Health and health risks - Mentally challenged people

People with an intellectual disability often have many health problems (see box). Sometimes these problems are part of a syndrome, in other cases they are additional problems.

Health and health risks - Mentally challenged people
People with an intellectual disability often have many health problems (see box). Sometimes these problems are part of a syndrome, in other cases they are additional problems.

Health and health risks

 

People with an intellectual disability often have many health problems (see box). Sometimes these problems are part of a syndrome, in other cases they are additional problems.

 

Health problems in people with Down's syndrome

  • Heart defect
  • Reflux complaints (gastroesophageal reflux)
  • Intestinal occlusion / intestinal abnormality; Celiac disease
  • Thyroid disorder
  • Increased risk of leukemia
  • Low muscle tone and coordination disorder
  • Dementia often occurs before the 60th year of life.

 

For the dental assistant of interest

 

  • Small oral cavity
  • A number of teeth and molars have not been created. Most often lacking wisdom teeth, second premolars, lateral incisors and mandibular incisors. The space between the teeth is therefore larger
  • The baby teeth and permanent teeth are delayed
  • Small crowns and small roots
  • Disorder in tooth enamel
  • More and at a younger age, gingivitis and periodontitis
  • Low muscle tone of lips and tongue.

 

Table shows additional health problems that often occur in adults with intellectual disabilities. The table lists problems that are not part of a syndrome.

 

Health problems in people with intellectual disabilities

  Occurs in ...% of adults with a VB Occurs in ...% of the general adult population
Reflux of acid from the stomach 48 (at IQ <50) 0.7
Earwax plug 43 2 - 4
Hearing impairment / deafness 30 16 - 17
Constipation 28 2
Epilepsy 16 - 25 1.5
Poor eyesight / blindness 19 2 (> 55 years)
Urinary tract infection 16 4
Osteoporosis 8 - 21 1
Spasticity 15 1.5
Dementia 13 (> 60 years) 5
Urinary retention 10 0.2 - 0.7
Thyroid disorder 8 - 12 1.5

 

Double diagnosis

In people with an intellectual disability, psychiatric disorders occur relatively often, such as autism spectrum disorders, psychoses, anxiety disorder, depression and dementia. In people with a mild intellectual disability, addiction is also relatively common. It is often difficult to recognize the psychiatric disorder, to diagnose and treat it.

 

Health risks

Obesity is common among people with a VB. The number of overweight people is increasing in this group, as is the case with the rest of the population. Sometimes overweight is part of a syndrome (prader-willis syndrome, characterized by insatiable appetite). Overweight is also common in people with a light VB, especially if they live independently or with limited support. They decide for themselves what and how much they eat. Due to an increase in obesity, type 2 diabetes also increases in people with a VB.

 

Caries and gum problems are common (see box).

 

Causes of increased risk of oral problems in people with intellectual disabilities

  • Problems with chewing and swallowing
  • Less natural cleansing of the mouth (due to stiff or weak muscles in and around the mouth, mouth breathing)
  • Reflux or ruminate (raising acid stomach contents and 'ruminating')
  • Deviating position of the teeth: by predisposition, but also by thumbs, sucking, sometimes by tapping against the teeth
  • Side effects of medicines:

- Dry mouth due to inhibition of saliva formation: some antipsychotics, urinating agents, cardiac arrhythmia

- Increased saliva formation, causing drooling (some painkillers, antipsychotics)

- Dental fat hyperplasia (anti-epileptic drugs)

- Tooth discolouration: chlorhexidine.

 

Oral care problems

There are many oral health problems. Table below shows problems that parents experience when they want to brush the teeth of their child with a VB. Three groups are distinguished in different studies:

  • Group A: aged 15-45, living at home and not living in an institution for more than one year.
  • Group B: 15-45 years old, now living at home, but lived in an institution in the previous 5 to 7 years.
  • Group C: children with a severe VB, living at home.

 

Oral care problems in people with intellectual disabilities

Kind of problem A % B % C %
No problems with tooth brushing 52 41 33
My child suffers from bleeding gums while brushing 26 28 22
My child has tight lips or cheeks 15,5 28 11.5
My child turns his head away when the teeth are being cleaned 8.6 26 72
My child closes his mouth     58
My child pushes the toothbrush away with his tongue 6.9 19 27
My child always bites on the toothbrush 7 17 54
My child often gurgles while brushing teeth 5.2 15 12.5
My child resists by crying loudly when the teeth are being cleaned 1.7 8.5 14
The teeth or teeth on the side of the tongue can not be cleaned 1.7 6.4 14
Irritability in the mouth area or brushing seems painful 1.7 6.4  
Sensitivity in mouth area     27
Brushing seems painful     18

 

Two thirds of the parents from study C have problems with the daily dental care of their child. They brush two minutes a day. More than two thirds of parents think that their child's oral hygiene can be improved.