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 to accommodate these patients by adapting the way dental care is scheduled, communicated, and delivered. 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 Why?
The most important to this to note is that special-needs dentistry isn't a practice exclusive to children — adults can have special needs as well. The full range of conditions a special-needs dentist may cover is too vast to list here, but here are some of the more common ones and the associated challenges:
- Autism: Communication issues, anxiety, outbursts, or aggression
- ADHD: Fussiness, unwillingness to cooperate
- Down Syndrome: Discomfort/risks related to physiological deformities, inability to process environment
- Alzheimer’s/Dementia: Capacity for patients to consent to treatment, especially as the condition progresses
- 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. Most special-needs patients lack private dental insurance and instead rely on Medicaid or Medicare. They also may not be able to afford or operate their own transportation, which can make it difficult to schedule appointments.
Provisions for Special-needs Dental Patients
No matter the disability, there are several provisions dentists can provide to make their practice accessible to special-needs patients:
Physical Accessibility
A facility in compliance with the Americans with Disabilities Act will make it easy for patients to receive their treatment. This means the office must have an accessible entrance and rooms, as well as accommodations for helping patients get into the dentist's chair. Ideally, the office will be near a public transportation stop and 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. For example, toothbrushes with alternative handles can be easier to grip, and toothbrushes with extenders can assist those with a limited range of mobility.
Communication
Communication is an important aspect of caring for any patient. When sensory or cognitive deficits hamper an individual’s ability to communicate traditionally, a special-needs dentist must adapt 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 expressions. An autistic patient might experience great anxiety in an unfamiliar situation — scheduling a desensitizing appointment beforehand will get them 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 special-needs patients.
Comfort and Safety
Backboards, head or neck pillows, towels, and modified dental chairs provide proper support throughout treatment. Oral stabilization apparatus 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.
The patient's emotional comfort shouldn't be taken lightly, especially if there are dental phobias or anxieties involved. In these cases, a licensed dental therapy dog like Dogtor Gizmo can stay with the patient throughout the visit.
General Dental Anesthesia for Special-needs Patients
Through no fault of their own, some dental patients either cannot or will not 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 their circumstances.