Table 1: Educational Resources in the Treatment of Patients with Special Needs • American Academy of Developmental Medicine and Dentistry http://www.aadmd.org • American Academy of Pediatric Dentistry, Guidelines on Behavior Guidance for the Pediatric Dental Patient http://www.aapd.org/media/policies_guidelines/g_behavguide.pdf • Association of University Centers on Disability http://www.aucd.org • Dental Education in Care of Persons with Disabilities http://www.dental.washington.edu/departments/omed/decod.php • Special Care Advocates in Dentistry (SAID) http://saiddent.org • Special Care Dentistry Association https://www.scdaonline.org/
Accreditation issues: Predoctoral and postdoctoral education The Commission on Dental Accreditation formally acknowledged
3. Adult. 4. Geriatric. 5. Special needs. (CODA [Dental Hygiene], 2022)
the need for improved education of dental professionals in the treatment of patients with special healthcare needs in its 2004 standards for dental and dental hygiene education programs. These standards were intended to ensure didactic and clinic opportunities in the care of patients with special needs. More recently, the standards have been updated. Currently, Standard 2-25 for predoctoral dental education programs, “Graduates must be competent in assessing and managing the treatment needs of patients with special needs.”(CODA-}Dental}, 2022). Dental Hygiene Standard 2-12 (5) called for “Graduates must be competent in providing dental hygiene care for all patient populations including: 1. Child. 2. Adolescent.
With regard to postdoctoral training, the Commission on Dental Accreditation requires that an appropriate patient pool be made available “to provide experiences that may include patients whose medical, physical, psychological, or social situations make it necessary to consider a wide range of assessment and care options” (Commission on Dental Accreditation [Dental], 2022, page 30). Overall, the changes in accreditation standards provide better training for new dental and dental hygiene graduates in the treatment of patients with special healthcare needs. ● Adopt a case management approach : Another recommendation was the adoption of a case management approach in the treatment of patients with special healthcare needs, including triage and referral systems. This would facilitate identification of oral diseases with appropriate referral to care settings that best match the need. ● Develop a “tiered delivery system” : Another proposal was development for a tiered delivery system. In this system, in relation to other health and social service professionals, oral health professionals would serve as coaches, mentors, and supporters (Monteserin-Matesanz, et al., 2015). General health and social service professionals and caregivers of people with special needs are typical candidates for involvement. A tiered system would also allow the level of care to be matched to the appropriately trained provider, with complex care performed by those with the most extensive training and less complex care delivered by those with less extensive training. Such an approach would optimize available resources. ● Engage caregivers in maintaining oral health : There was a call for greater engagement of caregivers in maintaining the oral health of patients with special needs by developing incentives such as performance rewards and standards tied to licensing. ● Enhance educational opportunities for dental professionals : The Consensus Statement recommended increased training for all dental professionals in treating persons with special needs, including didactic instruction and clinical experience for dental and dental hygiene students and also continuing education requirement for all dental professionals. ● Miscellaneous recommendations : Other recommendations included cataloging and publicizing successful models that optimize treatment for patients with special needs. Successful cost-effective models should be funded and expanded as adjuncts to the current oral health delivery system for people with special needs. In addition, the Consensus Statement
STRATEGIES FOR IMPROVEMENT
Although some progress has been made in recognizing the oral health needs of patients with special needs, continued progress is required. To this end, several organizations and institutions have made recommendations to improve oral health in these populations. It will take a massive coordinated effort among the dental schools, organized dentistry and dental professionals in both the public and private sector to address the ongoing and future oral healthcare needs of the special needs patients. Some of the areas of consideration are noted below: ● Focus on prevention : Reducing the high burden of disease and providing care to the growing numbers of patients with special needs will require shifting the focus of oral health care in these populations from treatment to prevention. ● Adopt an incentive system that promotes services likely to improve oral health : The current reimbursement system primarily rewards more aggressive intervention rather than preventive education, prophylactic measures, and early intervention procedures, such as application of fluoride varnish. The Consensus Statement called for adequate reimbursement for these services. In particular, rewarding early promotion of preventive practices, rewarding early identification of potential and actual oral health problems, and creating incentives for less invasive solutions are recommended. In addition, a mechanism should be incorporated in Medicaid programs to reimburse clinicians for the additional time often necessary to care for a patient with special needs. ● Integrate the system with other community health and social service systems : The Consensus Statement recommended integrating oral health services with other community health and social service systems to reach more patients with special needs, optimize outcomes, and allow dental practitioners to focus on more complex procedures. In this regard, oral health goals and standards should be established for residential facilities along with quality improvement systems to improve compliance with these standards.
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