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Pediatric dentists are concerned about decreased access to oral health care for patients with SHCN as they transition beyond the age of majority.25 Finding a dental home for non-pediatric SHCN patients could be challenging. Pediatric hospitals, by imposing age restrictions, can create another barrier to care for these patients. This presents difficulties for pediatric dentists providing care to adult SHCN patients who have not yet transitioned to adult primary care. Some pediatric hospitals require dentists to be board certified, thus making it difficult for general dentists to obtain hospital privileges. Outpatient surgery centers and in office general anesthesia may be alternatives, although they may not be appropriate to treat patients with special needs due to medical complexity.Transitioning to a dentist who is knowledgeable and comfortable with adult oral health care needs often is difficult due to a lack of trained providers willing to accept the responsibility of caring for SHCN patients.27,28 It should be noted that the Commission on Dental Accreditation of the American Dental Association introduced an accreditation standard requiring dental schools to ensure that curricular efforts are focused on educating their students on how to assess treatment needs of patients with SHCN.Recommendations Scheduling appointments The parent’s/patient’s initial contact with the dental practice allows both parties an opportunity to address the child’s primary oral health needs and to confirm the appropriateness of scheduling an appointment with that particular practitioner. Along with the child’s name, age, and chief complaint, the receptionist should determine the presence and nature of any SHCN and, when appropriate, the name(s) of the child’s medical care provider(s). The office staff, under the guidance of the dentist, should determine the need for an increased length of appointment and/or additional auxiliary staff in order to accommodate the patient in an effective and efficient manner. The need for increased dentist and team time as well as customized services should be documented so the office staff is prepared to accommodate the patient’s unique circumstances at each subsequent visit.31When scheduling patients with SHCN, it is imperative that the dentist be familiar and comply with Health Insurance Portability and Accountability Act (HIPAA) and AwDA regulations applicable to dental practices.32 HIPAA insures that the patient’s privacy is protected and AwDA prevents discrimination on the basis of a disability.Dental home Patients with SHCN who have a dental home33 are more likely to receive appropriate preventive and routine care. The dental home provides an opportunity to implement individualized preventive oral health practices and reduces the child’s risk of preventable dental/oral disease. When patients with SHCN reach adulthood, their oral health care needs may extend beyond the scope of the pediatric dentist’s training. It is important to educate and prepare the patient and parent on the value of transitioning to a dentist who is knowledgeable in adult oral health needs. At a time agreed upon by the patient, parent, and pediatric dentist, the patient should be transitioned to a dentist knowledgeable and comfortable with managing that patient’s specific health care needs. In cases where this is not possible or desired, the dental home can remain with the pediatric dentist and appropriate referrals for specialized dental care should be recommended when needed.34Patient assessment Familiarity with the patient’s medical history is essential to decreasing the risk of aggravating a medical condition while rendering dental care. An accurate, comprehensive, and up-todate medical history is necessary for correct diagnosis and effective treatment planning. Information regarding the chief complaint, history of present illness, medical conditions and/ or illnesses, medical care providers, hospitalizations/ surgeries, anesthetic experiences, current medications, allergies/ sensitivities, immunization status, review of systems, family and social histories, and thorough dental history should be obtained.35 As many children with SHCN may have sensory issues that can make the dental experience challenging, the dentist should include such considerations during the history intake and be prepared to modify the traditional delivery of dental care to address the child’s unique needs. If the patient/ parent is unable to provide accurate information, consultation with the caregiver or with the patient’s physician may be required.At each patient visit, the history should be consulted and updated. Recent medical attention for illness or injury, newly diagnosed medical conditions, and changes in medications should be documented. A written update should be obtained at each recall visit. Significant medical conditions should be identified in a conspicuous yet confidential manner in the patient’s record.Comprehensive head, neck, and oral examinations should be completed on all patients. A caries-risk assessment should be performed.36 Caries-risk assessment provides a means of classifying caries risk at a point in time and, therefore, should be applied periodically to assess changes in an individual’s risk status. The examination also should include assessments of trauma and periodontal risk. An individualized preventive program, including a dental recall schedule, should be recommended after evaluation of the patient’s caries risk, oral health needs, and abilities.A summary of the oral findings and specific treatment recommendations should be provided to the patient and parent/ caregiver. When appropriate, the patient’s other care providers (e.g., physicians, nurses, social workers) should be informed of any significant findings.Medical consultations The dentist should coordinate care via consultation with the patient’s other care providers. When appropriate, the physician should be consulted regarding medications, sedation, general anesthesia, and special restrictions or preparations that may be required to ensure the safe