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.
