CHAPTER 4. RESULTS
4.3 Analyses
4.3.4 Dental practices among care recipients .1 Toothbrushing pattern
4.3.4 Dental practices among care recipients
Of the few 7.7% of care recipients that used mouthrinses, it was more commonly used by care recipients in community housing compared to those at family homes and institutions (p<0.05, Table 4.10). About 16.4% of carers reported inadequate time to clean and 62.0%
of these were carers at family homes. Only 46.1% of carers were able to clean all teeth and the cleaning ability among carers was similar across the three settings.
4.3.4.1.1 Organisational difficulties when providing oral hygiene care
There were several organisational difficulties faced by carers when providing oral hygiene care (Table 4.11). Among all carers, about 26.4% of them reported lack of time in their usual routine (response of sometimes, fairly often and very often). Among paid carers, 17.4% of carers reported lack of staff and about 19.7% of carers reported lack of communication among staff between shifts (response of sometimes and fairly often).
However, as there was over 26% of missing responses, no further analyses were conducted.
Table 4.11 Frequency of organisational difficulties when providing oral hygiene care
Difficulties when providing Fairly Very oral hygiene care (all carers) Never Rarely Sometimes often often a. Lack of time in usual routine 173 (48.2) 91 (25.3) 67 (18.7) 24 (6.6) 4 (1.1) (paid carers only)
c. Lack of staff 125 (69.1) 24 (13.1) 26 (14.5) 5 (2.9) 0
d. Lack of communication among staff
between shifts 96 (56.8) 40 (23.6) 30 (17.8) 3 (1.9) 0
4.3.4.1.2 Behavioural difficulties when providing oral hygiene care
Several behavioural problems were encountered by carers when providing oral hygiene care for their care recipients. The most frequent problem, reported for 57.9% of care recipients, was inability to rinse with mouthwash, followed by inability to spit after using toothpaste (50.5%). Other problems included – bites toothbrush/swab/carer, drools, moves head or body around excessively, refuses oral hygiene care, does not open mouth, faces head down towards chest, kicks or hits during oral care and uses offensive language (Table 4.12a).
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Table 4.12a Prevalence of reported behavioural problems
Never Rarely Sometimes Fairly often Very often Problems n (%) n (%) n (%) n (%) n (%)
1. Does not or is unable to rinse with mouthwash 75 (24.0) 20 (6.4) 16 (5.0) 21 (6.7) 181 (57.9) 2. Does not or is unable to spit after using
toothpaste 88 (28.2) 16 (5.1) 25 (7.9) 26 (8.3) 158 (50.5)
3. Bites toothbrush/swab/carer 136 (44.1) 55 (18.0) 58 (18.8) 29 (9.4) 30 (9.8)
4. Drools 181 (58.9) 34 (11.1) 43 (14.0) 23 (7.6) 26 (8.4)
5. Moves head or body around excessively 134 (43.5) 50 (16.3) 74 (24.1) 21 (6.8) 28 (9.2) 6. Refuses oral hygiene care 132 (43.1) 51 (16.6) 75 (24.5) 24 (7.9) 24 (7.9) 7. Does not open mouth 121 (39.2) 68 (22.0) 76 (21.7) 24 (7.8) 20 (6.4) 8. Faces head down towards chest 169 (55.1) 45 (14.7) 64 (20.7) 14 (4.6) 15 (4.9) 9. Kicks or hits during oral care 245 (80.6) 31 (10.3) 19 (6.2) 3 (1.0) 6 (1.9) 10. Uses offensive language 278 (90.7) 12 (3.8) 11 (3.5) 3 (1.1) 3 (0.9)
One or more behavioural problems (a response of fairly often or very often) was present in 75.5% of care recipients and the percentage was similar across the three settings (P= 0.43, Table 4.12b). The mean number of behavioural problems reported per care recipient was 1.8 (Table 4.12b).
Table 4.12b Summary table of reported behavioural problems
Residential setting
All people Family Community Institution Chi-square Behavioural problems n (%) n (%) n (%) n (%) p value No problems 79 (24.5) 28 (21.1) 27 (25.7) 24 (28.6) 0.43 One or more problems 243 (75.5) 105 (78.9) 78 (74.3) 60 (71.4)
Mean number of problems 1.8 1.8 1.7 1.7
4.3.4.2 Dental visit pattern
Nearly one fifth of care recipients (18.6%) either never visited the dentist or had not attended after turning 18 years of age or visited only because of a dental problem, most of whom were from family homes (Table 4.13). Care recipients in institutions were seen most frequently at six-monthly recalls. Some 18.8% of care recipients required a general anaesthetic for routine dental examination and treatment, and 13.1% said they were usually treated in the chair under oral sedation.
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Table 4.13 Frequency of dental visit pattern among care recipients
Residential setting
All people Family Community Institution Chi-square Dental visit pattern n (%) n (%) n (%) n (%) p value
Frequency of dental visits <0.001
Never/not after 18 yrs
/only with a problem 87 (18.6) 68 (30.4) 14 (9.6) 5 (5.1) Every 1–2 years 190 (40.5) 81 (36.2) 76 (52.1) 33 (33.3) Every 6 months 192 (40.9) 75 (33.5) 56 (38.4) 61 (61.6)
Usual dental visit pattern <0.001
Without sedation 301 (68.1) 161 (76.7) 94 (68.6) 46 (48.4) With sedation 58 (13.1) 5 (2.4) 18 (13.1) 35 (36.8) Under GA 83 (18.8) 44 (21.0) 25 (18.2) 14 (14.7)
Carer involvement at dental visit <0.001 Yes 357 (75.8) 189 (84.4) 93 (62.4) 75 (76.5)
No 114 (24.2) 35 (15.6) 56 (37.6) 23 (23.5)
About 75.8% of carers accompanied their main care recipient(s) for their dental visit. Carers from family homes were most likely to be present at the dental visit compared to carers at other settings (p<0.001, Table 4.13).
The most frequently reported dental services provided to care recipients included check-up, followed by scaling, fillings, extractions and other treatments including dentures and radiographs (Table 4.14). Care recipients in institutions were more likely to have received scaling, fillings, extractions and other treatments compared to care recipients at other settings (p<0.001, Table 4.14).
Table 4.14 Frequency of usual dental services provided to care recipients
Residential setting
All people Family Community Institution Chi-square Services n (%) n (%) n (%) n (%) p value Check-up Yes 340 (72.8) 164 (74.5) 99 (66.9) 77 (77.8) 0.123
No 127 (27.2) 56 (25.5) 49 (33.1) 22 (22.2)
Scaling Yes 276 (59.1) 92 (41.8) 101 (68.2) 83 (83.8) <0.001 No 191 (40.9) 128 (58.2) 47 (31.8) 16 (16.2)
Fillings Yes 182 (39.0) 70 (31.8) 50 (33.8) 62 (62.6) <0.001 No 285 (61.0) 150 (68.2) 98 (66.2) 37 (37.4)
Extractions Yes 108 (23.3) 28 (12.7) 32 (21.8) 48 (50.0) <0.001 No 355 (76.7) 192 (87.3) 115 (78.2) 48 (50.0)
Other Yes 56 (12.0) 24 (11.0) 9 (6.1) 23 (23.2) <0.001 No 410 (88.0) 195 (89.0) 139 (93.9) 76 (76.8)
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Some 43.6% of carers reported one or more problems in obtaining dental care, the most frequent being dentists with inadequate skills in managing people with disabilities followed by cost, location of dental clinic, lack of dentists willing to treat people with disabilities and transportation problems (Table 4.15). Carers at family homes experienced the most number of problems in obtaining care, while those at institutions reported minimal problems in obtaining dental care for their care recipients (p<0.001, Table 4.15).
Other problems included carers not being aware of services available for people with disabilities and not knowing where to take their care recipients, or having the impression that there was a long waiting list to be seen at government clinics and inadequate disabled parking outside dental clinics. Some carers at institutions acknowledged that there were too many patients to be seen by one dentist in the single morning dental clinical session offered at the institution every week.
Table 4.15 Prevalence of problems obtaining dental care
Residential setting
All people Family Community Institution Chi-square Problems n (%) n (%) n (%) n (%) p value Inadequate skills Yes 89 (19.7) 55 (25.8) 30 (21.4) 4 (4.0) <0.001
No 363 (80.3) 158 (74.2) 110 (78.6) 95 (96.0)
Cost Yes 69 (15.3) 53 (24.9) 14 (10.0) 2 (2.0) <0.001 No 383 (84.7) 160 (75.1) 126 (90.0) 97 (98.0)
Location Yes 66 (14.7) 40 (18.9) 24 (17.3) 2 (2.0) <0.001 No 384 (85.3) 172 (81.1) 115 (82.7) 97 (98.0)
Lack of dentists willing Yes 63 (13.9) 40 (18.8) 18 (12.9) 5 (5.1) 0.004 No 389 (86.1) 173 (81.2) 122 (87.1) 94 (94.9)
Transport Yes 58 (12.8) 40 (18.8) 15 (10.7) 3 (3.0) <0.001 No 394 (87.2) 173 (81.2) 125 (89.3) 96 (97.0)
Other Yes 35 (7.8) 21 (9.9) 13 (9.4) 1 (1.0) 0.017 No 416 (92.2) 192 (90.1) 126 (90.6) 98 (99.0)
One or more Yes 197 (43.6) 122 (57.3) 67 (47.9) 8 (8.1) <0.001 No 255 (56.4) 91 (42.7) 73 (52.1) 91 (91.9)
Reported quality of dental care provided by dentist/hygienist was measured by 5 questions, with responses recorded on a 5-point Likert scale that ranged from "strongly disagree" coded as 1 through to "strongly agree" coded as 5 (Table 4.16a). Of the care recipients who visited the dentist, most carers reported that the dentist/hygienist showed sensitivity to the special needs of their care recipients, conducted a proper dental examination,
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diagnosis and treatment, fully explained treatment choices and offered clear oral hygiene instructions to them and their care recipients. Recall visits for care recipients were also arranged.
Table 4.16a Frequency of ratings of reported quality of dental care provided by dentist/hygienist (%)
At your care recipient’s dental visit, Strongly Strongly the dentist/hygienist…. Disagree (1) Disagree (2) Neutral (3) Agree(4) agree (5)
n (%) n (%) n (%) n (%) n (%) 1. Shows sensitivity to the special needs
of your care recipient 8 (1.9) 4 (1.0) 27(6.8) 180 (44.9) 182 (45.4)
2. Conducts a proper dental
examination, diagnosis and treatment 11 (2.7) 11 (2.8) 30 (7.7) 184 (46.5) 160 (40.4) 3. Fully explains treatment choices to carer
and care recipient 10 (2.6) 5 (1.3) 34 (8.7) 197 (49.8) 149 (37.6)
4. Offers clear oral hygiene instructions to
carer and care recipient 8 (2.0) 9 (2.2) 35 (9.0) 200 (51.1) 140 (35.7) 5. Arranges recall visits for care recipient
15 (3.8) 10 (2.6) 42 (10.6) 148 (37.5) 179 (45.5)
From the responses in Table 4.16a, quality of dental care provided was dichotomised as neutral/negative (total score ≤ 19) or positive (total score ≥ 20) (Table 4.16b). Generally, most carers had positive reports, however, carers at family homes were either more neutral or negative about their reports compared to carers from other settings (p<0.001, Table 4.16b).
Table 4.16b Summary report of quality of dental care provided by dentist/hygienist
Residential setting
All people Family Community Institution Chi-square Report n (%) n (%) n (%) n (%) p value Positive 303 (74.4) 123 (63.4) 97 (83.6) 83 (85.6) <0.001 Neutral/Negative 101 (25.6) 71 (36.6) 19 (16.4) 14 (14.4)
4.3.5 Oral disease risk behaviours among care recipients