Addressing the Oral Health Crisis in the U.S. and Abroad
It’s no secret, there is an oral health crisis here in the United States and around the globe. While our oral health is directly linked to our overall health status it is unfortunately not always prioritized. In 2018 the World Dental Federation even used the slogan “Think Mouth, Think Health” for World Oral Health Day suggesting that a healthy mouth means a healthy body. The U.S. Department of Health and Human Services (HHS) has also placed emphasis on reducing oral health disparities outlined in their Oral Health Strategic Framework 2014–2017 and HHS also echoes the World Dental Federation by stating “Total health and wellness cannot exist without oral health”.
Research has also shown that disparities in oral health largely impact the overall health and quality of life of an individual. The Oral Health in America: A Report of the Surgeon General referred to the oral health issues plaguing children and adults across the United States as the “silent epidemic”. Poor oral health can alter our appearance, speech, our eating habits and even our social and emotional wellbeing and also contributes to school and work absenteeism. So why aren’t we prioritizing oral health more? Some studies show that since oral health traditionally had been isolated and not included as an integral part of overall health there’s been a lack of priority placed on oral health prevention. Other contributing factors to poor oral health include cost of dental health services and access to providers. These barriers to care are preventing most people from improving their oral health, but more specifically, vulnerable populations like children and adults with disabilities.
Data has commonly shown the disparities in health status for children and adults with intellectual disabilities (ID) and in the areas of oral health this holds true as well. There are a few reasons why there is a gap in accessing oral health for people with ID. Cost in obtaining dental services is a barrier for close to 29% of people with disabilities, many of whom in the U.S. depend upon Medicaid for these services.
How is Special Smiles Addressing the Oral Health Care Crisis?
Since 1997, the Special Olympics Special Smiles program founded by Dr. Steve Perlman has been helping to address oral health issues for children and adults with intellectual disabilities. Special Smiles provides screening opportunities not only for Special Olympics athletes, but also other children and adults with intellectual disabilities within their local communities across the globe during Healthy Athletes Screening events. Special Smiles also trains oral health professionals and equips them with the skills to treat people with intellectual disabilities through a Train-the-Trainer program facilitated by an experienced oral health professional. During the Train-the-Trainer sessions some of the common health issues that affect the ID population are discussed, oral health professionals are trained on the Centers for Disease Control and Preventions standardized screening protocols during the didactic session, and then there’s the hands on opportunity that allows dentists to work with children and adults with ID. Special Smiles Train-the-Trainer opportunities are available to oral health professionals in the U.S. and internationally and have helped to break down barriers in care by creating exposure and increased knowledge.
Special Olympics data from Train-the-Trainer event’s post surveys also indicate that most clinical volunteers in Special Smiles have not had the opportunity to learn about treating the ID population while attending dental or dental hygiene schools, which plays into how people with ID are not able to access appropriate care or are often turned away by potential providers. We are also beginning to see a change within the dental student population who make up Special Smile’s largest volunteer base. Connecting with dental schools has created earlier exposure to the ID community as well as engaged student groups that are focused on serving this population. The American Academy of Developmental Medicine and Dentistry (AADMD) has been instrumental in this process by creating student chapters who are passionate about improving the health status of people with ID.
Special Olympics is also facilitating improved oral health here in the United States by creating partnerships with nonprofit organizations like The National Children’s Oral Health Foundation (NCOHF) that provides resources to help navigate dental health services, works with nonprofit dental service providers, and helps to improve the oral health status of underserved children here in the U.S. Under the recent leadership of NCOHF’s executive Director Jill Malmgren, Special Smiles has been able to be creative in our approach to improve and promote oral health among children participating in Special Olympics through our joint goals of emphasizing prevention and oral health education. In addition to nonprofit partnerships we have had a long lasting partnership with Colgate who is a leader in oral health education and has been equipping our athletes with oral health products like toothpaste and toothbrushes during Special Smiles Screenings here in the US and abroad for over 20 years. We are continuing to explore with Colgate how we can continue to address the oral health issues that are prevalent within the ID population.
Around the globe some of our most impactful stories are aligned with connecting people with ID to dental care services. In India where over 80% of children under the age of 15 have tooth decay Special Smiles Regional Clinical Advisor and Dean of Divya Jyoti College of Dental Sciences & Research in Uttar Pradesh, Dr. Reena Kumar approached the Dental Council of India and appealed to mandate all dental schools to provide Special Olympic Athletes free dental care countrywide. Because of Dr. Kumar’s request, the president of the Dental Council of India and the executive committee members issued a directive to over 300 dental colleges in India to provide free treatment to athletes of Special Olympics Bharat. This bold move has now unlocked oral health care for many Special Olympics Athletes in India who may not have otherwise been able to access this care that impacts their overall well being.
In a Special Olympic Healthy Communities program in Thailand, Varaya a 14 year old student from a special school had been receiving health screenings, which identified her tooth decay. Through a local partnership between her school and the healthcare agency in her providence, she was able to have dental treatment and ultimately, a tooth extracted, which caused her so much pain. Financial barriers prevented her parents from taking her to a dentist to have her screened. Without the screening conducted at her school through Healthy Communities this oral health problem could have exasperated into more serious health problems.
Another story that continues to have impact is the story of Dustin Plunkett, an athlete here in the United States who had many oral health issues including consistent gum swelling. He was referred to seek additional care following a Special Smiles Screening that indicated serious problems with his teeth and gums. Further examination uncovered oral cancer and Dustin underwent lifesaving surgery to remove the cancer and has been cancer free ever since. These are just a few of the stories that show how Special Smiles is creating linkages to care, raising professional awareness and other strategies that are not only cost saving, but lifesaving as well.
What Can Parents and Caregivers do to Improve Oral Health Care for Their Children?
As a parent, navigating health care services for your child can be tricky. Specifically, when trying to access health care for a child with ID, other issues often become priority and oral health care can become an afterthought. Parents and caregivers of children with ID must be proactive when it comes to preventative oral health care at home and connecting their children to dental services because of the additional barriers in place. Parents and caregivers also play a vital role in their children’s oral health by reinforcing good oral health habits as well. Nadia Hamilton and her brother Troy who is autistic experienced many challenges while trying to be proactive in maintaining good oral health practices both in home prevention care as well as regular dental checkups with an oral health professional. At home Troy would have to rely on his parents to help him brush and floss his teeth two times a day to help maintain good oral health, which caused a level of dependency. Outside of the home dental health service providers also proved hard to find with dental health care being privatized, meaning Canadians, like Troy and Nadia, pay for dental services through insurance or they pay out of pocket even though Canada has a universal health care system. Nadia went from dentist to dentist trying to find the right dental provider and even after finding the right provider she noticed an additional barrier, it was hard for many people with ID including her brother to manage any difficulties that may occur during a dental visit. To address some of these issues Nadia launched an app in 2015, MagnusCards, which has 12 life skills categories providing people with ID step-by-step visual and audio instructions for day-to-day task and even categories to improve in areas like hygiene and oral health. Colgate, the oral health partner of MagnusCards, developed the oral care platform that teaches and reinforces good oral health behaviors that a parent may not always be able to do, and even guides the user on a dental office visit and what one should expect during the visit. Innovators like Nadia and partners like Colgate are helping Special Olympics see how we can best support families in seeking oral health care prevention and care for children and adults with ID.
Special Olympics Special Smiles is continuously looking at ways to support parents and caregivers by providing resources like A Caregivers Guide to Good Oral Health for Persons with Special Needs and developing partnerships with advocacy groups and corporate partners to close the gap in care. Additionally Special Smiles will be developing more resources to promote improved oral health and will continue creatingopportunities for oral health care professionals to be trained to help improve the health status of children and adults with ID to help keep oral health a priority in overall well-being.
