Beyond Special Needs
Hygienists Provide Continuity of Care
Catherine Paulhamus, MA
Dental practices are experiencing a rise in the number of patients who require special accommodations during treatment. Patients with physical, emotional, developmental, cognitive, or medical needs are living longer and remaining independent, and therefore have to find continuity of care through a dental practice.
A special needs patient (SNP) is one who requires a modification of the usual plan to provide appropriate dental treatment, explains Tracye A. Moore, RDH, MS, EdD, in her course, "Dental Hygiene & Patients With Special Needs."1 Patients may exhibit disabilities due to "physical limitations (congenital, traumatic, and/or physiological), medical complications (systemic, acquired, and/or hereditary), developmental (congenital and/or acquired), and cognitive (mental, sensory, emotional, and/or behavioral) constraints."2-6 Whether permanent or temporary, any of these conditions require thoughtful alterations of the practice's treatment and office protocols.
When the dental team is unprepared to provide care under these circumstances, the situation becomes stressful for the providers and patients. Concerns about causing physical or emotional harm to the patient, liability for the practice, and even disruption to other patients weigh on the hygienist's mind.
For many dental professionals, accommodating these patients may at first seem overwhelming. Lack of experience and hands-on training, the need for special facilities and equipment, and inadequate compensation are barriers to be overcome.7 Fortunately, educational and experiential resources are expanding, as hygienists explore the opportunities to make a difference in this area.
"Most hygienists start out concerned, because this is unfamiliar ground for us," says Dee Humphrey, RDH, BS. "Most of us don't receive additional training into special healthcare needs. Sometimes, even a caregiver or parent doesn't know exactly what would work in a situation. They don't know what the options are, or what kind of products we could use that would help."
Humphrey learned in the field, by observing and asking questions. "I didn't know what was required of me," she says. "Talking with the parent, caregiver, or teacher is key, because they are carrying out the oral health care needs. We need to ask, what can we do here to help?"
Continuum of Care
Poor oral hygiene because of a patient's inability to achieve self-care may have serious health consequences. Oral health impacts learning, communication, self-esteem, and nutrition.7 By the time patients present, they may be dealing with a lifetime of compromised oral and physical health.7 When weighed against other serious, immediate health needs, oral care and preventive hygiene may fall to the wayside. "Usually when they may come to the dental office, they have several needs that need to be addressed quickly," Humphrey explains.
In addition, patients with special needs may be reluctant to seek treatment if they feel they are a burden to the practice: they can be quick to assess the attitude of a dental practitioner.
Patients with slight impairments have increased sensitivity in their other senses,8 Moore explains: "Communication in the dental setting by the dental team is affected through dialogue, tone of voice, facial expression, and body language. Communication may be compromised when the sender's expression and body language are not consistent with the intended message.5,9 Therefore, it is imperative for the dental team not only to pay attention to the body language of the patient, but to their own individual voices and body movements to ensure the messages (either verbal or nonverbal) intended for the patient were received in the manner sent."
Prepare for Individual Needs
Humphrey's work in special needs dentistry began with one question: "A teacher came into our office asking for a specialized toothbrush for an individual with special needs in her class. She wasn't speaking directly to me, but I started asking her questions to try to find the resources she needed. This initial contact opened up the opportunity to visit the public school setting, where I was able to assess and train the teachers in the special needs class. After interacting with the children, I saw a great need for preventive care services."
As a result, Humphrey applied for grant money which she used to develop an oral health program in the school. "I learned as I listened to each individual," she says. "What tools, what medicaments could I find to help them? Finding solutions requires patience, trial and error-and thinking outside the operatory." For example, Humphrey would like to see more dental hygienists at the corporate level, leveraging their experience by doing product research on preventive aids to help individuals with special healthcare needs.
Hygienists have opportunities within the practice to take the lead on special care dentistry. "The dental hygienist can use her acquired knowledge and insight to educate the whole team," Humphrey says. "It involves education, starting at the front desk with the appropriate questions to ask during the intake process. Then when a special need is identified, we can follow up for further patient assessment with the healthcare provider who's treating the patient. After obtaining as much information as possible, we can modify the treatment and plan for additional resources that are needed." The deciding factor in the patient's overall success of treatment can be the dental hygienist's willingness to ask, listen, and learn.
With many competing health issues in their lives, Individuals with special needs often need oral healthcare, yet have fewer options for treatment. An informed and responsive dental team can alleviate their concerns.
1. Moore TM. Dental hygiene & patients with special needs.
2. American Academy of Pediatric Dentistry. Guideline on management of dental patients with special health care needs. Pediatr Dent. 2012;34(5):160-165.
3. Muzzin K. Persons with disabilities. In: Darby ML, Walsh MM. Dental Hygiene Theory and Practice. 4th ed. St. Louis, MO: Elsevier Saunders; 2015:786-804.
4. Wilkins EM. Section VIII: Patients with special needs. In: Clinical Practices of the Dental Hygienist.. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2013:742-1056.
5. DiMatteo AM. Serving patients with special needs. Inside Dentistry. 2009;5(2). https://www.dentalaegis.com/id/2009/02/serving-patients-with-special-needs. Accessed November 5, 2015.
6. Commission on Dental Accreditation (CODA). Accreditation standards for dental hygiene education programs. https://www.ada.org/~/media/CODA/Files/2019_dental_hygiene_standards.pdf?la=en/. Accessed December 20, 2020.
7. Jaccarino J. The Patient with Special Needs: General Treatment Considerations. American Dental Assistants Association. March 2016. https://cdeworld.com/courses/20425-the-patient-with-special-needs-general-treatment-considerations. Accessed December 19, 2020.
8. American Association of Pediatric Dentistry (AAPD) Reference Manual. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent. 2011;36(6):179-191.
9. Jaccarino J. Helping the special needs patient maintain oral health. DentalCare CE. http://media.dentalcare.com/media/en-US/education/ce393/ce393.pdf. Accessed November 5, 2015.