Dentists’ attitude and perceived educational barriers to oral health promotion among patients with disabilities

Document Type: Original Article(s)


1 Associate Professor, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran

2 Assistant Professor, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran

3 Dentist, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, International Campus, Tehran, Iran

4 Epidemiologist, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran


BACKGROUND AND AIM: Individuals with disability usually suffer from complex oral problems and marked physical limitations, and therefore need special dental care. The dentists’ attitude and perceived educational barriers for oral health promotion among the individuals with disabilities were evaluated in the present study.METHODS: In this cross-sectional study, 193 dentists participating in the 54th International Congress and Exhibition of Iranian Dental Association in 2014 were invited to complete a valid and reliable questionnaire. The questionnaire included questions on attitude, satisfaction with training courses, perceived barriers to learn about oral health of patients with disabilities, age, gender, office location (city), and experience of treating patients with disabilities. The results were analyzed in SPSS software using linear regression analysis.RESULTS: A total of 177 questionnaires were collected. The mean age of the participants was 35.5 (10.1) years, and 53.8% of the participants were men. The mean score of attitude and perceived barriers was 27 out of 52, and 13.6 out of 24, respectively. Dentists were not satisfied with education they had received. The most important barrier was the shortage of experts for training (52.1%). The linear regression model controlling the confounders revealed a better attitude among dentists with higher satisfaction with their academic education and among those perceiving less barriers in receiving the related academic educations.CONCLUSION: The dentists’ attitude towards the oral health promotion of patients with disabilities was not in a desirable level. The dentists satisfied with their training during academic education had a better attitude towards treating these patients, indicating the need for more extensive interactive training programs.


  1. Kleinert HL, Sanders C, Mink J, Nash D, Johnson J, Boyd S, et al. Improving student dentist competencies and perception of difficulty in delivering care to children with developmental disabilities using a virtual patient module. J Dent Educ 2007; 71(2): 279-86.
  2. Matsuyama Y, Aida J, Watt RG, Tsuboya T, Koyama S, Sato Y, et al. Dental status and compression of life expectancy with disability. J Dent Res 2017; 96(9): 1006-13.
  3. Dao LP, Zwetchkenbaum S, Inglehart MR. General dentists and special needs patients: Does dental education matter? J Dent Educ 2005; 69(10): 1107-15.
  4. Fenton SJ, Hood H, Holder M, May PB Jr, Mouradian WE. The American Academy of Developmental Medicine and Dentistry: Eliminating health disparities for individuals with mental retardation and other developmental disabilities. J Dent Educ 2003; 67(12): 1337-44.
  5. Al-Zboon E, Hatmal MM. Attitudes of dentists toward persons with intellectual disabilities in Jordanian hospitals. Spec Care Dentist 2016; 36(1): 25-31.
  6. Raybould TP, Wrightson AS, Massey CS, Smith TA, Skelton J. Advanced general dentistry program directors' attitudes on physician involvement in pediatric oral health care. Spec Care Dentist 2009; 29(6): 232-6.
  7. Edwards DM, Merry AJ. Disability part 2: Access to dental services for disabled people. A questionnaire survey of dental practices in Merseyside. Br Dent J 2002; 193(5): 253-5.
  8. Wolff AJ, Waldman HB, Milano M, Perlman SP. Dental students' experiences with and attitudes toward people with mental retardation. J Am Dent Assoc 2004; 135(3): 353-7.
  9. Keselyak NT, Simmer-Beck M, Bray KK, Gadbury-Amyot CC. Evaluation of an academic service-learning course on special needs patients for dental hygiene students: A qualitative study. J Dent Educ 2007; 71(3): 378-92.
  10. Waldman HB, Perlman SP. Preparing to meet the dental needs of individuals with disabilities. J Dent Educ 2002; 66(1): 82-5.
  11. Mohebbi SZ, Chinipardaz Z, Batebi A. Effectiveness of training senior dental students on oral health care for disabled patients. Eur J Dent Educ 2014; 18(4): 214-21.
  12. Batista LR, Moreira EA, Rauen MS, Corso AC, Fiates GM. Oral health and nutritional status of semi-institutionalized persons with mental retardation in Brazil. Res Dev Disabil 2009; 30(5): 839-46.
  13. Khadem P, Karami M, Salehinia R. Evaluation of oral health status in mild to moderate mental disabled children in comparison with normal children in Isfahan [Iran]. J Mashad Dent Sch 2012; 35(4): 253-562. [In Persian].
  14. Oredugba FA, Sanu OO. Knowledge and behavior of Nigerian dentists concerning the treatment of children with special needs. BMC Oral Health 2006; 6: 9.
  15. Smith G, Rooney Y, Nunn J. Provision of dental care for special care patients: The view of Irish dentists in the Republic of Ireland. J Ir Dent Assoc 2010; 56(2): 80-4.
  16. Irigoyen M, Zepeda M, Lopez-Camara V. Factors associated with Mexico City dentists' willingness to treat AIDS/HIV-positive patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86(2): 169-74.
  17. alSarheed M, Bedi R, Hunt NP. Attitudes of dentists, working in Riyadh, toward people with a sensory impairment. Spec Care Dentist 2001; 21(3): 113-6.
  18. Bickley SR. Dental hygienists' attitudes towards dental care for people with a mental handicap and their perceptions of the adequacy of their training. Br Dent J 1990; 168(9): 361-4.
  19. Romer M, Dougherty N, Amores-Lafleur E. Predoctoral education in special care dentistry: Paving the way to better access? ASDC J Dent Child 1999; 66(2): 132-5, 85.
  20. Victoroff KZ, Hogan S. Students' perceptions of effective learning experiences in dental school: A qualitative study using a critical incident technique. J Dent Educ 2006; 70(2): 124-32.
  21. Vainio L, Krause M, Inglehart MR. Patients with special needs: Dental students' educational experiences, attitudes, and behavior. J Dent Educ 2011; 75(1): 13-22.
  22. Rutkauskas J, Seale NS, Casamassimo P, Rutkauskas JS. Preparedness of entering pediatric dentistry residents: advanced pediatric program directors' and first-year residents' perspectives. J Dent Educ 2015; 79(11): 1265-71.
  23. Massey CS, Raybould TP, Skelton J, Wrightson AS, Smith TA. Advanced general dentistry program directors' attitudes and behaviors regarding pediatric dental training for residents. J Dent Educ 2008; 72(3): 344-51.
  24. Sakaguchi M, Higuchi H, Maeda S, Miyawaki T. Dental sedation for patients with intellectual disability: A prospective study of manual control versus Bispectral Index-guided target-controlled infusion of propofol. J Clin Anesth 2011; 23(8): 636-42.
  25. Nishi C, Yoshida K, Tomoyasu Y, Higuchi H, Kohjitani A, Maeda S, et al. The influence of antiepileptic drugs on intravenous sedation with midazolam and propofol for dental treatments in patients with intellectual disabilities. Journal of Japanese Dental Society of Anesthesiology 2006; 34(2): 169-72.
  26. Kim N, Kim CY, Shin H. Inequality in unmet dental care needs among South Korean adults. BMC Oral Health 2017; 17(1): 80.
  27. van der Tas JT, Kragt L, Elfrink MEC, Bertens LCM, Jaddoe VWV, Moll HA, et al. Social inequalities and dental caries in six-year-old children from the Netherlands. J Dent 2017; 62: 18-24.
  28. Pau A, Croucher RE, Marcenes W. Demographic and socio-economic correlates of dental pain among adults in the United Kingdom, 1998. Br Dent J 2007; 202(9): E21-E29.
  29. Berglund E, Westerling R, Lytsy P. Social and health-related factors associated with refraining from seeking dental care: A cross-sectional population study. Community Dent Oral Epidemiol 2017; 45(3): 258-65.