Web Course To Help Improve Access To Care For Those With Disabilities

GAINESVILLE, Fla.---Current research emphasizes oral health is a vital part of our overall well-being. But for many people with disabilities - either mental, physical or emotional - finding a dentist trained to care for them can be difficult.

Now the solution could be as close as a dentist's computer - used to access an online continuing education course "anytime, anywhere, at any pace," said course developer Dr. Paul Burtner, an associate professor of pediatric dentistry at the University of Florida's College of Dentistry.

The program, titled "Oral Health Care for Persons with Disabilities," is one of only three in the United States. It is also the only one on the Web dedicated to familiarizing professionals with the issues and techniques involved in providing care to the estimated 49 millionAmericans who have some type of disabling condition, such as spinal cord injury, cerebral palsy, mental retardation, depression, visual impairment and arthritis.

"People with disabilities can experience barriers to achieving optimal oral health because many dentists have not received training in how to care for them," said Burtner. "Often such individuals or their families have to go on an extended search to locate a dentist who will providecare. Some are referred by general dentists to pediatric dentists; othersgive up and their oral health deteriorates."

While pediatric dentists are trained to treat children with emotional,behavioral, physical and mental handicaps, most do not routinely perform procedures that many disabled adults require, Burtner said. In addition, there is a national shortage of pediatric dentists.

In 1992, a provision was added to the American with Disabilities Act of 1990 that requires dentists to serve and accommodate people with disabilities. Dentists may refer patients with disabilities only if they would normally refer a nondisabled patient for the same treatment.

Designed to answer questions dental professionals might ask, the Web course describes how to position and protect the airway of people with spinal cord injuries (similar to those of actor Christopher Reeve), cerebral palsy or scoliosis. It also teaches professionals how to preventpatients from aspirating materials, fluid or instruments, and how to care for those who are unable to control their own oral secretions. Other topics include office accessibility and accommodations, treatment modifications and use of different restorative materials, druginteractions, psychological needs and communication considerations, such as large type on paperwork that visually impaired patients must read and sign.

The course also discusses how an unexpected touch to a blind or deafpatient's face or arm can be startling and can increase anxiety, and how dentists and assistants must communicate in some form with patients at all times to avoid such surprises.

"One option we have to increase the number of dental professionals with the necessary skills to treat people with disabilities is to train them while they are dental students," Burtner said.

In 1995, the American Dental Association Commission on Dental Accreditation began requiring all dental students to have clinical experience to complement instruction in the dental management of special needs patients.

The UF College of Dentistry's curriculum includes a three-hour class on disabilities and requires students to complete a rotation at Tacachale, astate-run facility in Gainesville for people with disabilities. Burtner and other UF dentists, who have specialized training, care for the dental needs of the facility's residents.

It was through word of mouth that Melinda Morrison of Gainesville found Dr. Clara Turner, an associate professor of pediatric dentistry at UF who also is a rotating dentist at Tacachale, to care for her son Nicholas. Nicholas, 11, has Down's syndrome and is hearing impaired.

"I know dental care is important for my son. I wasn't happy with how he was receiving dental care. His former dentist only saw patients with disabilities on the same day, which made it harder for me if I could not make the given day. I also was not allowed to go in the treatment roomwith him," said Morrison, who uses sign language to help dentists and hygienists communicate with Nicholas. "I had to find someone who could care for my child and be sensitive to his needs."

Dentists are also benefiting from the special training course.

"This online course provides an excellent guide for practitioners as they provide dental care for persons with disabilities," said Dr. F. ThomasMcIver, professor of pediatric dentistry at the University of North Carolina. "Completion of this course will significantly benefit both dentists and their patients."

The course is free to anyone wanting to learn more about treating the disabled. A fee is charged only for individuals wanting continuing education credit. The course can be found on the UF College ofDentistry's Web site located at http://www.dental.ufl.edu. Burtner canbe reached at Burtner@nerdc.ufl.edu

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