The use of oral health services by adults with intellectual disability. A mixed methods study.

Abstract

Objectives The intent of this study was to explore the use of oral health services by a group of adults with an intellectual disability.

Methods The study was an explanatory mixed-methods design. It consisted of an initial collection and analysis of quantitative data, and a second qualitative phase. In the quantitative phase of the study, a clinical audit of oral health services provided for adults with intellectual disabilities was carried out for individuals who underwent a general anaesthetic for dental treatment at Christchurch Hospital during the period of 1 January 2005 to 31 December 2009.

The second, qualitative phase was then conducted to investigate the experience and perceptions of individuals with an intellectual disability (and caregivers and guardians) relating to their oral health care. Fifteen semi-structured interviews were carried out with participants for 13 individuals with an intellectual disability who had a GA for dental treatment at Christchurch Hospital between 1 January 2009 and 31 December 2009.

Ethical approval for this study was obtained from the Upper South A Regional Ethics committee in July 2009. Quantitative data were entered onto a database and analysed using SPSS version 17.0 (SPSS Inc, Chicago, USA). Qualitative data were analysed by manual coding and labelling of the data in order to identify patterns and themes that were expressed by the participants.

Results The majority of individuals with intellectual disability who had dental treatment under GA at Christchurch Hospital in the 5-year period lived in care and many had severe medical issues. Most of the individuals had both restorative treatment and tooth extractions carried out under GA.

The major concern for individuals with an intellectual disability was anxiety related to dental visits. Support people/guardians shared this concern, and played a vital role in helping to manage this anxiety. Many support people/guardians had difficulty identifying dental problems in those with an intellectual disability, and often relied on detection of changes in the individual’s behaviour or demeanour. While the majority of feedback on encounters with dental and medical staff was positive, problems with continuity of care were a concern. The time spent waiting in waiting rooms for check-ups or treatment was a frequently reported cause of stress to the respondents. In addition, some problems were identified with the way in which waiting areas were set up for this patient group.

Conclusions As a group, these individuals present challenges for the provision of oral health care, given the severity of disability and the presence of systemic disease, and many require a high level of support for daily activities. When dental treatment is required, a GA is often necessary in order to carry out the treatment.

There is potential to improve the service with a multidisciplinary approach to coordinate other health services during treatment episodes, the delivery of preventive oral health care, and the utilisation of satellite clinics. Interview participants were particularly concerned with anxiety related to dental visits and identified potential improvements that could help to alleviate this anxiety.