DENTISTRY, MANAGED CARE, AND YOUR

CHILD WITH SPECIAL NEEDS

HOW DOES A DENTIST DEFINE A CHLD WITH

SPECIAL NEEDS?

Any child with mental, physical, or emotional problems

WHAT ARE SOME DIFFERENCES FOR CHILDREN WITH SPECIAL

NEEDS?• Problems with manual dexterity may

affect oral hygiene

• Diet, especially soft diet, may cause food to cling to the teeth

MORE DIFFERENCES• Medications

– may be high in sugar and contribute to decay

– may dry the mouth and lead to decay

– may cause the overgrowth of the gums (hypertrophy)

• a characteristic of the child’s disorder may be malocclusion or bite problems

WHEN DOES A CHILD FIRST NEED TO SEE A DENTIST?

By age 1 or when the first tooth erupts - (according to the American

Association of Pediatric Dentists and the American Academy of Pediatrics)

TYPES OF DENTAL INSURANCE• Dental Health Maintenance

Organization

• Regular insurance, also known as fee for service, or indemnity

• Preferred Provider Organization

DENTAL HMO• Dentists become part of the network

• The dentists are paid a fixed dollar amount per patient per month (capitation) to provide all services under the plan

• Family must choose a dentist from the providers listed

ADVANTAGES and DISADVANTAGES OF HMO

• ADVANTAGES

– reduced premiums

– reduced co-payments

– no deductibles or annual maximums

• DISADVANTAGES

– may have reduced accessibility

– may have limitations on covered services

DENTAL PPO (Preferred Provider Organization)

• A network of contracted dentists who have agreed to accept reduced fees according to a PPO fee schedule.

• It does not involve a monthly capitation payment system to the dentist

ADVANTAGE & DISADVANTAGES OF A PPO

• ADVANATAGES– premiums are less

than for fee for service– may go to the dentist

of their choice although payment will be greater if you stay in the network

DISADVANTAGES– costs will be higher

than with an HMO– payment is higher if

you do not use a network dentist

FEE FOR SERVICE or TRADITIONAL INSURANCE

• Family selects the dentist of their choice

• Bill is submitted to insurance company for payment

ADVANTAGE & DISADVANTAGES TO THE FAMILY FEE FOR

SERVICE• ADVANTAGES

– Family may choose their dentist without restrictions

• DISADVANTAGES– Premiums and out of

pockets costs will be greater

– Family may be responsible for sending forms to insurance

SEEING A PEDIATRIC SPECIALIST

• In an HMO you must see the general dentist first and be referred to a specialist

• In the PPO if you want to stay in network, you must see the general dentist for a referral

WHAT REASONS ARE THERE TO SEE A PEDIATRIC

DENTIST?

When the general dentist finds that there are special needs of the child that he/she would not

be able to meet.

SPECIAL NEEDS MIGHT INCLUDE:

• Severe dental problems

• Unusual dental problems

• Difficulty managing the child

IF YOU HAVE A CHOICE IN DENTAL PLANS: consider

• Think about how much care you will need. The more care that is necessary, the more savings you would realize under the HMO.

IF YOU HAVE A CHOICE IN DENTAL PLANS: consider

• Think about how much choice you prefer. An HMO has the least options, PPO has more options, and traditional or fee for service has

the most options for selecting a dentist. • Review the list of providers. Make sure the

provider you select is available.

• Compare the costs involved from plan to plan for a particular type of treatment

IF YOU HAVE A CHOICE IN DENTAL PLANS

• Review the list of providers. Make sure the provider you select is available.

• Compare the costs involved from plan to plan for a particular type of treatment

BEFORE YOU VISIT THE DENTIST WITH YOUR CHILD

• Talk about it- “the dentist will count your teeth and peek in your mouth”

• Use books (see list in Resources)

• Modeling - have your child watch someone else

• Desensitization- getting the child used to what is going to happen before it happens

HOW DOES A PARENT EXPLAIN A CHILD’S SPECIAL NEEDS?• Call in advance and talk to the

dentist and/or staff• Sit down and explain child’s

problems. Let them know any special concerns you have.

WHAT MIGHT MAKE IT DIFFICULT FOR A CHILD WITH

SPECIAL NEEDS?• EXAMPLE: Kerissa was mentally retarded

and needed help with brushing. But she would not let anyone in her mouth. She would gag. Two things were done:– Karissa came in to the dentist frequently for 6

weeks– Karissa’s family used a toothette to clean her

teeth beginning only with 1 tooth

OTHER TECHNIQUES THAT THE DENTIST MIGHT USE

• Tell, Show, and Do

–Tell the child what you’re going to do

–Show the child on a model what you will do

–Then go ahead and do it

DIFFICULTIES THAT MIGHT OCCUR AT HOME

• Child is sensitive to touch

• Parent may not be able to clean all of the child’s teeth-especially back teeth

• Child may gag and pull away from you

SEALANTS• Protects the surface of teeth

with grooved and pits

• Made of shaded plastic and applied to teeth to keep them cavity-free

• Usually covered by insurance

DENTAL CARE IN A HOSPITAL SETTING

• Dentist may recommend a hospital setting if child’s behavior or systemic problem indicate that care should be in a hospital

• Plan needs to be discussed with insurance company regarding payment

CLOSING REMARKS

• BEFORE DENTAL CARE:

• give short simple explanations of what is going to happen

• talk positively-avoid the word “pain or hurt”

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