Special needs dentistry, also known as special care dentistry, is a dental specialty that deals with the oral health problems of geriatric patients, patients with intellectual disabilities, and patients with other medical, physical, or psychiatric issues. Special needs dentists typically have additional postgraduate training after attaining their dental degree. These requirements are dependent on the dentist's country or other jurisdiction. Some countries offer Board Certification in special needs dentistry, such as the American Board of Special Care Dentistry (Diplomate) or the Royal Australasian College of Dental Surgeons (FRACDS (SND), Fellowship). Oral health therapists have incorporated studies to allow for their scope of practice to cover working with people with special needs. They may accompany a dentist within clinic or domiciliary environments to aid in education, disease control and maintenance of patients with special needs. Patients who require special needs dentistry may live at home, in hospital, in secure units, in residential or nursing homes, or they may be homeless or vulnerably housed. Their additional needs may be due directly to their impairment or disability, or to some aspect of their medical history that affects their oral health, or because their social, environmental or cultural context disables them with reference to their oral health.
Special Needs patients
Cardiovascular Disease For patients with cardiovascular disease, the dental team must have a thorough understanding of common cardiac conditions and how to manage these patients. This is because dental procedures and drugs used in dentistry may aggravate heart disease. Common cardiovascular conditions that are dealt with in special care dentistry include: hypertension, angina, myocardial infarction and inherited and acquired bleeding disorders. Cardiovascular disease is associated with the following oral implications:
Periodontitis Caries Xerostomia
Respiratory Disease The two most common respiratory diseases that may be encountered in dental practice are asthma and COPD (Chronic Obstructive Pulmonary Disease).
Developmental Disabilities
Autism Autistic patients have a higher risk of:
caries bruxism tongue thrusting self-injurious behaviour such as picking at the gingiva or biting the lips delayed tooth eruption can be seen in Autistic patients.
Cerebral Palsy Patients with cerebral palsy not only struggle accessing dental services and performing oral care. As a result, these patients are often faced with higher levels of untreated disease and tooth loss.
Poor oral hygiene Periodontitis Xerostomia resulting from mouth breathing and medications Enamel hypoplasia Caries Drooling Dysphagia Bruxism Fractured teeth
Down's Syndrome The majority of patients with Down's Syndrome can be seen in primary dental care with appropriate behavioural management techniques, the degree to which this is successful is entirely dependent on the extent of the learning disability and the cooperation of the patient. Many procedures can be successfully carried out under local anaesthesia but attention should be paid to any pre-existing cardiovascular or neurological conditions. Should the patient be uncooperative or require sedation or general anaesthesia, care can be shared with specialist services. The following oral features are common:
Delayed dental development and eruption Hypodontia Microdontia Hypocalcification High incidence of severe early onset of periodontal disease Protruded tongue Strong gag reflex
Mental Health Conditions This area of special care dentistry is more common in young adults and adolescents.
Schizophrenia Poor self care including diet and oral hygiene Xerostomia as a result of antipsychotic medication Caries Periodontal disease Tardive dyskinesias characterised by involuntary muscle movements
Bipolar Disorder Poor oral hygiene Increased levels of plaque and calculus Increased risk of periodontal disease Increased caries Xerostomia
Depression Xerostomia (typically due to tricyclic antidepressant medication or due to an anxiety component to the disorder) Poor self-care including diet and oral hygiene Caries (change in appetite/diet can be a factor in the disorder) Periodontal disease Oral dysaesthesia (generalised physical aches and pains)
Geriatric Patients Cardiovascular disease Diabetes Hypertension Macular degeneration When treating the geriatric age group it may not just be situated within the dental practice is can include; independent living, shared housing, assisted living, continuous care communities and nursing homes. The Oral Health Therapist and Dentist are readily needed in these areas to help treat and prevent the further progression of dental disease. Extra empathy must be used when treating geriatric patients as some of them that are being treated may be palliative care or suffering from a severe and enduring mental illness. One of the major obstacles when treating this group of patients is gaining informed consent. Many health care workers in the field consider that the geriatric group can make and assist in their own decision making. Ensuring that the patient is fully adequate in making the informed decision about treatment planning is vital for legality reasonings. The institutionalised elderly people show a greater number of caries and root caries than other elderly groups.
Drug dependent patients The drug dependent patients generally consume large quantity of sugar (especially methadone users) which lead to caries. Their teeth are mostly damaged or lost because of convulsions. They also show high level of anxiety towards dental services.
In Australia and New Zealand The Australian Dental Council recognized the specialty of Special Needs Dentistry in November 2003. Among some of the first countries to establish Special Needs Dentistry as a speciality are Australia and New Zealand. There are now a number of training programs, within both countries, which have been established as pathways into this speciality. There are several professional societies in the two nations that provide resources for dental health and advocate for people with special needs.
Australian and New Zealand Academy of Special Needs Dentistry This academy is a group of specialists who are registered as Special Needs Dental practitioners in both Australia and New Zealand. This organisation was developed with the intent to establish a network for those involved in Special Needs Dentistry.
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