developmental disabilities dental care

Oral health is one of the essential assets of our overall health and well-being. This becomes exceptionally crucial for people with developmental disabilities. Developmental disabilities are characterized as adverse health problems that significantly affect the mental and physical capabilities of a person. Moreover, it can lead to behavioral changes, neuromuscular disorders, seizures, and allergic reactions.

Some of the common developmental disabilities include autism, down’s syndrome, cerebral palsy, and cleidocranial dysplasia. Studies have shown that around 1.2 million Americans at present suffer from some developmental or intellectual disability. Often these developmental disabilities affect the functions of the brain, body, and motor skills that a person uses daily.

Maintaining proper oral hygiene in such conditions can be very challenging. Often people with developmental disabilities may require a caregiver to look after their oral health and overall well-being. Today’s article will highlight the different types of developmental disabilities and their effect on oral health. Additionally, we will also look at some of the treatment options and preventive measures to maintain good oral health in people with developmental disabilities.

What is developmental disabilities?

Developmental disabilities are described as a diverse group of chronic health impairments that have a significant effect on the mental and physical abilities of a person.  Often people with developmental disabilities encounter difficulty in speaking, learning, moving physically, and living independently. (1)

A survey study revealed that around 52 million Americans suffer from a specific type of developmental disability. This includes a wide range of developmental disorders such as autism, cerebral palsy, down’s syndrome, muscular dystrophy, and visual or hearing impairments. The incidence of the developmental disease is twice higher in males as compared to females. Additionally, people who live in poverty are linked to having a higher prevalence of developmental disabilities.

What causes developmental disabilities?

A large portion of the causes behind developmental disabilities remain unknown, which often leads to difficulty in diagnosing the root problem of the disorder. However, research studies have revealed a link between genetic factors that may potentially cause developmental disability in a person.

Research studies have linked around 1000 known genetic conditions with developmental disabilities as one of their prime symptoms. Additionally, environmental factors have been a debatable cause that may contribute to developmental disabilities in an individual. (2) Often developmental disability in children is suspected to occur due to malfunction during child developmental stages. However, an exact source has not been identified.

What are the clinical features of developmental disability?

Several clinical features are associated with a developmental disability. Some of these features may be noticed during childhood, while others may become evident later in life. Some of the standard clinical features associated with developmental disabilities include the following –

Cognitive malfunctions

Typically, cognitive dysfunctions are one of the most common characteristics among children with developmental disabilities. These features mainly include mental retardation and learning disability. Such children often perform poorly in their academic curriculum. Moreover, they have a limited vocabulary.

The presence of intellectual deficit can cause difficulty in processing speech, reading, writing, and even understanding the language. However, excellent educational support can help the children to overcome the cognitive limitations. (3)

Physical limitations

People with developmental disabilities may experience difficulty in walking and moving their arms. Often people with cerebral palsy experience severe motor damage that can lead to spinal cord injury, poliomyelitis, congenital limb abnormality, and muscular dystrophy.

Visual and hearing impairment

Visual and hearing impairments become evident during adulthood and progress with age. The leading cause behind this disability is neuromuscular disbalance. The most common form of visual impairment that people encounter is a refractive error. Refractive error is an inability to focus light accurately onto the eye which causes blurry or double vision.

Behavioral changes

Behavioral changes are more common among children with developmental disabilities. It is essential to understand psychological effects do not necessarily cause behavioral changes in such conditions. Contributing factors like poverty, famine, and family disputes can affect the mental health of a child that leads to behavioral change. (4)

Often adverse behavioral changes may make the child timid and shy. It may also affect the academic achievement and family relationships of the child. Often children with behavioral changes find peace when they are alone.

What are some of the typical developmental disabilities?

Typically, four main types of developmental disabilities affect the oral health of the individual. Let’s take a closer look at them –

Down’s syndrome

Down’s syndrome is categorized as a genetic disorder in which an extra copy of the 21st chromosome is present. It mainly affects the orofacial and skeletal development. The typical physical characteristics of a person with down’s syndrome include the following –

  • Small head
  • Flat nose
  • Short fingers with excessive spacing between each finger on the hands and feet
  • Short stature
  • Round face

Oral signs and symptoms of down’s syndrome include –

  • Narrow dental arch
  • Large and protrusive tongue (5)
  • Fissured tongue
  • Reduced tooth size
  • Delayed tooth eruption
  • Hypodontia

Most often, people with down’s syndrome suffer from periodontal problems and tooth decay. Professional teeth cleaning and gum treatment is followed to maintain oral hygiene. Moreover, a comprehensive dental approach is taken to treat dental malocclusions.

Cerebral palsy

Cerebral palsy is a disorder that mainly affects the muscle coordination of the body caused by brain damage. People with cerebral palsy struggle with motor activities like walking, moving their hands, and speaking. Some people may experience difficulty in learning, hearing, and seeing. Dental problems associated with cerebral palsy includes –

  • Poor oral hygiene
  • Gum and periodontal problems
  • Traumatic injuries
  • Malocclusions
  • Bruxism and lip biting
  • Difficulty in speaking, chewing and swallowing
  • Tooth decay

Dental treatment in such cases includes preventative and prophylactic measures to maintain oral health and hygiene. A team of orthodontists and speech therapists may continuously work together with the patient to improve the quality of communication.

Autism

Autism is typically characterized as a neurological development disorder. People with autism are usually socially inactive and may feel overwhelmed in crowded places. However, behavioral therapy and constant moral support can help to overcome fear and anxiety. (6)

Dental problems associated with autism include –

  • Increased risk of tooth decay
  • Periodontal breakdown
  • Oral habits like lip biting, bruxism, and tongue thrusting
  • Gum overgrowth
  • Poor oral hygiene

The key to better patient cooperation is communication. Special needs medical professionals are well trained in building up a rapport with the patient and making them comfortable. Conscious sedation or general anesthesia can be used as adjuncts to ease the patient during the procedure. Every step and procedure are explained clearly to the patient. Usually, a symptomatic approach is followed to treat the malformations.

Cleidocranial dysplasia

Cleidocranial dysplasia is a developmental disorder that affects the bones and teeth. It is an inherited genetic disorder that involves defective RUNX2 gene that helps in bone development. Typical characteristics of cleidocranial dysplasia include the following –

  • Hypermobility of the joints
  • Protruded mandible
  • Supernumerary teeth
  • Loss of teeth or missing teeth
  • Delayed eruption
  • Bulging of the forehead
  • Underdeveloped bones of the face

Treatment mostly involves a supportive measure that helps to protect the integrity of skull bones. Dental care involves a preventative and prophylactic approach to reduce the risk of tooth decay and gum disease. Moreover, cosmetic dental therapy may be required to design the smile and replace the missing teeth. (7)

What effects does developmental disability have on dental health?

Some of the common dental defects that can occur due to developmental disabilities include the following –

Changes in tooth eruption

The process of tooth eruptions can be delayed, accelerated, or even remain inconsistent in people with developmental disabilities. This is because the eruption pattern often depends on the genetic development, growth of the jaw and muscular actions of the mouth.

Malocclusions

There is a wide range of malocclusions that can occur in children with special needs. Some of the common malocclusions include crowding, spacing, overjet, overbite, protruding front teeth, an improper bite. (8) Around 25% of the craniofacial abnormalities in children are always associated with some developmental disabilities. Excessive malocclusions affect the appearance of the child; moreover, it can lead to dental caries and gum disease.

Tooth abnormalities

The common tooth anomalies encountered in people with a developmental disability include variations in the size, shape, and number of teeth in the mouth. Some of the common disabilities that may reflect these abnormalities include down’s syndrome and cleidocranial dysplasia.

Developmental dental defects

Tooth discoloration, the formation of pits, and lines on the tooth surface are some of the common dental defects that are prevalent in such conditions. (9)

High risk of oral diseases and infections

People with developmental disabilities are twice more prone to dental caries as compared to others. The prime reason for the increased incidence of tooth decay can be frequent vomiting, dry mouth, medications, and a sugary diet. Additionally, poor oral hygiene can contribute to the development of dental caries. Oral viral infections like herpes simplex, herpes labialis, and gingivostomatitis mostly affect children and adolescents.

Bruxism

Children with behavioral changes often experience anxiety and nervousness. To cope up with their anxiety and fear, children develop the habit of bruxism or teeth grinding. This can lead to tooth abrasion and bite marks on the soft oral tissue. (10)

Gum problems

Gum disease is a common occurrence in children with disabilities. One of the prime causes of the increased incidence of gum disease is poor oral hygiene. Some of the common symptoms of gum disease include swollen gums, bleeding, tenderness, and redness. (11) Untreated cases of gum disease often progress to advanced periodontal problems wherein the risk of losing the tooth increases significantly.

Additionally, gingival overgrowth is another gum problem encountered frequently in people with developmental disabilities. This dental issue occurs as a result of medications like phenytoin sodium and cyclosporin. Gum overgrowths can impact speech and chewing ability, especially in children.

Who can treat dental problems in people with developmental disabilities?

Special needs dentist is the best professional to treat dental problems. Children and adults with special needs require dental check-ups and treatment more frequently as compared to others. A special needs dentist is well trained to interact with patients who are anti-social. Moreover, they work with immense empathy and passion for treating the patients and building long-term relationships. This allows the patients to develop a comfort level and increases the level of compliance. (12)

Special needs dentistry also ensures optimal dental healthcare and maintenance throughout the life of the individual. Moreover, every staff member is trained to tailor their service and approach to the patient’s additional needs.

What is the role of caregivers?

Special needs caregivers are trained professionals with the skills to communicate and build a long- term relationship with the patients. Additionally, special caregivers have the knowledge and experience in taking care of the individual, providing comfort and keeping a track of their medical requirements.

Special needs caregivers often act as the support system of a person with developmental disability. They make sure that the individual is healthy and safe. Moreover, they perform regular tasks such as cleaning, feeding and bathing the person with developmental disability. Some of the activities performed by a special caregiver are listed below –

  • Daily grooming of the patient
  • Monitoring their health and provide medications on time as per the prescription
  • Managing every meal of the day
  • Housekeeping
  • Assist with mobility
  • Build a friendly environment

Overview of developmental disabilities

Developmental disabilities are characterized as a chronic group of illnesses that mainly affect the mental and physical capabilities of a person. Developmental disabilities often pose a long-term effect on the overall health and well-being of the individual. Some other issues related to developmental disabilities include hearing and visual impairment, seizures, behavioral changes, allergic reactions, and neuromuscular problems. Coming to the dental aspects, people with developmental disabilities experience increased the incidence of tooth decay, gum disease, tooth nobility, poor oral hygiene, bad breath, and oral malformations.

Some of the common developmental disabilities with dental effects include cerebral palsy, autism, down’s syndrome and cleidocranial dysplasia. It is essential to not only focus on the systemic health status of the person but also to look after the oral health and hygiene. Most people with developmental disabilities cannot take care of their oral health by themselves. In such cases, caregivers can play a significant role in ensuring the proper hygiene and welfare of the individual.