For patients who have physical disabilities, accessing a dentist can be a big struggle. So what can you do to help facilitate care for these patients?
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| An example of a wheelchair recliner - with me in it! |
1 in 4 people in the UK have a disability. There are various forms of disability from learning disability, hidden disabilities, sensory disability and physical disabilities. Physical disabilities can be progressive, temporary or fairly stable depending on the individual.
Examples of physical disabilities include:
- People who require assistance in walking e.g. walking sticks, walkers
- People who cannot walk or self-mobilise and require the use of wheelchairs
- People who cannot mobilise at all, often confined to their beds or require hoisting into a wheelchair
- People with dexterity issues for example arthritis in their hands, tremors, reduced grip strength
These can be because of conditions such as cerebral palsy, multiple sclerosis, Parkinson's disease, epilepsy, spinal cord injuries, amputations etc.
Physical disabilities can be congenital e.g spina bifida, cerebral palsy, or acquired such as amputations, arthritis.
They can be be musculoskeletal affecting joints bones and muscles (musclar dystrophy, arthritis), where the disease leads to inability to perform movement of body parts due to deformities, diseases or degeneration of muscles or bones. Alternatively, they can be neuromusculoskeletal where the inability to move affected body parts is because of disease, degeneration or disorder of the nervous system (cerebral palsy, stroke).
How do Physical Disabilities affect Dental Care?
People with physical disabilities could have poorer oral health and difficulties accessing dental care compared to the general population. This can be because:
- They find it difficult to get out of house. They might rely on carers or relatives to support them to mobilise or take them to appointments. They might require transport services to bring them to clinics, or a crew to get them out their house if there are obstacles for example stairs.
- They might struggle travelling to appointments. If they rely on public transport they might find it difficult accessing these services, or they have to allow extra time. They might be uncomfortable travelling long distances for example, sores from being in the same position in a wheelchair.
- Clinics might be inaccessible. For example, if there are steps or the clinic is up stairs without a lift. Doors and corridors might not be wide enough to accommodate a wheelchair. There might not be easy access or disabled parking available.
- Patients might struggle to get into the dental chair or cannot transfer without a hoist
- Oral hygiene can be challenging if patients cannot brush effectively
Top Tips in Managing these Patients
1. Complete Disability Awareness Training as a Team
It is so important that not just the clinical members of a team complete disability awareness, but also reception and admin staff.
This is because as soon as a patient contacts your practice or clinic, they might require reasonable adjustments according to the Equality Act to access care. This might mean accommodating them at the surgery at a certain time e.g. later on in the day if they have carers to assist them in the morning.
To read more about disability awareness in dentistry, read this blog here.
2. Think about your Clinic Environment
Are there simple adjustments you can do to increase accessibility at the surgery or clinic? For example:
- Installing handrails for steps
- Painting edges of steps in a different colour to make them visible
- Installing ramps if possible
- Ensuring there is a disabled parking space if possible
- Removing obstacles which narrow corridors or spaces
- Having a lower reception desk for those who are in wheelchairs
- If you are replacing a dental chair, having a break-leg design can be easier for patients to get in and out of
3. Do you actually HAVE to transfer patients from their Wheelchairs?
If patients cannot or find it difficult to transfer from their wheelchairs to the dental chair, if appropriate, sometimes you can see them in their wheelchairs.
Some wheelchairs recline back which can really help with your access. Certainly for examination and possibly simple treatment you could think about treating them in their chairs. Be careful of yours and your nurse's posture though - you don't want to injure yourself!
4. Complete Manual Handling Training
If patients need some help transferring, only do so if you are confident and have completed manual handling training to ensure you and the patient are safe. Always ask patients permission if you think they need some help.
5. Adapt Oral Hygiene Advice
Some patients might struggle with brushing and other oral hygiene, so listen to patients and what they find difficult to help guide them. Examples of adaptations might be:
- Brushing later on in the day for patients with arthritis who have 'morning stiffness'
- Having thicker handled toothbrushes to help with grip. You can buy toothbrush sleeves, adapt with a tennis ball or even make a putty handle to attach to their current toothbrush - see below
- Recommend an electric toothbrush or Dr Barman's 3 sided toothbrush if they get tired
- Engage with a carer to relative to assist with oral hygiene
- For interdental aids, using the long handled interdental Tepe brushes
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| Toothbrush adaptations. From left to right: Collis curve toothbrush, Tennis ball to adapt handle, putty to adapt handle & Dr Barman's 3 sided toothbrush |
What about those with Severe Disabilities?
For those who cannot transfer from their wheelchairs or where it is very challenging to treat them due to physical disabilities, or those who require stretchers, referral to Special Care Dentistry might be required.
They will be able to offer adaptations, for example:
- Patient transport to assist bringing them to clinic
- Domiciliary visits for those who really struggle to get out their residence
- Wheelchair recliners so the patient doesn't need to be transferred from their chair for treatment - see the top photo
- Hoists
- Access to stretcher lists
Treating patients with physical disabilities does sometimes take patience, out of the box thinking and really listening to patient needs - but all healthcare professionals have a legal and ethical requirement to make reasonable adjustments when seeing these patients.
