Dentistry For People With Development Disabilities

Introduction

            The population of disabled people is in the increase worldwide and this has suggested the need for development of specialized health care services provision schemes by the involved stakeholders. Developmental disabilities embark on anytime of embryonic development especially in organogenesis, during early development up to age of 22 years but usually these defects last throughout a person’s lifetime. People with developmental disabilities involve a variety of groups of severe chronic ailments that are either due to mental, psychological and/or physical impairments. In normal life activities these people with developmental disabilities encounter problems with most of major life per takings such as communication with others, locomotion between different destinations, acquisition of knowledge and education skills, self defense and development of individual decisions and even independent living.

        This has therefore led to change of perspective in the view of improving Health Care service provision especially on oral care for these developmental disabled patients. This is because data has indicated that people with intellectual disability for example have higher chances of developing dental conditions such as untreated caries and thus a higher prevalence of gingivitis plus other periodontal diseases than the normal population. Going contrary to the original approach of health care provider mostly dentists, discussing changes in dental practice based on the impact of third-party cover, development and acquisition new equipment, material and techniques. Approximately 20% of the world’s population at present lives with some kind of disability and this percentage is frequently on the increase, and these is accompanied with secondary health conditions which expose these individuals into a greater risk of medical complications than what is experienced by the general population. This is engineered to ensure access to appropriate health care for this population, which is often inadequate and generally of less quality than for the overall population (Waldman & Perlman, 2005).

Oral health for people with developmental disabilities

            In general, people with intellectual and developmental disabilities tend to have poorer oral health and oral hygiene than the general population of people who occupy a large part of the community, as shown by an increased prevalence of oral condition in these people. Providing oral health care services to these people with intellectual disability demands adjustment of the skills used for oral care operations for the normal populations mostly in the hospitals. In fact, there is a successful and an easy administration of conventional oral treatment to people with mild or moderate intellectual disability and this can be dealt with in general practice setting. Developmental disability is a disorder of mental and adaptive functioning; leading to the people who are affected to be challenged by the skills they use in everyday life and not a disease or a mental illness but it varies in severity and is usually connected with physical problems (National Institute of Dental and Craniofacial Research, 2009). While an individual with developmental disability may have insignificant intricacy in thinking and communicating, others may face chief challenges with fundamental self-care and physical range of motion.

               Providing dental care to individuals with developmental disabilities may call for improved understanding, concentration and accommodation by the dentist and dental staff, including repeated consultation with other health care providers and clinical officers in that particular health care organization, good relationship with these patients, communicating with patients with some sensory disabilities, relocation of patient from wheelchair to dental chair which is easy to manipulate on treatment provision, minimizing patient apprehension, obtaining apposite informed permission, appropriate airway positioning and modifications to habitual treatment procedures. In the recent times most of these people require to be habiting in community-based assemblage residences or at home among their family members and this is shown to be an estimated 80 percent of the total number of those with developmental disabilities (National Institute of Dental and Craniofacial Research, 2009). Together with their caregivers, they now look to practitioners in the community for dental services. The variations in mental capability, behavioral activities, and physical capability, such as these may call for flexibility and Creativity for the dental practitioner unlike the normal treatment.

Most of these people have been seen to receive less oral health care services, or of lower quality, in relative to the rest of the community, yet they may have oral problems that can affect systemic conditions and thus posing them to general body health problems. Through a community based dental care systems, there a possibility that achievement of improved oral health for people with special needs is practical in our community. Good education for both patients and parents or care takers of these developmentally disabled people In regard to prevention and treatment of oral conditions must be designed from an initial phase. By doing this disease and operative intervention requirement will be avoided, since teeth extraction and other oral surgical procedures in particular frequently create main problems to the patients (Roger, Raman & Scully, 2000). Also there is need for dental healthcare workers to be frequently subjected to educational programs about how to manage the oral health care of developmentally disabled people.

In addressing the effectiveness of oral care for the disabled, one has to ensure the following: good maximization of health hygiene of the oral cavity as this is a vital tool for oral hygiene and this can be done through frequent brushing, rinsing and if possible encourages flossing. This will prevent dental ling the oral health of a consumer a factor which will avoid the occurrences of bad breath associated with problems of the mouth and deprived oral hygiene, gum disease, dry mouth and eventualities of smoking. Since persons with disabilities require to overcome fear because in some cases it has been seen that fear prevents these people from obtaining the oral/dental routine care they need (Kerr, McCulloch & Oliver, 2003). In actual fact, the routine dental and oral procedures are not properly tackled under Medicare for instance in the state contracts (with dentists) it offers a limited cash pay for care for the disabled and even others such as Delaware plus other seven states that do not extend dental coverage to the poor and disabled through Medicaid (National Institute of Dental and Craniofacial Research, 2009).

            The commonest problems are in patients with a hemorrhagic syndrome or cardiovascular disease, or with a depressed immunity system and thus are easily liable to disease infections. Tooth extractions and other dental surgical procedures plus the use of local analgesic injections such as Lignocaine Hydrochloride, may be a cause of problems encountered in patients treated with anti coagulant drugs and those with coagulation abnormalities or extreme thrombocytopenic states. In general medical practice, it is safe to treat patients with anticoagulant drugs, local analgesia and minor dental surgery (simple extractions of less than three teeth from their tooth canals) without change of treatment regimes provided the test results are inside the standard therapeutic range (international normalized ratio of less than 3). This also applies for patients with thrombocytopenia if the platelet count is more than 50 x [10.sup.9]/1, one needs a post-operative application of about 4.8% tranexamic acid mouthwash, on a volume of 10 ml four times a day for seven days is useful. Except in severe cases of hemophilia, non-surgical dental management can be carried out on hemophilic patients under anti-fibrinolytic cover such as tranexamic acid, though care must be taken to maintain urinary flow to avoid urinary blood clot problems. Hematological advice must be sought before other procedures are undertaken. With mild hemophilia, minor oral surgery may be promising under desmopressin cover (Roger, Raman & Scully, 2000).

            Oral conditions affecting the immunocompromised people have a propensity to be more frequent with poor oral hygiene, malnutrition and eating of sugary food plus regular smoking and use of tobacco. This leads to development of usual lesions such as candidiasis and herpes viral infections, together with oral ulcers, periodontal disease, and malignant neoplasms in cases of chronic infections. Purpura hemorrhages and impulsive gingival bleeding also are seen to be associated with leukemia patients as use of drugs such as cyclosporine can cause or worsen gingival swelling. Oral lesions in AIDS patients are most likely to emerge when the CD4 cell count is low/down and are often controlled temporary, by administration of the antiretroviral drugs in the treatment.

But on the other hand these Anti-HIV drugs can place a foundation to lay down of some of the oral problems for instance ulcers, xerostomia and salivary gland swelling (National Institute of Dental and Craniofacial Research, 2009).  Dental officers should use extensive diagnostic procedures to avoid difficulty involved in the diagnosis of most of these conditions, and therefore biopsy with microbial studies may be needed to rule out infections like cytomegalovirus or deep mycoses and specific treatment regime indicated where by drugs such as Chlorhexidine and lignocaine ( a topical analgesic) can be supportive for local treatments. Despite the immune compromization, granulocyte colony motivating factor or thalidomide can be of great use in HIV associated aphthous-like ulceration.

            For patients with periodontal disease which is enhanced by the presence of poor medications and drug administrations, malocclusion of the teeth, compound disabilities and even poor oral hygiene coalesce to boost the danger of periodontal disease progress in people with various developmental disabilities. There should be need to encourage independence in every day oral hygiene where the patients should show how they brush their teeth, and follow up with definite recommendations on brushing techniques or adaptations to the available toothbrush. Dental health care provider should involve the patients in hands on demonstrations of teeth brushing and flossing unless they are impaired in physical coordination or cognitive skills and therefore must talk to the caregivers about their daily oral hygiene who should be given definite demonstration of proper brushing and flossing techniques.

It is necessary to emphasize that, a steady approach to oral hygiene is of health significance and the responsible caregivers should try to use the same site, timing, and positioning.  Patients should take advantage on the benefit obtained from the daily use of antimicrobial agents such as chlorhexidine for cleaning of the oral cavity, and this should base on a recommended and appropriate delivery method depending on the patient’s abilities. For instance rinsing of the oral cavity may not work for a patient dysphagia (swallowing difficulties) or one who has problems with the respiratory regulation especially expectoration, and thus these patients may obtain Chlorhexidine through the use of a spray bottle or toothbrush for high efficacy of the drug (National Institute of Dental and Craniofacial Research, 2009). If use of particular medications has led to gingival hyperplasia, emphasize the importance of daily oral hygiene and frequent professional cleaning of the oral cavity in these people.

References

H. Barry Waldman, Steven P. Perlman (Sept-Oct 2005), evolving realities of dental practice: care for patients with special needs-an Health Care Industry Article, retrieved on April 06, 2009, from  http://findarticles.com/p/articles/mi_m0MKX/is_5_74/ai_n15777176/pg_2/?tag=content;col1

Kerr AM, McCulloch D, Oliver K, et al (2003), Medical needs of people with intellectual disabilities require regular reassessment, and the provision of client- and care-held reports. Journal of Intellectual Disability Research; 47:134-145.

National institute of Dental and Craniofacial Research (NIDCR) in the Institute of Health (March 17, 2009), Practical Oral Care for People with Intellectual Disability, Bethesda, MD 20892-2190 301-496-4261, retrieved on April 6, 2009, from http://www.nidcr.nih.gov/OralHealth/Topics/DevelopmentalDisabilities/PracticalOralCarePeopleIntellectualDisability.htm

 Weddell JA, Sanders BJ, Jones JE (2004), Dental problems of children with disabilities, In McDonald RE, Avery DR, Dean JA, Dentistry for the Child and Adolescent (8th Ed.). St. Louis, MO: Mosby pp. 524-556 retrieved on April 6, 2009, from http://www.dhss.delaware.gov/ddds/files%5Clearn_curve_march09.txt

Roger Davies, Raman Bedi and Crispian Scully (Aug 19, 2000), Oral Health Care fro patients with special needs: British American Journal article on Healthy Care Industry, retrieved on April 6, 2009, from http://findarticles.com/p/articles/mi_m0999/is_7259_321/ai_65130563/