Global oral health policies and recommendations for children with special health care needs and their applicability and effectiveness during the COVID -19 pandemic: a systematic review.

AIM: This systematic review aims to assess effectiveness of oral health policies, recommendations and guidelines in safeguarding oral health of children with special healthcare needs during COVID-19. BACKGROUND: This systematic review evaluated the adaptation of global oral health policies for children with special healthcare needs (SHCN) during the COVID-19 pandemic, to provide evidence-based insights to inform policymakers and healthcare providers amid the ongoing global health crisis. The study focused on assessing the effectiveness of these adaptations in ensuring equitable access to quality dental care for this vulnerable group. METHODS: A PRISMA guided online search through LILIACS, PubMed, Scopus, COCHRANE and grey literature was conducted. The search strategy incorporated a combination of subject headings (MeSH terms) and free-text terms related to "oral health," "dental health," "policy," "effectiveness," "dental practice guidelines," "oral health policies," and "special care needs children." Eligibility criteria included oral health policies, recommendations and guidelines targeting individuals/children with special care needs. Both qualitative and quantitative studies published in English from 2008 to 2023 were included. RESULTS: Sixteen guidelines, recommendations and policies, from six authorities were identified. These documentations addressed six different areas mentioned broadly as comprehensive care, ethical considerations, preventive and therapeutic measures, equity, patient-centric treatment, and reducing disparities signaling a paradigm shift. International collaborations and standardization of guidelines indicated a unified approach. The review also emphasized on a commitment to continuous improvement through quality measurement, systematic referral management, and needs assessment. With the exception of two documents, the remaining guidelines did not address COVID-19 or provide specific adaptations for it. The lack of emphasis on individual condition was notable, as the guidelines generally took a more generalized approach toward individuals with special healthcare needs. CONCLUSIONS: In conclusion, this review assessed the impact of COVID-19 on oral healthcare for individuals with special needs. It underscores global and local efforts for equitable access, patient-centric care, and preventive measures. The lessons learned advocate for a resilient, inclusive healthcare framework capable of meeting diverse needs. PROSPERO REGISTRATION: CRD 42023452475.

The Role of General Anaesthesia in Special Care & Paediatric Dentistry; Inclusion Criteria and Clinical Indications.

Dental practitioners dealing with children and individuals with special needs can be supported by the provision of general anaesthesia for the most challenging patients in situations where other options are insufficient. The availability of general anaesthesia will further the aim of extending access to the widest range of dental care to the greatest number of patients regardless of disability, age or phobia. The objective is to ensure patients have a pain-free and healthy mouth, and any necessary treatment in the most appropriate setting related to their specific needs. A strictly individual and holistic approach is required when evaluating the risk versus benefit of proceeding with general anaesthesia for delivery of dental treatment particularly for children and special needs individuals. It is vitally important to consider and address all relevant factors specific to this particular group of patients including assessment of capacity, validity of consent, and any specific medical, social and behavioural issues. The other sedation modalities must be always taken into consideration. This article emphasises the crucial decision-making role of dentists in the referral process for dental treatment under general anaesthesia and the need for multidisciplinary co-operation between dental practitioners, community and hospital services.

Evaluation of satisfaction among relatives of mentally disabled patients who were users of a dental care protocol under general anaesthesia.

OBJECTIVES: In the field of action of disease associated with dependence the Third Health Plan of Castilla y León aims specifically at promoting the adjustment of health assistance to the needs of disabled people, according to their situation. Our objectives were: General: To know the satisfaction level among relatives or caregivers of people who were treated according to a protocol of dental care for mentally disabled people. Specific: To know if satisfaction is related to any sociodemographic characteristics of patients or to their pathology. STUDY DESIGN: Cross-sectional study by telephone survey, set in the Primary Health Area of Salamanca. The target population includes relatives or caregivers of mentally disabled patients who were sent to the hospital for treatment under general anaesthesia after being attended in Primary Dental Care Units, from 1st of June/2005 to 31st of May/2006. Social and demographic variables and patients' diseases, as well as level of satisfaction with the service, were studied through a survey. RESULTS: 67.4% of patients' relatives or caregivers answered the survey, among whom 94.7% (C.I. 95%: 89-100%) were quite or very satisfied with the service in general. CONCLUSION: The protocol has high acceptance despite its difficulties and it has achieved considerable improvements in several aspects of patients' life. This level of satisfaction was not related to any sociodemographic or clinical patient characteristics. Nevertheless, accessibility aspects and communication with patients may still be improved.

A special needs dentistry study of institutionalized individuals with intellectual disability in West Sumatra Indonesia.

People with intellectual disability have a higher risk of oral health problems. This study assessed the clinical oral health status and behaviors and treatment needs of people living in an institution in Padang, West Sumatra, Indonesia. We quantified oral health status of 65 individuals with intellectual disability using Oral Hygiene Index Simplified (OHIs), Angle's classification of malocclusion, Community Periodontal Index and Treatment Need (CPITN), and decay index and also recorded their brushing behavior. We found that males had significantly lower OHIs (p < 0.001), more malocclusion (p < 0.001), greater caries number (p < 0.001), greater CPITN (p = 0.001) and higher need of dental treatment (p < 0.01) than females. Additionally, we found that high caries number was associated with poor OHIS, malocclusion, periodontal disease, and dependent brushing behavior (p < 0.001). The findings of this study imply that there is a gap in appropriate oral health care in individuals with intellectual disability. There should be a greater focus on providing appropriate oral health education to people with intellectual disability, improving the health literacy and quality of care of caregivers, and providing more dentists with specialized training in special needs dentistry.

[Standard dental care for people who are mentally disabled]. / Reguliere mondzorg aan mensen met een verstandelijke beperking.

The Health Insurance Board (CVZ) initiated a study of the functioning of the dental care system for mentally disabled people in the Netherlands.Two independent samples were used for the study, each drawn from a subpopulation of people with a mental disability in the age-group 15-45: people who have always lived at home (n = 60) and people who have been at some time been institutionalized and as a result of decentralization now live outside of the institution (n = 52). Dental visits were in both samples remarkably frequent (95-100%) and relatively few problems with daily dental care were identified. However, the health insurance regulations were unclear to many parents and carers, and there were doubts regarding dentists' specific expertise. At first sight the results of this study do not give cause to assume that there are special barriers to access to professional dental care for adult people with special needs. For a definitive conclusion regarding the long-term effects of the implementation of policies to de-institutionalize disabled people, and their influence on quality of care, a longitudinal evaluation of the oral health status is required.

Guideline on oral and dental aspects of child abuse and neglect.

In all 50 states, physicians and dentists are required to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect and the role of physicians and dentists in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may be suspicious for child abuse or neglect. Physicians receive minimal training in oral health and dental injury and disease and, thus, may not detect dental aspects of abuse or neglect as readily as they do child abuse and neglect involving other areas of the body. Therefore, physicians and dentists are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions.

Guideline for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures.

The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the pharmacokinetic and pharmacodynamic effects of the medications used for sedation as well as an appreciation for drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of people to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to presedation level of consciousness before discharge from medical supervision, and appropriate discharge instructions.

Access to dental services for children with intellectual and developmental disabilities - A scoping review.

BACKGROUND: Children with Intellectual and Developmental Disabilities (IDD) face considerable challenges in participating in dental services. These challenges include resource constraints and inadequate skills of health service providers to work with this population. AIM: The aim was to scope published studies that addressed access to dental services for children with IDD in order to determine the extent to which various barriers have been researched, using an access framework derived from the literature. Access was defined to include the six dimensions of accessibility, availability, affordability, accommodation, acceptability, and appropriateness. METHOD: Arksey and O'Malley's scoping review framework was used. Relevant databases (e.g., Medline) were searched for all empirical studies conducted from January 2000 to February 2017 that met inclusion criteria. Data were extracted along the six dimensions of the access framework. RESULTS: Sixteen international studies were identified which indicated common key barriers to dental service use: the difficulties of physical inaccessibility, lack of access to information among carers, lack of knowledge of disability issues, and low experience and skills in caring for children with IDD among dental practitioners. CONCLUSIONS: Key recommendations made were exploring dental practitioners' understanding of disability legislation and developing training for practitioners to expand on issues specific to IDD.

An audit of paediatric dental treatments carried out under general anaesthesia in a sample of Spanish patients.

OBJECTIVE: To evaluate the success and failure rates of the clinical procedures carried out under general anaesthesia in disabled or medically comprised and healthy children. BASIC RESEARCH DESIGN: Retrospective study included 47 patients who received dental treatment under general anaesthesia, grouped according to whether they were disabled or medically compromised (group A, n = 16) or not (group B, n = 31), and subgrouped according to whether they were under or over 6 years of age. RESULTS: Mean duration of anaesthesia was 2 hours and 25 minutes, with a range of 1 to 4 hours. The percentage of children followed up was 87%. The procedures performed were: 105 preformed metal crowns, 142 restorations, 85 pulpotomies and 166 extractions. The success rate was 93% for preformed metal crowns, 96% for pulpotomies and 90% for restorations. CONCLUSIONS: General anaesthesia is necessary in some children, but should be complemented with a preventive programme, behavioural remodelling and a follow-up schedule to avoid having to repeat the use of general anaesthesia.

Conceptual frameworks for understanding system capacity in the care of people with special health care needs.

This paper seeks to (1) identify strengths and weaknesses of the US health care system regarding oral care for persons with special needs; (2) provide a framework for understanding system capacity; and (3) describe the context within which dental care is provided in the United State. It explores a series of concepts that help explain the current lack of access for those with special needs and synthesizes options for improvement.

Program for coordinated dental care under general anaesthesia for children with special needs.

AIM: To draw up a program for coordination of dental care for children with special needs between the Course at the Universidad Complutense de Madrid (UCMC) (Specialisation in holistic dental care for children with special needs), and the Disabled Children's Oral Health Unit (DCOHU) within the Madrid Health Service (SERMAS). MATERIAL AND METHODS: UCMC Protocol for children with special needs. Design of a clinical pathway based on consensus amongst the professionals involved. RESULTS: Algorithm for dental care for children with special needs. Matrix covering all activities and timing for full dental diagnosis in such patients (general health, oral health and behaviour) to facilitate proper referral of patients requiring general anaesthesia. Inclusion in the matrix of those responsible for each activity. CONCLUSIONS: Improved team work (University - primary health care) in patient evaluation, in provision of information to parents and guardians and in health care quality. From the teaching point of view, students learn to adopt a systematic approach in the decision-making process.

[Post-academic dental specialities 8. Post-academic specialization in dental care for disabled]. / Beroepsdifferentiatie in de tandheelkunde 8. Opleiding tot tandarts-gehandicaptenzorg.

The dental treatment of people with a mental and/or physical disability often entails a variety of related problems and requires extra expertise and competencies on the part of the dentist. If treatment in an ordinary practice is not (or is no longer) possible, the patient can be referred to a centre for special care dentistry or to dental practices in institutions for the mentally disabled. In the Netherlands, a three year postgraduate programme in dentistry for the disabled was established in 2004, the purpose of which is to improve the availability and quality of dental care for the disabled.

[Post-academic specialties 9. Dental care of disabled children living at home]. / Beroepsdifferentiatie in de tandheelkunde 9. Problemen in de mondzorg voor kinderen met een ernstige verstandelijke beperking.

The aim of this study was to identify possible problem areas regarding preventive selfcare and dental care for severely mentally retarded children living at home. The sample test comprised parents (n = 126) and dentists (n = 40) of children between the ages of 4 and 12 from 7 randomly selected daycare centres in The Netherlands, who were asked to fill out a questionnaire. Of the children 32% were found to receive no dental care at all, while among the children from ethnic minority groups this number exceeded 50%. Of the parents two-thirds indicated that they had encountered problems with daily dental care and 70% reported that their child's oral hygiene was in need of improvement. Of the dentists 25% were dissatisfied with the dental care they provide, and 75% felt that dental care for mentally retarded children needs improving. The results suggest that there is room for improvement in the support of parents of mentally disabled children in maintaining an adequate level of oral hygiene, and that adequate training of dental professionals in serving the needs of people with severe disabilities is wanted.

Oral Healthcare for Persons With Intellectual or Developmental Disabilities: Why Is There a Disparity?

Despite some progress, a significant disparity still exists in oral healthcare between individuals with intellectual or developmental disabilities and the general population. Barriers generated by finances, a lack of appropriately trained dental providers, and the patients themselves combine to create significant challenges to providing dental care. However, strategies exist that can help to decrease the magnitude of these hurdles so this disparity can be minimized.

['Emily goes to the dentist'. Oral care for individuals with Down syndrome]. / 'Emily gaat naar de tandarts'. Mondzorg voor mensen met het syndroom van Down.

This article is primarily based on an editorial letter in the Journal of Oral Health and Disability that describes the visits of a patient with Down syndrome named Emily. Oral health care for individuals with Down's syndrome and other people with learning disabilities in The Netherlands is discussed. Due to the syndrome related oral aspects and specificity, the authors argue strongly in favour of working multidisciplinary within oral health care centres. The dependency of persons with Down's syndrome necessitates an appeal to parents, relatives and carers to maintain oral health. Client-centred care is mandatory for an optimal oral health condition of this vulnerable group.

[Oral health care in nursing and old people's homes and institutions for the mentally handicapped]. / Mondzorg in verpleeg- en verzorgingshuizen en instellingen voor verstandelijk gehandicapten.

Staff members and residents of nursing homes and old people's homes were interviewed about the facilities and provision of oral health care. Clinical examinations were performed to obtain data about the oral health status of the institutionalised elderly. Results show that in most cases the oral health care facilities were insufficient to give care to persons with natural teeth. Of the edentulous elderly 43% reported that the retention of the lower denture was insufficient.

Condutas práticas para atendimento odontológico em pacientes com necessidades especiais em tempos de Covid-19: minimizando os riscos / Practical conduct for dental care for patients with special needs in times of Covid-19: minimizings risks

O mundo está diante da pandemia pela Covid-19, novo coronavírus conhecido como causa da Síndrome Respiratória Aguda Grave 2 (SARS-CoV-2) e a Odontologia pode ser considerada uma das áreas com maior risco de contaminação. Objetivo: revisar a literatura existente sobre as manifestações da Covid-19 relacionadas com a atuação odontológica e apresentar orientações aos profissionais de saúde bucal no manejo de pacientes com necessidades especiais. Métodos: foi realizada uma pesquisa bibliográfica nas bases de dados PubMed, SciELO, Wiley Online Library, Portal de Periódicos Capes e Google Acadêmico, além de orientações (protocolos) por órgãos oficiais de saúde nacionais e internacionais. Resultados: durante o atendimento odontológico, ocorre uma proximidade face a face entre dentistas e pacientes, além de exposição a saliva, sangue e instrumentos manuais que podem estar contaminados. A atenção aos pacientes com comprometimento sistêmico requer uma anamnese minuciosa, avaliando a necessidade ou não de interconsulta médica. Enquanto os pacientes de difícil manejo precisarão de técnicas lúdicas para reduzir as barreiras que dificultam o atendimento odontológico. Conclusão: pessoas com deficiência e com outras necessidades em saúde usualmente já tinham maior dificuldade para receber atendimento odontológico. Com a Covid-19, isso se agravou, visto que o atendimento eletivo é contraindicado neste grupo. No entanto, o conhecimento que a comunidade científica está produzindo não servirá apenas para esta pandemia. A melhora na biossegurança e a valorização dos profissionais de saúde devem ser mantidas mesmo quando o surto passar.(AU)

The world is facing the pandemic by Covid-19, a new coronavirus known as the cause of Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) and Dentistry can be considered one of the areas with the highest risk of contamination. The objective of this work was to review the existing literature on the manifestations of Covid-19 related to dental practice and to present guidelines that assist oral health professionals in the management of patients with special needs. Methods: a bibliographic search was performed in the databases PubMed, SciELO, Wiley Online Library, Portal of Journals Capes and Google Scholar, in addition to guidance by official national and international health agencies. Results: during dental care, there is a face- -to-face proximity between dentists and patients, in addition to exposure to saliva, blood and hand instruments that may be contaminated. Attention to patients with systemic impairment requires a thorough anamnesis, assessing the need or not for medical consultation. While difficult-to-manage patients will need playful techniques to reduce barriers that hinder dental care. Conclusion: people with disabilities and other health needs usually already had greater difficulty in receiving dental care. With Covid-19, this worsened, since elective care is contraindicated in this group. However, the TRAD that the scientific community is producing will not only serve for this pandemic. The improvement in biosafety and the valorization of health professionals must be maintained even when the outbreak passes.(AU)

Preparedness of Entering Pediatric Dentistry Residents: Advanced Pediatric Program Directors' and First-Year Residents' Perspectives.

For children to receive needed oral health care, adequate training at both the predoctoral and postdoctoral levels of dental education is required, but previous studies have found inadequacies in predoctoral education that lead to general dentists' unwillingness to treat certain young populations. As another way of assessing predoctoral preparation, the aim of this study was to determine the perspectives of first-year residents and pediatric program directors about residents' preparedness to enter advanced education programs in pediatric dentistry. Surveys were sent to all 74 U.S. program directors and 360 first-year residents. The survey focused on procedures related to prevention, behavior management, restorative procedures, pulp therapy, sedation, and surgery, as well as treating patients funded by Medicaid and with special health care needs. Among the first-year residents, 173 surveys were returned for a 48% response rate; 61 directors returned surveys for an 82% response rate. Only half of the residents (55%) reported feeling adequately prepared for their first year in residency; less than half cited adequate preparation to place stainless steel crowns (SSCs) (42%) and perform pulpotomies (45%). Far fewer felt adequately prepared to provide treatment for children six months to three years of age, including examinations (29%), infant oral exams (27%), and children with severe caries (37%). The program directors were even less positive about the adequacy of residents' preparation. Only 17% deemed them adequately prepared to place SSCs and 13% to perform pulpotomies. Approximately half reported their first-year residents were inadequately prepared to treat very young children and children with severe caries (55% each). This study found that the perceived inadequacy of predoctoral education in pediatric dentistry was consistent at both the learner and educator levels, supporting previous studies identifying inadequacies in this area.

Comparison of dentists' treatment and management of normal and handicapped patients.

Forty-eight of 120 dentists (40%) responded to a survey using a two-questionnaire time-series design. Responding dentists with a median age of 36 years and 9.5 years in practice had received education in care of the handicapped mainly in dental school (42%) and continuing education (40%). They were asked to make the same treatment and practice management decisions for both normal and handicapped patients. No significant differences were found between normal and handicapped patients in the amount of time dentists spend on diagnosis, treatment, planning, or recall (p less than 0.05). For both normal and handicapped patients, the dentists as a group always chose the same option as treatment of choice for both normal and handicapped patients most frequently from a list of treatment or management options. Individual dentist consistency between normal and handicapped patients in treatment and management was good, with four out of five dentists choosing the same first treatment of choice for both normal and handicapped patients for similar circumstances. Only about one out of six dentists maintained a consistent priority sequence for both normal and handicapped patients when asked to rank a list of four or five possible treatment or management choices.