Festering Cavities, Missing Teeth: Desperately Needed Dentistry For Disabled

(U.S. Department of Defense Current Photos/flickr)

(U.S. Department of Defense Current Photos/flickr)

Most people consider going to the dentist a minor inconvenience.

But for patients with an intellectual or physical disability, it can be a major ordeal.

Recently, there have been several reports on the significant obstacles people with all kinds of disabilities face in accessing the medical care they need.

People in wheelchairs, for instance, struggle with significant barriers trying to get appointments with medical specialists, according to a recent study by Dr. Tara Lagu, an internist at Baystate Medical Center in Springfield, Mass. And if you’re poor or mentally ill, dental care is even tougher to access, notes a 2011 report from the Institute of Medicine. Here, a dentist and Tufts University associate professor who treats people with disabilities offers his perspective on overcoming the towering barriers to oral health for the disabled.

By John Morgan, DDS
Guest Contributor

Dental care for people with disabilities can be particularly complex. It can also be life-changing.

Consider this:

An acquaintance of mine has a teenage daughter with a mild-to-moderate intellectual disability who attends a middle school in Boston. Because of badly aligned teeth and an open bite, she couldn’t close her mouth completely or use her tongue to speak effectively. On the recommendation of her daughter’s speech therapist and the encouragement of hygienists working with special needs children, the girl’s mother found a dental office that could manage her daughter’s dental care.

For three years, the daughter and her mom made three-hour trips by public transportation for monthly (sometimes more often) visits the dentist. But it was worth it. When the orthodontic treatment was completed, the girl’s speech was so improved that she was able to gain employment at a local fast food restaurant. She had gone from shy, awkward girl who hardly spoke to a girl who smiles and talks and enjoys being social.

On WBUR recently, Rachel Zimmerman’s piece, “Caring For Kevin: An Autistic Man, An Exceptional Doctor, A Life Renewed” – sheds needed light on the unique challenges of medical care for people with disabilities and their caregivers. Oral health is a fundamental part of overall health, and dental care for people with disabilities presents similar complexities. The challenges to providing dental care can be at least as complex, if not more so.

A recent study I conducted with my colleagues at Tufts University, published in The Journal of the American Dental Association documented the urgent need for dental care among people with intellectual and developmental disabilities. For instance, they are much more likely to have poor oral hygiene, periodontal disease, untreated tooth decay and missing teeth than the general population. Specifically, in our review of the electronic dental records of more than 4,700 people who received care, we found:

•10.9% of all patients did not have any teeth

•Over 80% of all patients had periodontitis

•32% of patients with teeth had untreated cavities

We found that nearly 25% of the patients had a limited ability to accept any dental intervention and required specialized resources, such as general anesthesia. Almost 40% of patients who were able to accept dental treatment required some form of behavioral assistance. Many dental offices are not equipped to provide care to patients with developmental or intellectual disabilities, in large part because of specialized training required to provide care for this population and because sedation and general anesthesia are not available to many dental providers.

Our study also found that, even with excellent care provided by dentists who are highly trained to treat people intellectual and developmental disabilities, there remains a high prevalence of disease, which signals the need for additional support and education among caregivers. The roles of the patient, caregiver and dental provider are all vital in developing preventive strategies to improve oral health.

Dr. John Morgan, DDS

Dr. John Morgan, DDS

My colleagues and I are now looking at ways to assist caregivers in promoting preventive oral health care at home, as well as how and when to access professional dental care. Our research team has just completed more than 800 surveys of paid and family caregivers and conducted focus groups of key stakeholders to determine the best ways to prevent oral disease and remove barriers to a healthy mouth for the I/DD adults.

Stay tuned. Particularly as our population ages and lives longer with more disabilities through advances in medicine or acquired though age and our caregiver resources dwindle, the findings of our research could shape how we manage oral diseases for people with disabilities and how we can maximize the roles of the dental professional, patient, and caregiver in promoting oral health for a vulnerable population.

John Morgan, DDS, is Associate Professor in the Department of Public Health and Community Service at Tufts University School of Dental Medicine. The Tufts Dental Facilities Serving People with Special Needs (TDF) is a network of Massachusetts dental clinics that provides oral health care to people with disabilities through a collaboration between Tufts University, the Massachusetts Department of Developmental Services and Department of Public Health.

(Posted by Rachel Zimmerman)

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