Researchers found poor brushing and flossing habits and high rates
of dental disease in a survey of disabled adults, and many
caretakers lacked confidence in their ability to help their charges
with daily dental care.
People with disabilities have more cavities and periodontal disease
than the general population, which can lead to loss of teeth and
infection. They also have cognitive, behavioral and physical
challenges that can make brushing and flossing difficult.
“It’s a critically important element to their quality of life,”
Paula Minihan, lead author of the study, told Reuters Health in an
More than 70 percent of the nation’s 4.9 million adults with
developmental disabilities live at home, while the rest live in
long-term care facilities, community-based settings or in
independent homes. So Minihan and colleagues at the Tufts University
schools of medicine and dental medicine looked at what kind of
at-home dental care this population is receiving.
They surveyed 808 caregivers, three quarters of them paid and about
15 percent family members, who brought adults with developmental
disabilities to appointments between September 2011 and May 2012 at
four Tufts Dental Facilities for Persons with Special Needs clinics.
The adults in the study, which is published in the October Journal
of the American Dental Association, were mostly men and between 40
and 59 years old.
Caregivers in this study reported that 79 percent of the adults with
disabilities brushed twice daily and only 22 percent flossed daily.
But fewer family than paid caregivers were confident with their
brushing and flossing help, as well as their ability to deal with
Both paid and family-member caregivers were less sure of their
flossing than brushing. Family members also had less formal training
than paid caregivers in the study.
The caregivers recognized general oral health problems, noting 28.5
percent of their wards had bad breath, 12.9 percent had trouble
chewing and 13.1 percent had dry mouth.
But they appeared to be missing many cases of periodontal disease,
reporting just 24.5 percent of their wards with swollen/bleeding
gums. A 2012 landmark study on the oral health problems of this
population (by two of the same researchers) found that 80 percent
had periodontal disease.
“The prevalence we think is an underestimate by far, actually,” said
Minihan, from the department of Public Health and Community Medicine
at Tufts University School of Medicine.
She said the caregivers didn’t seem to always recognize the telltale
signs of periodontal disease, such as bleeding after brushing, and
red, swollen or tender gums.
Dr. John Morgan, Minihan’s colleague and another study author, told
Reuters Health, that those problems, if untreated, could lead to
oral infections and “complicate” into future health problems.
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“With certain instruction, they could identify that tissue is more
inflamed and doesn’t look right,” said Morgan. “If they knew what
would be best recommended protocols for periodontal disease, they
might be a little more receptive to making sure the person gets
those types of services.”
Minihan said more federal money and training programs were needed.
“This is a sizeable population, it’s a population that government
has always assumed responsibility for, way back to colonial times,”
Minihan said. “Oral health is a very important dimension of overall
health and must be included in efforts to promote and protect the
health of this vulnerable population.”
Dr. Nancy Dougherty, who was not involved in the study, said she
hoped general care dentists would also take note.
“Education is the first step. You have to make people value oral
health and you have to give them the knowledge to perform it
adequately,” said Dougherty, president-elect of the Executive Board
of the Special Care Dentistry Association.
Dougherty, who is also clinical associate professor at New York
University College of Dentistry, said behavioral problems made the
task much harder.
“I don’t have an easy solution to it. It’s a chronic problem and the
behavioral constraints, medical issues that a lot of these
individuals have, the dietary issues, all contribute to the
problem,” Dougherty told Reuters Health.
Dr. Paul Glassman developed a training program for caregivers, with
DVDs on behavioral techniques, overcoming resistance, preventive
medication, brushing techniques and mouth rests.
“I recommend starting slowly, using lots of praise, gradually
encouraging the individual to allow you to do more or to do more for
themselves,” said Glassman, who directs the Pacific Center for
Special Care at the University of the Pacific, Arthur A. Dugoni
School of Dentistry in San Francisco, California.
Glassman also started a teledentistry program, where dental
hygienists help treat various undeserved populations - both disabled
and not - with virtual help from dentists.
Electric toothbrushes can also help people without the fine motor
skills to use manual ones, according to Valerie Lynch, director of
Nursing at Sertoma Centre, Inc., a non-profit for people with
developmental disabilities, in Alsip, Illinois.
Journal of the American Dental Association, online October 1, 2014.
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