The health status and needs of individuals with mental retardation

Background
Two 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.

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

Over the past 20 years, there has been an increased emphasis on health promotion, including prevention activities related to vision and oral health, for the general population, but not for individuals with intellectual disability (ID). This review explores what is known about the prevalence of vision problems and oral health conditions among individuals with ID, presents a rationale for the increased prevalence of these conditions in the context of service utilization, and examines the limitations of the available research. Available data reveal a wide range of prevalence estimates for vision problems and oral health conditions, but all suggest that these conditions are more prevalent among individuals with ID compared with the general population, and disparities exist in the receipt of preventive and early treatment for these conditions for individuals with ID. Recommendations for health improvement in these areas include better health planning and monitoring through standardized population-based data collection and reporting and increased emphasis on health promotion activities and early treatment in the healthcare system.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1002/mrdd.20096

Vision and oral health needs of individuals with intellectual disability.

Background People with mental retardation have limited access to oral health care. Dental school administrators reported minimal training in U.S. dental schools for these patients. As a result, students and practitioners may not be prepared to provide needed services. Methods The authors surveyed 295 third- and fourth-year students at five dental schools about their didactic and clinical preparation for, attitudes toward and comfort levels with treating people with mental retardation, as well as whether their experiences affect their willingness to treat people with mental retardation. The authors analyzed data using previously developed statistical software. Results A little more than 68 percent of respondents reported receiving five hours or less of instruction devoted to how to care for people with mental retardation, and 50.8 percent reported having no clinical training in this area. Nearly 60 percent reported that they had little to no confidence in providing care, while 74.6 percent reported they had little to no preparation in providing care. Students who had experience working with people with mental retardation attributed greater capabilities to such people than did students who had no such experience. Conclusions Many U.S. dental students are prepared inadequately to provide services for people with mental retardation. Spending time with these patients provides a more positive understanding of the capabilities of these people. Practice Implications Increasing numbers of people with mental retardation no longer live in institutions, and they are dependent on dentists in private practice for care. Increased dental school training and continuing education programs are needed to meet this need.

Dental students' experiences with and attitudes toward people with mental retardation

Background The U.S. surgeon general's report, Oral Health in America, stated that people living below the poverty level and those with mental retardation and/or physical disabilities have poorer oral health than the general population. Methods The calibrated examiners (volunteer dentists and dental students) assessed the oral health status of intellectually disabled people with or without a physical disability via screening examinations provided to 12,099 Special Olympics athletes at 53 sites, including 1,891 people from seven states in the southeastern United States. Measurements of gingivitis, untreated decay, missing molars, sealants, restorations and treatment urgency were recorded. Results The authors found that athletes from the very poor southeastern states were 1.6 times (odds ratio [OR] = 1.64; 95 percent confidence interval [CI]: 1.10 to 2.46) more likely to have restorations and almost one-third as likely (OR = 0.35; 95 percent CI: 0.21 to 0.60) to have sealants than were athletes from the poor states, after restricting the analysis by age. Conclusions Among intellectually disabled people in this study, oral health disparities were associated with poverty. Special Olympics athletes from the poorest states were significantly more likely to have restorations and less likely to have received preventive treatment.

https://jada.ada.org/article/S0002-8177(14)63058-0/pdf

Oral health status of people with intellectual disabilities in the southeastern United States

Caries, periodontal disease, oral hygiene and treatment needs were assessed in a group of handicapped adults. The study group comprised 199 individuals aged 17-64 yr, most of whom were mentally subnormal. The mean DMFT values ranged from 17.4 in the 17-24-yr-old age group to 26.9 in the 55-64-yr-old age group. Tooth loss increased rapidly with advancing age. In all age groups the F component was less than 20% and high numbers of untreated carious lesions were found. Of the group studied, 90% needed some conservative treatment. Oral hygiene was poor and a high prevalence of periodontal disease was found. Of the dentulous persons, 49% needed scaling and 34% complex periodontal treatment. The percentage of study group patients requiring dental treatment was very high, so that it can be concluded that dental care for the handicapped is insufficient. This situation must be improved and a suitable system for the delivery of preventive measures must be devised for this group of the population.

Bärbel Dirks

Papers

Caries, oral hygiene and periodontal disease in handicapped adults.