quate preparation of dental school students to provide care for patients with disabilities and the frequent reluctance of practitioners to supply the services for patients with special needs is not just a US problem. The situation exists throughout many parts of the world.

In addition, there are the barriers in preparing current practitioners to provide care to individuals with special needs (i.e., the dentist who graduated from dental schools before implementation of the CODA modified programmatic standard). The reality is that a few, if any, continuing education programs provide sessions dedicated to the care of individuals with disabilities. Whereas dental practitioners must carry out preparatory procedures similar to those of a physician (e.g., history taking, medication listings related to the particular disability), cooperation of the patient over an extended period is necessary (the use of general anesthetics caries added concern).

Another issue is that it may not be an easy task to find a dentist who is trained, willing, and able to treat children and adults with disabilities. Many studies have demonstrated the reality that the more significant the disabilities, the more difficult it is to find a dental professional who is willing to provide the needed care. In addition, limitations in insurance coverage, the restrictions of the Medicaid system (e.g., the elective inclusion of dental service coverage for children as they reach their adult years), and the general lack of funding for state programs will provide additional carriers to care.

People with ND/ID consistently face challenges finding clinicians that are trained to treat them within a healthcare system that has no mandate, nor model to treat them with the degree of excellence expected for all other conditions with impact health.

The majority of physicians and dentists have limited knowledge, regarding health and psychosocial needs of this population, primarily due to lack of exposure and training. Clinicians, as is true with society, often harbor limiting attitudes toward individuals with ND/ID and contribute to the stigmatization and marginalization that often defines their health care experience.

As a result, this population does not in general receive appropriate health promotion, preventative screenings, surveillance, or an approach to evaluation and management of health conditions consistent with that provided the neurotypical population.

Patients with ND/ID are rarely included in mainstream clinical trials and research efforts, therefore almost nothing is known regarding their suitability, response, or the clinical effectiveness of standard or emerging treatment protocols and guidelines. This severely hinders our ability to develop evidence based or best practice approaches to care that increasingly define the practice of medicine in the 21st century.

Patients with ND/ID are not adequately transitioned from pediatric to adult focused care, nor based on the premature aging and medical conditions frequently associated with their disability, to timely geriatric focused care.

Minority patients with ND/ID often experience ethnicity related disparities in addition to those of their disability specific conditions. The lack of disability-related, culturally competent care frequently compounded the challenges already faced by Hispanic and African American populations.

Since people with disabilities are already at greater risk for health problems due to comorbid and secondary conditions, PAOH seeks to improve access to quality oral healthcare and provide resources

to children and adults with disabilities to themselves and their caregivers.

PAOH's objectives are: To eliminate the barriers to overall healthcare, including inaccessible dental offices, difficulty with daily selfcare, lack of providers including those with competency and clinical and didactic training in pre and post doctorial programs in dental and hygiene schools.

PAOH seeks to find solutions to the additional barriers to care such as: Adult Medicaid benefits and reimbursement inequities, attitudes of the care providers, stigma, communication issues, training od direct support professionals, continuity of care, social role valorization, cultural bias, low health literacy, social justice and lack of awareness of those in positions of authority to make the necessary changes within a fractured system.

PAOH has assumed leadership roles in many dental schools and professional organizations such as the University of Pennsylvania School of Dental Medicine (UPenn), NYU College of Dentistry, Touro College of Dental Medicine, as well as partnering with organizations and industry such as, Delta Dental Foundation, Colgate, Henry Schein, Dental Trade Alliance Foundation, American Academy of Developmental Medicine and Dentistry, and Special Olympics.

PAOH seeks to improve access to quality oral healthcare and provide resources to children and adults with disabilities to themselves and their caregivers.

All Smiles Shine Campaign was recently launched in collaboration with the Delta Dental Foundation, Colgate, and Henry Schein. All Smiles PAOH seeks to improve access to quality oral healthcare and provide resources to children and adults with disabilities to themselves and their caregivers. Shine aims to communicate the inequities in oral healthcare for people with disabilities are unfair, unjust and 100% avoidable. As part of the campaign, we have created a dental professionals toolkit that supports those providing care to people with disabilities. It teaches best practices and accommodation recommendations to support the individuals as well as their caregivers. In addition, the newly-launched All Smiles Shine App supports individuals with autism and provides the user various tips, techniques, and training tools. Additionally, to help improve access to dental care for individuals with disabilities, Penn Dental Medicine has established a free continuing education series through the support of Delta Dental available to all dental professionals.

Project Accessible Oral Health is a global public-private partnership with its administrative home-based at the University of Pennsylvania School of Dental Medicine. The Project's mission is to act as a collective catalyst for change that will not only improve access to oral healthcare, but also ultimately improve the overall health of the disability community.•

ABOUT THE AUTHOR:

Barbie Vartanian is the Executive Director of Project Accessible Oral Health which is a global initiative focused on improving the health equity for individuals with disabilities. She is also the mother of a 13-year-old son with profound autism. For more information on resources, training, and ways to get involved visit paoh.org