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As regards to the most common oral disease in pediatric patients, intellectual disability is not a risk factor for caries disease itself, but it rather reduces the individual capability to self-care and therefore to his own oral care. Children suffering of systemic pathologies and/or with different stages of disability are to be considered at high risk for dental caries development. According to recent guidelines for oral health prevention in childhood, individual additional strategies for a preventive care should be applied for these patients. All the health providers, family and caregivers should be involved with the aim of being aware, motivated and informed on oral health issues, and a better access system to the dental care structure, both logistic, professional and economical should be assured.
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Annali di stomatologia
health promotion
Preventive strategies in oral health for special needs patients
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Review article
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F. Guerra
2015
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Department of Oral and Maxillo Facial Sciences, “Sapienza” University of Rome, Italy
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Preventive strategies in oral health for special needs patients
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                                                                                                     Review article



    Preventive strategies in oral health for special
    needs patients




                                                                                                      i
                                                                                                    al
                                                                                                 on
    Iole Vozza, DDS PhD                                    requirements: handicapped, special, exceptional,
    Edoardo Cavallè, DDS                                   disabled, special needs (1-3). A person is considered
    Denise Corridore, DDS                                  disabled when a long-term mental or physical disor-
    Francesca Ripari, DDS                                  der or condition affects the ability of performing daily
    Andrea Spota, MD, DDS                                  activities (Tab. 1) with a real difficulty, as well as




                                                                                         zi
    Orlando Brugnoletti, MD, DDS                           consideration is paid to possible recurrences, pro-
    Fabrizio Guerra, MD, DDS                               gressive impairing conditions, cancer, HIV infection,
                                                           multiple sclerosis, blindness and former suffering




                                                                         na
                                                           from disabilities (4).
    Department of Oral and Maxillo Facial Sciences,        Recently, the main trend is to consider disability as
    “Sapienza” University of Rome, Italy                   the outcome of the interaction between the individual
                                                           impaired condition and the environmental barriers
                                                           (behavioral, social, physical, intellectual, etc.) that




                                                             er
    Corresponding author:                                  “limit their complete and effective participation in the
    Iole Vozza                                             society in relation to feeling different from all the oth-
    Department of Oral and Maxillo Facial Sciences,        ers” (5).
    “Sapienza” University of Rome


                                                     t     Disparity in social acceptation and sustain are the main
    Via Caserta 6
    00161 Rome, Italy
                                                  In       obstacles that should be avoided. In the UN Conven-
                                                           tion on the Rights of Persons with Disabilities, held in
    E-mail: iole.vozza@uniroma1.it                         New York in 2006, the right of disabled people to be
                                                           equal with other persons has been declared, along with
                                                           “support for their specific cultural and linguistic identity,
                                       ni
    Summary                                                as well as for their signs language and deafs’ culture”
                                                           and “the right to get the highest standard of health with-
    As regards to the most common oral disease in          out any kind of discrimination”, whereas States should
                              io

    pediatric patients, intellectual disability is not a   guarantee access – either social, professional and lo-
    risk factor for caries disease itself, but it rather   gistic – to sanitary services (6-8).
    reduces the individual capability to self-care and     The need of this sort of declarations itself means that
    therefore to his own oral care. Children suffering     some kind of discrimination and disparity in general
                      iz



    of systemic pathologies and/or with different          health-care strategies, rehabilitation and prevention is
    stages of disability are to be considered at high      still present for disabled persons for their status, even
    risk for dental caries development. According to       in the most evolved societies (9).
         Ed




    recent guidelines for oral health prevention in
    childhood, individual additional strategies for a
    preventive care should be applied for these pa-        Health promotion and access to oral care services
    tients. All the health providers, family and care-
    givers should be involved with the aim of being        On a general basis, disease prevention and health
    aware, motivated and informed on oral health is-       promotion are more effective if focused on the indi-
IC




    sues, and a better access system to the dental
    care structure, both logistic, professional and        Table 1. Variables for normal daily activities performance
    economical should be assured.                          assessment.
C




    Key words: prevention, special needs, oral care,       Normal daily activities (4)
    health promotion.                                      Mobility
                                                           Manual ability
                                                           Physical coordination
    Introduction
©




                                                           Continence
                                                           Ability to heave, transport or move daily-life objects
    Defining “disability” is complex and controversial.
                                                           Language, hearing, sight
    During the decades, several terminologies have
                                                           Memory or concentration skill, acknowledge and
    been used for people with physical, intellectual or
                                                           comprehension
    mental conditions who also require health care and
                                                           Awareness of the risk to have physical damage
    services of a type or quantity beyond the common

    96                                                                        Annali di Stomatologia 2015; VI (3-4): 96-99
    Preventive strategies in oral health for special needs patients


    vidual risk assessment. According to Beck (1998) a                nant factor for willingness to treat patients with dis-
    risk factor is “a biological, environmental and behav-            ability or chronic conditions (15-17).
    ior factor that, throughout time, increases the possi-
    bility of pathology; if removed or absent, it reduces
    the probability. It is part of a casual chain or leads the        Oral health prevention and treatment issues




                                                                                                             i
    host to the casual chain. When the pathology has




                                                                                                           al
    been set off, the removal of it does not necessarily              According to Casamassimo (3), pediatric dentistry
    reduce it” (10).                                                  has automatically become the dental assistance ref-
    As regards to the most common oral disease in pedi-               erence for children as well as adults with special




                                                                                                        on
    atric patients, intellectual disability is not a risk factor      health needs, because pediatric practitioners are
    for caries disease itself, but it rather reduces the indi-        used to manage communication and uncontrolled
    vidual capability to self-care and therefore to his own           movements. But pediatric dentists do not represent
    oral care. In these patients caries pathology is there-           the majority of the dental care offer in most of the ar-




                                                                                                zi
    fore quite high (9, 11).                                          eas, consequently adult patients with special health
    For that reason, along with the acknowledgement of                care needs have to attend general dental practices.
    intrinsic oral disease risk of some general pathology,            Loeppky and Sigal (16) observed in their study that




                                                                                  na
    children suffering of systemic pathologies and/or with            most of pediatric dentists limited their practice to dis-
    different stages of disability are to be considered at            abled patients under 18 years of age, while general
    high risk for dental caries development. According to             dentists treat patients with special health care needs
    recent guidelines for oral health prevention in child-            of all ages. In the pediatric dentists practices, many
    hood, individual additional strategies for a preventive           of the disabled patients have conditions that were




                                                                        er
    care should be applied for these patients, such as the            congenital or acquired during childhood. General
    use of fissure sealants and fluoride gel and varnish-             dentists visit instead special needs adults who pre-
    es, along with clinical check-ups on a regular basis              sent conditions or disabilities consequent to aging
    (12-14).                                                          pathologies, as stroke, dementia and failing organ
    Limited access to dental care services for disabled

                                                             t        systems. This kind of patients may be more at ease
    persons is mostly due to:
                                                          In          in a general dental practice than in a pediatric one.
    • availability of dentist to treat patients with special          Therapy also differs significantly: general dentists
         health care needs;                                           provide rehabilitative care such as prosthodontics,
    • awareness of the oral health issue in the patient               periodontal procedures and endodontic therapies,
         environment (“halo effect”).                                 while pediatric dentists tend to provide more preven-
                                               ni
    In particular, the dentists’ availability is dependent by         tive procedures such as restorative, oral hygiene,
    the time committed in treatment of disabled persons,              scaling, fluoride, sealants and orthodontics.
    educational experience and training in treating pa-               In order to respond to dental care needs and concur-
                                    io


    tients with disabilities or chronic conditions, economic          rent medical conditions or low level of cooperation,
    factors and age (educational debt, financial practices,           some patients with intellectual/physical impairment or
    family expenses, more frequent in younger dentists),              systemic disease may require treatment in general
                           iz



    setting of the dental practice (public/private dental             anesthesia. However disabled patients’ pattern of
    service, small/large communities), reimbursement                  age, treatment need and caries experience is not pro-
    programs (15, 16).                                                portional, as one can imagine, to the severity of the
          Ed




    Moreover, accessibility is dependent on the National              impairing condition. Haubek et al. (18) report that, in
    Health System: national programs of reimbursement                 a group of patients who underwent to general anes-
    or financial coverage for health expenses is crucial              thesia for dental treatment, special needs children
    for improving access leeway of disabled patient to                “were older at referral and had a less comprehensive
    dental health services. Disabled patient have also lo-            total treatment need than non-special needs pa-
    gistic difficulties in receiving the dental care services,        tients”, supporting as a possible explanation that at-
IC




    due to architectonical barriers, public transportation,           tention to preventive oral health attitude is often paid
    problems in scheduling the treatment within the daily             by caregivers and specialized personnel, so that
    practice (15).                                                    these children develop a treatment need only at high-
    Dentists’ willingness to treat people with special                er ages.
C




    health care needs is affected by the uncooperative-               Similarly, Camilleri et al. (19), compared the level of
    ness of some patients during the dental treatment:                dental disease and the pattern of dental treatment
    perceiving it as a barrier depends by the type of per-            under general anesthesia for children with different
    formed practice of the dental providers and by their              ASA Physical Status Classification System level.
    educational experience (e.g. pediatric dentists com-              Children of both groups were about to undergo to
©




    monly raise minor obstacles in treating disabled per-             general anesthesia for dental treatment and had high
    sons, since their training and practice are focused on            caries experience indices. They report that children
    behavioral management of younger patients). Data on               with severe systemic diseases had significantly lower
    dentists’ availability are in reality controversial: no ev-       caries experience in both dentitions than normal
    idence is clear which among personal vocation, age,               healthy or mild systemic diseases affected children.
    education or clinical experience is the main determi-             In this case, too, the Authors explain their result with

    Annali di Stomatologia 2015; VI (3-4): 96-99                                                                            97
    I. Vozza et al.


    the high level of medical and preventive care of these       References
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    Annali di Stomatologia 2015; VI (3-4): 96-99                                                                                           99
