Oral health‐care utilization in adults with disabilities in Belgium

Leroy R, Declerck D. Oral health‐care utilization in adults with disabilities in Belgium.
Eur J Oral Sci 2013; 121: 36–42. © 2012 Eur J Oral Sci Reports on oral health‐service utilization among individuals with disabilities are very sparse. Nevertheless, such data are a prerequisite for the provision of proper care and for the development of optimal reimbursement schemes and may ultimately lead to better access to care. The objective of the present study was to provide data on oral health‐care utilization in Belgian residents with disabilities and to compare these data with the utilization pattern of their peers without special needs. Data from the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents, were used. The database contained prospective data on oral and general health‐care utilization and socio‐demographic variables from 1,221 individuals with disabilities and from 131,877 individuals without disabilities, collected from 2002 to 2008. Overall, annual dental‐attendance rates were very low and in those who attended, professional debridements, a cornerstone in preventive oral health care, were infrequently recorded. In adults with disabilities, significantly fewer radiographs, restorations, and endodontic treatments were recorded, whereas significantly more emergency visits were charged. Further research is indicated to evaluate whether this outcome points to high unmet oral‐treatment needs.     

The oral health status of 4,732 adults with intellectual and developmental disabilities

BackgroundTwo reports by the U.S. surgeon general noted the disproportionate impact of oral disease on and lack of oral health information regarding people with disabilities.MethodsIn this retrospective study, the authors used clinical and demographic data (from April 1, 2009, through March 31, 2010) from electronic dental records of 4,732 adults with intellectual and developmental disabilities (IDDs) who were receiving dental care through a state-supported system of dental clinics. The authors used these data to investigate the oral health status of, and associated risk factors for, adults with IDD.ResultsThe prevalence of untreated caries in the study population was 32.2 percent, of periodontitis was 80.3 percent and of edentulism was 10.9 percent. The mean (standard deviation) numbers of decayed teeth; missing teeth; and decayed, missing and filled teeth were 1.0 (2.2), 6.7 (7.0) and 13.9 (7.7), respectively.ConclusionsManagement of oral health presents significant challenges in adults with IDD. Age, ability to cooperate with dental treatment and type of residence are important considerations in identifying preventive strategies.Clinical ImplicationsThe study population demonstrated a high burden of dental disease. Further research is required to identify effective interventions to improve oral health in adults with IDD.     

Behavior guidance techniques in Pediatric Dentistry: attitudes of parents of children with disabilities and without disabilities

This study compared the parental acceptance of pediatric behavior guidance techniques (BGT). Forty parents of children without disabilities (Group A) and another 40 parents of children with disabilities (Group B) were selected. Each BGT was explained by a single examiner and it was presented together with a photograph album. After that parents evaluated the acceptance in: totally unacceptable, somewhat acceptable, acceptable, and totally acceptable. Results indicated that in Group A, the BGT based on communicative guidance was accepted by most participants. In Group B, just one mother considered totally unacceptable the voice control method and other two, tell‐show‐do. For both groups, the general anesthesia was the less accepted BGT. There was statistically significant difference in acceptance for protective stabilization with a restrictive device in Group B. Children's parents with and without disabilities accepted behavioral guidance techniques, but basic techniques showed higher rates of acceptance than advanced techniques.     

Access to dental care among adults with physical and intellectual disabilities: residence factors

Background:  There is limited information about access and barriers to dental care among adults with disabilities.
Methods:  A mailed questionnaire survey of carers of 18–44-year-old South Australians with physical and intellectual disabilities (care recipients; n = 485) in family homes, community housing and institutions. Bivariate associations were tested using chi-square tests. Odds ratios (ORs) and 95 per cent confidence intervals (CI) were estimated for irregular dental visits (IDV).
Results:  Carers from family homes and community housing were more likely to report problems in obtaining dental care than those at institutions (p < 0.001). Lack of dentists with adequate skills in special needs dentistry (SND) was the most frequently reported problem for carers from family homes and community housing. IDV were less likely (p < 0.01) for care recipients in institutions and community housing than in family homes. After adjusting for care recipients' age, gender and disability, odds of IDV was lower in community housing (OR = 0.2, 95% CI = 0.1, 0.3) and in institutions (OR = 0.1, 95% CI = 0.04, 0.3) relative to family homes.
Conclusions:  Care recipients in institutions and community housing had better access to dental care than those at family homes. The shortage of dentists in SND and treatment costs needs to be addressed.     

Attitudes of dentists toward persons with intellectual disabilities in Jordanian hospitals

This study examined attitudes of dentists in Jordanian hospitals toward persons with intellectual disabilities. The study also assessed the effect of gender and years of experience of the dentists on their attitudes. Fifty‐four dentists were asked to rank their attitudes toward persons with intellectual disabilities on an attitude survey. The results revealed highly positive attitudes of dentists toward persons with intellectual disabilities at Jordanian hospitals. There was no significant effect of years of experiences or gender of the dentists on these attitudes. The positive attitudes of dentists in this study can be used to encourage the medical sector to focus on improvement of services.     

Factors influencing caries experience among adults with physical and intellectual disabilities

Abstract – Background: There is limited and inconsistent evidence on the influence of residential setting on caries experience of adults with physical and intellectual disabilities (PID), described here as care‐recipients. Objective: To examine caries experience and associated factors among adults with PID. Methods: Mailed questionnaire survey (2005–2006) of carers of adults with PID (18–44 years) in South Australia from family homes, community housing, and institutions, and oral examinations of care‐recipients recording decayed (D), missing (M) and filled (F) teeth (DMFT). Results: Carers completed questionnaires for 485 care‐recipients, 267 of whom were examined (completion rate = 55.1%). The prevalence of decay (D > 0) was 16.9% and 76.3% had caries experience (DMFT > 0). In unadjusted analysis, care‐recipients at institutions had a significantly higher mean DMFT than other settings. After adjusting for carer and care‐recipient characteristics, there was no difference in any of the DMFT components among residential settings. However, there were statistically significant associations (OR ± 95% CI excluding unity) between decayed teeth and moderate and high intake of sweet drinks and frequency of dental visits. Higher odds of missing teeth were associated with type of disability, general anaesthetic requirement for dental treatment and low and high carer‐contact. Higher odds of filled teeth were associated with age, no oral hygiene assistance (OHA) and high carer‐contact. Higher odds of caries experience were associated with age and no OHA. Conclusions: Residential setting was not associated with caries experience. Modifiable risk factors were diet, frequency of dental visits, no OHA and carer‐contact hours.     

Psychoprophylaxis for oral conscious sedation for dental care in Down syndrome adults with behavioral disorder

Down syndrome (DS) presents with prevalent diseases in the oral cavity and the need of constant dental care and follow‐up. The use of conscious sedation (CS) for dental care in adult DS with behavioral disorders is poorly documented. The aim of this study was to evaluate the effectiveness and safety of CS procedures with oral midazolam using previous psychoprophylaxis sessions in DS adult patients with behavioral disorders. Methods: Twenty‐nine DS adults with behavioral disorders. The patients were managed with psychoprophylaxis followed by oral CS using 15 or 30 mg midazolam. Vital parameters were monitored. The Houpt and Brietkopf and Buttner scales were used. Results: Patients under CS received an initial dose of 15 mg midazolam; however, 51.72% needed a 30 mg dose at the following sessions. Results showed that 71.4% treated with the 15 mg dose had Houpt scale overall behavior scores of 4 or 5, while 93.33% of those receiving 30 mg had scores of 5 or 6 (chi‐square = 15.95 p < .01). Conclusion: Psychoprophylaxis sessions followed by CS procedures using oral midazolam in adult DS with behavioral disorders were shown to be a useful strategy to perform routine dental treatment safely. Midazolam produces anterograde amnesia, and participants were more cooperative in the following visits.     

Relationship between duration of treatment and oral health in adults with intellectual and developmental disabilities

The purpose of this study was to evaluate how dental outcomes changed over time among subjects with intellectual and developmental disabilities (IDD) who were under treatment. This retrospective study included 107 subjects who were treated at a Tufts Dental Facilities clinic. Data from each subject were collected at three time points: initial visit, midpoint visit, and most recent visit. Generalized estimating equations were used to assess the relationship between time in treatment and several outcome variables (cooperation level, hygiene rating, presence of caries, periodontitis, dental pain, and infection). Statistically significant decreases in caries (p < .001) and increases in periodontitis (p = .002) were found over time. Associations between time and other outcome variables were not statistically significant. The prevalence of caries decreased and the prevalence of periodontitis increased over time among patients with IDDs receiving regular comprehensive dental care. Even among patients under routine maintenance, significant oral health problems remain.     

Professional education to meet the oral health needs of older adults and persons with disabilities

A well‐prepared dental workforce is critical to improving the oral health of special needs patients. This paper, originally presented at the National Coalition Consensus Conference: Oral Health of Vulnerable Older Adults and Persons with Disabilities, reviews and suggests opportunities to enhance the professional education of the dental workforce, including enhanced faculty training in gerontology, geriatrics and special patient care, and opportunities for improved curricula and team training both within the dental team and among the diverse group of health professional that often collaborate in the care of special needs patients. Other considerations include the creation of a specialty of Special Care Dentistry, and the effective use of dental team members in the care of special needs patients.     

Applied behavior analysis: behavior management of children with autism spectrum disorders in dental environments

BackgroundThere are a limited number of studies addressing behavior management techniques and procedural modifications that dentists can use to treat people with an autism spectrum disorder (ASD).MethodsThe authors conducted a search of the dental and behavioral analytic literature to identify management techniques that address problem behaviors exhibited by children with ASDs in dental and other health-related environments.ResultsApplied behavior analysis (ABA) is a science in which procedures are based on the principles of behavior through systematic experimentation. Clinicians have used ABA procedures successfully to modify socially significant behaviors of people with ASD. Basic behavior management techniques currently used in dentistry may not encourage people with cognitive and behavioral disabilities, such as ASD, to tolerate simple in-office dental procedures consistently. Instead, dental care providers often are required to use advanced behavior management techniques to complete simple in-office procedures such as prophylaxis, sealant placement and obtaining radiographs. ABA procedures can be integrated in the dental environment to manage problem behaviors often exhibited by children with an ASD.ConclusionsThe authors found no evidence-based procedural modifications that address the behavioral characteristics and problematic behaviors of children with an ASD in a dental environment. Further research in this area should be conducted.Clinical ImplicationsKnowledge and in-depth understanding of behavioral principles is essential when a dentist is concerned with modifying behaviors. Using ABA procedures can help dentists manage problem behaviors effectively and systematically when performing routine dental treatment. Being knowledgeable about each patient’s behavioral characteristics and the parents’ level of involvement is important in the successful integration of the procedures and reduction of in-office time.     

At-home oral care for adults with developmental disabilities: A survey of caregivers

BackgroundLittle is known about effective at-home oral care methods for people with developmental disabilities (DDs) who are unable to perform personal preventive practices themselves and rely on caregivers for assistance.MethodsA convenience sample of 808 caregivers (84.5 percent paid, 15.5 percent family members) who accompanied adults with DDs (20 years or older) to appointments at a specialized statewide dental care system completed computer-assisted personal interview surveys. The authors used these data to investigate caregivers' at-home oral care experiences and to explore differences between caregivers who were paid and those who were family members.ResultsCaregivers reported that a high proportion (85 percent) of dentate adults with DDs received assistance with tooth cleaning. They also reported a high prevalence of dental problems, and low adherence to brushing (79 percent) and flossing (22 percent) recommendations. More caregivers reported that they felt confident assisting with brushing than with flossing (85 percent versus 54 percent). Family members and paid caregivers differed with respect to confidence and training.ConclusionsAt-home oral care, particularly flossing, presents substantial challenges for adults with DDs. Solutions must be tailored to address the different experiences and distinct needs of the family members and paid caregivers who assist these adults.Practical ImplicationsCaregivers play an important role in providing at-home oral care, and they must be included in efforts to improve oral health outcomes for people with DDs.     

Preventive oral health care use and oral health status among US children: 2016 National Survey of Children’s Health

Background

Research has identified significant gaps in preventive oral health care among certain subpopulations of US children. The authors of this study sought to estimate children’s preventive oral health care use and oral health and investigate associations with child, family, and health care characteristics.