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organizations about the management of oral health care needs particular to individuals with SHCN rather than provide specific treatment recommendations for oral conditions.Methods Recommendations on the management of dental patients with SHCN were developed by the Council on Clinical Affairs and adopted in 2004. This document is a revision of the previous version, last revised in 2012. This update is based on a review of the current dental and medical literature related to individuals with SHCN. An search was conducted via PubMed®/MEDLINE using the terms: special needs, disability, disabled patients/persons/children, handicapped patients, dentistry, dental care, and oral health; fields: all; limits: within the last 10 years, human, English, and clinical trials. Papers for review were chosen from the resultant list of articles and from references within selected articles. When data did not appear sufficient or were inconclusive, recommendations were based on expertand/or consensus opinion by experienced researchers and clinicians, including papers and workshop reports from the AAPD-sponsored symposium “Lifetime Oral Health Care for Patients with Special Needs” (Chicago, Ill.; November, 2006).2Background The AAPD defines special health care needs as “any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. The condition may be congenital, developmental, or acquired through disease, trauma, or environmental cause and may impose limitations in performing daily self-maintenance activities or substantial limitations in a major life activity. Health care for individuals with special needs requires specialized knowledge, as well as increased awareness and attention, adaptation, and accommodative measures beyond what are considered routine.”3Individuals with SHCN may be at an increased risk for oral diseases throughout their lifetime.2,4-6 Oral diseases can have a direct and devastating impact on the health and quality of life of those with certain systemic health problems or conditions. Patients with compromised immunity (e.g., leukemia or other malignancies, human immunodeficiency virus) or cardiac conditions associated with endocarditis may be especially vulnerable to the effects of oral diseases.7 Patients with mental, developmental, or physical disabilities who do not have the ability to understand, assume responsibility for, or cooperate with preventive oral health practices are susceptible as well.8 Oral health is an inseparable part of general health and well-being.4SHCN also includes disorders or conditions which manifest only in the orofacial complex (e.g., amelogenesis imperfecta, dentinogenesis imperfecta, cleft lip/palate, oral cancer). While these patients may not exhibit the same physical or communicative limitations of other patients with SHCN, their needs are unique, impact their overall health, and require oral health care of a specialized nature. According to the U.S. Census Bureau, approximately 37.9 million Americans have a disability, with about two-thirds of these individuals having a severe disability.9 The proportion of children in the U.S. with SHCN is estimated to be 18 percent, approximately 12.5 million.10 Because of improvements in medical care, patients with SHCN will continue to grow in number; many of the formerly acute and fatal diagnoses have become chronic and manageable conditions. The Americans with Disabilities Act (AwDA) defines the dental office as a place of public accommodation.11 Thus, dentists are obligated to be familiar with these regulations and ensure compliance. Failure to accommodate patients with SHCN could be considered discrimination and a violation of federal and/or state law. Regulations require practitioners to provide physical access to an office (e.g., wheelchair ramps, disabled-parking spaces); however, individuals with SHCN can face many barriers to obtaining oral health care.Families with SHCN children experience much higher expenditures than required for healthy children. Because of the unmet dental care needs of individuals with SHCN, emphasis on a dental home and comprehensive, coordinated services should be established.11,12 Optimal health of children is more likely to be achieved with access to comprehensive health care benefits.13 Financing and reimbursement have been cited as common barriers for medically necessary oral health care.14,15 Insurance plays an important role for families with children who have SHCN, but it still provides incomplete protection.16-18 Furthermore, as children with disabilities reach adult-hood, health insurance coverage may be restricted.Many individuals with SHCN rely on government funding to pay for medical and dental care and lack adequate access to private insurance for health care services.19 Lack of preventive and timely therapeutic care may increase the need for costly care and exacerbate systemic health issuesNonfinancial barriers such as language and psychosocial, structural, and cultural considerations may interfere with access to oral health care.18 Effective communication is essential and, for hearing impaired patients/parents, can be accomplished through a variety of methods including interpreters, written materials, and lip-reading. Psychosocial factors associated with access for patients with SHCN include oral health beliefs, norms of caregiver responsibility, and past dental experience of the caregiver. Structural barriers include transportation, school absence policies, discriminatory treatment, and difficulty locating providers who accept Medicaid.14 Community-based health services, with educational and social programs, may assist dentists and their patients with SHCN.Priorities and attitudes can serve as impediments to oral care. Parental and physician lack of awareness and knowledge may hinder an individual with SHCN from seeking preventive dental care.22 Other health conditions may seem more important than dental health, especially when the relationship between oral health and general health is not well understood.23 Persons with SHCN patients may express a greater level of anxiety about dental care than those without a disability, which may adversely impact the frequency of dental visits and, subsequently, oral health.24