Dental Treatments in Patients with Special Needs Provided by University Medical Center in South of Taiwan—A Retrospective Study

Dental Treatments in Patients with Special Needs Provided by University Medical Center in South of Taiwan—A Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Dental Treatments in Patients with Special Needs Provided by University Medical Center in South of Taiwan—A Retrospective Study Yu-Fen Yen, Hsiu-Ming Hsu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4115580/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Objectives : IN the medical center's special needs dental care department, we performed dental prevention and invasion interventions at OPD, under GA, and provided home visit dental care, depending on patients’ barriers. We aim to evaluate the profile of dental treatment procedures performed and the characteristics of special needs patients (SNP). Materials and Methods: This is a retrospective, observational study involving a sample of 3117 SNP treated in the medical center of South Taiwan. Demographic data and clinical information were collected. Data analysis was performed using descriptive analysis, frequency statistical tests, and correlation statistics analysis. Results: 3117 participants aged 1 to 100 years old; 89.3% of the SNP received care at the outpatient department and 7.7% received dental treatment under OPD GA, for the remaining 3% of SNP, we provided dental care via home visit. Among those SNP who received OPD GA, 91.2% were patients with mental or intellectual disabilities. A vast majority of all subjects under OPD GA underwent multiple dental extractions (56.5%) and restorations (69.5%). Conclusions: Comprehensive dental care, an integral part of special care dentistry, can be safely provided in a hospital setting. While early intervention using behavioral management partially mitigates the need for dental care under GA, most SNP may require dental treatment in the future to facilitate complex dental care. In addition, home visit dental treatment also provides a dental treatment option for some patients who are unable to go to the hospital due to their disability. Clinical Relevance: The oral care needs and supply of people with special needs have not been balanced. The dental provider and the demander are at two ends of the scale, and the role of the caregiver in the middle is crucial. This researcher, a dentist at a medical center was deeply aware of inequality, so we hope to get a glimpse of it by reviewing past cases. special needs patient home visit dental treatment Background The number of persons with disabilities almost 1.2 million in Taiwan. There were 201,644 people with disabilities in Yunlin, Chiayi, Tainan area and 98,829 in Tainan (49.0%). People with special needs account for about 5.1% of the total population, which means that one in 20 people has special needs. With the advent of an aging society, obstacles due to diseases also increase. The proportion of the population with special needs are also increased. The correlation between oral health and systemic health has been proven. [ 1 – 3 ] In addition, people with special needs may be more difficult to achieve good oral hygiene due to their comorbidities or other obstacles. The relationship between cognitive impairment and oral health status has been proven. [ 4 ] They can not only perform excellent oral hygiene in their daily life but also achieve good professional dental treatment or dental care. That is the individual barrier of SNP to achieve good oral health. In addition to the barriers of the patients themselves, there are social barriers, government barriers and the dental professional barrier. [ 5 ] One study found that 40 percent of caretakers experienced difficulty in locating a dentist willing to treat special needs patients, despite the fact that 75 percent of these individuals were cooperative enough to undergo dental treatment in a traditional dental setting.[ 6 ] [ 7 ]In clinical, special needs dentistry is mainly to provide oral treatment and dental care for people with special needs, but its essence is to break the barrier to the oral health of SNP. It is hoped that this large-scale data analysis and research can analyze the dental treatment profiles of SNP at the University Medical Center in Taiwan, figure out the barriers, and strive to increase the health and well-being of SNP. Materials & Methods This is a retrospective study, collecting special needs patients’ medical and dental data from HIS (Hospital Information System) of Cheng Kung University Hospital since 2019 to 2022. Studies were approved by the institutional review board (NCKUH-A-ER-111-369). We collect patients’ basic demographic information, dental treatment modes, and items from HIS and perform correlation statistics by SPSS to clarify the correlations between the patients’ unique variation and the dental treatments they received. The entire samples were divided into several groups: group 1, receiving dental treatment at OPD, the other receiving treatment under general anesthesia, and the third group, receiving domiciliary dental care. Based on the disability official certificate, the type of impairment is classified into whether there is a mental disorder or not, such as intellectual disability, autism, dementia, chronic mental illness, etc. The degree of impairment is divided into two categories: mild to moderate (mild, moderate) and severe to extremely severe (severe, extremely severe). Results 3117 SNP were included in our study to evaluate the correlations between their general data, age, gender, disability category, severity level, and the dental treatment they received in the medical center. The demography data was shown in Table 1 . According to the data analysis, the male-to-female ratio is 1.5:1, and the average age is 47.8. We classified the disability categories of the cases according to whether they had intellectual disabilities, or mental illnesses or not, and the numbers were 1340 (49.5%) and 1365 (50.5%) respectively. The degree of disability is classified as mild-moderate or severe-extremely severe, the numbers are 1892(67.9%) and 893 (32.1%). This data suggests that most cases are the "Mild-Moderate" classification, approximately two-thirds of the total cases, while the "Severe-Extremely Severe" classification makes up a third of cases. Among patients who received outpatient general anesthesia treatment, the male-to-female ratio was also 1.7, the average age was 23.2, and 91.2% had an intellectual or mental disability or chronic mental illness. The disability levels were 57.7% from mild to moderate, and 42.3% from severe to extremely severe. In the domiciliary dental care patient, the male-to-female ratio is 2.2, mean age is 61.4. The disability category with behavior or mental illness is 54.8% and with sensory or physical impairment is 37.6%. Most of them have severe to extremely severe disability levels of 78.5%. Table 1 Demography of special need patients had received dental care in the university medical center in Taiwan. OPD OPD GA Domiciliary dental care Case no 2785 239 93 Male/Female (M/F) 1661/1124 (1.5) 149/90 (1.7) 64/29 (2.2) Mean age (range) 47.8 (1-100) 23.2 (3–85) 61.4 (13–93) Disability category Behavioral or emotional, developmental disorder 1340 (49.5%) 218 (91.2%) 51(54.8%) Sensory impaired, or physical disorders 1365 (50.5%) 21 (8.8%) 35 (37.6%) Disability level Mild-moderate 1892 (67.9%) 138 (57.7%) 13 (14%) Severe-extremely severe 893 (32.1%) 101 (42.3%) 73 (78.5%) Others 80 (Rare disease & genetic disorder) - 7 (7.5%) (Disabled ageing) Table 2 The number and percentage of patient receive dental treatment. Treatment at OPD No (%) Under GA No (%) F- application 745 (26.8%) 128 (53.6) Ultrasonic scaling 1067 (38.3%) 119 (49.8) OD 774 (27.8%) 166 (69.5) ENDO 387(13.9%) 133 (55.6) Extraction 918(33%) 135 (56.5) Table 3 Correlations between the disability category and OPD dental treatment of SNP. F- Scaling OD ENDO EXT Total (n = 2785) 745 1067 774 387 918 With ID (n = 1340) 594 589 284 248 421 Without ID (n = 1365) 111 442 490 130 475 p value 0.000 0.000 0.000 0.000 0.062 Table 4 Correlations between the disability severity level and OPD dental treatment of SNP. (Chi-square test) Mild Moderate Severe Extremely severe p value no 2785 1008 884 562 331 Age (> 47) 1215/1570 568 520 294 188 Gender M/F 1661/1124 (1.5) 622/386 (1.6) 531/353 (1.5) 315/247 (1.3) 193/183 (1.1) F- (+) 745 204 227 209 105 0.000 Scaling (+) 1067 304 346 268 149 0.000 OD (+) 774 263 253 160 98 0.489 Endo (+) 387 139 140 67 41 0.154 Ext (+) 918 312 309 175 122 0.088 Table 5 Correlations between the disabled severity and OPD dental treatment of SNP with mental or cognitive disorder. (Chi-square test) Behavioral or emotional, developmental disorder Mild Moderate Severe Extremely severe p value no 1340 466 (34.8%) 425 (31.7%) 288 (21.5%) 161 (12%) Age (> 47) 464/876 125 165 118 56 Gender Male/Female (M/F) 765/575 (1.3) 285/181(1.6) 231/186(1.2) 151/137(1.1) 90/71(1.3) F- (+) 594 176 (29.6%) 187 (31.5%) 143 (24.1%) 88 (14.8%) 0.000 Scaling (+) 589 146 (24.8%) 186 (31.6%) 165 (28%) 92 (15.6%) 0.000 OD (+) 490 177 (36.1%) 153 (31.2%) 96 (19.6%) 64 (13.1%) 0.615 Endo (+) 248 97 (39.1%) 89 (35.9%) 39 (15.7%) 23 (9.3%) 0.002 Ext (+) 421 140 (33.3%) 142 (33.7%) 93 (22.1%) 46 (10.9%) 0.797 The items of dental treatment that patients received in outpatient and under general anesthesia are shown in Table 2 . Among the treatment items, ultrasonic scaling, cavity filling, and fluoride application are the major in the outpatient department, while in the outpatient general anesthesia treatment, the proportions of cavity fillings, tooth extraction, and root canal treatment are higher. The statement suggests that in the outpatient department, the most common treatments for SNPs are scaling, cavity filling, and fluoride application, which are typically non-invasive and preventive. In contrast, outpatient general anesthesia treatments involve more invasive procedures like caries management and restorations, root canal treatments, and tooth extraction. Ultrasonic scaling was the most frequently performed treatment in patients. Tooth extractions were the next most common treatment. The correlation statistics between treatment items received in OPD and demographic data show that the category with mental or cognitive disorder is positively correlated with fluoride application, scaling, OD treatment, root canal treatment, and extraction. (Table 3 ) Table 3 represents the correlation between the SNP with ID or without ID and treatment. The result is that those with ID provided more preventive dental care than those without ID, including teeth scaling, fluoride application, OD, and root canal treatment, but there is no correlation with tooth extraction. Table 4 shows the association of the disability level of SNP with treatment receipt across all studies. The results showed that there was a correlation between the disability level and tooth scaling and fluoride application, but there was no correlation between the others. The degrees of severity are positively correlated to fluoride application and scaling. (Table 4 ) That revealed the more severe the patient’s disability, the higher the rate of fluoride application and scaling. Table 5 shows the correlation between the dental treatment items received by the SNP with ID in this study and the severity of their disabilities. The results show that the treatment items in this group are related to the disorder level: tooth scaling, fluoride application, and ENDO. However, OD and tooth extraction does not correlate. (Table 5 ) Discussion 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. Conclusion Based on this study’s results, the following conclusions can be made: 1. Most people with disabilities who visit medical centers are intellectually or emotionally disabled. People with mental disorders or psychological illnesses who displayed uncooperative behavior were significantly less likely to receive regular dental care to prevent further oral disease. 2. The majority of people with disabilities who require dental treatment under general anesthesia also have mental disabilities. Moreover, tooth extraction is still the main treatment option. However, the current capacity to perform this part of the treatment cannot meet the demand. Despite the good national health insurance in Taiwan, unmet oral health needs remain prevalent among SNP. 3. Oral health is closely related to general health. For special groups who are bedridden or have multiple disabilities, whether the oral care for this group can be satisfied, based on current knowledge, is like the tip of the iceberg. Declarations Declaration of Interest statement The authors declare that they have no competing interests. Acknowledgements We acknowledge the support from the Clinical Research Center at National Cheng Kung University Hospital. Author Contribution Yu-Fen Yen who wrote the manuscript. Hsiu-Ming Hsu who gave the proposal framework. All authors read and approved the final manuscript. Ethics approval and informed consent: Ethics approval was granted by the Ethics Committee of National Cheng Kung University Hospital (A - E R - 1 1 1 - 3 6 9). Informed consent in this research is not applicable. Funding The present research was supported by grants from National Cheng Kung University Hospital only. Conflict of Interests The authors state that there are no other conflicts of interest to disclose. Acknowledgements The present research was supported by grants from National Cheng Kung University Hospital. References Brickhouse TH et al (2009) Barriers to dental care for children in Virginia with autism spectrum disorders. J Dent Child (Chic) 76(3):188–193 Mouradian WE, Wehr E, Crall JJ (2000) Disparities in children's oral health and access to dental care. JAMA 284(20):2625–2631 Newacheck PW et al (2000) The unmet health needs of America's children. Pediatrics 105(4 Pt 2):989–997 Kumar S et al (2021) Oral Health Status and Treatment Need in Geriatric Patients with Different Degrees of Cognitive Impairment and Dementia: A Cross-Sectional Study. J Family Med Prim Care 10(6):2171–2176 Alfaraj A et al (2021) Barriers to Dental Care in Individuals with Special Healthcare Needs in Qatif, Saudi Arabia: A Caregiver's Perspective. Patient Prefer Adherence 15:69–76 Hagglund KJ et al (1999) Access to health care services among people with disabilities receiving Medicaid. Mo Med 96(9):447–453 Ravikumar D, Sujatha S (2016) Break the barrier: Bringing children with special health care needs into mainstream dentistry. Int J Pedodontic Rehabilitation 1(1):42 吳淑雯 全民健康保險精神疾病病患牙醫門診醫療利用分析 Exploring the Dental Care Utilization of Psychiatric Patients in Taiwan Gugnani N, Gugnani S (2023) Does intellectual disability in children impact access to preventive dental services and oral health? Evid Based Dent 24(1):23–25 Savanheimo N et al (2012) Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service. BMC Oral Health 12:45 Mallineni SK, Yiu CKY (2018) A Retrospective Audit of Dental Treatment Provided to Special Needs Patients under General Anesthesia During a Ten-Year Period. J Clin Pediatr Dent 42(2):155–160 Schnabl D et al (2019) Dental treatment under general anesthesia in adults with special needs at the University Hospital of Dental Prosthetics and Restorative Dentistry of Innsbruck, Austria: a retrospective study of 12 years. Clin Oral Investig 23(11):4157–4162 Sitilci T et al (2017) Comparison of patients with and without intellectual disability under general anesthesia: A retrospective study. Niger J Clin Pract 20(4):438–444 Goodwin M et al (2015) Issues arising following a referral and subsequent wait for extraction under general anaesthetic: impact on children. BMC Oral Health 15:3 Jockusch J et al (2021) Outpatient, dental care of adult vulnerable patients under general anaesthesia-a retrospective evaluation of need for treatment and dental follow-up care. Clin Oral Investig 25(4):2407–2417 Dziedzic A et al (2020) Are Special Care Dentistry Services Prepared for a Global Disruption in Healthcare? A Call for a Wider Promotion of Dental Conscious Sedation Training. Healthc (Basel), 8(4) Ciftci V, Yazicioglu I (2020) Comparison of Dental Treatment under General Anesthesia Provided for Uncooperative Healthy Patients and Patients with Special Health Care Needs. J Clin Pediatr Dent 44(3):196–201 Ningrum V et al (2020) A special needs dentistry study of institutionalized individuals with intellectual disability in West Sumatra Indonesia. Sci Rep 10(1):153 Cortezo V et al (2023) Dental treatment under general anesthesia in patients with severe intellectual disability at the Gregorio Marañón General University Hospital: a 10-year retrospective study. Quintessence Int 54(1):78–86 Wilson NJ et al (2019) Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review. BMC Public Health 19(1):1530 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 17 Apr, 2024 Reviews received at journal 10 Apr, 2024 Reviewers agreed at journal 30 Mar, 2024 Reviewers agreed at journal 28 Mar, 2024 Reviewers invited by journal 28 Mar, 2024 Submission checks completed at journal 27 Mar, 2024 Editor assigned by journal 27 Mar, 2024 First submitted to journal 17 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4115580","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":291791570,"identity":"79fe6d36-dbda-4d60-aaa3-2ec5daebbeb8","order_by":0,"name":"Yu-Fen Yen","email":"data:image/png;base64,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","orcid":"","institution":"National Cheng Kung University Hospital, National Cheng Kung University","correspondingAuthor":true,"prefix":"","firstName":"Yu-Fen","middleName":"","lastName":"Yen","suffix":""},{"id":291791571,"identity":"e152f276-c60c-4d22-965d-63aec21a41a7","order_by":1,"name":"Hsiu-Ming Hsu","email":"","orcid":"","institution":"National Cheng Kung University Hospital, National Cheng Kung University","correspondingAuthor":false,"prefix":"","firstName":"Hsiu-Ming","middleName":"","lastName":"Hsu","suffix":""}],"badges":[],"createdAt":"2024-03-17 05:59:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4115580/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4115580/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54831579,"identity":"beb24921-ede0-4b8a-8024-881db477b41a","added_by":"auto","created_at":"2024-04-17 11:18:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":276930,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4115580/v1/c25c90c8-50a0-41fe-923b-7048e7ea99e5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Dental Treatments in Patients with Special Needs Provided by University Medical Center in South of Taiwan—A Retrospective Study","fulltext":[{"header":"Background","content":"\u003cp\u003eThe number of persons with disabilities almost 1.2\u0026nbsp;million in Taiwan. There were 201,644 people with disabilities in Yunlin, Chiayi, Tainan area and 98,829 in Tainan (49.0%). People with special needs account for about 5.1% of the total population, which means that one in 20 people has special needs. With the advent of an aging society, obstacles due to diseases also increase. The proportion of the population with special needs are also increased. The correlation between oral health and systemic health has been proven. [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] In addition, people with special needs may be more difficult to achieve good oral hygiene due to their comorbidities or other obstacles. The relationship between cognitive impairment and oral health status has been proven. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] They can not only perform excellent oral hygiene in their daily life but also achieve good professional dental treatment or dental care. That is the individual barrier of SNP to achieve good oral health. In addition to the barriers of the patients themselves, there are social barriers, government barriers and the dental professional barrier. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] One study found that 40 percent of caretakers experienced difficulty in locating a dentist willing to treat special needs patients, despite the fact that 75 percent of these individuals were cooperative enough to undergo dental treatment in a traditional dental setting.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]In clinical, special needs dentistry is mainly to provide oral treatment and dental care for people with special needs, but its essence is to break the barrier to the oral health of SNP.\u003c/p\u003e \u003cp\u003eIt is hoped that this large-scale data analysis and research can analyze the dental treatment profiles of SNP at the University Medical Center in Taiwan, figure out the barriers, and strive to increase the health and well-being of SNP.\u003c/p\u003e"},{"header":"Materials \u0026 Methods","content":"\u003cp\u003eThis is a retrospective study, collecting special needs patients\u0026rsquo; medical and dental data from HIS \u003cem\u003e(Hospital Information System)\u003c/em\u003e of Cheng Kung University Hospital since 2019 to 2022. Studies were approved by the institutional review board (NCKUH-A-ER-111-369).\u003c/p\u003e \u003cp\u003eWe collect patients\u0026rsquo; basic demographic information, dental treatment modes, and items from HIS and perform correlation statistics by SPSS to clarify the correlations between the patients\u0026rsquo; unique variation and the dental treatments they received.\u003c/p\u003e \u003cp\u003eThe entire samples were divided into several groups: group 1, receiving dental treatment at OPD, the other receiving treatment under general anesthesia, and the third group, receiving domiciliary dental care.\u003c/p\u003e \u003cp\u003eBased on the disability official certificate, the type of impairment is classified into whether there is a mental disorder or not, such as intellectual disability, autism, dementia, chronic mental illness, etc. The degree of impairment is divided into two categories: mild to moderate (mild, moderate) and severe to extremely severe (severe, extremely severe).\u003c/p\u003e "},{"header":"Results","content":"\u003cp\u003e3117 SNP were included in our study to evaluate the correlations between their general data, age, gender, disability category, severity level, and the dental treatment they received in the medical center.\u003c/p\u003e \u003cp\u003eThe demography data was shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAccording to the data analysis, the male-to-female ratio is 1.5:1, and the average age is 47.8. We classified the disability categories of the cases according to whether they had intellectual disabilities, or mental illnesses or not, and the numbers were 1340 (49.5%) and 1365 (50.5%) respectively. The degree of disability is classified as mild-moderate or severe-extremely severe, the numbers are 1892(67.9%) and 893 (32.1%). This data suggests that most cases are the \"Mild-Moderate\" classification, approximately two-thirds of the total cases, while the \"Severe-Extremely Severe\" classification makes up a third of cases. Among patients who received outpatient general anesthesia treatment, the male-to-female ratio was also 1.7, the average age was 23.2, and 91.2% had an intellectual or mental disability or chronic mental illness. The disability levels were 57.7% from mild to moderate, and 42.3% from severe to extremely severe. In the domiciliary dental care patient, the male-to-female ratio is 2.2, mean age is 61.4. The disability category with behavior or mental illness is 54.8% and with sensory or physical impairment is 37.6%. Most of them have severe to extremely severe disability levels of 78.5%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemography of special need patients had received dental care in the university medical center in Taiwan.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOPD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOPD GA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDomiciliary dental care\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCase no\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2785\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMale/Female (M/F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1661/1124 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149/90 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64/29 (2.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMean age (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.8 (1-100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.2 (3\u0026ndash;85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61.4 (13\u0026ndash;93)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDisability category\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBehavioral or emotional, developmental disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1340 (49.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e218 (91.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51(54.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSensory impaired, or physical disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1365 (50.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (37.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDisability level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMild-moderate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1892 (67.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e138 (57.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (14%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere-extremely severe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e893 (32.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e101 (42.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73 (78.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003cp\u003e(Rare disease \u0026amp; genetic disorder)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (7.5%)\u003c/p\u003e \u003cp\u003e(Disabled ageing)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe number and percentage of patient receive dental treatment.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eat OPD No (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnder GA No (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF- application\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e745 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128 (53.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUltrasonic scaling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1067 (38.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (49.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e774 (27.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e166 (69.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eENDO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e387(13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133 (55.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExtraction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e918(33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (56.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelations between the disability category and OPD dental treatment of SNP.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF-\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eScaling\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eENDO\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEXT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;2785)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e918\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWith ID (n\u0026thinsp;=\u0026thinsp;1340)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e589\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e421\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithout ID (n\u0026thinsp;=\u0026thinsp;1365)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e475\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelations between the disability severity level and OPD dental treatment of SNP. (Chi-square test)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eExtremely severe\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2785\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1008\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e884\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e562\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e331\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (\u0026gt;\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1215/1570\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e568\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e520\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e294\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eM/F\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1661/1124\u003c/p\u003e \u003cp\u003e(1.5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e622/386\u003c/p\u003e \u003cp\u003e(1.6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e531/353\u003c/p\u003e \u003cp\u003e(1.5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e315/247\u003c/p\u003e \u003cp\u003e(1.3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e193/183\u003c/p\u003e \u003cp\u003e(1.1)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF- (+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e745\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScaling (+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOD (+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndo (+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExt (+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e918\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelations between the disabled severity and OPD dental treatment of SNP with mental or cognitive disorder. (Chi-square test)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBehavioral or emotional, developmental disorder\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eExtremely severe\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1340\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e466 (34.8%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e425 (31.7%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e288 (21.5%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e161 (12%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (\u0026gt;\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e464/876\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender Male/Female (M/F)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e765/575 (1.3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e285/181(1.6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e231/186(1.2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e151/137(1.1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90/71(1.3)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF- (+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176 (29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e187 (31.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e143 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScaling (+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e589\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146 (24.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e186 (31.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e165 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e92 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOD (+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177 (36.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153 (31.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96 (19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.615\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndo (+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (39.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89 (35.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (15.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExt (+)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142 (33.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93 (22.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e46 (10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.797\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe items of dental treatment that patients received in outpatient and under general anesthesia are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Among the treatment items, ultrasonic scaling, cavity filling, and fluoride application are the major in the outpatient department, while in the outpatient general anesthesia treatment, the proportions of cavity fillings, tooth extraction, and root canal treatment are higher. The statement suggests that in the outpatient department, the most common treatments for SNPs are scaling, cavity filling, and fluoride application, which are typically non-invasive and preventive. In contrast, outpatient general anesthesia treatments involve more invasive procedures like caries management and restorations, root canal treatments, and tooth extraction. Ultrasonic scaling was the most frequently performed treatment in patients. Tooth extractions were the next most common treatment. The correlation statistics between treatment items received in OPD and demographic data show that the category with mental or cognitive disorder is positively correlated with fluoride application, scaling, OD treatment, root canal treatment, and extraction. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e represents the correlation between the SNP with ID or without ID and treatment. The result is that those with ID provided more preventive dental care than those without ID, including teeth scaling, fluoride application, OD, and root canal treatment, but there is no correlation with tooth extraction. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the association of the disability level of SNP with treatment receipt across all studies. The results showed that there was a correlation between the disability level and tooth scaling and fluoride application, but there was no correlation between the others. The degrees of severity are positively correlated to fluoride application and scaling. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) That revealed the more severe the patient\u0026rsquo;s disability, the higher the rate of fluoride application and scaling. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the correlation between the dental treatment items received by the SNP with ID in this study and the severity of their disabilities. The results show that the treatment items in this group are related to the disorder level: tooth scaling, fluoride application, and ENDO. However, OD and tooth extraction does not correlate. (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe 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. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eMental or intellectual disability group accounts for 30% of all people with physical and mental disabilities in Taiwan in 2023. (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dep.mohw.gov.tw/dos/np-5224-113.html\u003c/span\u003e\u003cspan address=\"https://dep.mohw.gov.tw/dos/np-5224-113.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) 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. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]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.[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Dental treatment of ID patients under general anesthesia can be performed just as safely as that with NID patients.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] 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. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn a considerable proportion of SNP, a \u0026lsquo;gentle approach\u0026rsquo;, 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 .[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]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.\u003c/p\u003e \u003cp\u003eAbout 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. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] 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. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] 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.\u003c/p\u003e \u003cp\u003eIt 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.\u003c/p\u003e \u003cp\u003eTherefore, 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. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] 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.\u003c/p\u003e \u003cp\u003e 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.\u003c/p\u003e \u003cp\u003eOn 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.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on this study\u0026rsquo;s results, the following conclusions can be made:\u003c/p\u003e\n\u003cp\u003e1. Most people with disabilities who visit medical centers are intellectually or emotionally disabled. People with mental disorders or psychological illnesses who displayed uncooperative behavior were significantly less likely to receive regular dental care to prevent further oral disease.\u003c/p\u003e\n\u003cp\u003e2. The majority of people with disabilities who require dental treatment under general anesthesia also have mental disabilities. Moreover, tooth extraction is still the main treatment option. However, the current capacity to perform this part of the treatment cannot meet the demand.\u003c/p\u003e\n\u003cp\u003eDespite the good national health insurance in Taiwan, unmet oral health needs remain prevalent among SNP.\u003c/p\u003e\n\u003cp\u003e3. Oral health is closely related to general health. For special groups who are bedridden or have multiple disabilities, whether the oral care for this group can be satisfied, based on current knowledge, is like the tip of the iceberg.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eDeclaration of Interest statement\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe acknowledge the support from the Clinical Research Center at National Cheng Kung University Hospital.\u003c/p\u003e\n\u003col start=\"1\"\u003e\n \u003cli\u003eAuthor Contribution\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eYu-Fen Yen who wrote the manuscript.\u0026nbsp;Hsiu-Ming Hsu who gave the proposal framework.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003eEthics approval and informed consent:\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eEthics approval was granted by the Ethics Committee of National Cheng Kung University Hospital (A - E R - 1 1 1 - 3 6 9).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInformed consent in this research is not applicable.\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003eFunding\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe present research was supported by grants from National Cheng Kung University Hospital only.\u003c/p\u003e\n\u003col start=\"4\"\u003e\n \u003cli\u003eConflict of Interests\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe authors state that there are no other conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe present research was supported by grants from National Cheng Kung University Hospital.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBrickhouse TH et al (2009) Barriers to dental care for children in Virginia with autism spectrum disorders. J Dent Child (Chic) 76(3):188\u0026ndash;193\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMouradian WE, Wehr E, Crall JJ (2000) Disparities in children's oral health and access to dental care. JAMA 284(20):2625\u0026ndash;2631\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNewacheck PW et al (2000) The unmet health needs of America's children. Pediatrics 105(4 Pt 2):989\u0026ndash;997\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar S et al (2021) Oral Health Status and Treatment Need in Geriatric Patients with Different Degrees of Cognitive Impairment and Dementia: A Cross-Sectional Study. J Family Med Prim Care 10(6):2171\u0026ndash;2176\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlfaraj A et al (2021) Barriers to Dental Care in Individuals with Special Healthcare Needs in Qatif, Saudi Arabia: A Caregiver's Perspective. Patient Prefer Adherence 15:69\u0026ndash;76\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHagglund KJ et al (1999) Access to health care services among people with disabilities receiving Medicaid. Mo Med 96(9):447\u0026ndash;453\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRavikumar D, Sujatha S (2016) Break the barrier: Bringing children with special health care needs into mainstream dentistry. Int J Pedodontic Rehabilitation 1(1):42\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e吳淑雯 全民健康保險精神疾病病患牙醫門診醫療利用分析 Exploring the Dental Care Utilization of Psychiatric Patients in Taiwan\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGugnani N, Gugnani S (2023) Does intellectual disability in children impact access to preventive dental services and oral health? Evid Based Dent 24(1):23\u0026ndash;25\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSavanheimo N et al (2012) Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service. BMC Oral Health 12:45\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMallineni SK, Yiu CKY (2018) A Retrospective Audit of Dental Treatment Provided to Special Needs Patients under General Anesthesia During a Ten-Year Period. J Clin Pediatr Dent 42(2):155\u0026ndash;160\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchnabl D et al (2019) Dental treatment under general anesthesia in adults with special needs at the University Hospital of Dental Prosthetics and Restorative Dentistry of Innsbruck, Austria: a retrospective study of 12 years. Clin Oral Investig 23(11):4157\u0026ndash;4162\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSitilci T et al (2017) Comparison of patients with and without intellectual disability under general anesthesia: A retrospective study. Niger J Clin Pract 20(4):438\u0026ndash;444\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoodwin M et al (2015) Issues arising following a referral and subsequent wait for extraction under general anaesthetic: impact on children. BMC Oral Health 15:3\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJockusch J et al (2021) Outpatient, dental care of adult vulnerable patients under general anaesthesia-a retrospective evaluation of need for treatment and dental follow-up care. Clin Oral Investig 25(4):2407\u0026ndash;2417\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDziedzic A et al (2020) Are Special Care Dentistry Services Prepared for a Global Disruption in Healthcare? A Call for a Wider Promotion of Dental Conscious Sedation Training. Healthc (Basel), 8(4)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCiftci V, Yazicioglu I (2020) Comparison of Dental Treatment under General Anesthesia Provided for Uncooperative Healthy Patients and Patients with Special Health Care Needs. J Clin Pediatr Dent 44(3):196\u0026ndash;201\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNingrum V et al (2020) A special needs dentistry study of institutionalized individuals with intellectual disability in West Sumatra Indonesia. Sci Rep 10(1):153\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCortezo V et al (2023) Dental treatment under general anesthesia in patients with severe intellectual disability at the Gregorio Mara\u0026ntilde;\u0026oacute;n General University Hospital: a 10-year retrospective study. Quintessence Int 54(1):78\u0026ndash;86\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilson NJ et al (2019) Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review. BMC Public Health 19(1):1530\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"special needs patient, home visit dental treatment","lastPublishedDoi":"10.21203/rs.3.rs-4115580/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4115580/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eObjectives\u003c/em\u003e: IN the medical center's special needs dental care department, we performed dental prevention and invasion interventions at OPD, under GA, and provided home visit dental care, depending on patients’ barriers. We aim to evaluate the profile of dental treatment procedures performed and the characteristics of special needs patients (SNP).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMaterials and Methods: \u003c/em\u003eThis is a retrospective, observational study involving a sample of 3117 SNP treated in the medical center of South Taiwan. Demographic data and clinical information were collected. Data analysis was performed using descriptive analysis, frequency statistical tests, and correlation statistics analysis.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResults: \u003c/em\u003e3117 participants aged 1 to 100 years old; 89.3% of the SNP received care at the outpatient department and 7.7% received dental treatment under OPD GA, for the remaining 3% of SNP, we provided dental care via home visit. Among those SNP who received OPD GA, 91.2% were patients with mental or intellectual disabilities. A vast majority of all subjects under OPD GA underwent multiple dental extractions (56.5%) and restorations (69.5%).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConclusions: \u003c/em\u003eComprehensive dental care, an integral part of special care dentistry, can be safely provided in a hospital setting. While early intervention using behavioral management partially mitigates the need for dental care under GA, most SNP may require dental treatment in the future to facilitate complex dental care. In addition, home visit dental treatment also provides a dental treatment option for some patients who are unable to go to the hospital due to their disability.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eClinical Relevance: \u003c/em\u003eThe oral care needs and supply of people with special needs have not been balanced. The dental provider and the demander are at two ends of the scale, and the role of the caregiver in the middle is crucial. This researcher, a dentist at a medical center was deeply aware of inequality, so we hope to get a glimpse of it by reviewing past cases.\u003c/p\u003e","manuscriptTitle":"Dental Treatments in Patients with Special Needs Provided by University Medical Center in South of Taiwan—A Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-17 11:10:49","doi":"10.21203/rs.3.rs-4115580/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2024-04-17T07:55:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-11T00:24:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21a598ca-d892-4efc-837c-1b79291c9e14","date":"2024-03-30T10:08:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"f1b38cd9-7ab5-4e40-b854-62b09f8a8401_SNPRID","date":"2024-03-28T09:19:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-28T09:18:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-27T20:44:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-27T20:44:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2024-03-17T05:47:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"5f01c779-34d5-4313-918b-a5ba5ed22598","owner":[],"postedDate":"April 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-06-20T08:52:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-17 11:10:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4115580","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4115580","identity":"rs-4115580","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}