Children and adolescents with intellectual disabilities: oral health status

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Children with intellectual disabilities are reported to have more obstacles in daily tooth brushing than healthy children. This might be due to their difficulty in achieving the required manual dexterity for self-care and lack of awareness of the importance of oral hygiene practice. Oral health care and routine dental treatment can be challenging for them and studies have shown poorer oral health status.

The aim of this systematic review was to summarise and compare the oral health status of children and adolescents with and without intellectual disabilities.

Methods

Searches were conducted in the PubMed, Embase, Web of Science, Scopus and Clinicaltrials.gov databases. Two reviewers independently selected studies and abstracted data. Study quality was assessed using the Newcastle-Ottawa Scale. Continuous data were reported as mean and standard deviation or median and interquartile range. Categorical data were described by proportion and frequency and meta-analysis conducted.

Results

  • 39 studies reported in 41papers were included.
  • 24 assess dental plaque, 21 gingival or periodontal status, 32 caries status.
  • 26 studies contributed to meta-analysis.
  • Dental Plaque
    • More than half of the studies supported the idea that children and adolescents affected by intellectual disabilities had significantly more dental plaque than their unaffected counterparts.
    • 12 studies contributed to meta-analysis with overall finding that children with intellectual difficulties had significantly higher plaque levels than those without; Standardised mean difference (SMD)= -0.67(95%CI; 0.17-1.18) p = 0.009.
  • Periodontal status
    • Most studies supported the observation that children and adolescents with intellectual disabilities demonstrated worse periodontal status
    • Meta-analysis (8 studies) found that overall children affected by intellectual disabilities had significantly worse gingival status than those without,  SMD=0.63( 95%CI; 0.14–1.12) p=0.011.
  • Dental caries
    • Nearly half of the relevant comparisons revealed that children with intellectual disabilities had fewer filled permanent teeth, more missing permanent teeth due to caries, higher DMFS score, and lower DMFS score
    • meta-analysis suggested that children and adolescents with intellectual disabilities had fewer decayed and filled permanent teeth (DFT), SMD= 0.36 ( 95%CI; 0.62 to 0.11),p=0.005. No significant difference was detected in other indices or the overall effect.

Conclusions

The authors concluded: –

Children and adolescents with intellectual disabilities had higher level of dental plaque, worse gingival status, and fewer decayed and filled permanent teeth than those without intellectual disabilities. Caries experience between males and females was similar in participants with or without intellectual disabilities. Although qualitative analysis suggested that children with intellectual disabilities had higher DMFS scores, more missing permanent teeth due to caries, and fewer filled permanent teeth than children without intellectual disabilities, these were not substantiated by quantitative analysis. Existing evidence on the profiles of specific caries experience among children and adolescents with intellectual disabilities remains elusive. More well-designed studies on children and adolescents with different levels of intellectual disabilities are warranted.

Comments

The helpful review pulls together a large number of studies that consider the oral health status of patients with intellectual disabilities.  As the authors note the overall sample included 53,092 children without intellectual disabilities compared with just 3325 with intellectual difficulties. There is also a broad time span for the studies and the newer tranche of studies found since 2000 may reflect different attitudes and availability of care for this group of patients.  Services for this group of patients are developing and improving and more well designed studies are needed to enhance out knowledge and support their development.

Links

Primary paper

Zhou N, Wong HM, Wen YF, Mcgrath C. Oral health status of children and adolescents with intellectual disabilities: a systematic review and meta-analysis. Dev Med Child Neurol. 2017 Oct;59(10):1019-1026. doi:10.1111/dmcn.13486. Epub 2017 Jun 19. Review. PubMed PMID: 28627071.

Other references

 Dental Elf –  4th July 2016

Periodontal treatment and prevention in Down syndrome patients

 

Learning Disability Elf –  17th Oct 2012

 

Learning disability found to be contributing factor to development of dental caries in children with cerebral palsy

 

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