1 - Scope of Care and Transition of Patients with Special Healthcare Ne

Purpose: The purpose of this study is to evaluate pediatric dentists’ current approach to providing care for patients with special health care needs (SHCN) and how the transition of care is managed for these patients as they age into adolescence and adulthood.

Methods: A 14-question cross-sectional survey was distributed electronically between March and April 2025 to active members of the American Academy of Pediatric Dentistry (AAPD). The survey gathered data on practice setting, training history, age groups treated, referral and follow-up behaviors, and perceived barriers to transitioning SHCN patients to adult care.


Results: A survey of 275 pediatric dental providers (3.37% response rate) revealed that the majority of referrals for patients with special health care needs (SHCN) were made to hospital or university-based dental clinics (39.39%), highlighting their central role in complex care. About 27.71% reported “N/A,” suggesting that some providers retain patients without formal referral pathways, while 20.78% referred to general dentists. Referrals were most often prompted by clinical complexity (49.5%), followed by patient age and behavior (both 20.7%). A statistically significant relationship (p = 0.019) was found between practice type and age of referral, with most patients with SHCN referred between ages 19–24, especially from private and hospital-based practices. Geographic analysis indicated urban and suburban practices tend to refer in adolescence and young adulthood, while rural referrals were more varied and less structured, though geographic differences were not statistically significant.


Conclusion: This study found that 39.39% of pediatric dentists refer patients with special health care needs (SHCN) to hospital or university-based clinics when unable to meet their needs, supporting the first hypothesis. While referral trends varied by practice type, the majority of respondents referred patients in the 19–24 age range, reflecting a critical transitional period. Rural providers appeared to refer at slightly later ages, but small sample sizes limit the generalizability of this finding. Overall, the study highlights the need for structured transition-of-care pathways and calls for further research to address referral barriers. Improving these elements is critical to ensuring long-term continuity of care for this population.