UMMS working to improve oral health for people with intellectual disabilities

By Ellen Moran

UMass Medical School Communications

March 09, 2015
  The Shriver Center, part of the medical school’s Commonwealth Medicine division, has received grants for two projects involving oral health.
  The Shriver Center, part of the medical school’s Commonwealth Medicine division, has received grants for two projects involving oral health.

People with intellectual disabilities are more likely to have untreated tooth decay, but finding dentists who are willing to provide them with dental care can be difficult. UMass Medical School’s Eunice Kennedy Shriver Center is meeting this challenge through research and training to educate dental professionals and students about making dental visits easier for individuals with intellectual disabilities.

The Shriver Center, part of the medical school’s Commonwealth Medicine division, has received grants for two projects involving oral health. A two-year grant from the National Institutes of Health enabled the Shriver Center, in partnership with Praxis, Inc., an educational technology company, and the Department of Exercise and Health Sciences at UMass Boston, to develop two online courses. A three-year grant from the Centers for Disease Control National Center for Birth Defects and Developmental Disability financed a project to determine the most effective interventions that may lead to improvements in oral health in individuals with intellectual disabilities.

“It is very difficult for people with intellectual disabilities to find a dentist, particularly once they become too old to continue to see pediatric dentists,” said Richard K. Fleming, PhD, adjunct associate professor of psychiatry at UMMS and associate professor of exercise and health sciences at UMass Boston. Some dentists don’t accept patients with intellectual disabilities because they lack the training to meet the patients’ needs and may not realize that a handful of behavioral supports is all that’s needed to treat the majority of patients.

Patients with intellectual disabilities may have significant anxiety, limited communication skills and low tolerance for dental procedures. One of the two-hour online courses focuses specifically on treating patients with autism spectrum disorder, who have unique challenges with sensory stimuli in the dental environment, while the other is about treating patients with intellectual disabilities.

“We hope to make it more comfortable and manageable for dentists to take more patients with disabilities,” said Helen Hendrickson, MPA, project director for the dentistry online courses. “We think it’s still their duty to make sure people have dental care.”

The online courses will undergo a trial in March with 120 dentists, dental hygienists and dentistry and dental hygiene students taking each course, allowing the research team to evaluate changes in participants’ knowledge, self-efficacy and intention to treat patients with disabilities. The courses, similar to video documentaries, include advice from dental and behavioral experts and interviews with parents, caregivers and patients with autism and intellectual disabilities.

Dr. Fleming and Hendrickson, who wrote the grant that funds the online course project, work closely with other researchers at the Shriver Center who are looking at ways to improve oral health through the CDC project on Oral Health Disparities.

Ways to increase access to oral health and address oral health issues have been developed, but not systematically studied, said Alexandra Bonardi, MHA, OTR/L, clinical assistant professor of family medicine & community health and former director of the Center for Developmental Disabilities Evaluation and Research at the Shriver Center. She said she hopes the review will encourage people to study whether they’re effective.

Partnering with the American Academy of Developmental Medicine and Dentistry, the team reviewed literature describing steps that have been taken to improve oral health. The broad study involved dentists, hygienists and physicians who helped with the screening of more than 4,000 articles, and pared them to about 125 articles that are in the final review.

Christine Clifford, MHP, research coordinator for the Oral Health Surveillance/Disparities project, cited four categories of ways to improve the quality of oral health care: prevention strategies, education and behavioral interventions, access and when and how to use sedation.

Prevention strategies include the use of fluoride varnish, spray or tablets to prevent tooth decay. Desensitization can help lessen fears by using videos to show individuals the steps involved in a dental visit to make them feel more comfortable going to the dentist,” Clifford said. Access focuses on the financing and reimbursement for oral health care.

Some dentists, concerned the patients might be disruptive, use sedation. Bonardi said sedation is often the go-to for dentists who don’t have the training in how to help make patients feel more comfortable. The researchers are looking at why and when sedation, which always carries risks, is used, she said. Ultimately, the project will provide evidence of effective strategies to improve oral health for people with intellectual disabilities and identify areas for further evaluation.

Fleming said he hopes the online courses eventually will be offered as continuing education for practicing professionals and as part of higher education curricula to introduce dentistry students to the disability world.

The ultimate goal of the National Institute of Dental and Craniofacial Research, the oral health division of NIH, Fleming said, is for the online dental courses to be developed, tested, used, and five or 10 years down the road, result in far more patients with disabilities being seen and effectively treated.

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