Perceived Barriers to Treating Patients with Disabilities and Complex Health Needs Reported by Oral Health Professionals: A Scoping Review
Main Article Content
Abstract
Background: People with disabilities and complex health needs have poorer oral health when compared to the rest of the population, with being able to find oral health professionals willing to provide treatment often identified as the main barrier. Despite this, our understanding of the barriers that oral health professionals face when treating these patients remains limited. This is crucial to overcoming the challenge of reducing oral health disparities faced by these vulnerable populations.
Aim: To provide an overview of barriers reported by oral health professionals in regards to treating patients with disabilities and complex health needs in the published literature.
Methods: Primary studies were searched for through PudMed, Ovid and Scopus databases using a search strategy developed by the research team. Articles were screened according to PRISMA guidelines and against inclusion and exclusion criteria.
Results: Eighteen studies fulfilled the criteria for evaluation, including studies using both qualitative and quantitative approaches. General dentists were most frequently included in the studies, but patient populations were highly variable, with the majority relating to people with disability. The reported barriers could be classified into three main areas: clinician, patient, and environment-related.
Conclusion: There are only a small number of studies reporting on barriers perceived by oral health professionals to impact on their ability to treat people with disabilities and complex health needs. While lack of training or experience was a factor underlying many of the reported concerns, studies raised concerns about clinicians being inadequately resourced or supported to provide this care. These are areas the dental profession will need to consider in order to address current oral health disparities experienced by people with disability and special health care needs.
Article Details
How to Cite
YANG, Xinyuan et al.
Perceived Barriers to Treating Patients with Disabilities and Complex Health Needs Reported by Oral Health Professionals: A Scoping Review.
Medical Research Archives, [S.l.], v. 11, n. 10, oct. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4544>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i10.4544.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. World Health Organization, The World Bank. World Report on Disability: Summary. World Health Organization;2011.
2. Wilson NJ, Lin Z, Villarosa A, et al. Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review. BMC Public Health. 2019;19(1):1-16.
3. Anders PL, Davis EL. Oral health of patients with intellectual disabilities: a systematic review. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry. 2010;30(3):110-117.
4. Morgan JP, Minihan PM, Stark PC, et al. The oral health status of 4,732 adults with intellectual and developmental disabilities. Journal of the American Dental Association (1939). 2012;143(8):838-846.
6. Khocht A, Janal M, Turner B. Periodontal health in Down syndrome: contributions of mental disability, personal, and professional dental care. Special Care in Dentistry. 2010;30(3):118-123.
7. Lopez Silva CP, Singh A, Calache H, Derbi HA, Borromeo GL. Association between disability status and dental attendance in Australia-A population-based study. Community Dentistry and Oral Epidemiology. 2021;49(1):33-39.
8. Sawhney S, Vu T, Chen F, Wong K, Zafar S, Lopex Silva C. Association between disability status and dental attendance patterns in Australian Children: A national survey. Community Dentistry and Oral Epidemiology. 2023;41:443-451.
9. Fisher K. Is There Anything to Smile about? A Review of Oral Care for Individuals with Intellectual and Developmental Disabilities. Nursing research and practice. 2012;2012:860692.
10. Nirmala S, Popuri VD, Chilamakuri S, Nuvvula S, Veluru S, Babu MM. Oral health concerns with sweetened medicaments: Pediatricians’ acuity. Journal of International Society of Preventive & Community Dentistry. 2015;5(1):35.
11. Cullinan M, Ford P, Seymour G. Periodontal disease and systemic health: current status. Australian dental journal. 2009;54:S62-S69.
12. van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, Schols JM, de Baat C. Oral health care and aspiration pneumonia in frail older people: a systematic literature review. Gerodontology. 2013;30(1):3-9.
13. Gomaa N, Glogauer M, Tenenbaum H, Siddiqi A, Quiñonez C. Social-biological interactions in oral disease: A ‘cells to society’view. PloS one. 2016;11(1):e0146218.
14. Pretty IA. The life course, care pathways and elements of vulnerability. A picture of health needs in a vulnerable population. Gerodontology. 2014;31(s1):1-8.
15. United Nations. Convention on the rights of persons with disabilities. In: Nations U, ed2006.
16. Fortune N, Madden RH, Clifton S. Health and access to health services for people with disability in Australia: data and data gaps. International Journal of Environmental Research and Public Health. 2021;18(21):11705.
17. Lim MAWT, Liberali SA, Borromeo GL. Utilisation of dental services for people with special health care needs in Australia. BMC Oral Health. 2020;20:360.
18. Pradhan A, Slade GD, Spencer AJ. Access to dental care among adults with physical and intellectual disabilities: residence factors. Australian Dental Journal. 2009;54(3):204-211.
19. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery. 2021;88:105906.
20. McHugh ML. Interrater reliability: the kappa statistic. Biochemia medica. 2012;22(3):276-282.
21. Tsai W-C, Kung P-T, Chiang H-H, Chang W-C. Changes and factors associated with dentists’ willingness to treat patients with severe disabilities. Health Policy. 2007;83(2-3):363-374.
22. Méndez SV, Rotman M, Hormazábal F, Sepúlveda L, Valle M, Álvarez E. Barriers and facilitators in the orthodontic treatment of teenagers with neurodevelopmental disabilities. American Journal of Orthodontics and Dentofacial Orthopedics. 2022;161(1):115-124.
23. Mandasari M, Rahmayanti F, Derbi H, Wimardhani YS. Special care dentistry perception among dentists in Jakarta: An online survey study. PloS one. 2021;16(4):e0249727.
24. Lim MAWT, Liberali SA, Calache H, Parashos P, Borromeo GL. Perceived barriers encountered by oral health professionals in the Australian public dental system providing dental treatment to individuals with special needs. Special Care in Dentistry. 2021;41(3):381-390.
25. Adyanthaya A, Sreelakshmi N, Ismail S, Raheema M. Barriers to dental care for children with special needs: General dentists' perception in Kerala, India. Journal of Indian society of pedodontics and preventive dentistry. 2017;35(3):216-222.
26. Chuang JCP, Pradhan A, Walsh LJ, Lopez Silva CP. Singapore dentists' attitudes toward dental care provision for older adults with disabilities. Gerodontology. 2023.
27. Coyle C, Humphris G, Freeman R. Dentists' training and willingness to treat adolescents with learning disabilities: the mediating role of social and clinical factors. Community Dent Health. 2013;30(4):263-268.
28. Hugar SM, Soneta SP, Gokhale N, Badakar C, Joshi RS, Davalbhakta R. Assessment of Dentist's Perception of the Oral Health Care toward Child with Special Healthcare Needs: A Cross-sectional Study. International Journal of Clinical Pediatric Dentistry. 2020;13(3):240.
29. Rajan S, Kuriakose S, Varghese BJ, Asharaf F, Suprakasam S, Sreedevi A. Knowledge, Attitude, and Practices of Dental Practitioners in Thiruvananthapuram on Oral Health Care for Children with Special Needs. International journal of clinical pediatric dentistry. 2019;12(4):251.
30. Chavis SE, Roth E, Dababnah S, Tepper V, Badawi DG, Mullins CD. Qualitative inquiry from multiple perspectives of barriers and facilitators of oral health care for adults with disabilities. Special Care in Dentistry. 2023;43(1):47-55.
31. Klingberg G, Hallberg U. Oral health–not a priority issue. A grounded theory analysis of barriers for young patients with disabilities to receive oral health care on the same premise as others. European Journal of Oral Sciences. 2012;120(3):232-238.
32. Reichard A, Turnbull HR, Turnbull AP. Perspectives of dentists, families, and case managers on dental care for individuals with developmental disabilities in Kansas. Mental Retardation. 2001;39(4):268-285.
33. Lim MAWT, Liberali SA, Calache H, Parashos P, Borromeo GL. Perspectives of the public dental workforce on the dental management of people with special needs. Australian Dental Journal. 2021;66(3):304-313.
34. Bedi R, Champion J, Horn R. Attitudes of the dental team to the provision of care for people with learning disabilities. Special Care in Dentistry. 2001;21(4):147-152.
35. Krishnan L, Iyer K, Kumar PDMM. Barriers in dental care delivery for children with special needs in Chennai, India: a mixed method research. Disability, CBR & Inclusive Development. 2018;29(4):68-82.
36. Suhasini K, Rajashekhar R, Reddy JS, Hemachandrika I, Tarasingh P, Shaik H. Awareness and Attitude of General and Specialist Dentists in Providing Oral Health-related Quality of Life for Children with Special Healthcare Needs. International journal of clinical pediatric dentistry. 2021;14(5):601.
37. Lim MAWT, Liberali SA, Calache H, Parashos P, Borromeo GL. Specialist networks influence clinician willingness to treat individuals with special needs. JDR Clinical and Translational Research. 2021;doi:10.1177/23800844211020250.
38. Soltani S, Takian A, Sari AA, Majdzadeh R, Kamali M. Financial barriers to access to health Services for Adult People with disability in Iran: the challenges for universal health coverage. Iranian journal of public health. 2019;48(3):508.
39. Ningrum V, Bakar A, Shieh T-M, Shih Y-H. The oral health inequities between special needs children and normal children in Asia: A systematic review and meta-analysis. Paper presented at: Healthcare2021.
40. Müller F. Oral hygiene reduces the mortality from aspiration pneumonia in frail elders. Journal of dental research. 2014;94(3 suppl):14S-16S.
41. Derbi HA, Borromeo GL. The perception of Special Needs Dentistry amongst general dentists within Western Australia, Australia. Journal of Gerontology and Geriatric Research. 2016;5(4).
42. AlKindi N, Nunn J. The use of the BDA Case Mix Model to assess the need for referral of patients to specialist dental services. British Dental Journal. 2016;220(8):401-406.
43. Lin TY, Gryst ME, Edwards SM, Liberali SA. Comparing the BDA case mix tool and simplified case mix tool for stratification of public dental patients with disabilities in South Australia. British Dental Journal. 2023:1-6.
44. Conquest JH, Skinner J, Kruger E, Tennant M. Adult capped dental payment model applied within a university setting: an Australian reflective case study. BMC Oral Health. 2021;21(1):414.
45. Brennan DS, Luzzi L, Roberts-Thomson KF. Dental service patterns among private and public adult patients in Australia. BMC Health Services Research. 2008;8(1):1-8.
46. Mac Giolla Phadraig C, Kammer PV, Asimakopoulou K, et al. Labels and descriptions of dental behaviour support techniques: A scoping review of clinical practice guidelines. Community Dentistry and Oral Epidemiology. 2023.
47. Kangutkar T, Calache H, Watson J, Taylor S, Balandin S. Education/Training Interventions to Improve Oral Health of Adults with Intellectual Disability. Paper presented at: Healthcare2022.
48. Moraru R, Ghannad P, Ulusoy E, et al. Evaluation or oral health knowledge among personnel in an institution for the rehabilitation of disabled young adults. Journal of Disability and Oral Health. 2007;8(3):135.
2. Wilson NJ, Lin Z, Villarosa A, et al. Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review. BMC Public Health. 2019;19(1):1-16.
3. Anders PL, Davis EL. Oral health of patients with intellectual disabilities: a systematic review. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry. 2010;30(3):110-117.
4. Morgan JP, Minihan PM, Stark PC, et al. The oral health status of 4,732 adults with intellectual and developmental disabilities. Journal of the American Dental Association (1939). 2012;143(8):838-846.
6. Khocht A, Janal M, Turner B. Periodontal health in Down syndrome: contributions of mental disability, personal, and professional dental care. Special Care in Dentistry. 2010;30(3):118-123.
7. Lopez Silva CP, Singh A, Calache H, Derbi HA, Borromeo GL. Association between disability status and dental attendance in Australia-A population-based study. Community Dentistry and Oral Epidemiology. 2021;49(1):33-39.
8. Sawhney S, Vu T, Chen F, Wong K, Zafar S, Lopex Silva C. Association between disability status and dental attendance patterns in Australian Children: A national survey. Community Dentistry and Oral Epidemiology. 2023;41:443-451.
9. Fisher K. Is There Anything to Smile about? A Review of Oral Care for Individuals with Intellectual and Developmental Disabilities. Nursing research and practice. 2012;2012:860692.
10. Nirmala S, Popuri VD, Chilamakuri S, Nuvvula S, Veluru S, Babu MM. Oral health concerns with sweetened medicaments: Pediatricians’ acuity. Journal of International Society of Preventive & Community Dentistry. 2015;5(1):35.
11. Cullinan M, Ford P, Seymour G. Periodontal disease and systemic health: current status. Australian dental journal. 2009;54:S62-S69.
12. van der Maarel-Wierink CD, Vanobbergen JN, Bronkhorst EM, Schols JM, de Baat C. Oral health care and aspiration pneumonia in frail older people: a systematic literature review. Gerodontology. 2013;30(1):3-9.
13. Gomaa N, Glogauer M, Tenenbaum H, Siddiqi A, Quiñonez C. Social-biological interactions in oral disease: A ‘cells to society’view. PloS one. 2016;11(1):e0146218.
14. Pretty IA. The life course, care pathways and elements of vulnerability. A picture of health needs in a vulnerable population. Gerodontology. 2014;31(s1):1-8.
15. United Nations. Convention on the rights of persons with disabilities. In: Nations U, ed2006.
16. Fortune N, Madden RH, Clifton S. Health and access to health services for people with disability in Australia: data and data gaps. International Journal of Environmental Research and Public Health. 2021;18(21):11705.
17. Lim MAWT, Liberali SA, Borromeo GL. Utilisation of dental services for people with special health care needs in Australia. BMC Oral Health. 2020;20:360.
18. Pradhan A, Slade GD, Spencer AJ. Access to dental care among adults with physical and intellectual disabilities: residence factors. Australian Dental Journal. 2009;54(3):204-211.
19. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. International journal of surgery. 2021;88:105906.
20. McHugh ML. Interrater reliability: the kappa statistic. Biochemia medica. 2012;22(3):276-282.
21. Tsai W-C, Kung P-T, Chiang H-H, Chang W-C. Changes and factors associated with dentists’ willingness to treat patients with severe disabilities. Health Policy. 2007;83(2-3):363-374.
22. Méndez SV, Rotman M, Hormazábal F, Sepúlveda L, Valle M, Álvarez E. Barriers and facilitators in the orthodontic treatment of teenagers with neurodevelopmental disabilities. American Journal of Orthodontics and Dentofacial Orthopedics. 2022;161(1):115-124.
23. Mandasari M, Rahmayanti F, Derbi H, Wimardhani YS. Special care dentistry perception among dentists in Jakarta: An online survey study. PloS one. 2021;16(4):e0249727.
24. Lim MAWT, Liberali SA, Calache H, Parashos P, Borromeo GL. Perceived barriers encountered by oral health professionals in the Australian public dental system providing dental treatment to individuals with special needs. Special Care in Dentistry. 2021;41(3):381-390.
25. Adyanthaya A, Sreelakshmi N, Ismail S, Raheema M. Barriers to dental care for children with special needs: General dentists' perception in Kerala, India. Journal of Indian society of pedodontics and preventive dentistry. 2017;35(3):216-222.
26. Chuang JCP, Pradhan A, Walsh LJ, Lopez Silva CP. Singapore dentists' attitudes toward dental care provision for older adults with disabilities. Gerodontology. 2023.
27. Coyle C, Humphris G, Freeman R. Dentists' training and willingness to treat adolescents with learning disabilities: the mediating role of social and clinical factors. Community Dent Health. 2013;30(4):263-268.
28. Hugar SM, Soneta SP, Gokhale N, Badakar C, Joshi RS, Davalbhakta R. Assessment of Dentist's Perception of the Oral Health Care toward Child with Special Healthcare Needs: A Cross-sectional Study. International Journal of Clinical Pediatric Dentistry. 2020;13(3):240.
29. Rajan S, Kuriakose S, Varghese BJ, Asharaf F, Suprakasam S, Sreedevi A. Knowledge, Attitude, and Practices of Dental Practitioners in Thiruvananthapuram on Oral Health Care for Children with Special Needs. International journal of clinical pediatric dentistry. 2019;12(4):251.
30. Chavis SE, Roth E, Dababnah S, Tepper V, Badawi DG, Mullins CD. Qualitative inquiry from multiple perspectives of barriers and facilitators of oral health care for adults with disabilities. Special Care in Dentistry. 2023;43(1):47-55.
31. Klingberg G, Hallberg U. Oral health–not a priority issue. A grounded theory analysis of barriers for young patients with disabilities to receive oral health care on the same premise as others. European Journal of Oral Sciences. 2012;120(3):232-238.
32. Reichard A, Turnbull HR, Turnbull AP. Perspectives of dentists, families, and case managers on dental care for individuals with developmental disabilities in Kansas. Mental Retardation. 2001;39(4):268-285.
33. Lim MAWT, Liberali SA, Calache H, Parashos P, Borromeo GL. Perspectives of the public dental workforce on the dental management of people with special needs. Australian Dental Journal. 2021;66(3):304-313.
34. Bedi R, Champion J, Horn R. Attitudes of the dental team to the provision of care for people with learning disabilities. Special Care in Dentistry. 2001;21(4):147-152.
35. Krishnan L, Iyer K, Kumar PDMM. Barriers in dental care delivery for children with special needs in Chennai, India: a mixed method research. Disability, CBR & Inclusive Development. 2018;29(4):68-82.
36. Suhasini K, Rajashekhar R, Reddy JS, Hemachandrika I, Tarasingh P, Shaik H. Awareness and Attitude of General and Specialist Dentists in Providing Oral Health-related Quality of Life for Children with Special Healthcare Needs. International journal of clinical pediatric dentistry. 2021;14(5):601.
37. Lim MAWT, Liberali SA, Calache H, Parashos P, Borromeo GL. Specialist networks influence clinician willingness to treat individuals with special needs. JDR Clinical and Translational Research. 2021;doi:10.1177/23800844211020250.
38. Soltani S, Takian A, Sari AA, Majdzadeh R, Kamali M. Financial barriers to access to health Services for Adult People with disability in Iran: the challenges for universal health coverage. Iranian journal of public health. 2019;48(3):508.
39. Ningrum V, Bakar A, Shieh T-M, Shih Y-H. The oral health inequities between special needs children and normal children in Asia: A systematic review and meta-analysis. Paper presented at: Healthcare2021.
40. Müller F. Oral hygiene reduces the mortality from aspiration pneumonia in frail elders. Journal of dental research. 2014;94(3 suppl):14S-16S.
41. Derbi HA, Borromeo GL. The perception of Special Needs Dentistry amongst general dentists within Western Australia, Australia. Journal of Gerontology and Geriatric Research. 2016;5(4).
42. AlKindi N, Nunn J. The use of the BDA Case Mix Model to assess the need for referral of patients to specialist dental services. British Dental Journal. 2016;220(8):401-406.
43. Lin TY, Gryst ME, Edwards SM, Liberali SA. Comparing the BDA case mix tool and simplified case mix tool for stratification of public dental patients with disabilities in South Australia. British Dental Journal. 2023:1-6.
44. Conquest JH, Skinner J, Kruger E, Tennant M. Adult capped dental payment model applied within a university setting: an Australian reflective case study. BMC Oral Health. 2021;21(1):414.
45. Brennan DS, Luzzi L, Roberts-Thomson KF. Dental service patterns among private and public adult patients in Australia. BMC Health Services Research. 2008;8(1):1-8.
46. Mac Giolla Phadraig C, Kammer PV, Asimakopoulou K, et al. Labels and descriptions of dental behaviour support techniques: A scoping review of clinical practice guidelines. Community Dentistry and Oral Epidemiology. 2023.
47. Kangutkar T, Calache H, Watson J, Taylor S, Balandin S. Education/Training Interventions to Improve Oral Health of Adults with Intellectual Disability. Paper presented at: Healthcare2022.
48. Moraru R, Ghannad P, Ulusoy E, et al. Evaluation or oral health knowledge among personnel in an institution for the rehabilitation of disabled young adults. Journal of Disability and Oral Health. 2007;8(3):135.