Oral Health Among Adults With Intellectual Disabilities

Intellectual Disabilities and Oral Health 

People with IDs have risk factors for poor oral health above and beyond those of the general population. Depending on the individual and their specific phenotype, these may include.^(3,4)

• Impaired ability to perform self-care – proper brushing or flossing may be difficult for some individuals, and the cognitive awareness to plan and carry out these self-care behaviors may be lacking; 

• Communication difficulties – some individuals may not be able to properly communicate concerns such as dental pain to caregivers and dental professionals; 

• Injurious behaviors – stereotypical behaviors and habits, such as mouth-breathing, bruxism, tongue-thrusting, or self-injury may impact oral health; 

• Medical conditions – certain medical conditions that cause IDs may also be associated with specific oral health problems. For example, children with Down syndrome experience premature periodontal disease that often results in early loss of adult teeth; 

• A higher prevalence of enteral feedings; 

• Lower educational and income levels compared to the general public; and 

• Having family members as caregivers rather than trained professionals. 

Interventions by Dental Professionals to Improve Oral Health in Adults with ID 

Studies have established that both caregivers and dental professionals can do better to improve the oral health of adults with IDs.4,5 A large 2019 literature review suggested ways that dental professionals can improve oral care and health among this vulnerable population:⁽⁴⁾

• Caregiver oral health education – teaching, coaching, and ongoing reinforcement by a dental hygienist is been associated with improved oral hygiene in people with ID, particularly if the education is with the disabled person present; 

• Dental care procedures – dental treatment under conscious sedation or a general anesthetic is a treatment facilitator for people with ID, particularly if they manifest behavioral problems, involuntary movements, or difficulty following instructions during dental treatments; 

• Patient communication – for individuals with ID who have high enough cognitive functioning, having access to information about their treatment and being included in decision-making has an impact on their satisfaction with their care. For all individuals with ID, making an effort to communicate with individuals with ID at their level and to make them feel included in the treatment process, as well as giving positive feedback, facilitates treatment. They often understand more than is apparent from their speech; 

• Calming environment – use a “show-and-tell” approach when introducing instruments into the treatment. Consider music or videos that the caregiver suggests. Minimize other visual or auditory distractions; 

• Staff consistency – caring for the individual with ID with the same staff on every visit facilitates their comfort level and reduces anxiety; 

• Specialized clinics – it has been suggested that dental clinics specialized in caring for ID patients would improve outcomes for this demographic. Also, training for non-specialized dentists in communicating with and treating ID adults may be beneficial on both sides of the chair. Lack of access to dentists skilled in working with patients with ID has been identified as a risk factor for poor oral health; and 

• Dentist reimbursement – difficulties in accessing affordable dental care services may be higher among individuals with ID than in the general public, and conversely, dental professionals may find that the additional time and skill required to treat patients with ID is not adequately compensated. 

Other considerations may be helpful in the treatment setting, such as:^(2,4) 

• Allowing the caregiver to be present in the treatment room; 

• Seizure disorders are a common comorbidity with ID. Dental care professionals should be prepared to manage seizures during treatment. This includes removing dental instruments from the mouth, turning the patient to one side, protecting the airway to reduce aspiration risk, remaining with the patient, and noting the time the seizure began; 

• Being prepared to treat a patient in a wheelchair. This can be facilitated by locking the wheels and placing a sliding board behind the patient for head support; and 

• Using physical restraints only as a last resort. 

Take-Home Message 

Individuals with ID are a vulnerable population, and that includes a vulnerability to poor oral health and dental disease well above the general population. They are also less likely to get meaningful professional dental care. Improving this health inequality requires efforts on the part of caregivers and dental health professionals, but dental healthcare providers can take the lead by educating caregivers and preparing themselves and their clinics for the nuances of treating patients with ID. 

^References

^{1. Ward LM, Cooper SA, Hughes-McCormack L, et al. Oral health of adults with intellectual disabilities: A systematic review. J Intellect Disabil Res. 2019;63(11):1359-1378. doi:10.1111/jir.12632}

^{2. Oral health fact sheet for dental professionals: Individuals with intellectual disability. University of Washington School of Dentistry. Published 2011. Accessed March 4, 2025. https://dental.washington.edu/wp-content/media/sp_need_pdfs/Intellectual-Dental.pdf}

^{3. Wilson NJ, Lin Z, Villarosa A, et al. Countering the poor oral health of people with intellectual and developmental disability: A scoping literature review. BMC Publ Health. 2019;19:1530. doi:10.1186/s12889-019-7863-1}

^{4. Practical oral care for people with Down syndrome. National Institute of Dental and Craniofacial Research (NIDCR). Published July 2009. Accessed March 4, 2025. https://www.nidcr.nih.gov/sites/default/files/2017-09/practical-oral-care-down-syndrome.pdf}

^{5. Shah AH, Naseem M, Khan MS, et al. Oral health knowledge and attitude among caregivers of special needs patients at a comprehensive rehabilitation centre: an analytical study. Annali Di Stomatologia. 2018;8(3):110–6. https://pmc.ncbi.nlm.nih.gov/articles/PMC5897091/pdf/110-116.pdf}