Oral Health Education Program for Adults with Disabilities: An Intervention Study

Abstract

Poor oral health is common in adults with physical and intellectual disabilities leading to risk of oral and respiratory infections, as well as malnutrition. This prospective longitudinal experimental mixed methods study evaluated the efficacy of a tailored Oral Health Education Program aimed at improving oral health knowledge and oral health behaviours in 36 adults with disabilities living in 12 supported living housing facilities in New Zealand. A single 90-minute training session on oral hygiene and health was undergone with interpersonal lectures through open discussions and hands on training for each of the 12 homes. Demographic information including age, gender, nutrition and swallowing risk checklists, medical history, dental questionnaire, and mini nutritional assessment (MNA) were collected prior to intervention. Outcome measures were collected pre, 1, 2 and 3 months: dental exam, plaque index, gingival signs, tongue coating index and behavioural rating scale. At 3 months, support workers and residents were interviewed by an independent interviewer. Residents’ interviews were supported by Talking Mats© and a total communication approach. Interviews were videotaped, transcribed, analysed by tallied responses for residents and by using content analysis for support workers. 94% of residents required support for oral health with 63% fully dependent on their support workers for oral cares and 31% only requiring prompts or some physical aid to perform their own oral hygiene. 24 (63%) residents had significantly improved plaque scores at 3 months, none got worse (p<.001). Resident interviews were restricted by resident communication competency but supported interviews indicated 91% positive response to the 3-sided toothbrush, 60% to the interdental brush / flosser, and 100% to the mouthwash. Support workers interviews revealed perceived i) health and social benefits including fresher breath and less bleeding, ii) benefits of building new routines, iii) equipment preferences, iv) participation challenges, v) economic benefits and vi) benefits of specialist dental support. As people with disabilities age, their ability to cooperate with dental care decreases, therefore, the risks of tooth decay, periodontal disease, and tooth loss increase. Daily oral hygiene practices at home can help with improving oral health knowledge and behaviours which aid in reducing plaque accumulation and improving social acceptability through fresher breath.