Guidelines for Medical Immobilization/Protective Stabilization for Your Practice.

Many patients with special healthcare needs present to medical, dental, and other health visits with behavioral, emotional, postural, and psychological issues. According to the American Academy of Developmental Medicine and Dentistry (AADMD) guidelines from 2017: "Clinical dental treatment is the most exacting and demanding medical procedure that persons with special needs undergo on a regular basis throughout their lifetime." Moreover, dental treatment is basically surgical in nature, usually requiring controlled placement of sharpened instruments in intimate proximity to the face, airway, and highly vascularized and innervated oral tissues. When medically necessary healthcare must be provided and the patient's inability to accept or cooperate will compromise the quality of care the clinician will be able to deliver, interventions may be indicated and implemented.

From Restraint to Medical Immobilization/Protective Stabilization.

Clinical dental treatment is the most exacting and demanding medical procedure that persons with special needs undergo on a regular basis throughout their lifetime. Dental treatment is surgical in nature, usually requiring controlled placement of sharpened instrumentation in intimate proximity to the face, airway, and highly vascularized and inner aged oral tissues. Although approximately 90% of patients with special needs can and should be mainstreamed through any general dental practice, without significant behavioral guidance, techniques, or medical immobilization/protective stabilization, there has been a drastic shift toward pharmacologic management of these patients using various forms of sedation and general anesthesia.

I Am A Pediatric Dentist: Why is Major Depression Among Adolescents my Concern?

The question, "why a pediatric dentist should be concerned about major depression among teenagers" is considered in light of reports from the National Institute of Mental Health. The results of these studies indicate that there is a progressive increase in the proportion of adolescents with a history of major depressive episodes; ranging from 6.4% among 12 year olds to 15% and 16% for 15-17 year olds. There are great variations by gender, race and ethnicity in the proportion of teenagers experiencing major depressive episodes and receiving needed care. In addition, there is an increased proportion of teenagers with disabilities who experience major depressive episodes. This combined impact is a reality for youngsters with disabilities as they pass through the teenage years into adulthood. Listing of symptoms of depression are provided to facilitate dental treatment planning, as well as well as assisting parents/guardians in seeking the overall needed care for their youngsters.

Special Smiles: Sports Dentistry and the Special Needs Athlete.

There is a need to expand dental services to underserved populations, such as athletes with intellectual and developmental disabilities. This review introduces dentists to this need by sharing the direction taken by the Special Smiles program of Special Olympics and addressing the need to educate special needs athletes on prevention and care of sports-related mouth injuries.

The largest minority population in the U.S. without adequate dental care.

A recent series of reports in Health Affairs reviewed the disparities in securing needed oral health services in the U.S. Despite an extensive oversight of the many issues involved, no direct mention is made of the particular conditions of the largest minority population in the U.S. unable to access dental care-the tens of millions of individuals with special health care needs. A review is provided of the particular barriers and conditions faced by this increasing population in its efforts to secure needed services.

I Am a Pediatric Dentist: Why Is Substance Abuse among My Patients My Concern?

The rapidly evolving demographic base of our communities intensifies the need for an awareness which in the past seemed beyond the traditional concerns of pediatric dentists; in this case, substance abuse by teenagers. A review was carried out regarding evolving demographics, the proportion of teenagers involved with substance abuse, the rationale for the use of varying elicit substances and the associated symptoms. A series of options for action are considered given the potential for pediatric dentists to be involved in the care of teenagers using elicit substances.

Comprehending the Number of Individuals with Disabilities and the Need for Oral Health Services.

INTRODUCTION: The use of mega-large numbers and percentages to describe the one billion people with disabilities in the world is beyond the comprehension of most people. We find it difficult to personalize such information and tend to skip over the data without considering the multitude of factors that impact on individuals with disabilities and their families. STUDY DESIGN: A review of World Health Organization, U.S. Census Bureau, and Canadian and U.S. dental school accreditation agency documents were used to establish the current information on disability numbers, proportions and dental education programs. RESULTS: More meaningful details from government agencies and the health professions and their educational institutions can provide data that could be used to demonstrate the increasing number of individuals with disabilities in a more meaningful manner; as well as preparing health professionals to provide the needed care. DISCUSSION: The use of survey data for specific countries by: age, types of disabilities, race/ethnicity, family and individual economics, employment and regional distribution provides a more personalized presentation which can be used to reach legislative bodies and health providers.

Traumatic dental injuries in children with special health care needs.

BACKGROUND/AIM: Children with special healthcare needs (CSHCN) are at an increased risk for traumatic dental injuries (TDI) due to unique predisposing factors; moreover, their access to dental care is compromised. In Jordan, there is a need to study TDI among CSHCN to highlight their dental care needs. The aim of this study was to identify the prevalence, types, possible risk factors associated with TDI, and treatment-seeking behavior in CSHCN in Jordan. MATERIAL AND METHODS: Children (n=959) were examined in schools/centers for CSHCN, and compared to a healthy age- and gender-matched control group. Data concerning demographics, types of trauma, risk factors associated with TDI, and treatment-seeking behavior were collected. Data were analyzed using SPSS for descriptive and bivariate analyzes. Significance level was set at P≤.05. RESULTS: Prevalence of TDI in the study group (age, 11.76±4.2 years) and control group (age 11.70±4.2 years) was (83 of 959, 8.7%) and (42 of 1010, 4.1%), respectively. TDI prevalence was highest in children with multiple disabilities (14.0%), followed by intellectual disabilities (13.1%), and cerebral palsy (12.2%). The most common type of TDI was an uncomplicated crown fracture (91.0%). Increased overjet and incompetent lips were significant risk factors associated with TDI. Reasons for not seeking treatment in the study vs control group included parental attitude and lack of dental awareness (68.1% vs 60%), difficulties getting an appointment and availability of dental clinics willing to see CSHCN (36.2% vs 0%), P≤.01, and financial reasons (31.9% vs 40%). CONCLUSIONS: Prevalence of TDI was higher in CSHCN, and associated with increased overjet and incompetent lips. Uncomplicated crown fracture was the most common injury. In both groups, the main reason for not seeking treatment was lack of dental awareness among parents/caregivers; however, difficulties in getting an appointment and availability of dental clinics willing to see children were more prominent in the CSHCN group.

A Smaller Percent of Hispanic Children Have Special Health Care Needs: Is that Possible?

The results from latest study of children with special health care needs indicate at the national and state levels that (except for Asian children) the proportion of Hispanic children with special needs is less than for other child populations. A review of a series of associated factors raises questions of the validity of these general national and state findings. The significant projected increases in the Hispanic population during the next decades points to the necessity of reconsidering the recent survey findings in light of what could be continued increases in the numbers of youngsters with special health care needs and the evolving family cultural adaptation, education and employment opportunities.

Dental Economics and the Increasing Hispanic Population in the U.S. and New York State.

The continuing dramatic increases in the U.S. Hispanic population are considered relative to the economic concerns of dental practice. Oral health needs, limited finances and health insurance, together with varying cultural orientation, are reviewed in terms of the potential for growing Hispanic political strength.

Pediatric Dentistry Specialty as Part of a Longer Continuum of Care: A Commentary.

The transition of teenagers with special needs to young adulthood is a complex period for the children and their families. This transition is especially difficult when it comes to securing needed oral health care. The teenager is forced to transfer from the services of an age defined pediatric dental specialist with training to provide care for individuals with special needs, to 1) general practitioners with limited formal training and often unwillingness to provide care and 2) at a period when most states provide limited or lack of adult dental Medicaid programs. These issues and the need to expand pediatric dental specialist involvement in the general transitional period are reviewed. "Pediatric dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs."(1) "Our system of preparing and maintaining our abilities to provide oral health services for an increasing diverse population must be brought up to date to meet the challenges posed by the treatment of young adults with disabilities."(2) "Most responding dentists (to a national study of pediatric dentists) helped adolescents with and without SHCNs (Special Health Care Needs) make the transition into adult care, but the major barrier was the availability of general dentists and specialists."(3).

Ethics, Economics and Dentistry for Individuals with Disabilities in New York State.

The ADA Principles of Ethics and Code of Professional Conduct is an expression of the obligation occurring between the profession and society to meet the oral health needs of the public. At a time of economic concerns for the profession, suggestions are made to bring together the ethics of the profession and the need to expand services to underserved populations, including individuals with disabilities and the poor. The profession's effort to secure economic support for such an effort is possible with increased legislative awareness of the magnitude of the problem. To this end, the number of individuals with disabilities was developed for each Congressional district in New York State in an effort to challenge members of Congress to recognize the need in terms of their constituents, rather than in terms of the tens of millions with disabilities in the United States-which become "just numbers," not actual people.

Dental Practice as the Population Demographics Change in Massachusetts.

General population demographics in the United States, individual states, and counties are undergoing dramatic changes. Long-term customary populations, which provided the bulwark for many successful dental practices, are being replaced by the many minority populations (in particular, the Hispanic population), foreign-born residents, and many for whom English may not be their first language. These developments are reviewed for the Commonwealth of Massachusetts and its counties in an effort to challenge practitioners by the extent of these developments.

New York State Dental Establishments and Dentists: 2007-2012. Economic Survey.

Every five years a series of studies is carried out by the Census Bureau which provides an opportunity to review the basic economic well-being of the many industries at the national, state and county levels. A comparison of dental economic data from the 2007 and 2012 studies for the period that encompassed the 2007-2009 "Great Recession" details the general economic difficulties faced by the dental profession during this period.

Access to Dental Care Depends on Appreciation of Demographics and Economics.

The evolving demographics and economics of dental practice require consideration as the profession plans forfuture changes in the dental workforce, the makeup of the population and ongoing access to care crisis. This paper is a sampling of U.S. Census Bureau reports on demographics and an appraisal of JADA and ADA News statements regarding the economics of dental practice, as well as a review of historical developments of the profession's perceptions of dental education and government support for dental care. The trends in economics and population-based changes affecting U.S. dental practice indicate a general downturn in practice busyness, stagnation of expenditures for dental services, and a continuing increase in the proportion in minorities throughout the country and the limited ability to make changes in dental economics without altering some long-held views on the delivery of dental services. Customary populations which provided the bulwark of dental practices are being replaced by minorities.The economics of dental practices will be dependent upon (a) developing cultural and structural competence in the economics of the evolving shift in population demographics, (b) implementing changes in the economics of dental education and expansion of delivery models,

Dental Economics and the Increasing Numbers of Individuals with Disabilities in New Jersey.

The dual needs of 1) providing increasing oral healthcare for individuals with special needs, and 2) improving the economics of dental practice, are explored in a review of the State of New Jersey and its counties.