Survey: Developmentally disabled adults often lack sufficient dental care

A new survey in the Journal of the American Dental Association has found that adults with developmental disabilities continue to have "significant dental disease," despite a recent focus on expanding access to care for these patients.

Researchers from Tufts University School of Medicine and Tufts University School of Dental Medicine, both in Boston, conducted what they are calling the first large-scale survey to investigate factors influencing at-home oral care provided by caregivers to adults with developmental disabilities. The study findings suggest that, in addition to addressing access to care, policy initiatives must improve support for caregivers (JADA, October 2014, Vol. 145:10, pp. 1018-1025).

Access to dental care alone was not enough to guarantee positive outcomes, according to principal study investigator Paula Minihan, PhD, MPH.

"While access to dental care is a necessary component of good oral health, it is not enough to guarantee positive oral health outcomes in this vulnerable population. Our findings highlight the need for additional training and support for caregivers in promoting oral health," Dr. Minihan stated in a news release. She is an assistant professor in the department of public health and community medicine at Tufts University School of Medicine.

The researchers noted that people with developmental disabilities have a high prevalence of cavities, gum disease, and tooth loss. Those who cannot independently brush or floss rely on caregivers to provide assistance and support.

The researchers surveyed more than 800 caregivers (family as well as paid) who have extensive experience providing care to adults with developmental disabilities in either family homes or supervised residences in Massachusetts.

Survey results revealed the following:

• 85% of adults with developmental disabilities received assistance with teeth cleaning.
• 79% brushed twice daily as recommended by the ADA.
• 22% flossed daily as recommended by the ADA.
• 45% never flossed.

Behavioral problems were cited most as interfering with oral healthcare routines than any other factor by the caregivers surveyed.

The survey results indicated that while the frequency of brushing and flossing among these adults was higher than reported in previous studies, many did not meet ADA recommendations on brushing and flossing. Caregivers reported that flossing in particular presented a challenge.

Another concern cited by the study authors was the lack of oral healthcare training received by family caregivers, according to senior author Aviva Must, PhD, a professor and the chair of the department of public health and community medicine at Tufts University School of Medicine.

"We were surprised to find that while 71.6% of paid caregivers who participated in our study reported having received formal group training in oral healthcare, only 6.4% of family caregivers reported the same," Must stated in the release. "Given the vital role that caregivers play in promoting good oral health in this population, we need to ensure that all receive the guidance and support they need to be effective."

This need for more training was confirmed by co-principal investigator John Morgan, DDS, an associate professor in the department of public health and community service at Tufts University School of Dental Medicine.

"In addition to the effective use of fluoridated toothpaste and the application of topical fluorides, policymakers should also consider establishing an organized system that provides caregivers, including family caregivers, with information and support," Dr. Morgan said.