1
|
Kildahl AN, Berggren T, Rønneberg A, Molnes CSY, Nordgarden H. A call for trauma-informed dental care for individuals with intellectual disabilities. SPECIAL CARE IN DENTISTRY 2024; 44:1126-1134. [PMID: 38192120 DOI: 10.1111/scd.12959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/20/2023] [Accepted: 12/24/2023] [Indexed: 01/10/2024]
Abstract
People with intellectual disabilities are at increased risk of dental anxiety and poor oral health. In addition, people with intellectual disabilities are at increased risk of potentially traumatic experiences, such as violence and sexual abuse, and appear to be more vulnerable to developing trauma-related disorders following such experiences. While psychological trauma is associated with poor oral health and dental anxiety in the general population, the potential link between dental anxiety, poor oral health and psychological trauma is yet to be explored in people with intellectual disabilities. In this conceptual paper, we provide an overview of recent findings concerning the relationships between oral health and intellectual disabilities, psychological trauma and intellectual disabilities, as well as between psychological trauma and oral health, and discuss the relevance of these findings related to dental care for people with intellectual disabilities. We conclude that psychological trauma is likely to contribute to dental anxiety and poor oral health also in people with intellectual disabilities. Implications include an urgent need for research exploring how trauma affects oral health and experiences of dental care for people with intellectual disabilities, as well as the importance of individualized and trauma-informed dental care for these individuals.
Collapse
Affiliation(s)
- Arvid Nikolai Kildahl
- Regional Section Mental Health, Intellectual Disabilities/Autism, Oslo University Hospital, Oslo, Norway
- NevSom - Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Tiril Berggren
- TAKO-Centre, National Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Oslo, Norway
| | | | | | - Hilde Nordgarden
- TAKO-Centre, National Resource Centre for Oral Health in Rare Medical Conditions, Lovisenberg Diakonale Hospital, Oslo, Norway
| |
Collapse
|
2
|
Tobis RM, Cardoso EOC, Yarascavitch C, Tenenbaum HC, Azarpazhooh A, Sale JEM. Experiences of dentists and caregivers of patients with special care needs-A qualitative study. SPECIAL CARE IN DENTISTRY 2024; 44:584-591. [PMID: 37470722 DOI: 10.1111/scd.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/05/2023] [Accepted: 06/24/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Patients with special care needs (developmental disabilities) have unique and complex needs regarding their oral health and care. This qualitative study aimed to identify the experiences, preferences and challenges of dentists and caregivers regarding behavior guidance techniques for dental care in persons with special care needs. METHODS Relying on qualitative description as articulated by Sandelowski, we conducted telephone interviews with a purposeful sample of five special care dentists and seven caregivers. We analyzed the data using thematic analysis. RESULTS Four themes were highlighted: (1) Neither pharmacological or non-pharmacological behavior guidance techniques was universally suitable, (2) A patient-centered approach was critical, (3) The dental environment triggered patients' behaviors and anxiety levels, (4) There was more demand for, than supply of, qualified dentists to treat patients with special care needs. CONCLUSIONS Persons with special care needs are heterogeneous and respond to various behavioral techniques required to deliver their treatment. Behavior guidance planning should be negotiated carefully with patients and caregivers and then individualized based on patients' capabilities and needs for treatment. The necessity to manage complex behaviors has contributed to the limitation of access to dental care for persons with special care needs. Dentistry as a profession has the obligation to uphold the social contract and meet its responsibility to the dental care needs of this population.
Collapse
Affiliation(s)
- Rachel M Tobis
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Elaine O C Cardoso
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- Centre for Advanced Dental Research and Care, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Carilynne Yarascavitch
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- Department of Dental and Maxillofacial Sciences, Sunnybrook Sciences Health Centre, Toronto, Ontario, Canada
| | - Howard C Tenenbaum
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- Centre for Advanced Dental Research and Care, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joanna E M Sale
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Faulks D. Oral health inequalities and disability: Closing the gap. Community Dent Oral Epidemiol 2023. [PMID: 36732929 DOI: 10.1111/cdoe.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/03/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
Abstract
The social determinants of health impact disproportionately on disabled people creating a cumulative risk of unequal oral health outcomes, compounded by impairment. Problems in early life, education and employment, poor social status and support, social exclusion, poverty and stress characterize the life course of many disabled people. Ableism and exclusion combine to ensure that disabled voices are rarely heard, ignorance and indifference lead to prejudice in policy-making and enforcement and negative media attitudes fuelled by political austerity lead to stigmatization. Yet, the health disparities experienced by disabled people are still perceived as being uniquely caused by a medical condition or impaired body function, excluding disabled people from the inequalities discourse. In parallel, the influence of medical conditions within other marginalized groups are minimized (e.g. mental health), leading to the underestimation of the impact of disability on oral health generally. The common ground between all groups subject to oral health inequalities can be conceptualized using the WHO International Classification of Functioning. Outcomes for all might be improved by emphasizing this common ground; by considering disability as a primary variable, such as gender or age; by identifying disabled people within existing inequalities research; and by explicitly including disabled people in future research.
Collapse
Affiliation(s)
- Denise Faulks
- Université Clermont Auvergne, Centre de Recherche en Odontologie Clinique (CROC), Clermont-Ferrand, France.,CHU Clermont-Ferrand, Service d'Odontologie, Clermont-Ferrand, France
| |
Collapse
|
4
|
Balkaran R, Esnard T, Perry M, Virtanen JI. Challenges experienced in the dental care of persons with special needs: a qualitative study among health professionals and caregivers. BMC Oral Health 2022; 22:116. [PMID: 35397582 PMCID: PMC8994058 DOI: 10.1186/s12903-022-02153-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/31/2022] [Indexed: 12/05/2022] Open
Abstract
Background This study aimed to explore the challenges experienced in dental health care by professionals and caregivers of persons with special needs in Trinidad and Tobago. This research presented results from the first qualitative study which gained insight into the service component of dental care for people with special needs in this country. Methods This qualitative study was conducted between March and June 2021. Recruitment of participants used both purposive and snowball sampling. A semi-structured interview schedule was used in the interviews of dentists, (a dental assistant), physicians and caregivers of people with special needs. Narrative inquiry was used in data analysis. The transcripts were individually coded and a follow-up peer debriefing session to cross reference responses and increase the validity of the analysis was performed. Results Barriers related to the provision of dental care included readiness of health care professionals, the level of specialized care and the resources required for patient treatment. Caregivers encountered barriers such as cost and lack of accessible dental care for persons with special needs. Possible solutions were education of key stakeholders, policy intervention, advocacy and prevention strategies. Conclusions Caregivers and allied health care professions experience multiple barriers when treating patients with special needs. Study participants indicated a need change in the provision and access of dental services for people with special needs. Education of healthcare professionals, improved social policies and health promotion is warranted.
Collapse
|
5
|
Mac Giolla Phadraig C, van Harten MT, Diniz-Freitas M, Limeres Posse J, Faulks D, Dougall A, Diz Dios P, Daly B. The impact of COVID-19 on access to dental care for people with disabilities: a global survey during the COVID-19 first wave lockdown. Med Oral Patol Oral Cir Bucal 2021; 26:e770-e777. [PMID: 34414999 PMCID: PMC8601643 DOI: 10.4317/medoral.24742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It is unclear what immediate impact the COVID-19 pandemic has had on delivery of oral healthcare to people with disabilities worldwide. AIM To report the international impact of COVID-19 lockdown on oral healthcare provision for people with disabilities before, during and after the first lockdown (March to July 2020). MATERIAL AND METHODS Cross-sectional online self-administered survey of dentists who treat people with disabilities completed 10th to 31st of July 2020. Responses allowed comparison from before, during and immediately after the first wave lockdowns of the COVID-19 pandemic. Data were analysed using McNemar's test to compare reported practice before to during lockdown, and before to after lockdown. RESULTS Four-hundred-thirty-six respondents from across global regions reported a significant reduction from before to during and from before to after lockdown regarding: the proportion of dentists treating people with all types of disability (p <0.001) and the number of patients with disabilities seen per week (p<0.0001). The proportion reporting no availability of any pharmacological supports rose from 22% pre-lockdown to 61% during lockdown (p < 0.001) and a persistent 44% after lockdown (p < 0.001). An increase in teledentistry was observed. CONCLUSIONS During the first COVID-19 lockdown, there was a significant negative impact on the delivery of dental care to people with disabilities. Oral healthcare access was significantly restricted for people with disabilities with access to sedation and general anaesthesia particularly affected. There is now an increased need to ensure that no-one is left behind in new and existing services as they emerge post-pandemic.
Collapse
Affiliation(s)
- C Mac Giolla Phadraig
- Department of Child and Public Dental Health Dublin Dental University Hospital Trinity College Dublin, Dublin 2, Ireland
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Barriers in Access to Dental Services Hindering the Treatment of People with Disabilities: A Systematic Review. Int J Dent 2020; 2020:9074618. [PMID: 32774378 PMCID: PMC7396116 DOI: 10.1155/2020/9074618] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/21/2020] [Indexed: 11/18/2022] Open
Abstract
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.
Collapse
|
7
|
Faulks D, Fabián Molina G. How to provide the evidence base for techniques and interventions that ensure equal treatment outcomes for people with disability? SPECIAL CARE IN DENTISTRY 2018; 38:119-120. [PMID: 29738622 DOI: 10.1111/scd.12285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Denise Faulks
- CHU-Clermont-Ferrand, Service d'Odontologie, and Université Clermont Auvergne, EA4847, UFR d'Odontologie, 63000 Clermont-Ferrand, France
| | - Gustavo Fabián Molina
- Gustavo Facultad de Ciencias de la Salud-Universidad Católica de Córdoba and The Dental Faculty-Universidad Nacional de Córdoba, Argentina
| |
Collapse
|
8
|
Blaizot A, Catteau C, Delfosse C, Hamel O, Trentesaux T. Obstacles to comprehensive dental care in patients with sustained limitations of their decision-making abilities: findings from a Delphi study. Eur J Oral Sci 2018; 126:222-233. [DOI: 10.1111/eos.12413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Alessandra Blaizot
- Laboratory of Medical Ethics and Forensic Medicine; University of Paris Descartes; Paris France
- Faculty of Dentistry, Dental Public Health Department - University Hospital of Lille; University of Lille; Lille France
| | - Céline Catteau
- Faculty of Dentistry, Dental Public Health Department - University Hospital of Lille; University of Lille; Lille France
- Centre de Recherche en Odontologie Clinique; Clermont University; University of Auvergne; Clermont Ferrand France
| | - Caroline Delfosse
- Centre de Recherche en Odontologie Clinique; Clermont University; University of Auvergne; Clermont Ferrand France
- Faculty of Dentistry; Paediatric Dentistry Department; University Hospital of Lille; University of Lille; Lille France
| | - Olivier Hamel
- Laboratory of Medical Ethics and Forensic Medicine; University of Paris Descartes; Paris France
- Faculty of Dentistry, Public Health Department - University Hospital of Toulouse; University of Toulouse III; Toulouse France
| | - Thomas Trentesaux
- Laboratory of Medical Ethics and Forensic Medicine; University of Paris Descartes; Paris France
- Faculty of Dentistry; Paediatric Dentistry Department; University Hospital of Lille; University of Lille; Lille France
| |
Collapse
|