Use of teeth as a compensatory strategy in unilateral upper limb amputation: a global descriptive case study

Introduction: Individuals with upper limb amputation or limb difference commonly adopt compensatory strategies to perform activities of daily living (ADLs). One under-recognised strategy is the use of teeth as functional tools, which increases oral health risks. The prevalence, nature, and impact of compensatory teeth use in this population are poorly described in the literature.

 Methods: A global descriptive case study was conducted using an online e-survey of individuals of any age with unilateral upper limb amputation or limb difference. Data included limb difference characteristics, use of teeth for ADLs, dental injury, oral hygiene challenges, and oral health advice. Quantitative data were analysed descriptively and using chi-square testing, and free-text responses were analysed thematically. 

Results: One hundred and thirty-one responses were analysed (77% adults, 23% children). Most adults (86.1%) and over half of children (58.1%) reported using their teeth for ADLs. Adults were significantly more likely than children to report tooth damage related to compensatory teeth use (42.6% vs 9.7%, p <.001). Almost all participants reported never receiving limb-difference-specific oral health advice. 

Conclusion: Compensatory tooth use is common and associated with substantial oral health risk. Rehabilitation professionals should proactively address prevention, hygiene adaptation, and patient education for this underserved population.