AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY
BY H. BARRY WALDMAN DDS, MPH, PHD, STEVEN P. PERLMAN DDS, MSCD, DHL (HON), AND MISHA GAREY, DDS
AN INORDINATE FONDNESS FOR BEETLES
“The Creator would appear as endowed with a passion for stars, on the one hand, and for beetles on the other, for the simple reason that there are nearly 300,000 species of beetle known, and perhaps more, as compared with somewhat less than 9,000 species of birds and a little over 10,000 species of mammals. Beetles are actually more numerous than the species of any other insect order.” – J.B. S. Haldane
INCREASING TOTAL POPULATIONS
Right now, on January 31, 2015 at 11:55 AM (Eastern Time Zone), the estimated world population is 7,291,818,083 persons. Worldwide, the number of births and deaths (at a slower rate) keep increasing so that as this sentence was finished, the estimated world population increased to 7,291,819,904. As of this date and time in January, there have been 11,616,519 births and 4,793,130 deaths in 2015. So far this day, there have been 189,813 births and 78,327 deaths.1 While it would appear that the Creator has a “fondness” for hundreds of thousands of species of beetles (and untold actual numbers of these insects), we constitute but one species (Homo sapiens) that is multiplying rapidly, and from the perspective of many scientists, despoiling our land, water and atmosphere. Projected estimates for the world human population is to reach 8 billion in 2024, 9 billion in 2040 and 10 billion in 2100.1
Right now, in the United States, as of January 31, 2015 at 6:45 PM (Eastern Time Zone) there are an estimated 320,257,170 residents (an estimated 7,291,873,626 residents worldwide).2 (Yes, we did take about a seven hour break between these two paragraphs.) By 2020, the U.S. population will increase to an estimated 334 million residents, 380 million in 2040 and 390 million in 2100. (see Table 1)
THE NUMBER OF INDIVIDUALS WITH DISABILITIES IN FUTURE
In 2010, there were an estimated 56.7 million U.S. residents with disabilities, including 38.3 million with severe disabilities.5 By 2013, the U.S. Census Bureau estimated that the number of residents with severe disabilities increased to 39.1 million individuals.6
Assumptions – Projecting the total number of U.S. residents with severe disabilities in future decades is complicated by any number of changes in demographic characteristics, including: 1) fluctuating economic conditions and health insurance factors which could affect gestational and early stages of life, 2) changing minority and majority population proportions with different histories of varying disability rates, 3) growing population with lengthened life spans into ages with greatly increased disability rates, and 4) the potential for dramatic advances in the health sciences which could significantly affect and alter disability rates.
Nevertheless, it is essential, the need to plan for the future and the potential number of individuals with disabilities. It is with these factors in mind, that projections of the number of U.S. residents with disabilities were developed through the next decades until 2050, with the working assumption that disability rates would remain constant (e.g. ranging from 0.8% for residents less than five years to 36.4% for residents 65 years and over – using the Census
Bureau American Community Survey data for 2013).6 (see Table 1)
Projections – Between 2015 and 2050, there will be:
• Limited increases among children with disabilities less than 18 years of age. Note: Census Bureau reports only hearing and vision difficulties for the less than 5 year age group.6
• An increase of more than 3 million adults with disabilities between 18 and 64 years.
• An increase of 13 million seniors with disabilities 65 years and older.
• Limited changes by race in the number of individuals with disabilities
• An increase from 2.4 to 4.3 million Hispanic residents with disabilities as the overall Hispanic population increases by78% during this period. (see Table 1)
If the distribution of the proportion of the population with various types of disabilities remains the same between 2013 and 2050, then:
• Among children 5-17 years, cognitive limitations will remain the most frequently occurring disabilities.
• Among adults 18 years and over, ambulatory difficulties will remain the most frequently occurring disabilities. (see Table 2)
A previous article on population projections in EP magazine raised the question, “Would the anticipated marked increase in the older population overwhelm the concern for the number of children with disabilities?” 7 The concern is still valid, in terms of sheer numbers. There is, however, another other side of the equation.
AVAILABILITY OF SERVICES
Question – Will there be sufficient numbers of trained health professionals who are willing and able to provide the needed care in 2050 for the additional 10 million U.S. residents with severe disabilities (an increase from 39 million residents in 2013 to 49 million in 2050)?
Consider some of the current difficulties for the delivery of just one health service to individuals with disabilities – oral health care. The following letter to the editor appeared in the Journal of Special Care in Dentistry.
“I am one of only two dentists in the State of Oklahoma who devotes a major portion of my practice to caring for patients with special health care needs. The other dentist is in Tulsa (90 miles away). Patients travel from all over the state to come to my office; many having to travel 3 hours or more one way. Some have to stay the night in a hotel because it is too taxing on the patient to travel that far in one day. Many of my referrals come from pediatric dentists who don’t feel qualified to provide general dental services to adult patients who often require (endodontics, periodontics surgical extractions, fixed and removable prosthodontics, and implant therapy).” (Personal communication with the author of the letter)
Note: The writer refers to the fact that pediatric dentists often are called upon to care for their pediatric patients who have reached adulthood, but who are unable to find general dentists who are willing and able to provide the needed care.
A review of the literature indicated that academic dental institutions have a history of not preparing students to treat the increasing population of individuals with special needs. In 2004, the Commission on Dental Accreditation (CODA) adopted a new standard, to be implemented starting in January 1, 2006, stating that “Graduates must be competent in assessing the treatment needs of patients with special needs.” Note: the standard does not require that students have clinical experience opportunities to provide actual care to fulfill the accreditation requirement.
Nevertheless, a study carried out in 2008 (and reported in 2014) indicated that 70% of the schools responding reported that, to some extent, predoctoral students were involved in routinely treating patients with special needs beyond simply observing.8 Other studies have suggested that the problem of inadequate education for caring for patients with special needs extends into graduate and specialty programs and dental hygiene programs. 9 ,10
WHAT OF THE TRAINING FOR CURRENT DENTAL PRACTITIONERS?
Continuing education programs can prepare current practitioners to provide needed services. However, few courses are offered and state relicensure concentrate on general numerical requirements do not ensure practitioner exposure to programs that would assist in the care for individuals with special needs.
For example, attaining Mastership in the Academy of General Density (MAGD), a professional designation within the Academy that reflects a general dentist’s ongoing commitment to provide quality care through continuing education (CE), requires a specified minimum number of CE hours in a range of subjects, including special patient care. Unfortunately, only a limited number of course presentations are available for practitioners to meet the MAGD requirements. Specifically, at the annual meetings of the American Dental Association and large regional conventions, few, if any, programs are scheduled for the care of children and adults with special needs.11 Despite these limitations many dental practitioners do provide care to individuals with disabilities!
However, in addition, there are the realities of limited government, insurance company and private financial resources to support the needed care.
NOW MULTIPLY
These are but a few of the problems faced by the dental profession as it is called upon to meet the oral health needs of the vast increasing population of individuals with disabilities. Now multiply these difficulties by similar and some quite different problems faced by the scores of other health and social professions that will be called upon to meet the needs of the increasing numbers of person with disabilities in our country and worldwide.
Right now – in the United States, on February 3, 2015, 7:25 PM (Eastern Standard Time – there are an estimated 7,292,559,708 residents worldwide, and an estimated 320,275,940 U.S. residents… and the clocks continue to tick.1,2 •
ABOUT THE AUTHORS:
H. Barry Waldman, DDS, MPH, PhD – Distinguished Teaching Professor, Department of General Dentistry at Stony Brook University, NY; E-mail:h.waldman@stonybrook.edu
Steven P. Perlman, DDS, MScD, DHL (Hon) – Global Clinical Director, Special Olympics, Special Smiles and Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine, Private pediatric dentistry practice – Lynn MA.
Misha Garey, DDS is Director of Dental Services at the Orange Grove Center.
References
1. Worldometers. Current world population. Web site: http://www.worldometers.info/world-population Accessed January 31, 2015
2. Census Bureau population clock. Web site: http://www.census.gov/popclock Accessed January 31, 2015.
3. Population Division. U.S. Census Bureau. Projections of the population and components of change for the United States 2015-2060. (NP 2014-T1). December 2014.
4. Population Division. U.S. Census Bureau. Projections of the population by sex, race and Hispanic origin 2015-2060. (NP 2014 T4C) December 2014.
5. Brault MW. American with disabilities: 2010. Current Population Reports, P70-131. Web site.
http://www.census.gov/prod/2012pubs/p70-131.pdf Accessed January 31, 2015.
6. Census Bureau. American Community Survey. Web site: factfinder2.census bureau. Accessed January 25, 2014.
7. Waldman HB, Perlman SP. Population projections: overwhelming the number of children with disabilities. EP Magazine; 2013;43(3):14-16.
8. Clemetson JC, Jones DL, Lacy ES, et al. Preparing dental students to treat patients with special needs: changes in predoctoral education after the revised accreditation standard. + Journal Dental Education, 2012;76:1457-1465.
9. Garfinkle AJ, Richards PS, Inglehart MR. Providing care for underserved patients: periodontists’ and periodontal residents’ educational experiences, attitudes, and behavior. Journal Periodontology 2010;81(11):1–9.
10. Dehaitem MJ, Ridley K, Kerschbaum WE, et al. Dental hygiene students and patients with special needs: a survey of U.S. programs. Journal Dental Education, 2008;72(10):1010–9.
11. Waldman HB, Wong A, Cannella, Perlman SP. No one left behind. AGD Impact, July 2021(July):10-
12. Web site: www.agd.org.
