Intellectual disability and oral health

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A previous review of oral health in adults with intellectual disabilities (Anders & Davis, 2010) found that while caries rates were the same or lower than the general population the level of untreated caries was higher in those with intellectual disabilities.  Since than a number of additional studies have been published.

The aim of this review was to assess the recent evidence on the oral health of community dwelling adults with intellectual disabilities.

Methods

Searches were conducted in the PubMed, Embase, Web of Knowledge and PsychINFo databases. Observational studies in community dwelling adults with intellectual disability reporting quantitative measures of oral health status published in English in or after 2008 were considered.

One reviewer screened and selected the studies with a 10% sample being check for inconsistency by a second reviewer. Data was extracted and study quality assessed using the Oxford Critical Appraisal Skills Programme (CASP) checklist. A narrative summary of the findings was presented because of sample heterogeneity.

Results

  • 33 studies involving a total of 14160 patients were included.
  • 17 studies were considered to be of strong quality.
  • Most studies were cross-sectional convenience samples 14 from dental service users and 9 surveys undertaken as part of the Special Olympics-Special Smiles (SO-SS).
  • Most studies including a clinical examination reported poor gingival health and a high prevalence of decayed teeth.
  • Levels of periodontitis reported in studies involving clinical examination ranged from 22.5% – 69.2% [ 10 studies]

Conclusions

The authors concluded: –

This systematic literature review shows the continuing high prevalence of oral disease and treatment need amongst adults with intellectual disabilities, despite changes in care provision. However, most existing research is limited, and heterogeneous, and more research is needed on generalisable populations to quantify the extent of poor oral health. More research is required also to address the numerous confounding factors that undoubtedly influence oral health in this population group. The findings of this work and others show the need for individual countries to address the oral health inequalities faced by adults with intellectual disabilities.

Comments

A good range of databases have been searched although limiting the included studies to those published in English means that some relevant studies may have been excluded.  Appraisal of study quality was undertaken using CASP worksheets which may not be ideal. Just over 50% of the included studies were considered to be of high quality although the heterogeneity of the studies meant that meta-analysis was not possible. It was noted that almost all of the papers reported poor oral hygiene/plaque control and gingivitis as well have a higher level of periodontitis than the general population.  As many of the study samples were of patients already in receipt of care the findings may not be representative of the broader community of patients with intellectual difficulties. Additional research is required with higher quality reporting assessing common outcomes and confounding factors to enable better comparisons with the general population and across the range of adults with intellectual difficulties. For while policy changes and guidance in some countries have supported changes in care provision to this group of patients there is much work to ensure that improvements in access to good oral health care and preventative services is improved.

Links

Primary Paper

Ward LM, Cooper SA, Hughes-McCormack L, Macpherson L, Kinnear D. Oral health of adults with intellectual disabilities: a systematic review. J Intellect Disabil Res. 2019 May 23. doi: 10.1111/jir.12632. [Epub ahead of print] Review. PubMed PMID: 31119825.

Review protocol on PROSPERO

 Other references

Anders P. L. & Davis E. L. (2010) Oral health of patients with intellectual disabilities: a systematic review. Special Care in Dentistry 30, 110–17.

Dental Elf – 3rd Nov 2017

Children and adolescents with intellectual disabilities: oral health status

 

 

Public Heath England – Guidance Oral care and people with learning disabilities – March 2019

 

 

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