There are 9.4 million disabled people in England, accounting for 18% of the population (Office for National Statistics, 2011). The majority of impairments are not visible and less than 8% of disabled people use a wheelchair (Papworth Trust, 2010). The dental team must be mindful of health conditions and disabilities to enable them to provide appropriate care for everyone, allocating additional time or special considerations where necessary.
An individual’s physical, mental and cognitive abilities to seek dental services and co-operate with any treatment are factors that influence oral health considerably. Physically disabled people may have difficulty accessing and using dental services due to the challenges of travel and mobility and in addition, it can be difficult for them to carry out effective oral hygiene due to limited movement. Patients with mental, developmental, sensory, learning or behavioural disabilities require a sensitive approach to dental care. However, special needs patients can be successfully treated in the dental practice with a few alterations to the skills that dental professionals use every day. It should also be noted that almost one in two people over state pension age are classed as disabled (Office for Disability Issues, 2009/2010) and support from an understanding dental team can make all the difference to their patient experience.
As with all patients it is paramount to determine the needs of each person individually; some people prefer to be independent but others require assistance. The person’s level of comprehension and ability to take direction needs to be established by asking some questions or speaking to carers. Communication methods need to be ascertained and any difficulties or fears identified to ensure a sensitive and receptive approach. Dental professionals can smooth the way by involving the patient in demonstrations, repeating information if necessary and seeking ideas to help put the patient at ease in order to ensure that proficient care is delivered.
Some hospitals or dental practices specialise in treatment for patients with disabilities involving sedation or general anaesthetic, which is sometimes considered the best solution for disabled children or patients with severe learning disabilities. This is also of benefit to patients who are unable to remain still during treatment due to impairment.
Neglected oral health
Unfortunately, patients whose lives are compromised by a disability often have the most neglected oral health and are at greater risk of tooth decay and gingival diseases (Fred Margolis, 2012). The reason for this is that good oral hygiene is frequently considered a lower priority compared to their daily living needs and other health problems. Similarly the prevalence and severity of caries and periodontal disease in the disabled population is significantly higher than the rest of the population (www.dentalcare.com, 2012). Some disabled individuals are not able to perceive or express the need for dental care or implement self care effectively. Others do not have the ability to feel pain in the same way as nondisabled patients and decay or disease can develop unchecked.
People with physical disabilities may be more trauma-prone and tooth damage can be unavoidable during falls or uncontrolled movements. Additionally, bruxism is very common among people with developmental disabilities and may lead to enamel and dentine abrasion, fracture, abnormal mobility of the teeth or mandibular joint disorder.
A number of disabled people are obliged to follow a soft diet, often rich in carbohydrates causing an increased risk of tooth decay. Also, inadequate nutritional intake can lead to dental problems and those who are tube-fed can develop calculus deposits on the teeth. Some disabled individuals may have a tendency to pouch food in the mouth or have problems clearing food from the oral cavity, which increases the bacteria that causes decay or disease. Others may not be able to tolerate certain tastes or textures or have a preference for sweet foods. Another significant problem for disabled patients is that often their medication contains sugar or causes side effects such as dry mouth, which further exacerbates the risk of tooth decay.
An effective oral hygiene routine can be extremely difficult to implement for some disabled people. The gag or choking reflex experienced by some presents significant challenges for carers particularly if teeth are already overcrowded and hard to clean. To ensure effective oral health for people with disabilities, dental hygienists recommend a small-headed toothbrush with soft to medium bristles to reach all the areas of the mouth to clean properly.
Since 1931, Tandex has developed and manufactured high quality dental products and offers an extensive range of specialist toothbrushes to suit a variety of needs. Tandex toothbrushes are also aimed at specific age groups and dental needs for optimal oral hygiene. For example, the Tandex Solo range has a small brush head, specifically angled neck and a long grooved shaft to ensure easy, accurate and proper access for all purposes. The Solo is also available in soft, medium, ultra soft and long and all materials used are free of PVC and latex.
Less of a challenge
Disabled people already face a myriad of challenges every day. When they come to the dental practice they are sure to receive excellent service but it is hoped that it can be a pleasant experience too. Dental professionals can help these patients by offering advice and practical help specifically tailored to their needs and difficulties. And, with a little understanding into the additional risks disabled patients encounter, it is hoped that their dental health and oral hygiene can be improved in the future.
For a list of references please contact [email protected].