Oral health -- not a priority issue a grounded theory analysis of barriers for young patients with disabilities to receive oral health care on the same premise as others

Qualitative inquiry from multiple perspectives of barriers and facilitators of oral health care for adults with disabilities

AIMS

Adults with special health care needs (ASHCN) face significant disparities in access to oral health care and subsequent health outcomes, resulting from several etiologies. This study investigated perspectives of patients, caregivers, and providers to better understand care barriers and facilitators for ASHCN.

METHODS

We conducted 26 semi-structured interviews with a purposive sample from an academic clinic specializing in oral health care for ASHCN with disabilities [patients (N = 4), caregivers (N = 8), and providers (N = 14)], and thematically analyzed transcripts for care barriers and facilitators.

RESULTS

Three overarching themes that encompassed overlapping barriers and facilitators of oral health care for ASHCN emerged: relational aspects, provider training/experience, and infrastructure aspects. Themes include intersecting perceptions of factors that hinder or help oral health care and management of ASHCN.

CONCLUSIONS

Building relationships with patients, inherent empathetic provider characteristics, and accommodating clinical infrastructure are imperative to facilitate oral health care for ASHCN. The primary themes revealed in this study are facilitators to care when they are present, and barriers to care when they are absent. No individual theme stands alone as a single contributor to quality care, and the provision of care for ASHCN relies on coordination of providers, patients, caregivers, and the overarching infrastructure.

Oral Care for Children with Special Healthcare Needs in Dentistry: A Literature Review

Oral health is a very important aspect of general health, especially for vulnerable groups such as children with special healthcare needs. It is important to provide appropriate oral care in order to promote quality of life and good health for everyone, especially for children with special healthcare needs. Method: We reviewed the recent literature to collect knowledge regarding the delivery of quality oral care to children with special healthcare needs. We also explored some of the treatment management options that could address the needs of these children when attending dental clinics. Result: Unfortunately, we noted significant inequalities with issues related to oral health among those children. This situation often results in limitations to the activities of daily living for these children. There is therefore a need for much-needed advancements and refinements in oral healthcare to address the needs of children who have special healthcare needs. Conclusions: Providing children with special healthcare needs with high-quality dental care may necessitate active liaisons with healthcare facilitators and will require work across professions to make certain that these children’s oral health is also prioritized. Coordinated efforts by dental professionals are needed to provide dental health education and preventive interventions for these children.

Dental health care for children with Down syndrome: Parents' description of their children's needs in dental health care settings

A visit to the dental clinic may be challenging for a child with Down syndrome due to medical and oral health problems as well as communication problems. The aim of the present study was to explore how parents of children with Down syndrome describe their child's needs in the dental health care setting. In a survey concerning parental experiences with dental health care in Sweden, free comments were analysed with content analysis and resulted in five categories: “Need for continuity of care in dental health care”; “Need for dental health care professionals to have knowledge and expertise in caring for children with Down syndrome and other disabilities”; “Need for dental health care professionals to use a caring approach with children with Down syndrome”; “Need for the child with Down syndrome to be prepared to participate in their dental health care visit” and “Need for the child with Down syndrome to be given the same rights as typically developing children”. To support children with Down syndrome in an optimal way, dental health care needs to be tailored to meet the child's unique needs. In addition, dental health care professionals need knowledge of and expertise in the care of children with Down syndrome.

A disability-based exploration of psychosocial barriers and enablers to accessing dental services for people with clinically severe obesity: A qualitative study

This qualitative study aimed to explore psychosocial barriers and enablers to accessing dental services for people with clinically severe obesity (PwCSO). Eight focus groups were conducted by one researcher with 40 adult participants at the Adult Healthy Weight Clinic within a hospital-based obesity service. Thematic analysis of focus group transcripts was performed to reveal insights relating to how PwCSO experience dental care and view oral health. A total of 11 participants were male, 29 female, all between the ages of 23 to 74 (mean age of 50). The body mass index of participants ranged from 31.6 to 84.6 kg/m² . The results highlighted four key themes, including "disempowerment to act to improve oral health", "weight-related stigma and discrimination", "unpredictability of the dental environment" and a "lack of tailored services for PwCSO". A number of subthemes were identified, which reflect the six categories of barriers to access from the disability literature: availability, affordability, acceptability, accommodation, accessibility and appropriateness. These were explored to further appreciate the unique psychosocial considerations for this group. This study concluded that PwCSO face significant barriers to accessing dental services across all six categories highlighted in the disability literature. The study findings provide valuable patient-based information regarding the psychosocial barriers to accessing dental services, which are relevant for all healthcare professionals. The study reflected an increased need for promotion of the dentist's role in obesity management and obesity-related dental training, including familiarization with the biopsychosocial domains of obesity to reduce weight related stigma and discrimination, as an area for further study. The findings also guide the design of Specialized Bariatric Dental Services in the future, with a focus on enablers to access.

Barriers in Access to Dental Services Hindering the Treatment of People with Disabilities: A Systematic Review

Background

People with disabilities tend to have greater oral health problems compared to those without disabilities. This may be due to barriers they come across in accessing dental services.

Objectives

The objective of this systematic review was to provide a critical digest of the scientific literature concerning barriers and facilitators of access to oral health services for people with disabilities.

Methods

The electronic databases PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS), and Brazilian Library of Dentistry (BBO) were searched using keywords relevant to the subject. The search was not restricted to specific languages or years of publication; all relevant studies were translated and reviewed.

Results

Sixteen studies including 14 articles, a doctoral thesis, and a monograph were selected, and their quality was analysed using the Downs and Black assessment tool. Barriers to dental services were divided into physical or nonphysical based on the dentist's perspective, as per the perception of parents/guardians or by the persons with disabilities. The barriers that emerged included the dentist's lack of preparation to assist people with disabilities, structural problems of access to dental offices, communication difficulties, and lack of awareness regarding the need for dental treatment for the disabled person.

Conclusion

It is concluded that people with disabilities continue to run into complex physical, behavioural, or multidimensional barriers in accessing dental services. Improved training of dentists for the care of this population is hereby emphasized. The legal framework enabling access to dental care for people with disabilities must also be respected in each country.

Dental caries and related risk factors in Saudi cerebral palsy children

Objective:

To determine caries experience and related risk factors in cerebral palsy (CP) children.

Methods:

Random sample of CP children was examined for dental caries and oral hygiene. Questionnaire was utilized for information about caries risk factors. This cross-sectional study was conducted in Riyadh from December 2014 to May 2015.

Results:

Fifty-two CP children were examined with mean age of 6.3±2.7 years. Only one (1.9%) child out of the 52 had no clinical caries. Combined (dmft plus DMFT) mean caries score among study sample was 9.98±3.99. Older children had significantly higher mean caries scores (11.5±3.34) than younger children (8.86±4.1, p=0.017). The CP children with good oral hygiene had lowest mean caries score (5.8±7.32) as compared to those with fair (9.72±3.3) and poor (11.55±3.05) oral hygiene (p=0.012). Those children whose first dental visit was for routine check-up had significantly (p=0.02) lower mean caries scores (7.33±4.65) than those who made their first visit due to dental problem (11.57±4.15). Similarly, those who had topical fluoride applications by dentist had significantly (p=0.003) lower mean caries scores (8.67±4.14) than those with no topical fluoride application (11.9±2.89).

Conclusion:

The studied CP children had very high caries experience and poor oral hygiene. There was strong association between the high caries experience and poor oral hygiene.

Could a national oral health promotion program improve the oral hygiene of persons attending special care establishments in France? Evaluation of a pilot program

This study aimed to investigate the effectiveness of an oral health promotion intervention implemented in special care establishments by dentists trained online. Twenty-six dentists intervening in 27 French special care establishments undertook a standardised oral health promotion intervention, including a conference presentation for care staff and hands-on toothbrushing workshops. Oral hygiene status of the residents was performed at baseline and at 6 months, and were compared using the McNemar test. Mixed logistic regression was performed to identify the factors associated with an improvement of dental plaque removal. The oral health intervention was completed by 890 residents: 445 children, 373 adults and 72 elderly adults. At baseline, dental plaque was observed for 79.8% of the 797 dentate residents. Among the 691 dentate residents included in the final analysis, dental plaque removal was improved for 34%. Improvement in dental plaque removal was recorded more often for the group of 13 to 20-year-old residents (OR = 1.97; 95% CI = 1.15-3.38). The results indicate that this programme failed to significantly improve the dental plaque removal of the residents. More research is needed to understand the limiting factors of such interventions.

Effectiveness of an oral health intervention program for children with congenital heart defects

Background

Children with congenital heart defects (CHD) are reported to have poorer oral health compared with healthy children. The aim of the present study was to evaluate the effectiveness of an intensive oral health care program among children with CHD followed from infancy to the age of 5 years, by comparing their oral health status at 5 years with a control group of children with CHD who had not received the program.

Methods

In this longitudinal study, children in western Norway with a need for lifelong follow-up due to congenital heart defects were invited to participate (n = 119). Children born in 2008–2011 were offered an oral health intervention program from infancy to the age of 5 years. The outcome measures for evaluating the intervention were dental caries prevalence, dental erosion, plaque index and gingival bleeding index. The data of the intervention group were compared with cross sectional oral health data of 5 year old controls with CHD born 2005–2007 (already published).

Results

Early oral health intervention did not affect the prevalence of caries (25.3% versus 25.4%) or dental erosion (22.2% versus 19.7%) of children with CHD assessed at 5 years. Children in the intervention group were less likely than those in the control group to present with both dental plaque and gingival bleeding at age 5 years. In spite of no difference in caries prevalence between the groups, caries affected children (d_1-5mft) in the intervention group had fewer teeth affected by caries than children in the control group (p = 0.06). The care index was reported to be higher in the intervention group compared with the control group, implying that fewer children in the intervention group suffered from untreated dentine caries. Parents in the intervention group were more likely to brush their children’s teeth twice a day than parents of children in the control group.

Conclusion

The oral health promotive program did not influence the prevalence of caries nor dental erosion. However, the findings indicated better oral hygiene, reduced gingival bleeding and less untreated dentine caries in the intervention compared with the control group.

Trial registration

ClinicalTrials.gov NCT03311438. Registration date: October 17th 2017, retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s12903-018-0495-5) contains supplementary material, which is available to authorized users.

Oral Health Status and Dental Treatment Needs of 5-12-year-old Children with Disabilities Attending Special Schools in Western Maharashtra, India

Introduction:

The individuals suffering from various disabilities form a considerable proportion of the community. The psychological reactions associated with a deformity can be devastating to the disabled, parents, caregivers, and family which often lead to attitudes of hopelessness in the lives of these disabled individuals.

Objectives:

To assess the oral health status and treatment needs among 5–12-year-old children attending special school in Western Maharashtra, India.

Materials and Methods:

A descriptive cross-sectional study was conducted among 5–12-year-old children attending specials school in Western Maharashtra, India. The study group consisted of 100 children (62 males and 38 females). The oral health status was assessed by using decayed, missing, and filled teeth (DMFT) index, Community Periodontal Index, Dentition status and treatment needs. Information on disability status, intelligent quotient, and systemic diseases were recorded.

Results:

The mean age of the study population was 9.35 ± 2.92 years. There were 62 (62%) males and 38 (38%) females in the study population. Among the total children examined, 50% of the children were suffering from mental retardation (MR), followed by MR with cerebral palsy (20%). The overall mean decayed and filled teeth and DMFT scores were 3.53 ± 1.02 and 3.89 ± 1.30, respectively, and decayed component had the highest score in both the groups. A statistically significant difference has been observed among the gender (P < 0.001).

Conclusion:

There is a high proportion of dental treatment needs required for these children which reflect the barriers to access and utilize oral health care among these children. As dentist, we should emphasize on health education, periodic recall, and monitoring among these individuals.

Oral health comprehension in parents of Saudi cerebral palsy children

Objective

To determine oral health comprehension among parents of cerebral palsy (CP) children.

Methods

A self-administered questionnaire was utilized to obtain the required information. The study was conducted in two main centers for disabled children in Riyadh, Saudi Arabia.

Results

Parents of all 157 CP children registered in the two centers completed the questionnaire. Mothers mostly (86.6%) completed the questionnaire. Majority (98.7%) of the parents knew the importance of dental health for general health. More than two-third (70%) of the parents thought that teeth should be brushed thrice daily or after each meal. About three in every ten (29.9%) parents were not aware of the beneficial effect of fluoride in preventing dental caries; and very few (9.6%) were aware of water as a source of fluoride. Almost all (98.7%) the parents knew that sugary foods caused dental caries. Three-fourth (75.8%) of the parents were not aware of the possible harmful effects of bottled juices on teeth. There were no significant (p > 0.05) associations between the parental age/gender with any of the dependent variables.

Conclusion

Parents of CP children generally showed satisfactory oral health comprehension. However, they need further oral health education in several areas.

Amelogenesis Imperfecta and Early Restorative Crown Therapy: An Interview Study with Adolescents and Young Adults on Their Experiences

Patients with Amelogenesis imperfecta (AI) can present with rapid tooth loss or fractures of enamel as well as alterations in enamel thickness, color, and shape; factors that may compromise aesthetic appearance and masticatory function. The aim was to explore the experiences and perceptions of adolescents and young adults living with AI and receiving early prosthetic therapy. Seven patients with severe AI aged 16 to 23 years who underwent porcelain crown therapy participated in one-to-one individual interviews. The interviews followed a topic guide consisting of open-ended questions related to experiences of having AI. Transcripts from the interviews were analyzed using thematic analysis. The analysis process identified three main themes: Disturbances in daily life, Managing disturbances, and Normalization of daily life. These themes explain the experiences of patients living with enamel disturbances caused by AI and receiving early crown therapy. Experiences include severe pain and sensitivity problems, feelings of embarrassment, and dealing with dental staff that lack knowledge and understanding of their condition. The patients described ways to manage their disturbances and to reduce pain when eating or drinking, and strategies for meeting other people. After definitive treatment with porcelain crown therapy, they described feeling like a normal patient. In conclusion the results showed that adolescents and young adults describe a profound effect of AI on several aspects of their daily life.

Oral health survey of 6-12-year-old children with disabilities attending special schools in Chennai, India

BACKGROUND

The dental literature is replete with reports on the oral health surveys of normal children. Relatively few data exist for the oral conditions of mentally challenged children and adolescents with multiple disabilities in India.

AIM

To assess the oral hygiene practices and treatment needs among 6-12-year-old disabled children attending special schools in Chennai, India, between 2007 and 2008.

DESIGN

A cross-sectional study data were collected using WHO criteria, a questionnaire (for the parents/guardians) regarding demographic data and oral hygiene practices, medical record review, and clinical examination.

RESULTS

Among 402 disabled children, majority of the children brushed their teeth once daily (89.7%) and with assistance from the caregiver (64.4%). The utilisation of the dental services was minimal (extractions 14.4%, oral prophylaxis 1.7%, and restorations 1.7%). There was significant difference between residents and non-residents for the mean dft/DMFT. The periodontal health was comparatively better among the residents of the institutions than the non-residents (P < 0.001). Regression analysis revealed that various variables were significantly associated with dft/DMFT and Community Periodontal Index (CPI).

CONCLUSION

This study gives sufficient evidence to suggest that the oral health status of this disabled population was poor and there was an increased unmet dental treatment needs.

Using e-learning to train dentists in the development of standardised oral health promotion interventions for persons with disability

BACKGROUND

This study aims to evaluate whether an e-learning curriculum was sufficient to impart the necessary knowledge to dentists to allow them to implement an oral health promotion intervention in an institution for persons with disability.

MATERIALS AND METHODS

Participants were asked to complete a 10-module online training course and to implement a standardised intervention in an institution. The outcome measures were as follows: online tracking of progress; multiple choice questionnaires completed at the end of most modules; self-efficacy questionnaire completed before and after online training; completion of training and calibration in the use of a standardised risk assessment form; initiation and full completion of an oral health promotion intervention in an institution; satisfaction of participants with the online training experience; and evaluation of the impact of the intervention by the institution staff.

RESULTS

The study sample included 26 dentists. The 10 modules were passed by 24 dentists, and the mean value of the highest overall score recorded in the multiple questionnaires was 88.4% (± 4.0). Twenty participants completed the self-efficacy questionnaire before and after training; the mean values of scores after training were statistically different and higher than those at baseline. Questionnaire regarding satisfaction with the online training experience was completed by 22 participants; all of them stated that they were satisfied with the online training experience.

CONCLUSIONS

The results indicate that the online training course helped participants to increase self-efficacy and to provide interventions in institutions. This study could have implications for both undergraduate and postgraduate dental education in France.