Wednesday, April 2, 2014

The Process of Obtaining Quality Dental Care for the Developmentally Disabled

If there is a specialty that is sorely lacking in the dental field, it is this one. And even though there doesn't appear to be an actual specialty category for treatment of disabled persons, in my humble opinion there should be! Is it because of the limited instruction given in dental schools? The slow or limited funding by medicaid or the governmental agencies that provide dental coverage for the disabled? Is it because of the cost of establishing a practice that can accommodate special needs patients? All of the above.

It is estimated that up to 80% of people with intellectual and developmental disabilities have periodontal disease. There are many possible reasons for this staggering statistic. Many have cognitive impairment, meaning that they simply don't understand the need for maintaining proper oral hygiene. Many do not have the manual dexterity to do the task, and many take medications to control drooling and excess saliva which causes the mouth to be dry, hence the risk for dental caries is increased. Caregivers are often the ones who must see to the basic needs of these patients. It is unfortunate, but brushing and oral hygiene are often overlooked in many cases because the medical needs of the patient are more pressing. Finding quality dental care in a private practice setting for patients of this type is difficult, because treatment is different for each individual due to the level of severity of their disability. Consequently, private practitioners will, in many cases, refer the patient to a University or a teaching facility to have their dental treatment done. This is not such a bad thing(!), as many Universities and teaching hospitals have residency programs and specialized treatment options and are well equipped to handle it. Additionally, pedodontists are the one specialty group that have the advanced training to handle patients with disabilities...although most limit their practice to children.

We've discussed the difficulties encountered by the patient and caregiver, now we'll address the issues and difficulties that the private practitioner faces when treating a developmentally disabled individual.

The first issue is training, or the lack thereof. Dental schools provide very limited, basic training in this field. Unless a new practitioner completes his/her residency in a teaching facility and gains hands on experience working with the disabled, he/she may come away with limited knowledge of how to treat the patient. They may leave college and go straight into private practice, or complete their residency with a private practitioner.

The next issue would be the cost of set-up; that is, establishing a practice that is equipped to accept disabled patients, i.e., special equipment, wider doorways, wider hallways, knowledgeable staff.

Next, slow or limited payment by the governmental agencies and programs designed to give financial aid to the disabled patient. Granted, this is a common problem everywhere...it doesn't matter what the specialty or service! However, it is a deterrent for private practitioners.

Every patient is different. It isn't as simple as being wheelchair accessible. Added challenges for treating developmentally disabled persons may include: behavioral problems, uncontrolled body movements and mobility issues (are they able to get into a dentist chair?). Some patients are non-verbal and cannot tell you if they are in pain, uncomfortable, etc. Some suffer seizures. Some have difficulty swallowing. The dentist must be aware of and sensitive to all of those issues in order to successfully treat the patient.

All of that said, there are continuing education classes available to a practitioner and it is possible to complete a residency at a teaching facility that has a specific department or program geared toward the disabled. The unfortunate thing is that such a small percentage of practitioners will actually take advantage of the opportunity.

Thanks to Dr. C and Dawn_DA for the professional input for this blog!

Keep Smiling!





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