Patients With Special Needs at Risk for Poor Oral Care

Lack of specialized dentists results in long wait times 

By Iris Winston, Postmedia News February 24, 2011 4:03 AM   

Many people with physical or mental disabilities are not receiving the oral care they need or have to wait for treatment for a year or more.

“Approximately 4.4 million people in Canada have disabilities. Ensuring that they receive proper oral care is a major issue,” says University of Toronto
dentistry student Alison Sigal, the founder of Oral Health, Total Health.

“We know that people with certain disabilities don’t have the hand function or ability to clean their teeth and that they are among the populations most
affected by poor oral care,” says Canadian Dental Hygienists Association board member Sandy Lawlor. “It is really important for them to see a dental hygienist to get the plaque off and the teeth scaled so that the gums remain healthy.”

To address the problems facing people with disabilities, Sigal created the non-profit organization OHTH in 2008.

“The primary reason behind founding OHTH was to raise awareness about the issues that persons with special needs face with regard to access to oral care,” says Sigal. “As well as getting information out to the public, it is important to have an impact on future generations. If every dental student at every
school treats even one patient with special needs a year, it will reduce the wait lists and wait times.”

She says that she became aware of the extent of the problem in 2006 while she was involved in a summer research project at Toronto’s Mount Sinai Hospital where her father, Dr. Michael Sigal, is dentist in chief.

In researching the files of deceased special-needs patients, she found “the primary cause of death was sudden cardiac arrest” and noted the close (95 per cent) correlation with aspiration pneumonia, which, she points out, is “due to inhaling bacteria in the mouth.”

“Had these patients had more frequent visits to a dentist or dental hygienist or even had improved daily dental care in their homes, they would have had
a reduced amount of bacteria in their mouths, thereby reducing the chance of inhaling them and the chance of pneumonia. We are really looking at a qualityof-life issue, not just an oralhealth issue.”

She also discovered that of the 3,500 or more patients with special needs seen annually at the Mount Sinai dental clinic dedicated to this group, some travelled up to eight hours for a 15-minute routine checkup.

One reason for referring these patients to Mount Sinai is that while they receive some financial support through provincial disability insurance, it doesn’t
always cover fees charged by dentists in private practice. The key issue, however, was practitioners’ unfamiliarity with dealing with special needs patients, says Sigal.

“When they appeared at their clinics, the dentists did not feel confident of their skills and abilities,” she says.

“We are known as the biggest program for these types of patients, so we are a catchment for referrals -some appropriate and some not,” says Dr. Michael Sigal. “The wait list to get into the program is about six months. If the person with special needs requires anesthesia, it is a year to a year-and-a-half.

If a child with special needs is uncooperative with the dentist in the community and the only way to treat him is for him to be asleep and he is referred
to us, it could be up to two years before the surgery is done. This is for something that is causing pain and suffering all along and will only get worse
with time.”

Efforts are being made to make dental care more accessible, say oral health practitioners.

“A lot of effort is being put in non-traditional settings,” says Dr. Anthony Iacopino, the dean of the faculty of dentistry at the University of Manitoba
and the director of the International Centre for Oral-Systemic Health.

“Healthcare professionals are out in the community or in other clinics. We’re also seeing a lot more programs for non-dental health professionals, so that they can participate in screening and referring patients to oral health professionals.”

© Copyright (c) The Ottawa Citizen   

Reproduced from