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 Facilities Physical 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.

10. Dental Facilities Physical Disability.. Design Specific (Britain)*
Full Function Wheelchair platform
Mobile Wheelchair platform
Wheelchair Recliner
* Design Specific, Special Needs Dentistry.

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.

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 –

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

28. Preventing xerostomia in 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.
World Health Organization, Oral Health Program. ART
Prevention of Oral Disease, J. J. Murray, 4th edition, 2003, Oxford Press.
Carisolv presentation. Februray
MediTeam Dental. February