Disability and Systemic Conditions in relation to their Impact on Oral health
Definitions
- IMPAIRMENT means the loss, the loss of the use, or the damage or malfunction, of any part of the body or of any bodily system or function or part of such system or function (safeworkaustralia.gov.au)
- An impairment refers to a biological or physical issue. A person can have an impairment without it constituting a disability if it does not significantly restrict their daily life.
- Persons are considered to have a DISABILITY if they have a limitation, restriction or impairment, which has lasted, or is likely to last, for at least six months and restricts everyday activities. (APSC.GOV.AU)
- A disability arises when an impairment, in conjunction with societal and environmental barriers, restricts a person’s ability to perform everyday activities. It is the interaction between the individual’s condition and their environment.
- Sensory
- Intellectual
- Physical
- Psychosocial
- Head injury, stroke, or other acquired brain injury
- Others How is this definition different from other countries?
- SPECIAL NEEDS DENTISTRY supports the oral health care needs of people with an intellectual disability, medical, physical or psychiatric conditions that require special methods or techniques to prevent or treat oral health problems, or where such conditions necessitate special dental treatment plans. (RACDS, 2015)
- This definition does not explicitly include social disadvantage as a primary criterion. For example, a healthy homeless person would not fall under this definition, but a homeless person with untreated medical, psychiatric, or substance use issues would. However, most patients seen in special needs dentistry do face significant social barriers.
Reality
Barriers in societal systems tend to be synergistic in causing vulnerability/ marginalisation. Families with a person with a disability often face compounded difficulties.
- Financial Strain : A caregiver may need to stop working, reducing family income while simultaneously facing increased costs for medical appointments and specialized care.
- Synergistic Barriers : These financial and logistical challenges build on each other, creating a significant setback for the entire family unit.
International Classification of Functioning, Disability and Health (ICF) (LO1)
The International Classification of Functioning, Disability and Health (ICF) is a framework developed by the World Health Organization (WHO) for describing and measuring health and disability. It provides a common language for health professionals to understand and communicate about functioning and disability, moving beyond a purely medical or social model to a biopsychosocial one. The ICF model views a person’s level of functioning as a dynamic interaction between their health condition, environmental factors, and personal factors.
Bio-psycho-social Model of Functioning, Disability and Health
Example of how ICF is used: Manual Wheelchair
Users (MWC)
- Health Condition
- Elderly and Aging MWC
- Body Functions and Structures
- Injury severity and neurologic level
- Cognition
- Fitness level
- Upper extremities and trunk
- Activities
- Mobility in the home and community
- ADL
- Physical activity and exercise
- Mobility is often limited to the home and familiar community areas. Activities of Daily Living (ADLs) like bathing and dressing may be challenging, and physical activity is often sedentary.
- Participation
- Quality of life
- Community Participation
- Social Engagement
- Self-care, self-esteem
- Work/Employment
- Community participation may be limited, and social engagement often depends on the availability of friends and neighbors. Self-care and self-esteem can also be affected.
- Environmental Factors
- Wheelchair design and seating configuration
- Home, community, and work barriers
- Transportation
- Accessibility of transport (cars, buses) and architectural barriers (stairs, slopes) play a crucial role. Weather conditions like rain can also create significant challenges.
- Personal Factors
- Age, skills, BMI, gender, ethnicity, duration of impairment, marital and socioeconomicstatus,
- Coping skills and skills from previous employment can influence how a person adapts to their situation.
Neurological Disorders
- NEUROLOGICAL DISORDERS PRESENT WITH ABNORMAL MOVEMENT (DYSKINESIA)
- Tremors
- Chorea
- Tics
- Other involuntary movements An OPG (orthopantomogram) X-ray can be difficult to obtain for these patients.
- Cerebral Palsy : Patients may exhibit uncontrolled, irregular movements, resulting in a non-diagnostic image.
- Parkinson’s Disease : Patients may have a light, regular tremor. In advanced stages, a hunched posture (kyphosis) can cause the X-ray machine’s rotating arm to hit the patient’s back, causing movement and a blurred image. Removing items like earrings can also be difficult due to hand tremors.
Parkinson’s - neurodegenerative
Cerebral Palsy - neurodevelopmental
Case Example: Huntington’s Disease
Case 1 : Huntington’s Disease Management
About Huntington’s Disease
Huntington’s Disease is an inherited degenerative neurological condition affecting the brain and central nervous system. It progressively impairs mental and physical abilities, eventually leading to the loss of critical functions such as walking, talking, eating and reasoning. Complications arising from HD ultimately resulting in death.
- Features
- Uncontrollable dance-like movements (chorea). Rigidity subtypes are rare
- changes behaviour, emotion, judgement, personality, hallucinations
- Causes:
- Mostly autosomal dominant, sometimes sporadic
- Mutation in Huntingtin gene, causing proteins to lodge in brain
- The specific symptoms (e.g., mood vs. movement) depend on which area of the brain is affected first.
- Prognosis: no cure, progress over 2 decades
- Epidemiology: 8-10 per 100,000 of European ancestry
- Treatment:
- Supportive: exercise, healthy diet, psychosocial support
- Palliative concepts of treatment
- Medication to reduce symptoms (movement, mood etc.),
ICF for Huntington’s
Health Condition: Huntington’s Disease
- Body Functions & Structures
- Uncontrolled mvm
- Cognition
- Mood
- Psychiatric issues
- Activities & Participation
- reduced mobility
- poor decision-making
- reliance of caregiving
- AODL/ADLs
- Employment
- Independence
- Community
- QoL
- Environmental Factors
- accessibility,
- Societal/cultural
- social supports avail
- healthcare expertise
- family support
- Personal Factors
- personal outlook
- socio-economic status
- age,
- concomitant health conditions
Interrelation of Health Aspects and General Well-being
Oral health is intrinsically linked to systemic health. Medications for systemic conditions almost universally affect saliva, which is a filtrate of blood, thereby impacting the oral environment.
Diabetes Mellitus
- Diabetes and Gum health share bi-directional effect
- When gum health is restored, HbA1c levels improve 3-4mmol/L (0.3-0.4%). this improvement is equivalent to adding a second medication like Metformin.
Dysphagia, poor oral hygiene & pneumonia
- In patients with neurological conditions and severe dysphagia, there is a high risk of aspiration pneumonia .
- Mechanism : Plaque, which contains billions of bacteria per milligram, can be aspirated into the lungs, causing a severe infection, especially in immunocompromised individuals.
- Weekly high quality oral care reduced mean annual pneumonia from 1.24 to 0.48
- reduce mortality
- reduce hospitalisation
- A study in Taiwanese nursing homes showed that providing professional oral care just once a week significantly reduced mortality and hospitalization costs.
Challenges for PwIDD (People with Intellectual and Developmental Disabilities)
- Medications cause overgrown gums
- Hyper-sensitive mouth
- Common in individuals with Autism Spectrum Disorder, making toothbrushing feel intensely unpleasant.
- Hypo-sensitive mouth
- Patients may not notice food pouching or debris stuck between teeth, leading to decay and infection.
- Poor manual dexterity
- There is often a conflict between promoting a patient’s independence (letting them brush themselves) and ensuring effective oral hygiene (requiring caregiver assistance). This must be assessed on an individual basis.
- Communication
- Self-inflicted injuries*
- Some individuals may bite their cheeks, hit their jaw, or scratch their gums as a way of coping or communicating distress.
Common Impairment/Disability/Systemic Conditions
Down’s Syndrome
Down’s Syndrome is a common genetic condition that serves as a good model for understanding the multifaceted approach required in special needs dentistry. The ACCESS framework is a useful tool for considering the various aspects of care.
- Access
- Escort/accompanying person. Mild mobility issues. Sensory issues
- Communication
- Communication can vary. Appropriate language, repeated and scaffolded. Possible sensory impairments (presbycusis, cataract)
- Use simple language, repeat instructions, and use visual aids like pamphlets with pictures.
- Consent
- PwDS have intellectual disability, and at risk of early-onset dementia, psychiatric conditions. Consider Legal Capacity principles in consent taking
- Education
- Consider brushing techniques (Modified Bass vs scrub etc), and assistive devices. Assisted oral hygiene. Additional effort for effective self-care. Control diabetes
- Oral hygiene instruction may need to be simplified (e.g., teaching a
- Surgery
- GA concerns - atlanto-axial joint instability, restricted airways, anaemic. Cardiac, haematological, endocrine (hypothyroid, diabetes, osteoporosis) concerns. Epilepsy, risk of sleep apnea, gastric reflux
- Atlantoaxial Instability : Instability in the neck vertebrae can lead to spinal cord injury during intubation.
- Airway Issues : Restricted airways and macroglossia can make intubation difficult.
- Cardiac Issues : Congenital heart defects are common.
- Hematological Issues : Anemia can affect oxygenation during GA.
- Spread
- DS does not spread. Might be immunocompromised (neutropenia, leukaemia, etc)
- The condition itself is not contagious, but patients are often immunocompromised , making them more susceptible to infections.
- Oral Finding
Some possible Oral Findings for DS (not all PwDS will have them)
- A
- Lip fisures, angular chelitis
- B
- hypoplastic tooth structure, AOB, tongue protrude
- The anterior open bite (AOB) is often due to tongue protrusion related to airway difficulties.
- C
- Bifid uvula, enlarged tonsils
- D
- cleft lip/palate, hypoplastic maxilla, pseudoprognathism
- The hypoplastic (underdeveloped) maxilla creates an appearance of a protruded mandible ( pseudoprognathism ).
- E
- conical shaped teeth, tooth wear, caries risk, missing teeth
- F
Improving tools for toothbrushing
Modified Brush-head
- Collis Curve
- Surround Brush
- A toothbrush with three surfaces (bristles on three sides) and a silicone-padded head. It is designed to clean all surfaces of the tooth simultaneously, which can be effective for children and adults with limited dexterity. However, it may not be ideal for patients with active periodontal disease.
Modified Handles
Caregiver’s Assisted Brushing Positioning
Whenever we do assisted brushing we stand brom the back this helps to support the head .
Personal and Professional Development (A2)
Demonstrate personal and professional development (A2) Societies that allow Continuing Professional Development :
- ASSCID — Australian Society of Special Care in Dentistry
- Australia New Zealand Academy of Special Needs Dentistry
- Malaysian Association for Disability and Oral Health (MADOH) (via the MYSCD CARE Conference which awards CPD points)
iADH 2026
INTERNATIONAL ASSOCIATION FOR DISABILITY & ORAL HEALTH Inclusion Health: Prioritizing, Diversity, Equity and Oral Health
- Date: 19-22 August 2026
- Location: Trinity College Dublin, Ireland
- Website: Home Conference Information Registration Sponsorship Contact