Prepared byDr. Rana Darwish

DDS, MPH

Impairment Disability Handicapped Special needs

The term "Special Patient" is used in the oral health field to describe an individual

with special needs, including physical, medical, developmental and/or cognitive conditions, resulting in limitations in their

ability to receive dental services and prevent oral diseases by maintaining

daily oral hygiene. *

* Prevention of Oral Diseases. 2003

Public Health Associations (American & Canadian)

Academy of Dentistry for Persons with Disabilities

British Society for Disability & Oral Health

Special Care Dentistry Association International Association for Disability

& Oral Health

Physical disabilities Mental disabilities Learning disabilities Syndromes ( e.g.

Down syndrome) Cerebral palsy Muscle atrophy Autism

Source: Palestine Children’s Relief Fund (PCRF Institution)

Atfaluna Society for Deaf Children – Gaza Strip

The development of personal dental services

Lack of funding for training Cost of specialist services & facilities Unwillingness of some general dental

practitioners to provide dental treatment for such groups

Some countries developed special dental units or chairs

Wheelchair platforms provide a better, cheaper, and more effective service to special care dentistry patients

* Design Specific, Special Needs Dentistry. http://www.designspecific.co.uk/

Full Function Wheelchair platform

Mobile Wheelchair platform

Wheelchair Recliner

* Design Specific, Special Needs Dentistry. http://www.designspecific.co.uk/

Carers (nurse, socialWorker, …)

Medical doctor

Family

Relatives

Poor cooperation Resistance to mouth cleaning Challenging behavior Limited access to dental services

Dental caries prevalence in patients with impairments is higher

More untreated decay More missing teeth Fewer restorations

Oral health can be maintained at high level if preventive &

treatment services were provided for such target group

Topical Fluorides (High doses) High Fluoride toothpastes (for certain

groups) Toothpastes alternatives (Fluoride

mouthwash) Dietary constituents & form Liquid oral medicines Chlorohexidine (gel, varnish)

Atraumatic Restorative Treatment ART *

* WHO, Oral Health Program. ART Manual 2008

Atraumatic Restorative Treatment ART *

* WHO, Oral Health Program. ART Manual 2008

Carisolv *: chemo-mechanical minimal invasive approach that removes necrotic decayed dentin only leaving healthy tooth structure

Ozone therapy: no need for using dental handpiece or localanesthesia…useful method

Oralsolv.se. Feb 2007. http://www.mediteam.com/

Neurological impairment clenching or grinding causes attrition

Cerebral palsy gastroesophageal disease vomiting causes erosion

Bizarre oral habits abrasion

If no toleration for extensive treatment remove badly worn teeth

With toleration under sedation or GA full coverage of affected teeth & molars

Cleaning aids not to be erosive

Poor oral hygiene resulting in plaque accumulation and gingivitis

Down syndrome more prevalent periodontal disease & early tooth loss

Epilepsy medications gingival hypertrophy

Mouth cleaning mission (carers & relatives)

Change medication or modify dose (physician)

Modified manual toothbrushes Mouth cleaning resistant patients

powered toothbrush or “Superbrush” (opposing bristles clean 3 surfaces with one stroke)

Barman’s Superbrush –www.smile-link.com

Difficult cases (extremely ill) mouth care carried out in bed by nurse or carer toothpaste or toothbrush dipped in mouthwash or chlorhexidine gel

Also chlorhexidine varnish can be used (sustained up to 6 months)

Patients refusing or resisting cleaning aids behavior modification desensitization

Self mutilation involving oral tissues in certain syndromes.

Teething sometimes triggers it

Lip & tongue biting pain & swelling mouth is too sore to drink or eat dehydration hospitalization

If offending teeth were primary extract Use soft splints to prevent soft tissue

trauma

If malocclusion teeth adjustment & orthodontic treatment depending on case

Excessive drooling especially in poor neuromuscular control (cerebral palsy or cerebro-vascular accident)

Prevention & management: Surgical Pharmacological Radiotherapy Palatal training aids ( Hyoscine patch

/anticholinergic ) Behavior modification

Associated with: Syndromes Medications

(elderly patients) Patients on

radiotherapy

Results in increased rate of dental caries and ill-fitting dentures

Radiotherapy: preoperative dental care to avoid extractions

High dose fluoride (varnish)

Chlorhexidine mouthwash or gel

Saliva stimulation (Pilocarpine)

Saliva substitution

Each dentist should do his/her best in trying to improve the quality of life for those in

need

Palestine Children’s Relief Fund (PCRF). www.pcrf.net

Design Specific, Special Needs Dentistry. http://www.designspecific.co.uk/

World Health Organization, Oral Health Program. ART. 2008. http://www.whocollab.od.mah.se/expl/artmore.html

Prevention of Oral Disease, J. J. Murray, 4th edition, 2003, Oxford Press.

Carisolv presentation. Februray 2007 www.orasolv.se

MediTeam Dental. February 2007. http://www.mediteam.com/