with developmental disabilities continue to have a high rate of dental disease, despite policies aimed at broadening access to care for the population. A new study, conducted by researchers from the Tufts University School of Medicine and Tufts University School of Dental Medicine, suggests that policy must also address education and support for caregivers to ensure this population receives first-rate at-home care.

The study, published in The Journal of the American Dental Association, surveyed 808 experienced caregivers (both family members and employees) in Massachusetts, providing care to adults with developmental disabilities. The results showed that:

  • 85% of adults with developmental disabilities received assistance with teeth cleaning.
  • 79% brushed twice daily as recommended by the ADA.
  • 22% flossed daily as recommended by the ADA.
  • 45% never flossed.
  • 63% of caregivers listed behavioral problems as the major interference with oral health care.

While the frequency of brushing and flossing among the adults in this study was higher than reported in previous studies, many still failed to meet ADA recommendations regarding such tasks. According to the study’s authors, flossing in particular presented substantial challenges. They went on to recommend that innovative strategies are needed to ensure adults with developmental disabilities are benefiting fully from at-home oral care to prevent dental disease.

Oral health disparities among people with developmental disabilities are a significant public health issue,” said senior author Aviva Must, PhD, professor and chair of the department of public health and community medicine at Tufts University School of Medicine. “We were surprised to find that, while 71.6% of paid caregivers who participated in our study reported having received formal group training in oral health care, only 6.4% of family caregivers reported the same. Given the vital role that caregivers play in promoting good oral health in this population, we need to ensure that all receive the guidance and support they need to be effective.”

Co-principal investigator John Morgan, DDS, an associate professor in the department of public health and community service at Tufts University School of Dental Medicine, added, “In addition to the effective use of fluoridated toothpaste and the application of topical fluorides, policy makers should also consider establishing an organized system that provides caregivers, including family caregivers, with information and support.”

Participating study caregivers visited the Tufts Dental Facilities for Persons with Special Needs (TDF), a network of clinics that serve more than 7,000 patients a year and support education and research to improve the population’s oral health.

The authors of the study acknowledged certain limitations in the study. The TDF clinics are designed for and financially accessible to people with developmental disabilities in Massachusetts, and many caregivers and patients have developed long-term relationships with dental professionals at the clinics. The study authors recognize that caregivers in this survey may not represent the experiences of caregivers more broadly. Caregivers who participated in the survey may also be particularly interested in oral home care and the information they provided reflects self-reports. In addition, the survey’s focus was on the occurrence of oral home care practices and not on their quality.