Saúde oral e qualidade de vida da pessoa portadora de deficiência intelectual leve

People with intellectual disabilities are often more vulnerable to develop oral health problems. In fact, numerous studies indicate that individuals with intellectual disability have poorer oral hygiene, worse signs of gingival disease and a higher prevalence of untreated dental caries compared with the general population. Although oral diseases rarely are a threat to the individual's life, they may cause an impact among the functional, psychological and social dimensions of the aspects of daily routines and impair quality of life. Furthermore, and despite a wide variety of quality of life assessment tools that have been developed in recent decades as a result of growing concern about the impact of oral health on the general health, nutrition, well-being and quality of life of the individual, such research rarely includes people with intellectual disabilities. Therefore, the purpose of this study is to assess oral health and its impact on the quality of life of people with mild intellectual disabilities. For this, a cross-sectional descriptive, observational epidemiological study was carried out in a population of people with mild intellectual disabilities living in (or attending) institutions of the central region of Portugal that are affiliated with HUMANITAS (Portuguese Federation for Mental Disabilities) in 2016. Firstly, the validation process of a modified version of the OHIP-14 questionnaire was carried out for the study population, which resulted in the OHIP-14-MID-PT questionnaire. The Portuguese version of the questionnaire was drawn up from the original English version, following internationally defined transcultural adaptation guidelines, followed by the evaluation of the properties and psychometric behavior of this new measuring instrument. Concurrently with the application of a sociodemographic/oral health questionnaire and the final version of the OHIP-14-MID-PT questionnaire (in the form of a face-to-face interview conducted by the study’s author, to a sample of 240 individuals of both genders and between the ages of 18 and 64 years old), an intraoral examination was also performed based on three clinical indexes: COHI (Clinical Oral Health Index Index), COCNI (Clinical Oral Care Needs Index) and Clinical Oral Prevention Index (COPI), to determine, respectively, oral health problems, dental treatment needs, and preventive/educational measures. The OHIP-14-MID-PT presented high reliability (ICC=0,999; Cronbach's α=0,922). The inter-item correlation coefficient ranged from 0,277 to 0,749, and the item-total correlation coefficient varied between 0,529 and 0,728. The OHIP-14-MID-PT total scores were significantly associated with the self-perception of need for dental treatment (U=2366,5, p<0,001), the oral health status (r=-0,545, p<0,001), the number of natural teeth (χ2=29,74, p<0,001) and with COHI’s results (χ2=18,50, p<0,001); the results support the convergent and divergent validities of the questionnaire. Of the 240 subjects participating in the study, 122 were female and 118 male, and the mean age was 35.9 years. 45% of the sample lived in an urban environment and 55% in rural areas. Although all the individuals under study had some form of institutional link, only 13,3% were institutionalized. More than half of the individuals (54,9%) presented “one or more problems with important to severe impact on health” (COHI level 2); only 4,6% of the individuals have “no need for care nor examination” (COCNI level 0) and 85% of the study sample needs, at least, “one preventive or dental health education action need” (COPI level 1). In 76,9% of the participants, oral health had impact on the quality of life. The most affected dimensions of life were physical pain, with 61,9%, followed by psychological discomfort and psychological disability with 45,1% and 45%, respectively. With relation to sociodemographic variables and oral health factors it was verified that the presence of fewer teeth and self-perception of higher need for dental treatment had a negative impact on the quality of life. On the other hand, institutionalization and an increase in at least one category in the self-perception of the oral health status had a positive impact on the quality of life. OHIP-14-MID-PT has proved to be a consistent, valid and reliable instrument with good psychometric properties to determine the impact of oral health on quality of life in adults with mild intellectual disabilities in Portugal. Given the high burden of oral disease and the considerable impact on quality of life found in this study, the establishment of guidelines to improve the oral health and quality of life of these individuals should be regarded as imperative.