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Dental Treatment for Children with Special Needs

Providing dental surgery and other dental services for children with special needs is an area of specialization and recent expansion for Children’s Hospital’s Pediatric Dental Program.

Routine dental care for children with cerebral palsy, autism, Down syndrome, severe behavioral disorders, severe developmental delays, brain injuries and other similar conditions often involves treatment in the operating room setting. “At Children’s Hospital, we have the facilities to provide same-day dental outpatient surgery under general anesthesia for children under the age of 21 who have medical, cognitive or developmental issues that prevent treatment in the dental clinic without pharmacological intervention,” comments Elizabeth Bortell, DDS, Director of the Pediatric Dental Program.

“Children with special needs can be very susceptible to tooth decay, gum disease and oral trauma,” she adds. “Many children with special needs require diets or medications that may be detrimental to oral health. Those with profound cognitive issues are often unable to cooperate for dental treatment and cannot communicate that they are in pain. Treatment under general anesthesia allows for proper diagnosis of a dental condition that may be causing pain.”

The Dental Program expanded to a two dentist practice in 2006 and since then has increased its dental surgical schedule to four days each week. Providing better access for children in need of pediatric and specialized pediatric dental care was a motivating factor for expansion, according to Sharon Darby, Vice President, Clinical Operations and CNO, and improving access to this much-needed care is also a primary reason for the hospital’s continued participation as a Virginia Medicaid Smiles for Children network provider. “Children’s Hospital’s overall mission targets care of the underserved,” Darby explains.

In line with this mission is the resultant increase in the availability of dental surgery for children with special needs. As part of programming designed for this patient population, Children’s Hospital has an operating room staff and anesthesiologist with many years of experience treating children with special needs and a recently renovated dental suite with an overall design that is very accessible for non-ambulatory patients. “I have great compassion for the parents of children with special needs, particularly those with limited access to care,” Dr. Bortell remarks. “Treating children with complex medical, physical and emotional needs is a privilege and a priority to me. It is the primary reason I chose a career in pediatric dentistry.”

In addition to addressing immediate oral health care needs, Children’s Hospital’s dental programming for children with special needs focuses on providing the basis for life-long oral health. Initial goals include taking care of acute needs in the operating room, then returning to the dental clinic every three to six months for checkup appointments without the use of sedation. These subsequent appointments include a focus on behavioral modification, prevention and oral hygiene improvement to encourage patients to allow treatment without the use of sedation. “Hopefully, with an emphasis on behavioral modification and positive reinforcement, the child may be able to transition to an adult provider after the age of 21 with optimal oral health and an overall increased likelihood of acceptance of dental treatment,” Dr. Bortell remarks.

Originally published in Early Edition Vol. X, No. 4

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