Policy on Hospitalization and Operating Room Access for Oral Care of Infants, Children, Adolescents, and Individuals with Special Health Care Needs

Purpose

The American Academy of Pediatric Dentistry (AAPD) advocates, when indicated, hospitalization and equal access to operating room facilities for oral care of infants, children, adolescents, and individuals with special health care needs. The AAPD recognizes that barriers to hospital oral care for patients who require treatment in that setting need to be addressed.

Methods

This policy was developed by the Dental Care Committee and adopted in 19891 and was last revised by the Council of Clinical Affairs in 20152. A PubMed®/MEDLINE search was performed using the terms: access for dental/oral care in hospitals, operating room access for dental/oral care, and access to hospital dentistry; fields: all; limits: within the last 10 years, humans, English, birth through age 18. Additionally, websites for the American Medical Association, American Dental Association (ADA), AAPD, American Dental Association Commission on Dental Accreditation, and Centers for Disease Control and Prevention were reviewed.

Background

Pediatric dentists treat patients who present special challenges related to their age, behavior, medical status, developmental disabilities, or special needs. Caries, periodontal diseases, and other oral conditions, if left untreated, can lead to pain, infection, and loss of function.3-5 These undesirable outcomes can adversely affect learning, communication, nutrition, and other activities necessary for normal growth and development.5-8 Many medical conditions (e.g., hematological, oncological) are exacerbated by the presence of oral maladies and disease. To address these challenges and to provide the treatment needs effectively, pediatric dentists have developed and employ a variety of management techniques, including accessing anesthesia services and/or the provision of oral health care in a hospital setting with or without general anesthesia.9 Some children with particular compromising medical conditions may only be able to receive their dental treatment safely in a hospital setting. Hospital dentistry is an integral part of the curriculum of all accredited advanced pediatric dental training programs. Pediatric dentists are, by virtue of training and experience, qualified to recognize the indications for such an approach and to render such care.10,11

Pediatric dentists occasionally have experienced difficulty in gaining an equal opportunity to schedule operating room time, postponement/delay of non-emergency oral care, and economic credentialing. Economic credentialing (i.e., the use of economic criteria not related to quality of care or professional competency) to determine qualifications for granting/renewing an individual’s clinical staff membership or privileges should be opposed.12 The AAPD and the ADA urge hospital insurance carriers to include hospitalization benefits for dental treatment in both private and public insurance programs so that the resources of a hospital are available to patients whose condition in the judgment of the dentist warrants treatment in the operating room.13,14

Hospital governing boards and medical staffs are interested in improving the quality and efficiency of patient care. Decisions regarding hospital privileges should be based upon the training, experience, and demonstrated competence of candidates, taking into consideration the availability of facilities and the overall medical needs of the community, the hospital, and especially the patients. Privileges should not be based on numbers of patients admitted to the facility or the patient’s economic or insurance status.15

Policy Statement

The AAPD shall work with all concerned medical and dental colleagues and organizations to remove barriers to hospital and operating room access for oral care for patients best treated in those settings. The AAPD affirms that hospitals or outpatient settings providing surgical treatment should not discriminate against pediatric dental patients requiring care under general anesthesia. Such patients and their care providers need accessto these facilities. The dental patient, as with any other patient, should have the right to be seen in a timely manner. Evidence has demonstrated dental treatment under general anesthesia in the operating room is a necessity, as well as an important component of comprehensive care, to assure optimal health for many, especially those considered high-risk.16-18

References

1. American Academy of Pediatric Dentistry Dental Care Committee. Hospitalization for dental care of infants and children. May, 1989. Orlando, Fla.: American Academy of Pediatric Dentistry; 1989.
2. American Academy of Pediatric Dentistry. Hospitalization and operating room access for oral care of infants, children, adolescents, and persons with special health care needs. Pediatr Dent 2015;37(special issue):88-9.
3. Acs G, Pretzer S, Foley M, Ng MW. Perceived outcomes and parental satisfaction following dental rehabilitation under general anesthesia. Pediatr Dent 2001;23(5):419-23.
4. American Academy of Pediatric Dentistry. Definition of dental neglect. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2020:16.
5. Low W, Tan S, Schwartz S. The effect of severe caries on the quality of life in young children. Pediatr Dent 1999;21(6):325-6.
6. Edelstein B, Yoder K. The child in context of the family, community and society. In: Dean JA, ed. McDonald and Avery’s Dentistry for the Child and Adolescent. 10th ed. St. Louis, Mo: Elsevier; 2016:645-62.
7. Thomas CW, Primosch RE. Changes in incremental weight and well-being of children with rampant caries following complete dental rehabilitation. Pediatr Dent 2002;24(2):109-13.
8. American Academy of Pediatric Dentistry. Definition of dental disability. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2020:17.
9. Velan E, Sheller B. Providing dental treatment for children in a hospital setting. Dent Clin North Am 2013;57(1):163-73.
10. American Dental Association Commission on Dental Accreditation. Accreditation standards for advanced specialty education programs in pediatric dentistry: Hospital dentistry. Chicago, Ill.: American Dental Association; 2018:31-3.
11. Forsyth AR, Seminario AL, Scott J, Berg J, Ivanova I, Lee H. General anesthesia time for pediatric dental cases. Pediatr Dent 2012;34(5):129-35.
12. American Medical Association. Policy H-230.975 Economic credentialing. 2017. American Medical Association PolicyFinder. Available at: “https://policysearch.ama-assn.org/policyfinder/detail/230.975?uri=%2FAMADoc%2FHOD.xml-0-1606.xml”. Accessed August 6, 2020.
13. American Academy of Pediatric Dentistry. Policy on model dental benefits for infants, children, adolescents, and individuals with special health care needs. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2020:131-4.
14. American Dental Association. Economic credentialing (Trans.1993:692). Hospitals. In: Current Policies. Adopted 1954-2019. Chicago, Ill.: American Dental Association; 2019:120. Available at: “http://www.ada.org/~/media/ADA/Member%20Center/Members/current_policies.pdf ”. Accessed August 6, 2020.
15. American Medical Association. Code of Medical Ethics Opinion 9.5.2. Staff privileges. Ethics. American Medical Association. November 14, 2016. Available at: “https://www.ama-assn.org/delivering-care/ethics/staff-privileges”. Accessed August 6, 2020.
16. Chi DL, Momany ET, Neff J, et al. Impact of chronic condition status and severity on dental utilization for Iowa Medicaid-enrolled children. Pediatr Anes 2010;20(9):856-65.
17. Chang J, Patton LL, Kim HY. Impact of dental treatment under general anesthesia on the oral health-related quality of life of adolescents and adults with special needs. Eur J Oral Sci 2014;122(6):363-71.
18. Park JS, Anthonappa RP, Yawary R, King NM, Martens LC. Oral health-related quality of life changes in children following dental treatment under general anesthesia: A meta-analysis. Clin Oral Investig 2018;22(8):2809-18.