12 Days of Christmas in Special Care Dentistry

In the run up to Christmas, over on my Instagram, I've been celebrating the diversity of patients I see as part of my speciality... Special Care Dentistry...

Special Care Dentists manage people with impairment or disability... and this can be very wide ranging, from medical disability to physical disability, to learning, disability to cognitive, disability to mental disability, to social disability, to emotional disability.....

So for every day in the run up to Christmas (and there's only 2 more to go!), I've been posting about the different groups we see, and why every day working with Special Care patients is different! So who do we see?

1.Medical Complexities

Since Special Care either has closer links with, or in some cases (such as the services I work in) are based in secondary care, we tend to manage patients with complex medical issues from cardiac issues, renal disease, liver disease, epilepsy, diabetes... etc etc. 

Whatever medical issues people have, you can classify their stability using the ASA classification. We use this to risk assess each of our patients to safely plan their dental care. 

2. Substance Misuse

Substance misuse is more than just IV drugs and alcohol. It includes the recreational use of other substances such as poppers, prescription drugs (benzos or pregablin for example), laughing gas or solvent. Of course, much of the popular drugs of choice are drugs such as alcohol, cannabis, cocaine and heroin. These all have an impact on oral health. 

If you'd like to learn more about IV drug use in dentistry, check out this presentation I did for our Special Care registrar group here

3. Physical Disabilities

These can be people who have difficulty walking and need frames, walking sticks or even wheelchairs, or other physical disabilities that mean that accessing dentistry or providing their oral care is difficult; such as obese patients. 

This means they might require additional adaptations such as banana boards, hoists, bariatric dental chairs or WC recliners - or even domiciliary care. 

4. Learning Disabilities

People with learning disabilities often have poor oral health, find accessing dentistry difficult and have difficulty in communicating, consenting and cooperating for their dental treatment. 

This means dentists need to use Mental Capacity Act principles to provide the care that is in their best interest; including dental treatment under sedation or general anaesthesia where appropriate. 

5. Brain Injuries

Brain injuries occur after birth and are most commonly caused by trauma, haemorrhage (i.e. a stroke) or from conditions such as encephalitis. 

This can lead to very specific oral health issues, such as limited mouth opening, lip biting, bruxism, drooling and dry mouth or saliva secretions. Good oral care is essential for this group, who are usually at higher risk of aspiration pneumonia, a very serious respiratory infection. 

6. Homeless or Socially Excluded

My favourite topic where you will find lots of blogs on over the years! These people encounter poor oral health, coupled with poor access to services that needs to be addressed.

7. Dental Phobia

Many people are anxious of the dentist, but around 10-12% of the population have a severe dental phobia. There are methods we can offer our patients to deal with their phobias from behaviour management techniques, to non-pharmacological methods, to sedation and in some cases general anaesthesia. 

8. Mental Health Problems

Mental health issues are common, with 1 in 4 people in the UK having these conditions; from anxiety and depression, to schizophrenia, eating disorders or personality disorders. 

These can have impacts on dentistry from again poor access, to poor oral health and consent or behaviour challenges in the surgery. 

9. Sensory Impairments

This includes people with sight or hearing impairments, people who are deafblind as well as disorders of other senses such as hypersensitivities to taste and touch (which is common in Autism). 

10. Oncology 

Special care is often included in the planning and management of patients who have just be diagnosed with cancer, those undergoing cancer treatments, and the long term management of people who survive their cancers. 

Making decisions can often be very difficult when planning care for these patients, especially when discussing the risks of MRONJ vs extraction of teeth prior to their treatment.

11. Autism

A condition characterised by difficulties in communication, difficulties in socialisation and a dislike of changes in routine. There are some wonderful resources in popular culture that reference autism, which can also have a learning disability associated with the condition. To learn more about tips to manage these patients, see my blog post here

12. Older People

Our population is ageing and so managing older people retaining their teeth for longer is something we should all be getting used to. But with ageing comes challenges, from medical conditions, failing dentitions, cognitive issues and having to increasingly rely on a third party for mouth care. To read more about gerodontology, see this blog post.

To learn more from my 12 days of Christmas Project, please check out my Instagram

Do you see any of these patient groups? Please leave your experiences in the comments below

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