Oral Health for People with Disabilities: Reflecting on Deficits and Advances in Dental Education and Care

Disabled boy on dental chair

No one (or practically no one) looks forward to a trip to the dentist. But, for many people with disabilities, dental care isn’t just uncomfortable or inconvenient, it’s de-humanizing. And that’s if they can find a dentist willing to treat them at all!

According to a recent article in the New York Times, “many dentists can’t — or won’t — treat people with disabilities” either because their offices aren’t wheelchair accessible (which violates the Americans with Disabilities Act) or simply because they are uncomfortable interacting with people with disabilities. That’s not terribly surprising since many dentists lack the training and experience necessary to provide good treatment for people with special needs.

Before deinstitutionalization in the 1970’s and 80’s, many people with disabilities received their health care, (inadequate though it might have been in some cases) through government-funded programs or on-site at the facilities where they lived. When these people were moved out of institutions and into the surrounding communities, they found few dentists in private practice with the skills or desire to treat them.

It wasn’t until 2006 that the Commission on Dental Accreditation began requiring that dental students be competent in assessing the needs of patients with disabilities. Nevertheless, The Times cites  a study in the Journal of Dental Education that found “as of 2012, less than three-quarters of dental schools [had] predoctoral students actively involved in [special needs patients’] treatment. In other words, though they received some coursework on treating patients with disabilities, they sorely lacked real-time experience.

What’s more, it was only last year that the American Dental Association updated its code of ethics to mandate that “dentists shall not refuse to accept patients into their practice or deny dental service to patients because of the patient’s race, creed, color, gender, sexual orientation, gender identity, national origin or disability.” Despite the change in its COE, contingencies in the code permit dentists to refer patients with disabilities to other dentists who they deem more experienced.

Fortunately, some dental schools and treatment facilities have gone beyond policy statements to provide real-life experience for students and thoughtful and useful accommodations for patients with disabilities.

For example, the NYU College of Dentistry was “one of 11 schools funded by the Robert Wood Johnson Foundation in the 1970’s to train dental students in caring for people with disabilities” according to the school’s website. “Since 1971, NYU College of Dentistry has run a successful Special Patient Care Program, an honors program for a small group of exceptional dental students to gain experience working with people with disabilities. Over time, the new center will expand these educational opportunities to all NYU dental students and residents, thereby expanding patient-care delivery.”

NYU is making good on that promise with its brand-new  Oral Health Center for People with Disabilities which opened in February 2019. The Center expands services to people with disabilities exponentially with features such as a wheelchair recliner that enables patients to be transferred from their chairs to the dental chair; two fully-equipped sedation suites; large treatment and consulting rooms and even an on-site multisensory room. Additionally, each patient is treated by an interdisciplinary team including a dental director, nurse, nurse practitioner, social worker, three patient-service representatives, a clinic manager and a patient care coordinator.

Another school and facility that seems to be getting it right is Rutgers University’s School of Dentistry and its Special Care Treatment Center in New Jersey. According to a 2017 report by the National Council on Disabilities, dental students at Rutgers receive extensive and comprehensive education on treating people with intellectual and developmental disabilities throughout their four years in dental school. Topics covered include pediatric dentistry; clinical communications; assessment-making and treatment planning for patients with disabilities. Dental students at Rutgers are also required to do one-week rotations through SCTC.

Rutgers’ SCTC “contains nine fully equipped dental operatories, one of which is dedicated to dental hygiene and two of which are specially configured to accommodate large wheelchairs and stretchers.” Additionally, says the NCD report: patient operatories offer extra privacy and each one is equipped with individual X-ray and nitrous oxide devices.

For more information on dental care for people with developmental disabilities, visit the National Institute of Dental and Craniofacial Research of the NIH or the Special Care Dentistry Association.

 

Mouthing Off

Photo of child at the dentist

s the summer winds down, many parents are turning their attention to back-to-school preparations. According to the American Dental Association and the American Academy of Pediatrics, those preparations should include a trip to the dentist.

“Regular dental visits are important year-round, but a back-to-school checkup is key in fighting the most common chronic disease found in school-age children: cavities. In fact, dental disease causes children to miss more than 51 million school hours each year,” say the ADA and the AAP. If your child has special needs, she may have special dental needs as well. Based on statistics gathered by the National Museum of Dentistry in partnership with the Kennedy Krieger Institute Center for Autism and Related Disorders and the University of Maryland School of Dentistry,

 

  • Children with special needs have higher rates of poor oral hygiene, gingivitis, periodontal disease than the general public
  • Medications, special diets and oral motor habits can cause oral health problems for many children with special needs
  • Dental care is the leading unmet health need among children with special needs
  • Across all income levels, children with special needs are almost twice as likely to have an unmet oral health care need than peers without special needs

Depending upon the nature of your child’s disabilities, various techniques and tools may be helpful. The National Museum of Dentistry’s Healthy Smiles for Autism Guide provides information and suggestions for helping children with autism spectrum disorders maintain good oral health at home. These include:

 

  • Giving your child choices when it comes to styles of toothbrushes, textures and tastes of toothpastes and dental flosses
  • Maintaining a consistent dental hygiene routine
  • Providing plenty of positive reinforcement and praise
  • Making dental hygiene into a game

Individuals with some motor challenges may be able to care for their own teeth using adapted dental tools. In it’s online caregiver’s guide, The National Institute for Dental and Craniofacial Research suggests these easy assists:

 

  • Make the toothbrush easier to hold by fastening the toothbrush to your child’s hand with Velcro straps or rubber bands
  • Cut a slit in a tennis ball and then slide it onto the toothbrush handle to make it larger and easier to hold
  • Buy a toothbrush with a larger handle or slide a bicycle grip onto the toothbrush handle to make it larger and easier to hold
  • Try having your child use an electric toothbrush instead of a manual brush
#3071, 3071M and 3071H
#3071, 3071M and 3071H

Children with sensory integration disorders who like to chew can satisfy sensory cravings while also improving oral health by using Enabling Device’s Oral Motor Chew Sets.

If your child is unable to brush or floss on his own, you and/or his caregivers may wish to experiment to find out what works best. The National Institute for Dental and Craniofacial Research’s online Caregiver’s Guide provides tips on handling behavior challenges, alleviating anxiety, maintaining a routine and how best to position your body when brushing and flossing your child’s teeth.

Finally, you’ll want to find a dentist with expertise in caring for children with special needs. You can find dentists trained to treat patients with special needs by visiting the website of the Special Care Dentistry Association.