The American Academy of Pediatric Dentistry (AAPD) defines a patient with special health care needs (SHCN) as an individual with “any physical, developmental, mental, sensory, behavioral, cognitive or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs.” Historically, children and even adults with SHCN have been treated by pediatric dentists because of the behavioral management necessary for many of these patients.
This year, ASDA focused its efforts on community service and highlighting underserved populations. The first special population we focused on was patients with special needs, which we highlighted over the summer. In addition, we shared posts on ASDA’s Facebook page as well as Mouthing Off. We heard a personal story from an ASDA member with family members who have autism and learned tips on treating patients from an IDD hygienist.
The population of dental patients who need special-needs care is growing dramatically. While predoctoral dental programs are incorporating more curriculum that allow students to treat special-needs patients, they still have a long way to go to develop competent practitioners.
Growing up in a household with a Special Education teacher exposed me to some of the most amazing people, but also the great challenges they face each and every day. From children to the elderly, special needs encompasses people of all ages and touches their lives in many different forms. Yet, regardless of the extent of their condition, special needs patients still have the same needs as you and me when it comes to oral health care.
Does the thought of treating a patient with an intellectual disability make you nervous? Health care providers are often intimidated by the idea that they may not know how to properly coordinate the patient’s care, communicate with him or her, or even manage behavior during the visit. Take a deep breath and look at it from the other side–your patient is just as nervous about you! Dental anxiety is common among many of our patients, and this fear can be magnified in someone with a cognitive delay who is coming to your office for treatments that they may not fully understand. Treating these patients may be a challenge, but it also might become one of the most rewarding patient visits you will ever encounter. Try some of these practical tips to facilitate smooth and enjoyable visit for you and your patient.
- Practice active listening. Patients with developmental delays may have difficulty with speech and communicating clearly. But, you might be surprised to find that they can understand much more than they can convey. Stopping your work for a minute and listening intently shows that you care about what they have to say. Your patients may use verbal language, nonverbal language, or a combination of both along with gestures. Be perceptive and sensitive to their efforts to show you are doing your best to understand. This small act of kindness can make the biggest difference in how well the appointment goes. After all, everyone wants to feel heard and understood.
- Prioritize clear communication. It’s respectful to talk to your patients directly with eye contact, even when the parent or caregiver is in the room. Make sure to use simple instructions and repeat them often during the appointment. You may need to take extra time, speaking slowly and clearly, to demonstrate what your instruments are prior to using them. Be patient and give one direction at a time, using clear and simple language. Show your patients what you want them to do and remember to encourage them with generous, earnest compliments.
- Set appointments early in the day. Do this when possible to keep the patient fresh. It is also recommended to keep appointments short, even if it means scheduling multiple appointments. Doing so can efficiently engage a patient with a cognitive impairment and limited attention span, while avoiding fatiguing him or her.
- Keep your team well-acquainted with the patient. Allow patients to take the time to get to know you and your staff so that they feel fully comfortable with their surroundings, especially before you try a difficult procedure. Before each appointment, inform all members of the dental team about your patient. When he or she arrives, ensure that each member of the team helps greet the patient and makes him or her feel welcome and special. Consider even giving patients and their family members a small tour of the office before you begin.
- Get the family involved. A patient with developmental delays is often more comfortable if you can incorporate family members into his or her first visit. Showing the patient around the office also gives you an opportunity to explain what all the new sights and sounds are and more importantly, reassure the patient that there is nothing to fear. Consider allowing a parent to stay during the appointment to hold the patient’s hand and talk to him or her. Some patients may even respond well to a friendly staff member holding their hand. Asking a family member to bring in the patient’s favorite stuffed animal or blanket can add an extra sense of comfort and familiarity.
- Be mindful of your light. Patients with an intellectual disability are often also sensitive to light. Try to avoid inadvertently shining the light directly into their eyes, especially as you work with loupes on. You can also try using only your loupe lights and forgo the use of the additional overhead light. The patient may also benefit from the comfort of wearing sunglasses during the appointment.
By taking the time to get to know each patient and his or her individual needs, you will find your unease quickly replaced by eagerness each time you see the patient’s name listed on your schedule. Take each challenge as a new opportunity to learn and enjoy the process!
~ Jamie Udell, Utah ’18, chapter newsletter chair
Imagine for a minute that you have an adult family member who has a neurodevelopmental disorder, such as autism, or an intellectual disability (ND/ID). This individual with special needs must see a dentist to alleviate pain or treat oral disease but you cannot afford care and don’t qualify for Medicaid. What do you do now? How long will your loved one have to suffer?
Now come back to reality. You are a dental student who has the ability to learn, provide care and advocate for patients with special needs. Currently, those with an intellectual disability are the most underserved medical and dental population (MUP).