Dentistry for Kids With Complex Medical Conditions

Dentistry is important for everyone, but it can be especially important for kids with complex medical conditions. These kids often have more complicated dental issues, as well as behavioral or medical issues, that make treating them difficult. For example, children who don’t eat by mouth may be more prone to dental decay. Children with specific conditions, such as reflux or dry mouth, may have significant problems with their teeth, while children with pain or sensory issues may damage their teeth through grinding. Certain medical conditions, such as immune problems, may make dental care critically important but challenging, since bacteria from the mouth can easily cause systemic infection.

In addition, these kids may need specialized treatment. Those who have difficulty coordinating their breathing and swallowing, or kids with trachs, may require a dentist who is trained to care for kids with breathing problems. Some children with behavioral issues may require sedation for dental treatment. Children with muscle problems, behavioral issues, or cognitive impairment may find it difficult to open their mouths for treatment.

In this article we will help you find a dentist who can treat your child and know what to look for in a dental clinic. We will also provide resources for covering the cost of dental care. Hopefully, all children will be able to receive the dental care they need!

Finding a Dentist

It can be surprisingly difficult to find a dentist to treat children who are medically complex. While the average dentist can handle a child with a mild medical condition or mild behavioral needs, many practices are not equipped to handle complex cases.

If you think your child may need extra support at the dentist, you probably want to find a practice that specializes in dental care for children with special needs. Here are some of the things you may want to consider:

• Availability of specialized seating (or a transfer lift) for kids with mobility issues, including positioning equipment if needed.
• A facility with separate rooms designed for children with sensory issues or autism.
• Experience with specialized equipment for children who cannot open their mouths well or need other assistance (i.e. mouth blocks).
• Experience with your child’s condition.
• Experience with medical needs (i.e. providing antibiotics prior to the visit).
• Ability to perform sedated procedures or procedures under general anesthesia.
• The knowledge and ability to use gentle restraints.
• Availability of extended appointment times for children who require extra time.
• Board certification or additional coursework in special needs dentistry.

You may find dentists who care for children with special needs in a variety of settings, including children’s hospitals, dental schools and training programs, and in regular offices in the community.

Children’s Hospitals

A great place to look for a dentist who knows how to care for children with special needs is your local children’s hospital. Most larger children’s hospitals have a dentistry program, and many even have specialty programs for children with special needs. The advantages to seeing a dentist right at the hospital are numerous. First of all, they likely have access to all of your child’s medical records, and can consult with your child’s other hospital-based physicians if needed. They are also better able to handle emergencies that may happen, such as if a child needs deep suctioning during dental treatment, or if a child experiences complications. In addition, if your child needs sedation or treatment under general anesthesia, they can treat your child safely with the assistance of trained pediatric anesthesiologists.

Many have special rooms designed for children with sensory or behavioral challenges to help make the visit less stressful. They may also have specialized equipment for children with physical disabilities, such as specialized chairs, positioning equipment, or patient transfer lifts.

The prime disadvantage of hospital-based clinics is that they tend to have waiting lists, because these services are so highly in demand. Many children need to wait months or years for a first appointment, and in some cases, these clinics are only able to see children who require significant treatment.

Resident Clinics and Dental Schools

Dentists in training need to learn how to care for patients with special needs, and many programs offer a dental resident clinic or student dentist clinic. These programs may be based out of a dental school, university, or a hospital-system, including a children’s hospital.

Typically, a student or resident dentist who is closely supervised by other dentists will treat your child. Many of these clinics specialize in care for people who are medically complex, and offer the most current technology and the most up-to-date care. These clinics are often equipped to handle patients with a variety of physical or medical conditions. They also have specialty care available for those who need it, including oral surgery and sedation or anesthesia services.

Independent Practices

There are many independent practices that focus on children with special needs or are able to accommodate them. In most cases, it is best to choose a pediatric practice, as these dentists have additional training to treat children, which includes children with special needs. Many include dentists who may also be on staff at the local children’s hospital, allowing them to treat children as needed in a hospital setting.

Independent practices vary considerably. While many may be able to treat children with autism or behavioral challenges, some may not be equipped to handle children with severe physical limitations or complex medical conditions. If you are unsure whether a practice can handle your child, it is best to talk to your child’s primary care provider or complex care specialist to determine whether a clinic may be adequate.

Paying for Dental Care

There are numerous sources for funding dental care, which often is not covered by private insurance plans. Some policies are more comprehensive than others and may require substantial coinsurance and other cost-sharing for treatment other than preventative care. Typical payers include Medicaid and Medicaid waivers, Children’s Health Insurance Programs (CHIP), private insurance, and charity care.

Medicaid

Children who receive financially-based Medicaid, disability-based Medicaid, participate in a CHIP-funded Medicaid expansion, or who participate in a Medicaid waiver program or Katie Beckett/TEFRA program receive comprehensive dental coverage. Full coverage includes all medically necessary services, such as preventative care and treatment. In most cases, there is no cost-sharing for children in Medicaid. Some middle-income children receiving dental care may be required to pay small copays.

Children’s Health Insurance Programs

Some states have Children’s Health Insurance Programs that are separate from Medicaid. These programs are for families with slightly higher incomes than those who qualify for Medicaid. Each state must provide dental coverage through its CHIP program, but this coverage varies by state. Most states provide comprehensive coverage, but some may limit certain services or place a cap on the maximum amount spent per year. Cost-sharing is common.

Private Insurance

Families who purchase individual or small group insurance on the exchanges through the Affordable Care Act (ACA), as well as families with private insurance through an employer, may have dental coverage. Policies purchased through the exchanges must offer pediatric dental coverage, either through the original policy or a state supplement. Typically, premiums and copays apply, with free preventative care and cost sharing for other services.

Most employer-based private insurance coverage does not include pediatric dental care, but many employers offer separate add-on dental policies for employees and their families for an additional premium. This coverage varies widely, but typically pays for preventative services without additional cost. Treatment and restorative services are usually covered partially, and coinsurance and cost maximums are common.

In rare cases, certain types of dental care may be covered by your child’s regular medical insurance. This is typically only the case for significant craniofacial conditions or other conditions that require both medical and dental/orthodontic treatment.

Charity Care

If no other option is available, your child may be eligible to receive free charity dental care. Dentists may hold free care clinics on occasion, and sometimes foundations can help cover costs, especially if the dental care is required to fix a disfiguring or disabling condition.