The dental home According to the AAPD, the dental home should be established by 12 months of age and represents the “ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way,” and that “includes referral to dental specialists when appropriate” Implementing the concept of the “dental home,” in which individualized oral health care is provided to patients with Patient assessment Taking an accurate, comprehensive, and up-to-date medical history is vital for correct diagnosis and designing a treatment plan in patients with special healthcare needs (Singh, 2019). The history should be consulted and updated at each patient visit, with documentation of recent medical attention for illness or injury, newly diagnosed medical conditions, and changes in medications (Moore, 2017). Medical consultations Coordination and consultation between the dentist and the patient’s other care providers, including physicians, nurses, and social workers, is an important feature of managing patients with special healthcare needs (Gupta, 2019). To ensure the safe delivery of comprehensive oral health care, medical consultations should take place regarding medications, sedation, general anesthesia, and special restrictions or preparations. Should a medical emergency arise, the dentist and staff should always be prepared. The dental record should include communications Patient communication In the treatment of patients with special healthcare needs, good communication depends on assessment of the patient’s mental status or level of intellectual functioning (Anzil, et al., 2017). Information provided by a parent or caregiver is very useful, but direct communication with the patient during dental care, if possible, is recommended. With patients for whom verbal communication is limited or challenging, the first signs of oral disease may be reflected in a change in behavior. An example would be patients with autism who normally sit alone quietly. Communicating pain may be beyond the ability of these patients. They may begin to display outward signs of aggression and combative behavior. Informed consent The AAPD guidelines emphasize that all patients must be capable of providing appropriate signed informed consent for dental treatment or have someone who legally can provide it on their behalf (AAPD, 2021). Documentation of informed consent in the dental record with a signed and witnessed form is recommended. The caregiver who accompanies a patient to the dental appointment might not be the person legally responsible for giving consent. The dental team should exercise care to ensure that the appropriate person can consent for the patient. The adult patient with cerebral palsy, for example, might be able to understand the risks and alternatives to care but be unable to sign his or her name. In this case, the patient might have an inked name stamp to indicate understanding. Behavior guidance Patients with special healthcare needs may have behavioral challenges that can impede the safe delivery of dental treatment (Da Mata, et al., 2021). Most patients with physical and mental disabilities can be managed in the dental office setting with assistance from the parent or caregiver. However, patients who do not respond to traditional behavior guidance techniques may Preventive strategies Those who care for patients with special healthcare needs should be thoroughly educated in appropriate daily hygiene
special healthcare needs, is associated with a higher rate of appropriate preventive and routine care (AAPD, 2018). As the patient grows older, he or she can be transitioned to a dentist informed and comfortable with managing that patient’s specific healthcare needs at a time agreed on by the patient, parent, and pediatric dentist. The dental home can remain with the pediatric dentist when care by a general practitioner is not possible or desired. In addition to the medical history, the patient assessment should include comprehensive head, neck, and oral examinations as well as caries risk assessment with a caries risk assessment tool or other means Gupta, et al., 2019). After evaluation of the patient’s caries risk, oral health needs, and abilities, a recommendation for an individualized treatment plan can be made. The patient and/or the person legally responsible for the patient should be presented with a summary of the oral findings and specific treatment recommendations. with medical care providers or dental specialists, as well as copies of various ancillary documents, such as test results, prescriptions, and laboratory work orders (Singh, 2019). Written referrals to other providers should include the nature of the referral, patient history, and clinical findings. In many instances, the dentist may request additional clinical tests including blood work and the evaluation of various organ systems. Information from psychiatrists or social workers can help assure compliance of patients with their medication regime. If verbal communication skills are limited, the oral healthcare team should be alert for nonverbal cues from the patient and recruit a parent, family member, or caretaker to facilitate communication or provide information. A patient that cannot communicate verbally may communicate in a variety of non- verbal ways. An accompanying caregiver can provide valuable information about non-verbal clues such as body language, posture and facial expressions as the patient’s means of communication with the dental staff. The ADA requires that communication be offered in forms that patients readily understand. This may include the obligation to provide translators at no cost to the patient. However, if a patient is of the age of majority but does not understand the risks, benefits, or alternative to care, alternatives for consent must be investigated. This might require the assistance of clinicians not involved with the care of this patient. Social workers can help with the filing of power of attorney or conservator paperwork to assign consenting responsibility to the appropriate individual if the clinician is concerned about the ability of a patient to offer consent. It is the responsibility of the clinician to determine whether or not the patient understands the risks, benefits, and alternatives of care. If there is some uncertainty, professional colleagues can assist with this task. be candidates for protective stabilization, intravenous conscious sedation, or general anesthesia (Singh, 2019). Provision of care in a hospital or surgical facility may be appropriate if adjunct anesthesia is not feasible or effective in the office setting. In many instances, delivery of dental care in these settings requires additional training or credentials.
practices (Anzil, 2017). Dental professionals should demonstrate oral hygiene techniques to parents, caregivers, and patients,
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