Received: 27 June 2018 Revised: 23 October 2018 Accepted: 26 October 2018

DOI: 10.1111/scd.12346

ARTICLE

Attitude and willingness of pediatric dentists regarding dental

care for children with developmental and intellectual disabilities

Simi Abraham DDS Farhad Yeroshalmi DMD Keith S. Margulis DDS, MPH
Victor Badner DMD, MPH

NYC Health + Hospitals | Jacobi, Pediatric

Dentistry, Bronx, New York
Correspondence
Farhad Yeroshalmi, DMD, NYC Health +
Hospitals | Jacobi, 1400 Pelham Parkway
South, Building #1, Suite 3NE1, Bronx,
New York 10461.
Email: Farhad.Yeroshalmi@nychhc.org
Abstract
Aim: Children with developmental and/or intellectual disabilities (DD/ID) are con-
sidered to be at greater risk of developing dental disease and are more likely to have
unmet dental needs than other children. The purpose of this study was to determine
the attitude and willingness of pediatric dentists and residents to provide dental care
for children with DD/ID.

Methods: Two surveys were created and emailed via SurveyMonkey® to pediatric
dentists and post-doctoral student members of the American Academy of Pediatric
Dentistry.

Results: Five hundred and seventy-four pediatric dentists (9%) and 143 pediatric
dentistry residents (13%) responded. Ninety-nine percent of the practicing pediatric
dentists do provide dental care for children with DD/ID. Ninety-six percent of the
practitioners are confident/very confident in treating these children with nonphar-
macological methods, while 86% are confident/very confident with pharmacological
methods. Among the residents, 99% are willing to provide dental care to children
with DD/ID after they graduate. Eighty-six percent of the residents are confident/very
confident in treating these children with nonpharmacological methods, while 70%
are confident/very confident with pharmacological methods.

Conclusion: Pediatric dentist and resident respondents to the survey were overwhelm-
ingly willing to provide dental care for patients with DD/ID and are confident with
pharmacological and nonpharmacological treatment modalities.

KEYWORDS
attitude, developmental disabilities, disabled children, intellectual disability, pediatric dentists

1 I N T RO D U C T I O N
Several definitions for special health care needs and disabili-
ties exist worldwide with no universally recognized standard
definition. The World Health Organization (WHO) defines
disabilities as an umbrella term, which includes activity limi-
tations, impairments, and participation restrictions.1 Children
with special health care needs are defined as “those who have
or are at increased risk for a chronic physical, developmen-
tal, behavioral, or emotional condition and who also require
health and related services of a type or amount beyond that
required by children generally.”2
The American Academy of Pediatric Dentistry (AAPD)
defines special health care needs as “any physical,

© 2018 Special Care Dentistry Association and Wiley Periodicals, Inc.

20 wileyonlinelibrary.com/journal/scd Spec Care Dentist. 2019;39:20–27.

ABRAHAM ET AL.
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.3
Health care professionals have a professional and moral
obligation to all members of the community. The Rehabil-
itation Act of 1973 section 504 made it illegal for health
care providers receiving federal funding to withhold services
to otherwise qualified persons on the basis of disability.4
Unfortunately, immense inequalities still exist in relation to
oral health, particularly amongst patients requiring special
care. The population of patients with complex needs has been
rapidly growing and represents a group of patients that has
great challenges in accessing oral health care.5 Advances in
medical technology have increased the likelihood that peo-
ple with multiple medical problems and developmental dis-
abilities will have a longer life expectancy.5 These children
have higher health care utilization rates compared with other
children.6 According to the U.S. Census Bureau report in
2010, approximately 56.7 million people or 19% of the pop-
ulation have a disability, with more than half of which are
severe.7 Boyle et al reported that approximately 1 in 6 chil-
dren in the United States in 2006-2008 had a developmen-
tal disability.8 A review of the literature reveals abundant
evidence that children and adolescents with developmental
disabilities have greater dental needs, poorer oral hygiene,
higher incidence of periodontal disease and require more
tooth extractions than the general population.9 The reasons
include frequent use of medications high in sugar, depen-
dence on a caregiver for regular oral hygiene, reduced clear-
ance of foods from the oral cavity, impaired salivary func-
tion, preference for carbohydrate rich foods, a liquid or puréed
diet, and oral aversions.9,10 Not surprisingly, patients with dis-
abilities also require treatment under general anesthesia more
frequently than nondisabled patients.11
In the past, research has suggested that dentists have found
the special needs population stressful or too challenging to
treat. Dao et al stated that: “Health care for individuals with
special needs requires specialized knowledge acquired by
additional training, as well as increased awareness and atten-
tion, adaptation, and accommodative measures beyond what
are considered routine.”12 Dentists may feel that the pressure
of time and the inadequacy of reimbursement create disincen-
tives to treat these populations.13 According to an article by
Casamassimo in 2004, only 10% of dentists examined chil-
dren with special needs.14 Special needs patients seek den-
tal treatment for remedial procedures compared to preven-
tive procedures. Based on a study conducted by Smith et al
treatment provided by dental practitioners on special needs
21
patients showed more than 70% of their dental visits were for
emergency services and extraction.15
The predominant barriers to the delivery of oral health care
for patients with special needs are:
1. Factors concerning special needs patient's behavior, dis-
ability level, and extent of oral disease/treatment needs;
2. Training for dentists and office staff in managing patients
with special needs;
3. Financing and reimbursement for direct and adjunctive ser-
vices required to provide treatment for patients with spe-
cial needs.16
Many general dentists are reluctant and/or not prepared
to treat children with special needs due to the complexity of
their medical conditions, patient behavior, and the dentists’
inadequate training and experience.12,17 General dentists
with advanced training also tend to see few children with
special needs, so treatment often falls on pediatric dentists.17
Pediatric dentists have traditionally been regarded by the
dental community as the specialty group best prepared to
treat patients with developmental disabilities. This may be
because it is the only specialty that receives formal training in
behavioral management techniques.18 A study by Dougherty
et al indicated that dental students were receiving very limited
educational experiences in the care of the disabled and those
experiences varied widely in terms of didactic, clinical and
hands on.18 Girdler et al stated that, successful treatment for
these patients depends on the dentist's ability to manage the
patient with appropriate behavior management techniques
as cooperation is often lacking in individuals with severe
disability.19
Pediatric dentistry includes in its definition the care of
patients with special health care needs.20 Since its recognition
as a specialty, pediatric dentists have been actively involved in
not only treating patients with special needs but also as strong
advocates for their educational and social needs. Accredita-
tion standards for advanced specialty education programs in
pediatric dentistry include didactic and clinical training in
examination, treatment and management of infants, children,
adolescents and adults with special health care needs.21 A sig-
nificant number of graduates of pediatric dentistry residency
programs maintain hospital privileges and have the capabil-
ity to treat patients in a hospital operating room setting. The
ability of a doctor to provide dental treatment under gen-
eral anesthesia increases access to appropriate care for the
developmentally disabled population that display behavioral
challenges in the dental operatory.18
While it is known that training of the pediatric dentistry
resident includes patients with special health care needs, little
is known about the amount of time devoted for special care
training both didactic and clinical in the residency program,
22
the type of training and the continuation of this care once the
pediatric dentists enter practice.
The Commission on Dental Accreditation (CODA) defines
competent as “having the knowledge, skills and value required
for the graduates to begin independent, unsupervised specialty
practice.”22 Many studies have evaluated the quality of educa-
tion in special care dentistry in dental schools and general den-
tist's perception of educational and treatment issues.5,12,14,18
There has been limited research on attitude and willingness of
pediatric dentists towards the treatment of children with spe-
cial needs. The main purpose of this study was to determine
the attitude and willingness of pediatric dentists and pediatric
dentistry residents to provide dental care for children with
DD/ID.
2 M AT E R I A L A N D M E T H O D S
A literature search of the MEDLINE/PubMed electronic
database was performed in August 2016, using the follow-
ing keywords: children with special needs, special health care
needs, developmental disability, intellectual disability, pedi-
atric dentists, dental residents, dental care and attitude. Search
inclusion criteria were articles published within the last 35
years and written in English. Aside from the articles found
via the literature search, guidelines published by the AAPD,
American Dental Association (ADA) and World Health Orga-
nization (WHO) websites were reviewed for our study. Based
on the reviewed literature, a twenty-four item questionnaire
for practicing pediatric dentists and a twenty-two item ques-
tionnaire for pediatric dentistry residents were created to col-
lect required data. The Institutional Review Board of the
Albert Einstein College of Medicine reviewed the study and
approved the conduct of this research protocol as exempt from
full review. The survey was pilot tested among current fac-
ulty and residents. Responses were reviewed for content valid-
ity. Individual items were then modified as needed. Surveys
were emailed via SurveyMonkey® to all active pediatric den-
tist members (N = 6132), and current postdoctoral student
members (N = 1069) of the American Academy of Pedi-
atric Dentistry as obtained from their membership mailing
list.
Participants received a reminder email 2 weeks after the
surveys were sent out if no response had been received. Four
weeks after the first mailing, data collection was discontinued
and the results were tabulated.
The responses by the pediatric dentists and residents were
analyzed. Both questionnaires included demographic ques-
tions, type of practice/residency training, and total num-
ber of patients seen per day. Residents surveyed were
asked about the amount of time devoted to treating people
with DD/ID. Questions about confidence in pharmacolog-
ical and nonpharmacological treatment modalities required
ABRAHAM ET AL.
pediatric dentists and residents to rate each characteris-
tic as: not confident, confident and very confident. Fisher's
exact test was utilized to evaluate some of the differences
between dentists and residents. We used Minitab® 17 soft-
ware (Minitab Inc., State College, PA, USA) and SPSS 23.0
software (IBM Corp., Armonk, NY, USA) for the statistical
analysis.
3 RESULTS
Nine percent of the pediatric dentists (N = 574) and 13% of the
pediatric dentistry residents (N = 143) responded to the sur-
vey. Out of 574 pediatric dentist respondents, 572 completed
the entire survey, while 2 provided partial responses. Of 143
residents, 115 completed the survey in its entirety, while 28
provided partial responses.
Table 1 shows demographic information of the respondent
pediatric dentists and residents.
Fifty-two percent (N = 298) of the responding practicing
pediatric dentists were female and 48% (N = 276) were male.
The gender distribution matched the known distribution
for all pediatric dentists. Therefore, at least as measured by
this one variable, it appears that the respondents were simi-
lar to the total population of pediatric dentists. Fifty-five per-
cent (N = 316) of pediatric dentists graduated from a com-
bined university/hospital based program, followed by 30.84%
(N = 177) from a hospital based program. Sixty percent
(N = 344) of the practitioners’ primary practice location was
suburban, followed by 28.92% (N = 166) urban, and 11.15%
(N = 64) in rural areas. Fifty-four percent (N = 310) of the
dentists were in a group practice, 35.54% (N = 204) in a solo
practice setting, 8.19% (N = 47) in an academic setting, 6.45%
(N = 37) in a hospital setting, 5.05% (N = 29) in a commu-
nity health center setting, 0.35% (N = 2) in a military setting,
followed by 2.26% (N = 13) in other.
Seventy-two percent (N = 103) of the residents were female
and 28% (N = 40) were male. Forty-eight percent (N = 69)
of the residents were in a combined university/hospital-based
program, followed by 34.27% (N = 49) in a hospital based
program. Eighty percent (N = 115) of the residents were in a
program located in an urban area followed by 11.19% (N = 16)
in suburban, and 8.4% (N = 12) in rural areas.
Thirty-eight percent (N = 55) of the residents were
expected to graduate in 2018; 60.14% (N = 86) were expected
to graduate in 2019; and 1.4% (N = 2) were expected to
graduate in 2020.
Among the practicing pediatric dentists, 99% (N = 572)
provide dental care for children with DD/ID. The percentage
of children with DD/ID in their practice was less than 20%
for 93% of the practitioners. All the pediatric dentists have
treated a patient diagnosed with Autism Spectrum Disorder,
and more than 97% have provided dental care for a patient
ABRAHAM ET AL. 23

TABLE 1 Demographic data

Pediatric dentists Pediatric residents
(N = 574) (N = 143)
Gender Male 48.08% (N = 276) 27.97% (N = 40)
Female 51.92% (N = 298) 72.03% (N = 103)
Program type University-based 10.10% (N = 58) 7.69% (N = 11)
Hospital-based 30.84% (N = 177) 34.27% (N = 49)
Combined University & 55.05% (N = 316) 48.25% (N = 69)
Hospital
Hospital & Community 3.66% (N = 21) 8.39% (N = 12)
Health Center
Other 0.35% (N = 2) 1.40% (N = 2)
Practice location Rural 11.15% (N = 64) 8.39% (N = 12)
Urban 28.92% (N = 166) 80.42% (N = 115)
Suburban 59.93% (N = 344) 11.19% (N = 16)
AAPD District of Current Northeastern 24.04% (N = 138) -
Practice Location Southeastern 21.08% (N = 121) -
Northcentral 18.12% (N = 104) -
Southwestern 17.94% (N = 103) -
Western 18.82% (N = 108) -
AAPD District of Residency Northeastern 35.19% (N = 202) 39.86% (N = 57)
Program Attended Southeastern 16.38% (N = 94) 13.99% (N = 20)
Northcentral 25.96% (N = 149) 23.78% (N = 34)
Southwestern 12.02% (N = 69) 11.19% (N = 16)
Western 10.45% (N = 60) 11.19% (N = 16)

with Intellectual Disabilities, Behavioral Issues, Seizure Dis-
orders, Syndromes, and Cerebral Palsy.
Among the residents, 99% (N = 142) were willing to pro-
vide dental care to children with DD/ID after they graduate.
All the residents reported to have provided some kind of den-
tal care for patients with DD/ID in their program or previous
training.
Ninety-nine percent (N = 142) of the residents have treated
a patient diagnosed with Autism Spectrum Disorder, fol-
lowed by Intellectual Disability (95%, N = 136), Behavioral
Issues (94.4%, N = 135), Seizure Disorders (92%, N = 132),
Syndromes (90%, N = 129), and Cerebral Palsy (87%,
N = 125).
The majority of the dental treatment rendered for chil-
dren with DD/ID by both pediatric dentists and residents
include the following: exam, prophylaxis, fluoride treatment,
composite/amalgam restorations, pulpotomy /SSC and extrac-
tions. Treatments such as permanent tooth root canal ther-
apy, orthodontics, fixed /removable prosthodontics, periodon-
tics and other surgical procedures comprised less than 20% of
procedures rendered (Graph 1).
Nitrous oxide is the most common anxiolysis/sedation tech-
nique used to provide dental care for children with DD/ID
by both practitioners and residents, followed by general
anesthesia. No statistically significant difference was noted
between pediatric dentists and residents using Fisher's exact
test (Graph 2).
Among the practicing pediatric dentists, 3.5% (N = 20)
were not confident, 47.6% (N = 273) were confident and
49.0% (N = 281) were very confident with utilizing non-
pharmacological treatment modalities, while 15.5% (N = 89)
were not confident, 49.8% (N = 286) were confident
and 34.7% (N = 199) were very confident with utilizing
pharmacological methods in treating children with DD/ID
(Graphs 3 and 4).
Among the residents, 13.3% (N = 19) were not confident,
71.3% (N = 102) were confident, and 15.4% (N = 22) were
very confident with utilizing nonpharmacological treatment
modalities, while 30.1% (N = 43) were not confident, 56.6%
(N = 81) were confident, and 13.3% (N = 19) were very confi-
dent with utilizing pharmacological methods in treating chil-
dren with DD/ID (Graphs 3 and 4).
Even though most of the pediatric dentists do provide
dental care for children with DD/ID, 55% have reported
the necessity to refer patients to some other settings.
Some of the reasons suggested include: treatment under
oral/intravenous sedation, general anesthesia, as well as
endodontics, prosthodontics, periodontics, orthodontics, and
24 ABRAHAM ET AL.

Pediatric Dentists N= 574

Residents N= 143
99.8% 100% 98.4%
95.5% 96.0%
100%
83.9%
79.7%
80% 65.0%

60%

40%
17.6% 20.0% 19.2%
14.7% 14.0% 11.9%
20%
5.1% 2.8%

0%

GRAPH 1 Type of services provided for

Pediatric Dentists Residents children with DD/ID at practice/residency

Pediatric Dentists N=574 Pediatric Dentists N=574

Residents N=143 Residents N=143
90.4% 56.6%
100% 85.3% 49.8%
60%
70.9% 72.0%
80% 34.7%
30.1%
49.0%
40%
60% 47.6%
15.5% 13.3%
40% 25.4% 23.1% 20%

20% 0%
Not confident Confident Very confident
0%
Nitrous Oral IV sedation General
Pediatric Dentists Residents
oxide sedation anesthesia
Pediatric Dentists Residents GRAPH 4 Confidence in treating children with DD/ID with
pharmacological methods
GRAPH 2 Type of anxiolysis/sedation technique provided for
children with DD/ID at practice/residency
Pediatric Dentists N=574
Residents N=115
Pediatric Dentists N=574
Residents N=143 60% 53.0%

50% 43.2%
71.3%
80% 40% 34.0%
70% 24.3% 26.1%
30% 21.6%
60% 47.6% 49.0%
13.0% 14.5%
20%
50% 6.8% 7.8%
10% 0.3% 0.9%
40%
30% 0%
13.3% 15.4% Refer all Establish a Refer for Refer for I do not Other
20% 3.5% patients dental treatment treatment refer
10% regardless home for under oral under children
of their preventive and IV general with
0% needs care and sedation anesthesia DD/ID
Not confident Confident Very confident refer for
treatment
Pediatric Dentists Residents Pediatric Dentists Residents

GRAPH 3 Confidence in treating children with DD/ID with GRAPH 5 Circumstances to refer a pediatric patient with DD/ID to
nonpharmacological methods another setting for dental care

surgical procedures. No statistical significance was noted in Fifty-three percent (N = 76) of the residents reported hav-
the responses between residents and dentists using Fisher's ing received some kind of previous training in treating chil-
exact test (Graph 5). dren with DD/ID.
ABRAHAM ET AL. 25

N=143 most residency programs prepare the residents to care for chil-
dren with special health care needs, inequalities in training is
40.0% 32.9%
27.3% still an ongoing issue (Graph 6), despite the CODA require-
30.0% 24.5%
ments. Lack of adequate training is still a major issue with
15.4%
20.0% the education system. There is paramount importance in post-
10.0% doctoral education and training in special care dentistry and
0.0% it cannot be underestimated. Education is an essential factor
None 1-4 hours 5-10 Greater in preparing the graduating residents to manage the need of
hours than 10
the growing population of children with any kind of special
hours
Responses
health care needs.
Confidence of pediatric dentists in treating children with
GRAPH 6 Hours of didactic training in special care dentistry at DD/ID with pharmacological methods was lower than with
residency program nonpharmacological methods. This could be due to the antic-
ipated complications that could occur while using sedative
N=143
33.6% medications in these children, especially in an outpatient
35.0%
30.0%
setting. Procedural sedation for pediatric patients has seri-
25.0% ous associated risks. According to the AAPD, children with
18.2%
20.0% 16.1%
developmental disabilities have been shown to have a three-
15.0% 11.2% 9.8% 11.2%
10.0%
fold increased incidence of desaturation compared with chil-
5.0% dren without developmental disabilities.24 Interestingly, res-
0.0%
None 1-40 41-80 81-120 121-160 Greater
idents reported having more confidence in treating children
hours hours hours hours than with pharmacological treatment modalities when compared
161
Responses
hours to practitioners. This could be due to the availability of a
supervising dentist, setting of the residency program, and/or
GRAPH 7 Hours of clinical training in special care dentistry at the interest in receiving more training in pharmacological
residency program
methods.
Even though most of the pediatric dentists do provide den-
Fifteen percent (N = 22) of residents reported no didactic tal care for children with DD/ID, 55% reported the necessity
training, 32.9% (N = 47) received 1-4 hours, 24.5% (N = 35) to refer patients to some other settings for various reasons.
received 5-10 hours and 27.3% (N = 39) received greater than This demonstrates that despite their willingness, many barri-
10 hours (Graph 6). ers still exist in providing adequate dental care for these chil-
Eleven percent (N = 16) reported no clinical training, dren. These barriers could be provider related such as lack
33.6% (N = 48) received 1-40 hours, 16.1% (N = 23) received of confidence, lack of adequate office facility, lack of prop-
41-80 hours, 9.8% (N = 14) received 81-120 hours, 11.2% erly trained staff, and lack of adequate financial reimburse-
(N = 16) received 121–160 hours, and 18.2% (N = 26) ment. Patient related barriers could be extreme uncooperative
received greater than 161 hours (Graph 7). behavior, need for a multidisciplinary approach due to com-
plex medical history, and parent or caregiver's lack of ade-
quate concern for patient's dental needs. Adequate financial
4 DIS CUSSI O N reimbursement is outside of the provider and patient control,
but undoubtedly is another barrier to care.
This study gathered information regarding the attitude and Only 9% of the dentists and 13% of residents responded
willingness of pediatric dentists and residents caring for chil- to this survey. Inability to collect data from the remaining
dren with DD/ID. It appears that 99% of the pediatric dentists dentists and residents represents a major limitation. Gener-
do provide dental care for children with DD/ID which is con- ally, pediatric dentists and residents receive numerous surveys
sistent with the results of the survey conducted by ADA in every year, and it could be overwhelming for them to respond
2012.23 The positive attitude and willingness of pediatric den- due to their busy professional life or various other reasons. A
tists and residents could be due to the wide exposure to chil- follow-up study should be conducted to confirm these positive
dren with developmental disabilities in the pediatric dentistry results.
residency programs compared to other post graduate training It is important to remember that the results of this survey
programs. are solely based on those who responded and may be biased
Results of this survey show that most of pediatric dentistry in favor of pediatric dentists and residents who choose to
residents are receiving both clinical and didactic training in treat children with DD/ID. Moreover, respondents may have
treating children with DD/ID. Based on this survey, while overstated their involvement in providing care to children
26
with DD/ID because of concerns regarding professional
perceptions.
5 CONC LU SI ON S
Based on this study's results, the following conclusions can be
made:
1. Pediatric dentists and residents are overwhelmingly will-
ing to provide dental care for children with DD/ID, and are
confident with pharmacological and nonpharmacological
treatment modalities.
2. Nitrous oxide is the most commonly used anxioly-
sis/sedation technique to provide dental care for children
with DD/ID by both residents and practitioners.
3. Even though 99% of pediatric dentists do provide den-
tal care for children with DD/ID, more than half had the
necessity to refer patients to another setting for various
reasons.
4. Lack of adequate training in special health care still exists
in pediatric dentistry residency programs.
ACKNOW LEDGMENTS
The authors wish to acknowledge the effort, dedication and
contribution of Jorge F Sansary, MD, MPH system project
leader, Department of Pediatric Infectious Diseases, NYC
Health + Hospitals | Jacobi, Bronx, NY for his statistical
analysis of our collected data.
CONFLICTS O F INTEREST
Authors have no financial, economic, or professional interest
that may have influenced the design, execution, or presenta-
tion of this scholarly work.
ETHICS STATE ME N T
This research did not involve utilizing any human data. All
authors listed participated in the study design and protocols,
data collection, manuscript writing and data analysis.
ORC ID
Simi Abraham DDS
https://orcid.org/0000-0001-6053-1290
REFERENCES
1. World Health Organization. 2008. Health topics: disabilities.
Available at: http://www.who.int/topics/disabilities/en/. Accessed
August 21, 2018. (Archived by WebCite® at http://www.webcita
tion.org/71qJLQHxB)
2. McPherson M, Arango P, Fox H, et al. A new definition of children
with special health care needs. Pediatrics. 1998 Jul;102:137-140.
ABRAHAM ET AL.
3. American Academy of Pediatric Dentistry. Definition of special
health care needs. Pediatr Dent. 2016:38(6):pp. 16-16(1).
4. U.S. Department of Justice. A Guide to Disability Rights
Law. Available at: https://www.ada.gov/cguide.htm. Accessed
August 23, 2018. (Archived by WebCite® at http://www.webcita
tion.org/71t6o1Lo7)
5. Subar P, Chávez EM, Miles J, Wong A, Glassman P, Labarre E.
Pre- and postdoctoral dental education compared to practice pattern
in special care dentistry. J Dent Educ. 2012 Dec;76:1623-1628.
6. Edwards JD, Davidson EJ, Houtrow AJ, Graham RJ. Pediatric resi-
dent attitudes toward caring for children with severe disabilities. Am
J Phys Med Rehabil. 2010 Sep;89:765-771.
7. Brault MW, Americans With Disabilities: 2010, Current Population
Reports, P70-131, U.S. Census Bureau, Washington, DC, 2012.
8. Boyle CA, Boulet S, Schieve L, et al. Trends in the prevalence of
developmental disabilities in US children, 1997–2008. Pediatrics.
2011;27:1034-1042.
9. Hulland S, Sigal MJ. Hospital-based dental care for persons with
disabilities: a study of patient selection criteria. Spec Care Dentist.
2000 Jul-Aug;20:131-138.
10. Charles JM. Dental care in children with developmental disabilities:
attention deficit disorder, intellectual disabilities, and autism. J Dent
Child (Chic). 2010 May-Aug;77:84-91.
11. Grant E, Carlson G, Cullen-Erickson M. Oral health for people with
intellectual disability and high support needs: positive outcomes.
Spec Care Dentist. 2004 Mar-Apr;24:70-79.
12. Dao LP, Zwetchkenbaum S, Inglehart MR. General dentists and
special needs patients: does dental education matter? J Dent Edu.
2005;69:1107-1115.
13. 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 Nov;16:195-201.
14. Casamassimo PS, Seale NS, Ruehs K. General dentists’ perceptions
of educational and treatment issues affecting access to care for chil-
dren with special health care needs. J Dent Educ. 2004 Jan;68:23-
28.
15. Smith G, Rooney Y, Nunn J. Provision of dental care for special
care patients: the view of Irish dentists in the Republic of Ireland. J
Ir Dent Assoc. 2010 Apr-May;56:80-84.
16. Crall JJ. Improving oral health for individuals with special health
care needs. Pediatr Dent. 2007 Mar-Apr;29:98-104.
17. Kerins C, Casamassimo PS, Ciesla D, Lee Y, Seale NS. A prelimi-
nary analysis of the US dental health care system's capacity to treat
children with special health care needs. Pediatr Dent. 2011 Mar-
Apr;33:107-112.
18. Dougherty N, Romer M, Lee RS. Trends in special care training
in pediatric dental residencies. ASDC J Dent Child. 2001 Sep-
Dec;68:384-387, 303.
19. Girdler NM, Hill CM, Wilson KE. Spectrum of patient man-
agement. Clinical Sedation in Dentistry. West Sussex: Wiley-
Blackwell; 2009:1-15.
20. American Academy of Pediatric Dentistry. Overview: definitions
and scope of pediatric dentistry. Pediatr Dent. 2017:39(6): 5-7(3).
21. Commission on Dental Accreditation: Accreditation Stan-
dards for Advanced Specialty Education Programs in Pediatric
ABRAHAM ET AL.
Dentistry. Patients with Special Health Care Needs. 2018, 30. Avail-
able at: https://www.ada.org/~/media/CODA/Files/ped.pdf?la=en.
Accessed August 21, 2018. (Archived by WebCite® at http://
www.webcitation.org/71qIOpOu1)
22. Commission on Dental Accreditation: Accreditation Standards
for Advanced Specialty Education Programs in Pediatric Den-
tistry. Definitions of Terms Used in Pediatric Dentistry Accred-
itation Standards. 2018, pp. 11. Available at: https://www.ada.
org/~/media/CODA/Files/ped.pdf?la=en. Accessed August 21,
2018. (Archived by WebCite® at http://www.webcitation.org/
71qIOpOu1)
23. American Academy of Pediatric Dentistry. Trends in Pedi-
atric Dentistry 2015. Available at: http://www.aapd.org/assets/
1/7/Trends_in_Pediatric_Dentistry-2015.pdf. Accessed August
21, 2018. (Archived by WebCite® at http://www.webcitation.
org/71qIHKaXK)
24. Coté CJ, Wilson S. Guidelines for monitoring and management
of pediatric patients before, during, and after sedation for diag-
nostic and therapeutic procedures: update 2016. Pediatr Dent.
2016;38:E13-E39. American Academy of Pediatric Dentistry,
American Academy of Pediatrics.
AU T H O R S' BIOG R A P H I E S
Dr. Simi Abraham is a pediatric dentist in Dallas, Texas.
27
Dr. Farhad Yeroshalmi is director of the Pediatric Dentistry
Residency Program at NYC Health + Hospitals | Jacobi, and
an associate professor of dentistry at Albert Einstein College
of Medicine, Bronx, New York.
Dr. Keith S. Margulis is associate director of the Pediatric
Dentistry Residency Program.
Dr. Victor Badner is chairperson of the Department of Den-
tistry/OMFS, both at NYC Health + Hospitals | Jacobi, Bronx,
New York.
S U P P O RT I NG IN FO R M AT I O N
Additional supporting information may be found online in the
Supporting Information section at the end of the article.
How to cite this article: Abraham S, Yeroshalmi
F, Margulis KS, Badner V. Attitude and willingness
of pediatric dentists regarding dental care for children
with developmental and intellectual disabilities. Spec
Care Dentist. 2019;39:20–27. https://doi.org/10.1111/
scd.12346