People with intellectual and/or developmental disabilities (IDD) living in family or group homes receive less preventive medical care than those living in institutions and are less likely to receive routine dental care. These individuals are more likely to have poor oral hygiene, increased decay, and periodontal disease than the general population-a significant health disparity. More importantly, poor oral health in persons with IDD may also contribute to respiratory infections including aspiration pneumonia. The oral health of this population is compromised not only by the lack of preventive dental treatment every six months but also their inability to adequately brush and/or floss their own teeth. Many of the moderately to profoundly disabled are dependent on their caregivers to maintain oral health but there is evidence that caregiver psychosocial factors serve as barriers to optimal oral hygiene behavior The proposed oral health planning grant is in conjunction with conducting a five-year randomized controlled trial with an oral health theory-based intervention delivered by case managers. The research will extend previous findings from a pilot study to a different population by using an empirical grounded theoretical framework, refined intervention strategy, larger sample size and pilot tested process and outcome measures. The U01 cooperative agreement trial would be the first outcome study properly powered to evaluate the effect of a dental case management strategy on oral health, related quality of life, and respiratory infections with caregivers and IDD participants in 124 community group homes. The two-year planning grant is requested to pilot test recruitment strategies, acceptability of the intervention, fidelity monitoring methods, and validity and reliability of study measures including intervention processes, mediators, moderators, and outcomes. The pilot will be conducted with a sample of caregivers in 25 group homes, with approximately 112 IDD participants. Upon completion of the planning grant, a full protocol and manual of operations will have been developed for the clinical trial (U01 cooperative agreement) grant application. Personnel from the University of Louisville and the Pacific Institute for Research and Evaluation will participate in these activities. The results of this study will impact the field of social and behavioral research by demonstrating whether dental case management improves the oral health and related quality of life of persons with IDD. If the results are positive, we would advocate for a larger multi-site randomized controlled trial to produce results that may be generalized to different populations with oral health disparities in diverse geographic areas. Ultimately, the results could impact healthcare reform and integrate dental case management into medical case management for disadvantaged persons.

Public Health Relevance

In the short term, the results of the proposed study have the potential to provide evidence that public health policies should include dental case management, especially for IDD participants living in the community. Additionally, this study may show that a behavioral intervention targeting caregivers could produce a greater impact on oral health outcomes in other dependent populations. In the long term, we hope this research can develop evidence for an oral health intervention for caregivers of cognitively impaired persons. We believe oral health can be positively impacted, preventing poor oral health and oral health related quality of life, and possibly respiratory infections in these vulnerable populations. Moreover, if future studies show that oral health outcomes are positively impacted by this intervention, then the overall healthcare cost could be reduced, because cognitively impaired individuals will have less need for expensive procedures resulting from lack of proper oral health behaviors.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Planning Grant (R34)
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Special Emphasis Panel (ZDE1-JR (17))
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Clark, David
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University of Louisville
Schools of Dentistry
United States
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Binkley, Catherine J; Johnson, Knowlton W; Abadi, Melissa et al. (2014) Improving the oral health of residents with intellectual and developmental disabilities: an oral health strategy and pilot study. Eval Program Plann 47:54-63
Binkley, Catherine J; Johnson, Knowlton W (2013) Application of the PRECEDE-PROCEED Planning Model in Designing an Oral Health Strategy. J Theory Pract Dent Public Health 1: