Caries Experience of Adults with Intellectual Disability in the Western Part of Germany

An Observation Study of Caries Experience and Potential Risk Assessments among Disabled Individuals Living in an Institutional Rehabilitation Centre

The aim of this study was to conduct salivary, microbiological, and caries risk assessments in relation to caries experience among individuals with intellectual disability in an institutional center in the Al-Baha region, Saudi Arabia. A cross-sectional study was conducted among 89 patients residing in special care homes in the Al-Baha region, Saudi Arabia, from October 2023 to February 2024. The demographic details of all participants were recorded. Clinical oral examinations were performed for the decayed, missing, or filled teeth (DMFT) and plaque indices. Salivary and microbiological assessments were also carried out. The mean age of the study sample was 30.11 ± 4.39 years, and the mean duration of years spent residing in the facility was 26.49 ± 4.66. There was no significant difference observed across plaque scores, S. mutans colony count, salivary rate, pH, DFMT, and caries experience when they were compared across the levels of severity of intellectual disability. Statistically significant differences were observed across diet score, circumstance score, and chances to avoid caries and were found to be correlated with the severity of intellectual disability (p = 0.001, p = 0.001, and p = 0.002), respectively. The cariogram revealed that participants in this study had poor oral health status, with participants with severe intellectual disability having higher diet scores, frequency scores, and susceptibility scores; hence lesser chances to avoid dental caries. Regular dental check-ups, including cleanings and other treatments if necessary, seem to be fundamental to prevent dental issues and maintain healthy teeth and gums for this group of people. Developing interventions that focus on improving oral health status among intellectually disabled individuals may be recommended to ensure the optimum level of support and reduce the burden of dental decay among those individuals.

[Utilization of dental care by adults with and without impairments and disabilities-results of the GEDA 2014/2015-EHIS study]

BACKGROUND

Impairments and disabilities can have a negative impact on oral health. However, studies on the oral health of people with impairments and disabilities are rare. This article examines the 12-month prevalence of dental utilization among adults with and without impairments and disabilities in Germany.

METHODS

Analyses are based on data from 23,372 persons aged 18 years and older with permanent residency in Germany from the GEDA 2014/2015-EHIS study. Participants were asked when they last visited a dentist or orthodontist on their own behalf - "less than 6 months ago," "6 to less than 12 months ago," "12 months ago or longer," or "never." For the analyses, the first two and the last two response options were combined, giving the 12-month prevalence of dental utilization.

RESULTS

Adults with impairments and disabilities were slightly more likely not to have visited a dental practice in the year prior to the survey than adults without impairments and disabilities (21.5% and 18.4%, respectively; p = 0.002). However, the association between the presence of impairments and disabilities and lower dental utilization did not persist after controlling for age, gender, partnership, and socioeconomic status.

DISCUSSION

There are hardly any differences in the dental utilization between persons with and without impairments and disabilities. However, due to their poorer oral health on average, it is necessary to consider how the dental care of this very heterogeneous group can be further improved. The analyses point to the need for care and prevention potentials.

A five-year cohort study on German dental students: Self-assessment in regard to previous experience and attitude toward patients with different types of disability

AIMS

In Germany, a curriculum in special care dentistry (SCD) is not mandatory. As a result, very little is known about dental students' attitudes toward interacting with people with disability (PwD). The study´s aim was to assess this among dental students at Witten/Herdecke University (UW/H).

MATERIAL AND METHODS

In the academic years 2016-2017 to 2020-2021, dental students in the 7th semester (UW/H) were asked to complete a self-assessment questionnaire. Prior to its start, the study had obtained a positive vote from the ethics committee of the UW/H (#174/2016).

RESULTS

Out of 199 students 166 persons on average 24.5 years old completed the questionnaire. Nearly all participants had already had previous experience with PwD in various domains of life prior to dental school (89.2%). Three-quarters indicated not having reservations about interacting with PwD. The proportion of persons without previous experience in interacting with a PwD was almost twice as high in the group with reservation (16.2%) as it was in the group without reservation (8.7%). Almost all surveyed students (92.8%) affirmed that they would like to learn more on the topic of "Professional Interaction with PwD."

CONCLUSION

Most of the respondents did not have reservations about interacting with PwD. Almost all the participants indicated a high level of interest in topics related to SCD. Also, the authors like to encourage the curriculum committees of dental schools at other universities to integrate courses on SCD, based on the iADH recommendations, into their dental curricula.

[Diagnostic Prevalence of Dental Findings in Children, Adolescents and Young Adults with Mental Disorders Compared to Healthy People - an Analysis and Estimation Based on Claims Data from 2019]

AIM

To analyse oral health-related diagnostic prevalences in children, adolescents (KiJu), young adults with mental/behavioural disorders (PEVS) and those of the general population in Germany based on claims data.

METHOD

Anonymously provided ZI (Zentralinstitut)-data sets of GKV-insured persons (0-44 years) were i. e. stratified according to gender, age groups, ICD-K00-K14 diagnosis.

RESULT

No reliable oral or dental health-related information was generated from the requested data set. Regardless of the F diagnosis, according to the data set, 1.8% of all 11,854,384 KiJu-GKV-insured persons and 0.2% of 18-44-year-olds (23,348,399 GKV-insured persons) had a diagnosis related to the dental hard tissue (ICD-10 K02/K03.2). Based on available literature on the prevalence of caries in KiJu with PEVS, a mean unweighted prevalence of 51% can be assumed. According to the available literature on the prevalence of caries in KiJu with PEVS a mean unweighted prevalence of 51% can be calculated. Following this and the diagnosis prevalence of PEVS in 0- to 17-year-olds from 2017, an estimated 957.952 children with PEVS should also have a caries.

CONCLUSION

The nationwide data on the prevalence of oral health-related diagnoses made by physicians in the general population and in people of the same age with PEVS are very low. Apparently, dental diagnoses are only given very rarely by general practitioners and paediatricians, among others. The existing literature as well as the clinical experience of the authors indicate that this claim data is not suitable to realistically represent the dental and oral health of the examined group of people. Thus, for networking, the improvement of health care research and the care, e. g. of subgroups of the society, is an interprofessional dental/medical, data protection-compliant central database to be driven forward.

Special Care Patients and Caries Prevalence in Permanent Dentition: A Systematic Review

Due to the increase in the population with special needs and the significant difficulty in their dental management, it is essential to analyze the caries prevalence in this group of patients. The systematic review was conducted following the PRISMA statement. A search was performed on 9 May 2022 and updated on 5 June 2022, in three databases: Pubmed, Scielo, and Cochrane library. Studies involving the analysis of caries in permanent teeth in patients with special needs were included. A total of 1277 studies were analyzed and 21 studies were selected. Quality assessments were performed using an adapted version of the STROBE guidelines. Among the analyzed groups (intellectual disabilities, human immunodeficiency virus infection, schizophrenia, down syndrome, drug addicts, adult heart transplant, kidney disease, diabetic, autism, psychiatric patients, cerebral palsy, and hemophilia), the highest prevalence of caries was observed in patients with intellectual disability, without differences between genders. However, there is a need for more studies with standardized methods for caries diagnosis to further investigate the prevalence of caries in permanent teeth in patients with special needs.

Oral Health Care of People with Down Syndrome in Germany

BACKGROUND

Due to a dearth of information on preventive and supportive oral care for people with Down Syndrome (PDS) in Germany, caregivers of PDS were surveyed on the topic.

METHODS

An anonymized questionnaire was sent to the 610 members of the German Down Syndrome Association. The study was approved by the ethics committee of Witten/Herdecke University (# 165/2017).

RESULTS

The parents/caregivers of 207 PDS responded. These PDS were between 1 and 55 years old (mean age 24.4 years) and included 111 males and 96 females. At their first dental appointment, 40.7% (n = 82) had been younger than three years. Although 78.3% (n = 162) tooth brushed twice daily, only 30.9% (n = 64) brushed for 2-3 min; 84.0% (n = 135) did not use other dental hygiene products apart from toothbrushes. Age-specific differences were found: Although only 30.8% (n = 12) of PDS < 18 years (n = 39) independently performed dental self-care; this was 67.3% (n = 113) for PDS ≥ 18 years (n = 168). A statistically significant (p < 0.001; Chi-Square-Test) difference in toothbrush preferences emerged: While PDS < 18 years mainly used manual toothbrushes, PDS ≥ 18 years preferred electric toothbrushes. In contrast to 72.6% of PDS ≥ 18 years, only 51.3% of PDS < 18 years accepted most types of toothpaste.

CONCLUSIONS

Age-dependent differences in tooth brushing behaviour became evident within the group of PDS in Germany. Hence, better age-specific, inter-professional dental prophylaxis concepts need to be developed and offered for all age groups of PDS. These concepts should include personalized check-up intervals and hands-on instruction in dental hygiene procedures by dental practitioners.

Risk factors for repeated general anesthesia for dental treatment of adult patients with intellectual and/or physical disabilities

AIM

Repeated dental treatment of patients with intellectual and/or physical disabilities under general anesthesia (GA) often becomes necessary. This study aimed to identify potential risk factors predictive of repeated dental treatment under general anesthesia.

MATERIALS AND METHODS

Data of adult patients with intellectual and/or physical disabilities receiving dental treatment under GA within a time period of 7 years were analyzed (n = 203, mean age: 41.0 ± 14.9 years). All patients received comprehensive dental treatment (professional tooth cleaning, periodontal therapy, composite restorations, and/or extractions); patients receiving extractions only for emergency dental care were not included as a second intervention for restorative treatment often followed. Demographic, anamnestic, oral health, and treatment factors were obtained from dental records. Duration of intervals without dental treatment under GA was assessed using Kaplan-Meier statistics. Potential predictive factors were tested using univariate and multivariate cox regression analyses.

RESULTS

Thirty-five patients (17.2%) received a second and five patients (2.5%) a third dental treatment under GA during that period. In the univariate analysis, patients' age, living situation, and nutrition were associated with repeated GA. In the multivariate Cox regression analysis, only nutrition remained significant. Risk for repeated treatment increased if patients were tube-fed (HR: 7.54, p = 0.001) or received pureed/liquid food (HR: 4.32, p = 0.007) compared to nutrition without limitation.

CONCLUSION

In adult patients with intellectual and/or physical disabilities, nutrition affects the risk for repeated dental treatment under GA.

CLINICAL RELEVANCE

Identification of risk factors making repeated dental treatment under GA of patients with intellectual and/or physical disabilities more likely is essential to adjust preventive measures.