In recent years, the dental industry has made significant strides in implementing practices that prioritize inclusivity, and cater to the specific requirements of individuals with special needs. These practices will make a measurable impact on more than a quarter of our population in the U.S.

According to the U.S. Census Bureau, approximately 61 million people are recorded as having some sort of disability, and 18 percent of children in the United States have a developmental disability including: autism spectrum disorders, intellectual disabilities, and attention-deficit/hyperactivity disorder (ADHD), among others.

Due to more limited care options, individuals with special health care needs may not get the level or frequency of care they need. As a result, the oral health of individuals with SHCNs deteriorates faster than the general population, as they grow older. They are at higher risk of gingivitis and periodontal disease due to excessive buildup of calculus, more susceptible to Hypoplasia (incomplete or underdevelopment), dental crowding, and abnormalities in tooth development.

The impact of poor dental health goes way beyond the health of an individual's teeth and mouth. These issues can lead to reduced nutritional intake, impaired social interaction, and elevated anxiety of coming to the dental office.

BREAKTHROUGHS : MORE INCLUSIVE ORAL HEALTH

Primary barriers to quality of care for individuals with SHCNs span several different categories and include:

FINANCIAL BARRIERS:

• Private Insurance may not cover dental care or may not fully cover the cost of modified treatments that are required for those with SHCNs, like sedation.
• Government insurance like Medicaid/Medicare does not have nearly enough providers to accommodate the need, which results in long wait times to get an appointment.

Private and public reimbursement systems need to ensure that dental care is covered for patients with special needs, to remove this financial barrier to care.

LIMITATIONS OF THE INDIVIDUAL

• language barriers
• sensory impairments such as vision or hearing problems
• psychosocial issues
• dental anxiety
• low oral health literacy (ability to obtain, process, and understand basic dental; health information and services needed)

These are issues dentists across the country are working to address. There are a number of opportunities to take advantage of continued education and best practices on how to address these challenges and break through barriers, to ensure all patients have access to the best oral care.

Important: To ensure individuals with SHCNs receive the care and attention they need to optimize their oral health, parents or caregivers should do their research and ask questions of the dental provider, to make sure expectations can be met. The most important aspect of choosing a dental provider for individuals with SHCNs is to find a provider providing truly personalized care.

It's also extremely helpful to establish a dental home for the child, as early as 12 months of age. The earlier the provider can get a child acclimated to the office and into a routine, and set expectations, the better. Ensure that your chosen provider has detailed medical, dental, and social patient histories. If a child has an issue with gagging for instance – their dentist needs to know that ahead of time and take that into consideration for their treatment care plan. The dentist should be aware of a patient's history of cardiac disorders, seizures, GERD and the patient's history of sedation.

Behavior can also complicate oral health care. Most commonly, anxiety and fear of dental care can cause issues with compliance. Caregivers should expect a customized approach to helping with fear and anxiety. Desensitizing appointments to allow patients to become familiar with the office, staff, and equipment prior to official care dates, help establish a non-threatening environment and safe level of comfort. Decreasing the length of appointments to accomplish more in shorter time periods can also help reduce the level of anxiety.

Ideally, the dental office is set up to accommodate mobility needs. This is a major concern for individuals with SHCNs who rely on a wheelchair or walker to move around. Assistance with wheelchair transfer and the ability of the office to use their equipment to assist those that are unable to transfer from the wheelchair, should be key considerations.

Caregivers should also expect the availability of translation services to ease communication barriers when needed. For those individuals who wear hearing aids, the provider needs to be aware and ready to inform the patient when volume adjustments need to be made, as the sounds may cause auditory discomfort. 

Caregivers should also expect the availability of translation services to ease communication barriers when needed. For those individuals who wear hearing aids, the provider needs to be aware and ready to inform the patient when volume adjustments need to be made, as the sounds may cause auditory discomfort. 

Our goal as providers is to create an environment conducive for all individuals to receive quality care. That means careful consideration of personal preferences, thorough explanation of each step to both patients and caregivers, the use of technology to assist with communication, comfort and care, and providing preventative and therapeutic services with a multidisciplinary approach and attention to detail.• 

ABOUT THE AUTHOR:

Kyle Bogan is the practice leader of a remarkable dental team in Central Ohio, a fellow in the International College of Dentists (FICD) and a fellow in the Academy of General Dentistry (FAGD). Dr. Bogan earned his Bachelor of Science degree in Chemistry from The Ohio State University, where he was involved in dental research involving the release of fluoride from "smart" polymeric hydrogels. He completed his Doctor of Dental Surgery Degree at the Ohio State University College of Dentistry, graduating Magna Cum Laude and being inducted into Omicron Kappa Upsilon - the National Dental Honor Society. He is a member of the American Dental Association, the Ohio Dental Association, the Columbus Dental Society, The American Academy of Dental Sleep Medicine, The American Academy of Facial Esthetics, the International Dental Implant Association, and the Academy of General Dentistry.