Disclaimer: If you think you have a medical emergency, call 911. The health tips and information we share on this blog are for educational purposes only and should not be considered medical advice. They are not a substitute for advice from your own doctor or healthcare provider.
Dental health is crucial for overall well-being. It directly impacts how we eat, speak, and smile – and it also contributes to systemic health. For many individuals with intellectual and developmental disabilities (I/DD), dental care can be both inconvenient and inaccessible. The barriers are deeply rooted: not enough trained providers, lack of accommodations, and a health system that often separates oral health from medical care entirely.
At StationMD, we see the consequences firsthand: dental issues that could have been addressed early become emergencies. Preventable pain leads to behavioral challenges. And caregivers are left navigating an overwhelmed system, often without support.
Kaylee Graham, RN explores how thoughtful coordination, preparation, and even telehealth services like StationMD can make dental care more accessible, efficient, and compassionate for individuals with I/DD.
The Complexities of Dental Care for People with I/DD
As of 2022, nearly 70 million people in the U.S. lived in a dental health professional shortage area, and adults with disabilities are more likely than those without to report unmet dental needs due to cost or access barriers [1].
But this isn’t just about insurance or geography. Many individuals with I/DD experience:
- Communication challenges that complicate reporting their symptoms or concerns.
- Sensory sensitivities that make the dental setting overwhelming and uncomfortable.
- Medical complexity that deters dentists unfamiliar with their unique needs leading to inadequate treatment and miscommunication.
- Mobility and other medical issues that prevent dentists from examining teeth for long periods of time, such as uncontrollable movements, seizures, or cardiac disorders.
The result is a perfect storm of delayed or avoided care. In fact, a 2016 study found that 40% of adults with IDD hadn’t visited a dentist in the previous year, and nearly 12% had never seen a dentist at all [2].
Preventable dental conditions, such as tooth decay, gum disease, malocclusion, or oral infections, can impair eating, lower self-esteem, and worsen overall health, especially for individuals with existing conditions like diabetes or heart disease. Pain or difficulty chewing may lead to malnutrition, and when that pain can’t be clearly expressed, it may show up as aggression or withdrawal — behaviors that are often misunderstood or misdiagnosed.
In many cases, emergency departments and urgent cares are used as fallbacks for treatment, becoming inappropriate and costly workarounds.
Coverage Gaps and Social Determinants of Oral Health
Even when a dental provider is willing and able to care for individuals with I/DD, the system doesn’t always make it easy to say yes.
- Nearly 4.5 million individuals with I/DD depend on Medicaid for their health coverage.
- But Medicaid does not uniformly provide dental coverage for adults with I/DD. In fact:
- 12 states provide no basic dental benefit to adults outside of emergency extractions.
- Of those, only 7 offer limited services through waiver programs, which are often capped or waitlisted. [3]
- Medicare, by default, excludes dental care altogether. Some Medicare Advantage plans include limited dental benefits, but these vary widely and often exclude more complex or preventive care.
As the National Council on Disability (NCD) notes, “Dental care is frequently neglected in Medicaid programs, and people with I/DD are among those most harmed” [4].
On top of the lack of insurance, broader social determinants of health also limit access to timely, preventive dental care for people with I/DD:
- Access to Care: Few dentists are trained or feel confident in treating individuals with I/DD.
- Transportation: Getting to a dental office, especially in rural or underserved areas, can be nearly impossible without consistent support.
- Income & Insurance: Even with Medicaid or Medicare, high out-of-pocket costs for uncovered services are common.
- Health Literacy: Individuals and caregivers may not understand the importance of routine oral care or may struggle to communicate emerging issues.
- Caregiver Support: Varying levels of caregiver advocacy and time can affect appointment follow-through and home hygiene routines.
A Smarter Workflow: How to Set Up a Supportive Dental Visit
Small changes to workflows can lead to big improvements in outcomes. Here’s how providers and caregivers can work together to improve the dental experience for individuals with I/DD:
1. Include Oral Health in Routine Assessments
Oral health shouldn’t be treated as an afterthought. It should be embedded into every routine health assessment and care planning process.
Ask the right questions:
- Do they have loose teeth?
- What do the gums look like — swollen, red, or bleeding?
- Are the mucous membranes moist or dry?
- Do they show signs of pain or discomfort?
- Are they wearing dentures or oral appliances?
- Do you see any sores, ulcers, or lesions?
And perform a basic visual check for:
- Gingivitis
- Gingival hyperplasia (especially in people taking anticonvulsants, calcium channel blockers, or immunosuppressants)
- Decalcification or early enamel breakdown
- Osteonecrosis, particularly in individuals receiving certain treatments
- Dry mouth, plaque buildup, or signs of high-sugar diets
- Poor hygiene due to improper techniques or lack thereof
2. Educate and Empower Care Teams and Families
Caregivers, support staff, and individuals themselves all play a vital role in oral health. Providing regular training and accessible education can lead to better daily hygiene and earlier identification of issues.
- Use plain language, visuals, or social stories to build understanding and reduce anxiety
- Teach how to recognize warning signs of oral disease
- Promote independence through adaptive aids, such as:
- Modified toothbrushes
- Flossing tools with handles
- Electric brushes with timers
- Emphasize consistent brushing, flossing, and hydration as daily habits, not just clinical tasks
3. Partner with Dental Providers Creatively
Access improves when we build relationships and meet people where they are.
- Develop partnerships with I/DD-competent dental providers in your area
- Explore mobile dental units or on-site services at group homes, day programs, or supported living environments
- Collaborate with providers who offer sedation dentistry or behavior supports when needed
StationMD can also serve as a real-time resource for medical clearance or consults before dental visits which can help providers feel more confident and reducing cancellations.
Conclusion
The best dental care for people with I/DD happens before, during, and after the appointment. A person-centered, whole-team approach leads to fewer ER visits, less anxiety, and better outcomes.
StationMD wants to help keep your system sustainable. We are a part of your team that understands and respects the unique needs of the I/DD community. That includes recognizing oral health as part of the larger health picture.
Let’s bring more preparation, compassion, and coordination into the process so every person can receive the care they deserve.
StationMD offers specialized telehealth services that ensure timely access to healthcare and mental health support for individuals with I/DD. Contact us here for more related clinical education, questions, or speaker engagements.