Physical Disabilities and Oral Health

Dental Conditions Associated with Physical Disabilities

Physical disabilities limit an individual’s mobility, stamina, and physical functioning overall. These disabilities make it difficult, or impossible, for patients to complete daily activities on their own. This includes getting dressed, eating, and even moving around. Many people with physical disabilities either have limited mobility or cannot walk at all. As a result, they may need a wheelchair, crutches, or additional assistance. 

Due to these limitations, people with physical disabilities are more likely to develop oral health complications, such as cavities, gum disease, and dental defects. Common physical disabilities that may lead to adverse oral health outcomes include, but are not limited to:  

Spinal Cord Injuries (SCI)

Up to 500,000 people suffer from spinal cord injuries (SCI) around the world every year. The injuries are typically caused by trauma, such as falls, sports, or car accidents. Depending on the severity, many people with an SCI are partially paralyzed or completely paralyzed, which makes performing daily activities extremely difficult. 

Due to these limitations, patients may also experience oral health complications. For example, arm weakness and impaired mobility cause poor hand function, so they rely on others to take care of their teeth. Lastly, many SCI medications cause dry mouth (xerostomia), which increases the risk of developing cavities and gum disease over time. 

Cerebral Palsy

Cerebral palsy (CP) is a physical disorder that affects muscle coordination and body movement abilities. It forms due to irregular brain development and typically originates before birth. Although, it can develop in the prenatal period, perinatal period, or during infancy. Characteristics of this disorder include slow or involuntary muscle movement, exaggerated reflexes, low muscle tone, and poor coordination. 

People with cerebral palsy have a higher risk of developing oral health issues due to poor oral hygiene. Conditions may include:

• Delayed eruption of permanent teeth
• Gingivitis and periodontal disease
• Dental caries (cavities)
• Mouth breathing, which can lead to cavities and bad breath
• Dental erosion, due to gastroesophageal reflux (GERD)
• Tongue thrusting, which can lead to malocclusion (misaligned teeth)
• Enamel hypoplasia (defective enamel) that can lead to dental decay 
• Bruxism, which is excessive teeth grinding (typically during sleep)
• Increased risk of dental injuries or trauma

Muscular dystrophy

Muscular dystrophy is a rare group of genetic diseases that result in severe muscle weakness and, eventually, muscle loss. Over time, people with this disability are unable to walk and need a wheelchair as the muscles deteriorate. Besides extreme muscle weakness, other symptoms of this condition include trouble swallowing and breathing. 

Lastly, patients with advanced muscular dystrophy cannot brush or floss their teeth without help. So, they have a higher risk of developing oral health conditions. This includes increased calculus buildup, dental caries, gingivitis, and periodontal disease. 

Cystic fibrosis (CF)

Cystic fibrosis (CF) is a chronic and genetic respiratory disorder that results in poor lung function. The condition is present at birth but is not considered a physical disability until the child is older. Common symptoms of CF include coughing up mucus, frequent lung infections, and breathing difficulties. Over time, the lungs become permanently damaged. The pancreas, livers, and kidneys may be affected as well.

Additionally, an individual may experience oral health complications, such as:

• Enamel defects, particularly enamel opacities, that appear as white spots in the middle of tooth crowns. Risk factors of opacities include dental erosion and cavities. 
• Increased calculus (hardened plaque) buildup that results in cavities and periodontal issues. 

Other Physical Disabilities

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

• Amputation — this is the removal of a limb due to an illness, accident, injury, disease, or surgery. Depending on the type of amputation, it may be difficult to perform daily activities, such as walking or eating. In addition, brushing your teeth regularly may also be difficult, which increases the risk of cavity formation and other oral infections. 
• Back Injuries — similar to spinal cord injuries, people with back injuries may become partially paralyzed or completely paralyzed. Often times, other people are in charge of their at-home oral care routine. Some medications for these injuries can also cause dry mouth and cavities. 
• Multiple Sclerosis (MS) — this is a disease that damages the brain and central nervous system (spinal cord). Over time, people with MS may become disabled. Symptoms include fatigue, impaired coordination, severe pain, and even vision loss. Due to these limitations, people with MS have a higher risk of developing cavities and gum disease.