People With Special Needs and Their Dental Care

Top quality dental care is imperative for people from all walks of life. If you have healthy teeth, you’re more likely to enjoy a healthy diet, and to avoid the wider problems associated with conditions such as gum disease, and teeth which look their best are a boost to the self-esteem and all round confidence of anyone. For people with special needs, however, accessing the right dental care can be more difficult, which is why it is important that dentists make the effort to be as accessible as possible.

The special needs in question may refer to physical problems which make it difficult actually getting into the surgery or the dentist’s chair, or learning difficulties, which might result in high levels of anxiety and distress. In certain cases, patients may require extra care or precautions and in all circumstances your dentist will take the difficult circumstances into account when providing care. Many dentists are happy to provide dental care within their own clinics, but this may not always be possible. If actually getting to the clinic is too problematic, then an appointment can be made in a suitable special health centre. In some cases, specific special care may be called for. Your local Community Dental Team will offer treatment for people who have a medical condition which calls for extra care or special facilities. Some health centres will also provide help, up to and including options such as sedation or general anaesthetic. If you feel that you or someone for whom you are responsible requires special care, then it will normally be accessed via your dentist. They will determine the best place for your treatment by writing a letter of referral to the Community Dental Officer, combined with hospital letters, x-rays and so on to create a full picture of the relevant dental history.

The dentist you go to see will require the following information:

  • Your medical history
  • Any medication you are taking (including inhalers and any regular prescriptions)
  • The name of your family doctor and hospital consultant
  • Details of any recent operations
  • Details of any allergies

The best time of day to book your appointment will depend upon the details of your special needs. Some patients may have very strict routines around which the appointment time will have to work, whilst others may tire easily and thus will require an appointment earlier in the day. By law, all practices should offer wheelchair access, and some may be specially adapted to deal with more complicated mobility issues. If you’re in doubt, ring your dentist to make enquiries. In some cases, patients may have needs which render them completely housebound, or make it particularly difficult to visit the surgery. In cases such as these your dentist may be able to arrange a home visit, although the range of treatment which can be offered at home is somewhat limited. Your dentist will decide if a home visit is applicable, depending upon the circumstances of your case. Children who have special needs, learning disabilities or other medical problems might be referred to the Community Dental Service by their health visitor, dentist or doctor. It is vital that a child be registered with a dentist from an early age, and that you instil a low sugar diet avoiding sugary foods and fizzy drinks. Decay may be more of an issue if children are unable to clean their teeth properly or take certain medications. The problem with medication – which the child may have to take to stabilise a range of conditions – is that many of them, particularly for younger patients, come in the form of sugary syrup which attacks the enamel of the teeth. If your child is taking medication of this kind, make sure that your dentist is fully aware. The other key building block of good dental health is a strict oral hygiene regime, and some special needs may make this more difficult, particularly amongst patients who find it difficult to move their hands or wrists. In such cases, a small or medium headed toothbrush might prove easier to manipulate and use can be made of adaptations such as special handgrips. Sometimes, your dentist might recommend using an electric toothbrush. This is particularly relevant to patients with learning difficulties, as the ‘fun factor’ of an electric toothbrush will encourage regular cleaning. Some patients with special needs might experience heightened levels of anxiety when dealing with a visit to the dentist, and in cases such as these your surgery might be able to offer intravenous sedation, an injection which places the patient in a state of deep relaxation whilst still keeping them awake. Whether this type of sedation is suitable will be a decision made by your dentist on the basis of facts such as age, weight and medical history. In many cases, sedation will have to be administered at a specialist clinic.  Another form of sedation often recommended is called Relative Analgesia. This takes the form of nitrous oxide and oxygen which are breathed in through the patients’ nose, and is the simplest and safest form of sedation, which is why it is so suitable for people with special needs, although not for some people, such as those with multiple sclerosis, limited understanding or cerebral palsy. The toothpaste which should be used by children with special needs, up to the age of three, should include 1000ppm (parts per million) of fluoride. Once the child has turned 3, a toothpaste containing 1350 to 1500ppm is recommended. In all cases, a blob of paste the size of a pea should be used. If your dentist feels that the patient is at particular risk of decay, they may recommend toothpaste containing a higher level of fluoride. All patients need to visit their dentist on a regular basis, but this is especially true for those with special needs. The patient, their carer and the dental health team, including a hygienist, need to build a strong relationship, particularly when dealing with patients who have severe learning difficulties. It is recommended that short, regular appointments are the best means via which to build this relationship. Many treatments for people with special needs are available on the NHS, although some practices charge, so it is vital that a detailed payment plan be drawn up at the start of the process. Similarly, although the Community Dental Service will carry out most work for free, there may be a charge for those treatments, such as crowns, bridges and dentures, which require laboratory work. If you have any further questions on the subject of dental care for people with special needs, then the best thing to do is book an appointment with our dentist in London at the earliest opportunity, since we are dedicated to the idea that every member of society is entitled to the best possible dental care.

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