Developmental Disabilities & Oral Health

Developmental disabilities can cause challenges to an individual’s oral health.

Developmental disabilities, also called intellectual and developmental disabilities or IDDs, are a group of conditions that usually begin at birth or in childhood. They are caused by physical, cognitive, learning, and/or behavior impairments.

People with developmental disabilities may find themselves at a disadvantage when it comes to oral health. Studies show that people with IDDs are at higher risk for dental and oral health problems.¹ There are many reasons for this.

Preventative dental care, such as a flossing and brushing routine, can be difficult to carry out regularly for those with IDDs. Additionally, some of the chronic health problems experienced by those with developmental disabilities, like diabetes, can also cause oral health problems.

Some dentists are also unequipped to deal with the special needs of a patient with a developmental disability. This can make it harder for an individual with IDD to find a practitioner who can provide quality care.

Prevalence of Developmental Disabilities

In the U.S., about one in six children will experience developmental disabilities or developmental delays.

People with developmental disabilities from birth or childhood usually struggle with them throughout their lives and into adulthood. About 5 million people in the U.S. have a developmental disability.

These conditions can have an impact on day-to-day life and also on health. Not only are people with developmental disabilities more likely to struggle with certain health problems, but they also may experience difficulty in performing tasks and routines that may help to prevent certain health problems.

What Are Common Developmental Disabilities?

There is a wide range of developmental disabilities, which are identified in someone before they reach the age of 22.

The most recognized developmental disabilities are intellectual disabilities, such as Down syndrome, cerebral palsy, and autism spectrum disorder.

These are other developmental disabilities:

• Bipolar disorder

• Attention deficit hyperactivity disorder

• Traumatic brain injury

• Learning disabilities

• Fragile X syndrome

• Williams syndrome

• Seizure disorders

• Neural tube defects

• Tourette syndrome

Oral Health Challenges Faced by Individuals with Developmental Disabilities

Because of the wide range of developmental disabilities, the dental and oral health challenges faced by individuals with IDDs will vary greatly based on the individual and their condition. It will also depend on factors like their living situation, age, and access to resources.

These are some common challenges:

• Mental capabilities: Some individuals may be unable to understand how to care for their teeth and dental health or why doing so is important.

• Behavior problems: Feelings of anxiety or frustration about a dentist visit or daily dental care can result in behavioral problems like anger, acting out, or refusing to cooperate.

• Neuromuscular issues: Muscular problems that affect the mouth can cause oral health problems and make daily dental and oral health care more difficult. These neuromuscular issues include drooling, gagging, swallowing problems, and tight or loose chewing muscles.

• Physical problems: Conditions like seizure disorders or uncontrolled body movements can result in an individual biting their cheek or chipping their tooth. Gastroesophageal reflux, which is common in central nervous system disorders like cerebral palsy, can cause tooth erosion.

• Visual and audio problems: Many individuals with developmental disabilities also have an auditory or visual impairment, which can also cause difficulties in oral care.

• Mobility problems: Some individuals with developmental disabilities may require a wheelchair or special accommodations for dental visits and to be able to perform oral health routines.

• Limited access to resources: A large percentage of individuals with developmental disabilities live in group homes, and approximately 35 percent depend on community services. Available dental services may be scarce or minimal. For many, dental care needs are not met due to a lack of adequate preventative care, necessary services, and restorative treatment.

• Medications: Some medications that are taken by individuals with developmental disabilities may cause dry mouth or other dental issues.

• Diabetes: A high percentage of individuals with developmental disorders suffer from diabetes. The high blood sugar caused by diabetes can weaken the white blood cells that fight off plaque and bacteria in the gums, increasing the risk of gum disease and tooth decay.

Oral Health Conditions Associated with Developmental Disabilities

Because of the challenges listed above, and because individuals with developmental disabilities are more prone to certain chronic health conditions that can also affect their oral health, some known oral health conditions are associated with developmental disabilities. These include the following:

• Tooth decay: There are many factors that make tooth decay so prevalent among individuals with developmental disabilities.

  A lack of preventative care, along with a high occurrence of uncontrolled chronic conditions like diabetes which can affect dental health, contribute to the high rate of tooth decay. This can ultimately cause other health problems and result in tooth loss.

• Gum (periodontal) disease: The same factors that result in tooth decay can also lead to gum problems and gum disease, which is caused by the bacteria in plaque. Overgrowth of this bacteria irritates the gums, causing inflammation.

  This can lead the gums to separate from teeth, allowing pockets of plaque to form and create further inflammation. Eventually, this can damage the bone structure of the tooth and lead to tooth decay and tooth loss.

• Malocclusion: This is prevalent among individuals with developmental disorders.² It means that the upper and lower teeth don’t align when the mouth is shut. It can increase the risk of gum disease and oral trauma.

• Damaging oral habits: Issues like tooth grinding, mouth breathing, and tongue thrusting may occur in individuals with IDDs at higher rates. These habits can lead to tooth erosion and damage.

Why Is Good Oral Health So Important for Individuals with Developmental Disabilities?

Because people with developmental disorders are at a higher risk of experiencing chronic health conditions that may not be treated appropriately due to a lack of resources or ongoing care, it is especially important that good oral health is maintained. This can help to prevent long-term dental problems like tooth loss, mouth cancer, and gum disease as well as prevent oral health problems from causing other health issues.

Research has shown that oral health has a direct connection to overall health and wellness. When the bacteria from the gums and mouth travel to other tissues and organs in the body through the bloodstream and respiratory tract, it causes inflammation.

Inflammation is a source of disease, infection, and weakened immune response.

Oral Health Tips for Caregivers

Although maintaining oral health and hygiene can be a challenge for the developmentally challenged and their caregivers, the immediate and long-term benefits are well worth it. To successfully keep up with oral health, caregivers should try to do the following:

• Ensure effective brushing is performed every day. Depending on the situation, this may require that the caregiver brush the person’s teeth.

• Floss or assist in flossing daily. Because of the coordination needed to properly floss, it may be difficult for some individuals with developmental disabilities to floss themselves, especially daily. Caregivers may need to perform the flossing or assist with tools like floss picks.

• Schedule regular dentist visits. In order to catch any oral health problems early before they get worse and create more problems, it’s important for individuals with developmental disabilities to see a dentist on a consistent basis.

Tips for Dental Visits for a Developmentally Challenged Patient

Dentist visits can be stressful for both the developmentally disabled individual and their caregiver. Despite this, these visits are absolutely vital to provide the individual with preventative care, early detection, and restorative care that can make all the difference in their oral and overall health.

To make dental visits as successful as possible, caregivers should consider the following:

• Choose a dentist with experience in providing care to individuals with developmental disabilities.

• Make sure any accessibility issues, such as the need for a wheelchair ramp or special medications, are addressed before setting up an appointment.

• Meet with the dentist beforehand to establish comfort between the individual and doctor, and assess any special accommodations that will be required for the appointments.

• Plan for longer appointments.

Tips for Dentists Who are Caring for a Developmentally Challenged Patient

As a dentist, you want to provide the best care for all your patients. If your experience is limited, you may be concerned about caring for an individual with developmental problems. However, your dental education and general practice experience will guide your care.

When providing care to an individual with a developmental disorder, it may be helpful to do the following:

• Meet or speak with the patient or their caregiver ahead of time to determine their level of communication and mental capabilities. Discuss any potential concerns with their caregiver. Discuss if there are any physical conditions or limitations that may require special planning or tools.

• Involve everyone who will treat the patient during their visit. Planning and anticipating the special needs of the individual, with the help of everyone they’ll meet (from the receptionist to the hygienist) ensures a smooth and positive experience for the patient.

• Be sure to ask if the patient is allergic to latex. Latex allergies are common and can be severe.

Additional Resources

For families:

• Oral Health for Families with Special Health Care Needs (South Carolina Department of Health and Environmental Control, Division of Oral Health)

For caregivers: 

• Practical Oral Care for People with Developmental Disabilities (U.S. Department of Health and Human Services)

By developmental disorder:

• Practical Oral Care for People with Down Syndrome (National Institute of Dental and Craniofacial Research)

• Practical Oral Care for People with Cerebral Palsy (National Institute of Dental and Craniofacial Research)

• Practical Oral Care for People with Autism (National Institute of Dental and Craniofacial Research)

For dentists:

• Practical Oral Care for People with Developmental Disabilities (The National Institute of Dental and Craniofacial Research)

Oral Health Fact Sheet for Dental Professionals: Individuals with Intellectual Disability. (University of Washington, School of Dentistry)