Oral Health Care Improvement in Mentally Retarded Children - Term Paper Example

Oral Health Care Improvement in Mentally Retarded Children Introduction For the health and well-being of the human body, oral health is an importantand integral constituent. From the perspective of the quality of life of an individual, good oral health is a contributing factor. In patients with mental disabilities, quality of life and well-being are already compromised, and poor oral health only exacerbates the situation. Yet, in comparison with their normal counterparts, mentally retarded children have greater expression of poor oral health. Contributing to the greater expression of poor health are the issues of compromised eating, swallowing, speech, chewing, and drooling from their condition that encourages malocclusion. The poor oral health in mentally retarded children only makes their functioning and general health condition even worse. In this section of the population, where good oral health is required because of the severity of their condition, the higher incidence of poor oral health stresses the need for adequate steps to be taken in attending to this aspect of their health and well-being (Bhambal, et al, 2012). Prevalence of Poor Oral Health in Mentally Retarded Children Among the several needs of children, oral health is a significant constituent. Yet, it possibly is the greatest unmet need among children, with nearly half the children in USA showing signs of tooth decay by the time the reach the age of eight years (Blevins, 2011). Several medical conditions play a large part to the presence of poor oral health among children with mental development deficits, like cerebral palsy and autism (Blevins, 2011). In addition to the limitations that their mental condition puts on mental retarded children, poor oral hygiene is an important secondary limiting condition. Evidence from the Traci et al, 2000, study, that examined the prevalence of oral hygiene problems among a mentally disabled population, of whom nearly 80% were mentally retarded, the prevalence of poor oral hygiene was 451 in 1000 of the population (Horwitz et al, 2000). Dental caries is the major dental problem in the general population, which is also true in the case of mentally retarded children, with a similar rate of prevalence. The World Health Organization (WHO) has recommended the use of DMFT for assessing the life time prevalence of dental caries in an individual or a group of population. DMFT stands for decayed teeth, the number of missing teeth, and the number of filled teeth. Evidence from studies show that the DMFT score in individuals with Down Syndrome to be 6.73, while it is 6.68 in individuals with other etiologies of MR. In comparison the DMFT score among the general population is 6.68. However, there is clear variance in the number of missing teeth to filled teeth. In mentally retarded individuals the number of missing teeth to filled teeth was much higher than in the general population. This suggests that extraction, rather than restoration is the predominant mode of dental treatment given to children with mental retardation (Horwitz et al, 2000). Gingivitis is the next most common oral health problem in children with mental retardation. The prevalence of gingivitis among children with mental retardation is much higher than in the general population, with it being 1.2 to 1.9 times more. The prevalence rate is higher among older mentally retarded children living in institutions and children with Down syndrome. Medications given to children with mental retardation and Down syndrome cause dryness in the mouth, which enhances the prevalence of gingivitis in these children (Horwitz et al, 2000). Other periodontal problems associated with mentally children are bruxism and lack of mastication. Bruxism occurs from the grinding of teeth that some mentally retarded children are prone to. Lack of mastication occurs from the lack of closing the mouth during chewing, which can be accompanied with drooling (Horwitz et al, 2000). Causes for Poor Oral Health in Mentally Retarded Children Saliva is a protective agent, and has an important role to play in the protection of the teeth and gums, and preserving them from bacterial action and other factors like build of food particles. From the perspective of the medical condition, any alterations that impact on the normal availability and functioning of saliva contribute to poor oral health. Normal saliva secretion can be affected by the medications prescribed to mentally retarded children (Blevins, 2011). From an individual perspective the key reasons for poor oral health among mentally retarded children are the impaired ability to understand instructions, the reduced ability for concentrated effort, the poor motor skills, and the reduced innate skills and lack of manual coordination (Bhambal, et al, 2012). Thus, to a very large extent mentally retarded children require the support of family members or care providers to maintain oral health, which normal children are expected to take care on their own. Even among normal children parental perceptions have an influence on the efforts that the children make to maintain good oral health. In the case of mentally retarded children this influence is even larger, due to their dependence on support from parents and other family member for maintaining good oral health (Paula et al, 2012). Many aspects on the delivery of oral health services contribute to poor oral health of mentally retarded children. The impaired cognition and their inability to understand the requirement for dental treatment in maintaining good oral health, causes fear, and lack of cooperation in any dental treatment processes. Furthermore, they need to be accompanied by a care provider or a family member to dental care facility. The problem is compounded due to the lack of easy access to appropriate dental care facilities for mentally retarded children. While evaluating the adequacy in the delivery of oral health services as a contributory factor to poor oral health among mentally retarded children it is necessary to factor in the issues of poor attitude and lack of training and skills among oral health service providers, to provide adequate oral services to these children (Davies, Bedi & Scully, 2000). Improving Oral Health in Mentally Retarded Children Measures to improve the oral health in mentally retarded children should be viewed from two perspectives. The first is treating the damage that has already occurred and preventing further damage or preventing the occurrence of poor oral health. For this these objectives assessment of the current state of oral health is required (Blevins, 2011). History taking of the oral health of mentally retarded may be obscured by the concentration of the parents and family of the child on other issues of drooling, grinding, and feeding problems. While acknowledging these issues, it is also necessary to get a clear picture of the history of oral health problems, through perseverance and patience (Koch, & Poulsen, 2009). This brings into the picture the proper attitude of oral health service providers to the needs of mentally retarded children. Since dealing with mentally retarded children requires more effort and time, there is generally apathy in dealing with their oral health issues. Removing this situation in the treatment of oral health requires kindness, empathy, and patience, which is best provided through specialized programs that target the oral health in mentally retarded children (Muthu & Shivakumar, 2009). Treatment procedures for mentally retarded children have to be altered to suit the needs of their condition. With poor cognitive skills, fear of what is going to happen to them increases the resistance for dental treatment procedures, making it necessary to familiarize them with the environment and the various devices that they see. It would be useful to employ McKesson bite blocks or Molt’s mouth props to assist in keeping the child’s mouth open for the duration of the treatment process. The duration of the treatment process should be brief, and in case it is necessary for long duration treatment, then general anesthesia would prove useful (Muthu & Shivakumar, 2009). Prevention of poor oral health in mentally retarded children begins by providing the necessary oral hygiene by methods that can be implemented in this population. Brushing the teeth twice daily with fluoridated toothpaste is the first step towards maintaining oral hygiene. In these children with poor motor skills assistance in brushing of teeth may have to be provided by parents and family, and so educating them on the importance of teeth brushing is necessary. Tooth brushes used need to be soft and of the right size for the mouth of child. Motorized toothbrushes may assist in removing plaque and food particles between the teeth more easily (Blevins, 2011). Flossing will not be easy for these children, and educating parents and family members on the use of a floss holder is helpful. Chlorehexidine is well tolerated by mentally retarded children, and is recommended as a mouthwash in the prevention and treatment of gingivitis. In case it is not possible to use it as a mouth wash, it can be sprayed or swabbed on using an applicator. In case, brushing of teeth is found insufficient for preventing caries, then pit and fissure sealants are to be used for the prevention of occlusal caries. Reducing the sweets and sweeteners to offset the sweetness in oral medicines being taken by the child and rinsing of mouth after intake of sweet medicines should be informed to the parents and family (Bhambal, et al, 2012). Mentally retarded children are more likely to use public funded oral health care services for accessing dental care services. Easy accessibility then becomes the key to seeking and accessing optimum dental care services towards improving oral health in mentally retarded children (Koch, & Poulsen, 2009). Conclusion The nature of their medical condition aggravates the potential for poor health oral health in mentally retarded children. Treatment and prevention of oral health problems associated with mentally retarded children will reduce the incidence of poor oral health in mentally retarded children. Literary References Bhambal, A., Jain, M., Saxena, S. & Khothari, S. 2012, ‘Oral health preventive protocol for mentally disabled subjects – A review’, Journal of Advanced Dental Research [Online] Available at: http://www.ispcd.org/~cmsdev/userfiles/rishabh/Dr%20ajay%20bhambal_4.pdf (Accessed April 01, 2012). Blevins, J. Y. 2011, Oral Health Care For Hospitalized Children, Pediatric Nursing, vol.37, no.5, pp.229-235. Davies, R., Bedi, R. & Scully, C. 2000, ABC of Oral Health: Oral health care for patients with special needs, British Medical Journal, vol.321, no.7259, pp.495-498. Horwitz, S. M., Kerker, B. D., Owens, P. L. & Zigler, E. 2000, ‘THE HEALTH STATUS AND NEEDS OF INDIVIDUALS WITH MENTAL RETARDATION’, Department of Epidemiology and Public Health, Yale University School of Medicine [Online] Available at: http://www.specialolympics.org/uploadedFiles/LandingPage/WhatWeDo/Research_Studies_Desciption_Pages/healthstatus_needs.pdf (Accessed April 01, 2012). Koch, G. & Poulsen, S. 2009, Pediatric Dentistry: A Clinical Approach, Second Edition, John Wiley & Sons Ltd., Chichester, West Sussex, UK. Muthu, M. S. & Shivakumar, N. 2009, Pediatric Dentistry: Principles & Practice, Reed Elsevier Indi Pvt. Limited, NOIDA, India. Paula, S. J., Leite, I. C. G., Almeida, A. B., Ambrosano, G. M. B., Periera, A. C. & Miahle, F. B. 2012, The Influence of Oral Health Conditions, Socioeconomic Status and Home Environment Factors on Schoolchildrens Self-perception of Quality of Life, Health and Quality of Life Outcomes, vol.10, no.6 [Online] Available at: http://www.medscape.com/viewarticle/760327 Accessed April 01, 2012). Read More