DENTISTRY, MANAGED CARE, AND YOUR CHILD WITH SPECIAL NEEDS

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DENTISTRY, MANAGED CARE, AND YOUR CHILD WITH
SPECIAL NEEDS
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HOW DOES A DENTIST DEFINE A CHLD WITH SPECIAL
NEEDS?

• Any child with mental, physical, or emotional
  problems

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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

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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 childs disorder may be
  malocclusion or bite problems

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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)

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TYPES OF DENTAL INSURANCE

• Dental Health Maintenance Organization
• Regular insurance, also known as fee for service,
  or indemnity
• Preferred Provider Organization

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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

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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

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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

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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

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FEE FOR SERVICE or TRADITIONAL INSURANCE

• Family selects the dentist of their choice
• Bill is submitted to insurance company for
  payment

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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

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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

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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.

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SPECIAL NEEDS MIGHT INCLUDE

• Severe dental problems
• Unusual dental problems
• Difficulty managing the child

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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.

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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

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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

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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

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HOW DOES A PARENT EXPLAIN A CHILDS SPECIAL NEEDS?

• Call in advance and talk to the dentist and/or
  staff
• Sit down and explain childs problems. Let them
  know any special concerns you have.

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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
• Karissas family used a toothette to clean her
  teeth beginning only with 1 tooth

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OTHER TECHNIQUES THAT THE DENTIST MIGHT USE

• Tell, Show, and Do
• Tell the child what youre going to do
• Show the child on a model what you will do
• Then go ahead and do it

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DIFFICULTIES THAT MIGHT OCCUR AT HOME

• Child is sensitive to touch
• Parent may not be able to clean all of the
  childs teeth-especially back teeth
• Child may gag and pull away from you

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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

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DENTAL CARE IN A HOSPITAL SETTING

• Dentist may recommend a hospital setting if
  childs behavior or systemic problem indicate
  that care should be in a hospital
• Plan needs to be discussed with insurance company
  regarding payment

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CLOSING REMARKS

• BEFORE DENTAL CARE
• give short simple explanations of what is going
  to happen
• talk positively-avoid the word pain or hurt

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