Dentistry used to be associated with dental cleanings, fillings, extractions and dentures. In recent years, its scope has expanded to include smile makeovers. An often overlooked but important aspect of dentistry, however, is the treatment of special needs patients.
This unique branch of dentistry is defined by the Royal College of Surgeons of Edinburgh, a UK specialist board, as “the specialty of dentistry concerned with the oral health care of patients with special needs for whatever reason including those who are physically or mentally challenged.”
Dentistry for Medically Compromised Patients
Medically compromised patients include:
- those who have medical problems such as cerebral palsy and stroke;
- those who are taking immunosuppressive medication;
- those undergoing radiation and chemotherapy; and
- those who are scheduled for major surgical procedures such as organ transplantation.
Patients with cerebral palsy usually have involuntary movements, making surgical procedures and fine precision work dental work a challenge. A combination of special techniques and sedation can ensure that these patients are efficiently, safely and predictably treated.
Severe stroke patients are usually wheelchair bound with impaired mobility. Most of them also take blood thinning medication to enhance blood flow which may complicate certain dental procedures, e.g. cause prolonged bleeding after a surgical procedure. Close coordination between the dentist and the patient’s medical specialists and a clear understanding of the clinical impact of these medications forms the foundation of safe treatment. This type of patient should be best treated by a specialist team which regularly encounters these clinical issues.
Transplant patients (for example, organ transplants or bone marrow transplants) commonly take immunosuppressive medication which impairs their body’s ability to fight off infections in the oral cavity and other areas. These patients usually have abnormally swollen gums and are best managed by regular dental assessments before and after the organ transplant procedure.
Some dental conditions that may not bother a healthy individual may become a significant problem for cancer patients during treatment. Conditions such as gum disease or tooth infections, can be cost-effectively managed if properly diagnosed and attended to promptly before the initiation of the cancer treatment. Should these pre-existing dental problems flare up later, they tend to result in complications and are expensive to manage. Most importantly, a dental complication may interrupt the overall treatment strategy and potentially compromise the overall success of treatment.
Dentistry for the Elderly and Physically Challenged
Elderly patients usually have multiple medical conditions and have been prescribed a long list of medications. Thus, familiarity with treatment goals, side effects and interaction of those medications and how they impact on the clinical condition of these patients is important. Patients who are physically challenged face barriers to accessing dental care such as issues in mobility. Patients with functional handicaps, such as visual or hearing impairments, will require the dentist to use skills such as Braille or sign language for communication and gaining of trust.
To ensure good oral health for special needs patients:
- Brushing of teeth should be done at least twice a day, to reduce the amount of food deposits and build-up of bacterial plaque.
- Sugar consumption should be restricted or as advised by the patient’s medical doctor.
- Consider the use of an electric toothbrush. Patients with limited hand mobility may find it easier than using a regular toothbrush.
- Regular visits to the dentist are advised. The specific time interval will be designated by the dentist, customised to the individual needs of every patient.
Dental management is an integral and crucial part in the overall health equation. Patients with special needs can share the same healthy life style and dental health as everybody as long as proper care and attention is given in their everyday living.
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This post on dental assessments is especially useful for those who are about to undergo cancer treatment (radiation or chemotherapy) or a major surgical procedure (e.g. organ transplantation, heart bypass, etc).
There is increasingly more research suporting the link between oral health and overall health. In the situation where the body’s immune system is down, it is even more important to be aware of how to avoid oral complications in the middle of treatment or post-surgery.
Oral Complications
Oral complications are present in:
(1) Almost all patients receiving radiation for head and neck cancer;
(2) Up to 75% of blood and marrow transplant recipients; and
(3) Nearly 40% of patients receiving chemotherapy.
Effects of Oral Complications
The effects of oral complications on the patient include:
(1) Seriously compromising the patient’s health and quality of life;
(2) Affecting the patient’s ability to complete the course of treatment;
(3) Resulting in tolerance of a lower and less effective dose of therapy;
(4) Postponing scheduled treatments;
(5) Stopping treatment; and
(6) Developing potentially life threatening systemic infections.
Thus, oral care before, during and after cancer treatment is critical in the prevention or reduction of the incidence and severity of oral complications, with the net result that patient survival and quality of life are enhanced.
Here is how the dental specialist team can work together with the medical team in these special cases:
I. Pre-Treatment Dental Assessment
Sending cancer patients for a pre-treatment dental assessment prior to undergoing radiation therapy or chemotherapy:
(1) Reduces the risk and severity of dental complications developing during the course of treatment;
(2) Allows early detection and treatment of existing infections and other problems;
(3) Increases the likelihood that the patient will successfully complete the treatment;
(4) Minimizes oral infections that could lead to potentially fatal systemic infections;
(5) Prevents or reduces later incidence of bone necrosis;
(6) Prevents, eliminates or reduces oral pain;
(7) Improves the quality of life; and
(8) Decreases the cost of care.
A dental assessment enables the identification and treatment of problems such as infection, fractured teeth or restorations, and gum disease that could worsen oral complications once cancer therapy is started. Baseline data can also be established in order to compare the patient’s status in subsequent examinations.
The identification of any pressing dental treatment needs, including gum swelling, loose or decayed teeth, and any other lesions in the oral cavity would indicate dental treatment should be provided before the patient undergoes chemotherapy or radiotherapy.
II. On-going Dental Treatment Needs
Continued follow-up by the dental specialist is important during the course of cancer treatment to prevent, detect, and treat oral complications in a timely manner.
For more information on Dental Assessments, please click here.
A recent study published in the Australian Dental Journal has indicated that ethanol-based mouthwashes may increase the risk of developing oral cancer. The paper by Professor Michael McCullough of the University of Melbourne recommends against long term use of alcohol-containing mouthwashes.
Dr. Ansgar Cheng, Consultant Prosthodontist at Specialist Dental Group and an Adjunct Associate Professor at the National University of Singapore, was quoted in a New Paper interview on the topic.
According to Dr. Cheng, Specialist Dental Group does not recommend that patients use mouthwash on a regular basis but only as indicated for their dental condition and only for a specific period of time, e.g. for patients recovering from oral surgery or having other oral problems. If patients are required to use mouthwashes, they are usually recommended a non alcohol-based mouthwash.”
Mouthwashes should be regarded as a topical application of medical substance – Professional common sense dictates that prescriptions of any medication should be prudent and specific to address a certain clinical situation with a specific clinical outcome in mind,” said Dr. Cheng.
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