The National Health Insurance is a government-operated social insurance program that offers healthcare coverage to all residents of Taiwan. The core spirit of universal healthcare is universal coverage, comprehensive benefits, cost sharing, efficient healthcare delivery, and financial sustainability. [8]
The core spirit of the National Health Insurance includes universal care, which includes groups with special needs. Due to the diversity of their individual obstacles, in addition to physical deficiencies, they are more likely to be mental and psychological, behavior disturbances.
Mental or intellectual disability group accounts for 30% of all people with physical and mental disabilities in Taiwan in 2023. (https://dep.mohw.gov.tw/dos/np-5224-113.html) Due to cognitive impairment or insufficient ability to express themselves, their medical needs are often ignored, indirectly affecting whole-body health's health promotion. Children with intellectual disabilities have poor access to preventive dental care and also exhibit a higher incidence of caries experience and extractions. [9]This study mainly uses statistical methods to explore the relationship between the mode and contents of dental treatment received by people with disabilities in medical centers and their differences. This may be because patients undergoing general anesthesia might have more complex dental issues that require these interventions and performing them under anesthesia can be more comfortable for the patient. Other retrospective studies in special needs patients treated under GA conformingly found a higher demand for restorative procedures than for extraction therapy in adolescents and adults.[10–12] Dental treatment of ID patients under general anesthesia can be performed just as safely as that with NID patients.[13] A substantial proportion of children (i.e. falling within the 75th percentile) were still experiencing pain before the majority of children had been seen for their operation. This is troubling as it suggests pain is experienced throughout the wait for GA. [14]
In a considerable proportion of SNP, a ‘gentle approach’, behavioral management, and/or cognitive behavioral therapy is deemed ineffective, and such patients require pharmacological management in the form of conscious sedation utilizing several pathways, as well as dental general anesthesia (GA) in the most severe cases .[15–17]It's important to note that the choice of treatment depends on the patient's specific dental condition and needs, as determined by the dentist during a thorough examination. Additionally, the availability of treatments may vary by dental practice and region.
About half of the subjects of this study are people with intellectual or mental disabilities. There is a gap in appropriate oral health care for individuals with intellectual. disability. [18] As age increases, the risk of dementia and the severity of the disorder also increase. The characteristics of this group will affect subjective expression and individual cognition, as well as whether they can put forward treatment needs and cooperate to receive treatment. An increase in age showed a higher demand for surgical procedures and extractions. [19] Access of patients with special needs to dental care may be limited by the ability of their caregivers to evaluate their oral condition and by the person's inability to express their pain or discomfort. (20) The complexity of oral hygiene behavior for this population indicates the need for bespoke individual care plans and complexity in interventions to improve population oral hygiene.
It is important to note that the specific services offered can vary based on the resources, expertise, and capability of the Stomatology department in the Medical Center. Additionally, the dental management plan is individualized for each patient, taking into consideration their unique needs, abilities, and medical history.
Therefore, the care team, which includes caregivers, doctors, school, or institutional personnel, etc., must be more sensitive to this group of people and observe during daily activities or medical visits to detect whether these disabled people need oral treatment and deal with it as early as possible. Early detection and intervention can significantly contribute to better oral health outcomes for this population. It is also important for healthcare workers to be able to identify the verbal and non-verbal cues of emotional distress of these patients promptly. 2019 Nathan J. Wilson proposes outreach and exclusive oral health services as successful strategies for increasing access to oral care services for individuals with intellectual and developmental disabilities. [20] The best way to avoid seeking medical treatment only in the acute stage is to establish regular scheduled oral examinations. Once a problem is discovered, seek treatment as soon as possible to avoid falling into the dilemma of having to extract teeth.
Maintaining good oral hygiene can help prevent oral health issues like dental decay, gum disease, and infections. Moreover, poor oral health can have systemic effects and may exacerbate existing health conditions.
On the medical side, education is also needed to learn diagnostic and treatment skills for SNP; and health insurance benefits should be increased to encourage more clinicians to devote more time and energy to oral care for SNP. Since oral health can improve the quality of life of an individual, the oral health of special groups can not only improve their health and quality of life but also improve the quality of life of caregivers and even the whole family.