Three decades have passed since former U.S. President George H.W. Bush signed one of the most important laws about equal opportunity—the Americans with Disabilities Act or ADA. Since its enactment on July 26, 1990, the ADA has ensured that people with disabilities access opportunities and services available to all Americans.

As we celebrate the 31st anniversary of the ADA, let’s look back on how the law was enacted, how it has evolved, and how dental practitioners can advocate for the law.

What Every Dentist Needs to Know: Answering 9 Common Questions About the Americans With Disabilities Act

What Does the Americans With Disabilities Act of 1990 Do?

Just as the Civil Rights Act of 1964 prevents discrimination of any kind based on race, color, religion, sex, or nationality, the Americans with Disabilities Act protects people with disabilities against any form of inequity. The ADA upholds the rights of people with impairments to equal opportunities in all aspects of community life, including:

• Employment
• Transportation
• Communication
• Trade and Commerce
• Healthcare
• State Affairs

The act aims to reduce barriers and expand opportunities for individuals with disabilities to participate in all facets of society. Additionally, the ADA law provides a solid standard for addressing discrimination issues against individuals with disabilities.

What Qualifies for Americans With Disabilities Act?

The Americans with Disabilities Act of 1990 qualifies anyone with a physical or mental impairment that significantly prevents the performance of at least one significant life activity, such as:

• Seeing
• Hearing
• Speaking
• Walking
• Performing Activities of Daily Living (ADL)

Additionally, the law covers people with a history or record of a disability and those perceived by others as having an impairment.

When identifying if a person is disabled under the ADA, the duration or severity of the condition is considered. If the impairment is just temporary or is not severe, the person is not considered impaired and not covered by the ADA. The following are examples of temporary impairment:

• Minor, non-chronic infection
• Sprain
• Broken limb

In January 2009, the ADA was amended after the Americans with Disabilities Act Amendments Act of 2008 (ADAAA) was passed. The law now extends protection to (1) individuals associated with or has relation to people with disabilities and (2) people who are prone to retaliation for helping people with disabilities in asserting their rights.

What Disabilities Does the ADA Law Cover?

The amendments made to the Americans with Disabilities Act in 2009 allow broad interpretation of ‘disabilities’ to protect as many individuals as possible. While the ADA does not have an exhaustive list of conditions, it defines conditions that fall under physical and mental impairment to include the following:

• Any physiological condition affecting one of these bodily systems:
  • Neurological
  • Special-sense organs
  • Musculoskeletal
  • Digestive
  • Cardiovascular
  • Respiratory
  • Reproductive
  • Hemic and lymphatic
  • Endocrine
  • Skin
  • Genitourinary
• Mobility impairments
• Cosmetic disfigurement
• Anatomical loss affecting one or more body systems
• Mental or psychological disorders
• Organic brain disorders
• Specific learning disabilities

Who Does the Americans with Disabilities Act Apply To?

The Americans with Disabilities Act of 1990 applies to all private employers with at least 15 employees, state and local governments, employment agencies, and labor unions. It also applies to all commercial facilities that offer public accommodation, such as restaurants, dental and doctor’s offices, schools, theatres, etc.

According to the ADA, the entities mentioned above must provide reasonable accommodation to people with disabilities. In the employment setting, reasonable accommodation means modifying the environment or adjusting tasks or work schedules to allow employees with disabilities to participate in essential functions.

On the other hand, commercial entities must meet minimum standards for accessibility when updating or constructing facilities, provided that the modifications will not cause undue hardship to their business or will “fundamentally alter the nature of services” they offer.

What Are the Americans with Disabilities Act Requirements to Dental Professionals?

The ADA requires dental professionals to provide people with disabilities with the same level of service they extend to all clients. Additionally, the law requires dental offices to give reasonable accommodations to employees and clients with disabilities, whether current or prospective. These accommodations include ensuring that dental practice facilities are accessible to people with impairments.

As part of its commitment to upholding equal rights for quality oral care, the American Dental Association modified its code of conduct to align with the Americans with Disabilities Act of 1990. The revised American Dental Association code of conduct prohibits dental professionals from denying care to patients with physical, developmental, and mental impairments.

If a patient requires special equipment, facilities, or expertise not available to the dentist, the dental professional must refer the patient to someone capable of meeting their needs.

What Do Patients With Special Needs Expect From Dental Professionals?

According to the Centers for Disease Control and Prevention, 61 million adults live with a disability in the U.S. However, only a few dental practices offer special needs dentistry.

The lack of access to oral care puts individuals with physical and mental impairments at higher risk for various dental issues. In Wisconsin alone, about one-third of adults with disabilities had tooth extraction in 2018.

Even practices that do not specialize in special needs dentistry can advocate for the rights of individuals with disabilities by accommodating their needs. Here are some of the specific needs of dental patients with disabilities:

• Accommodation
  To meet the unique needs of patients with disabilities, dental practices must remove any structural barriers that may interfere with the patient’s access to the dental facility. Dental practices are legally required to comply with this based on the Americans with Disabilities Act.Dentists may also allow flexible appointment scheduling and accommodate other reasonable requests to ensure smooth, safe, and comfortable dental care.
• Communication
  Dental professionals must ensure proper communication of dental treatments and procedures with patients with disabilities, including those who have hearing impairments. Dentists can accomplish this in various ways, such as through an interpreter, illustrations, or applicable apps.The patient must know everything about the recommended treatment, including risks, benefits, and possible complications. It is also essential to discuss the estimate of the cost of the treatments to avoid confusion.
• Medical Consultation and Coordination of Care
  To guarantee accurate diagnosis and safe and effective delivery of dental treatment, dental professionals should coordinate with the patient’s physician and other care providers.The entire dental team must have substantial knowledge of the condition of the patient and their medical history, including hospitalization, medications, allergies, immunization, and surgeries.
• Informed Consent
  Before any dental treatment, the dental professional must obtain the patient’s consent. The consent should be documented and signed by either the patient or someone legally allowed to provide consent on their behalf. The document should indicate all the possible benefits and risks of the treatment and other relevant information.
• Financial Considerations
  Financial barriers remain one of the primary reasons hindering people with disabilities from getting oral care treatments. By familiarizing themselves with available community-based resources, dentists can educate their patients of the options available to them and encourage them to take advantage of such.
• Individualized Oral Hygiene Program
  To help the patient maintain excellent dental health, dental professionals must create a hygiene program that considers the patient’s condition.

How Can Dental Professionals Ensure ADA Compliance When Building or Updating a Practice?

Complying with ADA regulations when constructing or remodeling dental offices keeps dental professionals from legal complaints; it also opens up wider opportunities to serve the oral health needs of more patients.

While the law does not require dental practices to alter their practice to cater specifically to patients with disabilities, considerable changes are required to meet the ADA requirements. Some of the crucial things to take note of when building or updating a dental practice are as follows:

• The location and facilities must be accessible to people using wheelchairs.
• There should be enough space on halls, doorways, etc., to allow patients with mobility limitations to move safely.
• The location must have designated parking spaces for people with disabilities.
• There should be proper signages for people with visual impairments.

The best way to ensure that your practice meets the ADA compliance requirements is to consult a lawyer well versed in the law. Doing this before the construction of your dental office will save you thousands of dollars in renovation (and lawsuits).

Are There Dental CE Courses That Help Dentists Remain Compliant With ADA Requirements?

Yes. Different dental institutions and organizations recognize the importance of dentist education in ensuring ADA compliance.

The UCLA School of Dentistry, for instance, offers a new dental CE course to address the barriers in communicating with deaf patients. Dental students, residents, and faculty members can learn about Deaf Culture, Deaf History, and the American Sign Language in the five-week-long elective program.

Andrew Moore, an ASL instructor, and deaf interpreter, developed the curriculum to prepare future dentists to interact with patients with hearing impairments effectively. “The course emphasizes that communication is key for all patient-centered care,” according to Eric Sung, D.D.S., a clinical dentistry professor at UCLA and the course’s faculty advisor.

The Special Care Dentistry Association (SCDA) also has a similar continuing education initiative. The organization offers the web-based, self-paced learning program, “Oral Health for People with Special Needs.” Accessible through a learning management system called Canvas, the 16-CE credit program focuses on various oral health care topics for people with special needs.

What If It’s the Dental Professionals Who Have a Disability?

The Americans with Disabilities Act also protects dentists and other dental professionals with disabilities. Although the possibility that a dentist will encounter a disability is low, the risk still exists, especially since clinical dentistry is a physically demanding profession.

If met with a temporary or permanent disability, here are some options that dental professionals may consider:

• Use of adaptive equipment. Consult your physician about the possibility of using adaptive equipment that will allow you to continue practicing.
• Exploration of other career options. If the continuation of practice is not a viable option, dental professionals may consider expanding their skills and expertise to open new opportunities, such as teaching or consulting.
• Practice Transition or Closure. If the practice has to close, the American Dental Association offers dental professionals legal and professional resources to help them manage the process. Information about insurance coverage and benefits is also available.

Additionally, eligible dentists with disabilities can enjoy continued membership to the American Dental Association even after leaving the practice. Reach out to ADA for more information or visit their website to access all related resources.

Stay Informed

Do you want to stay informed about the laws and regulations affecting dentistry practice? Benco Dental holds regular webinars and other programs to help dental professionals like you. For schedules, reservations, and other details, check out our website.

Sources: https://www.ada.gov/2010ADAstandards_index.htm