Preventive Dentistry & Special Needs Patients

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

2. Related terms • Impairment • Disability • Handicapped • Special needs

3. 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

4. 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

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

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

7. Atfaluna Society for Deaf Children – Gaza Strip

8. 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

9. Dental FacilitiesPhysical 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/

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

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

12. Preventing Oral Disease..Practical Aspects

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

14. 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

15. 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)

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

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

18. 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/

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

20. 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

21. 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)

22. 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

23. 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

24. 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

25. 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

26. Preventing hypersalivationin 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

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

28. Preventingxerostomiain special needs patients • Radiotherapy: preoperative dental care to avoid extractions • High dose fluoride (varnish) • Chlorhexidine mouthwash or gel • Saliva stimulation (Pilocarpine) • Saliva substitution

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

31. 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/