I could clean a patient's teeth in as little as 20 minutes, but it could take me twice as long if he or she has Parkinson's disease, or longer still if the person is frail and elderly and requires frequent breaks during treatment.
The problem many dentists face when they treat patients with special needs is the extra time and staffing required.
Some 54 million Americans have some type of disability, according to the Census Bureau, and 35 million of them have a severe medical, physical and/or psychological disability. Some have impairment from a medical condition such as stroke or cancer. Some have survived devastating car accidents. Others are elderly and frail. Add to these tens of thousands of soldiers injured on the battlefield, and the magnitude of the issue becomes apparent.
In addition, as the population ages -- as is true on Long Island -- the number of people with a condition that affects their ability to care for their teeth or which creates barriers to dental care will increase.
The fact is that insurance companies are cutting reimbursement rates for physicians, dentists and hospitals, but the need for time-consuming care is increasing.
Compounding the problem is the limited number of facilities accepting patients who require specialized dental care. This has become more serious as hospitals have closed because of financial difficulties.
In Queens, a community of more than 2 million residents, four hospitals have closed in the last few years, eliminating dental clinics that served many of these patients. Hospital mergers are becoming more common nationally, and programs are being eliminated to save money. Many other institutions are in financial trouble and face uncertain futures.
Hospital closures also have led to fewer operating rooms where experienced clinicians can help dental patients who cannot be treated in a clinic or a private office. Private insurance coverage and government funding of Medicaid also are lacking to cover the higher cost of treatment.
Providing treatment to these patients costs more than the same care for non-disabled people because of the extra time, staff and specialized equipment sometimes needed. The result is that treatment is delayed, which can cause dental conditions to deteriorate and costs to escalate.
Waiting lists at many institutions that treat special-needs dental patients can be great obstacles to care. Someone with a toothache shouldn't be told he or she must wait weeks or months for definitive care. Temporary measures like pain medication and antibiotics are not the answers when a root canal or extraction would promptly solve the problem. But with limited resources, and patients coming from miles around to get treatment, delays abound.
Locally, there are a few large hospitals with dental clinics for special needs patients: In Suffolk, Stony Brook University has a dental school and hospital. In Nassau and Queens, there's North Shore University Hospital in Manhasset, Long Island Jewish Medical Center in New Hyde Park and New York-Presbyterian Queens in Flushing.
Until the government and private insurance companies realize that this issue won't go away and funding is increased for care, the untreated dental conditions of special-needs patients will deteriorate. That will only prompt needlessly higher costs, because small problems are allowed to become big ones.