Common Oral Issues Faced by People with Physical Disabilities

People with physical disabilities may have a higher risk of experiencing oral health issues such as dental caries and gum disease. Here are some oral symptoms that persons with physical [...]

People with physical disabilities may have a higher risk of experiencing oral health issues such as dental caries (cavities), gum disease and dental defects1,2. This could be due to the physical disability that can limit an individual’s mobility, stamina and physical functioning, hence impacting their daily activities2.

For instance, people with amputated limb or spinal cord injuries (SCI), may have impaired mobility that results in poor hand function3, and thus struggle with daily activities like brushing3. Individuals with cerebral palsy2,4 or advanced muscular dystrophy who need help with brushing or flossing may also have a higher risk of oral health conditions2

Additionally, several SCI medications can cause dry mouth, which increases the risk of developing cavities and gum disease over time3.

Symptoms To Look Out For

Here are some oral symptoms that persons with physical disabilities and their caregivers can look out for early intervention.

1. Dental caries is the irreversible breakdown of the tooth layers leading to cavity formation. In the early stages, it may not be possible to detect caries by yourself since the enamel (outmost layer of tooth) may still be intact. Though eventually, food lodging, discoloration, sensitivity, or pain upon eating hot, cold or both types of food may be felt. One would need the help of a dentist once caries develops5.

A picture showing a comparison of healthy tooth, tooth decay (caries), and cavity (deep caries)
Photo credit: choice-dental.com.au

Physical disability groups that are more likely to have this condition: Persons with spinal cord injuries 3, cerebral palsy 2,4, muscular dystrophy2

2. Gingivitis is the inflammation of the gums. In its milder forms, one could experience gum tenderness. There could be puffiness, evident swelling, bad breath or pain of gums. Gums could bleed easily during regular brushing. The individual may also feel a recession in gums and hence sensitivity6.

Physical disability groups that are more likely to have this condition: Persons with spinal cord injuries 3, cerebral palsy 2,4, muscular dystrophy2

3. Periodontal disease is a more serious form of gum disease which affects the gums and other supporting structures. Along with the symptoms that one could experience in gingivitis (a mild version of periodontitis), gums can be tender when touched. When brushing, the toothbrush may show a tinge of pink due to bleeding gums. There could also be pus formation between teeth and gums. Loose and/or elongated teeth due to gum recession or tooth loss could be seen. Chewing food may be painful, prompting the individual to change their way of biting. One may also notice more spaces between the teeth7.

A picture showing the comparison between healthy gum, gingivitis, and periodontitis.
Photo credit: tooth-doctor.com

Physical disability groups that are more likely to have this condition: Persons with spinal cord injuries 2, cerebral palsy 2,4, muscular dystrophy 2

4. Xerostomia (dry mouth) happens when the salivary glands do not produce sufficient saliva, leading to a dryness in mouth. The symptoms include thick and stringy saliva, bad breath, and difficulty in chewing or swallowing. Xerostomia is most often a side effect of certain medications, aging issues or radiation therapy for cancer. It is less often caused by a condition that directly affects the salivary glands8.

5. Delayed eruption of teeth is when teeth do not grow out at the stipulated time. It is often a genetic condition or may be more likely to happen to people with cerebral palsy.

6. Bruxism is when one unconsciously grinds or clenches the teeth. People with bruxism may experience jaw pain, headache, flattening or fractured teeth, and exposure of inner layers (dentin) of teeth. To detect bruxism, caregivers can try to hear if there are sounds of their care recipients unconsciously grinding their teeth at night10.

A picture showing a comparison of normal teeth and bruxism or tooth grinding.
Photo credit: medindia.net

Physical disability groups that are more likely to have this condition: Persons with cerebral palsy 2

7. Mouth breathing takes place when one is unable to breathe normally through the nose. This occurs during common cold when the nasal passages are blocked. However, chronic mouth breathing also occurs in children with slower growth, behavioural issues and facial abnormalities. Mouth breathing can result in dental caries, xerostomia and gingival or periodontal diseases11.

Physical disability groups that are more likely to have this condition: Persons with cerebral palsy 2,4

8. Dental erosion is the gradual wearing away of enamel due to acid reflex from the stomach. One may experience dental caries, yellow discoloration of teeth and sensitivity while consuming hot or cold food12.  An unexplained sour taste in the mouth is also a symptom13.

Physical disability groups that are more likely to have this condition: Persons with cerebral palsy 2

9. Tongue thrusting is when the tongue presses too far forward. It can result in an improper bite and misaligned teeth. It can also cause speech impairment14.  

Physical disability groups that are more likely to have this condition: Persons with cerebral palsy 2

10. Enamel hypoplasia is the loss of the protective layer on the teeth. One can see pit and fissures on teeth, yellowish or brownish stains on teeth, or white spots on teeth, increase in dental decay, and sensitivity of teeth 15.

A picture showing the different levels of enamel hypoplasia.
Photo credit: heightspedoortho.com

Physical disability groups that are more likely to have this condition: Persons with cerebral palsy 2

11. Calculus or tarter is the plaque that gets deposited on the teeth and hardens above and below the gum line. Tarter can lead to dental caries, halitosis, gum disease and periodontal diseases16. While generally hard to remove, tarter can be removed by a dentist.

A picture showing teeth with calculus.
Photo credit: sciencedirect.com

Physical disability groups that are more likely to have this condition: Persons with muscular dystrophy 2

12. Enamel opacities are abnormalities in the tooth enamel due to a lack of minerals. It affects the natural translucency of the tooth17. Patients are often prone to cavity formation, plaque accumulation and gum diseases.

A photo showing enamel opacities in teeth.
Photo credit: semanticscholar.org

Schedule Regular Dental Visits

When people with physical disabilities experience these symptoms, it would be best to visit a dentist as soon as possible to receive early treatment. This would help to avoid a more elaborate, extensive and expensive route of treatment. In fact, these symptoms can happen to anyone, and not just those with physical disabilities. Hence, regular visits to the dentists are essential before oral health issues set in.

This article is contributed by Dr Sneha Sundar Rajan. Dr Sneha has a master’s degree in Dental Surgery (MDS) from Manipal University, India. She was a researcher with the National University of Singapore at the Faculty of Dentistry and Centre for Advanced 2D materials before taking a break for motherhood. 

References:  

1.Norwood KW Jr, Slayton RL; Council on Children With Disabilities; Section on Oral Health. Oral health care for children with developmental disabilities. Pediatrics 2013; 131(3):614-619. doi: 10.1542/peds.2012-3650.

2. https://www.newmouth.com/oral-health/effects/physical-disabilities/

3. Karthikayan, Ravi, et al. “Spinal Cord Injury and Oral Health Status: A Systematic Review.” International Journal of Community Dentistry, vol. 6, no. 2, 2018, p. 21., doi:10.4103/ijcd.ijcd_4_18.

4. https://www.nicklauschildrens.org/patient-resources/health-and-safety-information/dental-health-in-children-with-cerebral-palsy

5. https://www.healthline.com/health/dental-and-oral-health/what-does-a-cavity-look-like#cavity-symptoms

6. https://www.mayoclinic.org/diseases-conditions/gingivitis/symptoms-causes/syc-20354453

7. https://www.healthline.com/health/periodontitis

8. mayoclinic.org/diseases-conditions/dry-mouth/symptoms-causes/syc-20356048#:~:text=Dry%20mouth%2C%20or%20xerostomia%20(zeer,of%20radiation%20therapy%20for%20cancer

9. https://www.nicklauschildrens.org/patient-resources/health-and-safety-information/dental-health-in-children-with-cerebral-palsy

10. https://www.mayoclinic.org/diseases-conditions/bruxism/symptoms-causes/syc-20356095

11. https://www.brisbanebulkbillingdoctor.com.au/news/mouth-breathing-how-to-spot-it-and-fix-it-article/

12. https://www.mouthhealthy.org/en/az-topics/e/tooth-erosion-and-acid-reflux

13.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986576/#:~:text=GERD%20and%20other%20intrinsic%20factors,1%2C%208%2C%2010%5D

14. https://www.healthline.com/health/tongue-thrust#in-adults

15. https://www.mgadental.com.au/enamel-hypoplasia/

16. https://www.mayoclinic.org/diseases-conditions/cavities/symptoms-causes/syc-20352892#:~:text=It’s%20due%20to%20eating%20a,line%20into%20tartar%20(calculus

17.http://dentistry.dept.shef.ac.uk/paeds/calpack1/Pages/opacdefin.htm#:~:text=Enamel%20Opacity%20(definitions)&text=Enamel%20opacity%20is%20a%20qualitative,natural%20translucency%20caused%20by%20hypomineralization.&text=O%20An%20opacity%20can%20be%20demarcated%20or%20diffuse

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