Center for the Future of the Health Professions May 2025 digest
Posted: May 16, 2025
The Center for the Future of the Health Professions is proud to present our fifth op-ed column for 2025, focusing on critical innovations in specialized dental education. In this timely piece, we explore how one institution is addressing a significant healthcare gap affecting millions of Americans.
In the United States, approximately 61 million adults – one in four – live with a disability. This number is expected to rise due to increased life expectancy, an aging population, and higher survival rates from chronic illnesses. Individuals with disabilities face disproportionate oral health challenges, including higher rates of periodontal disease, tooth loss, and untreated dental caries, while simultaneously encountering significant barriers to accessing quality dental care. These barriers include social determinants of health as well as a critical shortage of dental professionals trained to provide appropriate care for patients with special healthcare needs. A.T. Still University’s Arizona School of Dental & Oral Health (ATSU-ASDOH) addresses this critical gap through its innovative Special Care Clinic, which teaches dental students to effectively care for patients with disabilities. This unique educational approach combines didactic learning with hands-on clinical experience, fostering the development of essential skills, reducing anxiety, and building confidence among future dental professionals who will serve this vulnerable population.
Ann Eshenaur Spolarich, PhD, RDH, FSCDH, professor and director of research at ATSU-ASDOH, is an internationally recognized authority on pharmacology and the care of medically complex patients who leads these efforts at the School. As professor, course director of pharmacology, and assistant dean for research, Dr. Spolarich brings her extensive expertise to both the classroom and the Special Care Clinic, where she teaches part time. Her impressive career includes over 1,100 invited lectures and more than 125 professional publications. Dr. Spolarich also serves as director of the Still Research Institute Center for Oral Health Research and is a faculty member in the NYU Langone AEGD residency program at ATSU-ASDOH. Her dedication to special care dentistry was recognized with fellowship status in special care dental hygiene and the Education Award from the Special Care Dentistry Association. Dr. Spolarich’s research focuses on identifying best practices for caring for individuals with disabilities and medical complexities, including cancer patients, and clinical testing of drugs and devices used in dentistry.
We welcome your feedback and comments on this month’s digest at cfhp@atsu.edu.
Randy Danielsen, PhD, DHL(h), PA-C Emeritus, DFAAPA
Professor & Director
The Center for the Future of the Health Professions
A.T. Still University
Smiles for all: ATSU-ASDOH’s pioneering approach to special care dentistry
In the United States, 61 million people, or one in four adults, have a disability.1 Rates of disability are expected to continue to rise, due to increased life expectancy, the aging population, and survival of long-standing illness, including long COVID. Disabilities may be congenital, developmental, acquired because of injury or disease, or associated with chronic diseases or conditions, including mental health disorders.2 While many disabilities are visibly apparent, others are not. Individuals with disabilities often present with more complex conditions that require additional services or modifications to care delivery. These people are often described as “people with special needs” or “individuals with special healthcare needs (SHCN).”3
People with SHCN and the frail elderly disproportionately carry a higher burden of oral disease and face the greatest barriers to accessing regular preventive and other dental care services.4,5 Oral health status among adults with intellectual, acquired, and developmental disabilities is worse than that of the general population, with higher rates of periodontal disease, missing teeth, and untreated caries.4,6-8 Craniofacial defects, malocclusion, anomalies in tooth development, and delayed eruption patterns may also be observed.9 Affected individuals often present with poor oral hygiene, which increases susceptibility to dental disease. A variety of contributing factors increase the risk for poor oral health in older adults, including chronic dry mouth. In this population, musculoskeletal and neurological disabilities, as well as cognitive impairments, all contribute to challenges in performing oral hygiene.10
Social determinants of health significantly contribute to poor oral health among people with disabilities.4,5 Challenges related to access to dental care include lack of a support system, lack of transportation, inadequate or lack of dental insurance, and other financial concerns.4,11-13 Access may also be difficult for those with communication challenges or disabilities related to visual and hearing impairments. However, lack of access to care may also be attributed to the availability of geographically close providers who have adequate facilities to accommodate those with SHCN and who are trained and willing to care for these vulnerable populations.11,12,14 There is an urgent need to address the lack of provider knowledge and related skills necessary to address the oral and comprehensive healthcare needs of individuals with disabilities.15
The FDI World Dental Federation and the International Association for Disability and Oral Health (IADH) encourage training in special care dentistry at all academic levels and through continuing education for all dental disciplines.3 Training providers to care for those with SHCN is essential to overcome barriers and reduce oral health inequalities.16 Educational standards by the Commission on Dental Accreditation include Standard 2-25, which states that, “graduates must be competent in assessing and managing the treatment of patients with special needs.”17
ATSU-ASDOH was founded to address the disparities in oral healthcare in Arizona and across the nation. It is unique among North American dental schools for having a Special Care Clinic (SCC) since its inception. Faculty members who teach in the SCC hold special training certification and fellowship status in the discipline. Most have devoted their careers to caring for those with a variety of disabilities as well as for those with medical complexities. ATSU-ASDOH was among the first dental schools in the nation to require students to rotate regularly through the SCC as part of their clinical training. Residents in the Advanced Education in General Dentistry (AEGD) program also treat patients with disabilities and medical complexities, as both the SCC and the AEGD program are housed within the ATSU-ASDOH Advanced Care Clinic. Students begin to rotate through the SCC at the end of their second year, after completing the didactic Special Care module. In the classroom and the clinic, students learn how to:
- Assess the need for modifications to deliver care safely
- Write medical consultations to request additional health information and communicate planned dental treatment with other healthcare professionals
- Treat patients with physical, neurological, neuropsychiatric, intellectual, and developmental disabilities
- Use specialized equipment, such as telecommunication devices for those with hearing impairments, and safety devices to provide support and prevent falls
- Manage patients with severe intellectual and developmental disabilities who require sedation to complete dental treatment
Clinical rotation experiences reduce anxiety and increase both comfort and confidence with caring for individuals with disabilities. These outcomes are well-documented in studies with dental and dental hygiene students.14,18-21 Greater comfort and confidence lead to a sense of self-efficacy, a hallmark of experiential learning.20 ATSU-ASDOH SCC faculty conducted a study funded by the Health Resources and Services Administration to teach area dental hygiene students to care for patients with SHCN.22 Dental hygiene students received both didactic training and hands-on experience through clinical rotation in the ATSU-ASDOH SCC. Data collected from over 300 dental hygiene students supports previous reports that clinical experience positively impacts students’ willingness and desire to treat individuals with disabilities after graduation.14,21,23
The inclusion of experiential learning in the clinic is widely advocated by special care dentistry organizations as an essential component of academic training programs.24-26 Clinical training opportunities help overcome the lack of provider preparedness as a barrier to access to care.14 Student experiences with people with disabilities, whether in a clinical or community setting, promote a positive attitude toward patients with special healthcare needs as well as a desire to care for their oral health.19-21, 27-29 Students gain new skills with listening and patient communication, and develop clinician behaviors, such as empathy, compassion, and kindness, which are important characteristics of emotional intelligence. The SCC faculty are conducting an ongoing educational research study known as “Rose, Bud, Thorn” – an educational exercise conducted at the end of a week of rotation in the SCC. This exercise enhances student self-assessment skills through reflection on their experiences, identifying what went well, what could be improved, and which skills or aspects of care delivery need development. This exercise and other educational strategies used during student training incorporate aspects of social-emotional learning.
In addition to clinical training, ATSU-ASDOH faculty and students are conducting a variety of research projects with the many unique patient populations treated in the Advanced Care Clinic, including those treated in the SCC. People with disabilities are among those who are often underrepresented in medical and dental research. Lack of inclusion of individuals with disabilities in large surveillance datasets and clinical trials complicates the identification of health-related issues that may be unique or disproportionately affect these populations. Furthermore, the evidence that drives best practices regarding treatment and guides clinical practice guidelines may not apply to those with disabilities or medical complexities, as these individuals are often excluded from recruited study populations for interventional studies. It is important to recognize people have the right to engage in research that affects their lives and/or informs the processes and outcomes of disability research.30
The SCC represents a transformative educational model for preparing the next generation of dental professionals to confidently serve individuals with disabilities. While our research continues to evaluate student learning outcomes from this innovative curriculum, there remains a critical need for expanded investigation on an international scale. Future studies must assess various curriculum models, examine how educational experiences translate to long-term professional engagement with vulnerable populations, and identify the key factors that inspire dental professionals to pursue special care dentistry as a career path. As both our aging population and the number of individuals with disabilities continue to grow, the dental profession faces an urgent workforce challenge: developing a larger cadre of specially trained faculty who can design and implement curricula addressing these evolving needs. By meeting this challenge, we can help ensure that all individuals, regardless of ability status, receive the quality oral healthcare they deserve.24
References
1. Okoro CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018; 67:882–7.
2. U.S. Department of Health & Human Services. Centers for Disease Control and Prevention. Disability and Health Promotion: Disability and Health Overview 2020. Accessed April 5, 2025. Available at: https://www.cdc.gov/disability-and-health/about/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html
3. FDI World Dental Federation. Policy Statement: Oral Health and Dental Care of People with Disabilities 2016. Accessed April 5, 2025. Available at: https://www.fdiworlddental.org/oral-health-and-dental-care-people-disabilities
4. National Institutes of Health. Oral Health in America: Advances and Challenges. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research 2021. Accessed April 5, 2025. Available at: https://www.nidcr.nih.gov/research/oralhealthinamerica
5. Weintraub JA. The oral health in America report: a public health research perspective. Prev Chronic Dis 2022; 19:220067.
6. Devinsky O, Boyce D, Robbins M, Pressler M. Dental health in persons with disability. Epilepsy Behav 2020; 110:107174.
7. Anders PL, Davis EL. Oral health of patients with intellectual disabilities: A systematic review. Spec Care Dentist 2010; 30:110-117.
8. Fernandes Gomes M, De Marco AC, Giannasi LC, Castillo Salgado MA. Periodontal diseases in patients with special health care needs. In: Manakil J, ed. Periodontology and Dental Implantology. IntechOpen; 2019: doi:10.5772/intechopen.78348.
9. American Academy of Pediatric Dentistry. Management of dental patients with special health care needs. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2022:302-9.
10. Gil-Montoya JA, de Mello AL, Barrios R, Gonzalez-Moles MA, Bravo M. Oral health in the elderly patient and its impact on general well-being: a nonsystematic review. Clin Interv Aging 2015; 10:461-7.
11. Da Rosa SV, Moysés SJ, Theis LC, Soares RC, Moysés ST, Werneck RI, Rocha JS. Barriers in access to dental services hindering the treatment of people with disabilities: a systematic review. Int J Dent 2020; 2020:9074618.
12. Barros RMCS, Possobon RF, Melo EA, Probst LF, Guerra LM, Cortellazzi KL, Ambrosano GMB. Influence of the quality of life and locus of control of mothers of disabled children on the oral health of their children. Spec Care Dentist 2017; 37:290-298.
13. Alfaraj A, Halawany HS, Al-Hinai MT, Al-Badr AH, Alalshaikh M, Al-Khalifa KS. Barriers to dental care in individuals with special healthcare needs in Qatif, Saudi Arabia: a caregiver’s perspective. Patient Prefer Adherence. 2021 Jan 22; 15:69-76.
14. Casamassimo PS, Seale NS, Ruehs K. General dentists’ perceptions of educational and treatment issues affecting access to care for children with special health care needs. J Dent Educ 2004; 68:23-8.
15. US Department of Health & Human Services, Office of the Surgeon General. The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities 2005. Accessed April 5, 2025. Available at: https://www.ncbi.nlm.nih.gov/books/NBK44667/
16. Faulks D, Freedman L, Thompson S, Sagheri D, Dougall A. The value of education in special care dentistry as a means of reducing inequalities in oral health. Eur J Dent Educ 2012; 16:195-201.
17. Commission on Dental Accreditation. American Dental Association. Accreditation Standards. Accessed April 5, 2025. Available at: https://coda.ada.org/standards
18. Borromeo GL, Ahmad MS, Buckley S, Bozanic M, Cao A, Al-Dabbagh M, Athale A. Perception of special needs dentistry education and practice amongst Australian dental auxiliary students. Eur J Dent Educ 2018;22: e321-e326.
19. Baumeister SE, Davidson PL, Carreon DC, Nakazono TT, Gutierrez JJ, Andersen RM. What influences dental students to serve special care patients? Spec Care Dentist 2007; 27:15-22.
20. Watters AL, Stabulas-Savage J, Toppin JD, Janal MN, Robbins MR. Incorporating experiential learning techniques to improve self-efficacy in clinical special care dentistry education. J Dent Educ 2015; 79:1016-23.
21. Perusini DJ, Llacuachaqui M, Sigal MJ, Dempster LJ. Dental students’ clinical expectations and experiences treating persons with disabilities. J Dent Educ 2016; 80:301-10.
22. Spolarich AE, Gohlke E, Fallon, K, Ba, RC. Training dental hygiene students to care for patients with disabilities. Int J Dent Hygiene. 2023; 21:699-709.
23. Subar P, Chávez EM, Miles J, Wong A, Glassman P, Labarre E. Pre- and postdoctoral dental education compared to practice patterns in special care dentistry. J Dent Educ 2012; 76:1623-8.
24. Dolan TA. Professional education to meet the oral health needs of older adults and persons with disabilities. Spec Care Dentist 2013; 33:190-7.
25. Hicks J, Vishwanat L, Perry M, Messura J, Dee K. SCDA task force on a special care dentistry residency. Spec Care Dentist 2016; 36:201-12.
26. Dougall A, Thompson SA, Faulks D, Ting G, Nunn J. Guidance for the core content of a curriculum in special care dentistry at the undergraduate level. Eur J Dent Educ 2014; 18:39-43.
27. Holzinger A, Lettner S, Franz A. Attitudes of dental students towards patients with special healthcare needs: Can they be improved? Eur J Dent Educ 2020; 24:243-51.
28. Mohamed Rohani M, Ahmad Fuad N, Ahmad MS, Esa R. Impact of the special care dentistry education on Malaysian students’ attitudes, self-efficacy and intention to treat people with learning disability. Eur J Dent Educ 2022; 26:741-9.
29. Alkahtani ZM, Stark PC, Loo CY, Wright WG, Morgan JP. Saudi and U.S. dental student attitudes toward treating individuals with developmental disabilities. J Dent Educ 2014;78(8):1145-53.
30. U.S. HHS Administration for Community Living (2023). I/DD Advancing a Roadmap for Health Equity Data for Persons with Intellectual and Developmental Disabilities, [Proceedings of a Summit]. Washington, D.C., November 17-18, 2022. Available at: https://acl.gov/iddcounts
*Portions excerpted from Spolarich AE, Gohlke E, Fallone K, Bay RC. Training dental hygiene students to care for patients with disabilities. Int J Dent Hygiene. 2023; 21:699-709.