Improving the oral health of adults with special needs proves challenging

The findings, published as the cover article in the August issue of The Journal of the American Dental Association, provide a foundation for further investigation into the significant oral health needs of adults with I/DD and the development of preventive oral health strategies.

The study of dental records of 4,732 people, led by dentists and public health professionals at Tufts University School of Dental Medicine (TUSDM) and Tufts University School of Medicine (TUSM), was conducted at the Tufts Dental Facilities Serving People with Special Needs (TDF), a network of Massachusetts dental clinics that provides oral health care to people with disabilities.

Each year, Tufts' program, which is recognized by the Association of State & Territorial Dental Directors as a national model, serves more than 7,000 patients at seven clinics in Massachusetts. The findings released today are the first of a three-part study conducted by principal investigators John Morgan, D.D.S., associate professor in the department of public health and community service at TUSDM, and Paula Minihan, Ph.D., M.P.H., assistant professor in the department of public health and community medicine at TUSM.

“People with intellectual and developmental disabilities are more likely to have poor oral hygiene, periodontal disease and untreated tooth decay than the general population,” said Morgan. “Our findings highlight the need for greater awareness of the unique and complex dental health care needs of this population. The roles of the patient, care giver and dental provider are all vital in developing preventive strategies to improve oral health.”

Morgan and colleagues analyzed clinical and demographic data documented in electronic dental records over a one-year period. They investigated oral health conditions (e.g. dental caries (cavities), periodontal (gum) disease, etc.), age, gender, ability to receive dental examinations and procedures, level of disability, and type of residence. Of the 4,732 patients whose records were reviewed, 61% were reported to have a mild to moderate disability, and 39% were assessed as having a severe disability. Dental records revealed a high burden of oral disease, including dental caries (cavities), periodontitis (gum disease) and missing teeth.

Nearly 25% of the patients had a limited ability to accept any dental intervention and required specialized resources, such as general anesthesia. Almost 40% of all patients able to accept dental treatment required some form of behavioral assistance. These behavioral challenges pose difficulties for dental staff when providing diagnostic and therapeutic procedures. “Behavioral challenges present barriers to good oral health and overall health,” Morgan said. “Often patients with significant developmental disabilities cannot tolerate complex and time consuming dental treatments.”

“From a public health perspective, our findings signal the need for the development of best practices for dental treatment guidelines that promote and protect the oral health of this vulnerable population,” said co-investigator Aviva Must, Ph.D., professor and dean of public health and professional degree programs at TUSM. “Further research is required to identify and develop risk-based preventive interventions to manage oral diseases for people with intellectual or developmental disabilities and maximize the role of the dental professional, patient, and caregiver in promoting oral health.”

TUSDM's general practice residency program includes training in the oral health care of special needs patients and provides post-graduate students with clinical experience treating people with disabilities in the TDF clinics under the guidance and supervision of experienced faculty members trained in special care dentistry.

Since 1976, the TDF have provided patients with general dental services, including examinations, dental prophylaxis, restorative dentistry, periodontal care, endodontic care, prosthetic dentistry and tooth extraction. TDF is made possible by a contractual partnership between TUSDM and the state's Department of Developmental Services and Department of Public Health. The program operates seven clinics in Massachusetts, located in Baldwinville, Canton, Hathorne, Palmer, Shrewsbury, Taunton and Wrentham. The program also provides support for patients who require more advanced behavioral or anxiety techniques such as sedation or general anesthesia for treatment.

Additional authors of the study are Paul Stark, M.S., Sc.D., professor at TUSDM and director of the division of advanced and graduate education; Matthew Finkelman, Ph.D., assistant professor at TUSDM; Konstantina Yantsides, B.S., research assistant at TUSDM; Angel Park, M.S., M.P.H., research analyst at TUSDM; Carrie Nobles, M.P.H., Ph.D., research assistant at TUSM; and Wen Tao, M.A., M.M., research analyst at TUSDM.

This research was supported in part by grant #DE020396 from the National Institute of Dental and Craniofacial Research, part of the National Institutes of Health. Support for the implementation of electronic dental records (axiUm) was provided by Delta Dental of Massachusetts.

Morgan J, Minihan P, Stark P, et al. The oral health status of 4,732 adults with intellectual and developmental disabilities. J Am Dent Assoc 2012;143(8):838-846.

About Tufts University School of Dental Medicine

Founded in 1868, Tufts University School of Dental Medicine (TUSDM) is committed to leadership in education, patient care, research and community service. Students obtain an interdisciplinary education, integrated with medicine, with access to training in dental specialties. Clinics managed at TUSDM provide quality comprehensive care to more than 18,000 diverse individuals annually, including those requiring special needs. Nationally and internationally, the School promotes health and educational programs and researches new procedures, materials and technologies to improve oral health.

About Tufts University School of Medicine and the Sackler School of Graduate Biomedical Sciences

Tufts University School of Medicine and the Sackler School of Graduate Biomedical Sciences at Tufts University are international leaders in innovative medical and public health education and advanced research. The School of Medicine and the Sackler School are renowned for excellence in education in general medicine, biomedical sciences, special combined degree programs in business, health management, public health, bioengineering and international relations, as well as basic and clinical research at the cellular and molecular level.

If you are a member of the media interested in learning more about this topic, or speaking with a faculty member at Tufts University, please contact Jennifer Kritz at 617-636-3707 or Siobhan Gallagher at 617-636-6586.