygiene among the adult population with intellectual disabilities in Brunei Darussalam had yet to be studied. Thus, the aim of this study was to determine the oral hygiene practices, oral health knowledge and dental appointment patterns among the adult population with IDs in Brunei Darussalam. A cross-sectional study was conducted at different service providers in Brunei Darussalam for adults with IDs. An easy-to-read questionnaire was distributed to the participants. The responses of the questionnaire for IDs were analyzed. A total of 34 participants were recruited. It was found that all participants were practicing their daily oral hygiene routine. In terms of dental visits, more than half visit the dentist at least once a year. The majority of the participants agreed that visiting the dentist every 6 months was essential. This study showed that adults with IDs in Brunei Darussalam were aware of the importance of oral health and were maintaining their daily oral hygiene, although not with the ideal method. It is important for clinicians to not only educate the individuals with IDs but also their carer(s) when it comes to oral health knowledge, as carers play a key role in the oral health of the people under their care.

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).

Is examining children and adolescents with autism spectrum disorders a challenge?-Measurement of Stress Appraisal (SAM) in German dentists with key expertise in paediatric dentistry

OBJECTIVES

This questionnaire-based validation study investigated if the dental examination of children and adolescents with autism spectrum disorder is viewed by dentists with key expertise in paediatric dentistry as a challenge or a threat in terms of transactional stress theory. The Stress Appraisal Measure (SAM) was used for this purpose and it's feasibility and validity was examined as a first part of a multi-stage process for validation in dentistry with a sample of German dentists. It has hardly been investigated how the treatment of children and adolescents with a disorder from the autism spectrum is perceived by dentists.

METHODS

An online-based survey (39 questions) plus the SAM as an add-on as well as a preceding short story of imagination on the topic (appointment for a dental check-up in a special school) were developed. Via e-mail members of the German Society of Paediatric Dentistry (DGKiZ) received a link which enabled interested members to participate. The majority of the members of the DGKiZ have additional qualifications in the treatment of children and adolescents and further training in the area of special needs care in dentistry. The data analysis was based on the SAM and its subscales.

RESULTS

Out of the 1.725 members of DGKiZ 92 participants (11 male, 81 female) fully completed the questionnaire and the SAM. All in all the dentists rated their own psychological and physical stress in course of treating children and adolescents with a disorder from the autism spectrum between less and partly stressful. Although the structure of the SAM could not be fully mapped by means of a factor analysis, the different ratings "challenge" or "threat" could be comprehensibly evaluated after reading the story. The participants rated the situation from the story in general as challenging but not as threatening. Intercorrelations between the subscales of the SAM (e.g threat and centrality) of r = .56 showed that the scales are not clearly independent of one another. According to the transactional stress model, the SAM bases on, stress (perceived stressfulness) arises from appraisal processes (e.g. threat, controllable-by-self) that bring about a comparison between the requirements for the described situation and one's own possibilities in terms of a person-environment-fit. In the hierarchical regression a variance of R2 = .48 could be explained with all six subscales (appraisal processes) to predict perceived stressfulness of the SAM within a sample of dentists.

CONCLUSIONS

Due to the response rate the results of the SAM are not representative for all German dentists, but it offers an insight into topics of special needs dentistry in Germany that have not yet been examined. Overall, the feasibility and validity of the SAM in the context of mapping cognitive appraisal processes and stress could be confirmed. Taking into account the result that the treatment of children and adolescents with autism spectrum disorder is seen as a challenge, it is concluded that there is a need to improve the education of dental students and graduated dentists in Germany in the field of special needs dentistry.

Parental psychosocial factors, unmet dental needs and preventive dental care in children and adolescents with special health care needs: A stress process model

Background

Children and adolescents with special health care needs (SHCN) have higher unmet dental needs, but the potential mechanisms by which parental factors can influence dental care use have not been determined. Parenting a child with SHCN can present special demands that affect parents’ well-being and, in turn, their caregiving. Hence, the study's overall aim was to apply the stress process model to examine the role of parental psychosocial factors in the association between child SHCN and dental care. Specifically, the study tested hypotheses regarding how (a) children’s SHCN status is associated with child dental care (unmet dental needs and lack of preventive dental visits), both directly and indirectly via parental psychosocial factors (parenting stress, instrumental, and emotional social support) and (b) parental social support buffers the association between parenting stress and child dental care.

Methods

A secondary data analysis of the 2011–2012 US National Survey of Children’s Health was performed for 6- to 11-year-old children (n = 27,874) and 12- to 17-year-old adolescents (n = 31,328). Our age-stratified models estimated associations between child SHCN status and parental psychosocial factors with two child dental care outcomes: parent-reported unmet child dental needs and lack of preventive dental care.

Results

Parents of children with (vs without) SHCN reported higher unmet child dental needs, higher parenting stress, and lower social support (instrumental and emotional). Instrumental, but not emotional, parental support was associated with lower odds of their child unmet dental needs in both age groups. The association between parenting stress and child dental care outcomes was modified by parental social support.

Conclusion

Differences existed in child unmet dental needs based on SHCN status, even after adjusting for parental psychosocial factors. SHCN status was indirectly associated with unmet dental needs via parental instrumental support among adolescents, and parental instrumental support buffered the negative association between parenting stress and both child dental care outcomes. Hence, parental social support was an important determinant of child dental care and partially explained the dental care disparities in adolescents with SHCN.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02314-y.

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.

Health checks for adults with intellectual disability and association with survival rates: a linked electronic records matched cohort study in Wales, UK

OBJECTIVE

To examine if mortality rates are lower in people with intellectual disability who have had a health check compared with those who have not had health checks.

SETTING

General practice records of 26 954 people with an intellectual disability in Wales between 2005-2017, of which 7650 (28.4%) with a health check were matched 1:2 with those without a health check.

PRIMARY OUTCOME MEASURE

Office of National Statistics mortality data; a Cox regression was utilised to examine time to death adjusted for comorbidities and gender.

RESULTS

Patients who had a health check were stratified by those who (1) had a confirmed health check, that is, Read Code for a health check (n=7650 (28.4 %)) and (2) had no evidence of receiving a health check in their medical record. Patients with a health check were matched for age at time of health check with two people who did not have a health check. The health check was associated with improved survival for those with autism or Down's Syndrome (HR 0.58 (95% CI 0.37 to 0.91) and HR 0.76 (95% CI 0.64 to 0.91), respectively). There was no evidence of improved survival for those diagnosed with diabetes or cancer. The people who had a health check were more likely to be older, have epilepsy and less likely to have autism or Down's syndrome.

CONCLUSIONS

Health checks are likely to influence survival if started before a person is diagnosed with a chronic condition, especially for people with autism or Down's syndrome.

Remote Training of Dental Students and Professionals to Promote Cooperative Behavior in Patients with Intellectual and Developmental Disabilities

Many individuals diagnosed with intellectual and developmental disabilities (IDD) are uncooperative during routine dental exams, leading to poor oral health in this population. Few studies have evaluated methodologies for preparing dental students and professionals to work effectively with patients diagnosed with IDD. In this study, experimenters used remote behavioral skills training (BST) to train dental students and professionals how to implement a practical intervention that included tell-show-do, contingent praise, and noncontingent reinforcement. Results suggested that group training conducted via videoconferencing was effective for teaching six of seven participants to implement the intervention in the absence of post-training feedback. This approach appears useful for quickly and efficiently training current and future dental professionals to implement behavior techniques to promote patient compliance.

Teledentistry for Patient-centered Screening and Assessment

Teledentistry is a powerful tool for connecting oral health providers with patients who cannot easily visit a dental office, such as patients with special health care needs. Teledentistry is a skill that must be learned and this article will review key concepts that will allow providers to be better prepared to use it within their practices. These concepts include considerations for data collection and information that is necessary for a successful teledentistry visit. The authors also provide different examples of teledentistry in action, such as guided oral hygiene or dental screenings. Lastly, the authors review some unique challenges related to teledentistry and recommendations for overcoming those challenges.

Oral Health Advocacy for People with Special Health Care Needs

People with special health care needs experience barriers to oral health care resulting in oral health inequities. This article outlines avenues for advocacy to better serve these populations and reduce oral health inequities. Concepts of cultural humility can aid in advocacy efforts and include critical self-reflection, addressing power imbalances in health care relationships, and advocacy for change that influences the social determinants of health. Developing cultural humility is a lifelong process that requires ongoing learning and action in reducing health inequities and barriers to health care.

Gender Identity, Disability, and Unmet Healthcare Needs among Disabled People Living in the Community in the United States

Disabled adults and transgender people in the United States face multiple compounding and marginalizing forces that result in unmet healthcare needs. Yet, gender identity among disabled people has not been explored, especially beyond binary categories of gender. Using cross-sectional survey data, we explored the rates of disability types and the odds of unmet healthcare needs among transgender people with disabilities compared to cisgender people with disabilities. The rates of disability type were similar between transgender and cisgender participants with two significant differences. Fewer transgender participants identified physical or mobility disability as their main disability compared to cisgender participants (12.31%/8 vs. 27.68/581, p < 0.01), and more transgender participants selected developmental disability as their main disability compared to cisgender participants (13.85%/9 vs. 3.67%/77, p < 0.001). After adjusting for sociodemographic characteristics, the odds of disabled transgender participants reporting an unmet need were higher for every unmet need except for preventative services.

Factors Associated with Tooth Loss in General Population of Bialystok, Poland

Background: The aim of this study was to assess risk factors for tooth loss in the population of the city of Bialystok, in north-eastern Poland, taking into account the entire population and different age groups. The study included 1138 subjects divided into three subgroups: 20–44 years, 45–64 years, and 65–79 years. Participants were classified according to the number of teeth lost (0–8 vs. 9–28). Socio-economic variables, smoking history, and dental habits were collected through a questionnaire. Medical examinations provided data on the body mass index and the fasting blood glucose level. Data were statistically analysed using Mann-Whitney U, Student’s t, chi² tests, and binary logistic regression, p < 0.05. Results: For the general population, being female (OR 1.38, 1.07–1.79, p = 0.015), having secondary education (OR 4.18, Cl 2.97–5.87, p < 0.000), higher body mass index (OR 1.13, Cl 1.10–1.17, p < 0.000), higher fasting blood glucose level (OR 1.03 1.03–1.04, p < 0.000), being former smoker (OR 1.72, Cl 1.29–2.31, p < 0.000), ever smoker (OR 1.69, Cl 1.29–2.20, p < 0.000), current smoker (OR 1.62, Cl 1.15–2.29, p < 0.006), longer smoking period (OR 1.11, Cl 1.09–1.14, p < 0.000), last visit to the dentist over a year ago (OR 1.92, Cl 0.44–2.58, p < 0.000) and tooth brushing less than two times a day (OR 1.6, Cl 1.14–2.23, p < 0.006) were associated with losing more than 8 teeth. In the subgroup aged 20–44 years, only smoking duration was a risk factor for tooth loss (p = 0.02). For the middle-aged and oldest groups, education level (respectively p < 0.001, and p = 0.001), body mass index (respectively, p < 0.001, and p = 0.037), smoking status ever/former/current (respectively p < 0.001 and p = 0.002), smoking status never/ever (respectively p < 0.001 and p = 0.009), smoking duration (p < 0.001) were related to tooth loss. Additionally, in the elderly group, fasting blood glucose level (p = 0.044) and frequency of dental visits (p = 0.007) were related to tooth loss. We concluded that in the evaluated population, tooth loss was associated with socio-demographic, medical, and behavioural factors.

Ecological Study on the Oral Health of Romanian Intellectually Challenged Athletes

This study aimed to give an image of the oral health status and treatment needs of intellectually challenged athletes taking part in Special Olympics—Special Smiles (SO-SS) events organized in Romania during 2011–2019 and to find potential associations with socio-economic factors. An observational ecological retrospective study was conducted, and 1860 oral examinations were performed on participants aged 8 to 30 years in nine SS-SO events. Oral examination was performed under field conditions. Percentage of caries-free subjects, mean DMF-T index and its components (D = decayed; M = missing; F = filled; T = teeth), restoration index RI = [F/(F + D) × 100]%, and Plaque Index were calculated for each of the nine groups. Caries-free subjects ranged between 5.90% and 21.70%. DMF-T ranged from 4.27 to 7.71. Higher values for “F” component (range 0.66–1.69) and RI (range 13.02–27.74%) were found in events held in cities from regions with higher reported Gross Domestic Product. Sealants were present in 0 to 8.4% of the subjects. In areas with lower numbers of inhabitants per dentist, more sealants were found (p < 0.001). Romanian SO athletes exhibited relatively poor oral health, limited access to dental treatment, and low level of prevention. Targeted prevention and treatment programs adjusted to specific conditions in each geo-economic region are needed.

Factors determining the need for general anesthesia to deliver dental treatment for adults with intellectual and developmental disabilities

Aim:

To investigate factors determining the need for general anesthesia (GA) to deliver dental treatment for adult people with intellectual and developmental disabilities (IDD).

Methods:

This study involved a retrospective review of medical records of adult patients with IDD who received dental treatment under GA at Tabuk Specialist Dental Center, Saudi Arabia, between 2018 and 2020. Demographic characteristics and dental-related details, level of cooperation, and methods of delivering dental treatment were collected.

Results:

A total of 86 adult patients with IDD were included. The mean age of the study participants was 34.8 years (standard deviation [SD] 6.5), and the majority were males (n = 47, 54.7%). Eighteen patients had aphasia (20.9%), 16 had epilepsy (18.6%), and 10 had cerebral palsy (11.6%). Most dental treatments delivered were complex dental treatments (n = 39, 45.3%) followed by dental extraction (n = 25, 29.1%), and non-surgical periodontal therapy (n = 22, 25.5%). Females had higher odds of undergoing GA compared to males (Odds ratio (OR) =6.79, 95% Confidence intervals (CI): 1.62–28.41). Furthermore, patients who had aphasia had higher odds of undergoing GA compared to patients who had no medical conditions (OR = 14.03, 95% CI: 1.05–186.7).

Conclusion:

Being female or having aphasia are independent factors related to the need for GA to deliver dental treatment for Saudi adults with IDD.

The impact of COVID-19 on access to dental care for people with disabilities: a global survey during the COVID-19 first wave lockdown

BACKGROUND

It is unclear what immediate impact the COVID-19 pandemic has had on delivery of oral healthcare to people with disabilities worldwide.

AIM

To report the international impact of COVID-19 lockdown on oral healthcare provision for people with disabilities before, during and after the first lockdown (March to July 2020).

MATERIAL AND METHODS

Cross-sectional online self-administered survey of dentists who treat people with disabilities completed 10th to 31st of July 2020. Responses allowed comparison from before, during and immediately after the first wave lockdowns of the COVID-19 pandemic. Data were analysed using McNemar's test to compare reported practice before to during lockdown, and before to after lockdown.

RESULTS

Four-hundred-thirty-six respondents from across global regions reported a significant reduction from before to during and from before to after lockdown regarding: the proportion of dentists treating people with all types of disability (p <0.001) and the number of patients with disabilities seen per week (p<0.0001). The proportion reporting no availability of any pharmacological supports rose from 22% pre-lockdown to 61% during lockdown (p < 0.001) and a persistent 44% after lockdown (p < 0.001). An increase in teledentistry was observed.

CONCLUSIONS

During the first COVID-19 lockdown, there was a significant negative impact on the delivery of dental care to people with disabilities. Oral healthcare access was significantly restricted for people with disabilities with access to sedation and general anaesthesia particularly affected. There is now an increased need to ensure that no-one is left behind in new and existing services as they emerge post-pandemic.

Oral health issues of young adults with severe intellectual and developmental disabilities and caregiver burdens: a qualitative study

Background

Oral health maintenance is difficult to be achieved alone by patients with special needs and insufficient self-care skills. This study aims to investigate how the oral health issues of young adults with severe intellectual and developmental disabilities (IDD) affect caregiver burdens.

Methods

A qualitative research method was employed with semi-structured interviews conducted with 14 maternal caregivers of patients with severe IDD. Eleven young adults had neurofunctional disorders and three had autism spectrum disorders. All recorded data were transcribed verbatim and subjected to thematic analysis.

Results

Three themes emerged from the main agenda: predisposing oral dysfunction, home care challenges, and professional treatment barriers. The severity of the disabilities had an impact on oral disease risks that increased as patients aged. Participants indicated that, among the daily living activities of their patients, toothbrushing was a particular hardship due to their dysphagia and behavioral issues. Factors impacting on dental treatment indicated by caregivers included social, emotional, and financial circumstances.

Conclusions

Dysphagia and behavioral issues of adult patients with severe IDD contributed to caregiver burdens in the dental care of the patients. Caregiver burdens and barriers to treatment were mutual factors hindering adequate interventions in dealing with dental problems of the patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01896-3.

Dental health problems and treatment-seeking behavior among special need school students in Amhara region, Ethiopia

Background

Oral diseases are a public health concern with a significant impact on the quality of life of individuals. Children with special needs face significant challenges in carrying out oral hygiene due to their disability, and they are more prone to poor oral health and illnesses. This study assessed dental health problems and treatment-seeking behaviors of special needs school students in Amhara region, Ethiopia.

Methods

An institution-based cross-sectional study was conducted from November 2020 to April 2021, in eight special needs schools located in the Amhara Regional State, Ethiopia. A total of 443 randomly selected special needs students were included. Data were collected using a structured interview-administered questionnaire. Bivariable and multivariable logistic regression models were fitted to identify factors associated with oral health problems and treatment-seeking behavior. A p-value of less than 0.05 was used to declare statistical significance.

Results

The prevalence of self-reported dental health problems and treatment-seeking behaviors among special needs school students was 46.1% (95% CI: 41.4%, 50.7%) and 60.3% (95% CI: 53.4%, 66.8%), respectively. Place of residence, grade level, religious affiliation, years lived with disability, and knowledge of dental health-related risk behaviors were associated with dental health problems. Whereas, place of residence, being hearing impaired, and having prior information about dental health problems were associated with dental treatment-seeking behavior.

Conclusions

A significant number of special needs students reported dental problems and about 40% of them did not seek dental treatment. Oral hygiene practice and access to dental care services are important in the prevention of dental problems. Hence, oral hygiene promotion programs focusing on oral hygiene practice and dental treatment services are needed in special needs schools. It is also strongly suggested to incorporate oral health related information in health-related academic lessons to enhance optimum oral health among special needs students.

Safety of day surgery for patients with special needs

BACKGROUND

The objective of this study was to assess the safety and quality of day care management for dental surgery under general anaesthesia in a population with special needs and to compare the results with a control population.

METHODS

A retrospective observational cohort study was performed. The study population included all patients who had day care dental surgery under general anaesthesia for one year. The primary endpoint was the rate of unscheduled admission, which was defined as the unplanned need to maintain a hospital stay on the evening of the surgical procedure. Secondary endpoints included occurrence of complications during the perioperative period (either anaesthesia or surgery related) on the day of surgery (D0) and on day 1 and satisfaction of patients or their relatives.

RESULTS

Data from 138 patients (70 with special needs and 68 controls) were analysed. In both groups, patients were young (mean age 33 years ± 14 in each group). Special needs were mainly related to autism (34%), cerebral palsy (19%), intellectual disability (19%) and Down syndrome (10 %). Surgical procedures were more extensive in the control group. There was 1 unscheduled admission in the special needs group and 3 in the control group (RR 0.32, 95% CI [0.03; 3.04]). There was no difference in the rate of complications.

CONCLUSION

In our cohort, day care management for dental surgery under general anaesthesia is safe and effective for patients with special needs.

Dental decision-making under general anesthesia for patients with disabilities: A qualitative study

AIMS

This paper explores the variables which influence decision-making processes in dentists providing dental care for people with disabilities under general anesthesia (GA).

METHODS

Face-to-face semi-structured interviews were undertaken on a purposive sample. Audio recordings were transcribed and checked for accuracy. Using thematic content analysis methods open codes were developed inductively. Codes were analyzed further by three authors adopting a deductive approach, leading to final coding, sorting and themes, subtheme and framework development.

RESULTS

Three themes emerged. The first theme explored Shared Decision Making, or lack thereof, as it influenced clinical reasoning. The second (Systematic, Analytical) and third (Intuition, and heuristics) themes explored features of clinical judgment as considered under dual process theory. Dentists primarily used intuitive decision-making processes and heuristic styled processes (or cognitive mental frames) assisted in intuition to extract teeth, without engaging type 2 processes.

CONCLUSION

The dentists experience subtle modifiers to their decision-making that ultimately promote extraction of teeth under GA for people with disabilities. Bias training, simulation and post-hoc reflection are examples of recommendations which may be used to improve decision-making in this area.

Caries Experience of Adults with Intellectual Disability in the Western Part of Germany

Background: In Germany, there is limited evidence on the oral health of adults with intellectual disabilities (AwID). Methods: In 2017/18, dental examinations of AwID and a questionnaire survey of their legal guardians were carried out. The mean D3MFT values were calculated to describe the caries experience. The prevalence of AwID with at least one fissure sealant (FS) was determined and associations between caries experience and various sociodemographic factors (e.g., age, gender, living arrangements) were investigated. Results: The data of 132 AwID (mean age 35.2 years; range 18–69 years) could be included. For all AwIDs the mean D3MFT value was 9.5 (95% CI 8.1–11.0). The mean D3MFT value for the 35–44-year-olds was 10.9 (95% CI 8.4–13.4). All caries-free persons (n = 14) were younger than 45 years. Furthermore, the mean D3MFT value for AwID living with their parents was lower at a statistically significant level than that of AwID in independent living arrangements. Moreover, younger AwIDs (18–34-year-olds) with at least one FS had a statistically significantly lower mean D3MFT value compared to those without any FS (D3MFT: 3.0 vs. 6.7). Conclusions: The dental health of AwID has improved in Germany in recent years, but, on average, AwIDs still have more missing teeth than their peers in the general population. Oral epidemiological studies on AwID should include information on their living arrangements to assess potential associations between sociodemographic factors and oral health.

Effectiveness of silver diamine fluoride and glass ionomer cement combined with fluoride varnish in arresting dental caries among intellectually disabled individuals: A randomized controlled trial

AIM

To assess the clinical effectiveness of 38% silver diamine fluoride (SDF) in arresting dental caries when compared to combination of fluoride-containing glass ionomer cement (GIC) and fluoride varnish(FV) (5%) among intellectually disabled (ID) individuals.

METHODOLOGY

A randomized controlled trial was conducted among ID (n = 82) individuals, in permanent posterior teeth with Nyvad score 2 and 3 (active caries) of dental caries, randomly allocated to experimental arm (38% SDF) (n = 41) and control arm (GIC along with FV) (n = 41). The caries arrest rate and caries preventive fraction was observed at 6-months among both groups.

RESULTS

The caries arrest rate was 94.5% with SDF and 90.1% with GIC and FV (p = 0.405).The caries preventive fraction of SDF over GIC with FV was 45%, with hazard ratio (-0.588) at 6 months (p = 0.292). The binary logistic regression revealed that the Odds of arresting caries in SDF group is two times when compared to GIC group with p value = 0.218 which is not significant.

CONCLUSION

The present study concluded that the SDF is as clinically effective as combination of GIC and fluoride varnish in arresting caries. Further research and longer follow-up required for more conclusive results.

Association between motor proficiency and oral health in people with intellectual disabilities

BACKGROUND

People with intellectual disabilities (IDs) may be at increased risk of developing periodontal diseases and dental caries due to poor oral hygiene. Our aim was to investigate motor proficiency factors associated with presence of visible plaque and gingival bleeding in people with IDs. We were particularly interested in the level of dependence, manual coordination and fine manual control of people with ID, as well as the level of exhaustion of the primary caregiver.

METHODS

In this cross-sectional study, 299 people with ID were evaluated for oral hygiene using the simplified Visible Plaque Index and for gum inflammation using the Gingival Bleeding Index. The Bruininks-Oseretsky Motor Proficiency Test assessed motor proficiency through fine manual control (fine motor integration and fine motor precision) and manual coordination (manual dexterity and upper limb coordination). The level of dependence was assessed by the Katz dependency index, and the caregiver was tested for exhaustion using the fatigue severity scale. Prevalence ratios [and 95% confidence intervals (CI)] were calculated using crude and adjusted Poisson regression with robust variance.

RESULTS

The exhaustion of the caregiver was associated positively to visible plaque [prevalence ratio (PR) = 1.36; 95% CI 1.06-1.65]. For gingival bleeding, people with IDs that had better fine motor integration (PR = 0.49; 95% CI 0.33-0.75) and precision (PR = 0.50; 95% CI 0.26-0.94), as well as manual dexterity (PR = 0.62, 95% CI 0.49-0.77), presented better results.

CONCLUSION

Poor oral hygiene and gum inflammation were associated with motor proficiency of people with IDs and caregivers' exhaustion. Interventions to improve the oral health of people with IDs should take into account such conditions.

The Oral Status Survey Tool: construction, validity, reliability and feasibility among people with mild and moderate intellectual disabilities

BACKGROUND

A lack of robust data about the oral health of people with intellectual disabilities (IDs) contributes to health disparities. Appropriate research tools are therefore needed. This study reports the construction and evaluation of the Oral Status Survey Tool (OSST), designed to be administered with people with disabilities by non-dental personnel.

METHOD

Oral Status Survey Tool construction and evaluation was achieved adopting a non-clinical construction and content validation phase and a clinical phase to test concurrent validity, reliability and feasibility. Final refinements were also made.

RESULTS

The OSST conceptual framework covered oral function (tooth count, denture wear and opposing pairs of teeth) and oral disease/treatment need (soft tissue status, oral cleanliness, gum condition, carious teeth and oral pain). A systematic literature review identified no existing suitable indices. Candidate items were identified and validated by experts generating content validation ratios. This framework was modified later to expand the function construct. In the initial clinical phase, 49 out of 60 participants underwent examination with OSST and standard dental assessments. All had mild to moderate IDs. Mean age was 43 years (SD = 16), and mean number of teeth was 22.1 (SD = 8.6). Data collectors included two dentists and three non-dentists. Later, a further 17 adults (nine female and eight male) with mild/moderate IDs were included for refinement. At this stage, data collectors included two dentists and five non-dentists. Concurrent validity was established for tooth count [intraclass correlation coefficient = 0.99 (95% confidence interval, CI: 0.99-0.99)], carious teeth [Gwet's AC2 = 0.94 (95% CI: 0.89-0.99)] and gum condition [Gwet's AC1 = 0.84 (95% CI: 0.64-1)]. For all final OSST items, inter-rater reliability ranged from moderate to very good; median test-retest reliability ranged from moderate to good. Acceptability was demonstrated for data collectors and participants. Mean time to complete the OSST was 7 min.

CONCLUSIONS

The OSST is a novel tool that can record a range of clinical oral features including tooth count, denture wear, occluding pairs of teeth and functional dentition, oral cleanliness, gum condition, carious cavitation and oral pain that will be useful within health surveys of people with mild-moderate IDs and similarly neglected populations. The tool demonstrates promising attributes and acceptability. From this study, the OSST appears to be a robust tool that can be incorporated into general data collection for people with mild-moderate IDs and similar populations. A key feature is that it can be administered by well-trained non-dentists.

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.