Guidelines for Medical Immobilization/Protective Stabilization for Your Practice

Many patients with special healthcare needs present to medical, dental, and other health visits with behavioral, emotional, postural, and psychological issues. According to the American Academy of Developmental Medicine and Dentistry (AADMD) guidelines from 2017: "Clinical dental treatment is the most exacting and demanding medical procedure that persons with special needs undergo on a regular basis throughout their lifetime." Moreover, dental treatment is basically surgical in nature, usually requiring controlled placement of sharpened instruments in intimate proximity to the face, airway, and highly vascularized and innervated oral tissues. When medically necessary healthcare must be provided and the patient's inability to accept or cooperate will compromise the quality of care the clinician will be able to deliver, interventions may be indicated and implemented.

From Restraint to Medical Immobilization/Protective Stabilization

Clinical dental treatment is the most exacting and demanding medical procedure that persons with special needs undergo on a regular basis throughout their lifetime. Dental treatment is surgical in nature, usually requiring controlled placement of sharpened instrumentation in intimate proximity to the face, airway, and highly vascularized and inner aged oral tissues. Although approximately 90% of patients with special needs can and should be mainstreamed through any general dental practice, without significant behavioral guidance, techniques, or medical immobilization/protective stabilization, there has been a drastic shift toward pharmacologic management of these patients using various forms of sedation and general anesthesia.

The largest minority population in the U.S. without adequate dental care

A recent series of reports in Health Affairs reviewed the disparities in securing needed oral health services in the U.S. Despite an extensive oversight of the many issues involved, no direct mention is made of the particular conditions of the largest minority population in the U.S. unable to access dental care-the tens of millions of individuals with special health care needs. A review is provided of the particular barriers and conditions faced by this increasing population in its efforts to secure needed services.

Special Smiles: Sports Dentistry and the Special Needs Athlete

There is a need to expand dental services to underserved populations, such as athletes with intellectual and developmental disabilities. This review introduces dentists to this need by sharing the direction taken by the Special Smiles program of Special Olympics and addressing the need to educate special needs athletes on prevention and care of sports-related mouth injuries.

Traumatic dental injuries in children with special health care needs

BACKGROUND/AIM

Children with special healthcare needs (CSHCN) are at an increased risk for traumatic dental injuries (TDI) due to unique predisposing factors; moreover, their access to dental care is compromised. In Jordan, there is a need to study TDI among CSHCN to highlight their dental care needs. The aim of this study was to identify the prevalence, types, possible risk factors associated with TDI, and treatment-seeking behavior in CSHCN in Jordan.

MATERIAL AND METHODS

Children (n=959) were examined in schools/centers for CSHCN, and compared to a healthy age- and gender-matched control group. Data concerning demographics, types of trauma, risk factors associated with TDI, and treatment-seeking behavior were collected. Data were analyzed using SPSS for descriptive and bivariate analyzes. Significance level was set at P≤.05.

RESULTS

Prevalence of TDI in the study group (age, 11.76±4.2 years) and control group (age 11.70±4.2 years) was (83 of 959, 8.7%) and (42 of 1010, 4.1%), respectively. TDI prevalence was highest in children with multiple disabilities (14.0%), followed by intellectual disabilities (13.1%), and cerebral palsy (12.2%). The most common type of TDI was an uncomplicated crown fracture (91.0%). Increased overjet and incompetent lips were significant risk factors associated with TDI. Reasons for not seeking treatment in the study vs control group included parental attitude and lack of dental awareness (68.1% vs 60%), difficulties getting an appointment and availability of dental clinics willing to see CSHCN (36.2% vs 0%), P≤.01, and financial reasons (31.9% vs 40%).

CONCLUSIONS

Prevalence of TDI was higher in CSHCN, and associated with increased overjet and incompetent lips. Uncomplicated crown fracture was the most common injury. In both groups, the main reason for not seeking treatment was lack of dental awareness among parents/caregivers; however, difficulties in getting an appointment and availability of dental clinics willing to see children were more prominent in the CSHCN group.

Dental Economics and the Increasing Hispanic Population in the U.S. and New York State

The continuing dramatic increases in the U.S. Hispanic population are considered relative to the economic concerns of dental practice. Oral health needs, limited finances and health insurance, together with varying cultural orientation, are reviewed in terms of the potential for growing Hispanic political strength.

Tennessee Dental Establishments: 2007-2012 Economic Survey

OBJECTIVE

To document the evolving economies of dental establishments in the State of Tennessee during a period of significant growth of the number of establishments before and after the "Great Recession."

METHOD

Published results from the five-year economic surveys by the U.S. Census Bureau on business receipts and salaries of employees (including dentists) for the State of Tennessee and its counties were used to construct a review of these developments.

RESULTS

Between 2007 and 2012, there were continued increases in average current dollar business receipts and employee salaries. However, in terms of standard dollars, removing the effects of inflation: 1) business receipts increased in 19 counties but decreased in 37 counties; 2) employee salaries increased in 13 counties but decreased in 30 counties.

CONCLUSIONS

Results are in line with the reports by the ADA Health Policy Institute, which indicate that nationally the percentage of dentists who report they are not busy enough has increased and dentists' earnings are stagnating. The need is to expand the delivery of care to underserved populations, including the poor, individuals with disabilities, minorities and new immigrant populations, for whom oral health services may not be a priority commodity.

Increasing Nonemployer Dental Establishments in New York State: A Component of a Changing Landscape

The increasing numbers of nonemployer dental establishments in the counties of New York State are a component of the evolving landscape for the delivery of dental services throughout the country. Limited attention has been directed to the more than 4,000 of these facilities in the state and the more than 43,000 in the nation. Increased attention needs to be directed to nonemployer facilities as the profession comes to terms with its economic concerns, legal challenges to delivery modalities and evolving population characteristics.

Dental Economics and the Increasing Numbers of Individuals with Disabilities in New Jersey

The dual needs of 1) providing increasing oral healthcare for individuals with special needs, and 2) improving the economics of dental practice, are explored in a review of the State of New Jersey and its counties.

Access to Dental Care Depends on Appreciation of Demographics and Economics

The evolving demographics and economics of dental practice require consideration as the profession plans forfuture changes in the dental workforce, the makeup of the population and ongoing access to care crisis. This paper is a sampling of U.S. Census Bureau reports on demographics and an appraisal of JADA and ADA News statements regarding the economics of dental practice, as well as a review of historical developments of the profession's perceptions of dental education and government support for dental care. The trends in economics and population-based changes affecting U.S. dental practice indicate a general downturn in practice busyness, stagnation of expenditures for dental services, and a continuing increase in the proportion in minorities throughout the country and the limited ability to make changes in dental economics without altering some long-held views on the delivery of dental services. Customary populations which provided the bulwark of dental practices are being replaced by minorities.The economics of dental practices will be dependent upon (a) developing cultural and structural competence in the economics of the evolving shift in population demographics, (b) implementing changes in the economics of dental education and expansion of delivery models,

Ethics, Economics and Dentistry for Individuals with Disabilities in New York State

The ADA Principles of Ethics and Code of Professional Conduct is an expression of the obligation occurring between the profession and society to meet the oral health needs of the public. At a time of economic concerns for the profession, suggestions are made to bring together the ethics of the profession and the need to expand services to underserved populations, including individuals with disabilities and the poor. The profession's effort to secure economic support for such an effort is possible with increased legislative awareness of the magnitude of the problem. To this end, the number of individuals with disabilities was developed for each Congressional district in New York State in an effort to challenge members of Congress to recognize the need in terms of their constituents, rather than in terms of the tens of millions with disabilities in the United States-which become "just numbers," not actual people.

New York State Dental Establishments and Dentists: 2007-2012. Economic Survey

Every five years a series of studies is carried out by the Census Bureau which provides an opportunity to review the basic economic well-being of the many industries at the national, state and county levels. A comparison of dental economic data from the 2007 and 2012 studies for the period that encompassed the 2007-2009 "Great Recession" details the general economic difficulties faced by the dental profession during this period.

Dental Practice as the Population Demographics Change in Massachusetts

General population demographics in the United States, individual states, and counties are undergoing dramatic changes. Long-term customary populations, which provided the bulwark for many successful dental practices, are being replaced by the many minority populations (in particular, the Hispanic population), foreign-born residents, and many for whom English may not be their first language. These developments are reviewed for the Commonwealth of Massachusetts and its counties in an effort to challenge practitioners by the extent of these developments.

Increased number of dental professionals in New York State counties

Despite decreases in the population for 49 of the 62 counties in New York State between 2006 and 2013, the number of dentists increased in 52 counties. In addition, in 2013, there were more dental hygienists than dental establishments in 54 of the state counties. This change in landscape from 2000 to 2006, when the number of dentists decreased in 27 counties and a sizeable proportion of the state had little or no coverage, is reviewed using federal and state government reports.

Use of oral healthcare and need to expand population that is served: a commentary

General population demographics are undergoing dramatic changes. Long-term customary populations that provided the bulwark for successful dental practices are being replaced by the many minority populations. Despite these significant general population developments, the demographic profile of the dental profession has experienced (and, apparently, based on dental student populations, will continue to experience) limited changes. The economic strength of the profession may well be predicated upon its responses to these developments. The question remains, "Is the profession preparing for them?".

Texas dental establishments in 2011

OBJECTIVE

To document the evolving Texas dental establishment pattern between 2000 and 2011 as the profession seeks to provide care to the burgeoning population of the state.

METHODS

Published results from the Department of Commerce, Census Bureau's annual study of business patterns for each county and state (with specific information on numbers of establishments, employees, salaries and resident population) were used to permit a review of these developments.

RESULTS

Between 2000 and 2011 there was an almost 30% increase in dental establishments, predominantly in establishments with greater number of employees. Statewide the average number of employees per establishment increased to 6.6, ranging by county from 3.6 to 9.9 employees; with an average state salary of $47,000, ranging by county from an average of $35,000 to $59,000.

CONCLUSION

The burgeoning state population growth is being matched by a greater proportional increase in dental establishments, but a smaller percentage increase in the number of dentists. The need to monitor dental establishment activities beyond the confines of one's own facility is emphasized.

New York State after last recession. Dentists and dental establishments

Data from the U.S. Census Bureau and the New York State Office of the Professions indicate an increase in emigration and immigration, resulting in slowing in the overall growth of New York State's population, with accompanying modifications in the numbers of dentists and dental establishments in state counties. In addition, ADA data suggest that per capita dental spending has not rebounded since the end of the last recession. While there have been many changes at the county level, there does not seem to have been dramatic changes in the overall state numbers of dental practitioners and establishments through the early years of the current decade.

Impact of residency requirement for dental licensure: an update

As of 2007, New York State Education Law requires successful completion of dental school training and completion of an approved dental residency program for dental licensure. In a transitional period, from 2003-2006, a dental licensure applicant could select the path of an approved residency program or the New York State-recognized regional standardized clinical examination. By contrast, in 2007, the state of Connecticut adopted and continues to abide by regulations that permit licensure by either completion of an approved residency program or passage of the recognized regional standardized clinical examination. A review of the changing number of dentists licensed in these two adjoining Northeastern states under new licensure guidelines is considered in terms of the possible relationship to the new licensing process.

Massachusetts dental establishments in 2011: after the last recession

Census Bureau reports for 2007 and 2011 (before and after the last recession) were used to develop data for "average" dental establishments in the counties of Massachusetts. Any changes should be considered while bearing in mind the American Dental Association (ADA) 2013 report indicating that spending for dental services has stagnated. In terms of these findings, the need for continued monitoring of dental establishment activities beyond the confines of one's own facility is emphasized.

The proportion of elderly in Pennsylvania is slipping but

Media reports describing the anticipated increase of tens of millions of elderly residents and their attendant billions of dollar costs for health services during the next decades are difficult for any person to place in proper perspective. As a result, these estimates become "just numbers" not actual people. Census Bureau reports are used at the national, state and county levels to provide an increased meaningful picture when the 65 and older population of Pennsylvania will increase to 22.6 percent of the state population. In 2000, 12.4 percent of the U.S. population was 65 years and older (15.6 percent in Pennsylvania, 1.9 million elderly). Only in the state of Florida was the proportion greater. In 2010, the proportion of elderly in the population of Pennsylvania ranked 4th (behind Florida, West Virginia and Maine). It was tied for 3rd (behind Florida and North Dakota) with 2.5 percent of the population 85 years and over. By 2030, the projected number of elderly in Pennsylvania (22.6 percent of the state population) will rank 11th. But ... "Starting on Jan 1, (2011) our 79-million-strong baby boomer generation will be turning 65 at the rate of one elderly every eight seconds.

Many people unable to obtain dental care due to cost

While overall spending for dental services appears to be favorable during the period after the last recession, a review of a series of government and private agency reports indicates an increasing proportion of the population is unable to secure needed services due to cost factors. In addition, projections for annual increases in future spending for dental services are lower than for other professional health services.

New York State ranked favorably for adults and reasonably well for children in terms of oral health standards

Results from the National Health Interview Survey place New York State at or near the top among states for the oral health standards of its residents. Nevertheless, continued unmet service needs exist, particularly for minority populations, individuals in lower income families and residents with disabilities.

Fewer children in New York State

Census Bureau reports for the 2010 Census detail the slowing overall growth of the number of children, with specific emphasis on the increasing proportion of Hispanic children in the population. A review of these data at the national and state levels, in particular, New York State and its counties, is carried out with regard to potential developments in dental services for children.

Ensuring oral health for older individuals with intellectual and developmental disabilities

AIMS AND OBJECTIVES

To emphasise the oral health needs of older individuals with intellectual and developmental disabilities, the impact on the individual's general health and the role that can be played by nurses.

BACKGROUND

All too often an examination and consideration of the oral health condition of this patient population by nurses/physicians is cursory at best. The increasing retention of the dentition into later years of life provides both the favourable abilities for eating, speech and self esteem, but also the potential for local and general health concerns.

DESIGN

Discursive paper.

METHOD

Based on the findings from dental examination of thousands of international athletes in the Special Olympic Games and clinical experiences in academic and private practice settings for care of individuals with intellectual and developmental disabilities, a discursive listing was developed for use in a preliminary examination of the oral cavity.

CONCLUSION

A nurse can play a critical role in the examination, preventive services and referrals for dental care for older individuals with intellectual and developmental disabilities.

RELEVANCE TO CLINICAL PRACTICE

The specific oral health needs of older individuals with intellectual and developmental disabilities should be an integral component of the preventive and general health care provided by nurses.

How many residents with disabilities are there in Massachusetts?

The availability of the U.S. Census Bureau data for 2010 provides an opportunity to review the increasing child, adult, and elderly populations with disabilities and the reality that there are individuals with disabilities not only in the larger population centers, but also in the small towns throughout the Commonwealth of Massachusetts.

Dental establishments in Tennessee

Census Bureau data indicate a continuing national increase in the number and size of dental establishments. These developments are reviewed for the State of Tennessee during the past decade, including the number of establishments, employees, population per establishment and related factors.

Dental health of children with autism spectrum disorders: a population-based study

Data from the 2007 National Survey of Children's Health were used to investigate how autism spectrum disorder (ASD) symptom severity and comorbidity are associated with the dental health needs of children. The results of this study help provide insights into the greater oral needs of the increasing population of children with ASD that reside in our communities and their dependency upon local practitioners for treatment.

Would you believe that about 1-in-5 U.S. children has a disability?

A review of a series of federation reports documents the numbers of youngsters with a variety of special health care needs who are residents in our communities and are dependent upon local dentists for needed services. The increased costs for health care and complexities of access to this care are emphasized. While dental schools have introduced changes in their curricula to improve the preparation of new graduates to provide services for patients with special health care needs, the challenge is to provide current practitioners with programs to ensure the treatment of youngsters (and the not so young) with disabilities.

More than 71 million seniors (including 26 million with disabilities) will reside in the United States in 2030

In the coming years the United States will experience a burgeoning number of senior residents, including those with disabilities. A review of these developments and the dental and medical concerns in the delivery of dental services is presented.