Challenges Impacting Delaware Dental Professionals’ Capacity to Care for Patients with Disabilities

Abstract

According to Delaware Health and Social Services, nearly one in six Delaware residents has a disability. Many individuals with special needs face significant challenges in finding dental providers who can meet their distinct care requirements. This small study explored the factors influencing dental professionals’ perceptions of their capacity to treat patients with disabilities. Convenience sampling provided interviews with dentists and dental hygienists in Delaware, which were conducted virtually and recorded. Each interview was transcribed and the collection of interviews was analyzed using qualitative thematic analysis techniques. Findings revealed that interview subjects experience low confidence and limited exposure to treating this population, stemming from inadequate education and training. Additional barriers include limited accessibility, time constraints, insufficient accommodations, and inadequate insurance coverage. The wide spectrum of disabilities further complicates the issue by limiting the preparedness of providers. Many dentists interviewed indicated that a general practice residency is crucial for receiving first hand experience required to treat patients with special needs. Both interview data and public secondary sources indicate a pressing need for improvement in special needs dental care. Overall, expanding education, mentorship, and hands-on clinical experience is essential to enhance provider competence and patient access. These can be achieved by integrating more hands-on training in dental school, requiring continuing education, improving Medicaid reimbursement, and creating special needs clinic days in dental school.

Introduction

In Delaware, people with disabilities often face barriers in accessing dental care, contributing to poorer oral health compared to the general population. Tooth decay, periodontal disease, and damaging oral habits are more prevalent in this population due to a range of factors, including difficulty practicing oral hygiene and limited access to professional dental care. Although Delaware offers community resources, such as Family SHADE and the Division of Developmental Disabilities Services,¹ these resources are often difficult to navigate, and locating a qualified dentist with experience in treating people with special needs remains a major challenge.

The 2017-2018 National Core Indicators (NCI) report shows the national disparity in oral health care for people with disabilities, with Delaware’s data closely reflecting national trends. In Delaware, 28% of people with a disability report not having been to a dentist in the past year, which is larger than but close to the national average of 22%.² This data was obtained by subtracting the data from table 1 (which shows the percentages of people with disabilities who have had a routine dental exam in the past year) by 100% to get the percentage of people who have not had a dental exam in the past year.

Table 1. In-Person Survey: Have You Had an Exam in the Past Year?².

State	Average	N
Delaware	72%	241
NCI-IDD Average	78%	14,489

Studies consistently report that underinsurance, inadequate accommodations, dental anxiety, and difficulty finding willing providers are key barriers to care.³ Local specialized clinics, like Progress With Practice (PWP) in Pike Creek, face additional challenges such as low reimbursement rates, difficulty managing patient volume due to complexity of care, limited resources (such as outdated equipment and insufficient operating room time), as well as an insufficiency of dental care providers who can work with people with special needs.⁴

While the Commission on Dental Accreditation (CODA) requires that dental graduates be competent in assessing and managing patients with special needs, research shows that dental education across North America often provides minimal hands-on experience with this population.⁵ Many dental students report graduating without feeling prepared to treat people with disabilities, and dental schools often lack the resources to improve this training. Delaware, lacking an in-state dental school, relies on external programs (e.g., Temple University) for training its future dentists.

Dental education regarding treating patients with special needs has very little research on it. “Future research is needed to delve further into the … perception that dental providers are unwilling to serve disabled people, neither of which has been explored in-depth quantitatively or qualitatively.”³ This research project, which was conducted with funding by the University of Delaware’s Industry Scholars Program in summer 2025, examined how well dentists in Delaware are educated and trained to care for individuals with special needs, and how this affects access to care. Using a convenience sampling method, practicing dentists and support specialists in Delaware were contacted and recruited for interviews, combined with an analysis of existing data and literature on the topic. Ultimately, this research assessed the severity of dental care inequities for people with disabilities in Delaware. The research is a first step in illuminating opportunities to improve dental education, enhance support systems, and help close the gap in oral health care access for this underserved population.

Data Source and Methods

The interviews were conducted by the primary investigator (Shah) with dentists and dental hygienists in the State of Delaware. Participants were identified through professional networks, referrals, and direct outreach to dental practices. Most of the participants were found as a product of snowball sampling, a form of convenience sampling, resulting in a sample size of seven. The interviews were conducted virtually via Zoom or phone call, and each interview took about 15-20 minutes and were audio-recorded (with consent) for transcription and analysis.

Data Analysis

Qualitative thematic analysis was used to identify recurring themes and patterns related to dental training, accessibility, and perceptions of care for individuals with disabilities. Additionally, supplementary sources included public data, like from the Delaware Health and Social Services or National Core Indicators, and was used to contextualize and support the interview findings.

Results

A total of 7 dental professionals were interviewed, including dentists and dental hygienists. The participants varied in age and experience ranging from newly graduates to professionals who have been in the field for more than 30 years. Demographic data were limited, however, the participant pool represented a range of training levels and practice settings. Findings revealed that many professionals experience low confidence and limited exposure to treating this population, stemming from inadequate education and training (see Figure 1). Additional barriers include limited accessibility, time constraints, insufficient accommodations, and inadequate insurance coverage. The wide spectrum of disabilities further complicates the issue by limiting the preparedness of providers. Many dentists indicated that a general practice residency is crucial for receiving first-hand experience required to treat patients with special needs. Both interview data and public secondary sources indicate a pressing need for improvement in special needs dental care.

Figure 1. Themes and Concepts from Interviews.

Discussion

Overall, expanding education, mentorship, and hands-on clinical experience were key themes to enhance provider competence and patient access. The majority of dentists who were interviewed emphasized the need for increased hands-on training during dental school, with many noting that clinical exposure to patients with special needs was limited. Several participants also highlighted the importance of required continuing education to maintain competency in treating this population. In addition, a strong consensus, with more than half of the participants, was observed regarding the need for improved Medicaid reimbursement as many dentists identified this as a major barrier to care. One dentist had the idea of creating special needs clinic days in dental school as a way of incorporating this training early into a dentist’s career.

Limitations

The interviewees were identified through a snowball sampling process, where participants would refer new subjects for interviews. Due to this sampling technique, all of the participants interviewed had experience with working with patients with special needs, but the results are not generalizable to all dental professionals in the state of Delaware who work with patients with special needs. Dental professionals who have such experience have different perspectives on this topic than dental professionals who do not, potentially skewing the results. Additionally, many dentists that were asked for an interview who did not work with patients with special needs declined. This could be because they felt they did not have enough experience to answer the research questions effectively.

Another limitation is the limited sample size. This project was done on a short timeline (summer 2025, through the Office of Undergraduate Research at the University of Delaware) so finding a large number of participants was difficult. The small sample size could have skewed the results by offering only a small glimpse into the dentists in Delaware, and since the dentists were all in around the same area, this could mean there is limited representation in the sample. Future research on this topic should broaden the sampling pool and attempt to reach a wider array of dental professionals throughout the state.