Adults with intellectual disability: a mixed-methods investigation of their experiences of dental treatment under general anaesthetic.N Z Dent J 2014; 110(2):58-64NZ
This study aimed to explore the experiences of dental care under general anaesthesia in adults with an intellectual disability.
The study used an explanatory mixed-methods design. In the initial quantitative phase of the study, a clinical audit of oral health services provided for adults with intellectual disabilities was carried out for individuals who underwent a general anaesthetic (GA) for dental treatment at Christchurch Hospital during a 5-year period. In a qualitative second phase, fifteen semi-structured interviews were carried out for 13 individuals with an intellectual disability to investigate the experience and perceptions of individuals with an intellectual disability (and caregivers and guardians) relating to their oral health care.
The majority of the treated patients lived in care, and many had severe medical problems. Most had both restorative treatment and tooth extractions carried out under GA. Their major concern was anxiety associated with the dental visits. Support people/ guardians shared this concern, and played a vital role in helping to manage this anxiety. Many of the latter had difficulty identifying dental problems in their charges, and they often relied on detection of changes in the individual's behaviour or demeanour. The time spent waiting in waiting rooms for treatment was a frequently reported cause of stress.
As a group, these individuals present challenges for the provision of oral health care, given their severe disability and medical conditions, and many require a high level of support for daily activities. When dental treatment is required, a GA is often necessary in order to carry it out. The management of anxiety was a key issue for the patient group and support people play a vital role in helping to manage this anxiety, and achieve a successful visit. There is potential to improve the service with a multidisciplinary approach to coordinate other health services during treatment episodes, reduced time spent in waiting rooms, and improved waiting room layout.