Children and adults with special needs often have routine dental care under general anesthesia. Prominent dental schools all over the US teach dental students that this is the way to treat severe special needs individuals who cannot tolerate routine dental procedures. These individuals may appear to have limited understanding. Just knock them out every two years or so, and do all the dental work under general anesthesia. With this plan in place we never really know the status of the individual’s dental hygiene until they are under general anesthesia.
So what happens when an individual diagnosed with autism who has poor communication skills develops a dental problem during the two years of no checkups and no cleanings? Dental problems can certainly brew when there are no dental appointments for two years and dental hygiene may be less than optimum. Let’s suppose that our patient develops severe temper tantrums or aggressions as a result of a toothache. Since the individual cannot communicate, we might see this problem as a behavioral health issue – so we might give him Risperdal (second generation antipsychotic). After all, Risperdal has been approved by the FDA to treat agitation in those diagnosed with autism.
Now as a result of the Risperdal, the patient has gained quite a bit of weight, and is suffering from metabolic syndrome. While this happens, the desperate parents are continually searching the healthcare system to find out why their child is still agitated. They want to know how to help him. Perhaps, this is a gastroenterology issue. How about a colonoscopy? Maybe the Risperdal isn’t working. Should they try a different med? Raise the dosage? Now let’s add the cost of the general anesthesia for the dental procedure. Okay, by now you get the idea of how expensive this could get. Did you ever notice how many individuals with special needs have teeth missing and not very aesthetic smiles? It is not a happy picture.
So what is the alternative?
How about using a combination of grit, desensitization, and behavior modification? A cost benefit analysis might prove that working on getting these individuals to cooperate with dental professionals might be the best solution. Many states now have laws in effect that require health insurers to pay for medically necessary healthcare procedures for individuals with autism. Some insurers do pay for ABA (Applied Behavior Analysis). ABA is an evidence based method used to help individuals modify behavior or to acquire new skills. ABA can be used to reduce maladaptive behaviors, to learn activities of daily living, to teach just about anything the individual needs to learn, and yes- you can use ABA in order to help the individual accept dental care as well.
Depending on the diagnosis and insurance carrier, insurers may cover the development of a behavioral plan for cooperating with dental care. The learning process and maintenance of the learning may require many visits to the dentist. Dental visits are the responsibility of dental insurance. Dental insurers usually do not cover the multiple visits that are needed in order to make this type of dental care plan work. When the patient undergoes general anesthesia for dental treatment, regular health insurance covers it (not dental insurance). It is the old “different pot of money” story. So here lies the (costly) problem.
(originally published on LinkedIn, August 26, 2014 , written permission granted to reprint article, Irene Tanzman is the mother of an adult son diagnosed with autism. After many years of working with her son and his dentist, he cooperates with dental cleanings and x-rays, but still requires general anesthesia for dental fillings and more involved dental work. He still visits his dentist every month. His dentist carefully monitors and documents his dental hygiene. Irene has a special interest in improving health care and reducing health care costs for individuals with severe special needs.)