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      Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review

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          Abstract

          Background

          People with intellectual and developmental disability (IDD) have poor oral health and need support to maintain optimal oral health outcomes. Little is known about how, when and where to intervene for this population. Thus the aim of this review was to summarise the existing evidence surrounding improving oral health outcomes for people with IDD.

          Methods

          A scoping literature review was conducted focusing on ‘oral health’ and ‘intellectual disability’. Systematic searches of five electronic databases were conducted in line with the study aims and two authors independently examined all records for relevance, with consensus achieved by a third author.

          Results

          A small number of approaches and interventions were identified to support people with IDD to independently maintain optimal oral hygiene. Identified studies highlighted that caregivers play a vital role in the provision of oral health support, emphasising the effectiveness of educational interventions for caregivers. However, there was uncertainty regarding the efficacy of specific tooth brushing interventions for people with IDD. In cases of more severe IDD and/or dental-related behavioural problems, dental treatment under general anaesthesia was often both a necessary and effective method of oral health care provision. The findings also identified outreach and exclusive oral health services as successful strategies for increasing the limited access of people with IDD to oral care services.

          Conclusions

          A uniform approach to supporting oral health for people with IDD is unlikely to succeed. A system-based approach is needed to address the diverse needs of the population of people with IDD, their caregivers and service context. Further high quality evidence is required to confirm these findings.

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          Most cited references65

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          An overview of clinical research: the lay of the land.

          Many clinicians report that they cannot read the medical literature critically. To address this difficulty, we provide a primer of clinical research for clinicians and researchers alike. Clinical research falls into two general categories: experimental and observational, based on whether the investigator assigns the exposures or not. Experimental trials can also be subdivided into two: randomised and non-randomised. Observational studies can be either analytical or descriptive. Analytical studies feature a comparison (control) group, whereas descriptive studies do not. Within analytical studies, cohort studies track people forward in time from exposure to outcome. By contrast, case-control studies work in reverse, tracing back from outcome to exposure. Cross-sectional studies are like a snapshot, which measures both exposure and outcome at one time point. Descriptive studies, such as case-series reports, do not have a comparison group. Thus, in this type of study, investigators cannot examine associations, a fact often forgotten or ignored. Measures of association, such as relative risk or odds ratio, are the preferred way of expressing results of dichotomous outcomes-eg, sick versus healthy. Confidence intervals around these measures indicate the precision of these results. Measures of association with confidence intervals reveal the strength, direction, and a plausible range of an effect as well as the likelihood of chance occurrence. By contrast, p values address only chance. Testing null hypotheses at a p value of 0.05 has no basis in medicine and should be discouraged.
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            Oral health of patients with intellectual disabilities: a systematic review.

            A systematic review of original studies was conducted to determine if differences in oral health exist between adults who have intellectual disabilities (ID) and the general population. Electronic searching identified 27 studies that met the inclusion criteria. These studies were assessed for strength of evidence. People with ID have poorer oral hygiene and higher prevalence and greater severity of periodontal disease. Caries rates in people with ID are the same as or lower than the general population. However, the rates of untreated caries are consistently higher in people with ID. Two subgroups at especially high risk for oral health problems are people with Down syndrome and people unable to cooperate for routine dental care. Evidence supports the need to develop strategies to increase patient acceptance for routine care, additional training for dentists to provide this care, and the development of more effective preventive strategies to minimize the need for this care.
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              Periodontal Disease, Tooth Loss, and Incidence of Ischemic Stroke

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                Author and article information

                Contributors
                + 61-2-45701926 , N.Wilson@westernsydney.edu.au
                Z.Lin@westernsydney.edu.au
                amy.villarosa@westernsydney.edu.au
                + 61-2-45701352 , P.Lewis@westernsydney.edu.au
                philcyphilip@gmail.com
                B.Sumar@westernsydney.edu.au
                a.george@westernsydney.edu.au
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                15 November 2019
                15 November 2019
                2019
                : 19
                : 1530
                Affiliations
                [1 ]ISNI 0000 0000 9939 5719, GRID grid.1029.a, School of Nursing and Midwifery, Centre for Oral Health Outcomes & Research Translation (COHORT), , Western Sydney University, ; Hawkesbury Campus, Locked Bag 3, Richmond, NSW 2753 Australia
                [2 ]ISNI 0000 0000 9939 5719, GRID grid.1029.a, School of Nursing and Midwifery, , Western Sydney University, ; Hawkesbury Campus, Locked Bag 3, Richmond, NSW 2753 Australia
                [3 ]COHORT, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Penrith, Australia
                [4 ]ISNI 0000 0004 1793 6833, GRID grid.464829.5, Bangalore Baptist Hospital, ; Bellary Road, Hebbal, Bangalore, Karnataka State 560024 India
                [5 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, School of Dentistry, Faculty of Medicine and Health, , University of Sydney, ; Sydney, Australia
                [6 ]Translational Health Research Institute, Campbelltown, NSW 2560 Australia
                Author information
                https://orcid.org/0000-0002-6979-2099
                https://orcid.org/0000-0002-7701-6217
                https://orcid.org/0000-0002-6795-2546
                Article
                7863
                10.1186/s12889-019-7863-1
                6858643
                31729967
                de2a98ba-97a2-49c9-8ad0-20d3c3a5ab72
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 May 2019
                : 29 October 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Public health
                intellectual disability,oral health,health disparities,dental interventions,gender,nursing

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