Magazine article The Exceptional Parent

Oral Health for Adults with Disabilities: Dental Treatment for Adults. (Part XIV)

Magazine article The Exceptional Parent

Oral Health for Adults with Disabilities: Dental Treatment for Adults. (Part XIV)

Article excerpt

Approximately 50 million Americans have some type of disabling condition. "Special care dentistry" is a term commonly used for addressing the oral health needs of a person who is medically compromised or an individual with some type of mental, physical or developmental disability. This type of dental treatment may be provided in private practice, community health centers, group homes, long-term-care facilities, skilled nursing facilities or hospitals. It typically involves modifying the process of the dental examination and of the required dental treatment to accommodate the person's disability.

Special care dentistry may include consulting with the person's physician, coordinating dental treatment with other care providers, assisting a person with the aid of the family and direct support professionals (DSPs), adaptations to the treatment procedure, communicating through an interpreter and treatment planning with the person to mitigate future oral health problems.

Oral diseases for individuals with disabilities do not differ from those of individuals without disabilities. Various factors related to the disability, however--such as grasping a toothbrush or articulating the source of oral pain--make it more difficult to prevent and treat dental disease. Keep in mind that, as children and teenagers, adults with disabilities are likely to have had inadequate oral health care. Thus treatment may also differ, because the disease is typically addressed at a later stage, and must often be adapted to fit the needs of the individual's physical and cognitive impairments.

Adults with disabilities are subject to the same ailments and chronic diseases (eg, heart disease, lung disorders, arthritis, type II diabetes) as adults without disabilities--except that these conditions may manifest themselves 15 to 20 years sooner in people with disabilities. This means that a 30-year-old adult with mental retardation/development disabilities (MR/DD) may have a level of oral health similar to that of a 50-year-old person without disabilities.

Common seen as people with disabilities age

Certain oral conditions appear more often in persons with specific disabilities, partly because of the disability itself, but also because of behavior patterns that accompany the disability.

For example, in many people with MR/DD, the teeth erupt in an altered pattern, which may result from over-retained primary (baby) teeth or even the malformation of the teeth. If left untreated, delayed eruption patterns will lead to poor alignment and positioning (malocclusion) of teeth.

Broken teeth are commonly seen in individuals with disabilities; they may result from falls caused by poor ambulatory skills or seizure disorders. Another cause might be the behavioral tendencies of repetitive body movements and fixation on certain tasks that are characteristic of people with autism. These tasks typically include chewing on hard, non-edible objects that tend to break teeth.

Dry mouth (xerostomia) is a common and often-overlooked oral health problem. Once considered an inevitable consequence of aging, it is now known that saliva production remains essentially unchanged in healthy elders. Yet the secretion of saliva may be indirectly dependent on individuals' systemic health as well as the number and type of medications that they are taking. Medications used to treat high blood pressure, heart disease, diabetes, allergies, depression and many other conditions have been found to cause dry mouth.

Saliva maintains the oral environment by limiting bacteria, strengthening tooth enamel, lubricating tissues and enhancing taste sensation. Diminished salivary flow is associated with increased burning and soreness of the oral tissues, difficulty in chewing, swallowing and speaking, oral infections and overall mouth feel, all of which can adversely affect food selection and dietary compliance. Dry mouth can further contribute to the accumulation of food debris around teeth, which can lead to advanced stages of tooth decay, gum disease or even tooth loss. …

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