Dentistry for Patients with Special Needs

A patient with special needs can be defined as someone with medical, physical, psychological or social circumstances that require a change in their normal routines. In the context of dentistry and oral health, a patient with special needs requires a change in regular approaches to dental care in order to receive treatment. A patient with special needs is not, however, always severely physically and/or mentally disabled.

Who Are Dental Patients with Special Needs?

Dental patients with special needs often – but not always – have higher rates of poor oral hygiene. As a result, they also have a higher incidence of gum diseases and cavities than people in the general population. Those considered dental patients with special needs represent individuals with a broad range of conditions that do not necessarily relate to oral health.

For example, dental patients with special needs include the following:

Aging and elderly people. These individuals may need more frequent dental visits to monitor tooth wear, pain and the effects of medications that they cannot detect themselves due to decreased pain sensations. These individuals are often sensitive to glare and have a hard time hearing dental information or instructions if background music is loud. Therefore, blinds or shades may need to be drawn and the music lowered during their appointments to enhance their comfort.
Individuals with mobility issues. Patients with mobility issues may need assistance in and out of the dental chair, as well as to and from the dental office.
Mentally disabled individuals. Those who are mentally challenged or intellectually disabled may need to be accompanied to dental appointments by a caregiver, since they may not be able to comprehend dental hygiene requirements or homecare instructions.
Immunocompromised people and those with complex medical problems.People with cardiovascular disease, diabetes, bleeding disorders or other systemic conditions need to have their conditions – as well as their medications – taken into account before receiving dental treatments. Dentists will likely need to collaborate with their physicians.
People with a mental illness. An individual with a mental illness may have difficulty following proper dental hygiene regimens, obtaining dental care and countering the effects of medications that affect oral health (such as antidepressants that cause dry mouth). These individuals may need shorter appointments that are scheduled when they are in a balanced state, as well as be accompanied by a caregiver or case manager.
Children with behavioral or emotional conditions. Children with autism, for example, are averse to changes of any kind. These patients with special needs would likely need to be seen by the same hygienist – wearing the same outfit, working in the same dental office – whenever they visit the dentist to receive care. Or, children who need medication for ADHD may need to be given their medications at such a time that they are able to sit through a dental appointment.

What Dental Patients with Special Needs Actually Need

First and foremost, you or the person with special needs for whom you provide care need a qualified and experienced dentist. Any other requirements thereafter will be specific to the individual and the particular illness, condition or disability.

Among the accommodations that dental patients with special needs may require are the following:

An efficient and systematic approach to the examination and treatment so that appointments are short, when necessary
Knowledge of the medical, physical, mental or behavioral condition in order to better manage the appointment and oral health needs
More assistants during examinations and treatment procedures to better control and monitor the patient and the appointment
Sedation dentistry to promote patient comfort if longer appointments are required
Flexible appointment scheduling
Caregiver or case manager involvement in treatment planning, providing instructions and information, and while performing dental procedures

Choosing a Dentist for Your Care

Dentists and dental specialists (endodontists, periodontists, orthodontists) are trained to provide care specifically in dentistry, regardless of who the patient is. This means dentists can perform a clinical examination, carry out procedures to diagnose and treat oral diseases, and provide restorations such as fillings or crowns. It is only in recent years that an increasing number of continuing education programs have been developed to help dentists learn techniques for providing dentistry in more understanding ways to patients with special needs.

If you or someone you are caring for is a patient with special needs, choose a dentist capable of taking a different approach to treatment based on what those needs and circumstances are. The dentist you choose should have or be willing to develop a complete understanding of the disability, illness or special need that warrants different consideration during dental treatment.

Questions to consider include the following:

How does the dentist and staff interact with you and/or the person under your care?
Do they seem comfortable and willing to develop a relationship with you? Do they listen to what you say when you explain what is needed or desired during office visits?
Has the dentist and staff attended any state, regional or national training sessions or hands-on courses for treating patients with special needs?
If the nature of your needs or those of the person you provide care for is such that special scheduling consideration is needed, is the practice willing to accommodate you?
If the nature of your special needs – or those of the person you provide care for – has created a financial burden, does the dental practice provide payment plans, financing, or liaisons to charitable agencies that may provide financial assistance for dental treatments? For example, the National Foundation of Dentistry for the Handicapped (NFDH) provides donated dental care to approximately 7,300 people valued at more than $17 million a year. That amount represents all costs associated with the time and talents of dentists, the materials and expertise of dental laboratories, and the value of other dental products. For more information, contact www.nfdh.org.