1. Poor oral health in adults with learning disabilities
and its determinants
Dr Deborah Kinnear, Professor Jill Morrison, Associate Professor Linda Allan, Professor Sally-Ann Cooper
Introduction
Adults with learning disabilities experience extensive health inequalities compared with the general population. There is some evidence suggesting that they also have greater dental treatment needs. Adults with learning disabilities may experience poor oral health because of conditions linked with dental disease (e.g. diabetes), use of certain medications (e.g. antipsychotics) and poor dental hygiene. We investigated whether tooth loss is actually greater in adults with learning disabilities than in the same-aged general population and also investigated the determinants of poor oral health in adults with learning disabilities.
Methods
The adult population (aged 16 years and over) of people with learning disabilities living within the geographical area of Greater Glasgow Health Board, Scotland, were identified and recruited
Each participant underwent a dental examination
Data analysis generated descriptive statistics about the oral health of people with learning disabilities
A logistic regression was carried out to identify the determinants of poor oral health
We also compared the data generated with data collected as part of the Scottish Health Survey in 2015, which included 4,979 adults representative of the Scottish general population1
Research Questions
How many adults with learning disabilities are edentulous (have no teeth)?
Is tooth loss greater in adults with learning disabilities than in the same-aged general population?
What are the determinants of poor oral health?
Results
560 adults with learning disabilities took part twice, in and
298 men (53.2 %) and 262 (46.8%) women consented to take part
Mean age 46 years (18 – 81years)
112 (20.2%) had Down syndrome
A total of 252 (45%) adults with learning disabilities lived with paid support, 223 (39.8%) lived with a family carer, 49 (8.8%) lived independently and 36 (6.4%) lived in a congregate setting
Level of learning disabilities : 225 (40.2%) mild , 162 (28.9%) moderate, 98 (17.5%) severe, 75 (13.4%) profound
Research Question 1.
A total of 178 (30.6% ) adults were edentulous, of which 89 (29.9%) were men and 89 (34%) were women
Research Question 2.
There was a marked difference between adults with learning disabilities and the same-aged general population, evident from the start of adulthood, with a widening inequity with progressive age groups (Figure 1 and Figure 2). 22% aged years with learning disabilities, 52% aged years, 43% aged years, and 39% aged years were edentulous (numbers too small to infer from for 75+ year age group), compared to markedly smaller proportions of the same aged general population; 1% at age years (none in the earlier age groups), 8% at age years, and 19% at years. This is a substantial health inequality.
Figure 1. Number of teeth by age in adults in general population
Figure 2. Number of teeth by age in adults with learning disabilities
Research Question 3.
Edentulous adults were stratified by gender, age, with and without Down syndrome, neighbourhood deprivation, living arrangements, level of learning disabilities, with and without autistic spectrum disorder, with and without problem behaviours and use of antipsychotic and antiepileptic medication
Associations were found with: Increasing age, level of ability, whereby adults with severe and profound learning disabilities were more likely to be edentate, taking antipsychotic medication and neighbourhood deprivation (associations in both the least and most deprived areas)
No associations were found between edentate adults and a diagnosis of Autistic Spectrum Disorder, Down syndrome, taking antiepileptic medication or living circumstances
Conclusions
Addressing poor oral health is a pressing need in adults with learning disabilities. Oral problems are painful and will inevitably have an impact on quality of life. It is therefore essential to identify and raise awareness of relevant issues with people with learning disabilities and carers who support them in oral hygiene. Doing so will enable better daily care for this group, and improve access to services for check-ups and treatment, and lead to improved oral health.
Reference: Scottish Government. The Scottish Health Survey: A National Statistics Publication for Scotland, The Scottish Government, Edinburgh, 2015.