Minnesota Title V MCH Needs Assessment Fact Sheets

Children with Special Health Needs

Oral Health

Summer 2004

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Size of the Problem

Over 36,000 (22.5%) children with special health needs in Minnesota did not receive preventive dental care or all needed restorative dental care in 2001 [1].

  • For an estimated 26,000 of the children, families did not perceive a need for any dental care;
  • An estimated 10,000 who identified a need for dental care couldn't get it.

Reasons Children With Special Health Care Needs in Minnesota Did Not Receive All Needed Dental Care N=10,525

Reason

Number

Percent

Cost

5,394

51.53

Health Plan Problem

3,088

29.50

Difficulty Getting An Appointment

1,224

11.69

Other Reason

1,131

10.80

No Insurance

845

8.08

Not Available In Area

701

6.69

Couldn't Find Someone

638

6.10

Not Convenient Times

558

5.33

Doctor Did Not Know How To Treat

360

3.44

Child Refused To Go

145

1.38

Results from 1999 oral assessments of U.S. Special Olympics athletes (all ages), based on an extremely conservative assessment protocol (without the use of x-rays, mirrors, or explorers), and carried out by the Special Olympics Special Smiles Program in 20 states, indicate that 12.9% of the athletes reported some form of oral pain, 39% demonstrated signs of gingival infection, and nearly 25% had untreated decay [2].

Children with disabilities present unique problems and are at increased risk for oral infections, delays in tooth eruption, periodontal disease, enamel irregularities, and moderate-to-severe malocclusion. Exposure to certain medications and therapies, special diets, and difficulty in maintaining daily hygiene threaten to compromise the oral health of children with special health care needs [3]. In Minnesota, 76% of the children and youth identified as having special health needs take prescription medications; 18% experience functional limitations.

Some children with special health care needs have medical and oral conditions such as cleft-lip and palate, that call for extraordinary care and require oral health professionals to have specialized knowledge. The incidence of cleft-lip and palate is one in 1,000 live Caucasian births; the incidence of cleft palate alone is one in 500 live births [4].

Even in areas with an adequate supply of dentists there is reluctance among dentists to serve public program patients largely because of an increased number of missed appointments, additional documentation and low reimbursement rates [5].

Seriousness

No national studies have been conducted to determine the prevalence of oral and craniofacial diseases among the various populations with disabilities or chronic conditions. Some smaller-scale studies show that the population with mental retardation or other developmental disabilities has significantly higher rates of poor oral hygiene and needs for periodontal disease treatment than the general population, due, in part, to limitations in individual understanding of and physical ability to perform personal prevention practices or to obtain needed services. There is a wide range of caries rates among people with disabilities, but overall their rates are higher than those of people without disabilities [6].

Rural areas in Minnesota have a dentist-to-population ratio of one dentist for every 2,000 people compared to a ratio of one metro area dentist for every 1,400 people [7]. Pediatric dentists are available in only 15 of Minnesota's 87 counties. (MDH).

If untreated, oral diseases in children frequently lead to serious (and costly) general health problems and significant pain, interference with eating, hearing and speaking, the use of emergency rooms, lost school time and difficulty paying attention in school. Nationally, it has been estimated that 51 million school hours per year are lost because of dental-related illness alone [8].

Poor children have nearly 12 times more restricted-activity days because of dental-related illness than children from higher-income families [9].

The costs of dental health care account for 30% of family out of pocket expenditures for children's health [10].

Interventions

To increase awareness of attention to oral health among caregivers of children with special health needs, materials such as "A Guide to Good Oral Health for Persons With Special Needs" [11] and "Dental Care Every Day: A Caregivers Guide" [12] have been developed and are readily available. Along with raising awareness of the issue, materials provide practical suggestions to overcoming barriers to good oral health specific to the needs of the population. Distribution through medical and oral health providers, school nurses, service coordinators, and disability specific organizations could be expanded.

To improve the capacity or oral health providers to care for children with youth with chronic illnesses and disabilities, oral health practitioners need condition specific information. The National Institute of Dental and Craniofacial Research has developed a series of materials for oral health providers serving people with developmental disabilities. "Practical Oral Care" identifies health challenges of specific conditions, associated oral health problems, and strategies for care for 5 different disabilities.

An ongoing relationship between an interdisciplinary craniofacial team and the patient/family was identified as the standard of care for children with craniofacial anomalies [13].

In Minnesota, children who are identified at birth as having a craniofacial anomaly are referred to Minnesota Children with Special Health Needs for follow-up and referral to a craniofacial team. A limited number of craniofacial teams funded through the Minnesota Children with Special Health Needs Program are in place in Greater Minnesota.

Status

Eliminating health disparities is a priority for state and local public health in Minnesota. Improving the oral health of citizens as well as improved access to dental care are also public health priorities. Communities are committed to addressing these issues for the general population. However, the extent to which the issues and strategies relevant to this population are included is unclear.

Federal resources available to address the issue of oral health and children with special health needs are increasing. Expectations for integrating activities of state oral health programs and CSHCN programs have been outlined by the Surgeon General's Report.

1. National Health Interview Survey of Children with Special Health Needs, National Institutes of Health.
2. Oral Health in America: A Report of the Surgeon General.
3. ibid
4. Stewart, M. "Introduction to Cleft Lip and Palate." Grand Round Archives, Baylor College of Medicine. 1991. http://www.bcm.tmc.edu/oto/grand/6191.html [Attn: Non-MDH Link] Accessed 6/21/04.
5. Office of Rural Health and Primary Care. "Dental Workforce Profile." Minnesota Department of Health. February 2002.
6. ibid
7. Born, David, O. "Treading Water: Minnesota's Dental Workforce in the Year 2000." Northwest Dentistry. September-October 2000, 79(5): 23-28.
8. "Oral Health in America: A Report of the Surgeon General"
9. National Center for Chronic Disease Prevention and Health Promotion. "Preventing Dental Caries." Centers for Disease Control. 10/31/2002.
10. "Oral Health in America: A Report of the Surgeon General" 2001.
11. Healthy Athletes. Special Olympics A Guide to Good Oral Health for Persons with Special Needs [Attn: Non-MDH Link], 6/27/04.
12. National Institutes of Dental and Craniofacial Research. "Dental Care Every Day: A Caregivers Guide." NIH Publication No. 04-5191. May 2004.
13. American Cleft Palate/Craniofacial Association and Maternal and Child Health. "Parameters for the Evaluation and Treatment of Patients with Cleft Lip/Palate or Other Craniofacial Anomalies." Cleft Palate Craniofacial J. 1993;30(suppl 1): 54-512.