By Candace Hsu, RDH, MS, MPH
The Centers for Disease Control and Prevention defines developmental disabilities as "a group of conditions due to an impairment in physical, learning, language, or behavioral areas."1 Causes of developmental disabilities range from genetics to parental behaviors to complications during birth. Nearly 15% of children ages three to 17 years have one or more developmental disabilities.1 Common developmental disabilities are autism spectrum disorder, cerebral palsy, and intellectual disability. These individuals are likely to suffer from oral conditions as a secondary effect of their disability. These include more severe periodontal disease and bruxism.2
Individuals with developmental disabilities disproportionately experience poorer health outcomes compared to the general population.4 Individuals with developmental disabilities often do not obtain the health services needed for their health conditions, which include oral health.5 The 2000 Surgeon General's Report stated that patients with special needs are more likely to have poor oral health than patients without special needs.
There are many contributing factors that lead to the poor oral health outcomes seen in special-needs patients:
- Complex medical histories
- Physical limitations
- Reliance on guardians and caregivers
- Poor access to dental care.4
However, perhaps the greatest barrier to dental care that this population experiences is undeveloped interest and negative perceptions of individuals with developmental disabilities from dental professionals.
Access to Dental Care
In 1990, the Americans with Disabilities Act was passed. This is a civil rights law that forbids the discrimination of people with disabilities so that they may have the same opportunities as the general population.5 This includes employment, architecture, transportation, public and private entities, organizations, and medical care. The law prohibits discrimination against people with disabilities based on their disability program or financial assistance.
Although dental clinics are required to have their facilities and staff accessible to individuals with developmental disabilities, often these individuals are still unable to receive quality care for a number of other reasons. These include low numbers of dental providers who accept Medicaid as well as safety concerns.
In 2012, only 20% of practicing dentists in the United States participated in Medicaid programs.6 More than 10 million children and adults in the United States who qualify for Medicaid based on their disability have some kind of developmental disability.7 Medicaid benefits for this population include preventive services, specialized care, prescription medication, medical equipment, and long-term care services.7 Unfortunately, due to the limited number of dental providers who accept Medicaid, many people with developmental disabilities will not receive dental care.
Oftentimes the provision of dental treatment for patients with developmental disabilities requires methods of medical stabilization to ensure the safety of the clinician and patient. Falling into this category are mechanical devices such as rubber mouth props, papoose boards, and arm restraints. Additionally, sedation techniques are often used to reduce stress and agitation during the dental appointment, often including preoperative sedative medications. Many dental professionals lack sufficient training in these techniques, leading to decreased comfort in working with this patient population.4 Research indicates that many dental providers are reluctant to provide routine and emergency dental care to people with developmental disabilities. This is more often associated with inadequate training causing concerns of safety.8
However, in addition to insufficient training of medical stabilization, there is often a negative stigma associated with individuals with developmental disabilities. Individuals with developmental disabilities are often seen as "uncooperative," "violent," and "aggressive." With adequate training and tools, it is possible to see patients with developmental disabilities without fear of violent outbursts or uncooperative tendencies. Individuals with developmental disabilities should not be viewed by their disability, but seen as unique individuals with the same needs as individuals without disabilities. As clinicians, there needs to be improved willingness to work with patients who have developmental disabilities, and this includes seeking institutions that provide additional training to work with this population.
Research indicates that by exploring avenues to improve knowledge and skills in working with patients with developmental disabilities, there would be increased willingness and comfort in treating patients in this population group. Additionally, there would be an increased number of dental providers trained to treat this population as well as improved attitudes toward individuals with developmental disabilities.
While there are educational resources aimed at training licensed dental providers in special-needs dentistry, there are few training resources that provide hands-on learning. Offering dental hygiene students, dental assistant students, and dental school students more exposure and experience with this population would be a viable way to increase interest and the likelihood of treating individuals with developmental disabilities in their future careers. As licensed providers who are no longer in the educational setting, there needs to be increased demand for special-needs dentistry training in continuing education. In order for increased demand to be present, there needs to be a positive shift in dental clinician attitudes toward people with developmental disabilities.
Overall, individuals with developmental disabilities require the same health needs as any other individual. Consider this a call to action to improve the mental outlook toward individuals with developmental disabilities, to push leaders and educators to improve special-needs dentistry training programs, and-above all-to improve the quality of life for this population.
Candace Hsu, RDH, MS, MPH, is the special needs dental hygiene liaison at the University of New Mexico and practices dental hygiene with individuals with developmental disabilities. She also teaches dental hygiene students at the University of New Mexico Division of Dental Hygiene. You may contact her at [email protected].
1. Facts about developmental disabilities. Centers for Disease Control and Prevention. http://www.cdc.gov/ncbddd/developmentaldisabilities/facts.html. Published 2015. Updated July 9, 2015. Reviewed August 31, 2016. Accessed October 25, 2015.
2. Kleinert H, Sanders C, Mink J, et al. Improving student dentist competencies and perception of difficulty in delivering care to children with developmental disabilities using a virtual patient module. Journal of Dental Education. 2016;71(2):279-286.
3. Salama F, Al-Balkhi B, Abdelmegid F. 2015. Dental students' knowledge of oral health for persons with special needs: a pilot study. The Scientific World Journal. Vol. 2015. Article ID 568464, 7 pages. https://www.hindawi.com/journals/tswj/2015/568464/. doi.org/10.1155/2015/568464.
4. Vainio L, Krause M, Inglehart M, Habil P. Patients with special needs: dental students' educational experiences, attitudes, and behavior. Journal of Dental Education. 2011;75(1).
5. Introduction to the ADA. Information and technical assistance on the Americans with Disabilities Act. United States Department of Justice and Civil Rights Division. https://www.ada.gov/ada_intro.htm. Published 1990. Accessed October 25, 2016.
6. Grantmakers in Health. 2012. Returning the mouth to the body: integrating oral health and primary care. Grantmakers in Health. Issue brief 40. http://www.gih.org/files/FileDownloads/Returning_the_Mouth_to_the_Body_no40_September_2012.pdf?123. Published September 2012. Accessed October 25, 2016.
7. Paradise J, Lyons B, Rowland D. 2015. Medicaid at 50: People with disabilities. The Kaiser Commission on Medicaid and the Uninsured. The Henry J. Kaiser Family Foundation. http://kff.org/report-section/medicaid-at-50-people-with-disabilities/. Accessed October 25, 2016.
8. Havercamp SM, Scandlin D, Roth M. Health disparities among adults with developmental disabilities, adults with other disabilities, and adults not reporting disability in North Carolina. Public Health Reports. 2004;119(4):418-426. doi:10.1016/j.phr.2004.05.006.