Preventive Dentistry & Special Needs Patients Prepared by Dr. Rana Darwish DDS, MPH

Related terms Impairment Disability Handicapped Special needs

Special Care Patient The term "Special Patient" is used in the oral health field to describe an individual with special needs, including physical, medical, developmental and/or cognitive conditions, resulting in limitations in their ability to receive dental services and prevent oral diseases by maintaining daily oral hygiene. * * Prevention of Oral Diseases. 2003

Professional Dental Associations Focused on Special Needs Dentistry Public Health Associations (American & Canadian) Academy of Dentistry for Persons with Disabilities British Society for Disability & Oral Health Special Care Dentistry Association International Association for Disability & Oral Health

Disabilities Physical disabilities Mental disabilities Learning disabilities Syndromes ( e.g. Down syndrome) Cerebral palsy Muscle atrophy Autism

Congenital or Acquired Disabilities Source: Palestine Children’s Relief Fund (PCRF Institution)

Atfaluna Society for Deaf Children – Gaza Strip

Delivery of care to people with special needs The development of personal dental services Lack of funding for training Cost of specialist services & facilities Unwillingness of some general dental practitioners to provide dental treatment for such groups

Dental Facilities Physical Disability* Some countries developed special dental units or chairs Wheelchair platforms provide a better, cheaper, and more effective service to special care dentistry patients * Design Specific, Special Needs Dentistry. http://www.designspecific.co.uk/

Dental Facilities Physical Disability.. Design Specific (Britain)* Full Function Wheelchair platform Mobile Wheelchair platform Wheelchair Recliner * Design Specific, Special Needs Dentistry. http://www.designspecific.co.uk/

Cooperation & Coordination with… Carers (nurse, social Worker, …) Medical doctor Family Relatives

Preventing Oral Disease.. Practical Aspects

General Aspects of oral status in impaired patients Poor cooperation Resistance to mouth cleaning Challenging behavior Limited access to dental services

Preventing dental caries in special needs patients Dental caries prevalence in patients with impairments is higher More untreated decay More missing teeth Fewer restorations Oral health can be maintained at high level if preventive & treatment services were provided for such target group

Preventing dental caries in special needs patients Topical Fluorides (High doses) High Fluoride toothpastes (for certain groups) Toothpastes alternatives (Fluoride mouthwash) Dietary constituents & form Liquid oral medicines Chlorohexidine (gel, varnish)

Preventing dental caries in special needs patients Atraumatic Restorative Treatment ART * * WHO, Oral Health Program. ART Manual 2008

Preventing dental caries in special needs patients Atraumatic Restorative Treatment ART * * WHO, Oral Health Program. ART Manual 2008

Preventing dental caries in special needs patients Carisolv *: chemo-mechanical minimal invasive approach that removes necrotic decayed dentin only leaving healthy tooth structure Ozone therapy: no need for using dental handpiece or local anesthesia…useful method Oralsolv.se. Feb 2007. http://www.mediteam.com/

Tooth wear in special needs patients Neurological impairment  clenching or grinding  causes attrition Cerebral palsy  gastroesophageal disease  vomiting  causes erosion Bizarre oral habits  abrasion

Preventing tooth wear in special needs patients If no toleration for extensive treatment  remove badly worn teeth With toleration  under sedation or GA  full coverage of affected teeth & molars Cleaning aids not to be erosive

Gingivitis in special needs patients Poor oral hygiene resulting in plaque accumulation and gingivitis Down syndrome  more prevalent periodontal disease & early tooth loss Epilepsy medications  gingival hypertrophy Mouth cleaning mission (carers & relatives)

Preventing gingivitis in special needs patients Change medication or modify dose (physician) Modified manual toothbrushes Mouth cleaning resistant patients  powered toothbrush or “Superbrush” (opposing bristles clean 3 surfaces with one stroke) Barman’s Superbrush –www.smile-link.com

Preventing gingivitis in special needs patients Difficult cases (extremely ill) mouth care carried out in bed by nurse or carer  toothpaste or toothbrush dipped in mouthwash or chlorhexidine gel Also chlorhexidine varnish can be used (sustained up to 6 months) Patients refusing or resisting cleaning aids behavior modification  desensitization

Self inflicted trauma in special needs patients Self mutilation involving oral tissues in certain syndromes. Teething sometimes triggers it Lip & tongue biting  pain & swelling  mouth is too sore to drink or eat  dehydration  hospitalization

Preventing self inflicted trauma in special needs patients If offending teeth were primary  extract Use soft splints to prevent soft tissue trauma If malocclusion  teeth adjustment & orthodontic treatment depending on case

Preventing hypersalivation in special needs patients Excessive drooling especially in poor neuromuscular control (cerebral palsy or cerebro-vascular accident) Prevention & management: Surgical Pharmacological Radiotherapy Palatal training aids ( Hyoscine patch /anticholinergic ) Behavior modification

Xerostomia in special needs patients Associated with: Syndromes Medications (elderly patients) Patients on radiotherapy Results in increased rate of dental caries and ill-fitting dentures

Preventing xerostomia in special needs patients Radiotherapy: preoperative dental care to avoid extractions High dose fluoride (varnish) Chlorhexidine mouthwash or gel Saliva stimulation (Pilocarpine) Saliva substitution

Each dentist should do his/her best in trying to improve the quality of life for those in need

Refernces Palestine Children’s Relief Fund (PCRF). www.pcrf.net Design Specific, Special Needs Dentistry. http://www.designspecific.co.uk/ World Health Organization, Oral Health Program. ART. 2008. http://www.whocollab.od.mah.se/expl/artmore.html Prevention of Oral Disease, J. J. Murray, 4th edition, 2003, Oxford Press. Carisolv presentation. Februray 2007 www.orasolv.se MediTeam Dental. February 2007. http://www.mediteam.com/