Barriers to dental care access for patients with special needs in an affluent metropolitan community

Access to Oral Healthcare in Individuals With Rett Syndrome: A Qualitative Study of Parent Perspectives

BACKGROUND

Intellectual and developmental disabilities (IDD) are varied in their nature and presentation. Barriers to oral healthcare are reported in studies of general populations with IDD but these may not reflect the barriers experienced by individuals with rare disorders such as Rett syndrome (RTT). There are also few peer-reviewed studies in the Australian context exploring barriers to dental care access for patients living with a disability. This qualitative study explored caregivers' perceptions and experiences regarding oral health and access to dental care for those with RTT in Australia.

METHODS

Parents of 31 individuals with a confirmed MECP2 mutation were sampled purposively from the Australian Rett Syndrome Database. Interview questions were based on earlier studies used in other disability populations and queried identification and management of dental pain and influence of other comorbidities in their child's oral care. Interviews were audio-recorded, transcribed and analysed using NVivo (Version 12 Plus). Directed content analysis was used to code data to a framework constructed from a literature review of factors affecting access to professional oral healthcare systems and factors affecting access to optimal at-home oral care in disability.

RESULTS

The most frequently cited barriers to professional dental care were dentist-related, while caregiver related financial barriers were cited by a minority of families. Dentist-related financial barriers were not present in these data. Most factors affecting access to optimal at-home oral care coded to the existing framework, with further enablers identified under training for the caregiver or parent.

CONCLUSIONS

The findings of this study provide a point of reference to understand factors affecting provision of at-home dental care and professional services to enable optimal oral health in RTT. Future research could explore the provision of targeted oral health information on RTT to carers and clinicians.

Oral Health Behaviour, Care Utilisation, and Barriers among Students with Disabilities: A Parental Perspective

BACKGROUND

Oral health is a critical component of overall well-being. However, students with disabilities (SWDs) face unique challenges in maintaining oral hygiene and accessing dental care. This study aims to explore oral health behaviours, dental care utilisation, and barriers to accessing dental care among SWDs in Al-Ahsa, Saudi Arabia, from the perspectives of their parents.

METHODS

A descriptive cross-sectional study was conducted among parents of SWDs in Al-Ahsa, Saudi Arabia. Data were collected using a validated questionnaire covering oral health behaviours, dental care utilisation, and barriers to care. The sample size was determined based on the SWDs population in the region. Data were analysed using descriptive and analytical statistics, with significant associations identified at p < 0.05.

RESULTS

Findings revealed that 45.7% of SWDs brushed irregularly, with only 16.8% brushing twice a day or more. Dental flossing was reported by just 4.3% of SWDs. Emergency-based dental visits were common (51.9%), and 29.5% of SWDs had never visited a dentist. Significant associations were found between maternal education and tooth brushing frequency (p = 0.004) and between parental education and the frequency of dental visits (p = 0.035). The most reported barriers included fear of treatment (47.1%), difficulty finding willing dentists (45.5%), and long wait times for appointments (44.7%).

CONCLUSIONS

The study emphasises the pressing need for targeted interventions to improve oral hygiene practices and enhance accessibility to dental services for SWDs.

Countering the Identified Barriers to Delivered Oral Care for Children With Special Healthcare Needs: A Narrative Review

Children with Special Health Care Needs (SHCNs) have poor oral health as a result of structural and systemic barriers. These children frequently have limited access to dental treatment, a higher prevalence and incidence of dental problems, and worse oral hygiene than the rest of the population. This review aims to offer an understanding of the existing oral care barriers of children with SHCNs. We reviewed the literature on children with SHCNs and their caregivers to identify the implications of the barriers faced by these individuals. Some of the perceived barriers to appropriate oral healthcare faced by these children include obstacles to adequate oral care and hygiene in the home, challenging behaviours, and limited preventive care and accessibility. We focussed on interventions and different management approaches to support the stakeholders responsible for these children. There is a need for strong communication as well as care coordination between caregivers, dentists, and other providers to achieve positive outcomes. The current dental healthcare system appears to desert the needed demands of this demographic.

Estimating the magnitude of different barriers to dental care for special needs patients: A systematic review

Quite often, it is seen that the number of special care individual in the dental OPD/clinics is quite low, as compared to their population. This can be due to specific barriers that restrict them in availing dental treatment. Our aim was to identify different barriers to dental care of persons with special needs through a systematic review and to quantify them. A systematic review was carried out according to PRISMA guidelines. PubMed data was searched with predefined keywords leading to retrieval of 576 records. Full length studies published in English language from 2010 onwards with mention of proportion of persons citing a barrier to dental care were included. Three studies published in peer reviewed journals from other data sources were also identified while retrieving the full length texts. Out of a total of 576 PubMed and three additional records, a total of 22 studies were included in the systematic review. Cost, communication, physical facilities, fear/uncooperativeness, unawareness, distant location/inaccessibility, unwilling dentist, transportation, and difficulty in getting appointment were identified as nine major barriers. Pooled proportions for different barriers ranged from 22.75% (Accessibility; 95%CI = 19.96-25.54) to 44.35% (Communication; 95% CI = 32.63-56.07A). There was a high heterogeneity across different studies for both fixed effects and random effects models. Communication, physical facilities, and unawareness were identified as the three most common barriers showing minimum heterogeneity in random effects model.

The impact of school-based social media and online technology on oral health education for individuals with disability

AIM

To evaluate the impact of school-based online communication methods on the oral health-related behavirs of individuals with disability.

METHOD

A prospective interventional study was conducted on 154 students (age 3-22 years) with various disabilities attending educational centers. A clinical examination was carried out before and after a school-based online educational program. Online in-person sessions were held for the participants, and educational videos were shared with parents and teachers over social media. The clinical examination included the Special Olympics HAS form, (1) Oral Hygiene Index-Simplified (OHI-S) (2) and the Modified Frankl Behavior Index. (3) Dietary and oral hygiene habits were collected via parent-administered questionnaires.

RESULTS

Improvements in behavior in a dental setting (p < .001), oral hygiene levels (p < .001) and dietary choices (p < .001) were observed throughout the study.

CONCLUSION

Oral health education online modalities can be used effectively by dental professionals to educate individuals with disabilities and their carers regularly, thus helping improve oral health and rapport with dental professionals.

Training dental hygiene students to care for patients with disabilities

OBJECTIVE

The purpose of this study was to evaluate the impact of a novel training programme on dental hygiene students' knowledge, attitudes, and beliefs about caring for individuals with disabilities.

METHODS

A mixed methods approach was used. Students from five dental hygiene programmes based at community colleges completed a two-hour didactic training session to supplement their existing special care dentistry coursework. Students completed an original 14-item pretest and posttest before and after the training that assessed attitudes and beliefs, and two validated posttests that assessed knowledge. Afterwards, students completed a clinical rotation in an advanced care dental clinic at a local academic institution, gaining hands-on experience with equipment and patient treatment. Descriptive statistics were used to report training scores, types of services rendered, and modifications to treatment. Student comments about their experiences were assessed using thematic analysis.

RESULTS

Two hundred and ninety-four students completed didactic training, and 261 completed clinical rotations. Posttest scores indicated positive improvements in knowledge, attitudes, and beliefs. All students provided direct patient care. Sixty-nine percent treated patients with intellectual and developmental disabilities; 75% placed silver diamine fluoride or fluoride varnish. Altered patient positioning was used by 70.5%. Most students (95.4%) reported that their experience positively changed their attitudes towards caring for patients with disabilities in the future. Eight themes emerged, notably increased comfort and confidence, a willingness and desire to treat patients, the acquisition of new skills, and clinician behaviours of empathy and compassion towards others.

CONCLUSION

Training can help prepare dental hygiene students with the confidence and skills to address the oral health needs of individuals with disabilities.

Intersection of the iADH undergraduate curriculum in special care dentistry and the association of Canadian faculties of dentistry competencies framework

AIMS

To map the International Association of Disability and Oral Health (iADH) curriculum to the Association of Canadian Faculties of Dentistry (ACFD) competencies framework to develop a strategy for teaching special care dentistry (SCD) using the International Classification of Functioning, Disability, and Health (ICF). To review the literature to identify educational methodologies that support teaching SCD competencies.

METHODS

The 20 subdomains of the ACFD competencies framework were mapped to the 18 subdomains of the iADH competency matrix. A literature review of methods, techniques, or innovations used to teach SCD was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and the Sample, Phenomenon of Interest, Design, Evaluation, and Research Type (SPIDER) tool.

RESULTS

The iADH curriculum was mapped to the ACFD competencies in the areas of patient care, professionalism, communication and collaboration, practice information management, and health promotion. A total of 176 articles from PubMed and 10 resources from MedEdPortal were identified in the literature search. Eleven articles met the inclusion and exclusion criteria. The overall quantity and quality of studies was low. Experiential learning in either a dental school or hospital-based program seemed to improve knowledge of SCD and to incite greater willingness to treat patients requiring SCD.

CONCLUSIONS

Case-based learning, computer-based modules, standardized patients, and clinical practice are educational strategies for teaching SCD competencies. The integration of SCD into the undergraduate dental curriculum seems feasible, as most required competencies are transferable to all dental disciplines. Furthermore, the ICF provides a functional model that is a patient-centered approach and is applicable to dentistry beyond SCD.

Preparedness of Dentists to Manage Anxiety in Developmentally Disabled Patients

Background

Recently, the National Council on Disability urged the Commission on Dental Accreditation to require more thorough training in the care of developmentally disabled patients. Curricula is early in its development and its' effectiveness is unknown.

Objectives

The aim of this study was to determine if special needs dental education has had an impact on providers' professional behavior, practice characteristics, attitudes, and confidence when treating these patients and managing their dental anxiety.

Methods

A nonrandomized, noninterventional, and anonymous, Qualtrics survey was administered prospectively to members of one local and one national organization.

Results

Of the 107 respondents (response rate of 81.06%), 89% treat special needs patients. Positive reinforcement (88.64%), distraction (85.23%), and enhancing control (85.23%) were the modalities most used by these participants. Regarding treating this population, the average response regarding both confidence and wanting to learn more fell between disagree and agree at 2.92, while the average response regarding concern about safety fell between agree and strongly agree at 3.22. Level of specific expertize had the strongest influence on a provider's decision to treat, while reimbursement level had the least influence. Among participants who completed postdoctoral education, the average response for how well their education prepared them to manage patients with special needs was higher for their postdoctoral training compared to their dental school training, with pediatric dentists reporting the highest rate of preparation. No correlation was found between year of dental school graduation and how well they felt their education prepared them for treating this population. Significance level was set at 5%.

Conclusion

Dental education can have a significant impact on dentists' knowledge, attitudes, beliefs, and confidence about treating those with developmental disabilities and managing their dental anxiety. Acknowledging that this relationship exists should encourage educational improvements in this area.

Dental care provision for people with neurodevelopmental disorders in Iran; a qualitative study of barriers

INTRODUCTION

One of the most underserved populations among dental patients is the people with Neurodevelopmental Disorders (PNDs). This study aimed to explore the barriers to dental care provision for PNDs from the viewpoint of stakeholders in provision in Iran.

METHODS

We arranged a qualitative study based on an individual in-depth, semi-structured interview between October 2019 and February 2020. We interviewed 30 participants using a snowball sampling strategy with three groups: dentists who provided dental care for PNDs, dental public health professionals, and policymakers/managers in dental care provision in Iran. The interviewer used an interview framework based on Levesque's model of patient-centered access. The main question was: "How do you assess the barriers to the provision of dental services to PNDs in Iran?" The data were analyzed by the qualitative content analysis method described by Graneheim and Lundman.

RESULTS

From the 30 interviewees (11 women), there were 11 dentists, nine dental public health professionals, and 10 participants who worked as policymakers/managers. They were aged 35-62 years and had working experience between 4 and 25 years. In the content analysis, 60 meanings units were extracted, and later classified into 14 subthemes, and four main themes.

CONCLUSION

Four main barriers were traced regarding access, financial, competency-related, and policy-making aspects.

Prognostic Factors for Successful Dental Treatment in Autistic Children and Adolescents

Aim

The aim of this study was to recognize and assess the prognostic factors which could predict the level of cooperation of children with autism for dental appointments.

Methods

A total of 395 parents of children with autism participated in this study. Prognostic factors of cooperation were evaluated using questionnaires. Data were collected using parent surveys by a dentist.

Statistical analysis

Statistical analyses used in the present study include the formation one way and two-way frequency tables, binomial tests, Pearson's Chi-squared tests, Fisher's exact test, and collation of multiple proportions tests.

Results

Autistic children meeting their own needs, cooperation for nail-clipping and haircuts, smiling frequently, using toothbrushes and toothpaste and being assisted by parents for toothbrushing, and children who brushed their teeth once a day were more cooperative with the dentist. Children who had thumb-sucking and nail-biting habits were cooperative with the dentist. Children who bit their hands appeared to be more cooperative with the dentist when compared to other self-inflicting habits.

Conclusion

This study identified "prognostic factors" such as their cooperative ability during nail clipping, hair cutting, and ability to read, write, and meet their own needs that are answered by a parent and that may show a child's cooperative potential.

How to cite this article

Chamarthi VR, Arangannal P. Prognostic Factors for Successful Dental Treatment in Autistic Children and Adolescents. Int J Clin Pediatr Dent 2023;16(S-1):S45-S50.

Cross sectional study on the competence and confidence of dental students and graduates in the management of medically compromised patients and acute medical emergencies

A rapidly aging population means many people have multiple health issues leading to an increased risk of acute medical emergencies. The objective of this study was to evaluate how essential experiential learning is in developing dental graduates' ability to manage medically compromised patients. Three hundred and twenty-seven students and graduates were invited to participate in an online survey to rate their confidence in managing medically compromised patients and acute medical emergencies using a 5-point Likert scale. Competence of knowledge was evaluated using 30 multiple choice questions (MCQs) across six domains. The respondents were also asked whether a theory-only training adequately prepared them to manage medically compromised patients, or whether it must be supplemented with clinical training. Two-hundred and sixty-four responses were collected from 75 undergraduates (UG), 96 junior dental officers (JDO) and 93 senior dental officers (SDO). The UG reported that they infrequently managed medically compromised patients, whereas both the JDO and SDO reported having frequent encounters with these patients. The mean confidence scale in the management of medically compromised patients were 2.62, 3.50 and 3.69 (out of 5), respectively. In contrast, their confidence scale in the management of acute medical emergencies was 2.05, 2.33 and 2.50 (out of 5), respectively. The MCQ scores were 25.51, 26.44 and 26.86 out of 30, respectively. The outcomes of the JDO and SDO were significantly better than the UG (t-tests, p<0.05). All three groups responded that a theory-only training in dental school did not adequately prepare them to manage medically compromised patients. Both the JDO and SDO felt that their clinical work experience better prepared them to manage these patients. Experiential learning from "real-life" clinical experience is an essential component in developing graduates' confidence and competence in the management of medically compromised patients. A dental curriculum with theory-only training in this aspect is inadequate.

Qualitative inquiry from multiple perspectives of barriers and facilitators of oral health care for adults with disabilities

AIMS

Adults with special health care needs (ASHCN) face significant disparities in access to oral health care and subsequent health outcomes, resulting from several etiologies. This study investigated perspectives of patients, caregivers, and providers to better understand care barriers and facilitators for ASHCN.

METHODS

We conducted 26 semi-structured interviews with a purposive sample from an academic clinic specializing in oral health care for ASHCN with disabilities [patients (N = 4), caregivers (N = 8), and providers (N = 14)], and thematically analyzed transcripts for care barriers and facilitators.

RESULTS

Three overarching themes that encompassed overlapping barriers and facilitators of oral health care for ASHCN emerged: relational aspects, provider training/experience, and infrastructure aspects. Themes include intersecting perceptions of factors that hinder or help oral health care and management of ASHCN.

CONCLUSIONS

Building relationships with patients, inherent empathetic provider characteristics, and accommodating clinical infrastructure are imperative to facilitate oral health care for ASHCN. The primary themes revealed in this study are facilitators to care when they are present, and barriers to care when they are absent. No individual theme stands alone as a single contributor to quality care, and the provision of care for ASHCN relies on coordination of providers, patients, caregivers, and the overarching infrastructure.

Evaluation of a special needs dental workshop for health professionals and students in Trinidad and Tobago

Aims

This study aimed to evaluate a special needs dental workshop for dentists, allied dental health professionals and students in Trinidad and Tobago.

Methods

This feedback study conducted in 2019-2020, included two surveys, one at the time of the workshop and a second survey one year after it. The first survey utilized an anonymous self-administered questionnaire enquiring about the reason for attendance, profession/education, demographics, and difficulties faced in treating patients with special needs. The follow-up study used an online survey tool assessing the workshop and queried comments/suggestions. The Chi-square test served for statistical analysis.

Results

Of the 176 attendees 131 participated (response: 74.4%). The majority (81.5%) were females. Most attendees were dental students (50.3%) or dentists (38.9%). Knowledge acquisition (73.1%) and professional development (14.2%) were the main motives for attendance while communication (31.8%) and non-compliance (34.5%) were the main problems faced in treating patients with special needs. The follow-up evaluation (post-workshop) (response: 72.5%) showed that most participants (90.5%) assessed the workshop as positive; 80% reported an increase in their knowledge and 64.2% perceived a need for further education.

Conclusion

These findings suggest a considerable demand for special needs dental services and continuing education and show that workshops can actively affect patient care.

Regulatory barriers to dental anesthesia services for special populations

AIMS

Sedation and general anesthesia are necessities for the treatment of many individuals within special populations such as those with physical and intellectual disabilities, fear/anxiety, or individuals requiring extensive procedures. This study aims to discover regulatory factors that may be contributing to the limited access to anesthesia services provided by dentist anesthesiologists.

METHODS AND RESULTS

The study included an online survey completed by self-reported dentist anesthesiologists with 2 or more years of formal anesthesia training. The survey was distributed at the April 2019 American Society of Dentist Anesthesiologists national meeting in Chicago. Participants responded to questions regarding the effect of specific state regulations on decisions to practice in a particular state and how such regulations influenced patient safety and barriers to care. Rules and regulatory restrictions on the mobility of dentist anesthesiologist equipment/supplies and additional state narcotic transportation regulations were deemed statistically significant in failing to improve safety. Requiring airway and sedation training for a facility's provider and staff were not barriers to care. Rules and regulations were not a factor to establishing clinical practice in one state over another state.

CONCLUSION

Individuals and organizations responsible for influencing the regulatory environment of anesthesia services should improve regulations to facilitate the mobility of dentist anesthesiologists.

Parental psychosocial factors, unmet dental needs and preventive dental care in children and adolescents with special health care needs: A stress process model

Background

Children and adolescents with special health care needs (SHCN) have higher unmet dental needs, but the potential mechanisms by which parental factors can influence dental care use have not been determined. Parenting a child with SHCN can present special demands that affect parents’ well-being and, in turn, their caregiving. Hence, the study's overall aim was to apply the stress process model to examine the role of parental psychosocial factors in the association between child SHCN and dental care. Specifically, the study tested hypotheses regarding how (a) children’s SHCN status is associated with child dental care (unmet dental needs and lack of preventive dental visits), both directly and indirectly via parental psychosocial factors (parenting stress, instrumental, and emotional social support) and (b) parental social support buffers the association between parenting stress and child dental care.

Methods

A secondary data analysis of the 2011–2012 US National Survey of Children’s Health was performed for 6- to 11-year-old children (n = 27,874) and 12- to 17-year-old adolescents (n = 31,328). Our age-stratified models estimated associations between child SHCN status and parental psychosocial factors with two child dental care outcomes: parent-reported unmet child dental needs and lack of preventive dental care.

Results

Parents of children with (vs without) SHCN reported higher unmet child dental needs, higher parenting stress, and lower social support (instrumental and emotional). Instrumental, but not emotional, parental support was associated with lower odds of their child unmet dental needs in both age groups. The association between parenting stress and child dental care outcomes was modified by parental social support.

Conclusion

Differences existed in child unmet dental needs based on SHCN status, even after adjusting for parental psychosocial factors. SHCN status was indirectly associated with unmet dental needs via parental instrumental support among adolescents, and parental instrumental support buffered the negative association between parenting stress and both child dental care outcomes. Hence, parental social support was an important determinant of child dental care and partially explained the dental care disparities in adolescents with SHCN.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02314-y.

Impact of disability diagnosis on dental care use for adults in the United States

BACKGROUND

Approximately 25% of adults in the United States have a disability that limits function and independence. Oral health care represents the most unmet health care need. This population has been found to have decreased oral health outcomes compared with the general population.

METHODS

The authors used the 2018 adult National Health Interview Survey to assess the association between disability status and dental care use (dental visit within or > 2 years). Disability status was categorized as adults with an intellectual, acquired, or developmental disability (IADD) that limits function, other disability that limits function, or no disability, on the basis of diagnoses of birth defect, developmental diagnosis, intellectual disability, stroke, senility, depression, anxiety, or emotional problem, all causing problems with function.

RESULTS

Adults with an IADD with functional and independence-limiting disabilities experienced higher crude odds of going 2 years or more without a dental visit than adults without disabilities (odds ratio [OR], 2.29; 95% CI, 1.96 to 2.67). This association was part of a significant interaction and was stronger among those with IADDs who could afford oral health care (OR, 1.73; 95% CI, 1.47 to 2.14) than among those who could not afford oral health care (OR, 1.21; 95% CI, 0.88 to 1.67; P value of interaction <.01).

CONCLUSIONS

Adults with IADDs have decreased access to oral health care compared with adults with other disabilities or without disabilities. The inability to afford oral health care lessens the impact of disability status.

PRACTICAL IMPLICATIONS

Dentists can use this study to understand the implications of IADD diagnoses on dental care use and make efforts to facilitate care for these patients.

Challenges experienced in the dental care of persons with special needs: a qualitative study among health professionals and caregivers

Background

This study aimed to explore the challenges experienced in dental health care by professionals and caregivers of persons with special needs in Trinidad and Tobago. This research presented results from the first qualitative study which gained insight into the service component of dental care for people with special needs in this country.

Methods

This qualitative study was conducted between March and June 2021. Recruitment of participants used both purposive and snowball sampling. A semi-structured interview schedule was used in the interviews of dentists, (a dental assistant), physicians and caregivers of people with special needs. Narrative inquiry was used in data analysis. The transcripts were individually coded and a follow-up peer debriefing session to cross reference responses and increase the validity of the analysis was performed.

Results

Barriers related to the provision of dental care included readiness of health care professionals, the level of specialized care and the resources required for patient treatment. Caregivers encountered barriers such as cost and lack of accessible dental care for persons with special needs. Possible solutions were education of key stakeholders, policy intervention, advocacy and prevention strategies.

Conclusions

Caregivers and allied health care professions experience multiple barriers when treating patients with special needs. Study participants indicated a need change in the provision and access of dental services for people with special needs. Education of healthcare professionals, improved social policies and health promotion is warranted.

Unmet Dental Treatment Needs and Barriers to Dental Care of Patients with Special Needs Attending a Dental Teaching Hospital

Objectives

This work attempted to determine the unmet dental treatment needs and self-reported barriers to continued care, in patients with special needs, attending a dental teaching hospital in the English-speaking Caribbean.

Methods

A chart audit of patients who were planned for comprehensive treatment for the period from August 1, 2015 to July 31, 2017 was used to determine the types of treatment required for the sample of patients. Treatment was classified as either urgent, preventive, or restorative. Restorative treatment was further divided into operative, endodontic, periodontic, and prosthodontic treatment. Reasons for not returning to the clinic to complete planned treatment care were ascertained via a telephone interview. A non-parametric McNemar change test for related samples at an alpha level of 0.05 was used to compare planned treatment with completed treatment.

Results

34% of patients with special needs had comprehensive treatment plans developed for the period under investigation. Preventive dental treatment was included in most comprehensive plans (96.1%). Large proportions of patients also required care for periodontal disease (65.7%) and operative management of caries (52.9%). While there was no significant difference between preventive treatment planned and received, there were significant differences in treatment planned and received for all types of restorative care. Major identified barriers included cost, accessibility, and psychosocial issues.

Conclusions

There was an unmet need for restorative and periodontal treatment. Major self-reported barriers to dental care included cost, accessibility to care in terms of transportation issues, and psychosocial issues.

Healthcare Access and Utilization for Young Adults With Disability: U.S., 2014-2018

PURPOSE

Young adults with disability experience barriers to healthcare access and are at risk for not receiving needed services as they transition from pediatric to adult health systems. This study examined patterns of healthcare utilization for young adults with disability and potential barriers to receipt of care.

METHODS

Data from the 2014 to 2018 National Health Interview Survey were analyzed to examine differences in service utilization, unmet need, care satisfaction, and financial worry between young adults (18-30 years) with and without disability (unweighted n = 15,710). Odds ratios were adjusted for individual, family, and interview characteristics.

RESULTS

Compared to those without disability, young adults with disability were more likely to have had an emergency room visit in the past year (39.2% vs. 19.5%). They were also more likely to have a usual source of care when sick (82.2% vs. 75%). Among young adults who affirmed they had a usual place of care, those with disability were more likely to use the emergency room as their usual place of care (5.3% vs. 1.8%). A greater percentage of young adults with disability delayed medical care due to cost (19.1% vs. 8.9%) and reported an unmet medical need (21% vs. 10.2%).

CONCLUSIONS

Findings highlight gaps in healthcare access for young adults with disability. Differences in healthcare utilization patterns for young adults with disability and factors that may negatively influence health outcomes for this population were found. Further research focused on the continuity of healthcare services in this age group through the healthcare transition period may provide additional insight into these discrepancies.

Enablers and barriers in dental attendance in Rett syndrome: an international observational study

AIMS

Intellectual and developmental disabilities are heterogeneous in aetiology and presentation, and one cannot make assumptions about the oral health barriers of those with Rett syndrome (RTT) based on findings from generic studies. This study investigated caregivers' perceptions regarding access to dental care for those with (RTT), and associations of dental treatments received by those with RTT with their caregivers' perceived value of oral health and perception of their own as well as their daughter's dental anxiety.

METHODS AND RESULTS

Retrospective observational data of a subset of individuals with confirmed MECP2 mutations in the InterRett database (n = 216) were used to explore caregiver-related factors and their relationships with longitudinal data on dental service utilisation, using negative binomial regression. The main reported barriers to dental care access for individuals with RTT were primarily dentist-related in nature, regardless of dental service history. Those with reported dental nonattendance were of older age. Increasing levels of caregiver-reported dental fear were associated with less frequent dental check-ups or for any appointments for affected individuals.

CONCLUSIONS

Dentist-related barriers and caregiver-reported anxiety may both adversely affect dental attendance for those with RTT. Future research should explore caregivers' beliefs and oral health literacy.

Oral health care for people with disabilities in Brazil: Transition from the specialized dental services between 2014 and 2018

OBJECTIVE

To identify changes in the dental service provision to people with disabilities (PD) in the Dental Specialties Centers (acronym CEO in Portuguese-Centro de Especialidades Odontológicas) between the first and second cycles of the Program for the Improvement of Access and Quality of CEO and analyse factors associated with any changes.

METHODS

This nationwide ecological time series study adopted the CEO as the analysis unit. The 827 CEO who participated in the two program's cycles (2014 and 2018) were included. Data on the structure and the work process were considered to identify features of providing services to PD in both cycles. Latent transition analysis (LTA) was performed to identify latent status (LS) with similar features and model the transition between LS over time. Models with five variables and with two to five LS were tested, considered best conceptual interpretability and best model fit parameters: human resources structure (dentist working exclusively with PD) and work process that identified guarantee of PD treatment at the CEO, the CEO's interface with primary care, and the interface with tertiary care. Spatial analysis was performed to identify spatial patterns of LS in the Brazilian territory with choropleth maps. A multinomial logistic regression model was performed to identify factors associated with changes in the provision of CEO (improved, remained or worsened).

FINDINGS

The best-fit model identified four LS: 'Better', 'Medium better', 'Medium worse' and 'Worse'. CEO remained in the LS 'Better' (94%), LS 'Medium' (5.3%) and LS 'Worse' (78.4%). It is noteworthy that the highest proportion of CEO, in both cycles, was in the LS 'Better', featured by the CEO, characterized by all the CEO guaranteeing treatment to users with PD, high proportions of professionals working exclusively with PD, and most CEO articulated with primary care and with tertiary care. However, there is a decrease in the number of postgraduate professionals specializing in this service profile (1.3%). The higher the population growth, the greater the likelihood of the CEO achieving 'improved' in the LS. Moreover, the higher the number of goals, the lower the likelihood of the CEO getting 'worse' in the LS.

CONCLUSION

Advances in dental service provision were observed, with more significant transitions to the 'Better' class, with improvements mainly in the interface with primary and tertiary care. Disability will be an even more significant concern as the population ages. Initiatives that can remove barriers and empower PD are potent in the provision of oral health services.

Provision of dental services for vulnerable groups: a scoping review on children with special health care needs

BACKGROUND

The provision of dental services for children with special health care needs (CSHCN) needs to be considered by policymakers. This study is aimed to explore the determinant factors affecting dental and oral services provision for this vulnerable group.

METHODS

A review was conducted applying the 9-steps approach. Five scientific databases of PUBMED, SCOPUS, Web of Science and PROQUEST and EMBASE were searched up to 10.07.2021, applying appropriate keywords. Thematic analysis was used to analyse the extracted data, and a conceptual map was developed according to JBI manual for evidence synthesis.

RESULTS

From the abstracts of the 136 articles that fulfilled the inclusion criteria, 56 articles were included. Five main themes were identified as determinants affecting the provision of dentistry services for CSHCN, including needs assessment, policy advice, oral health interventions, providers' perception and access barriers. According to the developed conceptual map, assessing the needs of CSHCN can lead to particular policy advice. Regarding the policies, appropriate oral health interventions can be presented. These interventions, along with providers' perception about service delivery to CSHCN and the barriers to access them, determine the provision of dentistry services for CSHCN.

CONCLUSIONS

An effective needs assessment of CSHCN and their parents/carers can lead to evidence-informed policymaking and applicable policy advice according to the needs. Then policymakers should develop interventions to improve the community's health literacy, as well as support the seeking behaviours for appropriate services. Policymakers should also consider how to limit the barriers to accessing oral and dental health by CSHCN to decrease disparities.

Dental visit experience and dental care barriers among Hong Kong preschool children with special education needs

BACKGROUND

Children with special education needs (SEN) require additional supports in education settings, as well as extra supports in healthcare services.

AIM

To investigate dental visit experience and dental care barriers among Hong Kong preschoolers with SEN.

DESIGN

This was designed as a cross-sectional study. A structured questionnaire was employed to investigate dental attendance and dental care barriers among Hong Kong preschoolers with SEN. Binary logistic regression and multi-factor ANOVA were performed to identify factors associated with children's dental visit experience.

RESULTS

A total of 383 children were included in the final analysis. The average age of the recruited children was 3.87 ± 0.95 years. 72.5% parents reported that dental visits were a challenging task for their children. Among children with caries, 70.7% had never visited a dentist. Regression models indicated that (a) children over 3 years or children whose parents received tertiary education were more likely to visit a dentist; (b) the existence of dental care barriers was associated with children's primary diagnosis, practical skills, conceptual skills, and parents' education attainment; and (c) children with low conceptual skills (95%CI:0.71 to 2.40, P < .001), or children from low-income families (95%CI:1.21 to -0.06, P = .031) had more dental care barriers than their counterparts.

CONCLUSION

Unmet dental treatment needs and dental care barriers existed among pre-schoolers with SEN. Dental care barriers were associated with children's developmental profile, parents' education attainment, and household income.

Oral Health Among Children and Youth With Special Health Care Needs

OBJECTIVES

We sought to estimate the prevalence of oral health problems and receipt of preventive oral health (POH) services among children and youth with special health care needs (CYSHCN) and investigate associations with child- and family-level characteristics.

METHODS

We used pooled data from the 2016-2018 National Survey of Children's Health. The analytic sample was limited to children 1 to 17 years old, including 23 099 CYSHCN and 75 612 children without special health care needs (non-CYSHCN). Parent- and caregiver-reported measures of oral health problems were fair or poor teeth condition, decayed teeth and cavities, toothaches, and bleeding gums. POH services were preventive dental visits, cleanings, tooth brushing and oral health care instructions, fluoride, and sealants. Bivariate and multivariable logistic regression analyses were conducted.

RESULTS

A higher proportion of CYSHCN than non-CYSHCN received a preventive dental visit in the past year (84% vs 78%, P < .0001). Similar patterns were found for the specific preventive services examined. However, CYSHCN had higher rates of oral health problems compared with non-CYSHCN. For example, decayed teeth and cavities were reported in 16% of CYSHCN versus 11% in non-CYSHCN (P < .0001). In adjusted analyses, several factors were significantly associated with decreased prevalence of receipt of POH services among CYSHCN, including younger or older age, lower household education, non-English language, lack of health insurance, lack of a medical home, and worse condition of teeth.

CONCLUSIONS

CYSHCN have higher rates of POH service use yet worse oral health status than non-CYSHCN. Ensuring appropriate use of POH services among CYSHCN is critical to the reduction of oral health problems.

Oral health care and service utilisation in individuals with Rett syndrome: an international cross-sectional study

BACKGROUND

There is a dearth of literature available on the comparative oral health status of those with Rett syndrome (RTT) despite diurnal bruxism being a supportive diagnostic criterion for the disorder. This study was designed to investigate the dental experiences of individuals with RTT in terms of perceived at-home and professional dental care.

METHODS

Using data in the InterRett database, provided by English-speaking families of individuals with a confirmed MECP2 genetic mutation, the study investigated relationships between dental problems, oral care, child factors including bruxism and use of gastrostomy, and socioeconomic indicators. The study also explored relationships between dental presentations and socioeconomic, child, and family-related factors.

RESULTS

Individuals with RTT exhibiting bruxism were more likely to access dental treatment. Those who had full oral feeding had a higher incidence rate of dental treatment than those with full tube feeding. A conservative (under) estimation of the overall dental caries progression rate revealed that this may be similar to that of the normal population.

CONCLUSIONS

Drivers for dental treatment in RTT include bruxism as well as dental caries. Those who have full oral feeding experience more dental treatment than those with full tube feeding. A higher maternal education level may confer a protective effect for oral health outcomes in those with RTT. Nevertheless, families generally tended to value the importance of oral health despite reported difficulties in day-to-day mouth care.

Special care dentistry perception among dentists in Jakarta: An online survey study

Special Care Dentistry (SCD) or Special Needs Dentistry is a branch of dentistry concerned with the oral health of people with a variety of medical conditions or limitations that require more than routine delivery of care. There were reports on oral status of special care patients and special interest group for SCD dentists in Indonesia has existed. However, there was not perception report on SCD amongst dentists in Jakarta. This paper will describe the perception of dentists in Jakarta towards SCD. A cross-sectional questionnaire, translated and cross adapted to Indonesian, was distributed online through Whatsapp to dentists registered in Jakarta late 2019. Quantitative data was analyzed using statistical software for proportion and correlation using Chi-Square test. The questionnaire explored dentists’ perception towards SCD. A total of 250 dentists participated in this study, of them 173 general practitioners and 77 specialist dentists. Most respondents reported that they did not have SCD component during undergraduate dental school and did not provide treatment to patients with special needs in their clinical practice. Most respondents have poor perception of SCD, however, most of the respondents showed motivation and interest towards SCD training. Dentists in Jakarta involved in this study had poor perception of SCD. More efforts should be performed to improve SCD education and awareness.

Perspectives of the public dental workforce on the dental management of people with special needs

BACKGROUND

People with special health care needs continue to have difficulties accessing regular dental care partly due to oral health professionals feeling they lack the knowledge and experience to provide treatment to these individuals.

METHODS

Qualitative interviews and focus groups provided an insight into the types and nature of supports that oral health professionals working in the Australian public dental system desired and felt may improve their willingness and/or ability to treat patients with special needs.

RESULTS

Although participants did not identify one group of patients with special needs that were more difficult to treat, they did report a feeling of being unsupported. Clinicians felt that improved training and access to ongoing education in Special Needs Dentistry, opportunities for greater support from specialists or other health professionals, either through networking or other media such as telehealth, and fostering a more supportive clinical environment, particularly in relation to appointment lengths and productivity pressures, may improve their willingness and ability to treat patients with special needs.

CONCLUSIONS

Additional support, in the form of greater interaction with specialists and reduced time and productivity pressures, may improve the willingness of oral health professionals in the public dental system to treat patients with special needs.

Epidemiological profile of patients with disabilities undergoing dental treatment under general anesthesia

Abstract Introduction General anesthesia is commonly used in the dental treatment of people with disabilities, anxious or difficult behavior, who need complex and/or extensive treatments. Objective The aim of this study was to evaluate the epidemiological profile of patients with disabilities undergoing dental treatment under general anesthesia by the team of the Dental Unit for Patients with Special Needs of the Federal University of Sergipe. Material and method Through the analysis of 371 dental records of patients assisted between August 2002 and March 2019. Result The analysis showed that 56.1% of patients were male, the most prevalent age group was 11-20 years, and the most frequent medical conditions were intellectual disability, followed by multiple disabilities. Relative to dental procedures, in 94.1% of the patients, it was observed that 4,056 dental extractions were performed and in 52.3% of patients, 1,156 restorations were performed. In 30.2% of patients, total multiple extractions were performed. Radiographic examination was performed in 51.8% of patients. As regards the origin of patients, 58.8% were from municipalities in the state, other than the capital. Return to the service for follow-up and prevention was observed in 38.5% of patients. Conclusion There is great need for early dental intervention, with specific preventive actions for this group of patients, focusing on those from interior regions of the state.

Photodentistry - an innovative approach to improving students' empathy and learning experiences in comprehensive patient care

OBJECTIVES

Preparing future dental school graduates to provide comprehensive patient care with empathy requires the completion of adequate training in such practice. This study was undertaken to investigate the effectiveness of the Photodentistry learning activity, which uses visual arts, in improving dental students' empathy and learning experience in comprehensive patient care.

METHODS

All fourth-year undergraduate dental students (n = 69, response rate = 100%) participated in the Photodentistry learning activity developed by specialists from the areas of dentistry, arts, education, and psychology. A survey using the Toronto Empathy Questionnaire (TEQ) was conducted both pretest and posttest, followed by an open-ended written survey of their reflection towards the learning activity. Quantitative data were analyzed via paired t-test (P < 0.05), while qualitative data were analyzed using thematic analysis.

RESULTS

There was a significant increase in both students' total mean empathy score and the individual scores for 8 (out of 16) items of the TEQ after the learning activity. Students stated that they had an improved understanding of managing patients in a comprehensive manner (e.g., managing medically compromised patients, performing treatment planning, communication with patients who have special health care needs). Students also reported the development of skills (e.g., observation, critical thinking) and positive attitudes (e.g., empathy, responsibility) towards patients.

CONCLUSION

Photodentistry is an effective learning approach for improving dental students' empathy and learning experience in comprehensive patient care.

Extramural Oral Health Educational Program Involving Individuals With Disabilities: Impact on Dental Students' Professionalism

Context

Oral health inequalities experienced by patients, including people with disabilities (PWD), have been related to dentists' lack of professionalism and inadequate experience in managing patients with special needs.

Aims

This study investigated the impact of an extramural program involving PWD on dental students' professionalism and students' perception of training in managing patients with special needs.

Materials and Methods

A group of 165 undergraduate dental students (year 1 to year 5) participated in a voluntary program, involving 124 visually impaired children, at a special education school in Kuala Lumpur, Malaysia. A dedicated module in oral health was developed by specialists in special care dentistry, pedodontics, and medical sciences. Dental students then participated in a semi-structured focus group interview survey to discuss perceptions of their learning experiences. Qualitative data were analyzed via thematic analysis.

Results

The program had positive impact on various aspects categorized into four major domains: professional knowledge (e.g., understanding of oral-systemic-social-environmental health interaction and understanding of disability), professional skills (e.g., communication and organizational skills), professional behavior (e.g., empathy and teamwork), and value-added learning (e.g., photography and information technology skills). Students showed improved willingness to manage, and comfort in managing PWD, and expressed support for future educational programs involving this patient cohort.

Conclusion

Improved knowledge, skills, attitudes, and personal values, as well as support for future programs, indicate the positive impact of extramural educational activities involving PWD in developing professionalism in patient care, while providing an opportunity for students to be exposed to managing patients with special needs.

Oral health care for patients with developmental disabilities: A survey of Michigan general dentists

AIMS

The aim of this study to examine the level of access to dental care in Michigan for individuals with DD and explore the dentists' practices, attitudes, and perceived barriers to providing care to this vulnerable population.

METHODS AND RESULTS

A survey was mailed to a random sample of 1250 general dental practitioners with an active license in the State of Michigan. The survey included questions related to dentists' demographic information, opinion about willingness, barriers, and training needs associated with delivering care to children and adults with developmental disabilities. Descriptive statistics were computed and chi-squared tests and logistic regression models analyzed the association between predictor and key outcome variables. Results show that most dentists treated individuals with developmental disabilities (80.3%). Respondents who indicated that they currently do not treat these patients identified behavior management of patient (67.9%), inadequate training and experiences (52.4%) and severity of patient's condition (41.7%) as the most common reasons for not providing care to individuals with developmental disabilities.

CONCLUSION

A majority of Michigan general dentists treat patients with developmental disabilities. Addressing barriers like training and improved reimbursements might help in increasing the number of dentists willing to treat patients with developmental disabilities.

Problems with access to dental treatment for children with epilepsy

INTRODUCTION

Epilepsy is a common medical disorder and due to a variety of barriers, people with epilepsy may not have access to needed healthcare services, particularly based on their place of residence.

OBJECTIVES

The aim of the study was to assess access to dental treatment in children and adolescents with epilepsy in Lublin Voivodeship.

MATERIAL AND METHODS

Clinical and questionnaire examinations were performed in 107 children and young people, of both sexes, in the ages between 6 and 18years old from the Lublin macroregion.

RESULTS

The majority (77.57%) of respondents regularly visited a general practitioner. Most of the children did not undergo regular dental checkups. Children from the large cities significantly more often went to a dentist compared with examinees from a small town and from rural areas. According to the respondents 46.73% have encountered barriers to dental care of their child.

Practicing Dentists' Self-Efficacy and Associated Factors in Managing the Treatment of Adults with Mental and Physical Disabilities: An Exploratory Cross-Sectional Study in Riyadh, Saudi Arabia

Background: Provision of oral healthcare to adults with mental and physical disabilities (AMPD) remains a challenging area across various healthcare systems. The present study aimed to assess self-reported efficacy and investigate factors associated with self-efficacy in the management of AMPD among practicing dentists in Saudi Arabia. Methods: A pilot-tested, self-administered questionnaire was distributed to a convenience sample of 1000 dentists. Descriptive and inferential analyses were performed on the collected responses. Results: Among the respondents (54%), 43% were males. Only 14% described their self-efficacy in managing AMPD as "High". Multivariable regression analyses revealed significant associations between "High" self-efficacy and male gender (Odd ratio (OR) = 2.39, 95% CI = 1.16-4.89), experience practicing dentistry for 11 years or more (OR = 2.19, 95% CI = 1.04-4.47), specialization in pediatric dentistry (OR = 3.98, 95% CI = 1.31-12.07), previous experience in managing AMPD (OR = 4.23, 95% CI = 1.59-11.22), and awareness of regulations for managing AMPD (OR = 2.62, 95% CI = 1.42-4.38). The interaction of gender x age was significantly associated (p = 0.028) with "High" self-efficacy. Gender-stratified analyses revealed a significant association between age and "High" self-efficacy among male dentists only. Conclusions: The findings of the present study highlight that a large percentage of dentists reported "Low/Moderate" self-efficacy in managing AMPD, particularly among female dentists. However, further studies are required to verify the factors associated with self-efficacy in the present study, and to identify other factors that may influence self-efficacy in managing AMPD.

Making Treatment of Special Needs Patients an Important Part of Your Growing Dental Practice

Today many young dentists want to find a way to make their practices satisfying in ways other than the financial rewards of dentistry. Some of these practitioners have gained additional training in diagnosis and treatment of medically and physically compromised patients in hospital-based, general practice residency programs. A hospital affiliation can create a unique niche that will allow dentists to differentiate themselves from other dentists. By welcoming those ongoing relationships for patients with special needs, and having the resources and desire to treat them, dentists will achieve greater visibility and a reputation as caring, capable practitioners in their community.

Changing Population Health Policy: A Model for Identifying Health Needs and Recommendations to Improve Health Status

In the spring of 2014, the North Dakota Center for Rural Health (CRH) was tasked with completing an objective assessment of the state oral health environment. This included an assessment of oral health status, review of workforce needs, evaluation of current oral health programs, and policy recommendations to ameliorate identified oral health needs. The report was prepared for the North Dakota Legislative Health Services Interim Committee. This article highlights a research method developed and employed to identify current population health status and policy recommendations through statewide collaboration, transparent process, and objective analyses, regardless of the health specialty of focus. Evidenced-based decision making in health policy requires more than presentation of data. It requires input from the population or community utilizing or struggling to gain access to the given health service. It is now understood that health services researchers must employ a variety of research methods, include end users in the research process, tailor presentation of the findings for the appropriate audience, and include the population of study in the research, allowing them to provide recommended solutions when possible. Although the effort to be described focused specifically on oral health in North Dakota, the methodologies used to answer the research questions could, and are encouraged to, be employed in other states with regard to other specialty health disciplines and population health studies. The study sought to answer 3 questions: (1) What is the population health need?; (2) What is already being done?; and (3) What are the recommendations to improve population health? (Population Health Management 2016;19:216-223).