Last Updated: August 2023

Author: Office of Oral Health, Vermont Department of Health

Six in ten Vermont adults with a disability went to the dentist in the past year. This is less than the three-quarters (75%) of adults without a disability that visited the dentist. There are various reasons that limit adults with disabilities seeking dental care such as being able to express their need for care, identifying dental pain, feeling emotionally stressed, being unable to sit in the chair for a length of time, finding a dentist that is comfortable treating adults with disabilities and low reimbursement compensation for dental providers. All these factors can contribute to the low percentage of adults who visited the dentist in the last year. To address this problem, adults with disabilities has been identified as one of the target populations for our State Health Improvement Plan (SHIP) and State Oral Health Plan (SOHP) strategies. By involving adult Vermonters with disabilities in the development of strategies and work plans in the SHIP and SOHP, we will increase the likelihood of reducing the oral health disparities that exist between adult Vermonters with and without disabilities. 

Due to infection control concerns, practices were limited to providing emergency dental care for about two months during the COVID-19 pandemic. Practices also saw increases in the amount of PPE required to treat patients, increasing the cost of providing care. Lastly, infection control concerns contributed to early retirements and dental care providers leaving the profession. These issues have led to a “perfect storm” of long wait times for appointments, fewer practices accepting Medicaid insurance, and workforce shortages throughout the state, all of which affect access to dental care, which may help explain the decrease seen here.

Oral health is essential to overall health. Good oral health improves a person’s ability to speak, smile, taste, socialize, be employed and enjoy life. Maintaining good oral health is important as it effects our general health. 

Many adults with disabilities experience dental decay or gum disease caused by their medical condition or developmental disabilities. Six in ten Vermont adults with a disability went to the dentist in the past year. This is less than the three-quarters (75%) of adults without a disability that visited the dentist. 

Many dental providers have not been trained to care for adults with disabilities. The lack of good insurance coverage is also a deterrent because it may not compensate for the time and risk involved for both the provider and patient. This limits them the ability to find sources of care in their own community, it causes treatment delays and can result in dental conditions worsening over time. Adults with a disability are almost twice as likely to have ever had a tooth removed (68% vs. 35%) compared to adults without a disability.  Even with diabetes or cigarette use, adults without a disability are still less likely to have had any teeth extracted compared to adults with a disability. 

• State of Vermont Developmental Disabilities Council 
• Vermont Coalition for Disability Rights
• American Academy of Developmental Medicine and Dentistry (AADMD)
• Vermont State Dental Society
• Vermont Dental Hygiene Association
• Vermont Technical College of Nursing and Health Professions
• UVM MC Dental Residency program
• Special Care Dentistry Association 
• Department of Vermont Health Access

Vermont's State Oral Health Plan includes activities to promote oral health for people with disabilities (see page 19).

• Empower adults with disabilities and their families/caregivers and advocate for their oral health.
• Support, educate and train the dental workforce to serve adults with disabilities.
• Extend coverage of oral health services in Medicaid for adults.
• Enhance our partnerships to support an oral health program of outreach, case management, preventive services and dental care for adults with disabilities.

At the Vermont Department of Health, we will explore multiple strategies to promote oral health for Vermonters with disabilties. Examples include: 

• Empower adults with disabilities and their families/caregivers and advocate for their oral health. 
• Support, educate and train the dental workforce to serve adults with disabilities.
• Extend coverage of oral health services in Medicaid for adults.
• Enhance partnerships to support an oral health program of outreach, case management, preventive services and dental care for adults with disabilities.

Vermont tracks risk behaviors using a telephone survey of adults called the Behavioral Risk Factor Surveillance Survey (BRFSS). Since 1990, Vermont, along with the 49 other states, Washington D.C. and U.S. territories, has participated in the BRFSS with the Centers for Disease Control and Prevention. Several thousand Vermonters are randomly and anonymously selected and called annually. An adult (18 or older) in the household is asked a uniform set of questions. The results are weighted to represent the adult population of the state. The results are used to plan, support, and evaluate health promotion and disease prevention programs. 

Due to BRFSS weighting methodology changes beginning in 2011, comparisons between data collected in 2011 and later and that from 2010 and earlier should be made with caution. Differences between data from 2011 forward and earlier years may be due to methodological changes, rather than changes in opinion or behavior. 

This indicator is age-adjusted to the 2000 U.S. standard population. In U.S. data, age adjustment is used for comparison of regions with varying age breakdowns. In order to remain consistent with the methods of comparison at a national level, some statistics in Vermont were age adjusted. For more detailed information on age adjustment, see the CDC Statistical Notes. 

The CDC provides the Vermont Department of Health with funding each year to carry out the survey. Currently, ICF Macro with an office in Burlington, Vermont, is the interviewing contractor for the Vermont BRFSS.

Beginning in 2009, Vermont started interviewing adult residents on cellular telephones as well as landline telephones. This change ensures the survey is conducted among a representative sample of Vermont adults and was made due to changing telephone patterns with more households using primarily cellular telephones.

1. ASTDD Best Practice Approaches for State and Community Oral Health Programs: Oral Health of Children, Adolescents and Adults with Special Health Care Needs

2. US Department of Health and Human Services Oral Health Strategic Framework, 2014-2017

3. Behavioral Risk Factor Surveillance Survey (BRFSS)

4. Vermont Department of Disabilities, Aging and Independent Living