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.     

Improving oral health for people with special needs through community-based dental care delivery systems.

A community-based dental care delivery system is described. This system has been used in a number of communities in California to improve oral health for people with special needs. It includes oral health assessment, coalition building, development and networking of local resources, training of dental professionals, and utilization of preventive dentistry training materials. Also discussed are challenges of the future that will need to be met to continue to make oral health a priority and reality for people with special needs in California.     

Periodontal treatment needs and oral hygiene for institutionalized individuais with handicapping conditions

Forty-five patients aged 3 to 22 who have handicapping conditions were examined to determine their oral hygiene leveis and periodontal treatment needs. This study shows that oral hygiene leveis for males and the older population were higher. Periodontal treatment needs were highly correlated to oral hygiene, and were much higher for males and older age groups.
Various aspects were discussed and it was concluded that primary prevention is an immediate, although a partial solution. However, new aids and antibacterial solutions should be further investigated in this population to simplify plaque removal.     

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.     

Improving and maintaining oral health for people with special needs

The number of people in the United States population with disabilities and other special needs is growing dramatically. These individuals present unique challenges for oral health professionals in planning and carrying out dental treatment and for the oral health delivery system. Because it has been recognized that the current delivery system is not working well for these populations, new workforce, financing, and delivery models are beginning to emerge that may hold promise for creating and maintaining oral health for currently underserved populations, including people with disabilities and other special needs. This article discusses the implications of this for the oral health profession, describes the challenges of providing oral health services for this population, and discusses the implications of these challenges for the organization of the oral health delivery system.     

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.     

New models for improving oral health for people with special needs

The number of people with special needs is increasing dramatically. In this context, people with special needs refer to people who have difficulty having good oral health or accessing oral health services because of a disability or medical condition. Among these groups, the number of people with developmental disabilities and the emerging population of aging "baby boomers with teeth" are demonstrating dramatic growth. People in these groups have significantly more dental disease than the general population. It is already difficult to impossible for many people with special needs to obtain oral health services. Under the current system of care, this situation will only get worse. The characteristics of a new model, which can better address the oral health problems of people with special needs, are described.