Providing dental care for certain patient groups is complicated due to difficulties with cooperation, communication, health conditions, and social context, amongst others. The majority of dentists in France work within a public fee-per-item system. A new measure has been introduced providing a financial supplement to dentists for each episode of care for a patient with a severe disability. This supplement is justified by completion of the French Case Mix tool (FCM), a new measure designed to retrospectively identify episodes of dental care that have required adaptation and additional time or expertise. The aim of this study was to investigate the validity and psychometric properties of the FCM. The content validity of the tool was improved at each round of pilot development, involving 392 patient encounters. Test–retest data at 2 weeks for 12 fictional patient treatment episodes were collected from 51 dentists. This phase confirmed inter- and intra-dentist reproducibility, criterion validity, and interpretability. Retrospective analysis of 4814 treatment episodes nationally demonstrated high reliability, internal consistency, and construct validity. Overall, the FCM showed high validity and good psychometric properties. However, the impact of providing a financial supplement on improving access to care for persons with special needs has yet to be evaluated.

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AimsThis scoping review aimed to document tools designed to identify persons requiring special care dentistry (SCD) and to provide a better understanding of the factors that justify adaptation in the provision of care.MethodsA scoping review methodology was applied. An electronic search was performed in April 2021 using Pubmed and Embase. Additional tools were sought using hand searches and informal professional networking.ResultsTen tools were identified that either predict the complexity of dental management or that retrospectively judge the complexity of care, of which two are as yet unpublished. Some had been developed for a specific population (e.g., patients with Alzheimer's disease, with learning disability, elderly persons) whilst others were applicable for any population (case mix tools). Factors considered included the patient's medical history, ability to cooperate, physical and cognitive autonomy, communication skills, anxiety, need for sedation, oral risk factors, ability to consent and the administrative burden for the dentist.ConclusionIdentifying persons requiring SCD is possible by looking at various factors that influence the provision of dental care. There may be need for adaptation of tools to local circumstances and to the intended usage of the tool at a health services, systems or policy level.

AimThis study aimed to review the qualitative scientific literature investigating experience of the mouth and oral health amongst adults with disabilities and/or complex health conditions.MethodsA scoping review methodology was applied in accordance with the methodological framework of Arksey & O'Malley and the PRISMA‐SCR checklist. Electronic searching was performed using the databases Pubmed, Embase, and PsychInfo.ResultsThirty articles were included in the final selection. The populations included in the selected studies were very varied in terms of health conditions and disabilities. Three major themes relating to the experience and understanding of the mouth, oral health, and function were highlighted in the review: the representation of oral health, the influence of oral health on the participant's life, and the influence of the socio‐environmental context on oral health. No study explicitly described the functional, social, and psychological roles of the mouth in a comprehensive manner.ConclusionsPerception of the mouth and oral health differs depending on the individual and their health condition. Oral health is described as dependent on the socio‐environmental context, however, outside of the experience of dental care services, this context is not investigated in the literature. This scoping review demonstrated that exhaustive understanding of the dimensions of the mouth and oral health has not been explored in published research for this population.