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DISABILITY
Chris Sproat

Disability is dened by the World Health Organisation as a


restriction or lack of ability to perform an activity in the manner
or within the range considered normal for a human being. It is
well known that people with a disability may not have an equal
opportunity to receive normal dental care.
Epidemiology. Using the current UK criteria, approximately
10 million people are classied as being disabled. The
proportion of people with long-term illness or disability
increases with age (Fig. 19.1). Types of disability, as
described in the Disability Discrimination Act, include:
physical
intellectual
psychiatric
sensory
neurological
physical disgurement
presence in the body of organisms causing or capable
of causing disease.
Barriers to health care exist at many different levels,
including:
Physical. Patients may not be able to travel to the
dental surgery, gain access to the building or
treatment room.
Psychological. There tends to be an increased level of
anxiety in both the patients and providers of dental
care when disability is involved.
Availability. The availability of routine NHS treatment
is decreasing and may be difcult to nd in the local
area. Specialist services are often not able to cope
with the demand. There may be a lack of domiciliary
services.
Training. There is often reduced awareness of
disability and its implications for oral health among
dental health providers.

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Disability

80
Percentage

Men

Women

60
40
20
0

5064 6584 85 and


over

5064 6584 85 and


over
Age

Fig. 19.1 Long-term illness or disability which restricts daily


activities: by sex and age, April 2001, Great Britain (Household
Survey 2001).

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The Disability Discrimination Act (DDA) is designed to


ensure that services are equally accessible to disabled and
non-disabled people. This act covers all aspects of delivery
of dental care and includes both patients and employees.
New providers have to comply with the act and existing
providers have to make reasonable adjustments to comply.
The act covers those who have had a disability for greater
than 12 months.
Oral implications of disability are related to the disability
itself and to the side-effects of treatments used. In addition
to reduced access to normal dental care many patients are
not able to maintain their own oral health and require
assistance to perform regular tasks, e.g. tooth brushing.
Those with severe neuromuscular, neurological or learning difculties often suffer with incontinence of saliva and
bruxism, increasing tooth wear. Patients with seizure disorders may suffer frequent traumatic injury to their teeth
and oral soft tissues. In Downs syndrome there is an
increased susceptibility to periodontal disease. Many
drugs used for treatment of disabling conditions, e.g. antiParkinsons or antidepressants, cause dry mouth as a sideeffect, leading to swallowing and speech difculties and
increased susceptibility to caries. In disorders that affect
muscle control and movement, denture wear and routine
dental treatment are often difcult.
Management of disability often requires a multidisciplinary approach with close liaison between the
dental team and those involved in the medical and social

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Disability

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Fig. 19.2 Large print information leaets are required for patients
with visual impairment.

care of the patient. The most helpful strategy is removal of


the barriers to dental care, allowing the vast majority of
disabled patients to be treated in general practice.
Physical alterations to building may be required but
equally important is the availability of information in
formats understandable by all patients, e.g. large print
(Fig. 19.2) and Braille. Training of staff in the awareness of
the problems posed by disability is useful.
Patients with severe disabilities may require specialist
treatment and the availability of general anaesthesia.

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Disability

DENTAL RELEVANCE OF DISABILITY

The vast majority of disabled people can be treated safely in


dental practice.
Disability is common, with 16% of the population currently
classied as disabled.
Disabled patients and staff should be able to gain easy access
to all the services in dental practice.
Domiciliary treatment may be required.
There is an increased incidence of oral disease in disabled
patients.

Useful website
www.disability.gov.uk

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