Purpose: To compare the transition time of young adults with SHCN to those without SHCN from the pediatric clinic to the adult dentist and to identify obstacles faced by the parents of patients that transition out of the pediatric practice, the obstacles faced by the pediatric dentist in facilitating this transition, and the obstacles faced by the general dentist in providing care for this patient population.

Materials and Methods: All participants were seen at The University of Texas-Graduate Pediatric Dentistry Clinic since 2011, over the age of 18, and were covered by state insurance at the time of their last visit in the pediatric clinic. All participants were randomly contacted via phone to complete a 9-question survey regarding the patient's transition time and perceived obstacles faced to find a new dental home. Additionally, an online anonymous survey of adult restorative dentist and pediatric dentists of the Greater Houston Area was conducted regarding treatment of patients with SHCN and perceived obstacles in finding care for the adult SHCN patient population. Descriptive analysis was completed, and data was analyzed for significance utilizing Fischer exact test, likelihood ratio test, and Pearson's Chi squared test.

Results: Parents of forty-two subjects with a diagnosis of either autism or cerebral palsy and 28 healthy age-matched controls completed the survey. As expected, those with the SHCN were significantly more likely to have poor behavior in the dental office. Interestingly, those with cerebral palsy were more likely to have poor behavior when compared to those with autism (p<0.001), and age was inversely related to behavior (p=0.024). While there was no difference between the groups in establishing a dental home (p=0.15), there was significance in the patient's behavior and their SHCN affecting their transition time to a new dentist (p=0.047). Those with SHCN were more likely to require sedation for treatment (p<0.001). Both groups were shown to have similar challenges in finding a new dentist, methods of finding that dentist, more recent treatment provided and time since last dental visit. Surveys of the providers, had responses from 69 adult dentist and 51 pediatric dentists, demonstrating that pediatric dentist perceived great challenges in referring these patients for adult care, however over 90% of adult dentist report that they see these patients and the majority reported there were not major obstacles in providing care for this patient population.

Conclusions: Patients will SHCN are more likely to experience longer transitions when changing from pediatric dentist to adult dentist, and this is largely dependent on the positive or negative behavior. Not surprisingly, the more challenging the behavior the longer the transition time and the more likely the parents reported obstacles to finding care. Opinions of providers are drastically different, with pediatric dentist perceiving challenges in referring for adult care for their SHCN patients, and adult dentists reporting no perception of obstacles and a willingness to treat this patient population.