Dare to Ask: Mental disabilities: In the teeth?

By PHILLIP MILANO, The Times-Union

Question

Is it true that more people with mental disabilities have oversized and crooked teeth?

D.M.V., 35

Replies

I've never heard that. That's interesting. A good deal of this population would be eligible for Medicaid coverage, which does not cover (for the most part) any dental work. My brother is mentally challenged and has had several teeth pulled due to major bone loss in his jaw. My parents paid for his teeth implants out of pocket because, according to my mother, he only has so much going for him, and it would be devastating if he didn't even have all of his teeth.

Annie, 51, Lawrenceville, Ga.

There are two reasons for your observation. First, people with mental disabilities are less likely to realize the value of good dental hygiene . . . and as a result, [their teeth] end up crooked. Second, many people with mental disabilities actually have good teeth, good grooming habits, etc. And thus, they are less likely to be recognized as being "different." You could have passed 10 mentally challenged people today on the street, all with good teeth, and never knew they were handicapped.

Kortni, Denver

Expert says

First, to be clear: In most states, if you're under 21 and eligible, Medicaid will cover basic dentistry and some orthodontic work. The latter is generally reserved for a medical necessity, such as pretty severe malocclusions (for us non-dental experts, that's when teeth don't meet properly when you bite down).

If you're 21 or older, dental coverage gets dicier, depending on the state.

Carlton Horbelt, past president of the Special Care Dentistry Association (www.scdonline.org), has looked into a lot of the mouths of the intellectually disabled during the past 24 years.

Has he seen a lot of overly large teeth? Nope.

Crooked teeth? More so.

"That's a fairly common finding with developmental syndromes," he said. "It's not necessarily just people with intellectual disabilities, but any genetic syndrome that produces physical abnormalities or intellectual disabilities."

With conditions such as Down, Apert or Crouzon syndromes, for example, there can be oral abnormalities - such as a delay in the eruption of teeth, spacing problems or teeth coming in in the wrong order - that can result in crooked teeth, he said.

The danger often is not lack of treatment, but too much of it, Horbelt said.

"There can be a tendency for a private office to overtreat. That's not a criticism, because they want to offer the best care possible."

The problem is that corrective bridgework, dentures or partials may not be advisable if the patient can't maintain them, he said. Or, in the case of cerebral palsy (in which the person may fall a lot), fixed bridgework in the mouth can dislodge and become a choking hazard.

"In the end you have to stand back and say, what can the person tolerate? That's the difference: You want to offer the very best dentistry that they can tolerate."

Phillip Milano, author of I Can't Believe You Asked That! (Perigee), moderates cross-cultural dialogue at Y? The National Forum on People's Differences. Visit www.yforum.com to submit questions and answers. Send general column comments to phillip.milano@jacksonville.com. You can also hear his podcasts or watch his TV spots.