2 Related termsImpairmentDisabilityHandicappedSpecial needs
3 Special Care PatientThe 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 DisabilitiesBritish Society for Disability & Oral HealthSpecial Care Dentistry AssociationInternational Association for Disability & Oral Health
5 Disabilities Physical disabilities Mental disabilities Learning disabilitiesSyndromes ( e.g. Down syndrome)Cerebral palsyMuscle atrophyAutism
6 Congenital or Acquired Disabilities Source: Palestine Children’s Relief Fund (PCRF Institution)
8 Delivery of care to people with special needs The development of personal dental servicesLack of funding for trainingCost of specialist services & facilitiesUnwillingness of some general dental practitioners to provide dental treatment for such groups
9 Dental Facilities Physical Disability* Some countries developed special dental units or chairsWheelchair platforms provide a better, cheaper, and more effective service to special care dentistry patients* Design Specific, Special Needs Dentistry.
10 Dental Facilities Physical Disability.. Design Specific (Britain)* Full Function Wheelchair platformMobile Wheelchair platformWheelchair Recliner* Design Specific, Special Needs Dentistry.
13 General Aspects of oral status in impaired patients Poor cooperationResistance to mouth cleaningChallenging behaviorLimited access to dental services
14 Preventing dental caries in special needs patients Dental caries prevalence in patients with impairments is higherMore untreated decayMore missing teethFewer restorationsOral 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 & formLiquid oral medicinesChlorohexidine (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 structureOzone therapy: no need forusing dental handpiece or localanesthesia…useful methodOralsolv.se. Feb 2007.
19 Tooth wear in special needs patients Neurological impairment clenching or grinding causes attritionCerebral palsy gastroesophageal disease vomiting causes erosionBizarre oral habits abrasion
20 Preventing tooth wear in special needs patients If no toleration for extensive treatment remove badly worn teethWith toleration under sedation or GA full coverage of affected teeth & molarsCleaning aids not to be erosive
21 Gingivitis in special needs patients Poor oral hygiene resulting in plaque accumulation and gingivitisDown syndrome more prevalent periodontal disease & early tooth lossEpilepsy medications gingival hypertrophyMouth cleaning mission (carers & relatives)
22 Preventing gingivitis in special needs patients Change medication or modify dose (physician)Modified manual toothbrushesMouth 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 gelAlso 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 itLip & 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 extractUse soft splints to prevent soft tissue traumaIf malocclusion teeth adjustment & orthodontic treatment depending on case
26 Preventing hypersalivation in special needs patients Excessive drooling especially in poor neuromuscular control (cerebral palsy or cerebro-vascular accident)Prevention & management:SurgicalPharmacologicalRadiotherapyPalatal training aids ( Hyoscine patch /anticholinergic )Behavior modification
27 Xerostomia in special needs patients Associated with:SyndromesMedications (elderly patients)Patients on radiotherapyResults in increased rate of dental caries and ill-fitting dentures
28 Preventing xerostomia in special needs patients Radiotherapy: preoperative dental care to avoid extractionsHigh dose fluoride (varnish)Chlorhexidine mouthwash or gelSaliva 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.World Health Organization, Oral Health Program. ARTPrevention of Oral Disease, J. J. Murray, 4th edition, 2003, Oxford Press.Carisolv presentation. Februray 2007MediTeam Dental. February
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