On February 10, the Arthur A. Dugoni School of Dentistry held its Give SPECIAL Kids a Smile event at its Union City Dental Care Center for children and adults with physical and/or mild developmental disabilities. Each of the 42 patients there received a free dental screening as well as a free dental health kit containing a toothbrush, paste, floss, and other items.
Some patients received free dental procedures as well, including exams, X-rays, cleanings, fillings, sealants, personalized hygiene instructions, caries risk assessment, and extractions, with no insurance required or requested. Overall, the student, faculty, and professional volunteers provided $28,695 in dental services.
Allen Wong, DDS, EdD, helped lead and participated in the event. He is a professor and director of the Advanced Education in General Dentistry (AEGD) Program at the school. Also, he is a global clinical advisor for the Special Olympics Special Smiles Program and an expert in special care dentistry, and he shared his insights about treating this population with Dentistry Today.
Q: Why did the school hold an event specifically geared toward the disabled?
A: The “Give SPECIAL Kids A Smile” event was held to bring awareness to the community of the challenge of access to care for the developmentally delayed population and those with intellectual disabilities, as well as to provide experiential education to those in the dental community. The event was co-hosted by the Southern Alameda County Dental Society and the Union City Dental Care Center, which is an AEGD residency clinic that is part of University of the Pacific’s Arthur A. Dugoni School of Dentistry. There were also many volunteers from the local dental community who participated.
Q: What are the biggest challenges in practicing oral hygiene for the disabled?
A: Early prevention strategies such as desensitization for the developmentally disabled and recognizing effective strategies that patients can tolerate without being aggressive. The mouth is a sensitive place and very personal. Start with baby steps in introducing techniques that will lead to future success and a healthy habit. For instance, brushing teeth does not need to start out with minty toothpaste. It can be just with a soft, wet toothbrush of the correct size until they are accustomed to the sensation, and then introduce a small amount of toothpaste. Find a flavor that they can tolerate. Keep in mind that not all oral care needs to occur in the bathroom. You can use a bowl and do it where they feel most comfortable first.
Q: What are the biggest obstacles in accessing oral healthcare for the disabled?
A: Finding dentists and offices willing to see and treat a population that they are not familiar with. Another would be dental insurances not fairly reimbursing or setting up “criteria” that may apply to the neurotypical population but not for a developmentally disabled population. For example, due to limitations of contractures, dental X-rays may not be possible or compromised at best, so does this mean that we cannot authorize treatment?
Q: What are the most common oral health issues that the disabled face?
A: A lack of “proper” oral hygiene instruction from their caregivers, as many of them have dexterity issues. They also may need modified handles to conform with their grip. Dental offices that expect too much and try to rush through the process rather than try to understand the patient’s diagnosis and limitations. Neglect of oral care from caregivers who give up trying. Then, dental caries, periodontal disease, and medication-induced xerostomia.
Q: What are the biggest challenges in providing oral healthcare once patients are in the office?
A: It depends on the disability, but generally, being exposed to new environments that overstimulate their senses of smell, touch, taste, sight, and sound. Also, there’s a lack of time or a sense of rush.
Q: Are there any strategies that dental professionals can use to address these issues?
A: A “seek to understand, then be understood” philosophy. The office should mildly prepare to understand the diagnosis and ask the patient or caregiver what is the best way to accomplish tasks. For instance, don’t assume those in wheelchairs are unable to move. Many can slide from their wheelchair to the dental chair if you ask. They or their caregivers just need to know what your needs are.
Q: Looking ahead, what kinds of techniques or technologies would improve care for this population?
A: An experience and willingness to learn more about the population. Every diagnosis is different, and there is a spectrum for each. The internet and social media are starting to populate with some good, informational “how to” videos that can help educate and reinforce the patient and the dental team. New prevention philosophies, materials, and products are emerging to lessen the risk factors and even strengthen teeth if properly administered. Recently, silver diamine fluoride and glass ionomer (fluoride-releasing) fillings have been in the news for high and extreme caries (cavity) risk patients. Caries Management By Risk Assessment (CAMBRA) protocols are key to controlling a preventable disease, or at least slowing it down.
Q: What kinds of policies would improve care?
A: Proper reimbursement for prevention and consideration for increased remuneration for time spent on patients that require such due to medical necessity. Postdoctoral dental programs (general dentistry residencies and AEGD) serve a great purpose in providing advanced care to the patients with special needs, but only a minor percentage of graduates receive such training. For those dedicating their careers to the field of developmental dentistry, perhaps loan forgiveness or grants can be awarded to help them treat this medically underserved population. Meanwhile, dental schools are trying to increase both didactic and clinical training for the new dentists to be comfortable providers.
Q: Where can dentists go to learn more about treating disabled patients?
A: The internet has many resources for syndrome-specific concerns. Continuing education courses at the larger meetings are helpful. The Academy of Developmental Medicine and Dentistry website and the Special Care Dentistry Association website also have information. And, your local dental society may have the names of those individuals locally with experience who can help mentor or answer questions.
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