Dental Care for Patients With Special Needs:
How Does It Work?
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A survey was conducted to identify the most critical issues special needs dentists encounter when treating their patients.
Among the dentists surveyed, 73.5% said that they treat less than ten patients annually. Also, 73.1% (38) of dentists believe that people with physical disabilities do not have good oral hygiene.
Based on the same study, the percentage increases among patients with collaborating and non-collaborating cognitive disabilities.
This survey tells a lot about the challenges constantly faced by persons with disabilities and caregivers regarding dental care.
Whatever the circumstance, everyone deserves access to oral healthcare and a healthy smile.
If your child’s physical or cognitive challenges have become a roadblock to visiting a dentist, read this guide.
Ultimately, you'll learn how dental professionals like us in Culver City tailor appropriate dental treatments for people with specific needs.
Understanding special needs dentistry
According to the Americans with Disabilities Act of 1990, disability “is a physical or mental impairment that substantially limits one or more major life activities of such individual.” These may include hearing, vision, communication, mobility, or other activities of daily living.
On the other hand, special healthcare needs, as defined by the American Academy of Pediatric Dentistry (AAPD), encompass many conditions, including physical, developmental, mental, sensory, behavioral, cognitive, or emotional disabilities.
Patients or children under special healthcare needs encompass individuals who face challenges arising from various physical disabilities, such as:
- Congenital, traumatic, or physiological factors
- Medical complexities (including systemic, acquired, or hereditary conditions)
- Developmental challenges (either congenital or acquired)
- Cognitive impairments (covering mental, sensory, emotional, or behavioral aspects)
Persons who are suffering from these conditions also possess unique requirements that necessitate special dental care services.
Special needs dentistry often addresses and treat various oral health conditions, including:
- Accumulation of calculus, leading to heightened gingivitis and an elevated risk of periodontal disease
- Enamel hypoplasia
- Dental caries
- Oral aversion and behavioral issues
- Dental crowding
- Malocclusion
- Irregularities in tooth development, size, shape, eruption, and arch formation
- Bruxism and the formation of wear facets
- Tooth fractures or trauma
Providing proper dental treatment to patients with special needs has always been a struggle due to some factors. But with recent studies and developments in special needs dentistry, dental care professionals are making treatment processes more comfortable for patients and parents.
But before we discuss these approaches further, let’s first talk about the factors influencing dental care for patients with disabilities.
Factors influencing dental care for patients with intellectual and developmental disabilities
Research conducted by the US Census Bureau revealed that approximately one out of every eight individuals in the United States has a disability that impacts their ability to maintain proper oral hygiene practices or hinders their access to dental care.
For example, developmental conditions, such as Down syndrome, cerebral palsy, and other cognitive challenges (e.g., autism spectrum disorder, attention deficit hyperactivity disorder) may often present challenges for parents and caregivers, or guardians and dental professionals.
Other factors influencing dental care for patients with special needs include:
- Language barriers
- Economic status
- Vision and hearing impairments
- Anxiety
- Complexity of medical conditions
- Inaccessibility of appropriate or patient-friendly equipment (e.g., wheelchair and ramps)
Special needs dentists are trained to address situations and factors that can influence dental care, including the ones mentioned above.
Just like how we do it in United Dental Care, we employ a patient-centered approach, tailoring care with the unique challenges and requirements our patients are facing.
And by understanding these factors, we can provide optimal treatment. But prior to any dental procedure, we ensure that parents or guardians alike are completely involved in the process.
Things parents need to know before treatment
Before any intervention can begin, pre-treatment planning is needed to administer a thorough review of the patient’s:
- Medical or dental history
- Behavior level
- Treatment development and goals
Special needs patients may often have limited decision-making capacity or require additional support to understand and make informed decisions about their dental treatment. That’s why parent or guardian consent plays a critical role during the pre-treatment planning stage.
In such situations, parental or guardian consent becomes essential for several reasons:
- Legal and ethical considerations - ensure that the patient's rights are protected, and that treatment is carried out appropriately.
- Shared decision-making – allows parents or guardians to participate in discussions regarding the patient's various oral health care needs, treatment options, potential risks, and benefits.
- Communication and information exchange - facilitates effective communication between dental professionals and the patient's support system team, ensuring that everyone involved in health care is well-informed and on the same page.
- Understanding of treatment plan and compliance – consent signifies their commitment to supporting the process, including any necessary modifications, post-treatment care, and oral hygiene maintenance.
The success of special needs dentistry depends on the pre-treatment planning stage. By thoroughly reviewing these aspects during pre-treatment planning, dental professionals can develop a comprehensive and patient-centered approach to address the specific needs and challenges of special needs patients.
Now, let's learn how special needs dentists tailor their approach to adapt to the specific needs and requirements of patients with disabilities.
Personalizing treatment for special needs patients
We have this so-called "’evidence-based dentistry” or a patient-centered approach to treatment decisions in dentistry. This approach to dentistry provides everyone access to personalized dental care services based on the most current scientific knowledge.
Evidence-based dentistry is essential because it helps dental professionals improve patient care quality by finding modern methods and ensuring high care standards.
The process of evidence-based dentistry (EBD) involves several steps:
- Formulating a clear and organized clinical question that can be easily searched
- Determining the appropriate level of evidence needed to address the question effectively
- Conducting a thorough search for the best available evidence related to the question
- Critically appraising the gathered evidence to assess its validity and relevance
- Applying the information obtained from the evidence to the specific patient's situation
- Evaluating the effectiveness of applying EBD in the patient's case
Let's use the following scenarios to put this approach into perspective and learn how special needs dentists handle such a case.
Treating tooth decay in patients with autism and sensory sensitivities
Imagine a 7-year-old male patient with a history of dental caries presents for dental treatment. The patient has autism and sensory sensitivities. The parents express concerns about the child's dental hygiene and seek guidance on managing his oral health effectively.
Aside from relying on experience, the dentist may search for systematic reviews, randomized controlled trials, and cohort studies related to dental caries management in pediatric patients with intellectual disabilities.
The dentist learned from his previous studies and further research that there is a high level of peripheral vision in autistic children. So lateral movements of any toy just before the patient are potential distractions and should be avoided during the initial consultation.
He is also aware that it’s crucial to decrease the exposure to auditory and taste stimuli for autistic patients. Therefore, during dental visits, minimizing overwhelming sensory experiences that may negatively impact oral hygiene practices is essential.
This includes reducing exposure to strong tastes from toothpaste and ensuring that the sensation of the toothbrush does not hinder effective brushing.
This stage may require setting up regular follow-up appointments to monitor progress, assess the effectiveness of the recommended approaches, and adjust as needed based on the child's response and parental feedback.
Administering sedation for patients with special needs
Due to issues relating to cooperation, communication skills, and limited mobility, many patients with disabilities may have difficulties accepting in-office dental treatment. Thus, they often need general anesthesia or sedation to receive treatment.
However, because of the misconceptions associated with sedation dentistry, parents have become more hesitant and anxious about the process.
But there’s more to learn about sedation dentistry and its benefits. And we’ve discussed them in this guide.
Nonetheless, parents or guardians need to know that sedation dentistry for children with special needs doesn’t always equate to complete anesthesia.
The decision to use anesthesia over sedation depends on several factors, including the complexity of the dental procedure, the patient's medical history, their level of anxiety or fear, and the dentist's assessment of the patient's ability to tolerate the process.
Sedation may be preferred in less complex dental procedures or for relatively calm patients who can receive dental services with mild relaxation.
Three levels of sedation dentistry are available, and our pediatric dentist has the right experience to determine the best for your child.
Minimal sedation
The use of minimal sedation in dental medicine allows patients to relax while remaining fully conscious. It creates a sense of tranquility, enabling patients to feel comfortable enough to undergo dental procedures easily.
Administering minimal sedation often involves taking a prescribed pill approximately an hour before the appointment. The other sedation option is nitrous oxide or "laughing gas."
Moderate sedation
Unlike minimal sedation, moderate sedation involves a deeper level of sedation. Patients under moderate sedation are in a state of decreased awareness but can still respond to stimuli.
When patients receive moderate sedation, they often experience a heightened sense of relaxation and limited memory of the procedure.
This type of sedation is typically administered through an injection and takes effect quickly. Unlike minimal sedation, the recovery time for moderate sedation is usually longer, with the sedative effects taking up to 20 minutes or more to completely wear off.
Deep sedation
This option gives patients little to no recollection of the procedure, as they will be predominantly unconscious the entire time.
Deep sedation is suitable for individuals with intense dental anxiety or fear. Following the procedure, the sedative effects may take up to 24 hours to completely subside.
Evaluation before anesthesia may be complex for special needs patients. That's why a thorough review of the patient's medical history, previous anesthetic exposures, allergies, and drug use will be required.
On the other hand, general anesthesia is commonly recommended for extensive dental treatments that require significant time to complete, such as multiple extractions, extensive oral surgery, or jaw realignment.
It may also be preferred by the dental team for patients with severe disabilities who have difficulty coping with dental treatment in the dental practice.
Remember that a qualified dental professional should determine the choice between anesthesia and sedation in close collaboration with the parents or guardians.
Ultimately, the primary objective is to prioritize patient well-being, guarantee their comfort, safety, and the successful execution of dental treatment.
Special needs dentist in Culver City
Now that you’ve learned everything there’s to know about special needs dentistry, it’s time to act now.
With early intervention and comprehensive care, your child with special needs wouldn’t need to suffer from the risks associated with neglected oral health care.
If you’re looking for a special needs dentist near you, you can always reach out to our team at United Dental Care.
Visit our dental office in Culver City, and together we can create an effective treatment plan that will suit your kid's specific needs.