The American Academy of Pediatric Dentistry (AAPD) defines a patient with special health care needs (SHCN) as an individual with “any physical, developmental, mental, sensory, behavioral, cognitive or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs.” Historically, children and even adults with SHCN have been treated by pediatric dentists because of the behavioral management necessary for many of these patients.
According to the AAPD, treating adults with SHCN “requires specialized knowledge, as well as increased awareness and attention, adaptation, and accommodative measures beyond what are considered routine.”
Pediatric dentists are specially trained to manage behavioral issues in patients through two or three years of residency training beyond dental school. However, pediatric dentistry is age-dependent, and when these SHCN patients transition into young adulthood and are transferred out of pediatric units, they often experience a drop in continuum of care. According to Ambulatory Pediatrics, there is a lack of care opportunities for adult SHCN patients in the medical and dental fields, with dentistry being the most common category of unmet health care for this population.
An article in the November 2010 issue of the Journal of the American Dental Association said that most pediatric dentists help SHCN patients transition into adult care, but the biggest challenge is the availability of general dentists and specialists who will accept these patients. In a survey published in the Journal of Dental Education, 10 percent of general dentists said they treated patients with SHCN often or very often, while 70 percent reported rarely or never.
So, where do these patients go? They are staying in their original dental home with pediatric dentists. A survey of AAPD members, according to the May/June 2002 issue of Pediatric Dentistry, reported that 95 percent of them routinely treated patients with SHCN. Although this may seem like a viable solution, SHCN patients staying with their pediatric dentists rather than transitioning to a general dentist leads to another issue regarding access to care for these patients.
There are about 14.6 million children with SHCN under 17 years old, representing 19.8 percent of all U.S. children. According to the AAPD, there are approximately 6,000 pediatric dentists. An article in the March 2007 issue of Pediatric Dentistry says that because of this, more involvement by general dentists is necessary to address access to care challenges. This provider deficit can lead to adult SHCN patients not receiving the oral health care they need.
Part of this issue can be attributed to lack of education, starting in dental school. In the 2005 “Annual ADEA survey of dental school seniors,” treatment of patients with special needs was among the top four topics in which senior dental students felt the least prepared. While it is difficult for dental school to include everything a general dentist may encounter, there is a gap in the curriculum for treating this patient population. Continuing education courses and participation in programs such as the Special Care Dentistry Association’s fellowship can help those interested in treating SHCN patients attain increased comfortability and expertise.
In addition, change needs to be initiated within dental schools. One example of a positive change within a school is at the University of Pennsylvania School of Dental Medicine, which started a chapter for the American Academy of Developmental Medicine and Dentistry (AADMD). It organizes seminars focusing on how all fields of dentistry can treat patients with SHCN, and students have been able to have more visibility into treating this population.
As dentists, we should be treating as many patients as possible to the best of our ability. Dental students can demand stronger education in treating this population; however, education is only the beginning. It will be up to the individual provider to decide whether or not he or she wishes to treat a certain individual, including a person with special needs.
~Alec Robin, Pennsylvania ’19