Periodontics - Andrew Turchin, DMD

Caring for dental health in patients with disabilities requires a lot of attention. The conditions of these people often prevent them from maintaining proper hygiene. In addition to this, all diseases and treatments require special attention compared to patients who don’t have any disabilities. In this two-part post, we offer a guide so you know everything related to this topic.

Effects of disabilities on oral health

There are about 48 million people in the USA who have some type of disability. For them, dental care has special needs due to the condition or treatment they receive. People with disabilities include those who have some type of deficiency during their development; either before, during or after birth. The deficiency may be physical or psychological conditions, but degenerative, neurological or psychiatric diseases are also included.

These diseases can prevent the patient from being responsible for their oral hygiene. The same condition can cause problems such as physical disability in the oral cavity, appearance of cavities, malocclusions, etc. At home, those responsible for people with disabilities should be very attentive to their oral development. They have to make sure they have proper hygiene and take them regularly to a specialist.

Dental health in patients with disabilities

Generally, people with special abilities cannot take care of their oral health alone. That is why they require the help of other people during brushing. Medications and their own condition make them more likely to suffer from some disease. Even when they go to a dental office, they need special care. These may include some previous medication or even the physical restriction of the patient. Being prone to oral diseases, it is necessary to promote dental health in patients with disabilities. However, it should be made clear that there is no such condition that is exclusive to special patients.

Frequent dental problems in patients with disabilities

People who have some type of disability are prone to have problems in their mouth. Among the most common diseases are:

Bruxism: It is the involuntary act of clenching or grinding your teeth. Many people have it without knowing, but the dentist can detect it if there is wear or fractures in the enamel. Some of the symptoms of bruxism are:
- Headache or earache: clenching the jaw can cause severe headache.
- Dental hypersensitivity: tooth enamel wear leaves dentin exposed. So, contact with chemical, thermal or tactile stimuli can cause acute pain.
- Jaw pain: the pressure of the teeth can cause pain and inflammation of the maxillofacial muscles.
The cavities in patients with disabilities are frequent and cause periodontal diseases. This is due to the difficulty in eating, chewing and maintaining proper hygiene.
Dental trauma: It occurs due to the reduction of the patient’s reflexes, when they suffer epilepsy or have poor motor coordination; as well as in people with psychological disabilities. Early tooth loss is a common problem.
Bad alignment of teeth: Malocclusion and disorders of the temporo-mandibular joint are common in patients with neuromuscular imbalance.
Gingival hyperplasia and xerostomia: It may arise as a result of the consumption of certain medications.

What are the problem areas here?

In order to ensure a successful supply of dental implants, the dental implant must grow together with the jawbone. To this end, dental implants have been optimized with regard to their surface structure over the years. Today’s dental implants have a roughened surface. This not only promotes bone growth, but also the connection between the dental implants and the bone.

Since titanium dental implants are contaminated by small amounts of nickel and tin and there is direct contact between the metal surface and the bone cells, diffusion of metal ions cannot be ruled out. For example, there may be an allergic reaction to dental implants.

In order to make the provision of dental implants possible for periodontitis and risk patients, it is necessary that the metal surface of the dental implants is covered with a sufficiently thick titanium oxide layer.

Are there other problems that periodontitis and high-risk patients need to know about dental implant care?

Two other problems with normal dental implants can be mentioned. If you consider the connection piece between the implant part inserted in the bone and the build-up part, which serves as the basis for a tooth crown or prosthesis, there is a great risk that harmful bacteria will penetrate into the interior of the implant and cause inflammation, so-called peri-implantitis. If such an inflammation occurs, the loss of the dental implant is possible.

Dental implants specially designed for periodontitis and high-risk patients are equipped with a “Swiss pocket watch seal”. This prevents the micro movements between the dental implant and the abutment and thus the penetration of inflammatory bacteria.

What exactly is peri-implantitis?

Peri-implantitis is the, usually irreversible, inflammation of the tissue surrounding the implant. If peri-implantitis is not treated, bone is broken down and ultimately the tooth implant is lost. A lot of patients underestimate the large number of so-called “late implant losses”, which are often due to peri-implantitis.