Understanding the Scope of Special Needs Dentistry

Posted on May 27th, 2020 at 8:59 AM
Understanding the Scope of Special Needs Dentistry

According to the National Organization on Disability, roughly 54 million Americans live with at least one physical, medical, developmental, or cognitive condition — special needs dentistry aims at accommodating these patients, adapting the way dental care is scheduled, communicated, and delivered such that it can be successfully adopted and maintained. This often requires specialized training, facilities, and equipment — along with the requisite compassion, patience, and understanding.

Who exactly are our special care patients, and how do we modify our dental treatment plans to cater to their unique needs?

Who needs special needs dentistry, and what are the challenges?

The full range of conditions that might be covered by a special needs dentist are too vast to list here, but here are some of the more common ones and the associated challenges:

  1. Autism: Communication issues; triggering anxiety, outbursts, or aggression

  2. ADHD: Fussiness, unwillingness to cooperate

  3. Down Syndrome:  Discomfort/risks related to physiological deformities, inability to process

  4. Alzheimer’s/dementia: Capacity for patients to consent for treatment, especially as the condition progresses.

  5. Paraplegia/quadriplegia: Transference between wheelchair and dental chair, providing treatment in non-traditional positions

Failure to tend to these patients’ circumstances properly can lead to further oral health complications, injury (to either the patient or staff), and potential liability. 

Another barrier to regular dental treatment for individuals with disabilities is low income status, making it difficult to pay for care. Most special needs patients are without private dental insurance, and instead rely on Medicaid or Medicare for payment assistance. They also may not be able to afford or operate their own transportation, an additional challenge for scheduling appointments.

What provisions can we make for special needs dental patients?

Physical accessibility

A facility in compliance with the Americans with Disabilities Act will make it easy to get in the door, into the exam room, and into the dentist’s chair. Ideally, the office will be near a public transportation stop, have handicapped parking, ramps, wide doorways, handicapped-accessible restrooms, waiting rooms, and exam equipment.

When special needs patients leave the office, they should be given toothbrushes and other oral hygiene tools they can use effectively — toothbrushes with alternative handles can be easier to grip, toothbrushes with extenders can assist those with a limited range of mobility.

Communication

Other than proficiency, communication is the most important aspect in caring for any patient. When sensory or cognitive deficits hamper an individual’s ability to communicate traditionally, a special needs dentist will make the adaptations to understand and be understood. 

For instance, dentists, assistants, and hygienists might verbally narrate each step of a procedure to a visually impaired patient, so they can follow along with what they can’t see. A hearing-impaired patient would benefit from visual aids, hand signals, and nonverbal cues like facial expression. 

An autistic patient might experience great anxiety in an unfamiliar situation — scheduling a desensitizing appointment beforehand will get him or her acquainted with the office and equipment. Implementing a policy of show-tell-do — clearly and thoughtfully explaining and illustrating each step of the procedure before doing it — goes a long way for many patients.

Comfort and safety

Backboards, head or neck pillows, towels, and modified dental chairs provide proper support throughout treatment. Oral stabilization apparati like rubber or foam bite blocks, disposable bite sticks, cotton or gauze prevent the patient from biting their tongue and help keep the airway clear.

Emotional comfort should not be taken lightly if there are dental phobias or anxieties involved; for example, a dental therapy dog like Dogtor Gizmo who stays with you throughout the visit.

General dental anesthesia for special needs patients

Through no fault of their own, some dental patients either cannot or will not (refuse to) receive the special care they require. For those who would otherwise forgo treatment altogether, general dental anesthesia provides a safe, effective, and efficient route to getting more work done in less time, with less stress for patients and caregivers. Dr. Kevin Mahoney takes great pride in treating each patient with compassion, care, and respect, regardless of his or her circumstances. 

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