Our Uphill Journey with the AAPD (American Academy of Pediatric Dentistry) To Change!
Pictured: Graphic illustration depicting communication and collaboration
by Steven Perlman, DDS MScD, DHL (hon), Special Projects Senior Editor
Clinical Professor of Pediatric Dentistry, Boston University Goldman School of Dental Medicine
Adjunct Professor Division of Pediatric Dentistry University of Pennsylvania School of Dental Medicine
President Project Accessible Oral Health
and Co-Author Rick Rader, MD, FAAIDD, FAADM, DHL (hon)
Director, Habilitation Center, Orange Grove Center
President, American Association on Health and Disability
Board, American Academy of Developmental Medicine and Dentistry
Executive Committee, Friends of the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
Medical Advisory Committee, Special Olympics International
Emeritus Advisor, Agency for Healthcare Research and Quality, US Dept of Health and Human Services
Editor-in-chief, HELEN, J of Human Exceptionality
Member, National Academy of Practice in Medicine
National Medical Advisor, National Alliance for Direct Support Professionals
A year and a half ago, I was asked to become the President of Project Accessible Oral Health (PAOH). PAOH is a global public-private partnership and the first to nationally assemble and connect a consortium of dental and medical professionals, corporations, organizations, policymakers, educators, people with disabilities, caregivers, and other stakeholders in a pursuit of equal access to culturally competent oral healthcare. The Project’s mission is to act as a collective catalyst for change that will not only improve access to oral health care, but also ultimately improve the overall health of the disability community.
Pictured: Project Accessible Oral Health logo and child smiling
Photo credit: Project Accessible Oral Health
I bring almost fifty years of experience in the field, including private practice, academia, founder of the Healthy Athlete Program in the Special Olympics, and co-founder of the American Academy of Developmental Medicine and Dentistry (AADMD).
I am an old school pediatric dentist, as with others of my generation who were committed to caring for individuals with disabilities throughout their lifespan, or until a safe transition could be made to a clinician who was willing to treat them once they became adults.
It is a fact, that oral health and the ability to access dental care is the number one healthcare problem people with disabilities face. The problem has greatly exacerbated since pediatric dentistry decided to become an “age defined specialty” as specified in the definition and the scope of practice, in the Academy of Pediatric Dentistry’s (AAPD) Annual Reference Manual, and with all the barriers to care for people with disabilities face, PAOH felt that by declaring the specialty “age defined” only created yet another barrier to care for people with disabilities. This certainly has contributed to the crisis with a lack of providers available to treat this most medically and dentally underserved population.
Pictured: AAPD Logo
In discussions with our medical colleagues in the American Academy of Pediatrics and other subspecialties including cardiologists, neurologists, gastroenterologists, and others, we felt the need to begin a dialogue with the AAPD to eliminate the words “age defined,” as the care of the patient should be a shared decision between the patient, family member, caregiver, guardian, and clinician.
The AADMD, The American Association on Health and Disability (AAHD) and the Harvard Law School Project on Disability all signed the letter to the AAPD as well.
Throughout this process I was proud to have HELEN Editor in Chief and AADMD Co-Founder Dr. Rick Rader by my side as primary author of the letter. We want to share this with the HELEN readership, and the AAPD’s response.
It aligns with OUR mission and IF we do not advocate for better healthcare for our patients, WHO WILL?
Letter
Dr. John Rutkauskas
211 East Chicago Avenue, Suite 1600
Chicago, IL 60611-2637
Dear John,
The Role of the Pediatric Dentist in Advocating for Continuity of Care
In AD10, Celsus the ancient physician wrote, “Children require to be treated entirely…differently from adults,” which ushered in the specialty of pediatric medicine. Hippocrates, the Father of Medicine noted the variations of disease manifestations with age. Dentistry was slow on the uptake in recognizing that children were not “little adults.”
In 1909 Minnie Evangeline Jordon established the first dental practice in the United States devoted only to pediatric patients. While she was in dental school, she ran an oral health clinic at an orphanage in San Francisco; thus, realizing and appreciating that children required and deserved special knowledge and skills from a dentist. Her dedication to this nascent specialty culminated in her writing the first textbook in 1925 on pediatric dentistry titled “Operative Dentistry for Children.”
The specialty of pediatric dentistry become galvanized by the establishment of the Forsyth Dental Infirmary for Children in 1914, as the first institution of its kind in the world in providing dental treatment for children. The specialty led to the American Society of Dentistry for Children which merged with the American Academy of Pediatric Dentistry in 2002.
The medical side of healthcare for children, The American Academy of Pediatrics was founded in June 1930 by 35 pediatricians who met in Detroit in response to the need for an independent pediatric forum to address children's needs. When the AAP was established, the idea that children have special developmental and health needs was a new one. Preventive health practices now associated with childcare-such as immunizations and regular health exams-were only just beginning to change the custom of treating children as "miniature adults." (AAP).
Pediatricians often see “adult” patients. Patients with cystic fibrosis, congenital heart defects, intellectual and developmental disabilities and other complex conditions continue to be treated by the physicians who saw them from their earliest onset.
According to Dr. Karen McCoy, chief of pulmonary medicine at Nationwide Children’s Hospital in Columbus, Ohio some so-called “overage” patients require special care in being transitioned to adult care; often they are best suited to remain under the tutelage of the pediatric team that knows them best.
Good medicine is not based on chronological categories and the American Academy of Pediatrics allows, encourages, and promotes the ongoing care of adult patients by pediatricians. Pediatric medicine is not age restricted, age defined, or age limited; it is “patient centered.” Many pediatric patients with special healthcare needs (for example genetic disorders) had limited lifespans and thus the need for them to transition to adult physicians (family practice or internal medicine) was never a necessity. At the same time, the adult physicians did not have the skills, experience, confidence, or support to see these patients as their lifespan increased and they entered adulthood. The community physicians appreciated seeing the pediatricians stepping up to the plate to continue their oversight and treatment.
According to The American Academy of Pediatric Dentistry, “As advocates for children’s oral health, the AAPD promotes evidence-based policies, best practices, and clinical guidelines; educates and informs policymakers, parents and guardians, and other health care professionals; fosters research; and provides continuing professional education for pediatric dentists and general dentists who treat children.” Thus, the AAPD recognizes that general dentists should also be treating children when the circumstances, conditions and outcomes are justified. It seems reasonable that if general dentists can see children, then pediatric dentists should (again when appropriate) be seeing and treating adults (due to special circumstances).
The AAPD endorses the sensibility of pediatric dentists seeing adult patients with this posting, “The AAPD is a professional membership association representing the specialty of pediatric dentistry. Its 11,000 members provide primary care and comprehensive dental specialty treatments for infants, children, adolescents, and individuals with special health care needs.” It is noteworthy that “individuals with special health care needs” is not defined by any chronological guidelines, limits, or exclusions.
It is recommended that the American Academy of Pediatric Dentistry clarify its mission, guidelines, scope of practice, and recognition of best practices.
It is simply an announcement of what it has always stood for; and clearing the way for those pediatric dentists who are dedicated and committed to continue to see those patients who they have formed a collaborative relationship with; including their families. This clarification serves to echo the words of former Surgeon General C. Everett Koop, “You’re not healthy without good oral health.” ….to which we would add, “across the lifespan.”
It is noteworthy that the AAPD, The American Academy of Pediatric Dentistry shares its acronym, the AAPD with another respected national organization, The American Association of People with Disabilities....how fitting.
Steven Perlman, DDS, MScD, DHL (hon)
President Project Accessible Oral Health
Clinical Professor of Pediatric Dentistry
Founder of Special Olympics Healthy Athlete Program
Co-Founder American Academy of Developmental Medicine and Dentistry
Diplomate American Board of Special Care Dentistry
Adjunct Professor Division of Pediatric Dentistry, University of Pennsylvania
Rick Rader, MD, FAAIDD, FAADM, DHL (hon)
Member, National Council on Disability Alumni
President, American Association on Health and Disability
Board, American Academy of Developmental Medicine and Dentistry
Medical Advisory Committee, Special Olympics International
Response
March 1, 2024
Dr. Steven P. Perlman, DDS, MScD, DHL (hon)
500 Puritan Rd Swampscott, MA 01907-2818
sperlman@bu.edu
Re: The Role of the Pediatric Dentist in Advocating for Continuity of Care
Dear Dr. Perlman,
This is in response to your letter entitled The Role of the Pediatric Dentist in Advocating for Continuity of Care. To begin, I want to express my full agreement with the points articulated in this letter. To extend this, it is worth noting that the board of the Academy, during our discussion at the recent 2024 Winter Planning Meeting in January, demonstrated full support for the position outlined in the letter.
I want to reiterate our Academy's unwavering commitment to adults with special health care needs. This commitment is clearly articulated in our definition of the specialty, which emphasizes “including those with special health care needs.”
I have requested that the chairs of the Council on Clinical Affairs and Committee on Special Health Care Needs review our current policies, best practices, and guidelines to make any additional edits that could be warranted in discussions surrounding adults with special health care needs.
Thank you for your commitment to people with disabilities. Rest assured that our Academy is vigorously advocating for and supporting those with special health care needs.
All the best,
Scott W. Cashion, D.D.S., M.S. President
Cc: AAPD Board of Trustees
Pictured: A fish jumping out of a small bowl into a big bowl with the caption “Transition: Not a “transfer of care” to an adult provider… It is a process, not a jump”