Treatment needs and impact of oral health screening of athletes with intellectual disability in Belgium

Periodic health evaluation in Para athletes: a position statement based on expert consensus

Para athletes present a broad range of sports-related injuries and illnesses, frequently encountering barriers when accessing healthcare services. The periodic health evaluation (PHE) is a valuable tool for continuously monitoring athletes' health, screening for health conditions, assisting in the surveillance of health problems by establishing baseline information and identifying barriers to athlete's performance. This position statement aims to guide sports healthcare providers in the PHE for Para athletes across key impairment categories: intellectual, musculoskeletal, neurological and vision. A panel of 15 international experts, including epidemiologists, physiotherapists, optometrists and physicians with expertise in Para athlete health, convened via videoconferences to discuss the position statement's purpose, methods and themes. They formed working groups to address clinical, cardiorespiratory, neuromusculoskeletal, nutritional status, mental and sleep health, concussion and female Para athlete health assessment considerations. The PHE's effectiveness lies in its comprehensive approach. Health history review can provide insights into factors impacting Para athlete health, inform physical assessments and help healthcare providers understand each athlete's needs. During the PHE, considerations should encompass the specific requirements of the sport modality and the impairment itself. These evaluations can help mitigate the common tendency of Para athletes to under-report health issues. They also enable early interventions tailored to the athlete's health history. Moreover, the PHE serves as an opportunity to educate Para athletes on preventive strategies that can be integrated into their training routines, enhancing their performance and overall health. This position statement can potentially enhance clinical translation into practice and improve the healthcare quality for Para athletes.

Brazilian special olympics athletes: Oral health problems

AIMS

The people with intellectual disabilities have been reported to be a vulnerable population in terms of oral health. This study was carried out to determine the oral health condition and treatment needs of Special Olympics athletes in Brazil.

METHODS

This study is a retrospective review of oral health data collected from athletes participating in Healthy Athletes Program Special Olympics in Brazil, between the years 2015 and 2019. About 1241 athletes from the Brazil Special Olympics program were screened in the cities of São Paulo, Jundiai and Belo Horizonte (located in southeastern Brazil) and Recife (in northeastern Brazil). At each of these events, volunteer dental professionals performed an oral health screening for each athlete, All oral health assessments were done visually; and extra lighting were available if needed. The examinations were performed with the aid of a wooden spatula of the tongue depressor type and under natural light. The following parameters were recorded: mouth pain, untreated tooth decay, missing teeth, gingival signs, urgency and mouth hygiene habits. Data was analyzed using the STATA 14.0 program. Frequency tables were used for descriptive analyses. Categorical variables were compared between the different years of the event using the Chi-Square or Fisher's Exact test. Continuous variables were compared between different event years using the Kruskal-Wallis test followed by Dunn's post-hoc analyses. Simple logistic regression was used to assess the effect of age on dental assessment results. For all tests, a p-value was considered significant when less than or equal to .05.

RESULTS

No statistically significant differences were observed in the frequencies of Mouth Pain and Missing Teeth over the years (p > .05). In relation to Untreated Tooth Decay, there is a higher frequency in the years 2016 and 2018 and a lower frequency in the year 2015 (p = .048). Regarding Gingival Signs of inflammation, there is a higher frequency in the years 2016 and 2018 and a lower frequency in the year 2017 (p < .001). In relation to cases of urgency (in need of treatment (Urgent treatment need, Non-Urgent or Maintenance)), there was a higher frequency (no urgency) in 2016 (p = .007). Finally, in relation to mouth hygiene habits, there is a higher frequency of participants with irregular habits in the years 2017 and 2019 (p < .001).

CONCLUSION

The dental condition of Brazilian athletes Special Olympycs Brazil reported in this study from 2015 to 2019 showed us that athletes have a high prevalence of dental diseases and these needs could contribute to health damage. The athletes have many unmet dental treatment needs and these needs are similar in different regions of the country and in the years reported.

Maternal disability and prenatal oral health experiences: Findings from Pregnancy Risk Assessment Monitoring System

BACKGROUND

Although disability has associations with poor health and reduced access to health care services, limited research exists on the connection between disability, oral health, and oral health care use. Moreover, to the authors' knowledge, no study has examined the association between disability and oral health around the time of pregnancy. This is an important gap in research, considering that both disability and oral health play a critical role in maternal and infant well-being.

METHODS

The authors obtained cross-sectional data from 15 states from 2019 and 2020 from the Pregnancy Risk Assessment Monitoring System (N = 20,189). The authors used multivariable logistic regression analyses to assess the relationship between cumulative disabilities and specific forms of disability (seeing, hearing, walking, remembering, self-care, and communicating) for 6 indicators of oral health experiences during pregnancy.

RESULTS

Women reporting multiple forms of disabilities around the time of pregnancy (especially ≥ 3 disabilities) reported lower levels of knowledge of appropriate oral health care during pregnancy, were less likely to undergo dental prophylaxis during pregnancy, were more likely to report needing care for dental health problems, and had more unmet oral health care needs than those without disabilities.

CONCLUSIONS

Maternal disability is a risk factor for poorer oral health outcomes and oral health care use during pregnancy.

PRACTICAL IMPLICATIONS

Given the potential harms of poor oral health to maternal and infant well-being, the findings of this study suggest the need for increased health promotion efforts to foster improved oral health for pregnant women living with disabilities.

The comparative effects of exercise type on motor function of patients with Parkinson's disease: A three-arm randomized trial

BACKGROUND

Yang-ge dancing is a culturally specific exercise in which people are required to perform motor skills in coordination with rhythmic music. As an integrated exercise with both physical (decelerating the progression of aged-related motor function degeneration) and mental benefits, it has gained great popularity in China, especially among middle-aged and older adults. It remains largely unknown whether Yang-ge dancing (YG) can effectively improve main symptoms of Parkinson's disease (PD), while conventional exercise rehabilitation program has been recommended in the hospital setting. To this end, this study aimed to investigate the comparative effects of exercise therapy on motor function of PD patients.

MATERIALS AND METHODS

A sample of 51 PD patients were randomly assigned to Yang-ge dancing, conventional exercise, or conventional exercise with music. Participants in each group performed 60 min per session, five sessions per week of interventions for 4 weeks. All the participants were assessed using the Unified Parkinson's Disease Rating Scale-motor examination, Berg balance test, timed up and go test, and Purdue pegboard test. Motor performances were examined before and after intervention.

RESULTS

All the three groups were benefited from exercise. Compared to conventional exercise, the Yang-ge dancing and conventional exercise with music had additional positive effects in mobility with reference to baseline.In addition, compared to the two conventional exercise groups (either with/without music), the Yang-ge dancing further enhanced manual dexterity.

CONCLUSION

Exercise with rhythmic auditory stimulation optimized mobility in PD, while YG dance specifically contributed to improvement in manual dexterity.

CLINICAL TRIAL REGISTERATION

[https://clinicaltrials.gov/], identifier [ChiCTR2200061252].

Mapping Research Trends of Adapted Sport from 2001 to 2020: A Bibliometric Analysis

OBJECTIVES

To identify the research landscape in terms of keywords, annual outputs, journals, countries, and institutions and explore the hot topics and prospects regarding adapted sport research.

MATERIALS AND METHODS

Publications designated as "article" on adapted sport retrieved from the Web of Science Core Collection. VOSviewer 1.6.11, Citespace, and Bibliometrix in R Studio were applied for the bibliometric analyses.

RESULTS

A total of 1887 articles were identified. Over the past two decades, athletic performance, sociology/psychology, and rehabilitation were extensively investigated. Basketball, soccer, and swimming were the three most focused adapted sports. Researchers showed a growing interest in submitting their studies to sport science, rehabilitation, and sociological journals. Adapted sport research was more common in developed countries and regions. The UK contributed most publications accounting for about 20% of the total publications.

CONCLUSIONS

With the growth of publications concerning adapted sport, the bibliometric analysis presented an overview of collaboration, trends, and hotspots in the field.

Oral Hygiene Practices among Adults with Intellectual Disabilities-A Pilot Study

It is known that the oral health status of people with intellectual disabilities (IDs) is likely to be compromised as compared with the general population. Until recently, the trend of oral hygiene among the adult population with intellectual disabilities in Brunei Darussalam had yet to be studied. Thus, the aim of this study was to determine the oral hygiene practices, oral health knowledge and dental appointment patterns among the adult population with IDs in Brunei Darussalam. A cross-sectional study was conducted at different service providers in Brunei Darussalam for adults with IDs. An easy-to-read questionnaire was distributed to the participants. The responses of the questionnaire for IDs were analyzed. A total of 34 participants were recruited. It was found that all participants were practicing their daily oral hygiene routine. In terms of dental visits, more than half visit the dentist at least once a year. The majority of the participants agreed that visiting the dentist every 6 months was essential. This study showed that adults with IDs in Brunei Darussalam were aware of the importance of oral health and were maintaining their daily oral hygiene, although not with the ideal method. It is important for clinicians to not only educate the individuals with IDs but also their carer(s) when it comes to oral health knowledge, as carers play a key role in the oral health of the people under their care.

Ecological Study on the Oral Health of Romanian Intellectually Challenged Athletes

This study aimed to give an image of the oral health status and treatment needs of intellectually challenged athletes taking part in Special Olympics—Special Smiles (SO-SS) events organized in Romania during 2011–2019 and to find potential associations with socio-economic factors. An observational ecological retrospective study was conducted, and 1860 oral examinations were performed on participants aged 8 to 30 years in nine SS-SO events. Oral examination was performed under field conditions. Percentage of caries-free subjects, mean DMF-T index and its components (D = decayed; M = missing; F = filled; T = teeth), restoration index RI = [F/(F + D) × 100]%, and Plaque Index were calculated for each of the nine groups. Caries-free subjects ranged between 5.90% and 21.70%. DMF-T ranged from 4.27 to 7.71. Higher values for “F” component (range 0.66–1.69) and RI (range 13.02–27.74%) were found in events held in cities from regions with higher reported Gross Domestic Product. Sealants were present in 0 to 8.4% of the subjects. In areas with lower numbers of inhabitants per dentist, more sealants were found (p < 0.001). Romanian SO athletes exhibited relatively poor oral health, limited access to dental treatment, and low level of prevention. Targeted prevention and treatment programs adjusted to specific conditions in each geo-economic region are needed.

The Oral Health Inequities between Special Needs Children and Normal Children in Asia: A Systematic Review and Meta-Analysis

This meta-analysis aimed to analyze the oral health inequalities among special needs children during 2004-2019 in Asia to reveal the importance and the needs of establishing integrated and equitable special needs dentistry care system in Indonesia. PubMed, Scopus, Cochrane Library, Web of Science, and Wiley Online Library were systematically searched for full-text observational studies published from 1 January 2004 to 15 January 2020, in English in Asia. Studies that included children under 18 years of age with special needs and compared them to healthy controls were selected. Study quality was assessed using the Joanna Briggs Institute 2017 Critical Appraisal Checklist. Risk of bias was assessed using the ROBINS-E tool. The decayed, missing, and filled permanent teeth (DMFT) index indicated that special needs children who suffer from intellectual disability or autism spectrum disorder had significantly more caries than normal children (p < 0.001). The special needs children who had more caries than normal children lived in countries that had a high average DMFT value among 12 years old children (p < 0.001), and these two variables showed a positive correlation in meta-regression analysis (p < 0.001). Having an integrated and equitable care system and elevating children's oral health are important to maintain special needs children's oral health.

Assessment of dental pain in children with intellectual disability using the dental discomfort questionnaire

OBJECTIVE

This study aimed to compare the Dental Discomfort Questionnaire (DDQ) scores in children with and without intellectual disability (ID) and to measure correlation between the total DDQ and the Decayed, Missing, and Filled Teeth (DMFT/dmft) scores, as well as the condition of the tooth causing pain.

METHOD

This cross-sectional study included 81 children with normal intellectual development who attended the Departments of Pediatric Dentistry at two Turkish Universities and 80 children with different levels of intellectual disability who reported dental pain in special education centers. The 12-question DDQ (Turkish version) was applied to the parents of the patients with their consent. The relationship of the DDQ scores with tha of the DMFT/dmft, dental status, and demographic data was evaluated.

RESULTS

When the DDQ scores of children with intellectual disabilities were evaluated, it was found that the majority of the answers given to the questions were statistically similar (p < 0.05) to those of children with normal cognitive level. In the questions in which "pain when eating and brushing teeth" was evaluated, a higher score was obtained, which led to an increase in the total DDQ score (p < 0.001). There was a statistically significant difference between the groups in terms of the distribution of dental conditions (p < 0.001). When compared to the normal cognitive group, patients with mild and severe intellectual disabilities had more deep dentin caries, thoughy, frequent periapical abscess was less common in those groups (p < 0.001 and p = 0.022). There was no statistically significant relationship between DMFTscores.

CONCLUSION

The DDQ was found to be a descriptive, functional, and easy-to-use questionnaire for children with intellectual disabilitiesin terms of detecting the presence of dental pain. No correlation was found between DMFT/dmft, dental status and DDQ scores.

Oral health needs of athletes with intellectual disability in Southern Europe: Greece, Italy and Spain

AIMS

The population with intellectual disabilities (ID) has been reported to be a vulnerable population in terms of oral health. The aims of this study were to evaluate the oral condition and treatment needs of Special Olympics (SO) athletes from Greece, Italy and Spain.

METHODS AND RESULTS

A cross-sectional study was performed with data collected in annual SO events held in Greece, Italy and Spain, between 2010 and 2012. The recorded parameters were the presence/absence of edentulism, untreated decay, filled or missing teeth, sealants, tooth injury and signs of gingival disease. Among the main findings, the prevalence of untreated decay was 57.0% in Greece, 48.8% in Italy and 41.7% of the Spanish athletes. The prevalence of signs of gingival disease was 61.1% in Greece, 60.6% in Italy and 66.1% in Spain. While the majority of the athletes were in need of dental treatment.

CONCLUSIONS

Oral disease is an unresolved problem among athletes with ID in these Mediterranean countries. Therefore efforts should be directed to meet their treatment needs and to prevent oral disease.

Preoperative Dental Examination Might Prevent Unnecessary Tooth Extractions During Dental Treatment of Patients with Disabilities Under General Anaesthesia - Results of a Retrospective Cross-Sectional Study

PURPOSE

The aim of this retrospective cross-sectional study was to detect dental health and dental treatment under general anaesthesia, as well as associations to selected parameters in a patient cohort with different disabilities.

MATERIAL AND METHODS

Patients with disabilities, including mental, physical, combination of mental and physical as well as psychiatric disability, which received dental rehabilitation under general anaesthesia between 1 January 2002 and 31 December 2011 were included. Based on the available patients' records, findings of dental examination (Decayed-, Missing- and Filled-teeth index [DMF-T]), treatment documentation as well as further specific factors including the presence of preoperative dental examination or radiographs were analysed. Statistical analysis was conducted using Mann-Whitney U test, Kruskal-Wallis test, analysis of variance (ANOVA), chi-squared or Fisher's exact test (p <0.05).

RESULTS

A total of 464 patients were included. An overall DMF-T of 12.3 ± 7.5 (D-T of 5.8 ± 5.1) and a dmf-t of 9.2 ± 5.0 (d-t of 7.5 ± 4.5) were found. Patients with psychiatric disabilities showed worst dental health. About half of patients (56%) received a professional tooth cleaning. A tooth extraction was executed at 70% of patients, with 3.3 ± 4.5 teeth each patient. Nearly no patient received periodontal or endodontic treatment. Patients with a preoperative dental examination received statistically significantly less tooth extractions compared to patients without preoperative dental examination (2.7 ± 3.7 vs 4.5 ± 5.8).

CONCLUSION

Patients with different disabilities show high dental treatment need and require improved dental care. Thereby, the preoperative dental examination might avoid unnecessary tooth extractions and is therefore strictly recommended.

A special needs dentistry study of institutionalized individuals with intellectual disability in West Sumatra Indonesia

People with intellectual disability have a higher risk of oral health problems. This study assessed the clinical oral health status and behaviors and treatment needs of people living in an institution in Padang, West Sumatra, Indonesia. We quantified oral health status of 65 individuals with intellectual disability using Oral Hygiene Index Simplified (OHIs), Angle’s classification of malocclusion, Community Periodontal Index and Treatment Need (CPITN), and decay index and also recorded their brushing behavior. We found that males had significantly lower OHIs (p < 0.001), more malocclusion (p < 0.001), greater caries number (p < 0.001), greater CPITN (p = 0.001) and higher need of dental treatment (p < 0.01) than females. Additionally, we found that high caries number was associated with poor OHIS, malocclusion, periodontal disease, and dependent brushing behavior (p < 0.001). The findings of this study imply that there is a gap in appropriate oral health care in individuals with intellectual disability. There should be a greater focus on providing appropriate oral health education to people with intellectual disability, improving the health literacy and quality of care of caregivers, and providing more dentists with specialized training in special needs dentistry.

Oral health of adults with intellectual disabilities: a systematic review

BACKGROUND

There have been several past reports that adults with intellectual disabilities experience poor oral health (tooth loss, periodontal health and untreated dental caries). Loss of a functional dentition has serious consequences, including problems with chewing, swallowing, nutrition, speech, temporomandibular joint osteoarthritis and pain and systemic health conditions. Poor oral health is largely preventable through proactive oral care support. In recent years, social care provision for adults has changed, with deinstitutionalisation and home-based personalised care now being the typical provision in high income countries. Hence, oral health inequalities might be reducing. However, there is limited recent evidence-synthesis on the topic. We aimed to address this.

METHOD

PROSPERO registration number: CRD42018089880. We conducted a preferred reporting items for systematic reviews and meta-analyses systematic review of publications since 2008. Four databases were searched with a clear search strategy, strict inclusion criteria for selection of papers, double scoring (two raters), systematic data extraction and quality appraisal of included papers.

RESULTS

A total of 33/3958 retrieved articles were included, of which 14 were drawn from dental service users and 10 from Special Olympic athletes, therefore not necessarily being representative of the wider population with intellectual disabilities. Despite this limitation, adults with intellectual disabilities were still shown to experience poor oral health. High levels of poor oral hygiene and gingivitis were found, with many also affected by periodontitis and untreated dental decay. There is clear unmet need relating to both periodontal (gum) and tooth health, leading to tooth loss.

CONCLUSIONS

Despite reports in the past of poor oral health amongst adults with intellectual disabilities, and despite it being preventable, there remains a high burden of poor oral health. This highlights the need to raise awareness, and for polices on effective daily oral care, and appropriate service provision. The importance of oral health and its possible negative sequelae needs to be elevated amongst carers and professionals.

Oral Health Status of Athletes with Intellectual Disabilities: A Review

BACKGROUND

Oral health reflects the overall health of an individual; it impacts the mental and physical well-being, quality of life, and social relations of an individual. Special Olympics (SO) athletes have been found to have poorer oral health, and high unmet treatment needs globally. Nine articles are included in this systematic review to determine the oral health status of Special Olympics athletes with intellectual disabilities.

AIM

To identify the oral health status of athletes with intellectual disabilities who participated in the Special Olympics.

METHODS

Electronic bibliographic databases (PubMed, Biology database, Health management database, Science Direct, Health and medical collection (ProQuest), Mendeley, and Health reference centre academic) were used to search for eligible publications using "oral health," "special needs athletes," and "intellectual disabilities" terms. All included articles are in English and were published from 2000-2018. The whole process was conducted following PRISMA guidelines.

RESULTS

The search strategy yielded 4,090 articles. Only nine articles met the criteria and were included in the final analysis. All included articles reported outcome measurements of gingival signs, missing teeth, untreated decay, filled teeth and sealant.

CONCLUSION

The oral health status of athletes with intellectual disabilities can be considered poor compared with athletes without intellectual disabilities, which points to the need for oral health policies for this specific population.

Characterization of oral health in a Portuguese population with mild intellectual disability

AIMS

This study aims to characterize the hygiene habits, the self-perception of the need for treatment and the oral condition of a population with a disability.

METHODS AND RESULTS

This research is part of an observational, cross-sectional epidemiological study on oral health and quality of life of people with mild intellectual disabilities living in (or attending) institutions of the Central Region of Portugal that were affiliated with HUMANITAS (Portuguese Federation for Mental Disability) in 2016. A sociodemographic and oral health questionnaire, applied on the form of an interview to 240 individuals aged between 18 and 64 years, was used. Statistical analyses were performed using SPSS version 22.0. It was verified that 32.9% of the individuals had less than 20 teeth. Only 15% of all individuals used removable prosthesis. About 21% didn't do oral hygiene daily. Only 28.4% of the sample visited the dentist in the last 6 months. Note that 75.2% of the sample stated their need for dental treatment and less than half (37.4%) described their oral condition as good or superior.

CONCLUSION

Dental care among adults with intellectual disability is one of the most unattended health needs. Evidence suggests that inadequate oral health habits are more prevalent in the studied population than in the Portuguese population.

Erosive tooth Wear in special Olympic athletes with intellectual disabilities

Background

Special Olympics (SO) events represent an opportunity to obtain considerable information regarding intellectual disable (ID) patients. Studies done with SO data have shown an overview of the oral health status of these athletes; however, no information exists regarding the erosive tooth wear (ETW). Therefore, the aim of this study is to determine the presence and severity of ETW in athletes with ID who participated in the SO Belgium 2016.

Methods

The study population consisted in 232 athletes with ID who participated in the SO special smiles program, Belgium 2016. For analysis, the sample was divided in three groups: a) athletes with ID under the age of 25 not diagnosed with Down Syndrome (DS) (n = 174), b) athletes with DS under the age of 25 (n = 39) and c) athletes with DS from 25 and older ages (n = 58). Two calibrated dentists performed dental examinations using the Basic Erosive Wear Examination Index (BEWE). The BEWE sum > 0 was used to determine prevalence of ETW. Severity was determined by two- indicators: 1) By risk levels (low, medium and high risk) proposed by the BEWE index, and 2) by the highest score reached per subject in at least one tooth (BEWE1, 2 or 3). Chi-square test and Mann-Whitney U test were used to detect significant differences among different groups (p < 0.05).

Results

The prevalence of ETW for young athletes with ID was 51.14%. Within these athletes, the DS group presented a significant higher mean BEWE sum (4.67, SD 5.64) and prevalence of ETW (69.2%BEWE> 0) when compared to athletes without DS (mean BEWE sum: 1.96, SD 3.47 and 46.3% BEWE> 0; p < 0.05). Furthermore, a significantly higher percentage of athletes with DS were considered at high risk of ETW (p < 0.05).

Conclusions

As a conclusion, half of the young athletes with ID presented at least one affected surface with ETW. The recorded prevalence and severity of ETW for the younger group of athletes with DS was distinctly higher than the athletes with ID not having DS. This shows the need to generate knowledge in order to provide correct management and prevention of erosive tooth wear in populations with ID.

Validation of a Portuguese version of the Oral Health Impact Profile adapted to people with mild intellectual disabilities (OHIP-14-MID-PT)

BACKGROUND

The purpose of this study is to develop a Portuguese version of the Oral Health Impact Profile (OHIP-14) and validate it for people with mild intellectual disability (OHIP-14-MID-PT).

METHODS

The Portuguese version of the questionnaire was drawn up from the original English version, following internationally defined guidelines. Interviews were conducted with 240 individuals living in (or attending) institutions of the central region of Portugal that are affiliated with Humanitas (Portuguese Federation for Intellectual Disability) to measure oral health related quality of life (OHRQoL). The interview also included a sociodemographic and oral health questionnaire followed by an intraoral examination. Two types of reliability were analyzed: test-retest (ICC) and internal consistency (Cronbach´s α, inter-item and item-total correlations). Convergent and divergent validities were also assessed, and a confirmatory factor analysis was performed using the maximum likelihood method.

RESULTS

The OHIP-14-MID-PT presented high reliability (ICC = 0.999; Cronbach's α = 0.922). The inter-item correlation coefficient ranged from 0.277 to 0.749, and the item-total correlation coefficient varied between 0.529 and 0.718. Lower OHIP-14-MID-PT total scores were significantly associated with: a self-perception of better oral health status (r = -0.545, p<0,001) and reduced need for dental treatment (U = 2366.5, p<0,001), more natural teeth (χ2 = 29.74, p<0,001) and better results in the clinical oral health index (COHI) (χ 2 = 18.50, p<0,001); the results support the convergent and divergent validities of the questionnaire.

CONCLUSIONS

OHIP-14-MID-PT has proved to be a consistent, valid and reliable instrument with good psychometric properties to determine the impact of oral health on quality of life in adults with mild intellectual disabilities in Portugal.