PAOH President’s Message: Oral Health is An Integral Part of Total Health

By Steven Perlman, DDS, MScD, DHL (hon), PAOH President

“It always seems impossible until it’s done.”

--Nelson Mandela

When I began my career 53 years ago, access and the ability to receive oral healthcare services was the number one healthcare problem people with intellectual, developmental, and physical disabilities faced.

In the largest study published— “Unmet Dental Care Needs Among Children with Special Health Care Needs: Implications for the Medical Home.” (Pediatrics 2005, 116; 42b-e431. Lewis, Robertson, Phelps)—39,000 families with children that had special healthcare needs were surveyed, and almost 80% of the children needed dental care in the past 12 months, clearly their most prevalent unmet healthcare need. Although no comparable study has been done with adults, we empirically know it is much worse, especially for individuals over the age of 18;, the so called “falling off the cliff age.”

For over 50 years, I have heard the reasons why dental professionals don’t or won’t treat patients with disabilities—because of their lack of clinical and didactic training, and the inadequate reimbursement they receive for their services.

Through advocacy and the increasing numbers of people with IDD, we are finally addressing education and training issues, however limited they still might be. Regarding reimbursement for services, it remains a significant barrier for patients with disabilities, however, patient behavior has been shown to also be significant.

May is Mental Health Awareness month, yet, most people would not think of or understand the important correlation between a person’s oral and mental health. Oral health is an integral part of total health and impacts on a person’s quality of life. Poor oral health can impact a person’s ability to eat, speak, swallow, smile and laugh. It affects nutrition, social interactions, self-esteem, malocclusions, facial appearance, dry mouth, and bruxism.

Mental health is also important to the healthcare providers, the “trench warriors” who provide equal quality of care to a population that presents unique challenges.

In treating patients with disabilities, we are faced with delivering care to those with a higher prevalence of co-morbidities and secondary conditions than the neurotypical population. The barriers to their care appear to be endless and new challenges arise daily.

Throughout my and my colleagues’ careers, those adverse experiences, stress, and frustrations have affected our own mental health. This has not been caused by our patients but by the system, specifically the consultants to the health plans and the managed care organizations. They usually administer the Medicaid programs, but cases occur in the private sector as well. They often abuse their power and are protected by the bureaucratic organization they work for.

The worst experience of my professional career affecting my mental health involved a consultant from another state who admitted that he had never treated a patient with a disability. He wanted me to put my patient at risk, commit malpractice by keeping them under general anesthesia for an extended length of time to satisfy an insurance code that had no bearing on the clinical outcome of any procedure. I was denied a peer review. Multiple letters challenging his judgement were ignored, and when I contacted the company’s president, the consultant crossed the ethical line by making it personal.

He had his underling file a made-up charge against me with the State Board of Registration. Although everything was dismissed, it took two years before the hearing took place. Other clinicians have shared similar experiences with me and their response to the mental and emotional stress was to not see patients with disabilities and to eliminate Medicaid patients from their practices. The data from dentist participation in Medicaid programs is not accessible, but we know the numbers are dismal.

“Most people would not think of or understand the important correlation between a person’s oral and mental health. Oral health is an integral part of total health and impacts on a person’s quality of life.”

Not finding closure for me regarding my experience, years later I contacted the Chief Legal Counsel for the company to tell my story.

The conversation began with her telling me she had investigated my complaint, researched my background and credentials. She proceeded to tell me she had a brother with a severe disability and what it was like for her growing up. She said, however, that opening a case against the consultant would require an enormous amount of her time, which she did not have. She promised me that she would handle it internally and assured me that discrimination against patients with disabilities would end, changes would be made for individual circumstances and patient care would never be put at risk to satisfy an insurance code.

I believed her lies. Two years later I am still waiting to hear from her, to know that changes were made and our discussions would improve healthcare for people with disabilities. The fact that she did nothing despite her connection and family history speaks volumes about the culture of the organization she legally represents.

We need to not only be aware of the mental health of our patients, but how it impacts upon our mental health as well.

50 years ago, oral healthcare for people with disabilities was their number one unmet healthcare need. Today, mental and oral health still remain unobtainable with little hope in the future for change.

WE NEED TO DO BETTER!

About the Author

Steven Perlman, DDS, MScD, DHL (hon), President, PAOH (People Advocating for Optimal Health)