Oral health care is the most prevalent unmet health care need for U.S. children and adolescents with and without special health care needs (SHCN). Yet children and adolescents with SHCN are almost twice as likely to have unmet oral health care needs as their peers without special needs.
For many families, regular preventative health care, such as oral health care, may take a backseat to more urgent and chronic issues. Frankly, how critical does it seem to set up a cleaning every six months when your child is in and out of the hospital for procedures and has multiple therapies each week?
Add to this other barriers to oral care beyond a family’s control:
- Lack of specially trained dentists to successfully manage care for children and adolescents with SHCN.
- About half of the U.S. dental schools provide students with less than 5 hours of classroom instruction and less than 5 percent of clinical time devoted to care for children and adolscents with SHCN.
- A rural state like Vermont makes finding a specially trained dentist even harder.
- Fewer than 1 in 10 dentists regularly provide care for children or adolescents with cerebral palsy or developmental disabilities or who are medically fragile.
- The behavioral challenges associated with many children or adolescents with SHCN are often sited as the reason for discomfort or unwillingness to provide care.
- Challenges finding a dentist accepting new Medicaid patients. While finding a dentist in Chittenden County or in Rutland may be manageable, it is more difficult in rural areas of the state.
Nothing to Smile About
With all these barriers, it is no wonder so many children and adolescents with SHCN do not receive oral health care. Yet oral diseases may have an especially devastating impact on the health of these children. Children and adolescents with certain cardiac conditions or compromised immune systems can be particularly vulnerable to the effects of oral diseases.
Just as poor oral health can contribute to poor physical health, the opposite is true. General health impairments may adversely affect oral health. Craniofacial syndromes can signficantly impact oral development. Special medications or diets can lead to tooth decay, and excessive tooth grinding sometimes associated with self-stimulating behaviors can cause uneven or irregular wear of teeth.
Poor dental hygiene can and does lead to challenges in speech development, expressiveness and nutrition for children. Finally, the consequences of poor dental care can lead to long term negative impact on self-esteem.
Opportunities
It is critical for families to know that all children and adolescents enrolled in Medicaid are entitled to comprehensive dental care through EPSDT (Early and Periodic Screening, Diagnosis and Treatment). Many general dentists and dentists who participate in Medicaid may be more likely to provide care for children and youth with SHCN (https://www.vtmedicaid.com/secure/providerLookUp.do).
The recent push for the establishment of medical homes for children and adolescents with SHCN has expanded to include dental homes. The Vermont Department of Health has several established programs working to improve children’s access to good dental information including the school based flouride rinse program, Smile
Vermont program, and the Tooth Tutor program (http://healthvermont.gov/family/dental/services.aspx).
It Rests with the Family
Ultimately, the responsibility for ensuring that a child or adolescent with special health care needs gets the dental care they need rests with their parents or guardians. Resources for finding a dentist are available through Medicaid; the Vermont Department of Health can provide education materials for parents; and the Special Olympics Special
Smiles program is a community based program created to help increase public awareness about the
need for comprehensive oral care for children and adolescents with SHCN (www.specialolympics.org).
Remember that “you’re never fully dressed without a smile!” ©
