Physical Disabilities and Oral Health

About 1 in 4 adults in the US (61 million people) live with a disability.¹ 

A disability is any condition that affects the body or mind and limits the person’s ability to do certain activities. Disabilities can affect all areas of life, including physical and emotional health. 

Some people with disabilities, however, are prone to poor health, including oral health, and often require special health care.

This article describes how physical disabilities affect oral health. It also provides ideas for promoting oral health in people with disabilities.

What Are Physical Disabilities?

Physical disabilities limit a person's mobility, stamina, and physical functioning. A physical disability can be related to conditions present at birth, injuries, and chronic or progressive diseases. Mobility problems often make it difficult for people to do daily tasks on their own, such as:

• Practicing dental hygiene like teeth brushing and flossing
• Getting dressed
• Eating and preparing food
• Moving around
• Working
• Reaching for objects
• Bathing and showering

Some people have a mouth disability, which impairs mouth movements like chewing and swallowing.

What Are Intellectual and Developmental Disabilities?

People with intellectual and developmental disabilities may have mobility problems. This can cause challenges in obtaining proper oral health care.

Intellectual Disabilities

Intellectual disabilities affect a person’s cognitive functioning. This includes learning, reasoning, and judgment.

People with intellectual disabilities may be unable to access dental services and care for their oral health. They may need help handling money, scheduling dental visits, and practicing oral hygiene at home. 

Developmental Disabilities

Developmental disabilities appear in childhood and usually persist throughout life. A developmental disability can cause physical, intellectual, and behavioral impairment.

Common disabilities diagnosed in children include:

• Autism spectrum disorder (ASD)
• Attention-deficit/hyperactivity disorder (ADHD)

How Do Physical Disabilities Affect Oral Health?

People with physical disabilities are more likely to have poor oral health than the general population.² 

They’re more prone to several oral health problems, including:

• Cavities
• Gum disease
• Tooth enamel defects 

Why Are People with Disabilities More Prone to Poor Oral Health?

Mobility issues can create oral health care barriers for people with disabilities. They may be unable to:

• Grasp a toothbrush
• Move their hands to clean their teeth
• Get to the dental office
• Sit in a dental chair

Dental Conditions Associated with Physical Disabilities

Common physical disabilities that may lead to adverse oral health outcomes include:

Spinal Cord Injuries

Up to 500,000 people suffer from spinal cord injuries worldwide every year. Many people with a spinal cord injury are partially or completely paralyzed. 

Due to limited mobility, people with a spinal cord injury can experience oral health complications. Arm weakness and impaired mobility cause poor hand function, so they rely on others to care for their teeth.

Additionally, many spinal cord injury medications cause dry mouth (xerostomia). Dry mouth increases the risk of cavities and gum disease over time. 

Cerebral Palsy (CP)

Cerebral palsy (CP) is a physical disorder that affects muscle coordination and body movement.

People with CP have a higher risk of developing oral health issues due to poor oral hygiene.

These problems may include:

• Delayed eruption of permanent teeth
• Gingivitis and gum disease
• Tooth decay and cavities
• Mouth breathing, which can lead to cavities and bad breath
• Dental erosion due to gastroesophageal reflux (GERD)
• Malocclusion (misaligned teeth) from tongue thrusting
• Enamel hypoplasia (tooth enamel defects)
• Bruxism (teeth grinding)
• Increased risk of dental injuries or trauma

Muscular Dystrophy

Muscular dystrophy is a rare group of genetic diseases. It causes severe muscle weakness and difficulty breathing and swallowing.

People with advanced muscular dystrophy can’t brush or floss their teeth without help. They have a higher risk of developing oral health conditions, including:

• Cavities (dental caries)
• Tooth decay
• Gingivitis and periodontal disease

Cystic Fibrosis (CF)

Cystic fibrosis (CF) is a chronic, genetic respiratory disorder that results in poor lung function. It’s present at birth, but it’s not considered a physical disability until the child is older.

Children with CF may experience oral health problems, such as:

• Enamel defects
• Tooth decay and cavities
• Increased calculus (hardened plaque) buildup 

Other Physical Disabilities

Other common disabilities that can negatively impact a person’s oral health due to limited mobility include:

Amputation

Amputation is the removal of a limb due to an illness, accident, injury, disease, or surgery. It can make it difficult to perform daily activities, such as walking or eating.

Regularly brushing your teeth may also be difficult. This increases the risk of cavity formation and other oral infections. 

Back Injuries

People with back injuries may become partially or completely paralyzed. Family members or other people often take charge of their at-home oral care routine.

Some medications for back injuries can also cause dry mouth and cavities.

Multiple Sclerosis (MS)

Multiple sclerosis (MS) damages the brain and central nervous system (CNS). 

Symptoms include:

• Fatigue
• Impaired coordination
• Severe pain
• Vision loss

Due to these limitations, people with MS have a higher risk of developing cavities and gum disease. 

How to Improve Oral Health for People with Disabilities

Many people with disabilities have limited access to oral health care. This is especially problematic because oral health is linked to overall health.

Here are some things dental professionals, other health professionals, and family members can do to help improve oral health for people with disabilities:

Make the Dental Office Accessible

To attend regular dental visits, a person must be able to get to the office. Dental offices should be accessible to people who use a wheelchair.

This includes suitable parking spaces for vehicles that transport people in wheelchairs and access to the clinic.

A wheelchair lift and tilt device can help people who can’t transfer to a dental chair from their wheelchair. The device allows dentists and dental hygienists to perform treatment in the lifted and tilted wheelchair.

Adapt At-Home Oral Care

Some people with disabilities rely on family members and caregivers to help them manage their oral health at home.

If someone you care for is having trouble cleaning their teeth, here are some ways to help:

• Get adaptive hand grips for manual toothbrushes
• Use an electric toothbrush instead (requires less movement)
• Ask their dentist for advice on tooth brushing and general oral health care 

Summary

Disabilities are common, and they affect a person’s ability to perform certain activities. There are many types of disabilities, including physical, intellectual, and developmental.

People with disabilities are more likely to have oral health problems. For those with physical disabilities, this can be due to mobility restrictions. Some medications used to treat conditions that cause disabilities can cause dry mouth, a risk factor for tooth decay. 

Improving access to dental treatment and accommodating oral hygiene at home are key factors in promoting oral health in people with disabilities.