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TITLE PAGE
Title National levels of reported difficulty in tooth and denture cleaning among
an ageing population with intellectual disabilities in Ireland
Running Title Difficulty tooth brushing
Key words Ageism, Intellectual Disability, Tooth Brushing
Authors Mac Giolla Phadraig C
1,2,
el-Helaali R 1, Burke E 3, McCallion P
3,4,
McGlinchey E, McCarron M 3, Nunn JH 1,2
Corresponding Author:
Caoimhin Mac Giolla Phadraig, Lecturer in Public Dental Health (Disability
Studies), Department of Child and Public Dental Health, Dublin Dental University
Hospital, Trinity College Dublin, Dublin 2, Ireland, Ph +35316127337 Fax
+35316127298 macgiolla@dental.tcd.ie
1 Dublin Dental University Hospital, Department of Child and Public Dental
Health, Dublin, Ireland
2 School of Dental Science, Trinity College Dublin, Ireland
3 School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
4 School of Social Welfare, University at Albany, Albany, Canada
2
ABSTRACT
Aims and objectives: This paper aims to describe reported difficulty and
frequency in carrying out oral hygiene practices among an ageing population
with intellectual disabilities in Ireland; Methods: This cross-sectional survey was
based on a Nationally representative sample of people with intellectual disability
over 40 years of age, randomly selected from a National Intellectual Disability
Database as part of the first wave of the Intellectual Disability Supplement to The
Irish Longitudinal Study on Ageing (IDS-TILDA). Level of reported difficulty was
used to categorise the sample into three groups: those reporting no difficulty,
those reporting some difficulty and those who cannot care for their teeth /
dentures at all. Summary statistics and bivariate correlations are reported based
on this categorization. The sample was further categorized into those with and
without reported difficulty cleaning their teeth / caring for their dentures, for
purposes of logistic regression. Independent variables correlating (p < 0.05) with
level of reported difficulty brushing / cleaning dentures were included in this
regression model to identify factors predictive of difficulty caring for teeth/
dentures; Results: The mean age of participants was 54.1 years (SD 8.8). Out of
753 participants, 412 (55.5%) reported no difficulty cleaning their teeth /
dentures, 159 (21.3%) had some or a lot of difficulty and 172 (23.2%) reported
that they could not clean their own teeth / dentures at all. The regression model
showed that type of residence, increasing level of ID and the presence of
reported oral problems were predictive of reported difficulty cleaning
teeth/taking care of dentures. Conclusions: This study showed that most people
with ID in Ireland report no difficulties cleaning their teeth or taking care of their
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dentures. Even among those with some difficulty, the exact level of difficulty
varied from little difficulty to complete inability.
INTRODUCTION
Plaque is a key aetiological factor in oral disease, particularly dental decay and
periodontal disease. Effective tooth brushing is a fundamental cornerstone of
controlling plaque, provided the cleaning is sufficiently thorough, and performed
daily, along with interdental cleaning (Loe, 2000). Nevertheless, people are often
ineffective at adequate plaque control (van der Weijden and Hioe, 2005). This
difficulty is amplified among people with intellectual disability (ID), where poor
oral hygiene is a frequent finding (Anders and Davis, 2010, Davies and Whittle,
1990, Shaw et al., 1990) and may go some way in explaining why adults with ID
have poorer oral health outcomes than other populations (Glassman and Miller,
2003, Elliot et al., 2005, Anders and Davis, 2010).
Impaired physical coordination and cognitive ability are just two reported
barriers reported to limit some people who have an intellectual disability in daily
tooth brushing (Owens et al., 2006, Nunn, 1987). Tooth cleaning is therefore
difficult for many people with intellectual disability, meaning they may rely on
others to have their teeth cleaned (Faulks and Hennequin, 2000, Pradhan et al.,
2009b, Stanfield et al., 2003).
While recent guidelines (British Society for
Disability and Oral Health/Faculty of Dental Surgery of Royal College of Surgeons
of England, 2012) provide guidance in techniques for making tooth-brushing
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easier for people with intellectual disabilities, staff who care for them are
infrequently trained
(Crowley et al., 2005, Stanfield et al., 2003) and oral
healthcare sometimes may not be a priority (Rawlinson, 2001). Tooth cleaning
and denture care may also be difficult. One researcher noted that 68% of
residents in one institution required some form of physical intervention to
perform routine oral care (Connick et al., 2000).
People with ID are increasingly ageing (Bittles et al., 2002) and with advancing
age come changes to health status and health needs for people with ID (Evenhuis
et al., 2012) as well as changes in social circumstances, such as residential setting
(Kelly and Kelly, 2011), which has previously been shown to predict difficulty
brushing (Pradhan et al., 2009a). It is unclear how the ageing process will affect
their ability to care for their teeth and dentures. What implications this may have
for those who help them maintain their oral health, as well as those who plan
and deliver dental services for them.
Aim: This paper aims to describe reported difficulty in carrying out oral hygiene
practices among an ageing population with intellectual disabilities in Ireland.
METHODS
Design
This is a cross-sectional survey based on data collected via the first wave of the
Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing
(IDS-TILDA), which is a multi-wave longitudinal study of older adults with
intellectual disabilities. Survey instruments and methods were tested in an
extensive pilot study (McCarron et al., 2009) The Faculty of Health Sciences
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research ethics committee in Trinity College Dublin and all participating services
granted ethical approval.
Sample
A Nationally representative sample of 753 people with intellectual disability
over 40 years of age, were randomly selected from a National Intellectual
Disability Database in Ireland (Kelly et al., 2008).
Data collection
All participants were sent invitation packs, through gatekeepers, designated
individuals working in a range of disability services who, as per requirements for
ethical approval of this research programme, verified participants’ willingness to
participate prior to facilitating contact with research team.
These packs included
accessible formats of all documentation for invitees and their families and
supporting staff. Concurrently, the research team provided information seminars.
Eleven researchers, who underwent rigorous training and had extensive
experience with people with ID, collected data using a two-stage data collection
technique including a postal pre-interview questionnaire, followed up with faceto-face interviews. Respondents received support in answering questions where
needed, by using others involved in their care (proxies). In addition to
demographic data, items in the oral hygiene section consisted of six closed
questions. Table 1 lists the items included in this report.
Table 1 about here
Analysis
Data analysis was carried out using SPSS v.19 ®. Descriptive statistics were
reported for demographic data and oral hygiene practices. This summarized the
demographic and oral health related variables for the group as a whole. The
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group was also categorized by level of reported difficulty carrying out oral
hygiene practices allowing further bivariate analyses of the relationship between
the dependent variable – reported levels of difficulty cleaning teeth / taking care
of dentures and other variables. To this end, the sample was divided into three
groups based on reported level of difficulty cleaning teeth / dentures (Table 1,
Question 5). Participants reporting Some difficulty or A lot of difficulty were
grouped together under the heading Some Difficulty for purposes of analysis.
Correlations between the dependent variable: Reported level of difficulty and
independent variables were tested using Pearson’s Chi Square. Independent
variables found to correlate with reported level of difficulty in bivariate analyses
(p < 0.05) were then included in a binary logistic regression model to identify
factors predictive of reported difficulty brushing / cleaning dentures.
To
facilitate modeling, the outcome variable was re-categorised into a binary
variable: those with difficulty and those without difficulty cleaning teeth / taking
care of dentures.
RESULTS
Demographics
There were more females than males in this study. The mean age of participants
was 54.1 years (SD 8.8, range 41 -90 years), with almost half of participants
between 50 – 64 years. Table 2 summarises demographic data for the total
sample (n = 753).
Table 2 about here
Reported difficulty cleaning teeth / taking care of dentures
The majority of participants reported no difficulty cleaning their teeth / dentures
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(n=412, 55.5%). A total of 331 (44.5%) participants reported difficulty: 105
(14.1%) had “some difficulty” and 54 (7.3%) “a lot of difficulty” (this meant that
159 (21.3% of the total sample) were categorized for further analysis as having
Some difficulty) and 172 (23.2%) could not care for their teeth or dentures at all.
Those reporting difficulty (n=331) were asked if they received support from
others in cleaning teeth / dentures and 140 (42.3%) said yes, they did so with
support, while 172 (52.0%) were completely dependent on the support of others.
Eighteen (5.5%) reported not receiving any support in cleaning their teeth /
dentures despite reporting difficulty in doing so.
Most of those who were
completely dependent (n=145, 83.4%) could not clean their teeth at all. while
most (n= 87, 83.7%) of those reporting some difficulty received some support in
cleaning their teeth / dentures.
Gender and age were not associated with reported difficulty cleaning teeth /
dentures (Table 2) whereas type of residence and level of ID were. Table 3
demonstrates initial association between reported difficulty cleaning teeth /
dentures and reported problems with teeth or gums, as well as reported dentate
status. A lack of oral problems was associated with a lack of difficulty cleaning
teeth/dentures.
Table 3 about here
Frequency of brushing teeth / cleaning dentures
The majority (93.1%) of those with teeth or dentures reported having their teeth
brushed once or more per day. Similarly, 73.9% of the sample with no teeth or
dentures reportedly had their mouth cleaned at least daily. There was no
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association between reported difficulty in cleaning teeth/dentures and
frequency of either brushing teeth or mouth cleaning (Table 5).
Regression
This model (Table 5) shows that types of residence with increasing dependency,
increasing level of ID and the presence of reported oral problems had a
significant independent positive effect on reported difficulty cleaning
teeth/taking care of dentures. Dentate status did not. This model accounted for
only 35.2% of observed variance in whether there was reported difficulty
cleaning teeth/taking care of dentures or not, using Cox & Snell R Square.
Sensitivity of the model = 69%, specificity of model = 86.6%.
Table 5 about here
DISCUSSION
This study found that most older people with intellectual disabilities in Ireland
reported no difficulty carrying out tooth brushing / denture cleaning: 55% of
participants reported no difficulty cleaning their teeth / taking care of dentures;
22% reported varying levels of difficulty and 23% could not do it at all. This
gives the first nationally representative figures describing reported difficulty
cleaning teeth / dentures among older adults with ID, across residential settings.
Direct comparison with other research is difficult given differences in geography,
population and measurement, regarding difficulty brushing teeth / caring for
dentures among people with ID. In one French study, difficulty caring for oral
health of people with ID was reported at about 60% in one residential setting
(Faulks and Hennequin, 2000).
The current study shows that there are distinct levels of difficulty in oral hygiene
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practices among adults with ID who report some level of difficulty caring for
their mouths. Most of those who could not clean their teeth / dentures in the
current study were completely dependent on others to carry this out and those
reporting some difficulty received support to carry out tooth brushing and care
for dentures.
Therefore comparison to studies in residential care and
community home settings, where between 64 – 72% of adults with ID required
assistance brushing/cleaning teeth (or dentures) are meaningful and suggest a
higher level of difficulty than that found in our current cross-section (Pradhan et
al, 2009a, Stanfield et al., 2003, Crowley et al., 2005).
Factors associated with reported difficulty
Residential setting and level of intellectual disability were predictive of difficulty
brushing/taking care of dentures. Residential setting can be associated with
difficulty and frequency of tooth brushing (Pradhan et al., 2009a). In the current
study, the majority of people in residential care homes had difficulty brushing
their teeth. The opposite was true for those living independently. The proportion
reporting difficulty also rose with severity of ID. Age, previously shown to be
related to oral hygiene in younger people with ID in certain residential settings
only (Tesini, 1980), was not associated with difficulty cleaning teeth or dentures
in our study. Reported oral problems were associated with level of difficulty
cleaning teeth and dentures in our study. The nature of this correlation is unclear,
given the design of the current study.
These findings have some interesting implications for those who are interested
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in improving the oral health of this population. For example, a one-size-fits-all
approach to oral health skills training, whereby a uniform intervention is applied
to groups of people with ID (Kavvadia et al., 2009) or their carers (Mac Giolla
Phadraig et al., 2012), are perhaps inappropriate because a gradient of difficulty
is shown to exist within and between residential settings and levels of disability.
Stratified approaches using a range of techniques (Kaschke et al., 2005) may be
preferred. Those developing oral health programmes for use with populations
with ID are likely to come across a range of levels of difficulty brushing teeth and
dentures in community care and residential home settings and therefore should
design interventions to encompass this range. This means that both residents
and carers need a range of skills for dealing with differing levels of difficulty in
each setting. In community and residential settings, combinations of
independent manual skills for those with no difficulties; training of carers for
those completely dependent on care (Mac Giolla Phadraig et al., 2012) and a
range of skills for levels of difficulty in between these extremes (British Society
for Disability and Oral Health/Faculty of Dental Surgery of Royal College of
Surgeons of England, 2012) should be considered, when delivering oral health
skills training across these settings. Educators should consider teaching mainly
independent manual skills for those living independently or with family.
The majority of participants in this study reported daily tooth brushing / mouth
cleaning, despite high levels of difficulty and a high need for support,. This is a
positive finding and is comparable to reported rates among people with ID in
residential services, internationally (Stanfield et al., 2003, Pradhan et al., 2009a,
Faulks and Hennequin, 2000).
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Frequent brushing is not synonymous with effective brushing, which is
dependent on other factors such as toothbrush design, toothbrushing techniques,
and brushing time
(Loe, 2000). Other factors, specifically reported in this
population, include irregular changes of toothbrush and failure to purchase
toothpaste (Rawlinson, 2001) as well as intellectual and physical impairment
(Nunn, 1987), though the true range of factors influencing this are likely to be
broad and variable. The current study does not assess if this brushing, which is
reportedly frequent, is effective. Given the high levels of disease reported in the
population with ID (Glassman and Miller, 2003, Elliot et al., 2005, Anders and
Davis, 2010) it is unlikely to be effective – if health is the desired outcome. This
suggests, if respondents are accurate, that factors other than frequency are at
root cause of ineffective tooth brushing among people with ID. Faulks and
colleagues reported that only 40% of staff in one residential service provider in
France spent more than one minute cleaning their wards’ teeth (Faulks and
Hennequin, 2000), so perhaps time spent brushing warrants attention. This
highlights a need to promote not only daily brushing, but effective daily brushing
using appropriate technique with individualised support for an adequate length
of time.
Limitations of this study
The major limitation is that data were based on reported behaviours. This
introduces the spectre of social desirability bias whereby respondents may wish
to give the “correct answer” when responding to some questions (Philips and
Clancy, 1972). A design involving direct skills observation as per Glassman and
Miller (2006) would have allowed a measure of technique and clinical data
would have allowed us to quantify the effectiveness of brushing. Participants
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responses, in many cases, were completed on behalf of the participants by
proxies. Many questions, such as Do you have any obvious problems with your
teeth or gums? were answered from the point of view of the proxy and not the
participant. This poses a risk of misattribution bias, as seen in other research
(Shardell et al., 2013)
Conclusions
This study showed that people with ID in Ireland reported cleaning their teeth
and taking care of their dentures regularly. Many have difficulties brushing their
teeth or cleaning their dentures but most do not. Even among those with some
difficulty, the exact level of difficulty varied from little difficulty to complete
inability. This shows a variable population with variable needs and this evidence
can be useful in a number of ways. Firstly it may inform the design of targeted
interventions to improve brushing. Factors to consider are level of ID and
residential setting. This means that health promotion or educational
programmes can be tailored to meet these specific needs based on residential
setting and level of ID. Secondly, those planning these programmes need to
consider that a range of skills should be taught to carers and those with
disabilities. There is a need for further research into the effectiveness of tooth
brushing and denture cleaning in this growing population.
Acknowledgements: The authors would like to acknowledge all those who
participated in this study and their families and carers. The authors also wish to
thank Glaxosmithkline and the Health Research Board, Ireland who provided
student scholarships for one author to contribute to this research.
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References
Anders, PL & Davis, EL, 2010. Oral health of patients with intellectual disabilities:
a systematic review. Spec Care Dent, 30, 110-7.
Bittles, AH, Petterson, BA, Sullivan, SG, Hussain, R, Glasson, EJ & Montgomery, PD.
2002. The influence of intellectual disability on life expectancy. J Gerontol.
Series A, Biological sciences and medical sciences, 57, M470-2.
British Society For Disability And Oral Health/Faculty Of Dental Surgery Of Royal
College Of Surgeons Of England. 2012. Clinical guidelines and integrated
care pathways for the oral health care of people with learning disabilities
[Online]. British Society for Disability and Oral Health. Available:
http://www.bsdh.org.uk/guidelines/BSDH_Clinical_Guidelines_PwaLD_2
012.pdf [Accessed 22/01/2013).
Connick, C., Palat, M. & Pugliese, S. 2000. The appropriate use of physical
restraint: considerations. ASDC J Dent Child, 67, 256-62, 231.
Crowley, E., Whelton, H., Murphy, A., Kelleher, V., Cronin, M., Flannery, E. & Nunn,
J. 2005. Oral Health of Adults with an Intellectual Disability in Residential
Care in Ireland 2003. Department of health and Children
Davies, K. W. & Whittle, J. G. 1990. Dental health education: training of
homecarers of mentally handicapped adults. Community Dent Health, 7,
193-7.
Elliot, I., Nunn, J. & Sadlier, D. 2005. Oral Health & Disability: The way forward.
National Disability Authority.
Evenhuis, H. M., Hermans, H., Hilgenkamp, T. I., Bastiaanse, L. P. & Echteld, M. A.
2012. Frailty and disability in older adults with intellectual disabilities:
results from the healthy ageing and intellectual disability study. J Am
Geriatr Soc, 60, 934-8.
Faulks, D. & Hennequin, M. 2000. Evaluation of a long-term oral health program
by carers of children and adults with intellectual disabilities. Spec Care
Dentist, 20, 199-208.
Glassman, P. & Miller, C. E. 2003. Preventing dental disease for people with
special needs: the need for practical preventive protocols for use in
community settings. Spec Care Dentist, 23, 165-7.
Kaschke, I., Klaus-Roland, J. & Zeller, A. 2005. The effectiveness of different
toothbrushes for people with special needs. J Disab Oral Health, 2, 61-71.
Kavvadia, K., Polychronopoulou, A. & Taoufik, K. 2009. Oral hygiene education
programme for intellectually impaired students attending a special
school. J Disab Oral Health, 10:65-71.
Kelly, C. & Kelly, F. 2011. Annual Report of the National Intellectual Disability
Database Committee 2010. HRB Statistics Series Dublin: Health Research
Board.
Kelly, F., Kelly, C., Maguire, G. & Craig, S. 2008. Annual report of the National
Intellectual Disability Database Committee 2008. HRB Statistics Series 2.
Dublin: Health Research Board.
Loe, H. 2000. Oral hygiene in the prevention of caries and periodontal disease.
Int Dent J, 50, 129-39.
Mac Giolla Phadraig, C., Guerin, S. & Nunn, J. 2012. Train the trainer? A
randomized controlled trial of a multi-tiered oral health education
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programme in community based intellectual disability residential
services. Community Dent Oral Epidemiol, 41:182-92.
Mccarron, M., Swinburne, J., Andrews, V., Mcgarvey, B., Murray, M. & Mulryan, N.
2009. Intellectual disability supplement to TILDA: Pilot Report. Dublin:
School of Nursing & Midwifery, Trinity College Dublin.
Nunn, J. H. 1987. The dental health of mentally and physically handicapped
children: a review of the literature. Community Dent Health, 4, 157-68.
Owens, P. L., Kerker, B. D., Zigler, E. & Horwitz, S. M. 2006. Vision and oral health
needs of individuals with intellectual disability. Ment Retard Dev D R, 12,
28-40.
Pradhan, A., Slade, G. D. & Spencer, A. J. 2009a. Access to dental care among
adults with physical and intellectual disabilities: residence factors. Aust
Dent J, 54, 204-11.
Pradhan, A., Slade, G. D. & Spencer, A. J. 2009b. Factors influencing caries
experience among adults with physical and intellectual disabilities.
Community Dent Oral Epidemiol, 37, 143-54.
Rawlinson, S. R. 2001. The Dental and Oral Care Needs of Adults with a Learning
Disability Living in a Rural Community: Consideration of the Issues. J Intel
Dis, 5, 133-156.
Shaw, M. J., Shaw, L. & Foster, T. D. 1990. The oral health in different groups of
adults with mental handicaps attending Birmingham (UK) adult training
centres. Community Dent Health, 7, 135-41.
Stanfield, M., Scully, C., Davison, M. F. & Porter, S. 2003. Oral healthcare of clients
with learning disability: changes following relocation from hospital to
community. B Dent J, 194, 271-7; discussion 262.
Tesini, D. A. 1980. Age, degree of mental retardation, institutionalization, and
socioeconomic status as determinants in the oral hygiene status of
mentally retarded individuals. Community Dent and Oral Epidemiol, 8,
355-9.
Van Der Weijden, G. A. & Hioe, K. P. 2005. A systematic review of the
effectiveness of self-performed mechanical plaque removal in adults with
gingivitis using a manual toothbrush. J Clin Periodontol, 32 Suppl 6, 21428.
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Table 1: Questions asked to participants of the IDS-TILDA study
No. Item
Please indicate the level of difficulty, if any, you have with cleaning your
Q1
teeth/taking care of your dentures.
Q2
Does anyone ever help you to clean your teeth/take care of your
dentures? a
Q3
How often do you brush your teeth/have them brushed? b
Q4
How often do you clean your mouth/ have it cleaned for you? c
Q5
Do you have any obvious problems with your teeth or gums? (e.g. painful
or sensitive teeth, bleeding gums when you brush your teeth)
Q6
Which best describes the teeth you have?
a asked
of respondents reporting difficulty only b asked of dentate respondents /
those reporting denture use only; c asked of edentulous respondents only
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Table 2 Demographics of sample as a whole and by reported difficulty cleaning
teeth / taking care of dentures (valid %)
No
Some
Cannot do
p
Parameter
Total
Difficulty
difficulty
at all
Value
753
412
159
172
Total
(100%)
(55.5%)
(21.3%)
(23.2%)
Gender
>0.05
335
189
Male
75 (22.5%) 70(21.0%)
(44.9%)
(56.6%)
415
223
Female
84 (20.5%) 102(24.9%)
(55.1%)
(54.5%)
>0.05
274
151
40-49
63 (23.3%) 56(20.7%)
(36.4%)
(55.9%)
344
197
50-64
65 (19.1%) 78 (22.9%)
(45.7%)
(57.9%)
134
65+
64 (48.5%) 31 (23.5%) 37 (28.0%)
(17.8%)
Type of
<0.00
Residence
01
Independent
129
111
12 (9.4%)
5 (3.9%)
/ Family
(17.1%)
(86.7%)
268
187
Community
54 (20.4%)
24 (9.1%)
(35.6%)
(70.6%)
356
114
143
Residential
93 (26.6%)
(47.3%)
(32.3%)
(40.9%)
<0.00
Level of ID
01
166
145
Mild
15 (9.0%)
6 (3.6%)
(23.9%)
(87.3%)
323
195
Moderate
85 (26.6%) 40 (12.5%)
(46.5%)
(60.9%)
Severe
206
122
28 (13.9%) 51 (25.4%)
/ Profound
(29.6%)
(60.7%)
ID = Intellectual Disability; Community = Community Group Home; Residential
= Residential Care Home
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Table 3: Relation of reported dentate status and oral problems with reported
difficulty cleaning teeth / taking care of dentures (valid %)
No
Some
Cannot do
Parameter
Total
p Value
Difficulty
difficulty
at all
Dentate
<0.0001
status
186
91 (48.9%) 29 (15.6%)
66
Edentate
(25.1%)
(35.5%)
556
320
130 (23.4%)
106
Dentate
(74.5%)
(57.6%)
(19.1%)
Reported
problemsb
Yes
No
<0.001
160
(21.4%)
589
(78.6%)
68 (43.0%)
47 (29.7%)
341
(58.6%)
112 (19.2%)
43
(27.2%)
129
(22.2%)
ex 743; Dentate status = Which best describes the teeth you have? – responses
grouped to those with teeth and without; b ex 749; Reported problems = Do you
have any obvious problems with your teeth or gums? (e.g. painful or sensitive teeth,
bleeding gums when you brush your teeth)
a
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Table 4: The relationship between reported frequency of brushing
teeth/cleaning mouth and reported difficulty cleaning teeth/taking care of
dentures (valid %)
No
Some
Cannot do
p
Frequency
Total
Difficulty
difficulty
at all
Value
Tooth
brushing a
621
(100%)
369
(59.4%)
138 (22.2%)
114
(18.4%)
Once or
more a day
Less
frequently
578
(93.1%)
43
(6.9%)
343
(59.3%)
128 (22.1%)
107
(18.5%)
26 (60.5%)
10 (23.3%)
7 (16.3%)
Mouth
cleaning b
119
(100%)
42 (35.3%)
20 (16.8%)
57 (47.9%)
>0.05
> 0.05
Once or
88
31 (35.2%)
15 (17.0%)
42 (47.7%)
more a day
(73.9%)
Less
31
11 (35.5%)
5 (16.1%)
15 (48.4%)
frequently
(26.1%)
a Tooth brushing = How often do you brush your teeth/have them brushed?;
question asked of dentate respondents / edentulous respondents reporting
denture use only; b Mouth cleaning = How often do you clean your mouth/have
it cleaned for you?; question asked of edentulous respondents without dentures.
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Table 5. Predictors of difficulty cleaning teeth/taking care of dentures among
people with ID
B
OR
CI
p value
Type of residence
Independent/Family
1
Community Group Home
1.813
6.127
(3.21 - 11.694)
< 0.001
Residential
1.186
3.276
(2.162 - 4.962)
< 0.001
Level of ID
Mild
1
Moderate
3.269
26.298
(13.876 - 49.838) < 0.001
Severe / Profound
1.964
7.129
(4.407-11.533)
< 0.001
Dentate status
Dentate
1
A complete lack of teeth
0.273
1.313
(0.842 - 2.047)
0.229
Obvious problems with
mouth or teeth
No
1
Yes
0.265
1.303
(1.153 - 1.473)
B = Regression coefficient; OR = Odds Ratio; CI = Confidence Interval
< 0.001