Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the effectiveness of interventions prior to and during dental care (including desensitization programs, sedation, behavioral modifications and standard immobilization) to improve tolerance of dental procedures for persons with intellectual disabilities (ID)? Does effectiveness differ by type and severity of ID and other characteristics of the individual? Does effectiveness differ by provider and provider training?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Interventions prior to and during dental care (including desensitization programs, sedation, behavioral modifications and standard immobilization) to improve tolerance of dental procedures.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Persons with intellectual disabilities

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

We are interested in the effectiveness of interventions prior to and during dental care to improve tolerance of dental procedures for persons with ID, and the potential to reduce dental interventions that are generally considered more extreme or harsh, including teeth extractions versus restorations, or using sedation for routine office procedures. Minimizing these risks is particularly important in a population with pre-existing vulnerabilities. Implementation of evidence-based approaches could enhance quality of life for individuals with ID, and reduce oral pain and associated distress or behavior problems.

Describe any health-related risks, side effects, or harms that you are concerned about.

Persons with ID are at markedly high risk for such dental problems as gingivitis, poor oral hygiene, caries, and periodontal disease. Dental problems in people with ID remain one of the top ten rated secondary health concerns that significantly detract from overall quality of life. Indeed, undetected or untreated dental pain contributes to poor nutrition, irritability, and aggressive and self-injurious behaviors. As well, dental interventions in people with ID carry more risk as they typically involve more teeth extractions than restorations, and physical restraint or sedation for dental procedures.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Developmental delays, attention-deficit hyperactivity disorder, and autism

AHRQ Priority Populations

• Children
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)
• Other

Importance

Describe why this topic is important.

As standards and best practices for optimal dental care are well-known, a key research topic is identifying the obstacles and barriers to appropriate dental care in the ID population. Obstacles relate to people with ID, their families or care providers, dental providers, and health insurance coverage. Individuals with ID may have sensory, motor or behavior problems that complicate in-chair compliance, families may minimize oral health relative to more urgent medical concerns, and dentists or hygienists are not apt to be trained to work specifically with patients with ID. Understanding is needed of the effectiveness of ID training for dental professionals, educating families about oral hygiene, and increasing patient compliance in the office via behavioral analytic or de-sensitization procedures. For this research to inform treatment, it must include persons of various ages, cultural backgrounds, and causes of ID, as well as the perspectives of individuals with ID, their families, and dental professionals.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This topic was nominated by a panel of stakeholders to identify potential systematic research topics for health care and mental health for individuals with intellectual disabilities.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

There is substantial need for evidence-based approaches and training for dental professionals, educating families about oral hygiene, and increasing patient compliance in the office via behavioral analytic or de-sensitization procedures.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

N/A

Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Dental problems in people with intellectual disabilities remain one of the top ten rated secondary health concerns that significantly detract from overall quality of life. Indeed, undetected or untreated dental pain contributes to poor nutrition, irritability, and aggressive and self-injurious behaviors. As well, dental interventions in people with intellectual disabilities carry more risk as they typically involve more teeth extractions than restorations, and physical restraint or sedation for dental procedures. Obstacles relate to people with ID, their families or care providers, dental providers, and health insurance coverage. Individuals with ID may have sensory, motor or behavior problems that complicate in-chair compliance, families may minimize oral health relative to more urgent medical concerns, and dentists or hygienists are not apt to be trained to work specifically with patients with ID.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

N/A

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program