Health & Wellness
General Information
Giving Your Child With Special Needs a Happy, Healthy Smile
A daunting task facing parents of a child with multiple physical and mental challenges is to assemble a strong healthcare support team that can help them face the unknown, accept the challenges and conquer the barriers. One of the primary members of that team is the pediatric dentist. Even the thought of a routine dental visit can be stressful for parents. Children with developmental delays and physical limitations are often at higher risk for dental disease. Oral maladies can adversely affect a child’s overall health. It is imperative that a family be connected with the proper dental specialists who can offer guidance and who will work with pediatricians and other physicians to ensure good oral health.
In this two-part series, Richard Mungo, DDS, MSD, and MSEd , will share his insights and experience about pediatric dentistry for families who have children with special needs. Dr. Mungo maintains a private practice in Huntington Beach, California and is a faculty member at the University of Southern California in the Department of Pediatric Dentistry.
What does the pediatric dentist do?
Pediatric dentists see children from birth to the early or middle teen years. Our practices are a mixture of well-developed, healthy children and those who have multiple medical and developmental complications. Infants born with birth defects that prevent them from eating are often referred to our practices for the fabrication of feeding devices that can assist them during those crucial first months of growth.
We educate parents and the child about good oral health, including nutrition and the consequesnces of a poor diet and eating habits. Prevention is perhaps the most important part of our practice. We show families proper oral hygiene practices that prevent dental problems. An individual approach to a child’s needs is developed with the parents to empower them to take the information home and incorporate it into their daily lives. If treatment is needed for their child, a comprehensive plan is established, taking into consideration the dentistry required, the specific approach to the child and financial concerns.
Finally, the dental treatment that a child may need can range from a routine cleaning to invasive dental surgery. Fillings, extractions and actual jaw surgery can be accomplished through the coordinated efforts of the pediatric dentist working in concert with other dental and medical specialists, if needed.
Do you have any tips for parents on how best to work with their pediatric dentist?
There is a great deal that parents can do to make the dental experience a good one. The first is to find proper dental care practice for your children. Discuss with your own dentist, pediatrician and friends about their experience with the dental needs of their children or patients. The internet holds a wealth of information regarding pediatric dentistry. Local, state and national pediatric dentistry organizations offer informative websites and I encourage all parents to visit those sites as well as the website of the doctor they are considering.
Always inform the office you’ve chosen of your specific concerns. The better they know you and your child, the better they will be able to meet your expectations. For example, if your child has a history of seizure activity in the morning, then an afternoon dental appointment might be best. Specifics can be worked out when a good flow of information exists between the family and dental professionals.
Be sure to bring your child’s detailed medical history to the dental office. If the child takes medication, has had heart surgery, has periodic breathing problems or allergies, for example, it is important that the dental professionals are aware of these past and present medical conditions. A list the child’s doctors and their contact information will also help the dentist and staff to communicate better with other healthcare providers to prevent adverse reactions to medications and treatments. This “medical/dental” history of your child will avoid repeating the history of your child’s care when you interact with a new office.
Let your pediatrician or cardiologist know that you are taking your child to the dentist. Ask them if they have any information they want the dentist to know before any treatment is rendered. They may have specific concerns or want to alter daily medications.
Are there insurance issues that come up regularly?
If there is anything that can form a wedge between family and doctor, it’s insurance coverage issues. Unfortunately, most families are not fully aware of the specifics of their individual insurance policies. They often presume that the dental office will be up-to-date on their policy contents. This assumption can cause problems because it is impossible for every dental office to know all the details about the myriad of insurance plans.
The responsibility for understanding the insurance coverage lies with parents. Discuss the details of your policy with your insurance professional, service center, or human resources department. It is a good idea to bring a copy of your individual policy to the dental office. The office staff can review the policy and direct you to what they need to maximize benefits for your child.
It is also recommended that if the treatment for your child requires a complicated, costly plan to ask the dental office to “pre-authorize” the charges with the insurance company. After the insurer responds, you will know what you’re responsible for and what your insurance will cover.
What the most common areas of misunderstanding?
One common misunderstanding is when parents forget to inform the dental office about changes in insurance companies, the policy, employment and addresses. Another frequent problem occurs with families going through a change in marital status. For example, the dental office may become the “bad guy” if the billing goes to a divorced mother when the father is responsible for all medical/dental care for the children. Any paperwork that defines who is financially responsible for the costs of dental care should be given to the office. It is most important that both parents are involved in the process of accessing and approving care. The worse case scenario is when one parent receives a large dental bill but was not aware that the treatment for their child was being performed.
Finally, if your child is qualified for treatment covered under Medicaid, or some other form of governmental assistance, be sure to immediately inform the dental office and provide them with verification of your current status under the program. Governmental assistance programs are under-funded and do not reimburse the healthcare provider at a usual and customary rate. It might be difficult to find a private practitioner in your immediate area who accepts your specific program. You may need to go to a community service or dental school in which there are pediatric dental departments that will accept your coverage.
What accommodations are made for children with special needs?
Non-verbal children Many offices will have one or more staff personnel who have some degree of proficiency in the use of sign language. The parents are the best assistance in these matters. Whatever method they use to communicate with their child can be incorporated within the dental office experience. Discuss your role with the dental team prior to the visit or before a specific procedure is to take place. The dental professionals will guide you in your quest to make the visit a positive and productive one.
Non-ambulatory children Transferring children to the dental chair from their wheel chairs can be done with the assistance of the parents. Parents know comfortable methods of transfer and manipulation that will not bother or harm their child. The doctor and staff learn from the parents what works, and then document their recommendations for usage in subsequent visits.
There are times when we have made house calls to evaluate a dental situation for parents who cannot take the child out of the home. We are obviously limited in what we can do in the way of treatment without the appropriate dental equipment. However, a good assessment of the child’s needs can give us the opportunity to plan an approach to the child’s care and whether it requires a hospital setting or can be handled in the office.
Children in home care facilities or in the hospital can be assessed through a dental examination when a dental consultation has been requested. In the hospital, there are procedure rooms on various floors in which some minor surgical care can be rendered. Otherwise, care can be arranged to take place in the operating room suites of the hospital.
Should we move children from wheelchairs into the dental chair?
I believe it is better to leave the child in their wheelchair, if possible, when offering dental care in the office. The wheelchair has been customized for the child’s comfort and the dental chair may not be contoured well for any limitations in movement that the child may exhibit. Pillows can be used to add an additional secure feeling for the child in either the wheelchair or dental chair. Making sure that the child is comfortable, secure and safe is our most important concern when determining where the child should be placed for treatment. Most wheelchairs can be tilted backwards for better access for the dentist. We then can stand behind the wheelchair and gain good access to the mouth.
When is hospital dentistry appropriate?
We often need the environment of a hospital or surgery center to accomplish our required treatment. If the medical condition or mental status of the child is prohibitive in offering adequate safety or cooperation in a dental office, then the hospital setting is the better alternative. For example, patients who have cerebral palsy, cardiac problems, bleeding disorders, developmental delays are often best treated in a hospital setting. Each child is different and will require a comprehensive plan for their needs.
Children who have autism can be challenged when attempting to perform dental procedures. The dentist and the parents need to create the best approach to the child’s care. Tender love and care in office-conscious sedation or general anesthesia are the options.
Do you have any final recommendations or thoughts?
Identifying the kind of treatment that is necessary and the means of accomplishing those goals are the key factors involved in determining what’s best for the child. From medical issues, to insurance coverage, to dental treatment options, we must always keep in mind: “It is all about the children.” What we can offer the children is a healthy and happy smile. This task involves a team of caring people – the parents, the dentist, the staff and other healthcare professionals - -who have the child’s best interests at heart.