Dental care needs,use and expenditures among U.S. children with and without special health care needs

BackgroundControversy exists in the literature about whether dental care needs, use and expenditures differ between children with and without special health care needs (SHCN).MethodsThe authors used data from the 2005 Medical Expenditure Panel Survey (MEPS) for children younger than 18 years. The MEPS questionnaire included the Children with Special Health Care Needs Screener, which defines a child as having SHCN if he or she meets at least one of five specific criteria. Using bivariate and multivariable regression analyses, the authors evaluated the effect of SHCN on unmet dental care needs, type of dental care received and average dental care expenditures.ResultsChildren with special health care needs (CSHCN) had an adjusted odds ratio (AOR) of 1.49 (95 percent confidence interval [CI] = 1.09–2.05) of having unmet dental care needs compared with children without SHCN, and CSHCN who met four or five screener criteria had an AOR of 2.2 (95 percent CI = 1.16–4.20). CSHCN used more dental care services and were more likely to receive only nonpreventive care. Average dental care expenditures were not statistically different between CSHCN and children without SHCN, and there was variability among CSHCN in unmet dental care needs and use.ConclusionsUnmet dental care needs are associated independently with SHCN status and complexity (based on the number of screener criteria the child met). The CSHCN populations in MEPS varied in their ability to obtain and use needed dental care services.Practice ImplicationsIt is important to consider the diversity of CSHCN when developing systems of dental care for this population.     

A review of guidelines for sedation, anesthesia,and alternative interventions for people with special needs

There are significant numbers of people in our society with disabilities or other special needs. Their number and percentage are growing, in some cases, dramatically. Many of these individuals need special support in order to receive dental treatment. Modalities that can be used to provide dental treatment include pharmacological approaches to produce various levels of sedation or anesthesia. In addition to the use of medications, there are also techniques that employ behavioral or psychological interventions. In some circumstances, physical support or protective stabilization is used. There are also social supports and prevention strategies that can impact the individual's preparation for and need for dental treatment.
This review of the numerous guidelines, which have been published for the use of sedation and anesthesia to facilitate the delivery of dental treatment, indicates that there are fewer guidelines for the inclusion of behavioral or psychological interventions or for the incorporation of social supports or prevention strategies. In addition, most published guidelines do not include considerations for people with special needs. There is a need for increased research and documentation of combined treatment modalities, and these combined approaches need to be incorporated into guidelines for patient care for people with special needs.
There is also a need to advocate for reimbursement systems that support all appropriate treatment options so that practitioners can be free to recommend treatment options based on the efficacy and safety of each option.     

Parents' perspectives on a dental home for children with special health care needs

The authors surveyed parent-leaders about aspects of a dental home for children with special health care needs (CSHCN). State leaders in two advocacy groups completed the survey; the response rate was 70.6% of all states. Two of the most highly rated aspects of a dental home, endorsed as "essential" by 89% of respondents, pertained to dentist-parent interactions: the dentist listens carefully to the family, and the dentist helps the family feel like a partner in treatment decisions. Likewise, 89% said it was essential that insurance coverage allows the child to see needed providers. Dentists' lack of knowledge or willingness to treat CSHCN and refusal of Medicaid insurance coverage were identified as major barriers to care. More than 84% of respondents reported that parents were unaware of the recommendation to establish dental care by 1 year of age. Establishing policy and educational strategies should help parents meet this dental health goal.     

自制个别取模器颈缘取模技术精确度的研究

目的：对比个别取模器龈下取模技术与常用藻酸盐及硅橡胶取模方法的颈缘精度的差异。方法：在患口中用3种方法制取印模,灌模后分别在体视显微镜下测量代型标志点到龈沟底的距离。结果：个别取模器法的标志点到龈沟底的距离大于常用藻酸盐法,与硅橡胶法相比,其颊侧点到龈沟底的距离较大,但在近、远中标志点无差异。结论：使用个别取模器的取模效果优于常用藻酸盐方法,与硅橡胶取模技术相类似。     

Program evaluation of mobile dental services for children with special health care needs

This paper summarizes an evaluation of the Elk Mobile Dental Program for children with special health care needs. Evalutation results indicated overall client satisfaction with mobile dental unt services in the absence of competent community based dental care. Evaluator recommendations included expanding the mobile dental services along with a continued effort to establish permanent community based dental care for children with special healthcare needs. Recommendations for program improvement in the areas of patient care, service coordination, and ongoing continuous quality improvement evaluation were provided to program personnel and funding organizations. Many of the improvement recommendations were initiated during the process of the program evaluation.     

Special Care Dentistry Association consensus statement on sedation, anesthesia, and alternative techniques for people with special needs

Many people with special needs (PSN) have difficulty having good oral health or accessing oral health services because of a disability or medical condition. The number of people with these conditions living in community settings and needing oral health services is increasing dramatically due to advances in medical care, deinstitutionalization, and changing societal values. Many of these individuals require additional supports beyond local anesthesia in order to receive dental treatment services. The purpose of this consensus statement is to focus on the decision-making process for choosing a method of treatment or a combination of methods for facilitating dental treatment for these individuals. These guidelines are intended to assist oral health professionals and other interested parties in planning and carrying out oral health treatment for PSN. Considerations for planning treatment and considerations for each of several alternative modalities are listed. Also discussed are considerations for the use of combinations of modalities and considerations for the repeated or frequent use of these modalities. Finally, the need to advocate for adequate education and reimbursement for the full range of support alternatives is addressed. The Special Care Dentistry Association (SCDA) is dedicated to improving oral health and well being of PSN. The SCDA hopes that these guidelines can help oral health professionals and other interested individuals and groups to work together to ensure that PSN can achieve a "lifetime of oral health."     

Use of oral health care services and oral findings in children with special needs in Lagos, Nigeria

This study was carried out to determine the use of oral healthcare services by children with special needs in Lagos, Nigeria. In this study, 125 structured questionnaires were sent to parents of children in two public day schools for CSN in Lagos. Once the questionnaires were returned, oral examinations were scheduled. The findings were compared to a control group of healthy children from two public schools in the same environment. One hundred and nine CSN and 134 controls, aged 5 to 19 years, participated in the study. The majority of the children had parents who had a low educational level. Fewer than 5% of the children had ever been to the dentist, and had only attended because of some symptoms. Non‐attendance in 59.6% and 58% of CSN and controls respectively was reported to be due to absence of dental problem, 28% and 33.5% expressed ignorance about dentists and 8% of the parents of CSN identified finance and transportation as a problem. There were no significant differences between the two groups (p>0.05). It was found that 54% of CSN and 9% of controls had poor oral hygiene (p<0.05); dmft/DMFT was 0.25 in the controls and 0.12 in CSN (p>0.05). Untreated fractured teeth and missing teeth were more prevalent in CSN (p<0.05), while enamel hypoplasia was more prevalent in the controls (p<0.05). This study concluded that CSN and children from lower socioeconomic levels did not adequately utilize dental facilities in Lagos. Preventive programs in schools and the development of dental clinics in or near their schools could help.     

全口义齿印模技术的发展现状

全口义齿修复前,需通过可塑性印模材料来复制无牙颌牙槽嵴和周围软硬组织的解剖形态,清晰准确的口腔印模不仅为后续技工制作义齿提供了良好的结构基础,而且是保证最终修复体固位、稳定及功能的关键.现有研究表明,除印模材料、印模托盘、印模操作和印模消毒外,印模技术也是无牙颌印模制取精度的重要影响因素之一.近年来,随着各类牙科材料的...     

Risks of general anesthesia for the special needs dental patient

The risk of dental rehabilitation under general anesthesia has multiple contributing factors. The literature has addressed the general anesthetic risk of dental general anesthesia and sedation in the operating room and the office settings, but more studies are needed to address the special needs population in particular. There is still a great need for more studies to assess the risk versus benefit for special need population as well as to stratify such risk in order to assist care providers in decision making as well as in sharing such risk concerns with patients, caretakers, and guardians. One recommended approach is to conduct a national retrospective study of patients treated under general anesthesia in the past 10 years in all the various settings and assess the associated risks and complications related to their physical status and the underlying physical and mental disabilities. The product of such a study could be a stratification of risk versus benefit as well as some guidelines for decision making as far as which kind of procedures should be conducted under general anesthesia while weighing the level of risk for the particular patient. Although access to care is not a direct risk factor, it can certainly deter timely treatment and intervention for patients with special needs.     

Innovative dual impression technique for patients with atrophia idiopathica mucosa oris

Atrophia idiopathica mucosa oris is an oral fibrosing disease resulting in marked rigidity and an eventual inability to open the mouth or had limited mouth opening. Patients with limited mouth opening are a common occurrence in prosthodontic practice. The majority of these patients can be treated with exercise and stretching movements before impressions are made. Some will not respond to these procedures because of facial scarring and surgical manipulation of the facial muscles. This article presents an impression procedure for overcoming difficulties encountered in such reduced mouth opening patients that can be assembled intraorally, disassembled intraorally, and reassembled extraorally.     

Factors affecting provision of oral health care for people with special health care needs: A systematic review

BackgroundSpecial health care needs (SHCNs) individuals experience higher levels of dental problems including accessing oral health (OH) facilities. Improving standard of OH care in SHCNs requires identifying barriers and enablers. The aim of this study was to perform a systematic review of prior researches to identify OH care barriers and enablers for SHCN individuals.MethodsElectronic searching was conducted systematically in PubMed and Cochrane databases. The PICOS parameters were formulated for the inclusion of studies, and the PRISMA method was used to select the articles. Two reviewers independently screened the articles for eligibility and to minimise the risk of bias in the studies and also searched the contents of key articles, quality of methodology, outcomes and reference lists of all the studies included.ResultsA total of 1316 (PubMed 956, Cochrane 360) studies were found initially and after title and abstract screening and also removal of duplication, reviewers selected 53 papers from PubMED and 19 articles from Cochrane to go through full articles and led to the final confirmation of 21 studies. Common challenges included lack of OH knowledge and awareness, difficulty in accessing treatment, transportation problem, treatment cost, and lack of inter-professional collaboration for specialized services. Potential solutions included OHE training and services for patients and caregivers, easy access to dental services, specialized dental practitioners and use of a combination of expertise to meet the demands of SHCN individuals.ConclusionThis brief analysis will establish dental obstacles to the provision of information to policymakers for SHCN population at organizational, individuals and policy levels. It will help in effective planning for providing and improving OH care quality in caregivers.     

Complications associated with anesthesia administration for dental treatment in a special needs clinic

The goal of this study was to identify and quantify complications occurring with the administration of anesthesia for the dental treatment of patients with special needs. Anesthesia providers completed a standardized evaluation form, delineating possible complications for 202 consecutive ambulatory patients receiving anesthesia in a special needs clinic. Statistical analysis of four types of administered anesthesia showed that the overall complication rate was 23.8%. Evaluation of the data showed complications that were considered either mild (95.8%), or moderate (4.2%), while no reports of severe complications occurred. Airway obstruction and nausea/vomiting were the most frequently encountered complications. Variables found to affect the incidence of anesthetic complications included ASA classification, anesthetic technique, Mallampati airway classification, and type of dental procedure performed.
An evaluation of the results of the study showed that the majority of complications that occurred with anesthesia during care of patients with special needs were mild and did not lead to severe adverse events. Our findings show that anesthesia administered during dental treatment for patients with special needs is safe and effective.     

A new, simple implant-level impression technique for dental implants in limited interproximal space

Making an implant-level impression when implants are placed in limited interproximal space or compromising angulations can be a time-consuming procedure. This article presents a new method for developing a master cast for two implants clinically placed convergent and very close to each other. The technique consists of making an implant-level impression using a transfer jig fabricated on dental abutments.     

间接法制作个别取模器龈下取模技术的临床应用评价

目的：介绍一种简便高质量的龈下取模技术，解决龈下肩台边缘至龈沟底之间的牙体，牙龈外形精确复制问题。方法：在备牙的同时制作个别取模器，采用一次调和两步取模法。结果：可清晰、准确、完全地取得基牙肩台及肩台下精细结构的外形，经20例患者76颗基牙固定修复一年半的随访，修复质量明显提高。结论：个别取模器龈下取模技术操作简便易学，可大幅度改善固定修复颈缘质量，值得推广。     

Improving oral health for individuals with special health care needs

The purpose of this paper was to highlight information and issues raised in a keynote address for the American Academy of Pediatric Dentistry's Symposium on Lifetime Oral Health Care for Patients with Special Needs held in November, 2006. Topics include: (1) relevant statistics and definitions; (2) the prevalence and impact of common oral diseases in individuals with special health care needs (ISHCN); (3) an overview of oral health care delivery for ISHCN; (4) key delivery system and policy issues; and (5) a synopsis of major contextual initiatives related to ISHCN. In light of the Academy's primary interest in infants, children, and adolescents--including children with special health care needs--the major focus is on children. Significant oral health and oral health care issues for adults with special needs, however, generally parallel those for children and are of interest to the Academy, particularly as they relate to the transition from pediatric care to adult care, a critical period for extending the level of oral health and health trajectory established during childhood.