The Oral Health Epidemic in the Mentally/Developmentally Disabled Community

By Steven Leibof, Program Manager of Education

Health care is a very important issue in the mentally and developmentally disabled population. Certain disabilities have associated medical conditions that are imperative to treat both from a longevity and quality of life perspective.  While medical care is most often a priority, oral health generally takes a back seat. Oral health is vitally important for overall health, many serious infections and disorders can be linked to poor oral health.  Many oral health issues are ignored due to lack of knowledge about the implications of untreated infections. Along with this lack of knowledge and resources, physical and behavioral issues can further complicate receiving needed dental services. Because of the myriad compounding issues leading to low rates of access, oral health has become a serious problem amongst the mentally and developmentally disabled community that deserves attention and needs viable solutions.
           

Cavities, periodontal diseases (diseases affecting the tissue around the teeth), traumatic injury and oral malformations are particularly prevalent amongst the mentally disabled population. Studies have shown that individuals with intellectual disabilities have a higher instance of periodontal disease as well as higher levels of plaque.[1] Left untreated these issues can cause serious complications although, many of these problems are easily treatable upon early detection. Among the many issues that hinder dental care for the disabled community, problems such as communication deficiencies, motor function problems such as seizures or other issues hinder normal oral cleaning habits like brushing, and in some cases inability to handle the stresses and tactile sensations of a dental visit can make even the most routine visit difficult. Because of this increased difficulty level as well as the low reimbursement rates of Medicaid and other poverty programs many doctors avoid treating disabled patients. All of these factors add up to an access issue that cannot continue to be ignored.
             
Factors responsible for the epidemic:

Even among the non-disabled community oral health is a big issue often consuming many hours and resources. For individuals with mental and developmental disabilities the problems can be compounded by their disorder or disability as well as the lack of affordable care. The main issues impeding dental care are behavioral or patient based problems, cost of care, living situation and lack of resources.  

Behavioral issues can make a trip to the dentist for a special needs patient a complicated matter. Actual physical care can be a challenge as the necessary communication between patient and practitioner may be limited. Without complete information as to the source of discomfort or the problems experienced a dental practitioner cannot complete all of their job functions. On top of an inability to obtain full information, communication barriers can also prohibit dentists from necessary procedures that might be painful or jarring due to the sensations on the teeth or the noise of the instruments as they cannot fully explain the reason for these procedures or prepare the individual for the unpleasant sensation. The dental health professional may also have difficulty explaining the prescribed oral health regimen for the patient, in addition to the communication difficulties many individuals do not have the ability to sit still during a dental procedure due to issues involving seizures as well as the inability to endure the tactile and environmental stimulation of dental services.  Dental institutions spend little time instructing students on protocol for mentally disabled patients thus leaving many oral health professionals feeling inadequately prepared to serve this community. In a study done in 1999 more than half the dental schools in the United States, during a 4 year dental curriculum, presented fewer than 5 hours of classroom material devoted to special needs patients. [2] Even a modest increase in this number of instructional hours could have immense benefits.

Issues involving individuals living situations can have an impact on the type and continuity of care received.  In recent years there has been a push to move individuals out of large institutions and into small group homes and independent living situations. In the large institutions individuals are screened regularly and have full access to dental care. While this trend is great from the perspective of allowing individuals to live their own lives should they be able to, from a care perspective it is less efficient. In the large institutions individuals receive mandatory care from hygeine staff, but once out of the large state institutions prefessional dental resources are not as available.[3] When dental issues occur, there is simply a lack of options for handling minor issues and often times the problems do not get taken care of until they have become major issues that require extensive and aggressive treatment.

All of these compounding issues create a multifaceted problem that is going to take a united and concerted effort from many different parties to solve.

What is being done?

The main forms of care available to this population are in the form of university provided care, institution provided care, and donated dental services. These services are simply not enough to cover the population. According to the Cornell University run site disabilitystatistic.org, there are approximately 2.8 million individuals in the United States with a cognitive disability. [4] There are organizations that are working to raise awareness and develop statistical proof of the epidemic. One of the more well-known organizations is Special Olympics Special Smiles. This organization offers free dental care and education to Special Olympic athletes as well as caregivers. The statistics gathered by this organization have been vital in bringing greater attention to the oral health problems in this community. While not plentiful there are some nonprofits still operating to supply services. Websites such as myautismteam.org allow people to share their experiences with care providers and creates lists of professionals willing and equipped to work with this population.
           
What else can be done?

Education is the beginning point of any discussion involving problems of care in a specific community. This education includes informing caretakers, parents, and the mentally and developmentally disabled individuals on the necessity for maintaining oral health. Some of the greatest strides can be made by simply teaching and ensuring better oral care habits amongst individuals and their caretakers.           

Dental schools are in a good position to help meet the demand for dental care amongst special needs patients. At school clinics dental students can learn, in a supervised environment, how to care for the population. Here in the Bay Area the student clinics at University of the Pacific as well as University of California San Francisco have facilities capable of treating special needs patients.

As Dr. Paul Glassman says in his article for CDA compares oral health amongst the special needs population as “a world with heart disease with only heart surgeons to treat the disease”. [5] What he is referring to of course is the fact that many special needs individuals do not receive dental services until their oral health has deteriorated to a point where it becomes an emergency. Oral health involves not only the practicing dentist, but also the greater community working together to teach better habits, encourage people to get regular check-ups and have resources readily available and accessible to this population.

Conclusion:

Dental care is a very important ingredient in a healthy life. The mentally and developmentally disabled community is an underserved community that deserves the right to equal access to care, just like everyone else. This is an important issue that is relatively unknown; very few organizations are being proactive in this arena. Special Olympics Special Smiles is one organization that is working to make a difference by getting the word out about the issues at hand as well as actually treating individuals. These services offer a twofold benefit as the organization also records all the data collected during their services to prove the existence of an oral health epidemic amongst the population. There is headway being made in this field, but there is certainly a long way to go. We at PWDF recognize the importance of healthcare issues among the mentally disabled community and want to raise awareness so that we can start to address these issues. As a community of advocates and professionals we need to work together to ensure that everyone’s needs are equally met and that this issue gets addressed.

PWDF Profile

Who We Are

People With Disabilities Foundation is an operating 501(c)(3) nonprofit organization based in San Francisco, California, which focuses on the rights of the mentally and developmentally disabled.

Services

Advocacy: PWDF advocates for Social Security claimant's disability benefits in eight Bay Area counties. We also provide services in disability rights, on issues regarding returning to work, and in ADA consultations, including areas of employment, health care, and education, among others. There is representation before all levels of federal court and Administrative Law Judges. No one is declined due to their inability to pay, and we offer a sliding scale for attorney's fees.

Education/Public Awareness: To help eliminate the stigma against people with mental disabilities in society, PWDF's educational program organizes workshops and public seminars, provides guest speakers with backgrounds in mental health, and produces educational materials such as videos.

Continuing Education Provider: State Bar of California MCLE, California Board of Behavioral Sciences Continuing Education, and Commission of Rehabilitation Counselor Certification.