An Example of Full Inclusion: Prevention of Oral Diseases. (Part IX)

By Miller, Christine Ernst | The Exceptional Parent, March 2002 | Go to article overview

An Example of Full Inclusion: Prevention of Oral Diseases. (Part IX)


Miller, Christine Ernst, The Exceptional Parent


Many of us consider ourselves advocates working to advance full inclusion of individuals with special needs. Significant progress has been made over the past several decades in improving educational, recreational, work-oriented and social opportunities. Yet in the realm of health and total well being, issues related to oral health are one of the most commonly cited problems by people with special needs. Often, just locating a dentist to treat a dental emergency or to repair a tooth is a major accomplishment. Difficulties accessing timely and appropriate dental services combined with complex lives can push prevention of oral diseases off the radar screen for individuals, parents or caregivers. Full inclusion includes prevention of oral diseases.

Prevention of oral diseases is much, much more than a cosmetic task accomplished with a toothbrush. The cornerstone of prevention is really the heart. Being pro-active and caring closely follow and together can overcome most obstacles.

The complete picture of prevention is composed of four major areas: a positive attitude, policy and programs; the adoption of the medical model; assessment; and the use of a customized oral health plan. For a lifetime of oral health without episodes of pain, bleeding or overgrown gums, or loose or decayed teeth, these four areas should be addressed.

Attitude, Policy and Programs

Imagine what life would be like if social service and healthcare professionals, policy makers, legislators and health insurance administrators all considered preventive oral health an essential service for people of all ages with special needs. Results of the 1994-1995 National Health Interview Survey on access to care and use of services by children with special healthcare needs indicated that the most prevalent unmet need was dental care.

Positive attitudes about prevention by the professional team, parents, caregivers, direct support professionals (DSPs) and the person with a disability also have a profound impact on the reality of day-to-day preventive measures. It is time to stop segregating it as a dental-only issue; oral health is an issue of total well-being.

For a lifetime of good oral heath, attitudes and action leading to services should start at infancy. Think of what it would be like if, in early start health programs, infants' and toddlers' oral condition were evaluated along with hearing and vision. Yet even when dental health programs are available they, are poorly used. For example, all children and adolescents enrolled in Medicaid are entitled to comprehensive dental services through Early and Periodic Screening, Diagnostic and Treatment program. However, only one in five of those children and adolescents actually receive such services.

Dental professionals and families often cite reimbursement issues as a barrier to care. What if there were a dental insurance coverage for "extra time and management"? Or if imagine adult prevention services were covered by Medicaid nationally, not just in some states? Even with existing insurance coverage, 55 percent of preschool-age children and 50 percent of school-age children do not have private dental insurance. For African-American preschool-age children, 65 percent are without coverage from private dental insurance.

Adoption of the Medical Model

Two types of diseases can occur in the mouth: cavities (also called decay and caries) and gum disease. Cavities and gum disease are the result of different types of bacteria and the body's reaction to them.

Diet, Demineralization and Dental Caries

What causes cavities in children and adults? Cavities are caused by acids which are produced when bacteria eat available sugars in the mouth. Sugar foods are fermentable carbohydrates such as sucrose, glucose, fructose and cooked starch. Cavity-causing (cariogenic) bacteria plus fermentable carbohydrates yield organic acids which can dissolve or demineralize teeth

Many people with special needs can be at greater risk of this dissolving process because of developmental disorders which cause weaker enamel. …

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