Patients with special healthcare needs
Stopping oral health problems before they start is a big part of dental care for people with special healthcare needs.
Teaching patients and their caregivers how to prevent and treat oral health problems can change their lives.
Taking care of people with special healthcare needs means dentists and their teams need to know extra things and be more understanding. They might need to change how they do things to help.
Some people need extra help with their health. These are people who might have conditions that make it harder to do daily activities, like physical problems, having a hard time learning, or strong feelings. These conditions can be there from birth, grow over time, or happen because of an illness or accident.
Here are some types of people who might need special healthcare:
- Behavioral: People who get very worried (anxiety), have trouble concentrating (ADHD), or have autism.
- Born with it: People with Down syndrome (Trisomy 21) or heart problems from birth.
- Developed later: People with cerebral palsy.
- Learning difficulties: People with intellectual disabilities.
- Body-wide illnesses: People with cancer or sickle cell disease.
Taking care of people with special healthcare needs means dentists and their teams need to know extra things and be more understanding. They might need to change how they do things to help.
Sadly, people with special healthcare needs often don't get enough good dental care. This is a problem because they can have oral health issues that affect their whole body's health. The more serious their health problems are, the more likely they are to have dental needs that aren't taken care of.
Here are some oral health issues often seen in people with special healthcare needs:
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- Lots of hardened plaque (calculus) leading to swollen gums and gum disease.
- Problems with tooth enamel (the outer layer of the tooth).
- Cavities.
- Not liking to brush their teeth or having behavior problems.
- Crowded teeth.
- Teeth that don't fit together right.
- Differences in how teeth grow, their size, shape, when they come in, and the shape of the jaw.
- Grinding or wearing down teeth.
- Broken teeth or injuries to teeth.
The main goals of their dental care are:
- Finding a dental office they like when they are young.
- Getting a full history of their health, teeth, and home life.
- Making the dental office a comfy place for them.
- Teaching them and their caregivers about keeping their mouths healthy.
- Giving them ways to prevent problems and fix teeth, sometimes with help on their behavior or with other doctors.
Being aware of all details is key for all parts of their care, like making appointments, checking their teeth, making a treatment plan, getting consent for treatment, teaching them, and doing the treatment and follow-up visits.
Finding a dental home is important.
It's important to find a "dental home" by the time a child is 1 year old. A dental home is a place where the patient can receive dental care that fits their needs. The dental office and the patient can work together to develop a plan to prevent oral health problems, get needed dental care, and avoid dental issues.
Making the first appointment is easy.
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When you first call the dental office, you should:
- Say what the child's main dental problem is.
- Make sure the dentist or hygienist is the right person to see.
- Give the patient's name, age, and main concern.
- Say if they have any special health needs and what they are.
- Give the name(s) of their other doctors.
These details help the dental office figure out how long the appointment should be and if they need extra staff to help the patient feel safe. This should be written down in the patient's file so their needs are met at each visit.
Be open and honest in first conversation with providers.
It's important to have a real, complete, and up-to-date health history to know special healthcare needs, plan good treatment, and avoid making any medical conditions worse while doing dental work.
The first time you talk to the dentist or hygienist, you should talk about:
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- The main problem.
- How long they've had the problem.
- Any health conditions or illnesses they have.
- Their other doctors.
- When they have been in the hospital or had surgery.
- Any past time they have had anesthesia (medicine to make you sleep during a visit).
- Medicines they are taking now.
- Any allergies or things they are sensitive to.
- Their shots (immunizations).
- A quick check of their body systems.
- Their family's health history, their social life, and their dental history.
The chat should also include how the patient learns and hears things so they feel safe. At all visits, the dental team should ask if changes have happened with their health, like recent illnesses, injuries, new health problems, allergies, or changes in medicines.
A full dental exam includes checking the head, neck, and mouth, how they bite, any habits they have, and any injuries. It should also check for cavities and gum disease. After looking at their risk for cavities, their dental needs, and what they can do, a unique plan to prevent problems and a schedule for dental check-ups should be made.
Working with other doctors is sometimes needed.
Doctors should be asked about:
- Medicines.
- Medicine to relax them (sedation).
- Medicine to make them sleep completely (general anesthesia).
- Any special rules or things they need to do before dental care to keep them safe.
Planning treatment is specific for each patient.
The plan for dental care for people with special healthcare needs is the same as all people, but with careful thought about the risks, benefits, and how well the plan will work for the patient's condition.
Things to think about when planning treatment include:
- Fixing active problems before any needed medical procedures.
- Waiting on any elective dental work if the patient's body can't fight off infection well or if they have blood problems during active treatment.
- Giving them antibiotics to prevent infection if they are at high risk, like for heart infections.
- Knowing when certain medicines are helpful or harmful.
Signs that someone might need to see an orthodontist (a dentist who straightens teeth) include:
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- An uneven face.
- Problems breathing through their nose.
- Problems with their bite.
- Trouble chewing, swallowing, or talking.
- Unhappy with their smile.
Make sure to sign all consent forms.
All patients must be able to sign a paper giving consent for dental treatment, or have someone with them who can legally sign for them.
Helping with behavior can make appointments easier.
Sometimes, people with special healthcare needs might be unwilling because they are scared of the dentist, don't know what's going on, don't like things in their mouth, or are tired from many doctor visits. These behaviors can make it hard to do dental treatment safely.
With help from their caregivers, most patients with physical or learning disabilities can get dental care in the dental office.
If simple ways to help with behavior don't work, the dentist might suggest medicine to relax them or to make them sleep so the treatment can be done safely and quickly.
Stopping problems early is beneficial.
The dental team should create a personal plan for brushing and flossing that fits the patient.
- Brushing with fluoride toothpaste twice a day helps stop cavities and gum swelling.
- Electric toothbrushes and floss holders can help patients in managing their own home dental care.
- Caregivers should provide the best oral healthcare when the patient can't do it themselves.
- Eating foods that don't cause cavities is stressed for long-term prevention of dental disease.
There are groups that can help you get care.
Local hospitals, public health places, rehab services, or groups that help people with special healthcare needs can be good contacts to help the dentist or patient with language and cultural differences.
Other community groups might help with money or transportation issues that stop people from getting to care.
Referrals to other providers might be needed.
If the patient's needs are too much for the dentist to handle, the dentist should send them to another dentist who has the experience and ability to take care of the patient, including their overall health.
Where can you find a dentist?
Visit our Find a dentist page for a list of low-cost dental clinics near you.
You can also find a dentist that accepts Medicaid at https://medicaid.utah.gov.
Or call 1-866-608-9422 to talk to a Medicaid health program representative.
Click the links below to download flyers containing this information.
Visit the websites below for supplemental materials.
National Maternal and Child Health Resource Center
Easy-to-read oral health educational materials are available in multiple languages. Oral Health materials include tips for good oral health during pregnancy, tips for families, and information specific to infants and young children.
Special Care: An Oral Health Professional’s Guide to Serving Children with Special Health Care Needs—Second Edition is a series of five modules is designed to provide oral health professionals with information to help ensure that children with special health care needs have access to health promotion and disease prevention services that address their unique oral health needs in a comprehensive, family-centered, and community-based manner.
Utah Developmental Disabilities Council
The purpose of the Council is to advocate for, and strengthen leadership skills in, individuals with disabilities and their families. In addition, the Council collaborates with the legislature, and public and private agencies that serve individuals with disabilities to strengthen the service system. The focus of all the activities of the Council is to promote consumer and family-directed services that increase self-determination in individuals with disabilities and their families. “The Utah Developmental Disabilities Council supports and empowers people with intellectual and developmental disabilities to achieve inclusive, meaningful, and self-determined lives in their communities through its ongoing support of leadership, education, policy, and advocacy actions.”
Utah Office of Children with Special Health Care Needs
The mission of CSHCN is to improve the health and quality of life for children with special health care needs and their families through early screening and detection, data integration, care coordination, education, intervention, and life transitions. CSHCN provides and promotes family-centered, coordinated care and facilitates the development of community-based systems for these children and their families. CSHCN activities focus on reduction of preventable death, disability and illness in children due to chronic and disabling conditions.
Utah Services for People with Disabilities
The Division of Services for People with Disabilities (DSPD) promotes opportunities and provides supports for people with disabilities to lead self-determined lives by overseeing home and community-based services for more than 6,500 people who have disabilities. Support includes community living, day services, and supported employment services. DSPD employs over 100 highly trained and qualified staff whose sole mission is to improve the lives of people with disabilities throughout the state of Utah.