People with intellectual disability die from potentially avoidable causes at twice the rate of the general population. Dental practitioners can play a key role in bridging this shocking healthcare gap. By Shane Conroy
People with intellectual disability are facing a health crisis in Australia. The potentially avoidable death rate for people with intellectual disability is double that of the general population.
That’s according to the Oral Health & Intellectual Disability guide for dental practitioners. It sets out a practical framework dentists can use to help achieve better oral and overall health outcomes for people with intellectual disability.
“The link between oral and overall health is clear,” says Dr Richard Zylan, a co-author of the guide and practice principal of Dynamic Dentistry Cosmetic and Restorative Dentists in Victoria. “Poor oral health including periodontal disease has been linked to cardiovascular disease, diabetes and other chronic health conditions.”
But for people with intellectual disability, the link between oral and overall health goes much deeper. Greater incidence of tooth extraction, for example, contributes to a range of nutritional and digestive disorders.
“Tooth extraction can cause difficulty chewing, which may lead people to choose softer, more refined foods,” says Dr Zylan. “These are often high in sugar, which contributes to obesity, cardiovascular disease and diabetes. We have even seen people with intellectual disability die from constipation.
“So every tooth we remove unnecessarily in this vulnerable population becomes a failing on everyone’s part and shouldn’t be considered as inevitable. Near enough is not good enough. We want people with intellectual disability achieving optimal health.”
Barriers to care
So what exactly is stopping people with intellectual disability from achieving optimal oral and overall health? Dr Zylan believes there’s a combination of factors at play. People with intellectual disability tend to have less access to financial resources. They may also have difficulty identifying and communicating symptoms with carers and healthcare providers, and may face challenges carrying out effective general and oral care programs at home.
Dr Zylan also points to systemic failures such as a lack of collaboration between GPs and dentists. “People with intellectual disability tend to present at their GP much more frequently than the general population, so often a visit to the dentist becomes a lower priority,” he says. “I was recently speaking to a parent of a person with intellectual disability who had taken her daughter to the GP at least 40 times within nine months. However, despite all those GP visits, gingivitis was obviously present—and undiagnosed. Oral health is sometimes just not part of the conversation with GPs.”
When many people with intellectual disability do arrive at the dentist, they face challenges there too. Communication difficulties and uncertainty around treatment protocols mean some dentists may be less likely to see people with intellectual disability.
And even when people with intellectual disability do receive appropriate oral healthcare, dental practitioners must be mindful of the patient’s at-home care network.
“People with intellectual disability may have multiple carers, all with different levels of commitment to the patient. There needs to be communication across the patient’s at-home care network to ensure a home oral care plan is being executed effectively. This is not always happening.”
Bridging the gap
The good news in all of this is that dental practitioners can certainly be part of the solution. The Oral Health & Intellectual Disability guide sets out a clear action plan and treatment pathway for dentists.
“While this is a serious problem, the solutions are quite simple,” says Dr Zylan. “Treating many people with intellectual disability is no different or any more complex than treating the typical patient who really dislikes going to the dentist or needs to rinse out frequently. Use clear language, engage with carers and GPs, and put in place proactive healthcare plans with regular reviews to ensure interventions are being effectively implemented.”
The Oral Health & Intellectual Disability guide also includes Oral Health Assessment and Home Oral Care planning forms that can be used to document oral healthcare plans and communicate your follow-up protocols with the patient’s GP and at-home carers. These are vital tools that Dr Zylan encourages all dentists to adopt as standard practice for their patients with intellectual disability.
On a larger scale, Dr Zylan is currently working as an adviser with Inclusion Melbourne to set up a Community of Practice (CoP). Inclusion Melbourne has already brought the issue of oral health and intellectual disability to the attention of the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability.
“In the short term, the CoP will identify, through collective problem solving, best-practice solutions for Australian dental professionals to include people with intellectual disability in their everyday practice,” says Dr Zylan. “The long-term applied objectives are to improve the oral health of people with intellectual disability and increase the volume of people with intellectual disability being treated in community dental and private dental practice settings.”
These are certainly achievable goals. Dr Zylan shares a story of treating a patient with intellectual disability at his own practice: “His parents had brought him in to have some teeth extracted under general anaesthetic (GA). But when I had a look, they actually were not too bad. I asked his parents why they wanted them extracted and why they wanted a GA. They told me that was what they had always been told to do in the past. I had a chat with the patient, and we decided to do some fillings instead—which we completed in the chair. It was no more difficult or complex than treating any other patient, and his mum and dad were rapt that we had avoided the need for a GA.
“Since then, they have also become patients of mine, along with the patient’s aunty and a couple of their friends. This is one of the wonderful aspects of treating patients with intellectual disability. It is personally fulfilling and appreciated by everyone involved.”