Dental Professionals

Introduction

Providing Care to the Child with Special Health Care Needs

Partnering with Family, Medical Home Primary Care Provider and Community

Resources

References and Further Reading

Introduction

Dental homes are an urgent need for the population of children with chronic illnesses and developmental disabilities.   Approximately 80% of individuals with developmental disabilites are living in community-based group residences or their family home and need access to dental care in their local area.  In surveys of the special needs population, families identify dental care as the most common unmet health care need for their children. 

Although one may worry about managing care for this population, in reality these children are as varied as the general population of children for whom a dentist provides care.  Most individuals with chronic illnesses can easily cooperate and comply with dental routines common to a regular dental practice.  Most individuals with mild or moderate developmental disability, as well as many with severe developmental disability, can also be successfully treated in a general dental practice setting.

Providing Care to the Child with Special Health Care Needs

Oral care for children with special health care needs (CSHCN) is the same as for the typical child - prevention through home dental care and regular office check-ups, intervention and management for dental problems as they arise.  Strategies for providing oral care and information on the physical, mental and behavioral challenges these patients may present is available to help you meet their needs. (See below)  By adopting strategies suggested in these materials, you can make a significant impact on the individual's oral health and overall quality of life.   

The American Academy of Pediatrics recommends establishing a dental home by one year of age for children deemed at high risk for dental caries.  CSHCN are at higher risk than the general population for oral health problems for the following reasons: 

• Oral health may not be regarded as a priority because of the spectrum of other health care needs experienced by a child with SHCN. 
• Routine self-care may be difficult or impossible for a child, e.g. due to motor disability such as seen in spastic quadriplegia or due to cognitive or behavioral impairment. 
• Caries incidence may be increased due to the high rate of enamel defects (premature infants), the use of medications that cause xerostomia (e.g. children with allergies or asthma), and the need for altered feeding regimens (high caloric feedings, prolonged use of bottle)
• The underlying disease may impact oral health, such as with cleft lip and palate or leukemia. 
• The treatment of a chronic disorder may lead to secondary oral health problems, such as gingival hyperplasia with anticonvulsants, methotrexate, immunosuppressants and calciuim channel blockers.

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Practice Tools for Dental Offices Caring for Special Needs Children:

From The Maternal and Child Oral Health Resource Center

• Special Care: Dental Office Considerations Checklist
• Special Care:  Getting to Know Me
• Special Care: Family Satisfaction Questionnaire
• Parent Brochures with oral health tips for Children Special Needs, But ALSO for Pregnant women, young children

Information on 'Practical Oral Care for People with Developmental Disabilities'

The National Institute of Dental and Craniofacial Research

Link to main page:  www.nidcr.nih.gov/

Click to access:

• An Introduction to Practical Oral Care for People With Developmental Disabilities
• Continuing Education: Practical Oral Care for People With Developmental Disabilities
• Practical Oral Care for People With Autism
• Practical Oral Care for People With Cerebral Palsy
• Practical Oral Care for People With Down Syndrome
• Wheelchair Transfer: A Health Care Provider's Guide
• Dental Care Every Day: A Caregiver's Guide

Clinical guideline on appropriate use of local anesthesia for pediatric dental patients. Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2005. 8 p. [41 references]

Clinical guideline on appropriate use of nitrous oxide for pediatric dental patients. Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2005. 4 p. [16 references]

Oral conditions in children with special needs: A guide for health care providers.

Isman B, Newton RN. 2002. Los Angeles, CA: California Connections Project.

A guide for health professionals which describes oral conditions that can occur in children with special health care needs, including abnormalities in oral development, oral trauma, bruxism, oral infections, and gingival overgrowth.

Promoting the Oral Health of Children with Developmental Disabilities and Other Special Health Care Needs. Proceedings of the 2001 University of Washington Conference.

Oral Health Information: Children with Traumatic Brain Injury

• Oral Health Fact Sheet for Dental Professionals
  http://ask.hrsa.gov/detail_materials.cfm?ProdID=4586&ReferringID=4612
• Dental Health Guidance for Parents and Caregivers of Children with Traumatic Brain Injury
  http://ask.hrsa.gov/detail_materials.cfm?ProdID=4588&ReferringID=4612

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Partnering  with the Family, Medical Home Primary Care Provider and Community

A patient with special health care needs may require a special treatment plan.  Dental professionals may need information from the family and primary care provider about specific needs and beneficial management techniques to optimize care for the special needs patient.  Behavioral cues, positioning requirements and medication history are a few examples of additional information that will allow you to create a treatment plan and adapt the office setting for a special needs patient.  Collaboration and communication with others involved in the care of the special needs patient are key elements of creating a treatment plan. 

Resources

• American Academy of Developmental Medicine and Dentistry - www.aadmd.org/
• American Academy of Pediatric Dentistry - www.aapd.org
  • Guidelines on Behavior Guidance for the Pediatric Dental Patient
• AAPD Dental Home Resource Center - http://www.aapd.org/dentalhome/default.asp
• Association of University Centers on Disability - www.aucd.org
• Dental Education in Care of Persons with Disabilities - www.dental.washington.edu/departments/omed/decod.php
• National Foundation of Dentistry for the Handicapped - www.nfch.org
• National Information Center for Children and Youth with Disabilities - www.nichcy.org
• Special Care Dentistry - www.SCDonline.org

Other Oral Health pages on the Medical Home website:

• Service Provider Pages- Dentists- online resources for patients looking for dentists or other service providers looking to refer families to dentists

• Website Resources- Oral Health pages- reading about oral health issues related to children and youth with special health care needs

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References and Further Reading

• Bright Futures in Practice: Oral Health. Paul Casamassimo, D.D.S., M.S ed. 1996.
• Unmet dental needs among children with special health care needs: Implications for the medical home.  Lewis C, Robertson AS, Phelps S.  Pediatrics.  116(3):426-431, 2005.
• Oral health risk assessment timing and establishment of the dental home. Policy Statement.  American Academy of Pediatrics, Section on Pediatric Dentistry.  Pediatrics. 111(5):1113-1116, 2003.
• Oral health needs of persons with physical or mental disabilities.  Tesini DA, Fenton SJ.  Dental Clin N Amer. 38(3):483-498, 1994.
• Improving oral health for people with special needs through community-based dental care delivery systems. Glassman P, Miller CE.  CDA Journal. 26(5):404-409, 1998.

Posted 12-13-05

By: Katherine TeKolste, MD, FAAP, Developmental Pediatrician, MHLN Medical Consultant

Member, Interdisciplinary Children's Oral Health Promotion (ICOHP) project

Additional Contributors: 

• Wendy Mouradian, MD, FAAP, Developmental Pediatrician

  Director, Regional Initiatives in Dental Education (RIDE) Clinical Professor of Pediatrics, Pediatric Dentristy, Dental Public Health Sciences and Health Services (Public Health) University of Washington;

• Penelope Leggott, DDS, MS, Professor, Pediatric Dentistry, School of Dentistry, University of Washington; Director, Maternal Child Health Leadership Training Program in Pediatric Dentistry