Children with mental retardation/developmental disabilities: do physicians ever consider needed dental care?

In the late 1960s, there were more than a quarter of a million individuals with mental retardation/ developmental disabilities in state institutions. During the next 30 years, the number of residents decreased by more than 75% (Anderson, Lakin, Mangan, & Prouty, 1998). Changing social policies, favorable legislation for people with disabilities, and class-action legal decisions, which delineated the rights of individuals with mental retardation, have led to deinstitutionalization (i.e., mainstreaming, establishment of community-oriented group residences and enhanced personal family residential settings) and closure of many state-run large facilities. Many of the community residential facilities are too small in size to provide services within the residence. As a consequence, the monitoring of health care can be difficult when the delivery of service and health records are disseminated among multiple providers and locations. Thus, although most infants, children, and adolescents with mental retardation live with their natural or foster parents, pediatric and general practitioners may need to interact with a large and varied group of health providers. The success of community-based health programs, therefore, depends on: x The capacity to organize and maintain the services and health records of these ‘‘new’’ community residents and increasing numbers of youngsters with mental retardation/developmental disabilities in existing community families. x The ability of pediatric and general practitioners, who provide consultation and medical ‘‘gatekeeping’’ services for the population with mental retardation/developmental disabilities, to recognize and identify the wider range of needed health services—including preventive and restorative dental care. x The availability of private practitioners who are (a) convenient and accessible to the deinstitutionalized individuals and (b) are trained and willing to provide the needed care.