**2.3.2 Barriers to oral healthcare**

There are a number of barriers to oral healthcare for people with learning disabilities that need to be overcome if their oral health needs are to be fully met (Alborz et al., 2004, Scully et al., 2007). Scully et al have categorised these as:


(Scully et al., 2007)

treatment, and both low and high carer-contact; finally, higher odds of having 'filled teeth' were associated with age, having no oral hygiene assistance and having high carer-contact (Pradhan et al., 2009). This underlines the importance of high quality daily care as well as

It is also recognised that trauma to teeth can present a challenge to some people with learning disabilities. Epileptic seizures and falls due to dyspraxia and impaired mobility increase the risk of traumatic dental injury, which is likely to require urgent assessment and

It is vitally important to ensure that children and adults with learning disabilities, and their carers, are sufficiently supported to care for their oral health and prevent disease as outlined in Section 3.1, rather than just treating disease once it has developed. The main diseases and

associated with a high sugar consumption (food/drink{

plaque), is much more prevalent, particularly in adults

12 year olds (35%) in the general population in the UK.

There are a number of barriers to oral healthcare for people with learning disabilities that need to be overcome if their oral health needs are to be fully met (Alborz et al., 2004, Scully

wear caused by devices such as a toothbrush

disabilities through falls or accidents

Table 1. Common oral diseases and conditions

et al., 2007). Scully et al have categorised these as:



**2.3.2 Barriers to oral healthcare** 

one of the most prevalent conditions in adults and children worldwide,

affect most people to some extent. Moderate gum disease, demonstrated by bleeding gums and the presence of plaque and or calculus (calcified

a natural phenomena of ageing; however it becomes pathological when it is excessive either through erosion by means of acidic food, drink or acid reflux, attrition or tooth-wear through excessive grinding and abrasion by

cancer of the mouth, the majority of which are squamous cell carcinoma; this is a particularly emotive cancer because of its impact on eating, speaking and socialising and poor outcomes including long term survival

Significant need for orthodontic care is prevalent in just over one third of

trauma to teeth is a greater risk for some people with learning and physical

regular dental care.

**Disease or** 

**Dental caries**  *Tooth decay* 

**Periodontal diseases**  *Gum diseases* 

**Tooth wear:**  *attrition, erosion or abrasion of tooth surface*

**Oral cancer**  *Mouth cancer* 

**Orthodontic need** 

*Need for braces* 

(Scully et al., 2007)

**Trauma**  *Damage* 

treatment (Department of Health, 2007).

**condition Description** 

conditions are outlined in Table 1.

Individual barriers include a lack of perception of need by individuals (Halberg & Klingberg 2004) or their carers (Cumella el al. 2001); difficulty following instructions (Bollard 2002); and access problems (Dougall & Fiske 2008). Barriers relating to the dental profession include a lack of training (Gallagher and Fiske, 2007, Scambler et al., 2011); poor communication skills (Sentell 2007); high staff turnover (Pratelli and Gelbier, 1998) (Scambler et al., 2011) and a lack of time and resources (Scambler et al., 2011). Societal barriers include a general lack of awareness of the importance of oral healthcare, and a lack of positive attitudes towards oral health promotion (Owens et al., 2011). Finally, governmental barriers include a lack of resources for oral health services (Dougall and Fiske, 2008a). This suggests that whilst the oral health needs of people with learning disabilities are broadly similar to their non-disabled peers, there are significantly more barriers to timely oral health care of good quality.
