Risk factors for oral and dental disease in people with developmental disability

Personal factors

aberration in tooth formation resulting in missing, hypomineralised or hypocalcified teeth and microdontia (eg people with Down syndrome)

craniofacial abnormality, delayed and ectopic eruption of teeth, delayed exfoliation of primary teeth and imbalance in the muscular forces of the tongue and muscles of mastication causing dental malocclusion (eg people with cerebral palsy)

altered muscle tone and dexterity, kyphosis, compromised vision and a strong gag reflex hindering independent oral care and increasing reliance on a caregiver for assistance

challenging behaviour limiting intraoral access and making it difficult for caregivers to assess oral health and provide care

movement disorders, habitual movements and antipsychotic medication causing bruxism and mandibular movement, resulting in dental attrition, factitious (self-induced) oral injuries and temporomandibular joint disorders

falls and head injury associated with movement disorders or epilepsy resulting in orofacial and dental trauma

swallowing disorders resulting in leftover food in the mouth, and trouble with oral care

salivary hypofunction secondary to some medications or gastro-oesophageal reflux disease precipitating dental caries, dental erosion and oral candidosis

gingival hypertrophy or hyperplasia as an adverse effect of some medications (eg calcium channel blockers, phenytoin)

preference for frequent food consumption and drinks with high sugar and acid content leading to a high risk of dental caries

lifestyle choices such as smoking and alcohol consumption increasing risk of oral cancer

Caregiver factors

inadequate education about oral disease risk factors

lack of training in how to provide oral care

difficulty performing oral care in a person with swallowing difficulty, a bite reflex or oral hypersensitivity

reluctance to engage in provision of oral care in the setting of uncooperative or challenging behaviour

provision of food and drink that can contribute to dental caries (eg high sugar and acid content) and use of these as a reward for good behaviour

Environmental factors

lack of fluoridated water in some communities

lack of time allocated to providing oral care

lack of access to regular professional dental care (eg dentist, hygienist) for check-ups and prevention, due to inadequate wheelchair access, limited finances and long waiting times for public dental clinics

lack of specialist dental training and expertise in general dentists and lack of access to paediatric and special needs dentists