Journal Reading​

PERIODONTAL TREATMENT IN
PATIENTS WITH LEARNING
DISABILITIES PART 1: PREVENTION

Daniel Tetan-El

Dosen Pengampu:
Prof. Dr. drg. Sri Oktawati Sp.
Perio(K)​
 INTRODUCTION
2

A learning disability has been defined as a significantly reduced ability to understand new or
complex information, to learn new skills and to cope independently

As a group, those with learning disabilities are reported to have significantly poorer oral health
than their non-disabled peers with a direct relationship existing between the severity of the
learning disability and the degree of oral disease

Periodontal disease occurs due to an imbalance between the inflammatory reaction caused by
the bacterial biofilm, plaque which destroys the supporting tooth structures. The absence of pain
means its in early stages and the disease may unnoticed. Only at an advanced stage do signs and
symptoms such as mobility, infection, drifting/tilting of teeth and result in tooth loss.

Replacing missing teeth in this patient cohort may also be challenging. Lack of muscle
coordination and cognitive impairments may make denture-wearing difficult and the presence of
any removable prosthesis is likely to worsen oral hygiene and compromise remaining teeth.
Fixed denture like bridge or implant are contraindicating due to poor oral hygiene

The best option in this group is to improve the periodontal health with prevention.
BARRIER
Medical Barrier
Carer Barrier
​Professional Barrier
​
 MEDICAL BARRIER
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Patients with learning disabilities are
2.5 times more likely to have medical
problems likes:
• Respiratory disease
• Coronary heart disease
• Mental Health and
Psychiatric Disorders
• Dementia
• Epilepsy
• Diabetes;
• Musculoskeletal
impairments
• Osteoporosis;
• Immunosuppression and
Cancers.
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Patients with motor abnormalities and physical
impairments will directly face difficulties in
performing oral hygiene.
With complex medical conditions requiring
regular and multiple hospital appointments
may consider oral health low on their priority
list when compared to their other more
pressing conditions
Patient with type 2 diabetes are more likely to
have periodontitis and have significant alveolar
bone loss, Furthermore once periodontal
disease is established, oral infection may
worsening glycemic control. Bacterial products
may disseminate through the bloodstream from
the gingival blood vessels, causing an
inflammatory response at remote organ sites,
thus worsening the situation further.
4
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The stress of coping with serious medical
conditions can further reduce an
individual’s immune response,
potentiating a decrease in secretory IGA,
circulating IgG, impairment of T-
lymphocyte function and natural killer
cell cavity.
The medications required for certain
conditions also play an important role,
potentially causing alterations in the
quality and quantity of saliva produced,
thus leading to dry mouth and increased
plaque and food retention.
Phenytoin may be part of a patient's drug
regimen, increasing gingival overgrowth
risk and compromising oral hygiene
further.
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 CARER BARRIER 7

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Those with learning disabilities have an

impairment of intelligence. This may Many care-givers often only clean the anterior
reduce their ability to understand teeth, and ignore the posterior teeth, a lot of
preventive advice and must rely on care- challenges such as patients not opening their
giver assistance. mouth, pushing them away, moving their heads
uncontrollably, as well as spitting, biting,
Carers and parents of people with
hitting and/or kicking the care-giver.
learning disabilities often lack the
appropriate knowledge, support and
training that they require to fulfil the
oral health needs, only 37% in the
community being reported to receive any
oral health education
 PROFESSIONAL BARRIER 8

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On accessing the dental treatment, dental

teams themselves may not have adequate Although specialist training programs in
experience to provide care for people with Special Care Dentistry are now being
disabilities, with knowledge of non- developed to enhance knowledge and
pharmacological behavioral management awareness of more vulnerable groups in
principles rating low for both specialists society, the most appropriate treatment for
and non-specialists. these patients may still challenge the most
experienced clinicians owing to a lack of
Pharmacological interventisedation
evidence-based research and difficulties
techniques or full general anaesthesia, are
performing research due to issues with ethics,
more likely to be used by specialists to
consent, and sample selection.
achieve desired care, however, preventive
advice and oral hygiene instruction were
found to be of low priority in services for
profoundly disabled individualsons,
including
PREVENTION OF
PERIODONTITIS
 BEHAVIOR CHANGE 10

It is important to inform the patients about the disease

process fully and their own role in prevention as behavior
change is fundamental to treatment success. Where
cognition is limited, all reasonable steps should be taken
to help them understand, including non-verbal
communication such as Makaton, which uses signs,
symbols and drawings as a communication method
Newton and Asimakopoulou found that the best
interventions for changing oral health-related behavior in
individuals with periodontal disease was through
motivational goal setting, self monitoring and planning.
Giving oral health education to carers has been found to
be effective at reducing plaque levels, however, these
changes are not sustained without continuous, systematic
and individualized preventive care
The specific daily oral hygiene needs of the patient should
be confirmed as a personalized written oral hygiene
instruction plan which should be readily accessible to all
staff involved in the patient’s care
APPROPRIATE PREVENTION TOOLS 11
APPROPRIATE PREVENTION TOOLS 12
APPROPRIATE PREVENTION TOOLS 13
APPROPRIATE PREVENTION TOOLS 14
 RISK FACTOR CONTROL
SMOKING
• Smokers exhibit an increased number and
depth of periodontal pockets, an increased
rate of attachment loss and furcation
involvement
• Smokers to have at least a three times
higher risk of losing teeth when compared
to non-smokers
• It is therefore extremely important to target
smoking cessation not only to patients
themselves but to their peers who they
look to for advice and support
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CLOUD-BASED OPPORTUNITIES
• Patient with learning disabilities are much
more likely to be underweight or obese
when compared to the general population
• Excessive weight gain may be an
associated part of several genetic
syndromes, obesity has been reported as a
significant risk factor for periodontal
disease.
• Lack of fruit and vegetable consumption in
combination with increased consumption
of fatty foods has been shown
independently to increase the risk of
periodontitis by 2.3 times
• Carers should be encouraged to monitor
patients’ weight and food intake, thus
identifying nutritional problems as soon as
they occur
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CONCLUSION
 The successful prevention of periodontal disease in patients with
learning disabilities relies on the clinician’s understanding of the
barriers and risk factors faced by this group of individuals
 It is crucial that each factor is considered on an individual basis
and realistic adaptations and solutions implemented where
possible.
 Close collaboration with the patient’s supporting network of
family, friends and carers is essential in implementing effective
prevention strategies.
 Eliminating periodontal disease not only help retain a functional
dentition for longer, but also improving quality of life and
potentially increase life expectancy.
THANK YOU