The experience and understanding of learning disability and autism of orthodontic practitioners in the United Kingdom: A national survey

Abstract

Objective:

To explore the experience, knowledge and confidence of orthodontic practitioners in the United Kingdom in managing patients with learning disability or autism.

Design:

National online survey.

Setting:

British Orthodontic Society membership.

Methods:

A novel questionnaire was developed and distributed online to orthodontic practitioners within the British Orthodontic Society. It included questions on the participants’ prior training, experience in treating patients with learning disability or autism, knowledge levels using the Learning Disability Knowledge Questionnaire and Autism Knowledge Survey, and self-efficacy in managing these patients.

Results:

A total of 171 responses were received with participation from various practitioner groups: orthodontic consultants, specialists, postgraduates, therapists and dentists with special interest. The median score for the Learning Disability Knowledge Questionnaire was 73% (interquartile range [IQR] = 20). The median score for the Autism Knowledge Survey was 93% (IQR = 6.7). The percentage of respondents who reported feeling confident in patient management varied across the self-efficacy domains: (1) treating patients with learning disability (51%) and autism (64%); (2) making reasonable adjustments for patients with learning disability (54%) and autism (61%); (3) recognising the signs of learning disability (38%) and autism (48%); and (4) signposting patients with learning disability (27%) and autism (30%) to the relevant local care pathways or services. The participants employed a range of techniques and resources when managing these patients. These included tailoring communication to individuals, adapting to sensory needs, involving parents/carers in treatment planning, adjusting the pace of care, and building trust through behavioural and acclimatisation strategies.

Conclusion:

Having a good knowledge of learning disability or autism does not always translate to greater confidence in patient management. Improving access to orthodontic-specific learning disability and autism training, national guidance and communication aids could enhance the confidence of orthodontic practitioners in managing these patient groups.

Plain language summary

A national survey of the experience and understanding of learning disability and autism of orthodontic practitioners in the United Kingdom

Why was the study done? People with learning disabilities or autism can find it harder to access orthodontic care. This may be due to behaviour, other health needs or how confident the orthodontic clinician feels about caring for these patients. This study looked at how much the clinicians in the UK knew about learning disabilities and autism. They also asked about the clinicians’ experiences of and confidence in treating such patients. What did the researchers do? They sent an online survey to members of the British Orthodontic Society. It asked about their training, experience, knowledge and confidence in treating patients with learning disabilities or autism. A total of 171 clinicians replied. They were from orthodontic consultants, specialists, postgraduate trainees, therapists and dentists with a special interest in orthodontics.

What did the researchers find? The clinicians had a good knowledge of autism and moderate knowledge of learning disabilities. Many clinicians said they did not feel confident in managing both groups. This was mainly when spotting these conditions or knowing where to refer patients for extra support. Even so, they reported using a mix of methods that were helpful. These included using clear language, supporting sensory needs and involving families. Taking treatment in smaller steps and using methods to modify behaviour also helped.

What do the findings mean? The findings suggest that knowledge alone is not enough to make clinicians feel confident. More orthodontic-specific training, clear national guidance and easy-to-use communication tools could help clinicians feel more confident. These may make treatment better for people with learning disabilities or autism.