Good oral healthcare is just as important to the health and quality of life of people with a learning disability as anyone else. Yet as a group they are far more likely than the general population to suffer from poor oral health. In fact, one in three adults with a learning disability and four out of five adults with Down’s syndrome have unhealthy teeth and gums.
Unfortunately due to poor communication, assumptions about quality of life, and a lack of understanding, Mencap research has shown that people with a learning disability often receive a poorer standard of care across all healthcare settings.
Combine this with the problems that some people with a learning disability may have in maintaining an effective oral health regime, and it is no wonder that this group of people has higher rates of untreated decay and a greater number of extractions than adults in the general population.
There is a great deal of confusion generally about what a learning disability actually is. In short it means that a person has a reduced intellectual ability. The level of disability ranges in severity. For example somebody with a milder disability might only need a little support to help them live a full life. But a person with a profound and multiple learning disability (PMLD) will need full-time care and support.
The Disability Discrimination Act says that people with a disability must not be discriminated against. This means that all healthcare professionals must make reasonable adjustments to give people with a disability an equal outcome and there are many ways in which every dentist can better understand and adjust the service they provide for patients who have a learning disability.
Better communication
People with a learning disability often need more support to understand information about their treatment, and to communicate symptoms and concerns. For this reason it’s a good idea to schedule longer appointment times so that this important process isn’t rushed.
Make sure you use simple language when explaining problems and treatment options, and avoid using scales. For example asking the patient to rate the level of pain from 1-10.
The EasyHealth website (www.easyhealth.org.uk) has guides for professionals treating people with a learning disability. It includes easy read information that dentists can use to help explain health issues and treatments to patients.
Listen
In particular, people with profound and multiple learning disabilities (PMLD) have a great deal of trouble communicating, and are rarely able to speak. The people that know them best are therefore vital in understanding how the patient wants to treated.
They will also able to spot and advise when the patient is in pain or becoming distressed. This might not always be immediately obvious to somebody who doesn’t know them.
Educate
Adults with a learning disability who live with their families have more untreated decay and poorer oral hygiene, and those living in residential services have more missing teeth.
People with PMLD are reliant on their carers for their toothbrushing so it is essential they know how to maintain a state of good oral hygiene and are encouraged to do so. It can be challenging caring for somebody with PMLD, and if carers meet a large amount of resistance to toothbrushing, the regime can become infrequent. Offer advice and refer people to the PAMIS website (www.pamis.org.uk) where information is available to help overcome common barriers to effective oral hygiene.
Liaise with health professionals
Where appropriate, it might be useful to give the patient’s GP a call to see if the patient has underlying health concerns you should be aware of, or is is on medication that may react with any planned treatment.
Help reduce anxiety
As with many other patients, a trip to the dentist can be nerve-wracking, especially when major treatment is going to take place. Some patients might find it helpful to have a pre-appointment with you to discuss the treatment in full and receive further reassurance.
Make sure other staff at your surgery are aware of adjustments they can make to support patients. For example, the waiting room can be an additional source of stress, so it might be a good idea for them to offer patients with learning disabilities the first appointment of the day.
Case study one
Claire (names changed to protect anonymity) has a mild learning disability. She had been going to her family dentist for years but had never felt entirely comfortable. Claire found that he often rushed explanations and that she often did not understand what he was talking about. He also used humor in his explanations, which she found confusing.
She says that the staff at the surgery were sharp with her and gave her forms without explaining what they wanted her to do with them. All of this put her on edge, and led to her avoiding her appointments for six months, despite problems with her wisdom teeth that were causing her pain.
When her boyfriend eventually made her go back, the dentist said she’d need her wisdom teeth out and referred her to hospital. She had a much better experience at the hospital. The staff took time to explain the options clearly, arranged a pre-appointment, involved her mum in her care, and when she was scared made lots of adjustments to make sure she was comfortable with the treatment. Claire is now in the process of switching dentists.