Dental care among young adults with intellectual disability (ID) is poorly documented and largely unmet. By using population-based data from the Metropolitan Atlanta Developmental Disabilities Follow-Up Study, we assessed factors associated with at least one or two dental visits per year among young adults with and without ID. Significantly fewer young adults with ID (45%) visited a dentist at least once per year, compared with those without ID (58%). ID severity and the presence of co-occurring developmental disabilities predicted dental care use. Sociodemographics, daily functioning, societal participation, dental services, and dental health factors were examined as predictors of dental care frequency. Our findings can help focus efforts toward improving the frequency of dental care visits among young adults with ID.
Intellectual disability (ID) is significantly associated with poor oral health (USDHHS, 2000). Although recent advances in medical care have contributed to a substantial increase in the life expectancy of individuals with ID (Bittles et al., 2002 and Janicki et al., 1999), dental care remains an unmet need (Waldman & Perlman, 2002). A recently published systematic review of studies confirmed the existence of gaps in dental care among people with ID within different age groups (Anders & Davis, 2010). Individuals with ID are more likely to receive a lower quality of dental care, or are less likely to have had a preventive dental visit, compared with individuals without ID (Charles, 2010, Chi et al., 2010 and Reichard et al., 2001).
A study among children aged 3–17 years show older age, better access to dental health professionals, higher educational and family socioeconomic status, and experiencing a favorable interaction with the medical system, have all been associated with better preventative dental care use, irrespective of their ID status (Chi et al., 2010). On the contrary, other studies have shown that increasing dental care costs, lack of dental insurance or financial resources to pay for treatment, access to information, and willingness and training among dentists treating children with disabilities have negatively influenced dental care (Dasanayake et al., 2007, Schultz et al., 2001, Stiefel, 2002 and Wolff et al., 2004). Although these factors might also influence dental care across different age groups, understanding of the predictors and barriers for dental care among young adults with ID is limited.
One of the key limiting factors for dental care access among young adults is that, in the majority of states, Medicaid dental coverage is terminated when an individual attains 21 years of age (Centers for Medicare and Medicaid Services, 2011). In recent decades, a shift toward inclusion of individuals with ID into community-based or independent residential settings has occurred, which has led to disruption of routine dental care services available previously within institutional residential settings (Dwyer, 1998). Thus, as young adults are transitioning from pediatric to adult dental care, those with ID are particularly vulnerable to dental problems. Dental care among children with ID until age 18 years has received much attention; however, information specific to young adults in the earlier part of their young adulthood (ages 21–25 years) is lacking. Using a population-based study, we examined the frequency of dental visits and selected associated factors that promote or limit dental visits among young adults with and without ID. The study also examined the frequency of dental care on the basis of severity of ID and co-occurrence of other selected developmental disabilities (DDs).
In summary, our study identified a statistically significant disparity in dental care visits among young adults with and without ID. Young adults transitioning from pediatric to adult dental care face unique challenges regarding dental care. Changing living conditions, lack of dental insurance, and disappearance of community-based programs that cater to preventative care might force young adults to neglect dental care. These young adults should be identified, particularly those who do not have a high school education and who are not receiving vocational services, and information should be provided to their caregivers regarding resources for improving their dental care. Targeting dental services to young adults by increasing awareness and improving resources can help to reduce overall costs associated with delayed treatments, as well as restorative or emergency dental care. Finally, legislative policies that promote recommended dental care among young adults, particularly those with disabilities might help improve use among younger populations.
