Too many parents of children with special healthcare needs come upon dental care for their child out of necessity or urgency. In order to make the relationship most beneficial, the preferred way is to establish a Dental Home during your child’s infancy.
The Dental Home is the oral health corollary of the Medical Home concept that the American Academy of Pediatrics (AAP) has fostered to improve the quality of care for children, beginning at birth. Midway in this current decade, most professional organizations concerned about oral health of children united to push for a national practice shift to place every child in a Dental Home by his or her first birthday. The American Dental Association (ADA), the AAP and the American Academy of Pediatric Dentistry (AAPD) all support the Dental Home—a concept now synonymous with the age-one dental visit.
Table 1 at the end of this article shows the application of the principles and characteristics of the Medical Home as applied to dental practice. The Dental Home is a place for your child, but as you will see throughout this article, it really is a relationship, a frame of mind, and peace of mind. The purpose of this article is to mentor families to seek the best care for their child and to establish a life-long relationship with a dentist who can meet your needs and those of your child.
Start early. Do not wait for the first birthday to begin thinking about finding a Dental Home. Special needs often touch the oral cavity, and your child’s relationship with a knowledgeable dentist may begin with feeding issues, changes in oral structures, and preparing you and your child for developmental changes coming down the road—all right from birth.As you read and learn about your child, make mental notes about what to discuss with your child’s dentist.
Find a pediatric dentist. Honestly, what you may find as the parent of a special child in some cases is what you have experienced when seeking medical care—a willing dental professional with the best of intentions but a little rough around the edges. Of course, there are exceptions. If he or she has worked with families like yours and trained beyond dental school in caring for children with disabilities and special medical needs, then he or she is better qualified to treat your child. For instance, a pediatric dentist is trained beyond dental school in caring for children with special healthcare needs and has probably cared for many children like yours in training and then in practice. General dentists do not uniformly receive training in the care of special patients, although some may have had additional training after dental school encompassing patients with special healthcare needs. Pediatric dentists are also more likely to have affiliations with hospitals and established relationships with pediatricians and other child specialists, which creates a network of health professionals dedicatited to your child's well being.
Come prepared and knowledgeable. After 30 years of practicing in a pediatric hospital and several developmental centers, I still have lots to learn about my patients. Most parents of children with special needs are eminently versed in their child’s disability and the adjustments of family life, so a dentist’s lack of familiarity should not be a turn off. Many conditions exist, many are mixed, and medical treatments change frequently. Therefore, your child is truly an exceptional child in every sense of the word! It is up to you to present your expectations or a chief complaint and a view of daily life or family, medical, and social histories, because your child is unique. Bring your child’s history and articles about your child if a condition is rare or mixed. The list of medications is a must. Bright Futures, a set of national health supervision guidelines, encourages parents to attend every health visit armed with questions and information to maximize the benefit of that visit.
Trust a clinician who listens. Most dentists who care for children with special needs will agree that they are no more prone to common dental problems, such as tooth decay and gum disease, if provided with early preventive therapeutics and parental education. Similarly, treating most children with special needs requires skills that dentists use on everychild. What may be different is the dentist’s preventive plan and treatment approach for your child because of his or her constellation of strengths and weaknesses. The skilled dentist will listen, look, and learn a little from initial trial and error—all with your help.
The practice should be welcoming. Basic accessibility is notw taken for granted, but does the office or clinic demonstrate the attitude and aptitude for your child and you? This can range from things such as asking about special needs at the first phone call or showing diversity in artwork and décor. A dental office ready to care for all children is staffed by personnel who make you and your child feel at home and safe. This past June, while screening athletes at the Special Olympics, I asked parents about their choice of a dentist for their child. They said, to one, that the dentist’s demeanor, patience and willingness to “go with the flow” were the package they looked for...and appreciated.
The Dental Home should be linked to other services. The dentist you choose should have established relationships with other health professionals, both medical and dental, as well as with support services, such as physical therapy, spech and language pathology, and psychology. Most families will have already established an array of service providers they trust, but the dentist must be able to work with these other professionals for the benefit of your child, as might be the case when oral health is a part of the child's Individual Education Plan (IEP), or an intraoral device is needed to improve oral function. Networking is an important part of continuity of care across the health spectrum.
Table 1
The Dental Home and Your Exceptional Child
|
Characteristics |
What You Should Expect |
|
Comprehensive dental care, including acute and preventive services |
The dentist should be able to provide the same level of care for your child as for any other child, or have relationships with other dental and medical professionals to accomplish needed care |
|
Comprehensive assessment of oral diseases and conditions |
The dentist should be familiar with the conditions, medications, medical and other therapeutic regimens for your child |
|
Individualized preventive plan |
Your child’s individualized preventive plan should be designed so that specific oral health concerns as well as medical, behavioral, and other elements are considered and addressed |
|
Anticipatory guidance |
The dentist should provide you with advice for oral health that changes with the changing life needs and abilities of your child |
|
Plan for acute trauma if it occurs |
Is he/she available 24-7 in case of trauma or other problem requiring urgent care |
|
Proper home care for a child’s teeth |
Have you received the education and training necessary for you and/or your child to optimize home preventive care |
|
Dietary counseling |
The dentist should be familiar with special dietary needs and their implications for oral health, including things like special diets, gastrostomy, and restricted food choices |
|
Referrals to dental and other professionals |
The dentist has an established network of health care professionals to assist you and can work with your current array of professionals to optimize your child’s oral health |
|
Transition services for emerging adults |
The pediatric dentist anticipates the therapeutic needs of your emerging adult child or is capable of rendering continued care |
Dr. Paul Casamassimo is Professor at the Ohio State University College of Dentistry and Chief of
Dentistry at Nationwide Columbus Children’s Hospital, in Columbus Ohio. He has devoted his career to care of
exceptional children and adults for the last 30 years.