Special Needs Dentistry: Elwyn’s Dental Home for Supporting Oral Health

Abstract

Special Needs Dentistry

Elwyn operates two quality dental practices in the Philadelphia area serving over 3,000 patients with special needs. Its newest practice is located in West Philadelphia at 4040 Market Street. These practices serve people who have historically been underserved, such as individuals with intellectual and other disabilities. A number of key features including experienced staff, state of the art equipment, electronic dental records and a variety of funding sources have resulted in the success of these clinics. Participation of dental students from the University of Pennsylvania and Temple University enable the clinic to function within the Medicaid reimbursement rate structure. Serving people with special needs, such as intellectual disability or autism spectrum disorders, requires a unique skill set and results in the hygienist and dentist spending more time with each patient. Students are also introduced to new skills and experiences that will better enable them to care for the unique needs of this population when they open their own practices.

With the closing of state developmental centers in Pennsylvania and across the United States, increasing numbers of people with intellectual disability have been receiving community-based health services. This is a trend that has been occurring in the United States for the past several decades. Much of this change in service delivery has been funded through the Home and Community Based Service Waiver. This waiver allows the states to draw down federal matching funds for a list of services that have been agreed upon by the state and federal government. As a result, there are now far more individuals living in the community than are living in state developmental centers.

In Elwyn’s experience, community access to dental care for people with disabilities has posed several unique challenges. Finding a dentist who is skilled in treating those with behavioral challenges, clinic accessibility and a lack of available appointments create potential barriers to care. In addition, many patients with special needs also have communication difficulties and are unable to express pain in more traditionally expected ways. This may result in a failure to detect significant dental issues and lead to serious behavioral issues such as self injury and aggression. Many individuals also have difficulty cooperating with routine dental maintenance needs and are at increased risk for dental and periodontal complications caused by the long-term use of certain medications. Inherent maxillofacial abnormalities that occur in certain disabilities, such as Down syndrome, may also increase the probability of a dental problem.