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Dentistry for people with special needs

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    Dental care for people with special needs

    Who needs special care dentistry?

    Everyone needs to be able to have dental care. However, some people need special facilities or help if they are to have this care. People with physical disabilities may have problems getting into the surgery or into the dental chair. People with learning disabilities may become over anxious at the thought of going to the dentist or may need extra reassurance. People suffering from severe medical problems may need extra precautions or care. Dentists are able to take account of all these things when providing dental care.

    Who can provide treatment?

    Many dentists will happily treat people with special dental needs in their surgery. However, some people may find it difficult to get to the surgery so the practice will need to make other arrangements. This could include home visits or arranging appointments with special health centres.

    Some people need specialist care. The local Community Dental Service or health care clinic offers treatment for people with learning difficulties or a medical disability. This includes anybody who has a medical condition that needs special facilities, or extra time or care. Some hospitals or health centres will also help people needing specialist care and may be able to offer other treatment options, such as sedation or general anaesthetic.

    How do I get specialist care?

    Usually your dentist or doctor is responsible for referring you to the clinic best suited to your needs. Normally, the dentist or doctor will write a referral letter and send it, with any hospital letters and x-rays, to the Community Dental Officer to give them an idea of your dental history.

    What does the dentist need to know?

    The dentist will need to know your medical history and about any medicines you are taking. This includes any inhalers and regularly prescribed medicines from the doctor. The dentist will also need to know the names of your family doctor and hospital consultant, about any recent operations and about any allergies you may have.

    It is also helpful if the dental team know about any concerns or anxieties a patient has, so that they can help to make them feel at ease. This information can be given by the patient’s parents or carer. However, some patients do prefer to talk directly to the dentist. Some patients may have other special needs, for example an interpreter or translator, or to have a guide dog. Dentists are prepared for working in these circumstances.

    When is the best time to be treated?

    Some patients prefer to be seen at certain times of the day depending on their needs. For instance, evening appointments may not be suitable for patients who tire easily or may spend the day worrying. Some patients rely heavily on routine and may need regular appointments at the same time of day.

    How accessible are treatment clinics?

    All practices should offer facilities for wheelchair users, including access to the practice and ground floor surgeries. If wheelchair access is particularly important, contact the surgery and ask if this is something they are prepared for.

    Some clinics have specially adapted surgeries for patients with mobility problems.

    Can treatment be done at home?

    Some dentists may offer home visits for people who are housebound or have difficulty visiting the surgery (these are sometimes called ‘domiciliary’ visits). However, treatment options are limited outside the surgery. The receptionist will be able to tell you if home visits are an option and make your appointments if so.

    What about children’s dental treatment?

    Children with learning disabilities or other medical conditions may be referred to the Community Dental Service by their doctor, dentist or health visitor. It is important to register children with a dentist at an early age. A low-sugar dietis also important. Children may be more likely to have tooth decay if they have problems cleaning their teeth or take medication. Make sure fizzy drinks and sugary foods and drinks are kept to mealtimes only and are taken in small amounts.

    Why is medication a factor?

    Many patients with disabilities have to rely on medication to keep their condition under control. It is therefore important to ask the GP to prescribe sugar-free medicines, especially syrups.

    It is important to tell the dental team about any medication that the patient is taking, in case they need to take extra precautions or the treatment is affected.

    Is there anything to make tooth brushing easier?

    Some people find it hard to move their hands or wrists, which makes proper cleaning difficult. It is important to reach all the areas of the mouth to clean properly. A small- to medium-headed toothbrush with soft to medium bristles is usually recommended. There are special handgrips and other adaptations which can be fitted to manual toothbrushes to make them easier to hold. In some cases, electric toothbrushes are recommended for people with mobility problems. They are also helpful to people with learning difficulties as they can be a novelty and therefore encourage brushing. The dentist or dental team will be able to offer advice and practical help on brushing and general mouth care.

    Is sedation available?

    Intravenous sedation (an injection) is an effective way of treating most nervous patients. The drugs given can relax and calm the patient, so treatment can be carried out with dentist and patient still able to talk to each other. There are certain things that affect a patient’s suitability for this type of sedation. These include weight, age and medical condition. This would all be discussed beforehand and the dentist would give all the information needed. Usually the patient would need to be referred to a specialist clinic for this treatment.

    What other help is available?

    Relative Analgesia (RA) can also help patients get through their treatment more easily. Here, nitrous oxide and oxygen are breathed in through a nosepiece. It is the safest and simplest form of sedation and is often the one most suitable for both children and people with special needs. However, it is not appropriate for everyone, especially people with limited understanding, cerebral palsy or multiple sclerosis.

    In some cases the dental team prefer to use other ways of calming the patient. These can include simply talking, visiting the practice first to meet the staff or even hypnosis. These can all be effective in making the patient less anxious.

    What toothpaste should be used?

    It is recommended that children up to three years old use a toothpaste that contains at least 1000ppm (parts per million) of fluoride. Over the age of three, a toothpaste that contains 1350 to 1500ppm of fluoride is recommended. A pea-sized smear or ‘blob’ is the amount of toothpaste that should be used. If the dentist thinks that the patient is particularly at risk of tooth decay, they may prescribe a toothpaste or gel which contains a higher level of fluoride to offer more protection.

    How often should I see the dentist?

    It is important to visit the dentist regularly, as often as they recommend.

    The dentist may also recommend appointments with a dental hygienist who will clean your teeth and offer advice on how to brush properly and keep your mouth healthy. The dentist may also offer advice to carers.

    It is very important that there is a good relationship between the dental team, the patient and their carer. This can be a great help to people who have severe learning difficulties. Short but regular appointments seem to work better at building trust between the patient and the dental team than irregular, long appointments.

    What treatment might I have to pay for?

    Treatment may be available under the National Health Service (NHS) or might have to be paid for privately, depending on the type of treatment and practice. It is important to ask for a treatment plan and an estimate of charges at the time of the checkup. This will avoid confusion over payment later.

    NHS treatment is free for people receiving most benefits. If the patient does not claim any benefits, they may get help with charges by filling in an HC1 form. You can get this from either the dental practice or a doctor’s surgery. You may also be able to get help towards eye tests among other things.

    The Community Dental Service will provide most treatment for free. However, there will be a charge for any private treatment carried out. In some cases treatment needing laboratory work, such as dentures, bridges and crowns, will also be charged for.

    Source: British Dental Health Foundation

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