Special Olympics, special smiles: assessing the feasibility of epidemiologic data collection

The Top 50 Most Cited Articles on Special Olympics: A Bibliometric Analysis

The Special Olympics was established in 1968 to "provide year-round sports training and athletic competition in a variety of Olympic-type sports for children and adults with intellectual disabilities". It has gained recognition in the field of sports and healthcare of persons with intellectual disability, with a large number of dedicated researchers and institutions all over the world. However, there is an urgent need to analyze the progress and current status of this research field to identify knowledge gaps and develop this discipline. The aim of this study was to analyze the scientific production of the Special Olympics and report the bibliometric characteristics of the top 50 most cited Special Olympics publications. A systematic search was conducted on the Scopus database and bibliometric data were extracted and analyzed. The top 50 publications received 1632 citations. A total of 138 authors (63 female and 75 male) contributed to these publications. The two main areas of study were the physical health of Special Olympics athletes (n = 27) and the psycho-social health of athletes (n = 12).

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.

Teaching Oral Hygiene Skills to Elementary Students with Visual Impairments

This study investigated the effects of a program that taught oral hygiene skills to students with visual impairments using group instruction and individual coaching. The results showed that the program enhanced the oral hygiene skills of the three participants significantly, and its effectiveness lasted for at least two months after the instruction ended.

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.

Global oral health status of athletes with intellectual disabilities

Background

The aim of this study is to identify the oral health status and treatment needs of Special Olympics athletes with intellectual disabilities from 181 countries by the assessment of oral health parameters and differences between world regions.

Material and methods

Data were collected through interview and oral examinations within the Healthy Athletes Screening. These data were analysed with descriptive statistics of oral health parameters of athletes from Africa, Asia Pacific, East Asia, Europe/Eurasia, Latin America, Middle East North Africa (MENA) and North America. Mean differences of untreated visible dental caries, gingival signs and missing teeth were tested between regions by one-way ANOVA test and between age groups (8–11, 12–18, 19–39 and 40+) by chi-square tests for multiple comparisons with Hochberg-adjusted p value. The level of significance for all tests was set at a p value < 0.05.

Results

A total of 149,272 athletes with intellectual disabilities were screened. More than 80% of the athletes reported that they cleaned their mouths at least once a day. Athletes in Europe/Eurasia, Latin America, and MENA presented higher rates of signs of gingival disease than other regions. The prevalence of untreated dental caries was significantly higher in Latin America and the group of 8–11-year-olds from Latin America, Europe/Eurasia and Asia Pacific.

Conclusions

The data provided by this study demonstrate that continuous efforts for preventive and restorative oral health care are needed for the oral health of these athletes with ID especially in Latin America, MENA and Europe/Eurasia regions.

Interprofessional Collaboration in Improving Oral Health for Special Populations

People with complex medical, physical, and psychological conditions are among the most underserved groups in receiving dental care and consequently have the most significant oral health disparities of any group. The traditional dental care delivery system is not able to deliver adequate services to these people with "special needs" for a variety of reasons. New systems of care are evolving that better serve the needs of these groups by using interprofessional teams to reach these individuals and integrate oral health services into social, educational, and general health systems.

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

BACKGROUND

Special Olympics Special Smiles (SOSS) is an initiative created for oral health data collection and education in oral hygiene for athletes with an intellectual disability. The aims of this study were to evaluate treatment needs of participants of Special Olympics in Belgium 2013 in comparison with those from 2008 and to assess the impact of screening and referral within the SOSS in a group of athletes who participated in two consecutive events, 2012 and 2013.

METHODS

Data were collected following a standardized protocol developed by the U.S. Centres for Disease Control and Prevention, Division of Oral Health. Oral hygiene habits, treatment urgency and reports of oral pain, gingival signs, sealants, untreated caries, missing and filled teeth were recorded. Data analysis of data from 2013 consisted in descriptive statistics followed by the analysis of the data by univariable and multivariable logistic regression. This data was compared with data from 2008 published by Leroy et al., 2012 using Chi square tests. Data from athletes who participated in both Special Olympics events (2012 and 2013) were compared using Exact McNemar's test and Chi-square test for homogeneity of proportions. The level of significance for all tests was set at a p-value < 0.05.

RESULTS

A total of 627 athletes with intellectual disability participated to the SOSS program in 2013, while 132 athletes met the inclusion criteria of being a participant at both SO Belgium 2012 and 2013. The prevalence of gingival signs was 44.3 % in 2013, slightly higher than in 2008 (42.4 %). The burden of untreated decay affected 27.1 % of the population showing a net increase in comparison to 2008 (20.9 %). McNemar's test and Chi-square test revealed that there were no statistically significant differences in the proportions of all compared parameters between 2012 and 2013.

CONCLUSION

Special Olympics results from 2013 indicate a considerable unmet treatment need among Belgian Special Olympics Athletes, persistent from 2008 to 2013. Moreover, SO intervention had no impact in the oral health of athletes who participated in 2012 and 2013 events. Continuous efforts for preventive and restorative oral health care are needed for this population.

Oral health needs of athletes with intellectual disability in Eastern Europe: Poland, Romania and Slovenia

OBJECTIVES

The aims of this study were to evaluate the oral condition and treatment needs of Special Olympics (SO) athletes from Poland, Romania and Slovenia.

METHODS

A cross-sectional study was performed with data collected through standardised oral screening of athletes who participated in the annual SO events held in Poland, Romania and Slovenia, between 2011 and 2012. The data were compiled and transferred to an SPSS data file for analysis using descriptive statistics.

RESULTS

A total of 3,545 athletes participated in the study. Among the main findings, the prevalence of untreated decay was 41% in Poland and 61% in Slovenia, whilst 70% of the Romanian athletes had signs of gingival disease and only 3.8% presented molar fissure sealants. In addition, 47% of Polish athletes were in need of urgent treatment.

CONCLUSIONS

Analysis of the results obtained following screening showed comparable oral health needs of athletes with intellectual disability among countries. Exploration of the oral health systems of the countries revealed similar significant co-payments and lack of incentive for dentists to treat patients with special needs. The results from Romania, Poland and Slovenia demonstrated the need for a structured system in which a special population is a target for oral-health-related education programmes and system-included preventive, restorative and maintenance interventions.

Oral cleanliness and gingival health among Special Olympics athletes in Europe and Eurasia

Background

Special Olympics athletes, as well as the general population of people with intellectual disabilities, are expected to have poorer gingival health. The aim of the study is to explore the prevalence of gingival signs of inflammation and its relationship to oral cleanliness and age among Special Olympics athletes from Europe and Eurasia.

Material and Methods

A retrospective longitudinal study was performed with data collected through standardized oral from 15.941 athletes from annual Special Olympics events held in 49 countries, from Europe and Eurasia between 2007 and 2012. The data was analysed descriptively, with One-Way ANOVA test and Chi-Square test.

Results

The level of significance was predetermined at a p value < 0.05. A total of 7,754 athletes presented with gingival signs (48.64%). There were no significant differences (p= 0,095) in mean gingival signs between age groups, however the association between mouth cleaning and age, was statistically significant.

Conclusions

The data suggests that there is a high prevalence of gingival signs among individuals with special needs; over 50% in more than 20 countries. Therefore, there is a serious need for education and preventive programs for the patients, their parents and caregivers.

Key words:Gingivitis, prevalence, hygiene, disability, Special Olympics.

The relationship between income and oral health among people with intellectual disabilities: a global perspective

BACKGROUND

The scientific literature cites wide health disparities for people with intellectual disabilities compared to the general population. This study seeks to gain an understanding of the effects of income status on oral health in a global population of people with intellectual disabilities.

METHODS

Eighty-two thousand five hundred and seventy Special Olympics athletes were screened and eligible for inclusion in this study. The main exposure (income status) and selected oral health signs and symptoms (missing teeth, untreated decay, injury, gingivitis, and mouth pain) were used to conduct a cross-sectional analysis. Prevalence odds ratios were obtained through logistic regression.

RESULTS

Study participants from low-income countries experienced adverse health outcomes at a lower rate than expected. Study participants from upper middle, lower middle, and low-income countries had higher odds of mouth pain and untreated decay, yet lower odds of missing teeth, injury, and gingivitis, than participants from high-income countries. Overall, a great number of individuals from every income group required maintenance or urgent care.

CONCLUSION

Oral health problems are not exclusive to low-income study participants. Unexpectedly high odds of missing teeth, injury, and gingivitis in high-income countries may be attributed to the high proportion of participants from the United States, which is considered a high-income country but has large income disparities. Health-determining circumstances in low-income countries provide some protection from the hypothesized gradient of oral health for all measured outcomes.

Access Barriers to Dental Health Care in Children with Disability. A Questionnaire Study of Parents

BACKGROUND

A patient's with disability everyday life is rife with many limitations such as architectural, transport, information as well as medical, psychological, legal, economic and social barriers. The aim of this study was to evaluate access to dental health care of special-care schoolchildren with intellectual disability on the basis of their parents' opinion.

MATERIAL AND METHOD

A questionnaire survey was carried out among 264 parents/caregivers of children from eight special-care schools in Poznan (Poland). Close-ended questions concerned children's barriers in access to dental care and parents' satisfaction with their children's dental care.

RESULTS

Only 31.8% parents/caregivers did not have any problems with access to dental care and the most commonly reported barrier to obtaining dental care was protracted waiting time for a visit (36.7%). Most commonly, children were treated in dental surgery conditions (90.1%). Only 42.1% respondents were satisfied with their children's dental care.

CONCLUSIONS

The research revealed that there is a need to improve the access of children with disability to dental care. Hence, it seems to be beneficial to set up specialist dental surgeries in special-care schools which would improve the access of children with disability to prophylaxis as well as dental treatment.

Prevalence of podiatric conditions seen in Special Olympics athletes: a comparison of USA data to an international population

BACKGROUND

Persons with intellectual disabilities frequently have podiatric conditions. Limited information exists on their prevalence in international cohorts of Special Olympics (SO) athletes. Findings from multiple United States (US) venues are compared to those from athletes screened at the 2011 Special Olympics World Summer Games in Athens, Greece (ATHENS).

METHODS

Data from Fit Feet screenings from 2096 ATHENS participants was compared to 7192 US participants.

RESULTS

Frequently noted in the ATHENS population were motion restriction in both the ankle and the first metatarsal phalangeal joint (1st MTPJ), pes planus, metatarsus adductus, brachymetatarsia, hallux abducto valgus (HAV), onychomycosis, onychocryptosis, and tinea pedis. ATHENS differed from the US cohort as HAV and restricted ankle joint and 1st MTPJ joint motion was less frequent. Significantly more tinea pedis, xerosis, and hyperhidrosis were present in the ATHENS population.

DISCUSSION/CONCLUSION

SO athletes have a higher prevalence of podiatric structural conditions compared to the general population, and some vary between ATHENS versus US. Less prevalent in ATHENS was HAV, and restricted motion in both the ankle and 1st MTPJ. This may reflect differences due to varied clinical observers. The higher rates of several dermatological conditions in ATHENS may reflect venue seasonal climate, or social factors.

Oral health condition and treatment needs among young athletes with intellectual disabilities in Indonesia

BACKGROUND

Data on the oral situation of young people with intellectual disabilities are scarce, especially data of children from a developing country.

AIM

To describe and to evaluate the oral treatment needs of Special Olympics Special Smiles Athletes in Indonesia between 2004 and 2009.

DESIGN

A cross-sectional study data were collected through interviews and clinical examinations using the Special Olympics Special Smiles CDC protocol.

PARTICIPANTS

Indonesian Special Smiles athletes; their mean age was 13.46 years ± 2.97.

RESULTS

More than 70% of athletes had visible untreated decay. Almost 30% (29.8%) of the athletes had gingival inflammation. Pain in the oral cavity was reported by 28.6%. Athletes who had untreated decay reported 6.67 times (95% CI OR; 4.00-11.14) more pain compared to those who did not have untreated decay. Athletes living in provinces on Java Island had 1.54 times (95% CI OR; 1.15-2.07) more untreated decay compared to the athletes who live in provinces in outer Java Island. 21.63% of the screened athletes were referred to the dentist for urgent treatment.

CONCLUSION

The results suggest that there is an elevated oral treatment need in Indonesian Special Smiles population.

Foot-to-shoe mismatch and rates of referral in Special Olympics athletes

BACKGROUND

Improperly fitted shoes are frequently seen in athletes participating in Special Olympics competitions. This foot-to-shoe mismatch may result in deformities as well as discomfort and reduced performance or injuries in competitions. A primary purpose for providing medical screenings is to identify conditions unknown and to promptly refer to an appropriate provider for evaluation and care. This study attempts to determine the prevalence of improperly fitted shoes and the rate of referral for Special Olympics athletes screened at Fit Feet venues.

METHODS

To evaluate the foot-to-shoe mismatch and rate of referral, 4,094 Fit Feet screenings of Special Olympics athletes participating in US competitions in 2005 to 2009 were analyzed. The participants were 58.5% male and 41.5% female, with a median age of 25.6 years. A power analysis and the χ(2) test were used. The athletes voluntarily underwent a foot screening that followed the standardized Special Olympics Fit Feet protocol. The Brannock Device for measuring feet was used to assess proper fit.

RESULTS

A proper fit was found in 58.56% of the athletes, with 28.60% wearing shoes too big and 12.84% wearing shoes too small. Unrelated to shoe fit, 20% of the athletes required referrals for professional follow-up based on abnormal clinical findings.

CONCLUSIONS

There is a significant (41.44%) mismatch of foot to shoe in Special Olympics athletes. The most common mismatch is a shoe too big, with a much smaller number of athletes having shoes too small. Awareness of this foot-to-shoe incompatibility may be useful for the development of shoes better designed for athletes with a foot structure not consistent with conventional shoes. Because 20% of the athletes required a referral for professional follow-up, Fit Feet examinations are important for identifying athletes with conditions that can be more readily evaluated and treated, thus improving the athletes' comfort and performance. Beyond knowing the rate of referral, future studies can determine the conditions or findings that necessitate a referral and the ultimate outcome of that referral.

Receipt of dental care and barriers encountered by persons with disabilities

A study was conducted to describe the receipt of dental care by patients with disabilities and to understand their perspective with regard to barriers to dental care. Subjects for this study were recruited among patients with disabilities seen at Carolinas Rehabilitation's outpatient clinic. A questionnaire consisting of 66 questions was completed by 344 subjects; with the topics related to both medical and dental care. Among the study population, 57.2% of subjects reported being seen by a dentist within the last 12 months, versus 67.3% before they became disabled. The last dental appointment was a routine examination for 59.5% of the respondents. Since becoming disabled, 16.6% of subjects reported problems receiving dental care. Financial challenges were the primary problem followed by physical accessibility issues. Further research is required to discover how barriers to care can be overcome to assure that those with disabilities receive adequate dental care.

Prevalence of podiatric conditions seen in Special Olympics athletes: Structural, biomechanical and dermatological findings

BACKGROUND

Podiatric conditions are frequently seen in persons with intellectual disabilities. Unfortunately, many are not detected or addressed. This study attempts to determine the prevalence of a variety of selected podiatric conditions in Special Olympics athletes and compare the findings to studies of a similarly matched general population.

METHODS

Screenings from 1580 Special Olympics athletes participating in a sampling of United States competitions in 2004-2006 were used for the analysis. The athletes voluntarily underwent a foot screening which followed the standardized Special Olympics Fit Feet protocol.

RESULTS

The most commonly identified conditions included overpronated gait, abducted gait, restriction in both the ankle and the first metatarsal phalangeal joint, pes planus, metatarsus adductus, brachymetatarsia, hallux abducto valgus, onychomycosis, onychocryptosis and tinea pedis.

DISCUSSION/CONCLUSION

The prevalence of all the structural conditions was notably higher than a similarly matched general population and both conditions and biomechanical/gait findings associated with ligamentous laxity like pes planus and hallux abducto valgus had especially high prevalence rates. Restricted motion in the ankle and first metatarsal phalangeal joint was surprising and may indicate some athletes have intellectual disabilities with contractures. The higher rates of dermatophyte related conditions may reflect increased exposure from the athletic competition environment, immunocompromise, issues with hygiene or both. Higher rates of onychocryptosis in the athletes may be due to ill fitting shoes and/or hygiene issues.

Dental utilization by adult Medicaid enrollees who have indicators of intellectual and developmental disabilities (IDD)

The purpose of this study was to determine dental utilization and type of dental services for Medicaid-enrolled adults who had been identified as having intellectual and developmental disabilities (IDD). Using Iowa claims data, the authors identified adults who met any of five IDD criteria for inclusion during calendar year 2005. Service utilization rates, including use of preventive dental, routine restorative, and complex restorative services, were determined. Approximately 60% of adults with IDD had at least one dental visit in 2005. Among adults with at least one dental visit, 83% received a preventive service, 31% a routine restorative service, and 16% a complex dental service. Those age 65 and older had fewer preventive dental services than other age groups. In Iowa, dental utilization for adults 22-64 years of age with IDD was reasonably high (64%) in 2005, but individuals over age 65 had lower utilization (45%).

The impact of dietary and tooth-brushing habits to dental caries of special school children with disability

The daily oral activities may severely influence oral health of children with disabilities. In this survey, we analyzed the impact of dietary and tooth-brushing habits to dental caries in special school children with disabilities. This cross-sectional survey investigated 535 special school children with disabilities aged 6-12 years, 60.93% males, 39.07% females from 10 special schools in Taiwan. Oral examinations were carried out by dentists with a Kappa score of their inter-examiner agreement exceeding 0.8. Data on demographics, diet, and tooth-brushing habits of children with disabilities were collected using a standardized questionnaire completed by parents/caregivers. More than three quarters of the participants were combined with severe or profound disability. Children with profound severity in disability had a higher percentage (67.37%) in teeth-brushing by parents/caregivers compared to those children with mild/moderate severity in disability which had a higher percentage (81.60%) in teeth-brushing by themselves. Children whose teeth were brushed by parents/caregivers had a better dental health, and lower caries prevalence. The main risk factors related to decayed teeth of children with disabilities are frequency of sweets intake, ability to brush teeth and with plaque or not. The dental health education, prevention program and periodical oral check-up to children with disabilities and their parents/caregivers should be reinforced. Brushing skill should be taught to children according to their type, severity and individual characteristics of disability.

Oral health in 12- to 17-year-old athletes participating in the German Special Olympics

BACKGROUND

There is a lack of actual data regarding oral health in children and adolescents with intellectual disabilities.

AIM

To evaluate the oral health in adolescents with intellectual disabilities participating in the German Special Olympics games 2008.

METHODS

A free voluntary dental examination was offered to the participating athletes. Dental examinations were performed according to WHO criteria by dental clinicians. In addition, information about the athletes' oral hygiene habits was collected.

RESULTS

The number of adolescent athletes aged between 12 and 17 years who had their teeth examined was 160. On average they were 15.3 years old. Caries prevalence was 58.1% and the mean DMFT was 2.3. The mean number of fissure sealed teeth was 2.5. About half of the participants showed signs of gum inflammation. The proportion of the adolescents living at home with their parents was 88%. More than 90% of them brushed their teeth by themselves without assistance.

CONCLUSIONS

Adolescents with intellectual disabilities seem to have benefited from various caries preventive measures which had been introduced during the last two decades in Germany but still have a poorer oral health than the general population. More specific prevention programmes seeking close cooperation with parents, custodians, and caretakers should be developed.

Oral health of patients with intellectual disabilities: a systematic review

A systematic review of original studies was conducted to determine if differences in oral health exist between adults who have intellectual disabilities (ID) and the general population. Electronic searching identified 27 studies that met the inclusion criteria. These studies were assessed for strength of evidence. People with ID have poorer oral hygiene and higher prevalence and greater severity of periodontal disease. Caries rates in people with ID are the same as or lower than the general population. However, the rates of untreated caries are consistently higher in people with ID. Two subgroups at especially high risk for oral health problems are people with Down syndrome and people unable to cooperate for routine dental care. Evidence supports the need to develop strategies to increase patient acceptance for routine care, additional training for dentists to provide this care, and the development of more effective preventive strategies to minimize the need for this care.

Oral health condition and treatment needs of Special Olympics athletes in Nigeria

Special Olympics (SO) athletes in many parts of the world were reported to have poor oral health and high unmet treatment needs. This study was carried out to determine the oral health condition and treatment needs of SO athletes in Nigeria and to suggest ways of improving access to oral healthcare. Consenting athletes who participated in SO events in Nigeria from 2007 to 2008 received oral examination and evaluation by trained volunteers, using standardized Special Smiles screening forms and procedures designed for the event. A total of 1,286 athletes aged 3 to 71 years, 480 (37.3%) females and 806 (62.7%) males, participated in the screening. The majority (86.1%) cleaned their mouths once daily, 12.2% complained of pain, 21.1% had untreated decay, 6.6% had dental injury, 48.1% had gingival signs suggestive of periodontal disease, 15.8% required urgent treatment, and 43.7% required non-urgent treatment. We found that the oral health of SO athletes in this study was poorer than that of the general population in Nigeria.

How dental care can preserve and improve oral health

Oral health is associated with overall health, and lack of access to dental care has consequences that go far beyond aesthetics. Most oral diseases are preventable and are relatively easy and inexpensive to address at early stages. However, multiple barriers make dental care unreachable for a sizable portion of the United States population, who consequently has higher incidence and prevalence of disease. Achieving meaningful improvements in oral health status among these groups will require a revamping of the dental infrastructure, augmenting the productivity and skills of the dental workforce, and increasing the population's oral health literacy.

A review of guidelines for sedation, anesthesia,and alternative interventions for people with special needs

There are significant numbers of people in our society with disabilities or other special needs. Their number and percentage are growing, in some cases, dramatically. Many of these individuals need special support in order to receive dental treatment. Modalities that can be used to provide dental treatment include pharmacological approaches to produce various levels of sedation or anesthesia. In addition to the use of medications, there are also techniques that employ behavioral or psychological interventions. In some circumstances, physical support or protective stabilization is used. There are also social supports and prevention strategies that can impact the individual's preparation for and need for dental treatment. This review of the numerous guidelines, which have been published for the use of sedation and anesthesia to facilitate the delivery of dental treatment, indicates that there are fewer guidelines for the inclusion of behavioral or psychological interventions or for the incorporation of social supports or prevention strategies. In addition, most published guidelines do not include considerations for people with special needs. There is a need for increased research and documentation of combined treatment modalities, and these combined approaches need to be incorporated into guidelines for patient care for people with special needs. There is also a need to advocate for reimbursement systems that support all appropriate treatment options so that practitioners can be free to recommend treatment options based on the efficacy and safety of each option.

Planning dental treatment for people with special needs

People with disabilities and other special needs present unique challenges for oral health professionals in planning and carrying out dental treatment. This article presents a schema for planning dental treatment that encourages the oral health provider to fully consider multiple medical, social, psychologic and dental findings when preparing treatment recommendations for a patient with special needs. If these factors are fully integrated, the resulting treatment recommendations provide the best chance of helping the individual achieve and maintain a lifetime of oral health.

Improving and maintaining oral health for people with special needs

The number of people in the United States population with disabilities and other special needs is growing dramatically. These individuals present unique challenges for oral health professionals in planning and carrying out dental treatment and for the oral health delivery system. Because it has been recognized that the current delivery system is not working well for these populations, new workforce, financing, and delivery models are beginning to emerge that may hold promise for creating and maintaining oral health for currently underserved populations, including people with disabilities and other special needs. This article discusses the implications of this for the oral health profession, describes the challenges of providing oral health services for this population, and discusses the implications of these challenges for the organization of the oral health delivery system.

The oral health of people with intellectual disability participating in the UK Special Olympics

BACKGROUND

Research on the dental health of people with intellectual disability has consistently reported more untreated dental disease, more extractions and fewer fillings than in the general population. This paper describes the oral health of participants at the 2005 Glasgow Special Olympics (SO), relating this to the general population studied in the 1998 UK Adult Dental Health Survey (ADHS) and to participants' age and region of residence.

METHODS

Consenting SO participants were offered oral examinations which followed the standardized SO protocol plus an innovative soft tissue examination. Urgency of any treatment required was noted and reported to participants and carers. Three measures of good dental health--having 21 or more natural teeth, absence of fillings and having no obvious untreated decay--were compared across age groups, regions and with the general population. Logistic regression was used to control for age differences between regions.

RESULTS

In total, 1021 oral examinations were completed. Older SO participants were more likely to have fewer than 21 teeth and to have fillings, untreated decay, gum inflammation and heavy plaque levels. In all, 28% of SO participants had 21 or more teeth, no fillings and no obvious decay. Those from the north, midlands and south regions of England had significantly more chance of good dental health so defined compared with participants from Scotland [ORs 1.67 (1.09, 2.67), 1.69 (1.12, 2.54), 1.99 (1.26, 3.16), respectively]. Compared with the general population surveyed in the 1998 ADHS study, SO participants were more likely to be free from fillings and obvious untreated decay, but fewer had 21 or more natural teeth among older age groups. Nine per cent were found to have soft tissue problems, and one in four of these required follow-up. Gum inflammation was common. Overall, 5% of participants were judged to require urgent treatment for dental or soft tissue problems and 40% to require non-urgent treatment. This rose to 9% and 66% respectively among those aged 35 years and over.

DISCUSSION

The low prevalence of untreated decay and fillings among SO participants compared with the general population may be due to their being well supported by family and carers. The study identifies the vulnerability of the older participants to dental problems, and this may indicate greater difficulty maintaining surveillance as individuals age or informal carers become less able or available. Regional variations are similar to those found in the general population. The implications for the organization of care for this group are discussed.

Preventing dental disease for people with special needs: the need for practical preventive protocols for use in community settings

People with disabilities have more dental disease, more missing teeth, and more difficulty receiving dental care than other members of the general population. Because of the deinstitutionalization movement during the later 20th century, many formerly institutionalized people now reside in community settings, which lack oral health services. Even individuals who were not institutionalized have barriers to oral health services. These realities underscore the importance of preventing dental disease in people with special needs by establishing preventive dental disease protocols.

Practical protocols for the prevention of dental disease in community settings for people with special needs: preface

This issue of Special Care in Dentistry presents protocols that were designed during a conference, Practical Protocols for the Prevention of Dental Disease in Community Settings for People with Special Needs, which was held at the University of the Pacific School of Dentistry on February 1, 2002. After each expert reviewed and reported on one area of the literature, which included risk assessment; chlorhexidine mouth rinses; xylitol chewing gum; topical fluoride and fluoride varnish applications; and methods to control or treat periodontal disease, practical protocols were developed. Next, a strategy of implementation and dissemination will be designed using nurses, case managers, social workers, caregivers, and others to encourage people with special needs to use these protocols. A plan will also be implemented to increase social and health care provider awareness about these interventions through professional publications and educational opportunities. The goal is to reduce dental disease in special needs populations and thereby decrease the need for difficult and costly treatment.

Special Olympics: The oral health status of U.S. athletes compared with international athletes

The Healthy Athletes Special Smiles Program provides oral health screening and data collection for athletes with mental retardation who are participating in Special Olympic events. Recently, data regarding international athletes have become available for the first time, allowing a comparison against data collected in the United States. The international athletes from the countries of China, Lebanon, Poland, South Africa, and Turkey were generally younger than those of the United States (mean age 17.4 versus 24.0 years) and were more likely to be males (64.3 versus 54.6%). The international athletes were more likely to have untreated caries (50.1 versus 28.2%), and less likely to have restorations (19.6 versus 62.9%), sealants (1.8 versus 13.5%), fluorosis (3.5 versus 8.8%), signs of gingival disease (27.8 versus 40.1%), or to be edentulous (0.1 versus 3.7%). These relationships persisted after adjustment for sex and age differences between the populations.

Practical protocols for the prevention of dental disease in community settings for people with special needs: the protocols

People with special needs have more dental disease and more missing teeth than the general population. They also have reduced access to oral health diagnostic, preventive, interceptive and treatment services. If services are available, they can be complicated and costly. It is critical to prevent dental diseases in these individuals. This article presents a set of practical protocols for preventing dental disease in people with special needs. These protocols are designed to be used in community settings outside of a dental office.

Prevalence and predictors of untreated caries and oral pain among Special Olympic athletes

The authors assessed the prevalence and predictors of untreated caries and oral pain among Special Olympic athletes. The study population consisted of a convenience sample of 9,620 athletes who were participating in the 2001 Special Olympics events held at 40 sites in the United States, and who consented to a standardized oral health screening. The prevalence of oral pain and untreated caries was 13.5% and 30.4%, respectively. Statistically significant independent associations (adjusted odds ratios [OR], p < or = 0.05) between untreated caries and oral pain (OR = 1.50), gingivitis (OR = 1.92), injury (OR = 1.28), missing teeth (OR = 1.79), and home care (frequency of cleaning their teeth once or less per week compared with once or more per day OR = 2.13) were found. In another model, we found statistically significant independent associations between oral pain and untreated caries (OR = 1.58), gender (OR = 1.28), gingivitis (OR = 1.30), and home care (frequency of cleaning their teeth once or less per week compared to once or more per day OR = 4.60). Substantial levels of untreated caries and oral pain were prevalent and related to poor oral hygiene and poor oral health. These findings were discouraging given that the study participants represented a generally well-supported, high-functioning stratum of persons with mental retardation in the United States.

Dentistry for those requiring special care

Individuals with special needs, namely those whose dental care is complicated by a physical, mental or social disability, often have a higher level of unmet dental need and poorer oral hygiene than the general population, and offer unique challenges to the dental practitioner. This paper outlines the dental management of the three most common groups of individuals with special needs.

Mechanical and chemical home plaque control: a study of Brazilian children and adolescents with disabilities

The purpose of this study was to evaluate the compliance of children and adolescents with disabilities with a home plaque control program. A random sample of 52 students between 7 and 21 years old was solicited from a special school, in Belo Horizonte, Brazil. Measurement of the Debris Index and the presence of bleeding on light probing of the buccal gingival papillae were included as part of the initial clinical examination. Plaque control instructions were given during the first and subsequent clinical sessions. During the fourth clinical session, the patients who had more than 25% sites with bleeding papillae on light probing were placed in a separate group (Group 2) which used a mechanical and chemical plaque control protocol. Group 1 consisted of persons who used mechanical plaque control only. All of the patients were followed up for two more recalls (days 51, 81) during which they were given plaque control instruction and had another gingival examination. On day 111, the final Debris Index and gingival examination were carried out. A significant reduction (p < 0.02) was found between the first and final Debris Index recordings in both groups. Subjects in Group 1 had a significant reduction (p < 0.001) when the first gingival examination was compared with days 21, 51, 81, and 111. Group 2 showed significant reduction (p < 0.01) in gingival bleeding when day 21 was compared with days 81 and 111. Our study suggests that it is possible for these children/adolescents and their parents to learn and comply with mechanical and chemical plaque control at home.

Monitoring acute diseases during the Sydney 2000 Olympic and Paralympic Games

The Sydney 2000 Olympic Games (the XXVII Olympiad) will be the biggest peacetime event ever held in Australia. During the Games, all public health decisions will be centralised, with daily briefing sessions held to review emerging public health issues and facilitate responses. Infectious diseases will be monitored and reported through the Olympic Surveillance System, with particular attention to foodborne diseases and conditions spread via the respiratory route. This system relies heavily on the cooperation of key notifiers such as emergency departments, laboratories and general practitioners. The lessons learned during the Games, and the new and enhanced systems and linkages that have been developed to support it, will strengthen future disease surveillance in NSW.

Accuracy of estimation of dental treatment need in special care patients

OBJECTIVES

To assess the ability of carers and dental professionals to estimate treatment need in a group of children and adults with special needs.

METHOD

A retrospective study of a series of 103 special needs patients who had received restorative dental treatment under general anaesthetic was undertaken. The initial reason for attendance and the time lapse between first symptoms and decision to consult were established. The parent or carer was asked to estimate treatment need and to assess the degree of discomfort suffered by the patient. The dentist evaluated treatment need by means of a pre-operative treatment plan. These results were compared to actual treatment performed.

RESULTS

Treatment need was severely underestimated by both carer and dentist. The degree of advanced pathology found in the population would suggest that pain suffered was also underestimated.

CONCLUSIONS

Access of patients with special needs to dental care may be limited by the ability of their carers to evaluate their oral condition and/or by the persons inability to express their pain or discomfort.