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Providing Oral Care for People With Disabilities

Steven Perlman, Photo: Courtesy of Steven Perlman

Steven Perlman, DDS, MScD, DHL (hon)

Global Clinical Director and Founder, Special Olympics Special Smiles, Clinical Professor of Pediatric Dentistry, Boston University Goldman School Of Dental Medicine

Around the world, there are more than 1 billion people living with some form of disability. One of the most overlooked health challenges they face is oral health — only about 10 percent of dentists treat patients with disabilities.

“People with intellectual disabilities (ID) are the most medically underserved population,” said Steven Perlman, DDS, clinical professor of pediatric dentistry at Boston University Goldman School Of Dental Medicine. “The more severe the disability, the more trouble accessing care.”

Education and money

Perlman, who founded Special Olympics Special Smiles, an oral health initiative for Special Olympics athletes, is also a past president of The American Academy of Developmental Medicine & Dentistry (AADMD). He counts two major barriers to dental care people with disabilities face.

“Education is a huge barrier,” he said. “When a parent of a 14-year-old with cerebral palsy or Down syndrome calls a dental office, the answer is ‘I never got any training, I don’t feel comfortable doing it.’” 

Recent changes in ethics rules are changing that. 

“Dental schools have to come up with a plan by this year for their students to be trained in competency in treatment for people with disabilities,” Perlman noted.

Money is also a factor. “It takes a lot of time to treat these patients,” Perlman said, “but insurance companies and Medicaid don’t recognize the extra time.” 

Additionally, these patients often require extra staff, which is also not factored into reimbursements, and many patients require wheelchairs, making traditional examination rooms problematic.

While he knows there is still work to be done, Dr. Perlman thinks there is finally real progress. 

“It’s changing,” he said. “Today, 90 percent of people with ID can be mainstreamed through a dental office.”

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