BY DAVID FRAY DDS AND LARA E. RANEY
The scarcity of dental providers is attributed to insufficient education in dental schools regarding treatment methods and unique needs of persons with developmental disabilities.
Adults with special needs have long been one of the most under treated populations in dentistry. Many pediatric dentists are well equipped to treat children with special needs, but most general dentists are either untrained or unwilling to treat adults due to their lack of experience treating this population. Additionally, the lack of access to dental care prevents small dental problems from being caught early, resulting in the need for more costly and complex treatment.
Research has confirmed the greatest barrier in access to care for this population is a lack of trained dentists willing and capable to treat. The scarcity of dental providers is attributed to insufficient education in dental schools regarding treatment methods and unique needs of persons with developmental disabilities. All United States dental school curricula are required by the Council on Dental Accreditation to include minimal classroom didactic training regarding treatment of special needs patients. However, many students will never have the opportunity in school to actually treat a person with autism or cerebral palsy or Down syndrome. This lack of educational experience and exposure results in newly graduated dentists who lack confidence in treating patients with complex medical and behavioral needs.
However nationwide, State and Federal policy changes are needed to create lasting solutions to the lack of dental care for adults with special needs. This begins with the education of students and extends to creating job opportunities for dentists after graduation, and affordable treatment for families already strapped with extra costs. The American Academy of Developmental Medicine and Dentistry (AADMD) has embraced this challenge with a bold effort to teach, mentor and support young dentists for the future while advocating for changes in a system of care that rewards isolated and infrequent crisis dental care. The old saying that an ounce of prevention is worth a pound of cure is appropriate. Preventing and reducing dental caries (cavities) is far less difficult than saving and repairing badly damaged teeth.
Despite the deficiency in access to dental care for adults with special needs, awareness of this issue is growing through formation of student chapters of AADMD (American Academy of Developmental Medicine and Dentistry) in dental schools throughout the nation. The purpose of AADMD student chapters is to raise awareness of the obstacles faced by patients with special needs, educate students regarding successful quality dental care, and to engage students to promote national policies that will improve the needed access to healthcare. AADMD student chapters raise awareness of future dentists and within the special needs community.
Chapters each fall advocate within their school by participating in efforts such as the “Spread the Word to End the Word” campaign, in which AADMD members encourage faculty and classmates to discontinue the pejorative use of the “R” word. Founded in 2002, the AADMD is growing and now recognized as a national organization of professionals promoting collaborative and integrated healthcare for people who have intellectual and developmental disabilities. Additional new members and student chapters are being created every year across the United States and in several countries. In 2015, the University Of Texas School Of Dentistry in Houston created the first AADMD chapter in the state of Texas.
This chapter has hosted the annual AADMD national meeting, increased interest to spread throughout the state as students volunteer at events such as Special Olympics’ Healthy Athletes venues and through Friend of Down Syndrome’s “Buddy Walks”. Students are encouraged to select rotations that will give them treatment experiences and learn to develop a “bond of trust” with patients with disabilities. Future plans for the Texas Chapter include a “Day of Special Smiles” in 2018 and partnering with the Baylor College of Medicine to learn the art of integrated and collaborative care.
In addition to increasing awareness of the disparity of care for adults with special needs in dental schools, existing clinics are adopting integrated collaborative care models to improve access and quality of care for this population. This model encourages health professionals to treat patients collaboratively, allowing for better continuity of care between the various healthcare specialties. An example of this integrated collaborative care model’s success is apparent through the Lee Specialty Clinic in Louisville, Kentucky, where physicians, dentists, physical therapists, and other healthcare professionals work side-by-side to create interdisciplinary treatment plans.
Health professionals nationwide have collaborated in the treatment of patients with special needs, which is through the Healthy Athletes program of Special Olympics, providing medical, dental, optometry screenings in a centralized, convenient location. The AADMD and Special Olympics International recently jointly signed a new partnership agreement at the annual meeting in Houston. This new training opportunity of older clinicians will be demonstrated at next year’s National Special Olympics games in Seattle. Perhaps the most important aspect of the collaborative care model is that healthcare providers may perform screenings for healthcare fields outside their primary field. These screenings allow small problems to be detected early so that patients may be referred to appropriate specialists for treatment before more extensive treatment is required. For example, some physicians have been trained to look for signs of cavities and taught to apply a cavity-arresting measure until the patient can receive definitive treatment by a dentist. Dental screenings by physicians help prevent tooth decay from progressing and decrease the likelihood of patients needing more extensive and traumatic treatment, such as root canals or extractions. Similarly, dentists can screen for medical conditions, such as hypertension and diabetes, and refer the patient to a physician if treatment or medication is needed. Collaborative care improves the likelihood that preventive treatment will not be delayed and minimizes health care costs.
In addition to changes made at dental schools and established clinics, national policies are needed to create a more lasting impact in creating access to healthcare for adults with special needs. Current policy regarding healthcare of patients with special needs not only restricts their access to dental care but also costs the country greatly. In 2015, more than $400 billion was spent on treatment, yet health data indicates that many disparities continue. More than a decade ago, then US Surgeon General David Satcher stated, “Reports sit on shelves, but actions are needed.” That encouragement to the founders of the AADMD led to increased educational opportunity in medical and dental schools for future doctors to know how best to care for some of the nation’s most vulnerable and improve their health. Policy changes promoting access to care would not only reduce costs by focusing on preventative care to avoid expensive and traumatizing emergency treatment, but also give patients more consistent quality treatment, and family members the peace of mind that their relative is receiving appropriate evidence-based care.
Currently, the federal government defines “medically underserved” populations in terms of geographic and socioeconomic criteria; however, patients with disabilities are dispersed throughout their communities across the country and have various levels of income. People with intellectual and developmental disabilities (IDD) are “medically underserved” due to their lack of healthcare providers and affordability of care. New policies are needed to increase these patients’ access to dentists who are equipped to treat them. The National Council on Disability report in 2009 states that “the absences of professional training on disability competency issues for healthcare practitioners is one of the most significant barriers preventing people with disabilities from receiving… effective healthcare.” The United States’ official health goals found in the document, “Healthy People 2020”, proposes that courses on disabilities are needed in medical schools, dental schools, and post-graduate programs in order to prepare new graduates to treat this population. Allowing new graduates to further develop their skills in integrated IDD care clinic programs under the Health Services Resources Administration requires an official designation of people with IDD as being “medically underserved.”
Spreading awareness in the political and healthcare education arenas regarding the barriers to people with IDD to acquire quality affordable healthcare is necessary. Self-advocates, students, dentists, physicians and families are encouraged to advocate with their local dentists to provide the care they so sorely need. For further information, dentists can join the AADMD and find like-minded caring doctors at www.aadmd.org.
Although improvements have been made in providing access to dental care for adults with special needs, there is still a large disparity of care. Initiatives are being made, not only at local levels, such as formation of AADMD student chapters at dental schools, but also through nationwide policy changes providing improved access to care for adults with special needs. Health decision makers in many nations discount the importance of dental care for adults with intellectual and developmental disabilities. There is hope for the future that dental treatment will improve through the combined efforts of students and future dentists at both local and national levels.•
ABOUT THE AUTHORS:
David Fray, DDS is the current AADMD President and UTSD (University Of Texas School Of Dentistry) Associate Professor.
Lara E. Raney is a 3rd year dental student at UTSD.