including the proper positioning of the patient. Brushing techniques should also be demonstrated using a fluoridated dentifrice. Modified toothbrushes can facilitate brushing by individuals with physical disabilities, and floss holders may help in flossing. When the patient is unable to practice appropriate oral care, caregivers should be enlisted. Long-term prevention of dental disease can be aided through dietary counseling. A non- cariogenic diet rich in fruits and vegetables is encouraged, and both patients and their caregivers should be taught about the risk of caries from oral pediatric medications rich in sucrose and dietary supplements rich in carbohydrates (AAPD, 2021). Other oral side effects from medications (e.g., xerostomia and gingival overgrowth) might also be reviewed. Resources to overcome barriers When appropriate, dental healthcare professionals can enlist assistance from community- based resources for patients with special healthcare needs (Anzil, 2017). The dentist and patient might be better able to address language and cultural barriers with the assistance of local hospitals, public health facilities,
Prevention of caries may be aided by placing sealants as well as topical fluorides (using brush-on gel, mouth rinse, varnish, or professional application during prophylaxis), especially in patients at high risk for caries Gupta, et al., 2019; JADA, 2019). Interim therapeutic restorations with materials such as glass ionomers that release fluoride can also have both prophylactic and therapeutic benefits (AAPD, 2021; Gupta, et al., 2019; Rolim, et al., 2019). Chlorhexidine mouth rinse can be a useful therapeutic adjunct if the patient suffers from gingivitis or some other forms of periodontal disease. Application of chlorhexidine via toothbrush can be used for patients who might swallow the mouth rinse. More frequent recall, every 2 to 3 months, is indicated for patients having severe dental disease, and referral to a periodontist is recommended for patients with progressive periodontal disease. rehabilitation services, or groups that advocate for the special needs community. In addition, financial support or transportation to facilitate access to care might be available from community- based resources. Therapeutic intervention for congenital oral conditions may occur over a long period and often requires intervention coincident with developmental milestones (Krishnan, et al., 2018) Therefore, an interdisciplinary team approach is preferred, especially for patients with conditions such as ectodermal dysplasia, epidermolysis bullosa, cleft lip or palate, or oral cancer. Successful treatment outcomes depend on the coordination of services by the various healthcare personnel. Unique financial barriers may complicate treatment planning for patients with developmental or acquired orofacial conditions because medical health benefits often do not cover related professional oral health care (Killmurray, 2019). The dental community must make an effort to help the insurance industry recognize the medical indication and justification for treatment in these cases.
Patients with developmental or acquired orofacial conditions Clinicians should be aware of any special considerations required to meet the oral healthcare needs of patients with developmental or acquired orofacial conditions as these issues can present with unique clinical challenges. (AAPD, 2021). Although longer appointments or advanced behavior guidance techniques are not usually needed, management of some oral conditions can present challenges to the clinician (Anzil, et al., 2017). From their initial contact with the child and family, dental professionals should assist the family in adjusting to developmental or acquired orofacial conditions of the patient and related oral needs (Krishnan, et al., 2018). This is best achieved by a sensitive approach to the patient’s psychosocial well-being and by addressing the effects of the condition on growth, function, and appearance. Referrals For patients with developmental or acquired orofacial conditions, if timely intervention is not provided, progression of the patient’s oral disease may occur with associated pain, discomfort, increased treatment needs and costs, and
diminished oral health outcomes. Therefore, the dentist should make appropriate referrals when the patient’s needs exceed the skills of the practitioner to protect the overall health of the patient. (Anzil, et al., 2017). EDUCATING DENTAL PROFESSIONALS IN ORAL CARE FOR PATIENTS WITH SPECIAL NEEDS
Pediatric dentists have assumed the lead in treating children with special healthcare needs but with only about 5,000 pediatric dentists in the United States it is essential that the curriculum of each dental school incorporates didactic and clinical training for undergraduate students for the treatment of children and adults with special healthcare needs (National Council on Disability, 2019). In 2002, the ADA adopted Resolution 66H (Oral Health Access for Persons with Special Needs), which called for dental and allied programs to educate students about the oral health requirements of people with special healthcare needs. In response to interest from organized dentistry, the Special Care Dentistry Association (SCDA) formed the American Board of Special Care Dentistry to grant the credential of Diplomate in Special Care Dentistry for “outstanding individuals in the field of special care dentistry” (SCDA, 2016a). The SCDA also offers fellowship programs sponsored by the American Academy of Dentistry for Persons with Disabilities, the American Association of Hospital Dentists, and the American Society for Geriatric Dentistry. In addition to the SCDA, the American Academy of Developmental Medicine and Dentistry is another resource for dental professionals to obtain information and training on treating patients with special needs.
Current practitioners also have greater educational opportunities in the field of special care dentistry. A number of organizations and institutions have developed educational programs focused on patients with special needs. For example, both short- and long-term clinical training programs for dentists are available from the University of Washington through its Dental Education in the Care of Persons with Disabilities program (University of Washington School of Dentistry, n.d.). Distance learning is available for some portions of the didactic program as well as clinical training. Some institutions provide online courses in oral health care for persons with disabilities. Rutgers University offers a second-year general practice residency program in special care dentistry, including behavior management and training in comprehensive dental care in the operating room (Rutgers School of Dental Medicine, n.d.). Several institutions around the country offer general practice residency programs with exposure to special needs patients. SCDA provides a list of these programs, with contact information (http://www.scdaonline. org/?GPRPrograms). Table 1 presents resources from other organizations and institutions.
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