Tracey is a Registered Nurse working as the team lead in an adult inpatient unit for individuals with intellectual and developmental disabilities (IDD). We connected to discuss how our professional roles may interface with each other, and the concerns/issues we both face with dental care in those with an IDD.
Individuals who have an IDD experience decreased oral health, resulting in an increased prevalence of periodontal disease, edentulousness, untreated caries, and lower rates of restorative care compared to those without an IDD (Anders & Davis 2010). Decreased oral health can also increase the implications of poor oral health, including associations with aspiration pneumonia, chronic diseases including cardiovascular disease, diabetes, respiratory disease and stroke. Poor oral health may also impact an individuals psychological & social health. It can result in difficulty performing activities of daily living, decreased nutritional intake, and impair social interactions (Wilson et al., 2019). The definition of good oral health is not simply ‘heathy teeth’. It is the state of being free from pain/disease, the presence of a functioning dentition - ability to chew, swallow, speak, and obtain nutrition (Ward et al, 2019).
This lack of good oral care in those with an IDD can be due to many factors such as barriers related to accessing community dental care, the need for assistance while completing basic activities (brushing and flossing), behavioural challenges, and communication challenges (Wilson et al., 2019).
While discussing with Tracey i learned that CAMH (centre for addiction and mental health) has a dental clinic where clients go for regular dental appointments, and if treatment beyond that is required clients would go to Mt. Sinai hospital for treatment/procedures. Hospital based dentistry plays an important role in the delivery of oral health care to patients with IDD who are unable to receive dental care in their community. While many individuals with an IDD can be treated in the community, there are also individuals who must be seen in hospital due to an increased need for care under a general anesthesia (or other form of sedation) due to complex medical conditions or an inability to cooperate with community dental care (or in Tracey’s case inability to tolerate dental care within CAMH) (Park & Sigal, 2008). She also mentioned that in the inpatient unit at CAMH occupational therapists would devise an oral hygiene program, with steps for staff to follow. The nursing staff would then initiate and perform tooth brushing and/or flossing. Oral care is highly invasive, for some individuals who did not understand the importance of oral hygiene, this could lead to them being uncooperative, and potentially met with physical and aggression. Which unfortunately often would lead to the oral hygiene routine falling to the side (Chadwick, Chapman, & Davies 2017).
Dentistry has made a shift over the years to focus more on a preventative proactive approach, rather than a retroactive approach. This has in turn resulted in more individuals (with and without an IDD) keeping their full dentition for much longer. More emphasis is being placed on regular dental hygiene care, both in dental clinics and oral hygiene self care. While this emphasis on dental hygiene is increasing in the general population, it seems to be lacking in inpatient systems, as more individuals are keeping their full dentition. Dental care is more invasive and time consuming for a caregiver to properly care for a full dentition rather than dentures. Caregivers (family members or paid staff) play a vital role in maintaining adequate oral health of those with IDD. Caregivers attitudes toward oral health of those with IDD (or any inpatient) has been found to be unsatisfactory, even if their knowledge was adequate (Wilson et al., 2019). The importance of good oral hygiene and the potential health problems associate with oral disease need to hold a higher importance and level of awareness than what currently exists among care givers and professionals for adults with IDD (Ward et al., 2019).
Throughout my own experiences I have been in contact & participated in a few in hospital programs. While taking my BDH, Dalhousie had a partnership program with Mount Hope - which is home to a variety of mental health & addiction support programs & inpatient services. As students we would provide dental hygiene care to inpatients & refer them out for any other suspected dental related issues. While participating in this program i experienced many patients who had not been to the dentist or received dental hygiene care in years. During these appointments i spent a significant amount of time on self oral hygiene, and just chatting with patients - making them more comfortable coming to the 'dentist' so that they may feel more comfortable visiting a private clinic later on, and also giving them many tools so that they are able to maintain adequate oral hygiene on their own, or with help from a caregiver. We also went to several long term care homes to educate nursing staff on how to properly care for their patients dental needs, as well as providing basic oral care to inpatient care residents. While doing this we realized how dental care is lacking within inpatient services, which i attribute greatly to the fact that dentistry has a more proactive approach and many individuals are able to keep their teeth for longer than in the past.
Tracey and I have both realized through this exercise how lacking proper oral hygiene is in inpatient units for those with IDD. We have also realized how much work needs to be done on all levels to ensure the most vulnerable are receiving proper oral care.
Chadwick, D., Chapman, M., & Davies, G. (2017, October 17). Factors affecting access to daily oral and dental care among adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities. Retrieved January 28, 2021 from https:/doi/org/ 10.1111/jar.12415
Wilson, N. J., Lin, Z., Villarosa, A., Lewis, P., Philip, P., Sumar, B., & George, A. (2019). Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review. BMC public health, 19(1), 1530. https://doi.org/10.1186/s12889-019-7863-1
Park, M.S., Sigal, M.J., (2008) The Role of Hospital-Based Dentistry in Providing Treatment for Persons with Developmental Delay. Journal of the Canadian Dental Association. www.cda-adc.ca/jcda/vol-74/issue-4/353.html
Ward, L.M., Cooper S.A., Hughes-McCormack L., Macpherson L., Kinnear, D. (November 2019) Oral health of adults with intellectual disabilities: a systematic review. Journal of Intellectual Disability Research. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jir.12632
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