Special Care Dentistry

Question 1

What is special care dentistry?

Answer 1

Special Care Dentistry provides…

• preventive and treatment oral care services
• for people who are unable to attend routine dental care because of physical, intellectual, medical, emotional, sensory, mental or social impairment
• its concerned with the improvement of oral health of individuals and groups in society who fall within these categories.
• It requires a holistic approach that is specialist to meet requirements of people with impairments

Question 2

Who is special care dentistry for?

Answer 2

• Moderate/severe and profound multiple learning disabilities;
• Moderate/severe physical and/or communication impairment;
• Moderate/severe chronic mental health conditions including dementia;
• Complex medical conditions;
• Severe dental anxiety or dental phobias (dental anxiety scale >19);
• Bariatric patients with a weight over 22 stones. we can accommodate aweight of up to 71 stones (454kg).
• Moderate or severe behavioural problems;
• Children in need and subject to a child protection plan with additional orcomplex needs;
• Looked after children with additional or complex needs;
• Clefts, abnormalities of dental development or dental trauma of increasedcomplexity;
• Other complex dental conditions;
• Socially excluded people (case by case basis);
• People in secure units.

Question 3

Not all patients with a disability need to be seen by the community dental service… how when and why?

Answer 3

A referral from a dentist/DCP/HCP/GP/social worker is needed

Not everyone who fits the criteria is accepted into the service – we do expect (in most cases) clinicians to attempt treatment before referring

Referrals are triaged by dental nurses (mulit-disciplinary approach)

If we can treat the patient they are discharged from the service

Once a course of treatment is completed we refer the patient back to the referrer for ongoing care unless the patient can only accept treatment in the community

Question 4

Medical histories

Answer 4

• Heart problems (LA)
• Anti coagulant medications (LA, scaling or other treatment)
• Safe/unsafe swallow/dysphagia (all treatment)
• Peg fed (Percutaneous endoscopic gastrostomy)
• Diabetes
• Breathing difficulties
• Allergies
• Epilepsy
• Involuntary movements
• Bisphosphonate

Question 5

Social histories

Answer 5

• Does the patient live alone? If not who do they live with?
• Are they happy at home?
• How independent is the patient?
• What does the patient need help with in their daily life?
• What does the patient do during the day?
• Smoking & alcohol use

Question 6

Treatment considerations

Answer 6

• What am I being asked to do? (toothbrushing/restorations)
• Can the patient sit in the chair – how mobile is the patient – steady on feet?
• If the patient has a wheelchair am I going to hoist/transfer/treat in wheelchair…what typeof wheelchair? Do I need tipper/hoist?
• Realistic expectations (for all)
• Setting realistic goals• Holistic approach
• Prevention

Question 7

Communication

Answer 7

• Appropriate language
• Be inquisitive & interested
• Use available resources if appropriate e.g.Makaton or communication board
• Verbal/non verbal language
• Facial expression, eye contact & body language
• Speak directly to the patient even if the patientis non verbal
• Smile & be friendly
• Go with the flow- adapt
• Allow patients to finish their sentences
• Look at your patient – especially for hearingimpai

Question 8

Legal & ethicalconsiderations

Answer 8

• Consent
• Mental Capacity Act
• Clinical holding
• Safeguarding

Question 9

Learning disability

Answer 9

A learning disability affects the way aperson learns new things throughout their life.

A learning disability is different foreveryone. No two people are the same.

A person with a learning disability mighthave some difficulty:
• understanding complicated information
• learning some skills
• looking after themselves or living alone

Dental relevance -
1. Consent
2. Cooperation
3. Access
4. Communication difficulties
5. Poor oral health
6. High caries risk
7. High risk of periodontal disease

Question 10

Medical conditions an dental relevance - dementia

Answer 10

Dementia is a syndrome (agroup of related symptoms)associated with an ongoing decline of brain functioning.

Dental Relevance-
• Mobility issues
• Challenging behaviours•
Access to healthcare
• Poor oral health
• Prevention to avoid complex restorative care
• Consent
• Cooperation
• High caries risk

Question 11

Medical conditions & dental relevance - Down’s syndrome

Answer 11

Down’s syndrome is when you’re born with an extra chromosome.
People with Down’s syndrome will have some level of learning disability.
This means they’ll have a range of abilities.
Some people will be moreindependent and do things like get ajob. Other people might need regular care.

Dental relevance
• Cooperation
• Delayed eruption
• Hypodontia
• Risk of periodontal disease
• Heart disease – dental care implication
• Take care reclining dental chair
• Mouth breathing – dry mouth
• Risk of dental caries
• Large tongue
• Communication

Question 12

Medical conditions & dental relevance - cerebral palsy

Answer 12

Palsy Cerebral palsy is the name for agroup of lifelong conditions that affect movement and co-ordination

Dental relevance
• Mobility
• Cooperation
• Communication
• Unsafe swallow
• Mouth breathing
• Involuntary movements
• Risk of periodontal disease
• Poor OH
• Dexterity

Question 13

Other conditions..

There are going to be other medical conditions and lifelong conditions you come across in your practising career.

What should you do?

Answer 13

1. Google or research the condition
2. Check any medications in BNF
3. Discuss dental relevance with colleagues/referrers
4. Ask the patient