The Disparity in Oral Healthcare for Special-Needs Patients

There's been a push by leading dental organizations to increase funding and access to dental care for patients with physical, developmental, and mental disabilities. But, as these patients often wait months, even years, for treatment, the crisis for care grows.

By Genni Burkhart

In America, disabled patients needing to see the dentist often wait years to find qualified care. While some are fortunate and find treatment faster through special programs at dental schools, many with severe developmental, physical, and mental disabilities can only undergo dental procedures under general anesthesia – which is costly and difficult to find.

Because of this, many people with special needs cannot access routine and emergency dental care, resulting in rotting teeth, inflamed gums, and chronic pain that severely impacts their health and quality of life.

On September 23rd, the American Dental Association (ADA) submitted a request for information on "Disability Policies in the 21st Century: Building Opportunities for Work and Inclusion."

In doing so, the ADA has recognized a growing concern among dentists about accommodating patients with special needs and the disparity in their care.

In this discussion, we'll look at this epidemic and how the dental community's efforts to make oral health care affordable, available, and equal can benefit millions of Americans in need.

A Crisis of Care

In a St. Louis Post-Dispatch article by Michele Munz, Sallye Holland of St. Louis details the painful struggles that her daughter Cassandra Holland faces in finding the high level of dental care she needs.

In addition to being mute, Cassandra has epilepsy related to her spastic quadriplegia cerebral palsy, keeping her in a wheelchair. In the article, Sallye recalls her harrowing struggle to find dental care for Cassandra, often ending up in the emergency room where she was prescribed antibiotics and sent on her way, only to repeat the cycle all over again.

It was a year ago when Cassandra finally found hope. As one of the first patients to get care through a program created by Barnes-Jewish Hospital, the dentistry school at A.T. Still University (ATSU-MOSDOH), Washington University School of Medicine in St. Louis, MO, and Affinia Healthcare, Cassandra finally received the dental care she desperately needed.

Sallye remarks how emotional she gets when retelling this story. Thanks to a kind person on the other end of the phone at Barnes-Jewish Hospital, "…It was everything. That's when things started changing for us."

Robert J. Schmidt, DDS, who prompted the clinical collaboration, stated on Washington University's website: "Half a million people in the St. Louis area are living with disabilities, but few dentist offices accept special-needs patients, and even fewer accept Medicaid."

Advocacy for Access and Training

In the instance of the St. Louis area collaboration, it was part of a broader effort led by Affinia Healthcare and ATSU-MOSDOH to ensure equal access to "quality emergency and comprehensive dental care" for residents of St. Louis.

Founded in 2015, St. Louis Dental Center provides comprehensive, affordable oral health care to patients of all ages to address the lack of oral health services for underserved, vulnerable populations. Since 2017, the Center has treated 230 patients with special needs. Despite this, some patients' needs still exceed the Center's capabilities, and their waiting list has only grown.

Earlier this month, the Incisor published an article regarding three leading dental groups writing to the CMS on June 30th, specifying "significant concerns" about hospital access to dental procedures. Those three organizations include the American Academy of Pediatric Dentistry (AAPD), the American Association of Oral and Maxillofacial Surgeons (AAOMS), and the American Dental Association (ADA).

In this letter, they cited two main concerns: CPT codes related to dental surgical procedures on complex dental patients and lack of coverage and access to operating rooms and anesthesia for dental work. The CMS is considering the proposed changes; if approved, they'll take effect on January 1, 2023.

The ADA's September 23rd letter urged Congress to provide grants for dentists' training and continued education to treat patients with disabilities. Their request covers dental education, residency and fellowship programs, and dental associations.

Dental Schools Take the Lead

Nationwide, dental schools have developed innovative training programs and funding to serve disabled patients. Listed below are two examples.

  • University of Washington School of Dentistry, Seattle, WA

The DECOD clinic (Dental Education in the Care of Persons with Disabilities) at the University of Washington School of Dentistry in Seattle, WA, was established in 1974 to treat patients with disabilities that require a level of care beyond a typical dental office. Partially supported by private donations, this clinic provides care to patients with developmental or acquired disabilities, including autism, multiple sclerosis, and cerebral palsy.

The DECOD clinic has been operating since 1979, but the Center for Pediatric Dentistry opened its doors just six years ago to relieve countless families with special-needs children. In partnership with DECOD is U.W.'s Center for Pediatric Dentistry. While DECOD treats adults, the Center treats children with special needs. The Center for Pediatric Dentistry saw 21,000 patients last year, with approximately 20 percent special needs children.

  • Texas A&M College of Dentistry, Dallas, TX

Dr. Dan Burch grew up dreaming of being an aerospace engineer in Texas. Only when a family friend mentioned dentistry did he consider the idea. According to an article in the Dallas Morning News by Marin Wolf, Burch started working with special-needs patients during his residency at Howard University.

As a pediatric dentist, Burch remembers a mother whose grown daughter, who had cerebral palsy and used a wheelchair, couldn't get the treatment she needed. Despite her daughter's desperate need for dental care, she couldn't find a dentist capable of providing it. This situation propelled Burch to start the Compromised Care and Hospital Dentistry Fellowship at Texas A&M College of Dentistry, one of the first fellowship programs in the state designed to serve special-needs patients across their lifetimes.

Conclusion

With a population of nearly 40 million people, California has just 14 dental centers to treat people needing special accommodations in the state. In North Texas, only five dental offices serve patients in the region with severe physical, mental, or developmental disabilities.

Across the United States, special accommodation dental care is in crisis. Universities and progressive care organizations are shouldering a majority of the responsibility in providing care to this population. But as the ADA, AAPD, and AAOMS have advocated, without significant changes to funding and education, the lack of quality care for those with severe disabilities will continue to outpace demand.

 

Author: With over 12 years as a published journalist, editor, and writer Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides on the western shores of the idyllic Puget Sound where she works as the Editor in Chief for the Incisor at DOCS Education out of Seattle, WA.

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