A Clean Bill of Health for All Our Country's Citizens

By Eunice Kennedy Shriver

Article copyright 1998 Journal of the California Dental Association.
Photographs copyright of the authors.

As the next century approaches, the leaders, lawmakers, health care providers, and citizens of this country are wondering and worrying about the future of health. How do we -- as a compassionate, caring, great nation -- provide access to quality care for all Americans? Not simply the patients who have a lot of money. Not simply those who are the easiest to treat. Everyone.

The face of health care -- and oral health care -- in this country is changing dramatically. Donna Shalala, secretary of Health and Human Services, has said that government alone cannot solve the problems of access to necessary oral health care. She is right. To ensure that everyone has access to dental health services -- every man, woman, and child, rich and poor -- we need to be proactive and creative. We need to make oral health care a priority to our state legislators. We have to work in concert with one another. Only by developing grass-roots coalitions between health care providers, business, government agencies, and volunteers can we -- together -- meet the oral health challenges of the 21st century.

Happily, the Special Olympics Special Smiles program, with its wide range of dedicated partners and supporters, is an excellent example of successful coalition building at work. Oral health problems have long been among the most significant health problems confronting the 7.5 million Americans with mental retardation. This is due to a variety of factors, not the least of which is the severe financial constraints facing many disabled patients' families, 25 percent of whom live below the poverty level.

These extremely distressing facts become all the more distressing when you think about how much oral health affects our total health and our whole life. Imagine trying to run a race with a throbbing toothache. Or applying for a job with poor teeth or missing teeth, bad gums, or bad breath. None of us are at our best when our oral health is failing.

Additionally, it is a sad fact that many dental professionals have shied away from treating patients with special needs. Too often, patients with mental retardation have been perceived as someone else's problem. But "someone else" wasn't offering solutions either.

To respond to this unfair reality, Special Olympics formed a groundbreaking partnership with Boston University School of Dental Medicine, Oral Health America, and the Academy of Dentistry for Persons with Disabilities. Our collective goal was to improve access to dental care for people with mental retardation, and, in doing so, to improve every aspect of their lives. At the same time, we aimed to raise awareness within the dental community and the general public about this vitally important problem.

Today, I am proud to report that as a nationwide oral screening, educational, and referral initiative in its fourth season, Special Olympics Special Smiles is making marvelous progress. By routinely providing dental screenings and educational programs at Special Olympics events, we have shown our athletes that someone cares about their total health and well-being. In places including Atlanta, Baltimore, Chicago, Kansas City, Los Angeles, Miami and New York, thousands of Special Olympics athletes have been the beneficiaries of free quality oral health consultations and referrals.

At the 1995 Special Olympics World Summer Games in New Haven, Conn., more than 3,500 athletes received instruction on proper oral hygiene, nutritional counseling, and dental screenings. At the 1997 World Winter Games, more than 1,000 Special Olympics athletes also received these services.

High school, college, and professional athletes have always worn mouth guards to protect their jaws and teeth during practice and games. For the first time, through Special Olympics Special Smiles, our athletes have this much-needed equipment to protect their grins and lift their spirits while training and competing.

Educational initiatives have also been launched through Special Smiles to increase the knowledge of family members and dental professionals about the specific oral health problems of people with mental retardation. Special Smiles: a Guide to Good Oral Health for Persons With Special Needs was published last year for caregivers of people with mental retardation. Now families understand how they can help with dental hygiene and care. This groundbreaking booklet was not only distributed at Special Olympics events, but throughout the entire dental community in this country.

Our continuing education programs for dental professionals are also achieving success. In 1997, for-credit programs were held in 12 cities to instruct dental professionals on treating patients with mental retardation. Because of the widespread interest generated from these courses, the number of cities participating is expected to rise to 16 or more next year.

Our list of partners and supporters is also rapidly expanding, helping address this issue from all angles. The Centers for Disease Control and Prevention came on board this year to help develop a mechanism to obtain quality standardized data that can be presented to the scientific community on the oral health care needs of people with mental retardation. Some of these data are presented in this issue of your CDA Journal. The American Dietetic Association has also joined forces with Special Olympics Special Smiles to illustrate the impact of diet on the oral health of special needs patients and encourage eating habits that foster total health and nutrition. In addition, the California Dental Association recently passed a resolution in support of Special Olympics Special Smiles.

These strides on behalf of people with mental retardation are very impressive, not only because they provide such a valuable service, but also because they demonstrate the power of pulling together, the power of sharing the energy and resources of numerous partners, sponsors, agencies, and volunteers.

But let us not rest on our successes.

In a recent study of group homes in Florida that investigated access to care for people with mental retardation, 40 percent of caregivers reported difficulty finding dentists willing to take patients with mental retardation.

A landmark 1995 study, funded by a grant from Oral Health America, presented similarly disturbing statistics. The largest ever of its kind, the study queried 774 supervisors of group homes in seven states, responsible for a total of more than 18,000 clients. Seventy-two percent of the caregivers said there were not enough dentists in their communities willing to take on patients with special needs -- but there was certainly no shortage of dentists! Even more disturbing, 47 percent said their clients were refused treatment within the previous 12 months.

The study also found that 80 percent of the clients -- the very same who were denied access to care -- were people who required complete or partial assistance even for brushing!

Clearly, there is still more to do. And everyone can help.

Recently a bipartisan bill was signed into law that may provide increased access to oral health care for children. The Child Health Insurance Act, sponsored jointly by Sens. Orrin Hatch and Ted Kennedy, provides health care to children of families who cannot afford it, but do not qualify for Medicaid. The act is unique in that it gives a great deal of flexibility to individual states on whether oral health care benefits will be among those covered.

Make your voice heard. Contact your local child advocacy groups and state legislators. Let them know you want every child -- no matter what his or her parents' income is -- to have quality oral health care. Spread the word about Special Olympics Special Smiles. Talk to your colleagues, local dental societies, and businesses. Get them involved.

Every time we help one person gain access to the care he or she needs and deserves, we are saying, "you matter" -- to us and to our country. Every time we forge a new partnership, share our ideas, volunteer, or educate ourselves, we are making a difference -- now and for the future of our country. I believe if we truly work together, we can achieve our health care goals for the next century.

That will surely bring a smile to all of our faces.

Author

Eunice Kennedy Shriver is the founder and honorary chairman of Special Olympics International.

To request printed copies of this article, please contact, Eunice Kennedy Shriver, Special Olympics International, 1325 G St., N.W., Suite 500, Washington, D.C. 20005.