Special needs dentistry


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 or the Royal Australasian College of Dental Surgeons.
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:
The two most common respiratory diseases that may be encountered in dental practice are asthma and COPD.

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.
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:
This area of special care dentistry is more common in young adults and adolescents.

Schizophrenia

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 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.

Australian Society for Special Care in Dentistry (ASSCID)

The Australian Society of Special Care in Dentistry was formed in 1997 and currently has 65 representative members within each state and territory of Australia. The objectives of ASSCID include an oral health and special needs educational role for dental professionals and other allied health workers. They act as a resource hub for professionals on the special needs patient and how best to formulate care plans.

Australian and New Zealand Society of Paediatric Dentistry (ANZSPD)

The Australian and New Zealand Society of Paediatric Dentistry was established in 1988. It is a collaboration of two associations, the Australian Society of Dentistry for Children and the New Zealand Society of Dentistry for Children.

Australasian Academy of Paediatric Dentistry (AAPD)

The Australasian Academy of Paediatric Dentistry was developed in 1990.

Dental Health Services Victoria (DHSV)

The principal public oral health organisation in Victoria, Australia, is Dental Health Services Victoria. It was founded in 1996 DHSV provides clinical care to patients from the Special Care Unit at the Royal Dental Hospital of Melbourne, via two special dental vans and also through a domiciliary service.
All children enrolled in special or special developmental schools both in urban and rural areas are presented with the opportunity for oral health care at no cost at one or two-year intervals.

In the United Kingdom

Special Care Dentistry is the thirteenth and most recent dental speciality to be approved by the United Kingdom General Dental Council. To date, there are 73 specialists on the GDC specialist list. National Health Service consultant posts in Special Care Dentistry have been set up in some areas of the United Kingdom.
United Kingdom specialists in SCD, and dentists with a special interest in SCD, may work in NHS or private general practice, NHS community/salaried dental services or hospital dental services. People with impairments or disabilities who require Special Care Dentistry may seek a special care dentist by contacting their local healthcare provider or by obtaining a referral from, for example, their general medical or dental practitioner. Most SCD services have referral criteria which specify which groups of people they will accept for dental treatment.
Specialist training programmes are being introduced across the United Kingdom to provide training in SCD, leading to admission onto the GDC specialist list. Postgraduate qualifications in SCD are available from institutions such as the Royal College of Surgeons of England, the Royal College of Surgeons of Edinburgh, University College London Eastman Dental Institute and King's College London Dental Institute. There are also post-qualification courses available in SCD for Dental Care Professionals such as dental nurses, hygienists and therapists.

In the United States

s who want to treat patients in the United States with special needs conditions may choose to complete either a 1-year general practice residency or advanced education in general dentistry residency program. A GPR program tends to be associated with a hospital and give the dentist the experience of treating patients with special care needs under general anesthesia. One such example of this specialized training is through Rancho Los Amigos National Rehabilitation Program, at Los Angeles County Hospital, in Downey, CA.
Dentists in the United States are not obliged to complete formal post-doctoral residency training because it is not required by local, state, or national governing dental boards. There are various reasons why a dentist does not complete formal post-doctoral residency training, namely, it is not a requirement to practice general dentistry in the United States. However, dentists who desire to treat patients with special needs conditions can still do so with taking continuing education courses. One option to receive training and in-depth special care education is through the organization Special Care Dental Association. This organization also offers American Board Certification in Special Care Dentistry.