By Emma Yasinski
While everyone should visit the dentist twice a year, not everyone does. That’s especially true of patients with special needs, for who receiving routine dental care may require anesthesia, an operating room, and thousands of dollars of out-of-pocket expenses.
A recent article in the Washington Post highlighted this issue, describing two patients, one with a developmental disorder and one with cerebral palsy, who struggled first to find dentists willing and qualified to work with them, and then to cover the cost of treatment.
Such challenges often lead to patients with special needs missing routine care, allowing dental issues to progress to problematic extremes.
Treating special needs patients often requires collaboration between anesthesiologists, dentists, and sometimes hospitals or surgical centers. Since comparatively few dentists are equipped to handle these special cases, the waiting list for treatment – for those who can find it at all – can be more than a year.
[See our March 2018 video profile of Dr. David Kurtzman, a Marietta, GA general dentist who caters to the special needs of patients, including those with developmental disabilities, physical handicaps, significant mental and medical problems, and severe dental phobias.]
“That is actually really one of our biggest frustrations,” said Evelyn A. Chung, DDS, who specializes in serving special needs patients at the University of California, Los Angeles. “There aren't a lot of institutions or programs that can do it.”
Dr. Chung and her team apply for grants which help cover the cost of surgical suites they can use specifically for dental procedures and, sometimes, to cover some of the costs that Medi-Cal Dental Program (Denti-Cal) and other insurers may not cover, even after extensive negotiations.
There are dentists across the country who do work with special needs children, but it’s much rarer to find a private practice equipped to work with special needs adults. “The deficit really occurs at the adult special needs level,” said Dr. Chung.
“You can imagine a six-year-old autistic boy may be able to be restrained or more easily sedated. But if you get a 36-year-old autistic male whose level of functioning is very low, he’s going to be very combative. And this is not somebody that you could restrain or give a little pill to make sleepy. This is somebody who’s going to require a lot of techniques, a lot of work up, and possibly a deeper level of sedation.”
Dr. Chung notes that in dentistry, “special needs” doesn’t only mean patients with intellectual disabilities. It can also refer to geriatric patients or patients with complicated medical conditions, such as cancer.
Dr. Chung and her team will work with a medical team or other health providers to coordinate care for patients with all variety of special needs. If the patient receives anesthesia for dental care, they’ll bring in medical professions to take blood samples or conduct an EKG or other necessary non-dental exams during the same visit. “So we do try to not just do dental work, but try to do as much as we can in that one opportunity that we have for our patients,” she said.
While obtaining dental care for special needs patients remains challenging, Dr. Chung is optimistic.
“There is an increasing awareness amongst dental schools that this is a very important part of the dental school education. And I think that more and more schools are trying to develop special patient care clinics. They're trying to expose more dental students to the special patient care population,” she said.
“When dental students are exposed at the dental school level, they can see these types of patients, and they can see how rewarding it is to be able to service the disabled population,” Dr. Chung added.
Author: Contributing writer Emma Yasinski received her Master of Science (MS) in science and medical journalism from Boston University. Her articles have also appeared at TheAtlantic.com, Kaiser Health News, NPR Shots, and Genetic Engineering and Biotechnology News.
Other Recent Incisor Articles by Emma Yasinski:
- Phoning It In: Teledentistry Offers Patients a Viable Alternative to Long Waits and High Costs
- Researchers Studying the Teeth of the ‘Xujiayao Juvenile’ Hope They Will Tell Us More About Our Own Development
- Study: Where You Live Greatly Impacts Dentists and Patients Alike
- She Died About 1,000 Years Ago, But Her Teeth Are Still Telling a Fascinating, Unexpected Story
- It Could Be a BIG Mistake If You’ve Stopped the Use of Antibiotic Prophylaxis for All Patients
- The Strength of the Evidence Apparently Linking Periodontitis to Alzheimer’s Disease Surprised Researchers