Addressing Barriers to Oral Hygiene for Individuals with IntellectualDisabilities

Individuals with intellectual and developmental disability (IDD) experience significantly poorer oral health outcomes compared to the general population (Wilson, 2019). These are not superficial concerns- dental problems are associated with reduced quality-adjusted life expectancy (Matsuyama, 2019). Considering the impact that poor oral health has on physical comfort, mental wellbeing, social interactions, and eating behaviors, it is critical to proactively support dental hygiene for individuals with IDD. 

Barriers to Oral Hygiene 

In the Keep My Teeth study, which evaluated oral health training for healthcare students, Nowghani, et al. identified the following commonly identified barriers to oral health:

● Resistance to Care 

● De-Motivation 

Address the Resistance 

Resistance to dental care is common and may stem from physical discomfort, anxiety and sensory sensitivities. There are several strategies to reduce resistance and promote a positive experience of dental care for individuals with IDD. 

● Environmental Modifications: Individuals with IDD may experience resistance to dental care due to physical discomfort, anxiety or sensory sensitivities, which can make brushing their teeth and visiting the dentist more difficult or uncomfortable. Instead of going to a general dentists, support should consider: 

○ Sedation dentistry 

○ Sensory-Adapted Dental Environment (SADE) 

○ Mobile Dentistry 

These options may reduce stress and foster a more positive association with dental care.

● Offer Choices: Offering choices can reduce the perceived pressure and increase cooperation. Individuals may be less resistant to engaging in oral hygiene if they have options for how they can engage. Instead of telling an individual they need to brush their teeth, caregivers can ask questions with options such as: 

○ “Would you like to brush your teeth now or after breakfast,” 

○ “Would you like to brush your teeth with your regular or electric toothbrush”

○ “Would you like to brush your teeth in the bathroom or in your bedroom?”

Having options allows individuals to opt-in and dictate the details of how they accomplish an activity rather than feeling subjected to it. 

Make it Fun and Motivating! 

Many individuals with IDD struggle with task initiation, a key component of learning and maintaining dental hygiene behaviors. Integrating fun, personal interests, and supported structure can increase motivation and independence for individuals with IDD. 

Helpful Strategies: 

● Use checklists, visual schedules or alarms to promote independence. 

● Caregivers can positively pair oral hygiene activities with preferred interests. For example, caregivers can play an individual's favorite song while encouraging them to brush their teeth for the duration of the song. 

● Turn routines and learning opportunities into games. 

Evidence-Based Approaches: 

● Board Games: A team of researchers out of Taiwan, have designed and tested an oral hygiene board game used to teach oral health related knowledge for adults with intellectual disabilities (Liu, 2021). The team measured plaque index before and after the intervention, playing the game twice a week for an hour. Compared to the control group, the group of ID individuals that played the board game, had statistically significant less plaque and an increase in oral hygiene knowledge. 

● Augmented Reality: A team of researchers out of Korea tested the effectiveness of augmented reality-based training using a smart toothbrush with individuals with intellectual disabilities (Jeon, 2021). The group that was taught with augmented reality and a smart toothbrush had greater improvements in oral hygiene index after the training, compared to the control group that was taught using visual material created by the Korea Health Promotion Institute (KHPI) for oral hygiene improvement.  

While it is not necessary to have access to a smart toothbrush to improve oral hygiene outcomes, caregivers can creatively think of different ways to make learning fun and engaging.  

Beyond the Tooth Brush 

Supporting oral health in individuals is more than simply reminding them to brush their teeth; it is about promoting autonomy, comfort, and individualization. By reducing resistance and increasing motivation to engage in oral hygiene activities, caregivers are supporting overall quality of life.  

References 

Jeon, B., Oh, J., & Son, S. (2021, March). Effects of tooth brushing training, based on augmented reality using a smart toothbrush, on oral hygiene care among people with intellectual disability in Korea. In Healthcare (Vol. 9, No. 3, p. 348). MDPI.

Liu, H. Y., Chen, P. H., Chen, W. J., Huang, S. S., Chen, J. H., & Yao, C. T. (2021). The effectiveness of a board game-based oral hygiene education program on oral hygiene knowledge and plaque index of adults with intellectual disability: a pilot study. International Journal of Environmental Research and Public Health, 18(3), 946. 

Matsuyama Y, Tsakos G, Listl S, Aida J, Watt RG. Impact of Dental Diseases on Quality-Adjusted Life Expectancy in US Adults. Journal of Dental Research. 2019;98(5):510-516.

Nowghani, F., Lisiecka, D., Phelan, S., Horan, P., O'Reilly, L., Howell, Y., & Mac Giolla Phadraig, C. (2024). Keep My Teeth: An evaluation of multi‐disciplinary training in mouth care for people with intellectual developmental disorders. Special Care in Dentistry, 44(3), 852-862. 

Wilson, N.J.; Lin, Z.; Villarosa, A.; Lewis, P.; Philip, P.; Sumar, B.; George, A. Countering the poor oral health of people with intellectual and developmental disability: A scoping literature review. BMC Public Health 2019, 19, 1530.

Amanda Deering, Behavior Consultant, Miren Behavior