Oral Health Care for People With Special Health Care Needs: A Call to Action

Ray E. Stewart, DMD, MS, is a professor and chair of pediatric dentistry at the University of California, San Francisco. He has spent his career providing oral health services to children who are medically compromised or have other special health care needs. He is currently leading an effort to expand the availability of preventive and early interventional services to special needs patients of all ages throughout Northern California. Conflict of Interest Disclosure: None reported.

Ben Meisel, MD, or “Dr. Ben,” is a pediatrician focused on improving the lives of children with special health care needs (SHCN). He is the medical director of California Children’s Services, San Francisco, a professor of pediatrics at the University of California, San Francisco and former medical director of the medical camp The Painted Turtle. Dr. Ben is also an award-winning children’s recording artist and the founder of Dr. Ben & Company “Building Play Into Health,” a platform for development of childhoodempowering music, educational gaming and kids’ health entertainment for children with SHCN. Conflict of Interest Disclosure: None reported.

We are pleased to serve as editors of this curated edition of the Journal of the California Dental Association devoted to the subject of oral health care in the special health care needs (SHCN) population. This is a critical time for special needs dentistry, as there is a growing awareness and sense of urgency among state and local officials to address the persistent inequities and lack of access to basic oral health care services. We are hopeful that once they are made aware of this chronic health justice problem, legislators, community leaders, SHCN advocates and others will embrace the moral and ethical obligation to find a solution in California and beyond — working to provide the dental profession with the resources and incentives necessary to adequately address this serious problem. Furthermore, with inadequate access to preventive and restorative dental care for people with SHCN, who are the most at risk for medical complications and hospitalization, there is a significant fiscal incentive to reduce the high number of emergency room visits and frequent need for general anesthesia dental services that become necessary as a result of delayed or unmet dental care. It is appropriate to note that to begin to address this particular concern, as this issue goes to print, CDA is asking the California State Legislature for a one-time allocation of $50 million to establish a grant program that will build or expand stand-alone oral health care centers for people with SHCN to receive oral health care.

It is our hope that the reader will become more aware of the scope and magnitude of the unmet health care needs in the SHCN population as described in the article “Oral Health Care for Californians With Special Health Care Needs: A Problem in Need of a Solution” and will be introduced to some innovative approaches that are being applied in the search for solutions to this nationwide problem.

Solutions such as:

■ Efforts and recent policy modifications intended to change dental education and curriculum to better prepare future generations of practitioners to willingly and confidently accept SHCN patients into their practices. See the article “Predoctoral Curriculum Modifications in Caring for Patients With Special Health Care Needs.”

■ Efforts to address the unmet oral health needs of the SHCN population by more closely integrating medical and dental providers. See the article “Medical- Dental Integration: A Promising Approach To Address Unmet Dental Needs of Children and Youth With Special Health Care Needs.”

■ Efforts to develop alternative methods of delivering preventive and early interventional oral health services to the SHCN population at locations and facilities where they live, thereby reducing both the dependence on care under general anesthesia as well as the major travel burden further impacting families. See the article “Strategies To Reduce the Use of General Anesthesia for Children and Adolescents With Special Health Care Needs: Dental Desensitization and ‘Shorten the Line’ Models.”

■ Suggestions on the creation, design and equipping of facilities specifically intended to serve the SHCN population as well as how to modify an office environment to improve access to care by becoming SHCN patient friendly. See the article “The NYU Dentistry Oral Health Center for People With Disabilities.”

■ Suggestions on incorporating the concept of “care coordination” into practice workflow to facilitate better patient/caregiver/provider communication and eliminate the frequency of cancellations and appointment no-shows, which otherwise may frequently occur. See the article “Care Coordination: A Valuable Adjunct to Dental Practice — Lessons Learned in a Public Health Setting.”

■ Discussion of the California Department of Health Care Services policy allowing providers to bill for the extra time it takes them to treat individuals with special needs. See the article “Billing for Extra Time Needed To Treat Individuals With Special Needs.” Over the last decade, California has made significant progress in reducing barriers to oral health care, and each year we see more and more individuals receive coverage and care. However, our SCHN population has been left behind and improvements at the system and local level are still desperately needed. We hope this issue of the Journal inspires you to take another look at your practice and see how you can actively become part of the solution.