Developmental Disabilities and Oral Health

Key Takeaways

• 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.
• Various disorders, such as tooth decay (caries), gum disease, malocclusion of the teeth and/or jaw, or oral infections, may cause oral health complications.
• 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.

How Can Disabilities Impact Oral Health?

Developmental disabilities can significantly affect a person’s general and oral health. Because certain disabilities can impair learning and physical activities, they may struggle with oral hygiene.

In some cases, they may not be able to communicate that they’re experiencing oral health problems and other conditions. If not addressed, their lack of oral care can lead to serious problems over time. 

On the other hand, physical disabilities can make it difficult to eat 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. Some illnesses with known oral health consequences include:

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Developmental Disabilities and Oral Health

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1. Autism

Autism spectrum disorder (ASD) encompasses many symptoms and causes. However, people on the autism spectrum often struggle with communication, repetitive behaviors, and highly focused but restricted interests.

People with ASD may struggle with their oral hygiene in a few ways, such as:

• Neglecting toothbrushing and flossing
• Failing to make or keep dental appointments
• Struggling to follow instructions during a dental appointment
• Struggling to cooperate with dentists and staff

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.

2. Cerebral Palsy

Cerebral palsy is a group of neurological disorders that mainly affect movement. It can often cause uncontrollable movements, poor balance, learning disabilities, and seizures.

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

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.

3. Dementia

Dementia is the cognitive decline many people experience as they enter old age. People with dementia may require regular care and supervision to ensure good oral hygiene and overall health.

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, dry mouth, and gum disease.

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.

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 a weaker immune system and are at a greater risk for particular health problems.

There aren’t any oral health problems unique to Down syndrome. However, they may have trouble cooperating in a dental office or maintaining a good oral hygiene routine, putting them at risk of:

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

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. 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)

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:

• Misalignment of the jaw and/or teeth
• Mouth breathing
• Temporomandibular joint issues (jaw locking and displacement)

Is It Difficult for People with Developmental Disabilities to Get Care?

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.

What’s the Outlook For People with Disabilities?

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.

For example, the 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.

Meanwhile, the treatment of management of CF have vastly improved over the past decade, even though there’s no cure for the condition. People with CF today have a life expectancy between 40 and 50 years.