Developmental Disabilities and Oral Health

How Can Disabilities Impact Oral Health?

Developmental disabilities can significantly impact a person’s general and oral health. Certain disorders can impair learning and physical capabilities, making language and everyday tasks difficult.

Maintaining good oral hygiene at home may be challenging or impossible for people with these conditions, possibly leading to serious oral health issues over time.

Physical disabilities can affect oral health in other ways as well. For example, they may make eating difficult or reduce saliva flow. These effects can further lower someone’s level of oral health and limit their oral hygiene.

6 Conditions Associated with Oral Health Challenges

A wide variety of disabilities or chronic health conditions can make oral hygiene hard to maintain or otherwise impact oral health.¹

Some illnesses with known oral health consequences include:

1. Autism

Autism spectrum disorder (ASD) encompasses many symptoms and causes. However, some common traits of people on the autism spectrum include:

• Difficulty with verbal and non-verbal communication
• Repetitive behaviors (this may consist of keeping a strict routine or reacting poorly to change)
• Highly focused but restricted interests

People with ASD may struggle with their oral hygiene in a few ways:²

• They may neglect regularly brushing and flossing
• They may fail to make or keep dental appointments
• They may have trouble cooperating in a dental office
• They may find instructions during a dental visit challenging to follow

In some cases, moderate to severe ASD may require sedation dentistry. However, many people with mild ASD, including children, have little or no problem with dental visits or regular oral hygiene.³

2. Cerebral Palsy

Cerebral palsy is a group of neurological disorders that mainly affect movement. Symptoms vary but can include:

• Uncontrolled movements
• Poor balance
• Seizures
• Learning disabilities

Some people can have mild cerebral palsy that doesn’t prevent them from performing typical daily activities. In severe cases, however, someone with cerebral palsy may require constant assistance.⁴

People with cerebral palsy may be at risk of poor oral health outcomes due to:

• Lack of regular oral hygiene due to poor motor control
• Habits such as mouth breathing and tongue thrusting
• Difficulty swallowing (dysphagia), leading food to stay in the mouth for longer

These issues can lead to tooth decay, gum disease, and tooth and jaw misalignment. Orthodontic treatment may also be more difficult for people with cerebral palsy.⁵

3. Dementia

Dementia is the cognitive decline many people experience as they enter old age. Various conditions can cause or contribute to dementia; sometimes, the deterioration is severe.

Older people with dementia are less likely to care for themselves properly, which may weaken their motor skills. As a result, they have higher rates of:

• Plaque and tartar buildup
• Tooth decay
• Signs of gum disease, such as gum bleeding and deep gum pockets
• Dry mouth due to low salivary flow

These issues can lead to tooth loss, loss of bone tissue, and potentially severe infections. It’s also possible that poor oral health may increase your risk of dementia in the first place, but more research is needed.⁶

People with dementia may require regular care and supervision to ensure good oral hygiene and overall health.

4. Down Syndrome

Down syndrome, or trisomy 21, is one of the most common genetic disorders. It occurs due to a third copy of chromosome 21 (people generally have just two).

This extra chromosome changes how a child’s body and brain develop, causing physical and mental challenges throughout life. People with Down syndrome typically have:⁷

• Stunted growth
• Mild to moderate intellectual disability
• Distinctive facial features
• A weaker immune system
• Greater risk for particular health problems

There aren’t any oral health problems unique to Down syndrome, but people with the condition are at an increased risk for issues like:

• Periodontal disease (partly due to poor immune function)
• Open bite (due to muscular and skeletal defects)
• Bruxism

Children with Down syndrome may require extra help and supervision to ensure good oral care at home. They may also have trouble cooperating in a dental office.

However, children with Down syndrome are at lower risk for tooth decay than the average child.⁸ Their smaller teeth make it easier to avoid plaque buildup, and their diets are usually strictly managed.

Life expectancy and quality of life for people with Down syndrome have increased with improved medical knowledge and care. People with Down syndrome can live to be 60 or older with adequate care and assistance.

5. Cystic Fibrosis

Cystic fibrosis (CF) is a rare genetic condition affecting multiple body organs, especially the lungs. The pancreas, heart, liver, and other organs are also affected.

CF causes the body to produce sweat and mucus differently. People with CF have thicker, stickier mucus, which causes chronic and severe lung problems.

People with CF have a higher risk of specific oral health issues and a lower risk of others.^9,10 This is because of their genetics and respiratory problems, as well as their treatment and diet. For example, people with CF:

• Often have enamel defects, which can affect the appearance
• Have a greater risk of developing oral thrush (candidiasis)
• May have lower rates of cavities and gum bleeding (possibly due to high levels of dairy in their diet, as well as frequent antibiotics)¹⁰

CF has no cure, but treatment and management have vastly improved over the past several decades. People with CF today have a life expectancy between 40 and 50 years.

6. Muscular Dystrophy

Muscular dystrophy includes multiple genetic illnesses that cause a person’s muscles to degenerate over time. Various parts of their body become weaker over time as muscle tissue gets replaced with connective tissue.

People with certain kinds of muscular dystrophy may suffer from weakened facial, jaw, and throat muscles. This weakening can lead to oral health complications such as:¹¹

• Misalignment of the jaw and/or teeth
• Mouth breathing
• Temporomandibular joint issues, such as jaw locking and displacement

People with muscular dystrophy often eventually need wheelchairs and assistance due to progressive muscle loss. Medication and other treatments can help improve their quality of life, but no known cure exists.

Outlook

Different conditions have different outlooks, and no two people are precisely the same. Improved care, education, and treatment methods can reduce oral health complications due to physical and intellectual disabilities.

According to Dr. Nandita Lilly, people with disabilities experience more significant barriers when accessing oral health care. Fortunately, the Americans with Disabilities Act provides helpful direction for health professionals.

It ensures healthcare professionals make their practices more accessible to people with disabilities. As an example, the law requires dental operatories to be wheelchair-accessible.

Summary

Genetic conditions can affect oral and overall physical health in various ways. Some people may struggle with regular oral care due to cognitive or physical limitations. They may also experience issues with saliva flow, eating, and breathing.

These disorders may cause oral health complications such as:

• Tooth decay (caries)
• Gum disease
• Malocclusion of the teeth and/or jaw
• Oral infections
• Enamel defects
• Missing teeth

With adequate care, many people with developmental disabilities can maintain good oral health. If you or your child have one of these conditions, special needs dentists may be available in your area.