Intro to Special Needs Dentistry Flashcards
What is the typical presentation of disabilities “in the real world”?
Often patients present with multiple disabilities rather than just 1 specific kind.
What areas are covered by special needs dentistry?
Persons with disabilities
Geriatric disabilities
Hospital dentistry
What defines a geriatric patient as special needs?
Not necessarily the age. The physical manifestations of age are more important.
Who are medically compromised patients considered to be?
Transplant patients
Oncology patients
Cardiac patients
Renal disorders
Metabolic disorders
Bleeding disorders
Musculoskeletal disorders
Infectious diseases
What are the factors to consider for aged care?
Dementia
Frail elderly
Patients requiring domiciliary care (in patient’s home)
Nursing home care
Carer issue / parent issues
Medically compromised
Physically compromised
What should be considered when treatment planning for patients with special needs?
Individuals ability to carry out proposed OH +/- carer assistance
Patient’s level of interest in oral care
Patient/carer’s dental IQ
Urgency of medical condition
Medical treatment planned
What should the waiting room have for special needs patients?
Access to toilets
Specific modifications to music and sometimes a less stimulating atmosphere (Autism)
Children’s toys and other obstacles should be removed so patients don’t trip over or hurt themselves.
Higher seating for easier seating for patients.
What key questions should a dentist ask himself with special needs patients?
Does the disabling condition require the aid of the caregiver? (wheelchair access, income support, visual disturbances, etc)
Does the disabling condition require modification of the OH routine? (make modifications to make it easier to maintain good oral hygiene)
Does the disabling condition require OH aids or use of adjunctive modalities to maintain daily oral care? (Bigger handles, modified neck, suction on head of brush, etc)
Does the disabling condition require modification of the type and/or frequency of professional care? (patient that has been seen for many years may need continuation at home)
How should the treatment plan be modified for patients with special needs?
Treatment plan must meet the goals of providing oral environment that is:
Free from infection
Cleanable
Functional
Aesthetic
Lead to the best quality of life
What modifying factors affect the treatment plan that needs to be made for patients?
Medical conditions
Medications
Financial support
Perceived dental need
Functional status
Cognitive status
Social support
Transport
What common trends are seen with special needs patients?
Fewer dental visits
Longer intervals before dental visits
Unwillingness of dental team to provide care
History of extractions
Emergency hospital care rather than planned community care
Treatment with sedation or GA
What should be done to ensure ethical special needs treatmetn?
Inform patients adequately
Obtain consent
Restraints should be used with care and should be documented and only used when needed.
Informed consent still needed if patient can’t act independently patient needs to have free choice
Who can give consent?
Patient if able
Parent/carer
Person who is the enduring power of attorney
Appointed legal guardian by legal authority
Spouse
Primary carer
Older adult’s nearest relative (18+)
Emergency medical/dental decisions then 2 medical practitioners can make decision on behalf of the patient.
What information should be given to patient for consent?
Nature of the problem
Reason for proposed treatment
Options including no treatment
Risks and benefits of treatment
Length of time required
Costs
How can we know if a patient can provide consent?
Patient should be able to explain the treatment to you.
Appreciate the situation and its consequences
Manipulate information rationally
Communicate choices
