Abstract
BackgroundChildren with learning disabilities (CLD) have worse health outcomes than children with no learning disabilities (CNLD). This systematic review compared caries experience and met dental care need for CLD to CNLD using Decayed, Missing, Filled Permanent Teeth (DMFT) and decayed, missing/extracted, filled primary teeth (dmft/deft), care index (CI), and restorative index (RI) values.MethodsWithout date or language restrictions four databases were searched for; cross-sectional studies comparing caries experience and CI/ RI in CLD matched to groups of CNLD. Screening and data extraction were carried out independently and in duplicate. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analyses were carried out (random effects model).ResultsThere were 25 articles with 3976 children (1 to 18 years old), from 18 countries, fitting the inclusion criteria. Children with; Down syndrome were investigated in 11 studies, autism in 8 and mixed learning disabilities in 6. The overall mean DMFT for CLD was 2.31 (standard deviation±1.97; range 0.22 to 7.2) and for CNLD was 2.51 (±2.14; 0.37 to 4.76). Using standardised mean difference (SMD), meta-analysis showed no evidence of a difference between CLD and CNLD (n = 16 studies) for caries experience (SMD = -0.43; 95%CI = -0.91 to 0.05). This was similar for sub-groups of children with autism (SMD = -0.28; 95%CI = 1.31 to 0.75) and mixed disabilities (SMD = 0.26; 95%CI = -0.94 to 1.47). However, for children with Down syndrome, caries experience was lower for CLD than CNLD (SMD = -0.73; 95%CI = -1.28 to − 0.18). For primary teeth, mean dmft/deft was 2.24 for CLD and 2.48 for CNLD (n = 8 studies). Meta-analyses showed no evidence of a difference between CLD and CNLD for caries experience across all disability groups (SMD = 0.41; 95% CI = -0.14 to 0.96), or in sub-groups: Down syndrome (SMD = 0.55; 95%CI- = − 0.40 to 1.52), autism (SMD = 0.43; 95%CI = -0.53 to 2.39) and mixed disabilities (SMD = -0.10; 95%CI = -0.34 to 0.14). The studies’ risk of bias were medium to high.ConclusionThere was no evidence of a difference in caries levels in primary or permanent dentitions for CLD and CNLD. This was similar for learning disability sub-groups, except for Down syndrome where dental caries levels in permanent teeth was lower. Data on met need for dental caries was inconclusive.Trial registrationThe protocol was published in PROSPERO: CRD42017068964 (June 8th, 2017).
Highlights
Children with learning disabilities (CLD) have worse health outcomes than children with no learning disabilities (CNLD)
All 25 studies were comparative, cross-sectional in design they varied in how the CLD and CNLD were sampled; in some studies the CNLD were siblings or other family members whereas in others they were sampled from wider representative populations
For children with Down syndrome caries experience was lower for CLD than CNLD (SMD = -0.73; 95% Care index (CI) = -1.28 to − 0.18)
Summary
Children with learning disabilities (CLD) have worse health outcomes than children with no learning disabilities (CNLD). A learning disability can be defined as a reduced intellectual ability leading to challenges with everyday tasks and situations [2, 3] It affects people for the duration of their lives and often requires significant support from carers to interact with others [4]. Do people with learning disabilities suffer from co-morbidities but they have worse health outcomes than their non-learning disabled counterparts in areas of health not related to their disability [5] This is in part because they are more likely to have additional health problems [6] but can be associated with suboptimal care from health care professionals and social services [5]. Differences in health status between people with learning disabilities and people without learning disabilities represents a genuine health inequality that is largely avoidable and entirely unjust [7]
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