Something to Smile About: Oral Healthcare for People with Special Needs: Part 1
Perlman, Steven, Fenton, Sanford J., Friedman, Clive, Chamalian, David, The Exceptional Parent
EP introduces its brand-new, comprehensive series on dental and oral healthcare for the disability community. Over the course of the next twelve months, EP will publish the latest information, perspectives, and insights on this important, yet sometimes overlooked part of individual health. We wish to welcome article contributors and the Oral Healthcare Editorial Advisory Board, which was specially appointed for this Series and among whom are some of the top dental and oral healthcare experts in the US and world. Thank you for giving us "Something to Smile About."
Recent news reports and medical journal articles have reinforced the above statement by former Surgeon General Koop. Oral health and total health share an integral, mutual relationship. Periodontal disease, for example, has recently been linked to a higher incidence of both cardiovascular disease and, for women, the risk of bearing low-birth-weight and pre-term babies. Children with nursing caries (tooth decay brought on by the child falling asleep with a bottle of formula, or other liquids capable of initiating decay, in the mouth) often weigh significantly less as they age than comparison children, and are much more likely to satisfy one of the criteria for failure to thrive.
Dr. David Satcher, the current Surgeon General, reports that tooth decay is a highly common chronic disease among children-much more so than hay fever or even asthma. As mentioned in his newly released report on oral health in America, the negative outcomes of an unhealthy mouth are many. "Serious oral disorders may undermine self-image and self-esteem," reports Satcher, "discourage normal social interaction, and lead to chronic stress and depression as well as incurring great financial cost." As oral conditions worsen, some families may find treatments financially prohibitive; some conditions may not be amenable to any treatment at all.
Besides these insidious emotional and financial effects, the report continues, poor oral health may also interfere with vital physical functions such as breathing, eating, swallowing, and speaking. In the final analysis, the report concludes, "the burden of the disease restricts activities in school, work, and home, and often diminishes the quality of life."
The state of oral health among people with disabilities
As widespread as poor oral hygiene, gingivitis, periodontitis (gum disease), and tooth decay are in the general population, they are found far more prevalently in people with disabilities. Why is this so? One reason may be that more people with special needs are moving out of state institutions, which provide low-cost or free oral health services. With this move into the community, the continuity in their dental care services is suddenly disrupted. Once outside the state system, people with disabilities, parents, caregivers, and community-resident managers often do not know where to turn to obtain dental services. Many dental practitioners are unwilling to provide services to people with disabilities in the general population for many reasons, including lack of training, experience or interest, and inadequate reimbursement.
As a result of more independent living, there is an added burden placed on the person with a disability and his or her family to pay for needed dental services out of pocket, without the financial umbrella of the state system. For children with disabilities from low-income families, even Medicaid--a state-administered, federally reimbursed program that pays for medical care for people who meet the criteria--has not proven to be a reliable source of obtainable services. "Fewer than one in five Medicaid-covered children received a single preventive dental visit in a recent year-long study period," says Dr. Satcher's report. Many dentists understand very well that their reimbursement checks for services rendered can languish in Medicaid's bureaucracy, thus giving them little incentive to offer dental services to those who desperately need it. …