Steven P. Perlman

A profile of state-level differences in the oral health of people with and without disabilities, in the U.S., in 2004.

Objectives. The aim of this study was to provide state-level surveillance data to assess the oral health of people with disabilities. Methods. Data from the 2004 Behavioral Risk Factor Surveillance System (BRFSS)—a state-based, random-digit-dialed telephone survey of the U.S. civilian noninstitutionalized population 18 years of age and older—were used to estimate disability prevalence and state-level differences in oral health among people with and those without disabilities. Results. Nationally, people with disabilities were less likely than people without disabilities to visit a dentist or dental clinic in the past year. The percentage of people with disabilities who reported they had visited a dentist in the past year was lowest in Mississippi (48.9%) and highest in Connecticut (74.5%). Among people without disabilities reporting they had visited a dentist or dental clinic in the past year, the percentage was lowest in Mississippi (60.7%) and highest in Minnesota (80.7%). Edentulism was higher among people with disabilities compared with those without disabilities. Among people with disabilities, edentulism was lowest in the District of Columbia (4.1%) and highest in Kentucky (18.7%). Among people without disabilities, edentulism was lowest in California (2.7%) and highest in Kentucky (11.3%). Conclusions. Despite numerous studies and reports documenting the unmet oral health needs of people with disabilities, there has been no systematic national surveillance of oral health among people with disabilities in the United States. This article provides much-needed state-by-state and national epidemiologic data regarding the oral health of people with disabilities.

Children With Mental Retardation/Developmental Disabilities: Do Physicians Ever Consider Needed Dental Care?

In the late 1960s, there were more than a quarter of a million individuals with mental retardation/ developmental disabilities in state institutions. During the next 30 years, the number of residents decreased by more than 75% (Anderson, Lakin, Mangan, & Prouty, 1998). Changing social policies, favorable legislation for people with disabilities, and class-action legal decisions, which delineated the rights of individuals with mental retardation, have led to deinstitutionalization (i.e., mainstreaming, establishment of community-oriented group residences and enhanced personal family residential settings) and closure of many state-run large facilities. Many of the community residential facilities are too small in size to provide services within the residence. As a consequence, the monitoring of health care can be difficult when the delivery of service and health records are disseminated among multiple providers and locations. Thus, although most infants, children, and adolescents with mental retardation live with their natural or foster parents, pediatric and general practitioners may need to interact with a large and varied group of health providers. The success of community-based health programs, therefore, depends on: x The capacity to organize and maintain the services and health records of these ‘‘new’’ community residents and increasing numbers of youngsters with mental retardation/developmental disabilities in existing community families. x The ability of pediatric and general practitioners, who provide consultation and medical ‘‘gatekeeping’’ services for the population with mental retardation/developmental disabilities, to recognize and identify the wider range of needed health services—including preventive and restorative dental care. x The availability of private practitioners who are (a) convenient and accessible to the deinstitutionalized individuals and (b) are trained and willing to provide the needed care.

ARTICLE: Oral health condition and treatment needs of Special Olympics athletes in Nigeria

Special Olympics (SO) athletes in many parts of the world were reported to have poor oral health and high unmet treatment needs. This study was carried out to determine the oral health condition and treatment needs of SO athletes in Nigeria and to suggest ways of improving access to oral healthcare. Consenting athletes who participated in SO events in Nigeria from 2007 to 2008 received oral examination and evaluation by trained volunteers, using standardized Special Smiles screening forms and procedures designed for the event. A total of 1,286 athletes aged 3 to 71 years, 480 (37.3%) females and 806 (62.7%) males, participated in the screening. The majority (86.1%) cleaned their mouths once daily, 12.2% complained of pain, 21.1% had untreated decay, 6.6% had dental injury, 48.1% had gingival signs suggestive of periodontal disease, 15.8% required urgent treatment, and 43.7% required non-urgent treatment. We found that the oral health of SO athletes in this study was poorer than that of the general population in Nigeria.

Mandating education of dental graduates to provide care to individuals with intellectual and developmental disabilities.

In 2004, The Commission on Dental Accreditation adopted new standards for dental and dental hygiene education programs to ensure the preparation of practitioners to provide oral health services for persons with special health care needs. The course of action leading to the adoption of the new standards, together with the continuing obstacles of limited government support for dental services and the availability of faculty members to provide the needed dental educational experiences is reviewed. Expanding Health Resources and Services Administration definition of medically underserved areas is presented as one approach to improving the delivery of dental services.

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 individuals 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.

Latin‐American Special Olympics athletes: evaluation of oral health status, 2010

OBJECTIVES The purpose of this study was to evaluate the oral health status and dental needs of the athletes with intellectual disabilities from Latin-American and Caribbean countries who were participating in the II Latin-American Special Olympics games held in Puerto Rico, February 2010. METHODS There were 930 athletes who participated in the games, of whom 445 received a dental examination, including 367 from Latin-American and 78 from Caribbean countries. Forty-four trained and standardized dental professionals performed dental screenings of athletes with intellectual disabilities, following Special Olympic Special Smiles and CDC protocols. These criteria were used to record untreated caries, missing and filled teeth, and gingival status. Socio-demographics, existence, and severity of pain and oral hygiene habits were assessed by questionnaire. Statistical analysis was performed using EPI-INFO and SPSS Statistical Program to produce descriptive statistics and chi-square test. RESULTS Untreated dental caries was recorded for more than half of the examined athletes. Missing teeth were noted in more than one-third of the athletes. More than half of the participants had signs of gingival disease and half needed preventive mouth guards. Statistics for each Latin-American country suggests a dissimilar trend of dental decay and treatment needs among nations. CONCLUSIONS While the Special Olympic athletes may not be representative of the entire population of individuals with intellectual disabilities in their specific country, the general consistency of the oral health status of these athletes from the 31 countries supports the certainty of the need for increased dental services for individuals with intellectual disability in the respective countries.

Update on the imbalanced distribution of orthodontists, 1995-2006

A review of the 2006 and earlier American Dental Association studies on the distribution of dentists provides information on the evolving numbers of orthodontists in the United States. Despite an overall increase in the numbers of orthodontists, major differences persist in practitioner-to-population ratios in various geographic areas.

Disability and rehabilitation: do we ever think about needed dental care? A case study: the USA.

Purpose. To foster an awareness of the need for oral health care as a component of a programme for rehabilitation of individuals with disabilities. Method. A case study of the USA is used to illustrate the evolving community residential settings for individuals with disabilities and the resulting complexities in the delivery of health services. Examples of oral health conditions frequently present in individuals with disabilities are provided. Results. National and local reports indicate that barriers exist in the delivery of oral health services for individuals with intellectual/developmental and later life disabilities. Conclusion. Oral health care is a component of rehabilitation, as long as attendant pain erodes energy and aspirations of individuals with disabilities. Dental practitioners face many of the same complex difficulties encountered by other health practitioners in the provision of services for individuals with disabilities. The need is for the practitioners in the many health fields to play an important role in developing an awareness of, and referrals for, necessary oral health care.

Dentistry for Jordanians with special needs

There are thousands of residents with disabilities in Jordan. Despite national legislation to assure individuals with disabilities needed services, including education and employment, social inclusion of these individuals is difficult since societal views exclude them from functioning as members of a community. While there are no national studies of the dental needs of individuals with disabilities in Jordan, local reports indicates limited use of dental services and the need for increased oral hygiene and restorative services. Examples of dental education accreditation standards in other countries are used as models for the improvement in the preparation of dental students to provide services for individuals with special needs.

Medicare dentistry: the next logical step.

H. Barry Waldman, DDS, MPH, PHDa Mary Rose Truhlar, DDS, MSb Steven P. Perlman, DDS, MScDc In the mid 1960s, during Congressional review of the then-pending Medicare and Medicaid legislation, the American Dental Association (ADA) opposed dental care for the aged under the Medicare bill and lobbied for the inclusion of dentistry as a benefit under the proposed Medicaid legislation.1 Today, Medicare does not cover routine dental care or most dental procedures, such as cleanings, fillings, tooth extractions, or dentures. Medicare Part A covers certain dental services patients receive during hospital stays.2 In 2001, the Medicare program spent