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|
|Epilepsy||16 – 25||1.5|
|Poor eyesight / blindness||19||2 (> 55 years)|
|Urinary tract infection||16||4|
|Osteoporosis||8 – 21||1|
|Dementia||13 (> 60 years)||5|
|Urinary retention||10||0.2 – 0.7|
|Thyroid disorder||8 – 12||1.5|
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.
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.