Taking a child with special needs to the dentist can be stressful for both the child and the parent. Parents know that their child doesn’t want to see the dentist, but does the parent know if the dentist will want to see the child? It’s important for parents to find out, because results of surveys of dental students and practicing dentists indicate that not every dentist feels prepared for or is comfortable with treating children with special needs.
Whether or not a dentist is comfortable with treating patients with special needs appears dependent on their dental school training. According to a 2010 study, most dental programs are providing only limited training on treating patients with disabilities. Data collected from 22 dental schools in the United States and Canada showed that only 64% of programs offered a specific course on treating the patient with special needs, although 91% of programs addressed the topic in the clinical education. Additionally, only 37% of schools offered a special clinical area for treating patients with disabilities. Fortunately, the majority of schools indicated their intentions to increase the clinical and extramural training of dentists with regards to special needs patients, which is good given that both dental students and practicing dentists indicate that they feel unprepared and that their training was inadequate to treat patients with disabilities.
A 2008 survey by the American Dental Education Association of fourth-year dental students indicated that almost 40% felt that they were not prepared for dealing with patients with special needs. Along these lines, a 2004 report surveyed nearly 300 third- and fourth-year dental students from five different dental programs to assess how well trained they felt they were to treat patients with mental retardation and how confident they were with these patients. No more than 70% of students received more than 5 hours of direct training; only 51% received any clinical training. Not surprisingly, 60% of the students reported that they had little to no confidence in treating patients with MR.
Similar results were found in a 2005 study of dentists practicing in Michigan. Of 208 dentists surveyed, only a small percentage said that they felt that their educations had very well prepared (1.8%) or well prepared (10.4%) them to treat special needs patients. More than half of the dentists felt that were either not at all well prepared (25.9%) or not well prepared (33.8%) to treat patients with special needs. Not surprisingly, those dentists who felt prepared indicated that they were more likely to treat patients with disabilities. In an average week, 22.7% of dentists said that they had treated no adults with special needs, and 51.6% of dentists had not treated any children with special needs.
The dental profession is acknowledging that the education of dentists with regards to treating patients with disabilities is inadequate. Consequently, the American Dental Association adopted in 2010 new educational standards which state that dentists must be competent in assessing the treatment needs of patients with special needs . Specifically, “An appropriate patient pool should be available to provide experiences that may include patients who’s medical, physical, psychological, or social situations make it necessary to consider a wide range of assessment and care options. The assessment should emphasize the importance of non-dental considerations. These individuals include, but are not limited to, people with developmental disabilities, cognitive impairment, complex medical problems, significant physical limitations, and the vulnerable elderly. Clinical instruction and experience with the patients with special needs should include instruction in proper communication techniques and assessing the treatment needs compatible with the special need.”
Thus, all dentists should be able to treat patients with special needs. And according to the National Institute of Dental and Craniofacial Research of the NIH, most patients with special needs can be managed in a general dental practice, which may be why the American Dental Association does not offer a board certification in what is known as special care dentistry. However, there are practices dedicated solely to the care of patients with disabilities, and should dentists choose, they can pursue a post-doctoral program in special care dentistry. Additionally, professional societies offer credentials to dentists who have received additional training. The American Board of Special Care Dentistry offers fellowships in Dentistry for Persons with Disabilities. Pediatric dentists can be certified to treat children with special needs by the American Board of Pediatric Dentistry. Additionally, dentists can seek additional training, including CEU’s, to expand their knowledge base of the various disabilities, how the disability can affect the patient’s dental needs, and finally, how to best manage the patients.
So how should parents go about finding a dentist for their child with special needs? There are numerous articles on the web with suggestions on how parents should go about this process. Parents can also consult the Diplomate Roster from American Board of Pediatric Dentistry for pediatric dentists certified in special health care needs or the American Board of Special Care Dentistry for names. Parents can also seek referrals from their child’s physicians or specialists, from other parents whose children share their child’s disabilities, or from local organizations associated with the specific disability. Parents should visit the office and interview the dentist on the dentist’s (and his or her staff’s) comfort on dealing with children with disabilities and specifically if they have treated patients with their child’s needs. Parents should also pose “what if” questions to determine what the dentist is prepared or not prepared to do.
Visits to the dentist can be stressful with any child. But for the child with special needs, they can be much more so. With some advanced research, parents should be able to identify the dentist and practice which is most able (and willing) to provide care for their child. The right dentist and staff can help reduce everyone’s stress by treating the child appropriately and with understanding of his or her unique needs.