Healthy Athletes Germany Presents Data to Government Health Committee

By Dr. Imke Kaschke MPH; Manager Healthy Athletes, Special Olympics Germany

In order to discuss the necessity and means to improve oral health for people with special needs in Germany, a first meeting with politicians, delegates of the national health insurance, members of dental societies, and organizations for people with disabilities took place in April at the invitation of two members of the German Government Health Committee in Berlin. I was pleased to be able to attend the meeting as a representative of the German Group for Dental Treatment for Special Needs Patients and Manager of Healthy Athletes Germany, and to present data on oral health of people with disabilities and results from the German Special Smiles Program. Primarily, I addressed the problems of prevention, dental treatment and financing, particularly within the German context.

In 1996, the European Commission in Brussels issued a strategy paper on “Equality of Opportunity for People with Disabilities” which defined a new direction for the European Union (EU) disability policy. In this document, the Commission spoke out explicitly against any exclusion or discrimination of people with disabilities and called for much more unrestricted opportunities as well as their full participation in all areas of life. Furthermore, Article 3, §3 Basic Constitutional Law of the Federal Republic of Germany postulates: “No-one may be discriminated against because of his/her disability”. Corresponding measures at both national and community levels should ensure that people with disabilities have the same rights and opportunities as the majority of the population.

What are the key problems in Germany? An estimated 400,000 people with intellectual and developmental disabilities are living in Germany (German Federal Office of Statistics, 2007). Although structured preventive programs help improve oral health generally, people with disabilities do not benefit to the same extent from this development. Therefore, there should be a greater focus on the prevention of dental disease and promotion of oral health, especially in adults with disabilities. This is not only on medical ethical grounds but also as a matter of health care policy.

Epidemiological data indicates the need for improvement in prevention. Even though it has been shown that people with disabilities have a prevalence of caries similar to that of the general population, their oral hygiene, and hence periodontal condition, is still clearly worse. Because of their reduced motor and/or intellectual ability to carry out adequate oral hygiene measures, people with physical and/or learning disabilities still belong to the high-risk group for caries and periodontal disease. As I reported to the committee, the oral health of adults with disabilities in care homes in Berlin is considerably below the standard of population groups without disabilities.

Data collected in a study in 2006 were compared with data from age-matched people without disabilities. The plaque index was determined and, while more than 54% of the subjects examined in the general population had no plaque, this was the case for only 20% of the disabled. More than 55% of the residents in care homes showed grade 2 or 3 on the plaque index, as compared with 14% in the group without disabilities.

The German Special Smiles program has data from a successful pilot project for group prophylaxis in care homes. It suggests that sustained integration into life-long group and individual preventive programs, with the help of relatives and carers, is essential for improvement of oral health for people with disabilities. This approach also requires an appropriate political, legal and financial framework. Socio-economic aspects have to be taken into consideration, as well as the personal circumstances of the individual. That is why the goal of oral health promotion in Germany for people with disabilities must target the continuous progress of preventive dentistry in adults with special needs over the age of 18. At the present time, the corresponding costs are not covered by statutory health insurance or paid for by the state. Guaranteed provision of dental care in accordance with SGB 5 [German Social Security Code, Book V] Section 21 ends when the affected person comes of age.

During the meeting, I requested an overall societal concept for the infrastructure of services to those members of the population with disabilities. All participants, politicians, delegates of health insurance, members of dental societies and organizations for people with disabilities agreed and discussed the problem from their own position. As a result, there will be a “round” table meeting in August with all involved parties. There is a real chance to reach a first result: free life-long dental group prophylaxis for all adults with disabilities in Germany. It will be likely followed by a discussion about individual health programs and improvement of medical and dental treatment conditions for people with special needs in Germany.