Evelyn Crowley

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The Oral Health of Children and Adults with
Special Needs in Ireland
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Outline of Presentation
Background
Adults with an Intellectual Disability
Children attending Special National Schools and
Day Care Centres
Elderly in care
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Background

• National Programme for Dental Epidemiology Lot 1

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• What and who is a group with a special need?

Consultation process
What groups to study?
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National Epidemiology Program

• A Study of the Attitudes, Knowledge and
  Behaviour of Special Needs Groups Towards Oral
  Health 2002 - NUI Galway qualitative work
• Dental Services for People with Special Needs
  A Survey of Current Practices 2001 - A.
  Dolan-Mulhall situation analysis

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National Epidemiology Program
Other work in the area of Special Needs including
The Dental Health of Children in Special
National Schools in the ERHA Area 1999/2000
McAlister and Bradley and The Dental Health of
Schoolchildren of the Travelling Community 1997
- Fiona Graham and Helen Whelton

• A Study of the Attitudes, Knowledge and
  Behaviour of Special Needs Groups Towards Oral
  Health 2002 - NUI Galway
• Dental Services for People with Special Needs
  A Survey of Current Practices 2001 - A.
  Dolan-Mulhall
• Consultation process

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• Accessible

Consultation process
Objectives would be reasonable attainable Feasible
studies considering demands on service Emphasis
on collecting data to assess service needs for
the population under study
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Groups to be covered

• National Survey of Children attending schools
  designated special needs by the Department of
  Education and children attending Day Care Centres
• Assessment of the oral health needs of Adults
  with an Intellectual Disability in residential
  care in Ireland
• Mouth Care Needs of Elderly Residents in Long
  Term Care in Ireland

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• National Survey of Children attending schools
  designated special needs by the Department of
  Education and children attending Day Care Centres

Children attending Special National Schools and
Day Care Centres
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Children - The Sample

• General Population
• National Sample
• 17,863 Children and Adolescents examined
• 34 teams of Dentists and Dental Nurses
• Examinations took place over a 7 month period
  completed in June 2002

• Special Needs
• National sample excluding ERHA
• 537 Children and Adolescents examined
• 10 teams of Dentists and Dental Nurses
• Examinations took place over a 11 month period
  completed March 2003

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Children - The Sample
ERHA not included 10 examining teams also
participated in the national survey of the
general population Note these examiners not
employed in specific special needs posts

• General Population
• National Sample
• 17,863 Children and Adolescents examined
• 34 teams of Dentists and Dental Nurses
• Examinations took place over a 7 month period
  completed in June 2002

• Special Needs
• National sample excluding ERHA
• 537 Children and Adolescents examined
• 10 teams of Dentists and Dental Nurses
• Examinations took place over a 11 month period
  completed March 2003

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Special Needs Sample - Children
51 children could not be examined, 18, 20 and 13
respectively
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Clinical Examination

• Clinical Examination
• Drooling Scale
• Dental Trauma
• Soft Tissue trauma due to malocclusion
• Oral hygiene assessment
• Toothwear into Dentine
• Caries DMFT and Treatment Need
• Manageability Index and overall Treatment Status
• Questionnaire

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Results
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Special Needs Children have similar levels of
caries to children in fluoridated areas
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Decay experience, mean number of teeth affected
by visual dentine caries according to
disadvantage (fluoridated) and special needs
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Decay experience, mean number of teeth affected
by visual dentine caries according to
disadvantage (fluoridated) and special needs
Special Needs Children have lower levels of
caries than the less well off in fluoridated areas
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Untreated Caries and Missing Teeth 5-year-olds
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Untreated Caries
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Untreated Caries
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Untreated Caries
Untreated caries levels tend to be lower among
15-year-olds classed as moderate. The mildly
disabled group tend to have more extractions (12
15)
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Fissure Sealants
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Percentage of children with at least one
fissure sealant on their permanent teeth by age
group and disadvantage status
Disadvantage measured by parents ownership of a
medical card
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Findings

• Fewer 12- and 15-year-olds in special needs
  schools have fissure sealants compared to the
  general population

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of 5-, 12- and 15-year-olds requiring dental
treatment
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Overall Treatment Need
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Summary

• Treatment needs for this group remain high
• Treatment needed is mainly simple routine
  treatment
• Fewer of the children attending special needs
  schools have fissure sealants compared to the
  general population. Large numbers of these
  children were assessed by the examiners as
  requiring fissure sealants.
• These children have a higher number of
  extractions than children in the general
  population and require more extractions

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Dental Management for this population
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Manageability Index

•  
• Code 1 - Child is likely to accept routine dental
  care, conscious, without the necessity for
  adjuncts like sedation or GA.
• Code 2 - Child will accept minimal intervention,
  for example, examination, prophylaxis, topical
  fluoride application, restoration of small
  accessible single surface restoration but may
  need sedation as an adjunct.
• Code 3 - Child will not allow comprehensive exam
  toothbrushing possible with assistance, invasive
  dental care will need to be carried out under GA
• Code 4 - Child will not allow any examination and
  requires GA facilities for treatment

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42 of this group would not allow a comprehensive
examination
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59 of this group would allow all or some
treatment
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19 of this group would not allow a comprehensive
examination
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81 of this group would allow all or some
treatment
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15 of this group would not allow a
comprehensive examination
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85 of this group would allow all or some
treatment
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Summary

• The majority of the children attending Special
  National Schools could be treated within the
  conventional school dental care referral system.
• However there is a distinct group of children who
  do require specialist care. The data supports the
  need for specialist secondary care GA back up
  and specialist posts in special needs

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Prevalence and frequency of GA is high
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Overall SummaryHow are children with special
needs faring ?

• Dental decay is similar to the rest of the
  population
• Fewer fissure sealants than Gen Pop
• A high proportion have unmet treatment needs
• Medical card holders have poorer oral health than
  special needs children
• There is a distinct group of children who do
  require specialist care. The data supports the
  need for specialist secondary care GA back up
  and specialist posts in special needs

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Survey of Adults with an Intellectual Disability
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Survey of Adults with an Intellectual Disability

• Clinical dental examination of a random sample of
  clients in residential care (units 10 clients
  or more) under the direct care of the Health
  Boards excluding the NEHB
• Individual Client Carer questionnaire
• Unit questionnaire to all residential units in
  Ireland
• Examining dentists Senior Dental Surgeons
  (Special Needs)

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Adults Intellectual Disability

• Comparisons
• DMFT
• MT
• Edentulousness
• Denture needs
• Treatment needs
• Use of services
• Oral care support

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Number and of adults with intellectual
disability included in the study
Residential units with 10 or more residents
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DMFT Dentate Intellectually Disabled
23.7
14.2
6.4
Gen Pop dentate DMFT 16-24 5.7, 35-44 15.3,
65 21.8
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MT Dentate Intellectually Disabled and General
Population
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MT Dentate Intellectually Disabled and General
Population
Intellectually disabled dentate population have
more missing teeth than the general population
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Need for any treatment Dentate Intellectually
Disabled
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Need for any treatment Dentate Intellectually
Disabled
More than ½ of those under 55 and ¾ of those
aged over 55 have need of treatment
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Need for any treatment by type Dentate
Intellectually Disabled
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edentulous
Int dis age gp 16-34
35-54 55
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edentulous
Int dis age gp 16-34
35-54 55
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edentulous
Why is edentulousness more common amongst the
intellectually disabled ?
Int dis age gp 16-34
35-54 55
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Need for any denture treatment
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Type of denture treatment needed
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Type of denture treatment needed
The major difference in treatment need for
dentures is in the need for partial dentures
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Dental Management for this population
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Service Usage
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Has this client had any dental treatment while
residing in this unit?
Most of the group examined had been to the dentist
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Place last treatment received
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Place last treatment received
A substantial proportion of this group are
receiving treatment from health board dentists
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Intellectually disabled need Oral Hygiene Support
Who is training and supporting the carers?
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Conclusions

• Comparisons fewer teeth
• DMFT similar to gen pop
• Treatment needs high levels of untreated
  disease
• Edentulousness more edentulous
• Denture needs less than gen pop, esp. PD
• Use of services dependence on health board.
  Data support need for secondary specialist care
• Oral care support training of carers?

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Mouth Care Needs of Elderly Residents in Long
Term Care in Ireland
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Aim

• To assess at residential unit level the mouth
  care needs of elderly residents in long-term care
  in Ireland
• To measure current oral health practices at unit
  level
• Measure current level of service provision at
  unit level
• Barriers to care at unit level
• Communicate findings to decision makers

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• Unit questionnaire to all residential units for
  elderly residents under the direct care of the
  health boards
• Response rate of 71 to questionnaire
• Results will inform delivery of dental services
  to this group who and how

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Difficulties Encountered

• Compilation of accurate databases
• Consent
• Expectation that service will follow

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Thank You.

• Oral Health Services Research Team Dr. Helen
  Whelton, Principal Investigator
• Examiners
• Prof. June Nunn Advice on protocols and
  training of examiners
• Lot 1 and Lot 1 Special Needs Sub Group committee
• Health Board personel involved in piloting of
  questionnaires and compilation of databases
• Triona McAllister and Conac Bradley ERHA data
• Ms. Helen McEvoy Council of Aging
• Directors and staff of Residential Units