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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”
THANK YOU FOR JOINING US.
TO LISTEN TO OUR OTHER WEBCASTS, SEE
OUR ARCHIVES