There is increasing evidence suggesting that people with learning disabilities have greater dental needs. However, these studies have methodological limitations such as using convenience samples (e.g. patients attending a specialist dental clinic) or including small sample sizes. We aimed to address this by conducting a large data linkage study to identify the oral health experiences of adults with learning disabilities compared to the general population.
We used the Primary Care Learning Disabilities Register of NHS Greater Glasgow & Clyde to identify a representative population of adults with learning disabilities (aged 17 – 94). 4 305 adults with learning disabilities were matched to 12 915 general population controls on age, sex and neighbourhood deprivation. We obtained permission to access administrative health data linking information from dentists, pharmacists and doctors.
Although adults with learning disabilities attended their dentist more than people in the control group, they received different patterns of treatment compared to the general population. Adults with learning disabilities had fewer dental restorations (such as fillings) and fewer tooth extractions. These differences in dental treatments between the groups were larger when comparing adults aged 45 years or older: that is, there is an increasing oral health inequity as adults with learning disabilities get older. For example, people from the general population aged 55-64 were twice as likely to have received dental restorations compared to those with learning disabilities. This is pertinent as adults with learning disabilities are beginning to live longer and it is important that they receive appropriate health care, including oral health. When we examined medication with increased dental risks (sugar-containing liquids, and dry-mouth/ anticholinergic medication), we found that adults with learning disabilities were more likely to be exposed to these medicines compared to the general population. Taking these types of medication increased the odds of a dental extraction in the general population, but not in the learning disabilities group.
Our findings suggest that adults with learning disabilities are supported to attend dental appointments. However, dental professionals may be less likely to restore teeth, possibly extracting multiple teeth at individual appointments based on what we know from historical practice and previous research. Medications with increased dental risk were more frequently prescribed to people with learning disabilities, yet the problems caused were less apparent as more of their teeth are likely to have been extracted. These medications, e.g. antipsychotics are often used over prolonged periods/ decades in adults with learning disabilities, and the adverse impact on oral health is not yet fully understood. Dental caries and periodontal disease are the two main dental diseases leading to treatment, but are preventable, and the importance of good oral hygiene needs to be continually communicated to adults with learning disabilities, carers and health professionals.
Laura is an Affiliate Associate Researcher at the Observatory, involved in ongoing work about cancer screening, cancer incidence and cancer-related deaths, as well as pain and prescribing in adults with intellectual disabilities/autism. In 2023, Laura took up the role of Project Manager of the Trusted Research Environment (TRE) at the Health Informatics Centre (HIC) at the University of Dundee. The TRE, or Safe Haven as it is known in Scotland, is responsible for curation and provisioning of NHS Scotland patient data.
Anna set up the Scottish Learning Disabilities Observatory with funding from the Scottish Government. She wants the Observatory to make Scotland fairer and healthier for people with learning disabilities and their families, by: Finding out the health problems people have Finding out how good or bad health care is Telling people about health and health care problems Finding ways to make health and health care better Checking if health gets better or worse over time Helping the Scottish Government, and staff who provide health and social services, to get it right for people with learning disabilities Anna is a doctor. She has done a lot of studies on the health of people with learning disabilities. Anna’s full name is Professor Sally-Ann Cooper.
Deborah is the Director of the Scottish Learning Disabilities Observatory and Professor of Health and Neurodevelopmental Conditions, in the School of Health and Wellbeing, at the University of Glasgow. Deborah is passionate about her research which aims to improve the health of people with learning disabilities and their families. She has worked on many different projects about people with learning disabilities including: cancer incidence, cancer screening, multi-morbidity (having two or more health conditions), oral health and COVID-19, to name a few. She has also worked on projects about the physical and mental health of family members who support someone with a learning disability. Deborah is committed to conducting research that has impact and works closely with self-advocates with learning disabilities, family carers and third sector organisations who are pivotal in all of her work and who have a shared vision of ensuring the human rights of all people with learning disabilities are recognised, supported and upheld. Read more about Deborah here.
Angela was formerly the Director for Policy and Impact for the Scottish Learning Disabilities Observatory and remains an affiliate team member, having moved in 2024 to work with the Scottish Government leading the development of annual health checks and learning disabilities data. Angela is interested in how evidence is used in policy making and was involved in many projects at the Observatory. These included: Understanding the impact of Covid-19 on people with learning disabilities The Research Voices Project Helping to set up the SPIRE learning disabilities data project Analysing information about drug prescribing for people with learning disabilities
Christine is a doctoral student with research interests in health inequality, inclusive research, and optimising health care and prescribing for adults with learning disabilities. Her PhD research is examining the treatment of pain and painful conditions experienced by adults with learning disabilities focusing on any health inequality that may emerge from this project. Christine is a clinical pharmacist, with expertise in mental health, and has practiced professionally within community, hospital and mental health settings. Prior to commencing her doctoral studies, Christine worked within NHS learning disability psychiatry multi-disciplinary teams providing support with medication for people with learning disability and complex health needs. Christine is an experienced carer of a family member with learning disability and complex health needs.
The Scottish Learning Disabilities Observatory is based in the School of Health and Wellbeing at Glasgow University; Professor Jill Pell was formerly Director of the School. She is an expert in Public Health. Jill also has another role as Honorary Consultant in Public Health in NHS Greater Glasgow and Clyde. Jill’s main research interests are in: Long term conditions like diabetes Maternal and child health Obesity Smoking A lot of her research draws on different administrative data and uses data linkage methods to help answer important public health questions. For example, Jill is leading research which will help to understand the different things associated with additional educational support needs.