March is Developmental Disabilities Awareness Month, a time to recognize and promote the inclusion, contributions, and well-being of people with intellectual and developmental disabilities (I/DD). Individuals with I/DD represent a diverse population with unique abilities, needs, and experiences. Oral health is an often overlooked component of overall health for individuals with I/DD. Providing equitable dental care to people with I/DD requires awareness, flexibility, and a commitment to person-centered approaches.
Oral Health Challenges and Barriers to Care for People with I/DD
People with I/DD experience significantly higher rates of oral disease compared with the general population. Studies estimate that up to 80% of adults with I/DD experience periodontal disease, far exceeding the prevalence seen in the general population. Xerostomia (dry mouth), which can result from medications or anatomical differences affecting breathing or mouth closure, increases the risk of dental caries and gingival inflammation.
Beyond the mouth, untreated oral disease can worsen chronic health conditions, negatively affect mental health, and impact nutrition, speech, and social interactions. Adults with disabilities visit the dentist less frequently and are more likely to seek emergency treatment for dental problems than the general population. Some individuals with I/DD may need sedation in order to receive dental treatment safely, often in hospital operating rooms, which is costly, resource-intensive, and involves long wait times for care.
Access to Dental Care and Person-Centered Approaches
Individuals with I/DD often rely on Medicaid, yet numerous dental providers opt out due to low reimbursement rates and administrative challenges. As a result, adults with I/DD are often considered one of the most marginalized populations with unmet oral health needs.
Access challenges are compounded by the specific needs of patients with I/DD, who often require more frequent preventive visits, longer appointment times, and additional staff support. These necessary accommodations can create logistical and financial barriers for dental practices, further limiting access to care.
A health passport can help dental teams quickly understand a patient’s communication style, sensory preferences, medical history, and support needs. Because dental environments can be overwhelming with unfamiliar sounds, sensations, tastes, and bright lights, caregivers may consider contacting the dental office in advance to discuss accommodations. Possible modifications include using a quiet treatment room or providing desensitization visits so the patient can become familiar with the space and staff.
Supporting Daily Oral Hygiene for Individuals with I/DD
Caregivers play a crucial role in maintaining the oral health of individuals with I/DD. Attending dental visits allows caregivers to understand oral hygiene expectations, receive individualized brushing and flossing instructions, and get nutritional counseling. Collaborating with occupational therapists can also help identify strategies to improve independence with daily oral care.
Advocacy
Training for dental professionals
Dental education programs are increasingly recognizing the need for better preparation in caring for patients with disabilities. Training on the treatment management of patients with I/DD is now required in dental school education. Continuing education opportunities can equip current dental providers with skills to promote inclusive practices.
Medicaid coverage and reimbursement
Increasing Medicaid coverage and reimbursement rates for adults with I/DD could significantly improve access to care. Many dental practices face financial challenges when providing the longer appointments and additional staffing required. The emphasis should be on value, not volume.
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By improving provider training, expanding access to care, supporting patients and their caregivers, and advocating for policy change, we can help ensure that individuals with I/DD receive the preventive dental care they deserve.
