Patients with reduced capacity due to mental, motor or sensory deficits are a population characterised by greater therapeutic needs compared to healthy individuals (1). Higher risk of morbidity in this group of patients requires preventive actions adjusted to their needs, also in the aspect of oral health problems.

The number of generally available, specialist dental offices for patients with disabilities is limited in Poland. These patients are often admitted to dental offices under the same conditions as healthy individuals (2). In some provinces, funds are allocated for the disabled as a part of public health care. It should be noted that the need for professional oral care in this patient population has been repeatedly emphasised worldwide.

According to Article 25 of the Convention on the Rights of Persons with Disabilities, which was adopted by the General Assembly of the United Nations on the 13^th December 2006, “persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability” (3). The Convention was signed by the Polish government on the 20^th March 2007 and ratified by Poland on the 6^th September 2012 (4).

Furthermore, the FDI General Assembly held in Sydney (Australia) on the 18^th September 2003 adopted a position on the dental care for persons with disabilities, which was also adopted by the Polish Dental Association (5). It was agreed that “oral health of disabled people should be ensured through education on oral health and prevention of oral diseases”, “cooperation with decision-makers and other interested parties should be a part of an overall strategy for the development and implementation of dental services for disabled persons”.

However, there are no guidelines allowing for detailed specification of the principles for preventive and therapeutic management that would serve as a basis for health programmes to be implemented in this group of dental patients.

The aim of the paper is to present the recommendations for the preventive and therapeutic dental care in patients with disabilities as well as their parents/caregivers and dentists. The work was based on a national and worldwide literature review concerning dental caries and its prevention in patients with disabilities.

According to data from the World Health Organisation (WHO), more than 1 billion people (about 15% of world population) are affected by some form of disability (6, 7). Of those, 110-190 million (2.2-3.8%) of people over 15 years experience significant disabilities.

National data with comments was included in the report of the Central Statistical Office. It was noted that the information concerning persons with disabilities is derived from a number of statistical studies (8). However, due to the methodology used, the availability of data at a certain level of territorial division remains limited. So far, national census was the largest study to collect data regarding individuals affected by disability. The last National Population and Housing Census was conducted in 2011 and used a mixed method, i.e. administrative data sources, including registers and information systems, as well as data obtained directly from the population as part of a representative survey. Furthermore, it was stated that most data in the 2011 Polish Census, including information regarding disability, was derived from a representative survey performed in a 20% nationwide sample of randomly selected apartments, as well as on a voluntary basis. Hence, such an approach limits the availability of data at lower levels of territorial division (8). Such information can be treated as a basis for professional epidemiological studies.

Currently available data also indicates that the number of persons affected by disabilities is on the rise both in Poland and worldwide due to population ageing as well as an increased incidence of chronic diseases (6). Furthermore, significant development in medical sciences and technology as well as social facilities allows the survival of a significant percentage of people with disabilities (9), which should shape health policy to ensure proper quality of life for these individuals.

This patient population is characterised by higher caries rates.

In the years 2006-2007, a clinical evaluation of oral health in paediatric population with disabilities and a sociomedical study in their parents/caregivers were performed as a part of “Epidemiological assessment of oral health in disabled and chronically ill children” commissioned by the Ministry of Health in four Polish provinces: Greater Poland, Łódź, Podlasie and Lublin (10-12). The studied population was composed of individuals with moderate to severe intellectual disability, nervous system diseases (infantile cerebral palsy and epilepsy) and impaired sensory efficiency (poor vision and blindness). An assessment of dental health in 289 patients with mixed dentition showed caries incidence of 75.1% in the general population of these children, including 72.8% in the group with intellectual impairment, 76.1% among patients with nervous system diseases and 76.1% in patients affected by vision impairment and blindness (11). Caries intensity index (dmft + DMFT) was 5.3 in this population, and 4.8, 5.6 and 5.4, respectively, in the individual groups of patients. Among the total group of 499 patients with permanent dentition, the incidence of caries was 68.3%, and the intensity of caries (DMFT) was 6.5. The following values were obtained for different groups of patients, which were created based on health status: 70.3% and 6.7 in individuals with intellectual disability, 71.3% and 6.9 in patients with cerebral palsy and epilepsy, as well as 57.6% and 4.9 in adolescents with sensory dysfunctions (11).