A Survey on Mitigating Barriers to Dental Care for Children with Special Health Care Needs By Providing Dental Treatment Under General Anesthesia

Background:   Children and youth with special health care needs (CYSHCN) experience unique challenges in accessing health care. Among the greatest unmet needs among this population is dental care. Dental caries is the most common chronic disease in children, and children with developmental disabilities are more likely to have unmet dental needs than typically developing children^[i],[ii]. Barriers for CYSHCN accessing dental care may include but are not limited to: body movements, repetitive behaviors, and self-injurious behavior. Some CYSHCN experience excessive sensitivity involving their face/mouth influencing diet, nutrition, teeth brushing, speech, and routine dental check-ups. Providing dental treatment to this population may be challenging, thus warranting general anesthesia as the only mechanism to deliver the necessary dental treatment. This study seeks to examine and understand the experience and satisfaction of parents/caregivers of CYSHCN requiring general anesthesia for routine dental examinations.

Objectives:   The purpose of this preliminary study was to review survey results from parents with CYSHCN to understand the barriers of dental care for CYSHCN and to evaluate the effectiveness of providing dental and medical treatment under general anesthesia. This pilot study may inform future clinical procedures of CYSHCN by facilitating comfort of the patient and family.

Methods:   Parents/caregivers of CYSHCN (n=25; 14 with ASD, the other 11 with neurological, genetic, and developmental disorders) completed a survey to understand:  CYSHCN’s experience with dental treatment under general anesthesia, barriers they encountered, and other feedback regarding their clinical encounter. In this sample of parents, 10 (4 with ASD) had children who were placed under general anesthesia and 15 reported on general issues but not a specific experience.

Results:   The majority of respondents indicated challenges in accessing routine dental treatment for their child (76%). The most common barrier to getting dental treatment for a CYSHCN was intolerance of the child for dental treatment (76%). Other frequently listed barriers included: paucity of experienced dentists to treat CYSHCN (20%), inconvenient appointment time (8%), transportation challenges (8%), unaccepted dental insurance (4%), and unable to obtain medical clearance for dental treatment (4%). Of the 10 parents (40%) with children who had undergone dental treatment under general anesthesia, seven (70%) reported an excellent experience (on a five-point scale from excellent to poor) with the services and the remainder (30%) reported a very good experience with these services.

Conclusions:   Survey responses confirm CYSHCN experience a variety of challenges in accessing routine dental care. The most significant barriers to address,  include the child’s intolerance to dental care and lack of dentists experienced with CYSHCN. Additionally, these responses demonstrate resounding satisfaction of the parents whose children received dental care under anesthesia, although the small study warrants replication. Overall, when CYSHCN cannot tolerate dental procedures, anesthesia is a feasible strategy to support this needed care.