W11: Dental Patients with Special Needs Introduction Flashcards
How does AHPRA and RACDS define Special Needs Dentistry (SND)?
Definitions:
“The Branch of denttistry that is concerned with the oral health care of people with an intellectual disability, medical, physical, or psychiatric conditions that require special methods or techniques to prevent or treat oral health” AHPRA
“That part of Dentistry concerned with the oral health of peopleadversely affected by intellectual disability, medical, physical, or psychiatric issues.” RACDS
*RACDS- Royal Australia College of Dental surgeons
What are the different categories of Special Needs?
- Physical Disability
- Cognitive Impairment
- Sensory Impairment
- Infectious Diseases
- Endocrine Diseases
- Hepatorenal Diseases
- Bone Diseases
- Cardiovascular Diseases
- Respiratory Disease
- Bleeding Disorders
- Blood Dyscrasias
- Immunosupression
- Head and Neck Cancer
- Neurological Disorders
- Psychiatric Disorders
- Other Special Considerations
Why is it important to know about SND?
Remote practice
* You’re on your own
* More chronic disease
* Limited resources and access
* Environment
* Gratitude of patients
* Satisfaction of clinician
Increasing percentage of patietns
WHO- 15% of people have a disability
What are we here for- ethods of JCU? ADC
Describe SND specialty
- Specialty since 2003
- 18 practicing Specialist in Australia (major cities)
- Professional organizations
-ANZASND The Australia and New Zealand Academy of Special Needs Dentistry is the peak body repersenting regstered specialists
-ASSCID (Australian Society of Special Care in Dentistry) for anyone who has an interest
-iADH (International Association for Disability and Oral Helath)
Provide information about according to the Australian Bureau of Statistics (2020) and Australia’s Disability Strategy 2021-2022
Australian Bureau of Statistics 2020
* Almost 18% of Australian have a disability (4.4 million people)
* 1.4 million have a profound disability (1 SND: 78, 000)
* 8.2 per cent of Aboriginal and Torres Strait Islander people identified requiring assistance with core activties
* The most common disability in those under 60 is depression
* 76.6 per cent of people identifying as requiring assistance live with family and 19.4 per cent live alone
Australia’s Disability Strategy Hub | Disability Gatewayhttps://www.disabilitygateway.gov.au/ads
What are the Principles of SND?
Principles:
* All individuals have a right to equal standards of health and care
* All indivifuals have a right to autonomy, as far as possible, in relation to decisions made about them
* Good oral health has postive benefits for health, dignity, self-esteem, social integration and general nutrition. The impact of poor oral health can be profound.
* The majority of people with a disability have disabilities that are mild or moderate and do not require specialist dental care
* Most people with mild or moderate disability could, and should receive dental care in mainstream primary dental services.
What are implications for dentists ?
- Access
- Don’t assume
- Care with language
- Consider what the patient can maintain
- Acknowledge carers
- Consent/Capacity
- Restraint
- Who treats?
What considerations can be taken in an access audit?
- Parking, kerbs, lighting
- Entrance (ramp, proximity, ground floor?)
- Reception and waiting room (clear sinage, non-slip flooring, communication aids)
- Appropriate seating, space for wheelchairs
- Corridors (width and space to manoeuvre, no obstructions)
- Surgery (design, and space to manoeuvre), toilet facilities (space, transfer bards, raised seat, alarm in place)
- Means of escape (visual alarm, exits acceible by all, signage) disability awareness training for staff
What are the barriers to oral health care?
Patient
* Lack of perceived need
* Anxiety or fear
* Financial constraints
* Access difficulties/mobility
Dental Profession
* Inappropraite manpower resources
* Uneven geographical distribution
* Training and experience
* Insufficent sensitivity to patient needs and communication skills
Society
* Insufficent public support
* Inadequate facilities
* Inadequate manpower planning
* Insufficent support for research
Government
* Lack of political will
* Inadequate resources
* Low priority
* Waiting Lists
Care environments can increase behavioural challenges including those with:
- Limited social interaction
- Excessive noise
- Crowded accomodation
- Neglect and abuse
- Physical health needs not recognized
- Pain not recognized or managed
When are referrals made and what is included?
When to refer
* Significant communication difficulties (not simply non-verbal)
* Unco-operative
* Medical status (may require multidisciplinary team)
* Phyasical access (can’t transfer and weight bear)
What to include
* Reason for referral
* Information Gathering (from GP, current medications, past medications, specialist reports and results of investigations)
* Pain/Swelling/Trauma?
* Capacity
* Radiography (especially OPG)
When are referral inappropriate?
Inappropriate Referrals
* Mild communication difficulties (e.g. ASD, mild dementia, augmented communication aids)
* Mil co-operation challenges
* Mild medical complications (e.g. diabetes, blood thinners, bone-sparing medications). May need investigations first (e.g. INR, FBC)
* Can ask advice frm SND specialist
* These patients may take extra time but we don’t have to make a profit on every patient :)
*FBC- full blood count?
What is capacity?
Capacity is:
* Decision specific
* Temporal (e.g. may fluctuate in psychiatric conditions)
* The right to make “bad decisions”
* Substitute decision maker is a last resort
- Principle of autonmy
- Presume capacity
- Need the correct environment for consent (e.g. sensory issues in ASD)
Discuss consent
Consent
* Must be Valid
-voluntary and unconditional
-patient informed of all pertinent information
-patient understands the information and the consequences of treatment AND NO treatment
- Two aspects
-patient consent
-clincian consent - Discussion must be documented
-The “consent form” is not the consent
Disscuss Pain assessment in SND
Pain assessment in SND
* challenging if communication is limited (e.g. cognitive impairment)
* Pain may becme chronic before it is recognized
* Treatment is ineffective unless the aetiology is understood
* The usual assessment tools may not be applicable
* Changed behaviour may be the only clue
- agression, refusal to co-operate
- excessive drooling
- distrubed sleep
- pulling at face
- altered eating habuts
- changed communication
* Rely on carers to interpret
