Management of Persons With Special Health Care Needs

From Pediatric Dentistry vol. 28 No. 7 reference manual

Guideline on Management of Persons with Special Health Care Needs

Summary by Kris Hendricks

Purpose: AAPD accepts its responsibility to assist in treating this patient population

SHCN definition:

individuals who “have a physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. The condition may be developmental or acquired and may cause limitations in performing daily self-maintenance activities or substantial limitations in a major life activity. Health care for special needs patients is beyond that considered routine and requires specialized knowledge, increased awareness and attention, and accommodation.”

SHCN patients are more vulnerable to oral disease than the general population.

SHCN disorders that are specifically manifest in the orofacial complex:

• amelogenesis imperfecta
• dentinogenesis imperfecta
• cleft lip/palate
• oral cancer

Disorders that include orofacial problems:

• osteogenesis imperfecta
• ectodermal dysplasia
• epidermolysis bullosa

AwDA defines the dental office as a place of public accommodation. Failure to comply and accommodate SHCN patients is a violation of federal and/or state law.

Difficulties for SHCN patients:

• lack of financial resources
• lack of timely care can lead to more costly episodic care
• medical benefits don’t extend to cover the dental needs
• other health care needs may seem more important than dental
• limited transportation
• complex behavioral problems
• anxiety
• tough to transition these patients from care of pediatric dentist to generalist as they mature

Recommendations:

• strong phone triage at initial contact
• create a dental home--makes SHCN pts less likely to suffer from dental disease
• patient and parent education
• complete med history--updated at every recall
• comprehensive exam and caries risk assessment
• med consults as needed
• must make attempts to communicate with hearing/speaking impaired
• informed consent
• proper behavior management/protective stabilization/sedation/general anesthesia
• be cognizant of psychological well-being of SHCN patients
• make appropriate referrals for things you cannot treat

Preventative strategy

• education of patient and parent
• daily supervision of OH regimen
• Fluoride dentifrice
• electric toothbrush
• dietary counseling
• sealants