• What is special care dentistry?
• How does it deiffer from routine dental care?
• Where is special care dentistry available?

What is special care dentistry?

• A learning disability (e.g. Down syndrome, autism spectrum disorder)
• Physical impairment (e.g. cerebral palsy, muscular dystrophy, spina bifida)
• A chronic medical condition (e.g. cancer, congenital heart disease, epilepsy, multiple sclerosis, Parkinson’s disease)
• Mental illness
• People who are socially excluded (e.g. people from the travelling community, homeless people, people who misuse substances).
  These groups are not mutually exclusive. For example, someone with cerebral palsy may also have a learning disability and epilepsy.
  

How does it differ from routine dental care?

People with disabilities have the same dental needs as the rest of the population, but may have difficulties in accessing dental care due to physical barriers, such as steps up to a dental practice, a lack of suitable facilities, or attitudinal barriers.

Such people also need more time to understand the details of what dental care will be provided and may be more anxious about having dental treatment. Often all that is required is time to explain what is to be done, in small steps, to increase the patient’s confidence.

To help with this, dental treatment may be offered with some sedation – the patient may either breathe in a sedating gas (nitrous oxide mixed with oxygen, known as ‘laughing gas’) or take a sedative drug before the treatment. An alternative is to have the sedative drug in the form of an injection in the back of the hand or in the arm. For patients with medical conditions, sedation will be provided by a specialised dental team with training and experience in conscious sedation.

If a patient cannot co-operate sufficiently for routine dental care, either because their understanding is limited as a result of a significant learning disability, or they have a physical disability that results in uncontrolled movements, treatment may be offered under general anaesthesia. However, facilities to provide dental care under general anaesthesia are limited and, because every general anaesthetic carries a risk, should be used only when necessary.

Extra time is also needed to assess the patient’s capacity to consent to dental care. If the dentist judges that the patient does not have the understanding to make a decision about dental care, he/she must consult widely with other people, such as relatives and carers, who will consider what is in the patient’s best interests. If treatment under general anaesthesia is contemplated, the dentist is likely to discuss the proposed care plan with another dentist.

Preventing dental disease is the most important aspect of oral and dental care, since the need for more invasive dental treatment may often be avoided. Both dental decay and gum disease are totally preventable. Patients with special needs should be seen as often as their oral and dental condition dictates. Frequent visits to the dental hygienist may be all that is necessary. Each case should be judged on its needs, which will vary from patient to patient and from time to time.

Novel treatment techniques using chemico-mechanical (decay-dissolving solutions applied with special instruments) ways of removing decay, as well as ozone therapy (to destroy decay-producing bacteria), are in their infancy but may be particularly promising for people who find accepting dental care a challenge.

Where is special care dentistry available?

Special care dentistry can be accessed from three main sources:

• Dental practices
• Health board dental clinics
• Dental hospitals

Some dental practices provide care for people who need special care dentistry, but the health board dental service has senior dental surgeons with experience in providing this type of care. Limited sedation facilities are available in both dental practices and health board clinics. Access to general anaesthetic sessions are available through some health board dental facilities in hospitals and in the Cork Dental School and Hospital. Facilities providing comprehensive dental care, with the option of general anaesthetic, for adults with special needs are very limited. People with hereditary coagulation defects, such as haemophilia, have a dedicated dental service provided.

People with special needs should expect to receive similar oral and dental care to other people, although the facilities needed to provide that care might not be generally available. Some people with disabilities have particular needs that are best provided by the dental team – including speech and language therapists – from the dental hospitals, for example, the management of drooling, grinding and self-inflicted injuries.