“Giving Back, and Looking Forward”

It’s that time again to reflect on the year that was and set goals for the year to come. As I look back on 2018, I realize how honored I am to be an oral health care provider, and grateful for the opportunity to spend my time doing what I love to do. Part of my time in practice is spent treating individuals with specialized healthcare needs. I am reminded that this patient population have many challenges to overcome, and struggle with activities of daily living. In 2000, the first U.S. Surgeon General’s report on oral health indicated that patients who were medically compromised were at a greater risk for oral diseases. Population trends suggest that people are living longer and there is an increase of chronic disease. According to the U.S. Census Bureau and the CDC, approximately one out of every five adults in the United States is living with a disability. Furthermore, The World Health Organization estimates that one billion people in the world are living with a disability.

Our patients who have specialized healthcare needs will present with diverse conditions such as cardiovascular disease, diabetes, Alzheimer’s disease, head and neck cancer, Autistic Spectrum Disorder, Cerebral Palsy, PTSD or Down syndrome as examples. Oral healthcare providers must be prepared to meet the needs of the changing demographics of our patient population. According to The American Academy of Pediatric Dentistry Council on Clinical Affairs, health care for individuals with special needs requires specialized knowledge and skillset, as well as increased awareness and attention, adaptation, and accommodative measures beyond what are considered routine. However, researchers have found that not all dentists feel prepared or have been willing to treat patients with various special needs. There is a fear of harming a patient, belief that someone else will provide treatment, reimbursement/ longer appointment time concerns, and lack of proper training.

In 2006, the Commission on Dental Accreditation (CODA) adapted a standard for accreditation for dental and dental hygiene programs for training in treating special needs patients. Despite this, a 2011 survey reported in the Journal of Dental Education indicated that less than three-quarters of U.S. dental schools have pre-doctoral students actively involved in treating patients with special needs. In addition to dental healthcare provider concerns, there other barriers to care which include access, properly equipped dental facilities, transportation, dental anxiety, patient finances, and negative symptoms associated with psycho-affective disorders. Other hurdles may be low oral health literacy of the patient, guardian/healthcare proxy, and/or caregiver. Perhaps cultural and/or language barriers may be present. Patients may be non-verbal and may require alternative means of communication such as a communication board, eye blinks, specific sounds, facial expressions, and computer assisted devices.

As we look to 2019 and beyond, let us consider how more of us can provide improved oral health care for those patients with Specialized Healthcare Needs. Maybe in the form of engineering innovations such as advances in material science, or perhaps more efficient procedures, as well as equipment design. All of which will maximize positive dental health outcomes for the increasing special needs population. The extraordinary thing about Dentistry is that it is forever evolving. That is why publications such as “Modern Research in Dentistry” are so important to the advancement of our profession, and the well-being of our patients.