Archana Pradhan - Academia.edu (original) (raw)

Papers by Archana Pradhan

Research paper thumbnail of Effectiveness of sensory adaptive dental environments to reduce psychophysiology responses of dental anxiety and support positive behaviours in children and young adults with intellectual and developmental disabilities: a systematic review and meta-analyses

BMC Oral Health

Background People with Intellectual and developmental disabilities (IDDs) experience oral health ... more Background People with Intellectual and developmental disabilities (IDDs) experience oral health inequality due to myriad of risk factors and complex needs. Sensory processing difficulties, maladaptive behaviours and dental anxiety contribute to difficulties in receiving preventive and routine dental treatments. This study aimed to systematically review the evidence on the effectiveness of sensory adaptive dental environments (SADE) for children and young adults (up to the ages 24 years) with IDD to address cooperation and dental anxiety. Methods This review was reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE (Ovid), The Cochrane Library, Embase, Google Scholar, Web of Science and OT Seeker were searched using appropriate terms to identify Randomised Control Trails (RCTs) that matched inclusion criteria. Screening was conducted by two reviewers after de-duplication based on titles and abstracts followed by ful...

Research paper thumbnail of Enabling people with severe mental illness to overcome barriers to access dental treatment: a qualitative study applying COM-B framework analysis

Journal of Mental Health, 2020

Background: The oral health of people with severe mental illness is severely compromised. Rates o... more Background: The oral health of people with severe mental illness is severely compromised. Rates of premature total tooth loss and tooth decay are substantially higher than in the general population. Causation is complex, restricted access to treatment a major contributing factor. Aims: To examine factors enabling people with complex problems related to severe mental illness to attend scheduled dental appointments. Method: Qualitative semi-structured interviews were conducted with 15 service users who attended no-cost treatment at a university clinic, following oral health screening at an inner-city community mental health service. Analysis used a framework approach informed by a theoretical model of behaviour (COM-B). Results: Complex individual motivations, related variously to function, pain and/or self or social appraisal, were also influenced by expectations of treatment. Capabilities included managing "messy" life circumstances; participants overcame various psychological and physical challenges to attend treatment, enabled by opportunities of social and instrumental support. Conclusions: Genuine partnerships between agencies to provide access opportunities, in addition to individual support responsive to personal motivators and adapted to capabilities can enable access to services and improve the lives of people with severe mental illness.

Research paper thumbnail of Exploring dental behaviours of carers of adults with disabilities: oral health literacy and psycho-social factors

Background: People with physical and intellectual disabilities (PID) depend on their carers for d... more Background: People with physical and intellectual disabilities (PID) depend on their carers for daily oral care at home and attending regular preventive dental visits. However, very few carers seem to receive training in oral care for people with PID. Carers’ oral health literacy, and psycho-social factors (carer dental efficacy, carer oral health competency, and carer activation measure) may be associated with the ability of carers to provide good oral care to their care recipients. The oral health care provided could be further associated with the environment, such as the residential setting of the care recipients where the care is provided. Thus, the aims of the study were to describe and compare oral health literacy and psycho-social factors among carers, and assess any associations with preventive dental behaviours. Favourable associations could then be utilised to make recommendations for the development of appropriate education programmes for carers, that match their oral hea...

Research paper thumbnail of Oral Health Conditions and Treatment Needs of Children with Intellectual Disabilities Attending Special Olympics Australia

Journal of dentistry for children, 2021

Purpose: To describe and evaluate the oral health status and dental treatment needs of children w... more Purpose: To describe and evaluate the oral health status and dental treatment needs of children with intellectual disabilities attending Special Olympics in Australia from 2010 to 2018.Methods: This was a retrospective observational study. Children aged 18 years and younger with intellectual disabilities attending Special Olympics with their caregivers were screened between 2010 and 2018. Trained volunteer dentists performed the screening using the standardized Special Olympics Special Smiles protocol. Reported findings included presence or absence of untreated decay, filled teeth, missing teeth, trauma, fluorosis, and gingivitis as well as treatment urgency.Results: A total of 155 children with a mean age of 15 years participated in the dental screening in 2010, 2014, and 2018. Twelve percent reported oral pain, 15 percent needed urgent care, 21 percent had untreated caries, 39 percent had filled teeth, 39 percent had missing teeth, 59 percent had signs of gingival disease, 8.4 per...

Research paper thumbnail of Oral health related quality of life in people with multiple sclerosis

Research paper thumbnail of Motivations to volunteer in the dental profession

Research paper thumbnail of Event-Based but Not Time-Based Prospective Memory Is Related to Oral Health in Late Adulthood

Gerontology

Background: Most evidence now indicates that cognitive function is related to poorer oral health ... more Background: Most evidence now indicates that cognitive function is related to poorer oral health in late adulthood, but that this relationship is not invariant across specific cognitive domains. Prospective memory (PM) is a core memory skill that refers to memory for future intentions and is known to be related to the formation of habits such as tooth flossing. However, the relationship between PM and oral health has been subject to only limited empirical study. Objective: The two studies reported in this paper were designed to test whether PM is related to oral health in older adults of varying vulnerability status. Methods: Study 1 sampled community-dwelling older adults (N = 172) living independently in the community; Study 2 sampled older adults living in a retirement village (N = 32). Participants in both studies were asked to complete a behavioural measure of PM, with their oral health indexed via self-report (Study 1) or an objective oral health exam (Study 2). Results: In bo...

Research paper thumbnail of Global Early Childhood Caries: A Review of Literature

Nepal Medical College Journal

Early Childhood Caries (ECC) is a major public health concern in the world. There is a high preva... more Early Childhood Caries (ECC) is a major public health concern in the world. There is a high prevalence of ECC in developing countries. The review aimed to synthesise the published literature on the global prevalence of ECC and its associated factors. Researches conducted in Asian, European, American and African countries were included. The review included observational cross-sectional, case-control, cohort studies, and clinical trials. The ECC varies across countries and the continents. Several studies showed inequitable distribution of ECC within regions of a country. The result of this review provides global prevalence of ECC and associated risk factors. Despite the variation of prevalence of ECC, it remains a universal burden. Studies have demonstrated that even in developed countries, ECC represents a significant burden in preschool children. The S. mutans and , oral hygiene habits, breastfeeding and bottle feeding along with factors such as parental education are major risk fac...

Research paper thumbnail of Oral health impact on quality of life among adults with disabilities: carer perceptions

Australian Dental Journal, 2013

Research paper thumbnail of The use of lateral oblique radiographs in dental treatment planning for patients with special needs

This case series describes four cases on the use of oblique lateral radiographs as an alternative... more This case series describes four cases on the use of oblique lateral radiographs as an alternative technique where intra-oral radiographs or an orthopantomogram (OPG) are not possible due to the patients’ physical and/or intellectual disabilities. The cases represent patients across different age-groups (25-83 years), medical conditions (autism, dementia, intellectual disability) and varying clinical situations (assessment of third molars, decision to restore or extract teeth). The oblique lateral radiographs provided adequate radiographic information to confirm diagnosis and treatment. Due to the very short time exposure needed, oblique lateral radiographs are good alternatives to OPGs and still have a significant role in the diagnosis, treatment planning and therefore treatment outcomes for patients with special needs.

Research paper thumbnail of Submission to the Productivity Commission: Inquiry into Introducing Competition and Informed User Choice into Human Services

Research paper thumbnail of Conscious sedation, general anaesthesia for patients with special needs

International Dental Journal

Research paper thumbnail of Oral and aural problems in Australian Special Olympics athletes

Special Care in Dentistry

Research paper thumbnail of Targeting Dental Caries and Body Mass Index Among Special Olympics Athletes in Australia

Journal of Policy and Practice in Intellectual Disabilities

Research paper thumbnail of Access to dental services for children with intellectual and developmental disabilities - A scoping review

Research in developmental disabilities, 2018

Children with Intellectual and Developmental Disabilities (IDD) face considerable challenges in p... more Children with Intellectual and Developmental Disabilities (IDD) face considerable challenges in participating in dental services. These challenges include resource constraints and inadequate skills of health service providers to work with this population. The aim was to scope published studies that addressed access to dental services for children with IDD in order to determine the extent to which various barriers have been researched, using an access framework derived from the literature. Access was defined to include the six dimensions of accessibility, availability, affordability, accommodation, acceptability, and appropriateness. Arksey and O'Malley's scoping review framework was used. Relevant databases (e.g., Medline) were searched for all empirical studies conducted from January 2000 to February 2017 that met inclusion criteria. Data were extracted along the six dimensions of the access framework. Sixteen international studies were identified which indicated common key...

Research paper thumbnail of Atraumatic restorative technique: case report on dental management of a patient with Moebius syndrome

Australian Dental Journal

Research paper thumbnail of Factors influencing oral health of adults with physical and intellectual disabilities in various living arrangements

Australian Dental Journal

Research paper thumbnail of Pre- and post-training evaluation of dental efficacy and activation measures in carers of adults with disabilities in South Australia - a pilot study

Health & social care in the community, Nov 21, 2015

The aim of this pilot study was to train carers to provide oral care for adults with disabilities... more The aim of this pilot study was to train carers to provide oral care for adults with disabilities and to evaluate the training programme. Forty-one carers of 103 care recipients from three disability organisations in South Australia were trained in providing oral care for adults with disabilities (April 2013-April 2014). The training included an oral presentation and practical session by a special needs dentist on completing oral health assessments (OHA), developing oral healthcare plans, providing oral hygiene care and assessing the need for dental referral. Continued support was provided via home visits by dental hygienists for the first 2 months and a dentist visit at 3 months. At 6 months, agreement on OHAs between the dentist and trained carers was assessed. Pre- and post-training questionnaires (at 6 months) collected information on dental behaviours of carers and psychosocial factors: carer activation measure-knowledge (CAM-Knowledge), carer activation measure-skills (CAM-Ski...

Research paper thumbnail of Factors influencing caries experience among adults with physical and intellectual disabilities

Community Dentistry and Oral Epidemiology, 2009

There is limited and inconsistent evidence on the influence of residential setting on caries expe... more There is limited and inconsistent evidence on the influence of residential setting on caries experience of adults with physical and intellectual disabilities (PID), described here as care-recipients. To examine caries experience and associated factors among adults with PID. Mailed questionnaire survey (2005-2006) of carers of adults with PID (18-44 years) in South Australia from family homes, community housing, and institutions, and oral examinations of care-recipients recording decayed (D), missing (M) and filled (F) teeth (DMFT). Carers completed questionnaires for 485 care-recipients, 267 of whom were examined (completion rate=55.1%). The prevalence of decay (D>0) was 16.9% and 76.3% had caries experience (DMFT>0). In unadjusted analysis, care-recipients at institutions had a significantly higher mean DMFT than other settings. After adjusting for carer and care-recipient characteristics, there was no difference in any of the DMFT components among residential settings. However, there were statistically significant associations (OR+/-95% CI excluding unity) between decayed teeth and moderate and high intake of sweet drinks and frequency of dental visits. Higher odds of missing teeth were associated with type of disability, general anaesthetic requirement for dental treatment and low and high carer-contact. Higher odds of filled teeth were associated with age, no oral hygiene assistance (OHA) and high carer-contact. Higher odds of caries experience were associated with age and no OHA. Residential setting was not associated with caries experience. Modifiable risk factors were diet, frequency of dental visits, no OHA and carer-contact hours.

Research paper thumbnail of Access to dental care among adults with physical and intellectual disabilities: residence factors

Australian Dental Journal, 2009

There is limited information about access and barriers to dental care among adults with disabilit... more There is limited information about access and barriers to dental care among adults with disabilities. A mailed questionnaire survey of carers of 18-44-year-old South Australians with physical and intellectual disabilities (care recipients; n = 485) in family homes, community housing and institutions. Bivariate associations were tested using chi-square tests. Odds ratios (ORs) and 95 per cent confidence intervals (CI) were estimated for irregular dental visits (IDV). Carers from family homes and community housing were more likely to report problems in obtaining dental care than those at institutions (p < 0.001). Lack of dentists with adequate skills in special needs dentistry (SND) was the most frequently reported problem for carers from family homes and community housing. IDV were less likely (p < 0.01) for care recipients in institutions and community housing than in family homes. After adjusting for care recipients' age, gender and disability, odds of IDV was lower in community housing (OR = 0.2, 95% CI = 0.1, 0.3) and in institutions (OR = 0.1, 95% CI = 0.04, 0.3) relative to family homes. Care recipients in institutions and community housing had better access to dental care than those at family homes. The shortage of dentists in SND and treatment costs needs to be addressed.

Research paper thumbnail of Effectiveness of sensory adaptive dental environments to reduce psychophysiology responses of dental anxiety and support positive behaviours in children and young adults with intellectual and developmental disabilities: a systematic review and meta-analyses

BMC Oral Health

Background People with Intellectual and developmental disabilities (IDDs) experience oral health ... more Background People with Intellectual and developmental disabilities (IDDs) experience oral health inequality due to myriad of risk factors and complex needs. Sensory processing difficulties, maladaptive behaviours and dental anxiety contribute to difficulties in receiving preventive and routine dental treatments. This study aimed to systematically review the evidence on the effectiveness of sensory adaptive dental environments (SADE) for children and young adults (up to the ages 24 years) with IDD to address cooperation and dental anxiety. Methods This review was reported according to The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MEDLINE (Ovid), The Cochrane Library, Embase, Google Scholar, Web of Science and OT Seeker were searched using appropriate terms to identify Randomised Control Trails (RCTs) that matched inclusion criteria. Screening was conducted by two reviewers after de-duplication based on titles and abstracts followed by ful...

Research paper thumbnail of Enabling people with severe mental illness to overcome barriers to access dental treatment: a qualitative study applying COM-B framework analysis

Journal of Mental Health, 2020

Background: The oral health of people with severe mental illness is severely compromised. Rates o... more Background: The oral health of people with severe mental illness is severely compromised. Rates of premature total tooth loss and tooth decay are substantially higher than in the general population. Causation is complex, restricted access to treatment a major contributing factor. Aims: To examine factors enabling people with complex problems related to severe mental illness to attend scheduled dental appointments. Method: Qualitative semi-structured interviews were conducted with 15 service users who attended no-cost treatment at a university clinic, following oral health screening at an inner-city community mental health service. Analysis used a framework approach informed by a theoretical model of behaviour (COM-B). Results: Complex individual motivations, related variously to function, pain and/or self or social appraisal, were also influenced by expectations of treatment. Capabilities included managing "messy" life circumstances; participants overcame various psychological and physical challenges to attend treatment, enabled by opportunities of social and instrumental support. Conclusions: Genuine partnerships between agencies to provide access opportunities, in addition to individual support responsive to personal motivators and adapted to capabilities can enable access to services and improve the lives of people with severe mental illness.

Research paper thumbnail of Exploring dental behaviours of carers of adults with disabilities: oral health literacy and psycho-social factors

Background: People with physical and intellectual disabilities (PID) depend on their carers for d... more Background: People with physical and intellectual disabilities (PID) depend on their carers for daily oral care at home and attending regular preventive dental visits. However, very few carers seem to receive training in oral care for people with PID. Carers’ oral health literacy, and psycho-social factors (carer dental efficacy, carer oral health competency, and carer activation measure) may be associated with the ability of carers to provide good oral care to their care recipients. The oral health care provided could be further associated with the environment, such as the residential setting of the care recipients where the care is provided. Thus, the aims of the study were to describe and compare oral health literacy and psycho-social factors among carers, and assess any associations with preventive dental behaviours. Favourable associations could then be utilised to make recommendations for the development of appropriate education programmes for carers, that match their oral hea...

Research paper thumbnail of Oral Health Conditions and Treatment Needs of Children with Intellectual Disabilities Attending Special Olympics Australia

Journal of dentistry for children, 2021

Purpose: To describe and evaluate the oral health status and dental treatment needs of children w... more Purpose: To describe and evaluate the oral health status and dental treatment needs of children with intellectual disabilities attending Special Olympics in Australia from 2010 to 2018.Methods: This was a retrospective observational study. Children aged 18 years and younger with intellectual disabilities attending Special Olympics with their caregivers were screened between 2010 and 2018. Trained volunteer dentists performed the screening using the standardized Special Olympics Special Smiles protocol. Reported findings included presence or absence of untreated decay, filled teeth, missing teeth, trauma, fluorosis, and gingivitis as well as treatment urgency.Results: A total of 155 children with a mean age of 15 years participated in the dental screening in 2010, 2014, and 2018. Twelve percent reported oral pain, 15 percent needed urgent care, 21 percent had untreated caries, 39 percent had filled teeth, 39 percent had missing teeth, 59 percent had signs of gingival disease, 8.4 per...

Research paper thumbnail of Oral health related quality of life in people with multiple sclerosis

Research paper thumbnail of Motivations to volunteer in the dental profession

Research paper thumbnail of Event-Based but Not Time-Based Prospective Memory Is Related to Oral Health in Late Adulthood

Gerontology

Background: Most evidence now indicates that cognitive function is related to poorer oral health ... more Background: Most evidence now indicates that cognitive function is related to poorer oral health in late adulthood, but that this relationship is not invariant across specific cognitive domains. Prospective memory (PM) is a core memory skill that refers to memory for future intentions and is known to be related to the formation of habits such as tooth flossing. However, the relationship between PM and oral health has been subject to only limited empirical study. Objective: The two studies reported in this paper were designed to test whether PM is related to oral health in older adults of varying vulnerability status. Methods: Study 1 sampled community-dwelling older adults (N = 172) living independently in the community; Study 2 sampled older adults living in a retirement village (N = 32). Participants in both studies were asked to complete a behavioural measure of PM, with their oral health indexed via self-report (Study 1) or an objective oral health exam (Study 2). Results: In bo...

Research paper thumbnail of Global Early Childhood Caries: A Review of Literature

Nepal Medical College Journal

Early Childhood Caries (ECC) is a major public health concern in the world. There is a high preva... more Early Childhood Caries (ECC) is a major public health concern in the world. There is a high prevalence of ECC in developing countries. The review aimed to synthesise the published literature on the global prevalence of ECC and its associated factors. Researches conducted in Asian, European, American and African countries were included. The review included observational cross-sectional, case-control, cohort studies, and clinical trials. The ECC varies across countries and the continents. Several studies showed inequitable distribution of ECC within regions of a country. The result of this review provides global prevalence of ECC and associated risk factors. Despite the variation of prevalence of ECC, it remains a universal burden. Studies have demonstrated that even in developed countries, ECC represents a significant burden in preschool children. The S. mutans and , oral hygiene habits, breastfeeding and bottle feeding along with factors such as parental education are major risk fac...

Research paper thumbnail of Oral health impact on quality of life among adults with disabilities: carer perceptions

Australian Dental Journal, 2013

Research paper thumbnail of The use of lateral oblique radiographs in dental treatment planning for patients with special needs

This case series describes four cases on the use of oblique lateral radiographs as an alternative... more This case series describes four cases on the use of oblique lateral radiographs as an alternative technique where intra-oral radiographs or an orthopantomogram (OPG) are not possible due to the patients’ physical and/or intellectual disabilities. The cases represent patients across different age-groups (25-83 years), medical conditions (autism, dementia, intellectual disability) and varying clinical situations (assessment of third molars, decision to restore or extract teeth). The oblique lateral radiographs provided adequate radiographic information to confirm diagnosis and treatment. Due to the very short time exposure needed, oblique lateral radiographs are good alternatives to OPGs and still have a significant role in the diagnosis, treatment planning and therefore treatment outcomes for patients with special needs.

Research paper thumbnail of Submission to the Productivity Commission: Inquiry into Introducing Competition and Informed User Choice into Human Services

Research paper thumbnail of Conscious sedation, general anaesthesia for patients with special needs

International Dental Journal

Research paper thumbnail of Oral and aural problems in Australian Special Olympics athletes

Special Care in Dentistry

Research paper thumbnail of Targeting Dental Caries and Body Mass Index Among Special Olympics Athletes in Australia

Journal of Policy and Practice in Intellectual Disabilities

Research paper thumbnail of Access to dental services for children with intellectual and developmental disabilities - A scoping review

Research in developmental disabilities, 2018

Children with Intellectual and Developmental Disabilities (IDD) face considerable challenges in p... more Children with Intellectual and Developmental Disabilities (IDD) face considerable challenges in participating in dental services. These challenges include resource constraints and inadequate skills of health service providers to work with this population. The aim was to scope published studies that addressed access to dental services for children with IDD in order to determine the extent to which various barriers have been researched, using an access framework derived from the literature. Access was defined to include the six dimensions of accessibility, availability, affordability, accommodation, acceptability, and appropriateness. Arksey and O'Malley's scoping review framework was used. Relevant databases (e.g., Medline) were searched for all empirical studies conducted from January 2000 to February 2017 that met inclusion criteria. Data were extracted along the six dimensions of the access framework. Sixteen international studies were identified which indicated common key...

Research paper thumbnail of Atraumatic restorative technique: case report on dental management of a patient with Moebius syndrome

Australian Dental Journal

Research paper thumbnail of Factors influencing oral health of adults with physical and intellectual disabilities in various living arrangements

Australian Dental Journal

Research paper thumbnail of Pre- and post-training evaluation of dental efficacy and activation measures in carers of adults with disabilities in South Australia - a pilot study

Health & social care in the community, Nov 21, 2015

The aim of this pilot study was to train carers to provide oral care for adults with disabilities... more The aim of this pilot study was to train carers to provide oral care for adults with disabilities and to evaluate the training programme. Forty-one carers of 103 care recipients from three disability organisations in South Australia were trained in providing oral care for adults with disabilities (April 2013-April 2014). The training included an oral presentation and practical session by a special needs dentist on completing oral health assessments (OHA), developing oral healthcare plans, providing oral hygiene care and assessing the need for dental referral. Continued support was provided via home visits by dental hygienists for the first 2 months and a dentist visit at 3 months. At 6 months, agreement on OHAs between the dentist and trained carers was assessed. Pre- and post-training questionnaires (at 6 months) collected information on dental behaviours of carers and psychosocial factors: carer activation measure-knowledge (CAM-Knowledge), carer activation measure-skills (CAM-Ski...

Research paper thumbnail of Factors influencing caries experience among adults with physical and intellectual disabilities

Community Dentistry and Oral Epidemiology, 2009

There is limited and inconsistent evidence on the influence of residential setting on caries expe... more There is limited and inconsistent evidence on the influence of residential setting on caries experience of adults with physical and intellectual disabilities (PID), described here as care-recipients. To examine caries experience and associated factors among adults with PID. Mailed questionnaire survey (2005-2006) of carers of adults with PID (18-44 years) in South Australia from family homes, community housing, and institutions, and oral examinations of care-recipients recording decayed (D), missing (M) and filled (F) teeth (DMFT). Carers completed questionnaires for 485 care-recipients, 267 of whom were examined (completion rate=55.1%). The prevalence of decay (D>0) was 16.9% and 76.3% had caries experience (DMFT>0). In unadjusted analysis, care-recipients at institutions had a significantly higher mean DMFT than other settings. After adjusting for carer and care-recipient characteristics, there was no difference in any of the DMFT components among residential settings. However, there were statistically significant associations (OR+/-95% CI excluding unity) between decayed teeth and moderate and high intake of sweet drinks and frequency of dental visits. Higher odds of missing teeth were associated with type of disability, general anaesthetic requirement for dental treatment and low and high carer-contact. Higher odds of filled teeth were associated with age, no oral hygiene assistance (OHA) and high carer-contact. Higher odds of caries experience were associated with age and no OHA. Residential setting was not associated with caries experience. Modifiable risk factors were diet, frequency of dental visits, no OHA and carer-contact hours.

Research paper thumbnail of Access to dental care among adults with physical and intellectual disabilities: residence factors

Australian Dental Journal, 2009

There is limited information about access and barriers to dental care among adults with disabilit... more There is limited information about access and barriers to dental care among adults with disabilities. A mailed questionnaire survey of carers of 18-44-year-old South Australians with physical and intellectual disabilities (care recipients; n = 485) in family homes, community housing and institutions. Bivariate associations were tested using chi-square tests. Odds ratios (ORs) and 95 per cent confidence intervals (CI) were estimated for irregular dental visits (IDV). Carers from family homes and community housing were more likely to report problems in obtaining dental care than those at institutions (p < 0.001). Lack of dentists with adequate skills in special needs dentistry (SND) was the most frequently reported problem for carers from family homes and community housing. IDV were less likely (p < 0.01) for care recipients in institutions and community housing than in family homes. After adjusting for care recipients' age, gender and disability, odds of IDV was lower in community housing (OR = 0.2, 95% CI = 0.1, 0.3) and in institutions (OR = 0.1, 95% CI = 0.04, 0.3) relative to family homes. Care recipients in institutions and community housing had better access to dental care than those at family homes. The shortage of dentists in SND and treatment costs needs to be addressed.