Defining Special Needs Patients

Special Blog from Douglas Manning DMD, JD, MPH
Dental Director | DentaQuest | Florida

Time for Alignment and Action

Special needs is a term that many groups use to identify persons with a disability (impairment and handicap are other terms that may be used to describe a disability). Disabilities can be developmental or acquired; physical or intellectual. The term disability is more used to describe persons who have or are at an increased risk of having a variety of physical, developmental, behavioral, or emotional conditions and in many contexts is legally defined. In contrast the term special needs relates more to whether that disability requires special health services or accommodations.

The Americans with Disabilities Act (ADA) defines disability rather than special need. It defines a person with a disability as “as a person who has a physical or mental impairment that substantially limits one or more major life activity. This includes people who have a record of such an impairment, even if they do not currently have a disability. It also includes individuals who do not have a disability but are regarded as having a disability.”

It is important to remember that in the context of the ADA, “disability” is a legal term rather than a medical one. However, it’s definition is instructive as far as identifying a person with a disability.

In the dental setting, dentistry is dentistry – meaning specific dental diagnostic, preventive and treatment services are the same no matter who the patient. However, the extent of care (e.g., the frequency and type of diagnostic, preventive, and treatment services) and the mode of delivery (e.g., behavioral therapy, anesthesia/sedation) may vary depending on the disability and the severity of the disability.

For the disabled population, performing routine oral hygiene home care, accessing professional dental care, and giving informed consent concerning health care treatment may be significant issues. Some patients need routine dental care, but many have medical conditions or limitations that require accommodations as to the delivery of the dental care and treatments. However, a person who is disabled (or is considered disabled) does not necessarily need special services or an accommodation to deliver those services.

Some disabling conditions come with direct oral health ramifications and sequalae. Disorders such as ectodermal dysplasia and osteogenesis imperfecta directly affect tooth and facial development and demand specialized treatment to treat the disability (although any such treatments and services are still routine dental treatments). While other disabling conditions come with indirect oral health ramifications. A severely autistic person may thrash, bite, and have uncontrolled movements. While the dental treatment services the person may require such as examination, radiographs, cleanings, or fillings may be routine the behavioral component of the disabling condition requires an accommodation in the mode of delivery (e.g., anesthesia/sedation) of those dental services.

Subsequently, when we define special needs in dentistry it is these accommodations that are at the core of the determination and discussion.

From that standpoint the National Institute of Dental and Craniofacial Research (NIDCR) definition seems appropriate. It defines what special care is rather than attempting to define the population. The NIDCR states that special needs are “an approach to oral health management tailored to the individual needs of people with a variety of medical conditions or limitations that require more than routine delivery of oral care.”

More specific to dentistry the American Academy of Pediatric Dentistry (AAPD) has defined Individuals with Special Health Care Needs as those who “have a physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. The condition may be developmental or acquired and may cause limitations in performing daily self-maintenance activities or substantial limitations in a major life activity. Health care for special needs patients is beyond that considered routine and requires specialized knowledge, increased awareness and attention, and accommodation.”

Defining special needs is difficult due to the variety of possible conditions, the subjectivity involved in the determination process and the fact that there are no clearly defined parameters. However, it is an important first step to monitoring the burden of oral disease among this population (oral health outcomes, access to care, risk factors, etc.) and setting achievable state and local goals and objectives for improved oral health.

About the Author

Douglas T. Manning DMD, JD, MPH joined DentaQuest in 2011 and is currently the regional dental director for Florida. In this position he works to establish and maintain relationships with DentaQuest clients and state oral health stakeholders, oversees quality initiatives, addresses provider concerns and promotes innovative approaches to the delivery of oral health care.

Previously, Dr. Manning was a Senior Health Services Analyst for the Florida Department of Health (DOH), Division of Family Health Services, Public Health Dental Program. In that position he was part of the team that had responsibility for oversite of the county health department dental programs; he provided oral health care policy analysis and legislative planning; was the grant writer and Project Director for Florida’s 2008 and 2009 HRSA Grants to States to Support Oral Health Activities awards, the coordinator for the DOH Teledentistry Pilot Program; and led the Oral Health Workforce Workgroup and the Special Needs Oral Health Workgroup of the state Oral Health Florida Coalition.

In 2004, Dr. Manning was the Project Coordinator for and primary author of the DOH’s State Oral Health Improvement Plan (SOHIP). Additionally, Dr. Manning served as a dental consultant for Manatee County Health Department (CHD), where he assessed the county’s oral health needs and determined where the CHD could improve access to oral health care. Dr. Manning holds a law degree from the University of Florida, College of Law, a Master’s in Public Health from the University of South Florida, College of Public Health, and a Doctor of Dental Medicine (DMD) degree from Washington University, School of Dental Medicine. He also completed the Dental Public Health Residency at the University of Florida, College of Dentistry and attended a Health Law Master’s Program at the University of Houston Law Center. Dr. Manning practiced general dentistry for eight years in the Philadelphia area from 1985-1993. Additionally, he attended the University of South Florida’s Public Health Leadership Institute for 2007-2008. He is a member of the American Dental Association, Florida Dental Association, West Coast District Dental Association, and the Florida Bar.

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