By Kiley McLean
For people with intellectual and developmental disabilities, including autism, oral health is their most unmet health care need. Despite progress over the past few years in diagnoses and interventions for this community, a significant disparity still exists in oral healthcare between the autistic and non-autistic population. Autistic people are at much higher risk for dental and oral health problems and unfortunately, only 10% of dentists treat disabled patients. Access to inclusive, comprehensive, and affordable dental care is an often overlooked but critical area to address to improve the health of the autistic community.
Why Oral Health Matters
Oral health matters. It is a window into an individual’s overall health. Oral health includes the teeth, gums, and the entire oral-facial system that supports smiling, communicating verbally, and chewing. Cavities, gum disease, and oral cancer all impact overall health.
Research indicates that poor oral health is linked with other issues like pulmonary disease, diabetes, osteoporosis, and kidney disease. Oral health can also impact quality of life. People with good oral health tend to have better economic, social, psychological, and physical health across their lifespans. Quality dental care is the key to realizing these benefits. Unfortunately, access to dental care is not a guarantee.
Disparities in oral health and inequitable access to dental care are present across the US and disproportionately impact people with developmental disabilities like autism. Just like other health issues, oral health is shaped by many social determinants of health, including socioeconomic status, income, education, employment, transportation, health insurance, housing, physical health, and mental well-being. Disabilities do not cause disparities, but rather research shows us that people with developmental disabilities, including autistic people, report worse access to healthcare, including quality oral health care, and therefore have inequitable oral health outcomes overall.
Oral Health in the Autistic Community
Autistic people have a higher prevalence of many dental conditions including cavities, gum disease, and oral cancer compared to non-autistic patients. Autistic children tend to have poor oral hygiene and extensive unmet needs for dental treatment compared to non-autistic children.
According to a 2019 statement from the National Council on Disability, finding inclusive dental care is often the most difficult type of service for disabled people to find. They go on to explain that many dental and medical school deans feel their students are not prepared to treat people with developmental disabilities after graduation. Up until a rule change in 2019, accredited dental schools in the US were not required to teach their students about how to treat patients with developmental disabilities like autism. Therefore, dentists who graduated prior to this ruling likely have not received any training in this area.
Autistic people face a number of different challenges when it comes to adopting and maintaining oral health best practices and habits. Providing customized dental care that suits their needs is very important and a great first step. For example, autistic people can experience sensitivity to bright lights, strong smells, tastes, textures, and loud or unexpected noises. These types of sensory experiences are often found in a dentist’s office. For some autistic people, this sensitivity is heightened when they are nervous or anxious, like during oral healthcare visits. Because of this, some people can find routine activities like brushing or flossing very uncomfortable. Based on this, making sunglasses, noise-cancelling headphones, fidget toys, and unflavored toothpaste available to patients may be a helpful first step for dental practices.
Another barrier to dental care, especially for autistic adults, is insurance. States are required by the federal government to cover dental services for youth under the age of 21 as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Medicaid benefit. States then may choose whether to provide dental benefits to their adult Medicaid-eligible population as part of their Medicaid program. Most states do provide at least emergency dental services for adults, however, less than half of states provide comprehensive dental care. There are no minimum requirements for adult dental coverage. Ultimately, autistic adults are often stuck in a reality of unmet oral health needs. We must commit now to enacting solutions that will provide equitable access to care for all.
For more resources on this topic visit:
- SPARK Webinar: Autism in Dentistry- the Spectrum of an Over-Sensory Environment: https://sparkforautism.org/discover_article/webinar-autism-dentistry/
- AADMD Webinar Series: Optimizing Comfort for Individuals with IDD in the Dental Environment: https://www.youtube.com/watch?v=k0SZ88-BQdc
- Medicaid Adult Dental Benefits by State: https://www.chcs.org/media/Medicaid-Adult-Dental-Benefits-Overview-Appendix_091519.pdf
- An Inclusive Model for Dental Care in Philadelphia: https://penndentalmedicine.org/patient-information/dentist-for-special-needs/