Highlighted review: Oral hygiene programmes for people with intellectual disabilities

Catherine Waldron, June Nunn, Caoimhin Mac Giolla Phadraig, Catherine Comiskey, Suzanne Guerin, Maria Theresa van Harten, Erica Donnelly‐Swift, Mike J Clarke

Plain language summary: Oral hygiene programmes for people with intellectual disabilities

Review question
How effective are oral hygiene programmes for people with intellectual disabilities?

Background
The removal of dental plaque by daily toothbrushing plays a major role in preventing tooth decay and gum disease, the two main causes of tooth loss.

Toothbrushing is a skill that can be difficult for people with ID; they may require help and people who care for them may need training in how to help them.

Study characteristics
We searched for studies up to 4 February 2019. This review included 34 studies that involved 1795 people with ID and 354 carers. Nineteen studies randomly allocated participants to two or more groups (i.e. randomised controlled trials (RCTs), and 15 were non‐randomised studies (NRS).

The studies assessed different ways to improve the oral hygiene of people with ID:

  • special manual toothbrushes;
  • electric toothbrushes;
  • oral hygiene training for carers;
  • oral hygiene training for people with ID;
  • varying the scheduled intervals between dental visits and supervising toothbrushing;
  • using discussion of clinical photographs as a motivator;
  • varying how frequently the teeth of people with ID were brushed;
  • using a plaque‐disclosing agent; and,
  • using individualised oral care plans.

The studies evaluated gingival inflammation (red and swollen gums) and plaque. Some studies evaluated carer knowledge, behaviour, attitude and self‐efficacy (belief in their competence) in terms of oral hygiene, as well as the oral hygiene behaviour and skills of people with ID. Tooth decay and quality of life were not measured.

We grouped the studies according to when the outcomes were measured: short term (six weeks or less), medium term (between six weeks and 12 months) and long term (more than 12 months).

Key results
A special manual toothbrush (the Superbrush), used by carers, may be better at reducing levels of gingival inflammation and possibly plaque in people with ID than an ordinary manual toothbrush in the medium term, though this was not seen in the short term.

We found no difference between electric and manual toothbrushes used by people with ID or their carers in terms of gingival inflammation or plaque in the medium term, and the short‐term results were unclear.

Training carers to brush the teeth of people with ID may have improved carers' oral hygiene knowledge in the medium term.

Training people with ID to brush their own teeth may have reduced the amount of plaque on their teeth in the short term.

Regularly scheduled dental recall visits and carers supervising toothbrushing between visits may have been more likely than usual care to reduce gingival inflammation and plaque in the long term.

Discussing clinical photographs of plaque on participants' teeth shown up by a disclosing agent, to motivate them to better toothbrushing did not seem to reduce plaque.

Daily toothbrushing by a dental student may be more effective for reducing plaque levels in the short term than once or twice weekly professional toothbrushing.

Toothpaste with a plaque‐disclosing agent and individualised oral care plans were each evaluated in one nonrandomised study that suggested they may be beneficial.

Only one study set out to formally measure negative side effects; however, most studies commented that there were none. Some studies found that some people had difficulties with the electric or special manual toothbrushes.

Certainty of the evidence
Although some oral hygiene interventions for people with ID show scientific evidence of benefits, what these benefits actually mean for an individual's oral hygiene or oral health is unclear. The certainty of the evidence is mainly low or very low so future research may change our findings.

Moderate‐certainty evidence is available for only one finding: electric and manual toothbrushes are probably similarly effective for reducing gingival inflammation in people with ID in the medium term.

More and better research is needed to fully evaluate interventions that show promise for improving the oral hygiene of people with ID, and to confirm which interventions are ineffective.

In the meantime, changes to current habits based on this review should be made cautiously, and decisions about oral hygiene care should be based on professional expertise and the needs and preferences of people with ID and their carers.

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Citation: Waldron  C, Nunn  J, Mac Giolla Phadraig  C, Comiskey  C, Guerin  S, van Harten  MT, Donnelly‐Swift  E, Clarke  MJ. Oral hygiene interventions for people with intellectual disabilities. Cochrane Database of Systematic Reviews 2019, Issue 5. Art. No.: CD012628. DOI: 10.1002/14651858.CD012628.pub2.