Sukhmani Singh explains how dental care for disabled people in the UK may differ.

In 2016 in the UK there were approximately 13.3 million disabled people, according to www.gov.uk, while in the United States, 53 million adults suffer from a disability, www.cdc.gov claims. In the UK, out of the number of disabled people, 7% are children, www.scope.org.uk says, and they need extra special care. The traditional dental treatment plans in dental clinics need to be tweaked a little to accommodate a special needs patient.

A special needs patient may be suffering from:

  • Physical limitations: this includes traumatic, congenital, and/or physiological limitations
  • Developmental problems: these may be acquired or congenital
  • Medical complications: this may involve systemic, hereditary and/or acquired complications
  • Cognitive impairments: these include sensory, emotional, mental and/or behavioural impairments.

Problems faced by special needs patients

  1. Financial troubles: many times, the special needs patients are not able to afford dental treatments because often they belong to the low socioeconomic classes. Many such people are dependent on Government programs like Medicaid and Medicare for their health care. Those who rely on private health insurance policies face problems when their policies do not cover the specific dental procedure in question
  2. Communication problems: communication needs to be more effective for them to understand the dentist. The dentist’s way of communicating needs to be moulded according to the patient’s disability. For instance, simple, short and repetitive explanations work best for patients with mental disabilities
  3. Limited transportation: special needs patients with limb impairments, or people who use a wheelchair aren’t able to travel In such cases, their oral health care treatment plan and the centre itself may need to be modified accordingly.

Some care barriers faced by special needs patients

  • Difficulty in understanding: owing to psychosocial issues like low oral health literacy, past negative experiences and dental anxiety, special needs patients can get scared or panicky
  • Untrained staff: where the dental office lacks staff that are well-trained in taking care of such patients, it becomes increasingly difficult to provide them with the care needed.

How to overcome such barriers to care

Teaching dental students how to treat disabled patients: for instance, in 2006, The American Dental Association Commission on Dental Accreditation started a dental hygiene program that educated students about how to treat specially-abled patients. A visit to a special needs dentist is different from a regular visit to a dentist as this dentist tailors his approach towards the patient depending on the patient’s additional requirements. Special needs patients require a slower approach.

When given proper training, dental students/dentists learn how to cope with disabled patients. Understanding the importance of maintaining a good relationship with the patient’s caregiver, and how to handle the patient’s mood swings makes the process slightly easier.

Help patients learn how to maintain oral hygiene: many times, the reasons why disabled patients have a problem in maintaining oral hygiene is lack of oral hygiene education or the inability to do so. They could also be taking medication that effects their oral health adversely. Clinicians are able to modify self-care instruments like a toothbrush to accommodate the patient’s needs. Wider handles, better grips and extenders can be used to help the patient get a better grasp of the toothbrush (Wilkins, 2013).

The caregivers of the patients need to be educated on the importance and need for good oral health, nutrition for good dental health and about various oral hygiene techniques.

Dentists should be familiar with treatment tools for special situations: some helpful treatment tools like mouth props for facilitating an open mouth for a longer time, medical immobilisation devices, rolled towels for providing stability and support to the patient’s knees and sedation dentistry to stabilise erratic movements, go a long way in the treatment a special needs patient.

References

Wilkins EM (2013) Patients with special needs. In: Clinical Practice of the Dental Hygienist. 11th ed. Philadelphia: Lippincott Williams & Wilkins


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