22 April 2023

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Impact of COVID-19 on patients with intellectual and developmental disabilities, implications for future practice

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Background

This article addresses the impact of the novel SARS-CoV-2 virus (COVID-19) on dental care for patients with intellectual and developmental disabilities (IDD).

In 2020, the novel SARS-CoV-2 virus (COVID-19) spread rapidly across the globe, uprooting the health-care system. COVID-19 is spread person to person via respiratory droplets, making the dental office a high-risk location due to the generation of aerosols during various procedures.

In March 2020, during the initial rise of COVID-19 cases in the U.S., the American Dental Association (ADA) aligned with the World Health Organization (WHO) recommendation to postpone routine dental care and to perform only emergency or urgent dental care to minimize the risk of spreading the virus.

Because of the increased understanding of personal protective equipment (PPE) and clinical strategies to reduce the spread, the ADA recommendations reintroduced routine dental care by August 2020. Consequently, nonemergent dental care was delayed by almost 6 months.

Public health issues

The authors discuss public health issues affected, including the limited number of providers and the decreased access to hospital operating rooms that resulted in a backlog of patients needing care.

People with IDD are a subset of those with special health care needs who have limitations in physical, behavioral, and cognitive abilities. This specific population was included with data evaluating patients with special health care needs in the 2020 Health Resources and Service Administration’s (HRSA) Maternal and Child Bureau’s (MCHB) National Survey of Children’s Health (NSCH).

According to the NSCH, 19.4% of children in the U.S. had a special health care need and addressed unmet health care needs It highlighted that children with special health care needs were four times as likely to have unmet health care needs, including needs across medical, dental, vision, hearing, and mental health care.

The limitations of providers who are comfortable and willing to provide treatment for patients with IDD are a multifaceted issue. The reasons range from dental professionals who have insufficient training and do not feel comfortable treating to those who prefer not to treat because of the additional time required to treat people with IDD. While federally qualified health centers (FQHC) and pediatric dentistry training programs are the main providers for pediatric patients with special needs, including IDD, these same patients may experience a lack of dental services as they transition into adulthood.

Practical implications

Recommendations are presented for continuity of care during a pandemic in traditional clinical care settings and, if needed, with general anesthesia. Desensitization, noninvasive and minimally invasive techniques are discussed as methods to support continuity of care.

The COVID-19 pandemic positioned dentists in a supportive role for first responders. It is vital to keep current with the COVID-19 pandemic and educate patients, including those with IDD and their families, outside their oral health to continue addressing public health issues during a pandemic and beyond.

The first responder's supportive role as a vaccination educator and administrator is also addressed as an opportunity to increase access to care for those with IDD.

Krystle P. Rapisura, Michael Y. Alanes, Megan N. Maher & Sarah Y. Lu (2023) "Impact of COVID-19 on Patients with Intellectual and Developmental Disabilities and Implications for Future Practice," Journal of the California Dental Association, 51:1, DOI: 10.1080/19424396.2023.2173879