children and adolescents, and aids clinicians in developing rational thought processes for gathering information from these patients and their caregivers. Equipped with that information, the dental team can develop appropriate dental treatment plans and continuing care regimens that best serve their pediatric patients with complex medical needs. health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
that they result from an imbalance of multiple factors, the dental team has the responsibility to identify and educate patients and their families about this disease. The early establishment of a dental home can increase the opportunity for prevention and management of dental caries in their earliest stages. This intermediate-level course provides dentists, dental hygienists, and dental assistants with information on selected morbidities that are typical in professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient Implicit bias in healthcare Implicit bias significantly affects how healthcare or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact
INTRODUCTION
caregiver’s education, socioeconomic status, and beliefs concerning oral health. Advances in medicine have increased the life expectancy of the child with complex medical and developmental conditions. Thirty years ago, for example, a person with Down syndrome had a life expectancy of about 12 years, compared with 60 years today (Glassman et al., 2016). As a result, dentists are encountering an increasing number of patients with complex medical and developmental conditions in their offices for routine dental care. Many studies have indicated that oral health disparities continue to affect children with special healthcare needs, and unmet dental needs tend to be more prevalent in this population (Alamri, 2022). These needs also tend to vary by region of the country and are influenced by individual, family, community, and policy factors (Alamri, 2022).
The American Academy of Pediatrics employs a broad and inclusive definition of children and youth with special healthcare needs that encompasses the characteristics shared by children with a wide range of diagnoses. This definition includes “any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs” (American Academy of Pediatric Dentistry [AAPD], 2022a). In the years 2019–2020, an estimated 19.4% of all U.S. children presented with a special healthcare need as defined by having a chronic medical, behavioral, or developmental condition lasting 12 months or longer and experiencing a service-related or functional consequence (U.S. Department of Health and Human Services, 2022). The Americans with Disabilities Act defines the dental office as a place of public accommodation; therefore, dental providers are obligated to ensure access for this population (American Dental Association, 2022). It has been established that people with complex medical, developmental, and psychosocial conditions experience more oral health problems than those who do not have such conditions (Glassman et al., 2016). Children, and specifically children with special healthcare needs, are especially vulnerable to the oral effects of systemic diseases. Dental caries in primary and permanent teeth of children ages 2 through 11 were on the decline until the mid-1990s. However, this trend reversed at the beginning of the 21st century, with a small but significant increase in primary tooth decay (National Institute of Dental and Craniofacial Research, 2018). The relationship between a child’s oral health and that of their caregiver may result in part from the
Many types of pathogens live harmoniously in the oral cavity. When a patient is healthy, yeast, bacteria, and viruses coexist in balance. Given optimal daily oral hygiene, reasonable nutrition, and routine professional care, the need for emergency treatment should be low. However, if conditions change and the balance within the oral cavity shifts, the biofilm present on teeth can become much more aggressive. The spreading of a dental infection can cause damage to the cardiovascular, pulmonary, and other organ systems. For the pediatric patient with complex healthcare needs, such an infection can result in diminished overall health and the increased incidence of hospitalization, organ disease, organ transplant, and possibly death (Velten et al., 2017). DENTAL MANAGEMENT FOR PEDIATRIC PATIENTS WITH COMPLEX NEEDS Prevention of dental disease
leads to demineralization of the tooth structure (Coelho et al., 2022). Early childhood caries (ECC) is defined as the presence of one or more decayed (harboring non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child under the age of 6. In children
Dental caries is a common transmissible chronic disease of childhood. Now that the etiology of dental caries is better understood, a dental practitioner treating children has an obligation to discuss prevention with parents and caregivers. Dental caries results from a shift in the balance from protective factors toward risk or pathologic factors, which
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