Needs for oral care among people with intellectual disability not in contact with Community Dental Services.
Adults with ID who skip public dental clinics carry heavy untreated decay—plug the training gap for carers and dentists.
01Research in Context
What this study did
Geckeler et al. (2000) asked adults with intellectual disability who never use Community Dental Services about their teeth and gums.
They also asked carers how they help with tooth brushing and what they want from a dentist.
What they found
Most adults had untreated cavities and sore gums.
Carers did almost all the brushing and wanted dentists who talk slowly and give clear steps.
How this fits with other research
Ummer-Christian et al. (2018) later pooled 16 studies and found the same three blocks: hard-to-enter clinics, untrained dentists, and carers who lack know-how.
Nguyen et al. (2025) tested a fix: they coached carers over Zoom before a dental visit. Twenty-nine of thirty adults finished the exam without sedation, proving the training gap can be closed.
Hithersay et al. (2014) warn that no carer-led health program yet shows strong data, so the Zoom model still needs more proof.
Why it matters
Your clients may sit on long dental wait lists while small problems turn into big pain. Link local dentists to the Nguyen telehealth script, add picture schedules for the waiting room, and train carers to rehearse “open, count, rinse” at home. One dry-run can save a sedation slot and a day off work.
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02At a glance
03Original abstract
Previous research has found an unmet need for oral care among people with intellectual disability. The key factors which have been indicated are low expectations, fear of treatment, lack of awareness among carers and problems in accessing dental services. The withdrawal of many general dental practitioners (GDPs) from the National Health Service (NHS) may have exacerbated the latter problem in the UK. The aims of the present study were: (1) to assess the extent of unmet clinical needs in a group of adults with intellectual disability living in the community who were not in contact with the Community Dental Service (CDS); and (2) to explore their perceptions of teeth and contact with dentists to identify how oral care can be improved. Interviews were completed with subjects and/or carers and a dental examination was completed. There were higher levels of untreated caries (decay), and gingival or periodontal (gum) problems among the sample than in either the general population, or in a previous survey of CDS users at day centres and residential facilities. The subjects were largely unaware of dental problems, and used the appearance and absence of pain to judge the condition of their teeth. They depended greatly on their carers for decision-making and support with regard to visiting the dentist and tooth-brushing. Carers requested training in oral care and the use of dental services, and support in dealing with clients who have problems tolerating tooth-brushing. The subjects had experienced a wide variation in the treatment provided by dentists, but had not found it difficult to access a dentist despite recent reductions in the availability of NHS dental care. They expressed a particular need for a good relationship with their dentist and for their dentist to have personal skills in relating to people with an intellectual disability. Dental screening checks and oral care training for carers should be made easily available. Care plans should include tooth-brushing and dietary issues for all clients who have their own natural teeth. There are significant training issues for dentists in developing personal skills in total communication, disability awareness and attitudes which value people with intellectual disability.
Journal of intellectual disability research : JIDR, 2000 · doi:10.1046/j.1365-2788.2000.00252.x