Oral health promotion among preschool children with intellectual and developmental disabilities

Abstract

Introduction: Individuals with intellectual and developmental disabilities (IDD) have a higher risk of dental diseases and more unfavourable health-related behaviours than their peers. Establishing appropriate health-related habit is essential for health maintenance, but also challenging for children with IDD. Although the importance of health promotion in early childhood are highlighted in prior studies, limited oral health promotion activities have been conducted among preschool children with IDD.

Objectives: i) To systematically investigate and compare the oral health status between children with and without IDD; ii) To screen and compare the effectiveness of the existing health promotion strategies in preventing common dental diseases among children with IDD systematically; iii) To investigate the efficacy of social story intervention in training expected behaviours among preschool children systematically; iv) To determine the effectiveness of social story- based health promotion in modifying the oral health-related behaviours and improving the oral health status of preschool children affected by IDD.

Methods: Studies related to oral health status, oral health promotion activities, and social story-based behavioural training among the target population were systematically searched from the online databases. The identified studies were synthesised by qualitative summary and/or meta-analyses. After identifying the research gap, a 24-month randomised controlled trial was conducted among preschool children with IDD. Toothbrushing training and a package of oral health education materials were provided to the recruited children. The education materials for children in the test group were social stories. Parents were advised to read the health education materials with their children in daily lives. Dental caries experience, gingival health status, dental plaque accumulation and oral health-related behaviours of the recruited children were assessed in baseline and follow-up studies.

Results: Systematic reviews and meta-analysis showed: i) Children affected by IDD exhibited worse gingival status and higher levels of dental plaque deposition, than children without IDD; ii) Toothbrushing was the main mechanical approach used among children with IDD; iii) Social stories could be applied to teach expected behaviours among preschool children. The randomised controlled trial showed: i) Improved toothbrushing performance, decreased between-meal snacking frequency, and better oral hygiene status were observed in both groups after 24-month intervention; ii) Children were more likely to visit a dentist after using social story intervention (OR = 2.00, 95%CI 1.15 to 3.49), and those children’s toothbrushing behaviours were significantly improved than their peers who had not received social story intervention (OR = 2.85, 95%CI 1.21 to 6.68); ii) Children who had used social stories had healthier gingival condition (p = 0.009) and better oral hygiene status (p = 0.015) than their counterparts in the control group; iii) Caries progression was associated with parents’ occupation status (p = 0.040), and children’s social skills (p = 0.020).

Conclusion: Children with IDD had undesirable oral health status. Social story-based oral health promotion could be used to teach oral health-related behaviours, control dental plaque accumulation, and improve the gingival health status among young children with IDD, while the efficacy of oral health education might be related to children’s adaptive skills and family social-demographics.