The objectives of this study were to explore how U.S. and Canadian dental schools educate students about special needs patients and which challenges and intentions for curricular changes they perceive. Data were collected from twenty-two dental schools in the United States and Canada with a web-based survey. While 91 percent of the programs covered this topic in their clinical education, only 64 percent offered a separate course about special needs patients. The clinical education varied widely. Thirty-seven percent of the responding schools had a special clinical area in their school for treating these patients. These areas had between three and twenty-two chairs and were funded and staffed quite differently. Most programs covered the treatment of patients with more prevalent impairments such as Down syndrome (91 percent), autism spectrum disorders (91 percent), and motion impairments (86 percent). Written exams were the most common outcome assessments (91 percent), while objective structured clinical examinations (18 percent) and standardized patient experiences (9 percent) were used less frequently. The most commonly reported challenge was curriculum overload (55 percent). The majority (77 percent) planned educational changes over the next three years, with 36 percent of schools planning to increase clinical and 27 percent extramural experiences. The findings showed that the responding U.S. and Canadian dental schools had a wide range of approaches to educating predoctoral students about treating special needs patients. In order to eliminate oral health disparities and access to care issues for these patients, future research should focus on developing best practices for educational efforts in this context.