Special needs patients are often some of the most at-risk patient populations in need of dentistry. But many dental providers don’t realize that in many cases, the cognitive disorder is also accompanied by other disorders, which can have a detrimental effect on oral care.
Common Health Concerns
Decay is more common in individuals with developmental disabilities, and periodontal disease is more common at a younger age among these individuals than in the general population.
Xerostomia in special needs patients is often medication-induced, and many of these patients take a combination of medications. Combined with damaging oral habits, these medications can be a recipe for disaster.
Many individuals with special needs seek out stimulation, and they often will have damaging oral habits including chewing on non-food items. Clenching, grinding, mouth breathing, and tongue thrust also raise the risk of dental concerns.
Patients with autism spectrum disorder, Down syndrome, and other cognitive or developmental disabilities often will have an accompanying medical disorder too. Cardiac disorders may be common with Down syndrome. Gastroesophageal reflux disease or GERD is common with autism and cerebral palsy. Also, individuals with developmental disabilities may be more susceptible to latex allergies.
Oral Care for Special Needs
Special needs individuals often require more help for daily life activities, including personal care. Cognitive capabilities will vary depending on the person and impact how well they may perform personal care. The traditional brush and floss method may not be the best choice. Or, the individual may have mobility issues in addition to the cognitive concerns that require adaptation.
Uncontrolled body movements and anxiety often make treating these patients difficult to impossible in a clinical setting. The fear and anxiety around a disrupted routine or a stranger trying to touch them is enough to overstimulate a special needs patient, resulting in the inability to perform dental treatment.
Teach How They Learn
Individuals with disabilities generally will not learn from our typical ways of teaching. Instead, we need to adapt our ways and teach how they learn. With innovations in dentistry, we have a toolkit to help us treat special needs patients in the clinical setting.
Visual aids are key in reminders for special needs patients. Remembering steps and sequencing is often difficult. A simple instruction panel complete with images for your patient to post on the bathroom mirror can help create a successful oral hygiene routine.
Also, caregivers are often the ones providing oral hygiene care, so don’t forget to encourage and educate them about adaptive tools. Power brushes are a great option, though special needs patients may not be able to tolerate them due to sensory issues.
The Dental Experience
Utilize teledentistry to “meet and greet” these patients prior to the initial appointment in the clinic. Spend time to get to know your new patients without all the extra PPE, which can appear scary. Allow them to ask questions and find out what their interests are. This can help tailor the dental experience to ensure success.
Parents and caregivers will appreciate these initial visits from the comfort of home so they can discuss dental concerns and together plan the appointment. Remember, it is a day-altering experience for many of the special needs patients you treat.
Encourage the parent or caregiver to bring comfort items to the appointment if desired. You can work around a book, blanket, or stuffed animal without a problem. Find what motivates the patient and use it to engage them. Also, be mindful of signs of overstimulation, and take breaks for the patient as needed.
Dental hygiene appointments can be rough on both the patient and provider, especially when sensory issues come into play. It often takes coaching to get a special needs patient who is nervous into the dental chair. You may need to perform the initial evaluation from whatever position the patient is comfortable in and accepting. Plus, a quiet and cordless handpiece that is not air-driven allows for freedom of movement if you will be seeing the patient in an alternative position.
Many special needs patients are at higher risk of decay, and the use of a fluoride varnish should be recommended if indicated. Many parents complain that their child often has bad breath even after brushing, which often is related to GERD. I frequently recommend a chlorine dioxide mouthwash, such as Oxyfresh, due to its mellow flavor and effectiveness. The chlorine dioxide helps to neutralize the odor-causing bacteria.
Special needs patients often may be some of the most challenging to treat, but they also may be some of the most rewarding you will see on your schedule.
Ms. Collins is a clinical practicing hygienist in Idaho and Washington. She has been in the dental field for more than 20 years, both as an assistant and hygienist. With a passion for patient care, especially for those with greater risk factors, she enjoys sharing the tips and tricks of the dental profession through speaking and writing for multiple publications. In addition to clinical practice, she is a speaker and educator who has contributed to multiple textbooks, curriculum development, and key opinions. She can be contacted at firstname.lastname@example.org or at mydentaleducator.com.