Dentistry for Patients with Special Health Care Needs
Patients with special health care needs are those having medical, social, psychological, or physical conditions that interfere with their ability to receive routine dental care. These conditions not only require modifications to the manner in which dental care is provided, but also requires innovative plans and methods for daily oral hygiene practices either by the patient or their care giver. Examples of such conditions include accidental and developmental disabilities, complex medical conditions, psychological issues as well as situational anxiety and phobias from past dental experiences.
Accidental disabilities often occur following major traumatic events or illness. Many of these events leave the patient with physical or neurological conditions that make routine dental care and daily oral care challenging. Many patients with accidental disabilities have mobility problems which require special accommodations. Examples of patients with accidental disabilities include those who have suffered stroke, motor vehicle trauma, and those with other physical handicapping conditions.
Developmental disabilities such as autistic spectrum disorder, cerebral palsy, Down syndrome, and other forms of cognitive impairment are present from birth and last throughout the patient's lifetime. These disabilities affect the mind, body, and skills people use in everyday life. Many of these patients have variable abilities to cooperate during dental treatment and usually present with limited capacity to understand instructions and perform daily oral self care.
Medically compromised patients include those of advanced age as well as any patient with complex medical conditions. This may include patients with heart, liver or kidney disease or patients with Alzheimer's or other forms of dementia. Medical consultation is often a necessary part of this patient's care. Many medical conditions and the pharmaceutical agents used to treat them have effects on the health of the mouth as well as the procedures and drugs used during routine dental care.
Many patients have had bad experiences during previous dental encounters and have developed anxiety which may prevent them from seeking professional dental care. As a result of this avoidance, their oral health will often deteriorate until acute pain or serious infections forces them to seek care. Many apprehensive dental patients must be treated under conscious sedation or general anesthesia initially but may improve after experiencing several positive dental appointments.
Treatment for Patients with Special Health Care Needs
Providing dental care for patients with special health care needs requires adaptations to routine dental
procedures that allow for those procedures to be completed. It also requires working with the patient or
their care giver to develop innovative methods of performing daily oral care. Each patient's treatment
plan begins with a thorough evaluation of their medical and dental history along with the nature of their
special need. Oral and radiographic (x-ray) examinations are completed as much as the patient's
circumstances will allow. Finally, consultation with their physician or evaluation of laboratory data is
performed as needed.
Treatment modifications for patients with special health care needs include accommodating to their
special physical, emotional and psychological needs. This may involve physical accommodations to allow
for wheelchair use or transfer to the dental chair. It may also involve modification of their daily
medication therapy or physiological monitoring in order to assure their safety during the dental
For those patients unable to tolerate dental care due to anxiety, inability to remain still or inability to
understand or comprehend instructions, conscious sedation or general anesthesia is used to enable the
patient to receive comprehensive dental care all the while remaining safe and comfortable. Patient
safety is our utmost concern. When general anesthesia is used, a separate board certified
anesthesiologist is present to ensure patient safety and to monitor the patients during the dental