techniques although their dental fears have not been addressed (Moore, 2016). Lyons (2009) states that clinical dental treatment of patients with special needs, by virtue of its exacting surgical nature and need to place sharp instruments very close to the face, airway, and highly vascularized and innervated tissues, poses a great risk of serious injury. Nevertheless, he believes the
use of nonpharmacological behavioral support techniques allows many dentists to provide patients with special needs with oral care in a relatively normal fashion, often without having to resort to deep sedation and general anesthesia, which involve their own set of dangers.
Adapting nonpharmacological strategies for use with people with special needs Most of the strategies already discussed are equally appropriate when used to treat people with special needs. The disabilities
to the appointment (AAPD, 2016b). Information obtained in this manner may facilitate the use of more appropriate and effective communication with the patient, thereby fostering a sense of calm and increased trust. Tell-show-do Patients with disabilities are likely to have undergone numerous medical experiences. Consequently, they may be apprehensive when facing yet another perceived threat. The tell-show- do strategy, discussed previously, may be used to facilitate treatment for patients with disabilities. By seeing and touching the instruments and being shown how gently they will be used, patients can come to understand that there is nothing to fear. Positive reinforcement People with special needs experience many frustrating failures. They have few occasions to receive praise for a job well done. A smile, a touch, a word of praise, or a small gift as a token of appreciation for achievement can be a powerful reinforcement for future acceptable behavior and cooperation (Appukuttan, 2016; Oliver & Manton, 2015). Patients living in a group home setting with few opportunities to be singled out are particularly pleased to receive personal attention, including being addressed by name. Such personal attention often enhances the patient’s self-esteem, with positive reinforcement being provided by all members of the dental team during the procedure (Lyons, 2009; Singh, 2019). Distraction Distraction is well suited to people with certain special needs. Some patients with cognitive impairments have shortened attention spans, so this technique may need to be used several times during the procedure (Singh, 2019). Familiar music may be comforting and prevent disruptive behavior. By knowing the patient’s special interests, an observant staff member can direct attention to a relevant topic, away from negative stimuli, and possibly avert a problem. Some people with special needs may have difficulty processing or integrating sensory input. For them, an unstimulating environment or a sensory adapted environment may be beneficial. In one randomized pilot study, for example, darkening of the room, the playing of rhythmic music, and giving the patient the option for deep pressure stimulus (via a specially designed chair wrap) resulted in less physiological distress during a cleaning (Cermak et al., 2015). Further studies are needed, but this study’s results are promising. Home care Behavioral strategies should extend beyond the dental office. It is essential for the dental team to instruct and encourage patients with special needs and their caregivers in the importance of preventive home care and oral hygiene procedures (AAPD, 2016b). Certain physical limitations may require modification of toothbrush handles, floss holders, and oral hygiene techniques and should be tailored to the needs of each patient (Moore, 2016). impairment causes an increasing decline in their coping skills, and the skill of the dental team determines the outcome of their treatment. Behavioral strategies already mentioned for patients with special needs are also appropriate for persons with dementia. However, the dental team must be flexible because the patient’s condition can change dramatically in very short order. As a result, it may be difficult for the practitioner to know what to expect. Appointments for elderly patients with special needs should be kept short and waiting time kept to a minimum.
and needs of such patients vary greatly. However, several techniques are particularly effective for treating these patient groups. Behavioral support Patients with special needs may have complex behavioral issues because of their disability and life experiences. Their dental care calls for a confident team approach that may require more time and effort and increased staff. Under the current healthcare system, third party reimbursement is generally not available for additional support that does not result in a billable clinical procedure (which may also include pharmacological interventions; AAPD, 2016c). Behavioral support may require additional staff time and attention. Nevertheless, this support may be essential to enabling these patients to receive lifetime dental care and maintenance. Physical suppot Physical support (or protective stabilization) describes a range of nonpharmacological techniques for limiting mobility so patients remain still while receiving dental care. Such support may allow these patients to receive dental treatment with less medication than would otherwise be necessary or none at all (Moore, 2016). This strategy avoids or lessens the undesirable side effects of medication. However, there is concern about the psychological or emotional consequences of using restraints; other means of behavior guidance should be always be attempted first, and this technique should only be used in rare clinical situations in which no other alternative is available (Anthonappa et al., 2017). If physical restraints are deemed necessary and used, they must meet local, state, and federal regulations and informed consent must always be obtained (American Academy of Pediatric It is critical to use developmentally appropriate communication with this population (Moore, 2016). Communicating with people with disabilities is, in some cases, more about the manner in which the message is delivered than the choice of words. Although some people with disabilities may have a limited ability to comprehend language, they may be extremely sensitive to the mood of the speaker. The tone, volume, and pace of spoken words and the speaker’s body language and facial expression can send a calming and relaxing message and gain patient attention and trust. Communication with the patient need not be verbal. Touch, facial expression, body language, and general demeanor are all important in relaying a message (Oliver & Manton, 2015). Patients can sense genuine caring and concern on the part of the dental team. People with special needs may themselves communicate nonverbally (AAPD, 2016b). By being observant, the dental team can become aware of specific clues and react appropriately. In certain circumstances, it may be helpful for a member of the dental team to interview the patient’s caregiver or the individual accompanying the patient Dentistry, 2015). Communication
Adapting nonpharmacological techniques for use with older adult dental patients As the American population ages, the number of older adults seeking dental care will rise. As long as these patients are fully functional, they do not require additional behavioral support. However, they may become increasingly frail and suffer from a variety of disabilities. These patients should be treated with patience, and scheduling allowances need to be made to accommodate their decreasing stamina. Approximately 11% of patients older than 65 and 32% of patients older than 85 suffer from Alzheimer’s disease (Alzheimer’s Association, 2016). These dental patients require behavioral support. Their cognitive
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