November 2018 Volume LIII Number 6

 
 
 
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A Message from your President

September 2016 Volume LI Number 5

Our Continuing Commitment to the Oral Health Care of Children with Special Health Care Needs

Back in 1952, a dedicated group of pediatric dentists including Hugh Kopel, Michael Cohen, Chester Lloyd, Harold Berk and Manny Album defined the commitment of pediatric dentists to caring for the dental needs of the people with disabilities and formed the Academy of Rehabilitation of Handicapped Persons. This was five short years after the American Academy of Pedodontics (now our AAPD) was formed and can be seen as an outgrowth of pediatric dentist’s strong commitment. I can imagine them sitting around the table and saying, "Who, if not us, will care for these kids?"

Definitions abound, and are becoming more expansive and inclusive of more miscues of the developmental process, be they genetic or environmental. Our Reference Manual defines special health care needs (SHCN) as, "including any physical, developmental, mental, sensory, behavioral, cognitive or emotional impairment, or limiting condition that requires medical manage- ment, health care intervention and/or use of specialized services or programs."1 Temple Grandin, a Ph.D. in animal behavior sci- ence and an adult with autism herself, refers to it as, "the world just isn’t coming in right." 2

It is amazing for me to hear the stories of pediatric dentist involvement today, perhaps on their knees in their office examining patients or helping in the heat on a Saturday at a Special Olympics event, or perhaps, sitting in committee meetings to help guide policy decisions. Recently I was down on the floor with a young adult with ASD. As this young man has aged, his behavior has deteriorated and he has become physically bigger and stronger. Now he goes where he wants with a little coaxing from us. As we go through these types of contortions to provide care for these families, it makes me think our AAPD logo really is "big hearts for big and little teeth". This commitment is borne out by the ADA Practice survey which found that 95.5 percent of pediatric dentists see children (and adults) with developmental and intellectual disabilities. Of this we are very proud.
The pediatric dentists’ involvement in Special Care Dentistry extends far beyond the clinical care we have become to be known for. Our members work with National Institutes of Health (NIH), state dental society programs, Special Olympics, Academy of Pe- diatrics (AAP) and on ADA and AAPD Councils and Committees. In addition, there are a host of other committees or task forces in- volved in policy and guideline recommendation including national chapters of the many associations targeted to specific disabilities.

Often, due to a lack of trained general dentists comfortable treating special needs patients and the problems in transitioning care beyond our age-defined specialty we see these patients well into their adult years, as we would for family and our own children and grandchildren. Our Handbook of Pediatric Dentistry is perhaps the most comprehensive and up-to-date resource available to the profession.

Challenges with third party coverage and lack of reimbursement for special care populations have been a problem since long before I even started my dental career. Problems still exist with adequate coverage for families with Dentinogenesis Imperfecta, periodontal disease problems in Down Syndrome or reimbursement for behav- ior guidance in patients with ASD, to name a few. I sometimes think that the reimbursement issues are destined to be a rollercoaster ride lasting as long as a U.S. postal service "Forever Stamp". But never have pediatric dentists abandoned the cause or given up the fight to improve oral health care for this population.

As we approach the AAPD’s 70th anniversary, pediatric dentists reaffirm our commitment daily, to serve patients with special health care needs. There is still work to do but more than any other specialty, pediatric dentists have learned the secret to get into their world.

1Pediatric Dentistry (2015) Reference Manual 37(6) 15/16 (need to check reference format on this) 2Grandin, Temple; Cathrine Johnson (2005). Animals in Translation. New York: Scribner. p. 192. ISBN 0-7432-4769-8.

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