Treating Patients with Special Health Care Needs: A Great Way to Grow Your Practice

The American Academy of Pediatric Dentistry (AAPD) defines special health care needs (SHCN) as “any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. The condition may be congenital, developmental, or acquired through disease, trauma, or environmental cause and may impose limitations in performing daily self-maintenance activities or substantial limitations in a major life activity.¹ According to the 2019 U.S. Census, 41.1 million people (12%) have a disability and 7.9 million of them (ages 18-64) were fully employed. About 14 million children under 18 years old (19%) have a special healthcare need and 25% of homes had one or more children with a special healthcare need.²

SHCN create challenges in accomplishing daily activities, especially self-care activities. Individuals with these needs may require extra help to achieve and maintain good health, which includes oral health. To achieve and maintain good oral health, people with SHCN often require a special approach to dental care. Unfortunately, individuals with SHCN are one of the underserved populations in the United States.³

Providing oral care to patients with developmental disabilities requires adaptation of the skills you use every day. Most people with mild or moderate developmental disabilities can be treated successfully in the general practice setting.

As a dental professional you also need to be aware of the special challenges – behavioral, physical, and cognitive – that someone who arrives at the dental office with developmental disabilities may have. Your learning appropriate skills and techniques to meet the unique oral health needs of people with developmental disabilities will help you be successful in delivering care to these patients.

Health Challenges for those with SHCN³:

• Mental capabilities will vary from person to person and may have an impact upon how well someone can follow directions in a dental office and at home.
• Behavior problems can complicate oral health care. For example, anxiety caused by a developmental disability may make someone uncooperative.
• Mobility problems may require a person to use a wheelchair or a walker to move around. Access to the dental operatory and chair may require special arrangements and assistance with patient transfer. Longer appointment times may be needed.
• Neuromuscular problems can affect the mouth. Some people with disabilities have persistently rigid or loose chewing muscles, or have drooling, gagging, and swallowing problems that complicate oral care.
• Uncontrolled body movements can jeopardize safety and the ability to deliver oral care.
• Cardiac disorders, particularly mitral valve prolapse and heart valve damage, are common in people with developmental disabilities such as Down syndrome. Consult a cardiologist to determine the need for pre-treatment antibiotics.
• Gastroesophageal reflux sometimes affects people with central nervous system disorders such as cerebral palsy. Teeth may be sensitive or display signs of erosion.
• Seizures accompany many developmental disabilities. Patients may chip teeth or bite the tongue or cheeks during a seizure.
• Visual impairments and Hearing Loss and Deafness may also be present in people with developmental disabilities.
• Latex allergies may be more likely in people with developmental disabilities.

Oral Health Problems for those with SHCN⁴:

• Caries is common in people with developmental disabilities.
• Periodontal disease occurs more often and at a younger age in people with developmental disabilities. Difficulty performing effective brushing and flossing may be an obstacle to successful treatment and outcomes.
• Malocclusion occurs in many people with developmental disabilities, which can make chewing and speaking difficult and increase the risk of periodontal disease, caries, and oral trauma.
• Damaging oral habits such asteeth grinding and clenching,food pouching, mouth breathing, and tongue thrusting can be a problem for people with developmental disabilities.
• Oral malformations may cause enamel defects, high lip lines with dry gums, and variations in the number, size, and shape of teeth.
• Delayed tooth eruption may occur in children with developmental disabilities such as Down syndrome. Children may not get their first primary tooth until they are 2 years old.
• Trauma and injury to the mouth from falls or accidents may occur in people with seizure disorders or cerebral palsy.

Pediatric dental specialists are trained to provide special needs dentistry, but due to the significant numbers of patients with SHCN, access can be an issue.

To overcome access issues, especially as children age into adulthood, it is important that general dentists welcome these patients into their practices and provide a dental home. Below are some general tips to help you adjust to the special oral health care needs of people with SHCN⁴.

• Determine your patient’s mental capabilities and communication skills. Talk with the patient and their caregivers about how the patient’s abilities might affect oral health care. Be receptive to their thoughts and ideas on how to make the experience a success.
• Set the stage for a successful visit. Involve the entire dental team–from the receptionist to the dental assistant.
• Observe if physical manifestations of the disability(ies) are present. How does the patient move? Look for challenges such as uncontrolled body movements or problems with sitting in the dentist’s chair.
• Ask if the patient has an allergy to latex before you begin treatment. Latex allergies can be life threatening.

1. Definition of Special Health Care Needs (aapd.org)
2. Children and Youth with Special Health Care Needs (CYSHCN) | MCHB (hrsa.gov)
3. National Research Council 2011. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, DC: The National Academies Press. https://doi.org/10.17226/13116
4. Developmental Disabilities & Oral Health | National Institute of Dental and Craniofacial Research (nih.gov)