sept_2000slides.ppt

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sept_2000slides.ppt

  1. 1. DENTISTRY, MANAGED CARE, AND YOUR CHILD WITH SPECIAL NEEDS
  2. 2. HOW DOES A DENTIST DEFINE A CHLD WITH SPECIAL NEEDS? Any child with mental, physical, or emotional problems
  3. 3. WHAT ARE SOME DIFFERENCES FOR CHILDREN WITH SPECIAL NEEDS? <ul><li>Problems with manual dexterity may affect oral hygiene </li></ul><ul><li>Diet, especially soft diet, may cause food to cling to the teeth </li></ul>
  4. 4. MORE DIFFERENCES <ul><li>Medications </li></ul><ul><ul><li>may be high in sugar and contribute to decay </li></ul></ul><ul><ul><li>may dry the mouth and lead to decay </li></ul></ul><ul><ul><li>may cause the overgrowth of the gums (hypertrophy) </li></ul></ul><ul><li>a characteristic of the child’s disorder may be malocclusion or bite problems </li></ul>
  5. 5. WHEN DOES A CHILD FIRST NEED TO SEE A DENTIST? By age 1 or when the first tooth erupts - ( according to the American Association of Pediatric Dentists and the American Academy of Pediatrics)
  6. 6. TYPES OF DENTAL INSURANCE <ul><li>Dental Health Maintenance Organization </li></ul><ul><li>Regular insurance, also known as fee for service, or indemnity </li></ul><ul><li>Preferred Provider Organization </li></ul>
  7. 7. DENTAL HMO <ul><li>Dentists become part of the network </li></ul><ul><li>The dentists are paid a fixed dollar amount per patient per month (capitation) to provide all services under the plan </li></ul><ul><li>Family must choose a dentist from the providers listed </li></ul>
  8. 8. ADVANTAGES and DISADVANTAGES OF HMO <ul><li>ADVANTAGES </li></ul><ul><ul><li>reduced premiums </li></ul></ul><ul><ul><li>reduced co-payments </li></ul></ul><ul><ul><li>no deductibles or annual maximums </li></ul></ul><ul><li>DISADVANTAGES </li></ul><ul><ul><li>may have reduced accessibility </li></ul></ul><ul><ul><li>may have limitations on covered services </li></ul></ul>
  9. 9. DENTAL PPO (Preferred Provider Organization ) <ul><li>A network of contracted dentists who have agreed to accept reduced fees according to a PPO fee schedule. </li></ul><ul><li>It does not involve a monthly capitation payment system to the dentist </li></ul>
  10. 10. ADVANTAGE & DISADVANTAGES OF A PPO <ul><li>ADVANATAGES </li></ul><ul><ul><li>premiums are less than for fee for service </li></ul></ul><ul><ul><li>may go to the dentist of their choice although payment will be greater if you stay in the network </li></ul></ul><ul><li>DISADVANTAGES </li></ul><ul><ul><li>costs will be higher than with an HMO </li></ul></ul><ul><ul><li>payment is higher if you do not use a network dentist </li></ul></ul>
  11. 11. FEE FOR SERVICE or TRADITIONAL INSURANCE <ul><li>Family selects the dentist of their choice </li></ul><ul><li>Bill is submitted to insurance company for payment </li></ul>
  12. 12. ADVANTAGE & DISADVANTAGES TO THE FAMILY FEE FOR SERVICE <ul><li>ADVANTAGES </li></ul><ul><ul><li>Family may choose their dentist without restrictions </li></ul></ul><ul><li>DISADVANTAGES </li></ul><ul><ul><li>Premiums and out of pockets costs will be greater </li></ul></ul><ul><ul><li>Family may be responsible for sending forms to insurance </li></ul></ul>
  13. 13. SEEING A PEDIATRIC SPECIALIST <ul><li>In an HMO you must see the general dentist first and be referred to a specialist </li></ul><ul><li>In the PPO if you want to stay in network, you must see the general dentist for a referral </li></ul>
  14. 14. WHAT REASONS ARE THERE TO SEE A PEDIATRIC DENTIST ? When the general dentist finds that there are special needs of the child that he/she would not be able to meet.
  15. 15. SPECIAL NEEDS MIGHT INCLUDE: <ul><li>Severe dental problems </li></ul><ul><li>Unusual dental problems </li></ul><ul><li>Difficulty managing the child </li></ul>
  16. 16. IF YOU HAVE A CHOICE IN DENTAL PLANS: consider <ul><li>Think about how much care you will need. The more care that is necessary, the more savings you would realize under the HMO. </li></ul>
  17. 17. IF YOU HAVE A CHOICE IN DENTAL PLANS: consider <ul><li>Think about how much choice you prefer. An HMO has the least options, PPO has more options, and traditional or fee for service has the most options for selecting a dentist. </li></ul><ul><li>Review the list of providers. Make sure the provider you select is available. </li></ul><ul><li>Compare the costs involved from plan to plan for a particular type of treatment </li></ul>
  18. 18. IF YOU HAVE A CHOICE IN DENTAL PLANS <ul><li>Review the list of providers. Make sure the provider you select is available. </li></ul><ul><li>Compare the costs involved from plan to plan for a particular type of treatment </li></ul>
  19. 19. BEFORE YOU VISIT THE DENTIST WITH YOUR CHILD <ul><li>Talk about it- “the dentist will count your teeth and peek in your mouth” </li></ul><ul><li>Use books (see list in Resources) </li></ul><ul><li>Modeling - have your child watch someone else </li></ul><ul><li>Desensitization - getting the child used to what is going to happen before it happens </li></ul>
  20. 20. HOW DOES A PARENT EXPLAIN A CHILD’S SPECIAL NEEDS? <ul><li>Call in advance and talk to the dentist and/or staff </li></ul><ul><li>Sit down and explain child’s problems. Let them know any special concerns you have . </li></ul>
  21. 21. WHAT MIGHT MAKE IT DIFFICULT FOR A CHILD WITH SPECIAL NEEDS? <ul><li>EXAMPLE: Kerissa was mentally retarded and needed help with brushing. But she would not let anyone in her mouth. She would gag. Two things were done: </li></ul><ul><ul><li>Karissa came in to the dentist frequently for 6 weeks </li></ul></ul><ul><ul><li>Karissa’s family used a toothette to clean her teeth beginning only with 1 tooth </li></ul></ul>
  22. 22. OTHER TECHNIQUES THAT THE DENTIST MIGHT USE <ul><li>Tell, Show, and Do </li></ul><ul><ul><li>Tell the child what you’re going to do </li></ul></ul><ul><ul><li>Show the child on a model what you will do </li></ul></ul><ul><ul><li>Then go ahead and do it </li></ul></ul>
  23. 23. DIFFICULTIES THAT MIGHT OCCUR AT HOME <ul><li>Child is sensitive to touch </li></ul><ul><li>Parent may not be able to clean all of the child’s teeth-especially back teeth </li></ul><ul><li>Child may gag and pull away from you </li></ul>
  24. 24. SEALANTS <ul><li>Protects the surface of teeth with grooved and pits </li></ul><ul><li>Made of shaded plastic and applied to teeth to keep them cavity-free </li></ul><ul><li>Usually covered by insurance </li></ul>
  25. 25. DENTAL CARE IN A HOSPITAL SETTING <ul><li>Dentist may recommend a hospital setting if child’s behavior or systemic problem indicate that care should be in a hospital </li></ul><ul><li>Plan needs to be discussed with insurance company regarding payment </li></ul>
  26. 26. CLOSING REMARKS <ul><li>BEFORE DENTAL CARE: </li></ul><ul><li>give short simple explanations of what is going to happen </li></ul><ul><li>talk positively-avoid the word “pain or hurt” </li></ul>
  27. 27. THANK YOU FOR JOINING US. TO LISTEN TO OUR OTHER WEBCASTS, SEE OUR ARCHIVES

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