People with physical, intellectual, or developmental disabilities bring a lot of joy and wonder to the world and people around them. Unfortunately, many people with these disabilities have a hard time sitting through their dental experience successfully for a variety of reasons. As a result, they can end up with poor oral health that leads to all sorts of other problems and complications in their lives.
One study that analyzed dental data from over 4,700 adults with intellectual or developmental disabilities found that over 30% had untreated cavities, over 80% had problems with gum disease, and over 10% had tooth loss. While about one-third of the adults didn’t need any behavioral help to have a successful visit, the study found that about 40% of the patients required some form of behavioral support to make it through the dental appointment, and nearly a quarter couldn’t receive any dental assistance without significant help.
So why do people with physical, developmental, or intellectual disabilities have a higher risk of dental problems?
The reasons for the higher-than-average amount of dental problems are often complex and varied. There isn’t necessarily one cause per person, and unfortunately, there also isn’t a quick way to solve the problem.
Some people with physical, intellectual, or developmental disabilities struggle with oral hygiene and trips to the dentist because of physical factors. They may not be able to clean their own teeth, and so they rely on someone else to do it for them. Additionally, if they have feeding tubes or problems with their salivary glands, it can be difficult for their saliva to wash away the cavity-causing bacteria.
When people with disabilities are actually in the dentist’s chair, trouble keeping still, hyperactive gag reflexes, and tooth positioning can also cause problems. Some disabilities can come with crowded, missing, or malformed teeth, which can make it hard for both caregivers and dentists to clean effectively.
Dietary factors also play a role in the higher percentage of tooth decay and gum disease. If a person is on a pureed diet, for instance, the liquid food often sticks to teeth longer, which can break down enamel quicker. Foods that are high in sugar and carbs are often preferred, and that can also lead to more cavities.
One of the most significant cognitive factors that contributes to oral hygiene issues is oral aversions. Patients with physical, intellectual, or developmental disabilities may be prone to these aversions. As a result, they may resist cleaning and repair at the hands of a dentist as well as daily brushing and flossing from a caregiver. Additionally, some oral aversions can make it hard for people to get enough nutritional variety to get the vitamins necessary for strong teeth.
If people with disabilities are taking medicine regularly, this could adversely affect their dental health. Many liquid medicines are high in sugar to make them palatable, which can pose a problem for people who struggle with brushing. Additionally, some medicines have side effects like xerostomia (dry mouth), and some can even cause gingiva (gums) to grow too much altogether.
Access to Care
Access to care is probably the biggest hurdle that people with physical, intellectual, or developmental disabilities encounter as they try to get dental services. Many dentists simply don’t know how to help people with these disabilities, and a lot of the training they get comes simply through experience. Pediatric dentists usually have specialized training to help them manage all kinds of behavior, but it may be hard to find a general dentist who is knowledgeable enough to help effectively.
Just a few years ago, dentists could refuse treatment for people with physical, intellectual, or developmental disabilities, but recently, the American Dental Association changed its code of conduct to require dentists to provide a referral if they feel they cannot meet a patient’s needs. That change can be a double-edged sword, however, because specialty clinics may get overbooked, leading to long wait times and other delays.
If a person falls in the nearly 25% of patients that require significant help such as anesthesia, they could also run into the problem of insurance not paying for it. Having dental work at a hospital under anesthesia can get incredibly expensive, which can force caregivers to make the terrible choice between dental health and incurring medical debt.
What can be done?
Unfortunately, there isn’t a one-size-fits-all solution, but there are a few things that you can try if you are helping or advocating for someone with physical, intellectual, or developmental disabilities.
The first thing that you can do is start going to the dentist when the person is young. Some insurances recommend going to the dentist for the first time when a child is 3 years old, but for people with disabilities, advocates recommend a first visit by the first birthday. These first visits are quick and painless, but they establish very early on that a dentist is a helper. Going to the dentist as often as every two months starting after the first tooth appears can help normalize the dental experience and make it seem less scary.
Fluoride varnish is a preventative measure that can help people with physical, intellectual, or developmental disabilities maintain good oral health. It is painted onto the patient’s teeth as a way to protect the teeth against cavities when patients have a hard time sitting still during a dentist’s visit and maintaining good oral hygiene at home.
Patience is probably the most significant factor in a successful dental experience. People with disabilities may need to make extra visits to the dentist to get used to the office and how it smells, sounds, and looks. Caregivers may have to do a little more prep work by talking about the dentist, what he or she does, and what the patient can expect. There are plenty of books and videos that shine a positive and informative light on many aspects of going to the dentist.
Both for people with and without disabilities, sometimes enough is enough. Dentists and caregivers need to be adept at reading the signs that the patient is done and willing to cut the visit short if needed. It may be a little frustrating and inconvenient to pause a procedure and take it up again in a few days, but it will be better for the patient in the long run.
Sedation dentistry is always an option for people with and without disabilities. For more information on the different kinds of sedation dentistry and good candidates for this procedure, read this article.