Does intellectual disability in children impact access to preventive dental services and oral health?

Aim: The aim of this study was to determine the access to preventive dental care and oral health among children with additional educational support needs as compared to normal children in primary education years.

Design: This was a population-based record-linkage study, where the data was retrieved from six different national databases.

Cohort Selection: Children born in Scotland between years 2011 and 2014 and entered elementary school education in years 2016-19 were included and the corresponding information about their additional educational support needs (ASNs) was determined using a Pupil Census database. These children with intellectual disabilities were categorised as: intellectual disabilities, Autism spectrum, social learning-disabilities and other learning-disabilities. The data about their oral health, including caries experience and extractions under GA, and the data about their access to preventive dental care, including professional brushing instructions, fluoride varnish (FV) applications etc. was retrieved from other national databases. The caries experience and access to dental care was compared for these special children with that of normal children without any ASNs.

Results: Among primary outcomes, significantly higher caries experience was recorded among children with 'social'(aRR = 1.42, CI = 1.38-1.46) and 'other'(aRR = 1.17, CI = 1.13-1.21) ASNs, while higher risk of extractions under GA was found in ID (aRR = 1.67, CI = 1.16-2.37), social (aRR = 1.24, CI = 1.08-1.42) groups while autism group showed nonsignificant higher risk (aRR = 1.12, CI = 0.79-1.53). Among secondary outcomes, significantly less attendance at general/public dental practice was recorded for all the intellectual disabilities' groups, with least attendance by children with social ASNs (aRR = 0.51 CI = 0.49-0.54). Least exposure to professional advice was received by autism group (aRR = 0.93, CI = 0.87-0.99). Further, all the groups showed less participation in nursery toothbrushing (NTB) and FV program at school; while least exposure to these preventive programs was depicted by children with social ASNs (NTB: aRR = 0.89, CI = 0.86-0.92, FV aRR = 0.95, CI = 0.92-0.98).

Conclusion: Children with intellectual disabilities have poor access to preventive dental care and also exhibit higher incidence of caries experience and extractions.