For the week 4 activity, I partnered with Amelia to see how our professions as a Registered Nurse (RN) and a Registered Dental Hygienist, respectively, overlap.
We each contributed, with respect to our roles in providing:
In my nursing practice, I have spent almost 4 years working with clients who have an intellectual and developmental disability (IDD), combined with a pervasive mental health concern. I've noticed in my own practice as an RN, that dental and oral care is an activity of daily living (ADL) that often goes unnoticed. I have learned that individuals with IDD experience poorer oral health and increased likelihood of associated occurrence of periodontal disease and untreated caries than those without an IDD. Individuals with an IDD experience increased complications of poor oral health, including significant associations with aspiration pneumonia, and chronic diseases including cardiovascular disease, diabetes, respiratory disease, and stroke. Poor oral health can also impact an individual’s psychological and social health, thus leading to toothache, anxiety, difficulty performing (ADL’s), decrease in nutritional intake, and impaired social interactions with others (Wilson et al., 2019). Oral health is not only about having healthy teeth, but also “the state of being free from pain and disease, and the presence of a functioning dentition, facilitating chewing, swallowing, having clear speech, nutrition and normal digestion” (Ward, Cooper, Hughes-McCormack, Macpherson & Kinnear, 2019). And by and large, good oral health can be attained by providing supportive oral care, which includes brushing teeth and facilitating routine dental checkups” (Ward, et al., 2019).
In my experience as a registered nurse (RN), working in an adult inpatient unit for individuals with an IDD, I saw the challenges of our clients attending regular dental appointments for routine checkups. We have a dental clinic at my workplace, where our clients go to for routine cleaning. However, if treatment were required beyond that, our clients would go to Mt. Sinai Hospital for further treatment and procedures. However, often, our clients did not attend due to behavioral aggression. Thus, people with an IDD are more likely to experience barriers to accessible dental and oral care. The need for assistance in performing ADL’s is also much higher for individuals with IDD, and can result in behavioral challenges like aggression. In my former inpatient unit, our Occupational Therapist (OT) would devise an oral hygiene program, with the steps clearly laid out for staff to follow. It was the frontline nurses who would then initiate and provide toothbrushing and/or flossing for our clients. Oral care is highly invasive, and for an individual who may not be able to appreciate why someone is attempting to brush their teeth, this could very understandably lead to the individual being uncooperative with care (Chadwick, Chapman, & Davies, 2017). If this assistance were met with any physical or (non)verbal aggression, the nurses would terminate the attempt. This unfortunately led to the oral hygiene routine falling by the wayside. The negative impact was the recognition of dental or oral problems by nursing staff was reduced due to communication barriers, which would contribute to prolonged periods of dental or oral pain and discomfort, and in turn, this could manifest in the induvial becoming challenging behaviorally, thus creating a negative loop (Chadwick, et. al., 2017).
My collaborator, Amelia found that individuals with IDD can be and are treated in the community clinic setting. However, some individuals may require general anesthesia to receive comprehensive dental care and treatment. One indicator reported for recommending treatment in hospital and under anesthesia is that due to their intellectual disability, often, IDD clients are uncooperative with dental procedures, or are unable to receive treatment in community clinical settings (Park & Sigal, 2008). Amelia asserted that dental care has become more of a preventative approach rather than reactive one, and there is more emphasis on educating the public about the benefits of regular daily dental hygiene. Amelia’s experience, however, has been that this model of preventative oral care is lacking in the hospital, particularly in inpatient units. She has also found and echoed my earlier comments on the fact that staff members are often the ones to provide oral care to clients, and therefore, it may fall by the wayside, or if caregivers/family members provide oral care for their loved ones, they may omit providing oral care to rather attend to supporting their loved one with other ADL’s. Amelia shared that while taking her BHD, she had a collaboration with Mount Hope (home to a variety of mental health, addiction support programs & inpatient services) to provide dental care to individuals in inpatient settings. Amelia further reveals that many of the patients seen in this clinic had not been to the dentist or received dental care in several years.
From this exercise, I have learned that individuals with an IDD experience poorer overall oral health outcomes than those without an IDD. Many of my clients from my previous program, are non-verbal, and therefore unable to inform anyone of oral pain or discomfort. Preventative measures, as Amelia pointed out, are key to achieving good oral health. I firmly believe that this is a worthy topic, and one that needs more attention from municipal, provincial, and larger federal levels of government to affect change in the ways in which one of our most vulnerable populations have access to quality, client centred dental care.
References
Chadwick, D., Chapman, M., & Davies, G. (2017, October 17). Factors affecting access to daily oral and dental care among adults with intellectual disabilities. Journal of Applied Research in Intellectual Disabilities. From https:/doi/org/ 10.1111/jar.12415
Park, M.S., Sigal, M.J., (2008) The Role of Hospital-Based Dentistry in Providing Treatment for Persons with Developmental Delay. Journal of the Canadian Dental Association. www.cda-adc.ca/jcda/vol-74/issue-4/353.html
Ward, L.M., Cooper S.A., Hughes-McCormack L., Macpherson L., & Kinnear, D. (November 2019) Oral health of adults with intellectual disabilities: a systematic review. Journal of Intellectual Disability Research. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jir.12632
Wilson, N. J., Lin, Z., Villarosa, A., Lewis, P., Philip, P., Sumar, B., & George, A. (2019). Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review. BMC public health, 19(1), 1530. https://doi.org/10.1186/s12889-019-7863-1
photo by: Karoline Grabowska
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