SCDA Policy Statements

The Role of Oral Health in the Overall Health of
Individuals with Special Needs

Purpose:

SCDA believes the oral health of individuals with special needs can have a direct affect on the overall health of that person and adequate oral care should be accessible to everyone.

Methods:

A consensus forum titled Issues and Opportunities in Special Care Dentistry was held at the 23rd annual meeting of the Special Care Dentistry Association. The goal of this forum was to develop a policy statement focused on the impact that oral health in individuals with special needs has on their general health.

Three presenters representing dentistry, medicine and public policy provided an overview of the issues and concerns regarding oral health and general health in persons with special needs. This was followed by round table discussions where moderators directed the discussion through a series of questions designed to get information which could be used to form the policy statement. The speakers circulated among all of the tables to answer questions which may have come up during their presentations and to participate in the discussions.

The questions used to stimulate the conversations and focus the comments included:

How can we effectively define the problem that oral health impacts general health, especially for patients with special needs?

What are some specific examples where oral health impacts general health, especially for patients with special needs?

What barriers contribute to these situations?

Who needs to hear this message?

How do we get the message out?

The comments were all collected at the end of the session and organized in a master document. The information provided by the participants was used to formulate SCDA’s policy on the importance of good oral health in the overall health of individuals with special needs. The policy statement was developed entirely from the expert opinions and experiences of the attendees.

Background:

The mouth is a part of the body and diseases which affect the oral cavity can impact the overall health of an individual. Multiple diagnoses and medications which may be present in persons with special needs can make an individual more susceptible to oral diseases due to the lack of ability to perform basic oral hygiene or the decreased ability to fight an infection. In addition, access to care may be limited giving time for small problems to become more invasive and more difficult to manage. A comprehensive oral evaluation as part of an initial medical work up would identify existing dental problems which could be included in the overall care plan for that individual. Many standard forms exist for documenting oral health status and could be incorporated into the medical record. Another advantage of identifying and treating problems early, beside the health benefit to the individual, would be the cost savings. Managing dental problems in an emergency room is a very expensive and less than ideal place to provide dental care.

There have been many examples of how the mouth affects the rest of the body. The twelve year old boy who died from a brain abscess which was due to a dental infection is one prominent case. However, there are many cases occurring among people with special needs that do not get media attention. A renal transplant patient was not able to receive an available kidney because of a dental abscess. A patient with prostate cancer who was having fevers was eventually diagnosed with a dental infection as the cause rather than the cancer. The fevers resolved after the dental problem was treated. And a patient admitted to a geriatric hospital with back pain had a high white cell which was noted on routine blood work. The medical work up was negative, but an astute geriatric fellow who had the benefit of a dental rotation made a referral for a dental evaluation and a dental abscess was diagnosed and treated.

There have been many studies linking oral disease to systemic diseases such as diabetes, cardiovascular disease and respiratory disease, but the adverse affects of dental problems sometimes extend to behavior. Pain from a tooth or ill fitting denture, especially in individuals with dementia, may not only cause the person to stop eating but can also manifest as changes in behavior. Resolution of the pain will often cause the behavior to return to baseline which may have significant implications for the overall car e of the individual. The ability to care for a resident in an institution is enhanced by cooperative behavior. Uncooperative or combative residents require additional staff and time to provide proper care which may mean increased cost. Care providers should be aware that a sudden change in behavior or decreased nutritional intake can be an indication of a dental problem.

Unfortunately, many barriers exist to providing dental care to individuals with special needs. Finances and transportation are commonly cited as major obstacles to accessing oral care, but these are not the only barriers present. Education was proposed as a problem and a solution. If family and care providers do not recognize the importance of proper oral care, then it is unlikely that routine dental care will be provided. All of the staff in a facility, from aides to administrators, must recognize that the mouth is an important part of the body and daily oral care deserves the same attention that bathing and toileting receive. Education also includes training the professionals who can provide dental care institutional settings. And just as important is educating the public and legislators to understand and value the importance of proper oral health and recognize the impact that poor oral health can have on the general health of an individual.

POLICY STATEMENT

The oral health of an individual with special needs can have a direct impact on the overall health and well being of that person. Poor oral health can adversely affect quality of life due to chronic infection or pain, and could also result in increased healthcare costs. Documentation of oral health status should be part of the medical record and dental problems should be part of the individual’s problem list. All care providers and the general public should be educated about the importance of proper oral care and all individuals with special needs should have access to the same level of dental care that is available to the general public.

*This policy statement is based completely on the expert opinions and the extensive experience of the professionals who participated in the consensus conference held at the 23rd annual meeting of the Special Care Dentistry Association held in 2011 in Chicago, Illinois.