Mind The Gap - An Investigation of Oral Health Outcomes and Service Access Among People with Cerebral Palsy in Australia

Abstract

Background: Oral health is essential to overall health and wellbeing, influencing self-esteem and social participation. People with cerebral palsy (CP) are at increased risk of poor oral health due to biological, environmental, and systemic factors. However, the extent and nature of these challenges, particularly in high-income countries such as Australia, is not well understood. Methods: This thesis used a multi-phase research design. A scoping review mapped global literature on oral health conditions in people with CP. Quantitative surveys explored oral health-related quality of life (OHRQoL) and dental experiences among children and adults with CP. Qualitative interviews examined lived experiences of accessing dental care. A practitioner survey captured attitudes, confidence, and experiences in providing care for people with CP and other disabilities. Results: The review revealed critical gaps regarding adults, OHRQoL, and access to care in high-income contexts. Caregivers of children reported moderate OHRQoL (COHIP-SF 19 mean 51.9%), with lower scores linked to communication ability, oral care routines, and urgent dental needs. Adults with CP (OHIP-14 mean 10.3) reported challenges with daily oral care, limited access to regular dentists, and frequent need for specialised care. Interviews highlighted structural and interpersonal barriers, systemic failures, ableism, and a need for person-centred care. Trust, respect, and effective communication were essential for improving access and outcomes. Practitioner surveys (n=56) revealed moderate confidence in treating people with disabilities but lower confidence for CP-specific care. Conclusion: This research highlights the need for disability-inclusive dental education, workforce training, and accessible service design. Future research should prioritise adults with CP and co-designed strategies to address structural and interpersonal barriers, fostering equitable, person-centred oral health care across the lifespan.