Susan Parker RDH, B.S., MEd, MBA
There is a disparity in oral health between people with intellectual disabilities (ID) and the general population. Strategies to increase ID patient acceptance of routine dental care, provide specialized training for dental professionals, and increase prevention should decrease the disparity.
Among adults, is there a disparity in the oral health of individuals who have ID compared to the general population?
The authors searched three databases for research published in English from 1975 through October 2008. They used three selection criteria: adult human subjects with ID, a control or comparison group without ID, and at least one quantitative measure of oral health status. Two reviewers evaluated each article independently to determine if inclusion criteria were met and to identify any discrepancies. All discussions led to a consensus score. The authors modified the Newcastle-Ottawa Scale specifically for this review so that the quality of nonrandomized studies could be assessed.
The review included 27 studies, and with two exceptions, each study found that people with ID have poorer oral hygiene than the general population. The evidence also supports that people with ID have a higher prevalence and greater severity of periodontal disease than the general population. Studies that examined caries rates concluded that those rates in people with ID were either the same as the general population or lower. Only one study found a higher caries prevalence in adults with ID; however, the levels of untreated caries were consistently higher in people with ID. Only eight studies used a matched control group while the rest used historic controls. While this review found wide variation in the quality of studies, the average score indicated moderate quality overall for this body of evidence.
There is a need for increased ID patient acceptance of routine periodontal and restorative dental care, preparation of dentists and hygienists to provide such care, and establishment of preventive strategies to minimize the need for this care. Eliminating these disparities should become a public health priority.
Source of Funding:
Importance and Context:
Poor oral health can have a measurable impact on an individual's quality of life. For patients with ID, oral health needs are complex. These individuals are more likely than patients in the general population to have poor oral hygiene, periodontal disease and untreated caries. Dental and public health professionals should make it a priority to eliminate this oral health disparity. Instructions in self-care strategies, instructions for caregivers, training of dental and dental hygiene providers to treat special populations, access to care, and implementing advancements in sedation practices are necessary measures for improvement.
Strengths and Weaknesses of the Systematic Review:
Although the authors only considered articles written in English, they followed generally accepted guidelines to conduct this systematic review. Also, it is clear that more than one reviewer was involved in the search, selection and analysis of the included studies. Although modified, they used a standard instrument for assessing quality of nonrandomized studies. Some of the conclusions in this systematic review go beyond the stated objectives, and relate to proposed solutions to the identified problem.
Strengths and Weaknesses of the Evidence:
It was difficult to assess the overall magnitude of effect for the included studies because the findings were not reported in an aggregated manner. The authors included 27 studies with sample sizes ranging from 17 to 9,620. Methodological heterogeneity was noted since the study size and design varied across studies from 12 countries. All studies reported statistically significant findings with most providing evidence of adequate power. The conclusions from the evidence were consistent in spite of the methodological heterogeneity.
Implications for Dental Practice:
The Commission on Dental Accreditation recently adopted a new standard stating that graduates "must be competent in assessing the treatment needs of patients with special needs." This systematic review provides evidence for their standard and also identified three areas for improvement so that the oral health of adult patients with intellectual disabilities can be better managed.