By: Munir Gomaa
A few weeks ago, several of my dental school classmates and I were privileged with the opportunity to volunteer at a local resource center that provides community-based, educational services to students with severe developmental disabilities. The majority of these students, ranging from 3 to 21 years of age, have profound mental retardation that significantly impairs their ability to perform simple daily tasks, such as eating and drinking, communicating, and, of course, brushing and flossing. My colleagues and I spent the morning performing oral-health screenings on these children, making referrals to our school’s clinic for emergent care when necessary. Our time with each patient was brief. Screenings were performed in a small classroom–many were in wheelchairs as we performed one-minute examinations whenever possible, often only catching a glimpse or two of the oral cavity.
To nobody’s surprise, the oral-health of most of these students was amongst the poorest we’ve seen in children since we began treating patients a year ago. A plethora of dental problems were noted, ranging from neglected oral hygiene and severe tooth wear to rampant tooth decay and non-restorable teeth. Many of these children will require dentures as young adults, suffering from the reduced chewing efficiency by at least 50% that is typically associated with these prostheses. That’s not to mention the enormous difficulty even mentally healthy patients undergo for the first few months of wearing dentures, which include relearning to eat and speak, just as one with a prosthetic leg must relearn to walk. Envisioning the countless oral-health problems these children must overcome in addition to the physical and mental impairments they already experience daily is heartbreaking.
And yet, dental diseases such as caries and periodontal disease are among the most preventable chronic diseases one can be inflicted with through proper oral hygiene, a healthy diet, and regular visits to the dentist. If we had the similarly cheap and effective knowledge and resources for treating diabetes or cancer, there’s almost no doubt that the incidence of these diseases would decline substantially. This isn’t to imply that dental diseases are comparable in magnitude to these life-threatening diseases, however most people are simply unaware of the systemic impact, both physiological and psychological, that one’s dental health has been shown to have. Most people don’t know that periodontal disease has been shown to have significant associations with cardiovascular disease (including stroke and coronary heart disease), diabetes mellitus, bacterial pneumonia, low birth-weight babies and pre-term births. They haven’t a clue that the cavities in their mouths have been significantly linked with hepatitis, hypertension, asthma, stroke, liver disease and diabetes. If they did, dental caries surely would not remain the most prevalent chronic disease in both adults and children. Periodontal disease wouldn’t be affecting nearly 50% of all adults and 70% of adults 65 and up. 1 in 4 adults over the age of 60 wouldn’t have lost all of their natural teeth.
Despite these alarming statistics, recent times has shown a large decline in dental disease, due to factors such as water fluoridation and oral health promotion. However, research has reliably shown that those who suffer from severe mental illness have not shared in these improvements. This population has suffered and will always continue to suffer from a greatly increased risk of oral disease due to a number of factors, such as xerostomia (dry-mouth) commonly associated with psychotropic medications, tobacco and drug usage (over a third of those with any behavioral disorder in the US smoke cigarettes), significant fear and anxiety associated with the dentist, lack of oral-hygiene knowledge and habits, poor living conditions that negatively impact their diet, etc. The list really does go on and on, and every additional factor places this particular population at a much larger risk than the general population. Mentally-challenged or not, the more oral-health problems one has, the more fear and anxiety of the dentist typically overpowers them, and the less willing they are to make a trip to the dentist, let alone allow a dentist to treat them. And yet, this topic remains largely unspoken as the vicious cycle continues.
What initiatives are being taking to target the oral epidemic that exists in special needs patients? Why isn’t it working? And most importantly, what can be done to make a real difference for this at-risk population? Research over the past few decades begins to shed light on these questions, and the answers can be rather frustrating. I’ll share all this along with my ideas shortly.