Abstracts in Developmental Dentistry

AADMD INFO BLAST - FOR AADMD MEMBERS

Here is the latest installment of the ongoing AADMD Dental Abstracts. Our thanks and appreciation to our colleague Dr Barry Waldman the AADMD's Dental Abstracts Editor.

Dr. Waldman

Rick Rader, MD, AADMD

Smith BJ, Ghezzi EM, Manz MC, Christiana P. Markova CP. Oral healthcare access and adequacy in alternative long-term care facilities. Special Care Dentistry 2010;30(3):85-94.

This study was undertaken to determine practices and perceived barriers to access related to oral health by surveying administrators in Michigan alternative long-term care facilities (ALTCF). A 24-item questionnaire was mailed to all 2,275 Michigan ALTCF serving residents aged 60+. Facility response rate was 22% Eleven percent of facilities had a written dental care plan; 18% stated a dentist examined new residents; and 19% of facilities had an agreement with a dentist to come to the facility, with 52% of those being for emergency care only. The greatest perceived barriers were willingness of general and specialty dentists to treat residents at the nursing facility and/or private offices as well as financial concerns. Substantial barriers to care were uniformly perceived. Oral health policies and practices within Michigan ALTCF vary, as measured by resources, attitudes, and the availability of professional care. There is limited involvement by dental professionals in creating policy and providing consultation and service.

Thole K, Chalmers J, Ettinger RL, Warren J. Iowa intermediate care facilities: An evaluation of care providers' attitudes toward oral hygiene care. Special Care Dentistry 2010;30(3):99-105.

This study investigated the oral hygiene care (OHC) activities and attitudes of care providers in Intermediate Care Facilities for the Mentally Retarded (ICF/MR) in the state of Iowa. Questionnaires were distributed to care providers employed at three ICF/MRs. About 98% of the staff ranked OHC as important to extremely important for residents. Twenty-three percent disliked OHC occasionally or more frequently. Lack of time and lack of staff were the main reasons preventing care providers from assisting residents with OHC. Residents' behaviors resulted in inadequate OHC for 64.9%, and 49% of residents required complete assistance with OHC. Most common OHC difficulties reported were residents biting the toothbrush, refusing OHC, or not opening their mouths. Subjects reported spending 3.0 minutes brushing a resident's teeth and 3.0 minutes cleaning dentures. Care providers experienced significant behavioral and physical difficulties while providing OHC, but still found OHC important. Training programs for care providers are needed to address these difficulties.

Anders PL, Davis EL. Oral health of patients with intellectual disabilities: A systematic review. Special Care Dentistry 2010;30(3):110-117

A systematic review of original studies was conducted to determine if differences in oral health exist between adults who have intellectual disabilities (ID) and the general population. Electronic searching identified 27 studies that met the inclusion criteria. These studies were assessed for strength of evidence. People with ID have poorer oral hygiene and higher prevalence and greater severity of periodontal disease. Caries rates in people with ID are the same as or lower than the general population. However, the rates of untreated caries are consistently higher in people with ID. Two subgroups at especially high risk for oral health problems are people with Down syndrome and people unable to cooperate for routine dental care. Evidence supports the need to develop strategies to increase patient acceptance for routine care, additional training for dentists to provide this care, and the development of more effective preventive strategies to minimize the need for this care.

Waldman HB, Cannella DL, Perlman SP. Mental illness is also a disability--even for children. Alpha Omegan 2010 Mar;103(1):29-33.

The enactment of the 2008 Mental Health Parity and Addiction Equity Act was a major step in an effort to eliminate health insurance benefit inequity between mental health/substance use disorders and medical/surgical benefits. But individuals and their families may not seek needed care as mental illness could still remain an unrecognized disability, especially among children. The extent of the problem, related symptoms, some approaches for care and the involvement of dental practitioners are considered.

Waldman HB. Wong A. Perlman SP. Arizona is an “aging state”: is your practice ready? Journal of the Arizona Dental Association 2010;4:34-37.

The growth of the general population of Arizona and the proportion of seniors continues to outpace the national growth rate. The use and needs for dental services by the senior population, including those with disabilities, are considered in an effort to raise an awareness of this population that increasingly lives in our communities and is dependent upon local practitioners for treatment.

Waldman HB. Perlman SP. Disability and rehabilitation: do we ever think about needed dental care? A case study: the USA. Disability and Rehabilitation 2010;32(11):947-951.

A case study of the USA is used to illustrate the evolving community residential settings for individuals with disabilities and the resulting complexities in the delivery of health services. Examples of oral health conditions frequently present in individuals with disabilities are provided. National and local reports indicate that barriers exist in the delivery of oral health services for individuals with intellectual/ developmental and later life disabilities. Oral health care is a component of rehabilitation, as long as the pain erodes energy and aspirations of individuals with disabilities. Health practitioners, in the many fields that provide care to individuals with disabilities, can play a critical role in developing an awareness of, and referrals for, necessary oral health care.