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Children with special health care needs include those with behavioral issues, developmental disorders, cognitive disorders, congenital or genetic disorders, or systemic disease. These conditions may place them at increased risk for oral diseases, making it important to establish preventive oral health strategies at an early age. These children should have an established dental home, through which preventive care can be initiated and maintained, by 12 months of age. Dentists can establish prevention-based care from a young age by understanding the child's condition and how that condition influences the delivery of oral health care. This article outlines common conditions among children with special needs, focuses on their influence on dental health, and describes how these conditions influence preventive, operative, surgical, and behavior management strategies. The goal is to provide an overview that will help guide practicing dentists to understand their role in the care of children with special health care needs.
Doshi M, Burke M, Fiske J. Disability and cultural issues in research – lessons learned. Journal of Disability and Oral Health 2010;11(1):37-43
A study of the oral health of Bangladeshi young adults with a learning disability is used as an example, to highlight the barriers identified in the research process for this group. These barriers included: access, culture, language and literacy, consent, communication and co-operation. The paper highlights the approach required to gain co-operation for access to the study population via day centers; the development of an oral health questionnaire relevant to the particular ethnic community; and translation requirements. It also describes how support was given during a structured, informed consent process and the use of props, photographs and scales used to support and aid understanding. The results showed participants were very aware of oral health and their social implications indicating that the approach used facilitated understanding and communication.
By considering and adapting the research process to meet the needs of people with a disability and from an ethnic minority background, the study was acceptable to their needs and participation levels were high.
Lee Y, Dickinson C, Skelly M. Parental perceptions of oral health and access to oral health care services for children with special educational needs in South BedfordshireJournal of Disability and Oral Health 2009;10(4):156-160.
To undertake a questionnaire study of parents of children in primary and secondary schools in South Bedfordshire in order to investigate parental perception of oral health of their children and the factors that act as barriers to care and relate the parental oral health perceptions to their views on access to care. Parental perception underestimated the level of oral health and there was a reported lack of oral health education provided by the dental profession. Although the majority of children with special educational needs attended a dentist, parents were more likely to experience difficulties accessing oral health care services. The Disability Discrimination Act (2005) aims to reduce inequalities but parents still experience barriers when accessing oral health care services.
Gabre P. Strategies for the prevention of dental caries in people with disabilities: a review of risk factors, adapted preventive measures and cognitive support strategies for the prevention of dental caries in people with disabilities: a review of risk factors, adapted preventive measures and cognitive support.Journal of Disability and Oral Health 2009;10(4):184-192.
Individuals with disabilities have an increased caries risk mainly owing to impaired oral clearance, inappropriate food choices, difficulties in oral hygiene routines including use of fluorides, and low overall understanding of healthy behavior. Although individuals with disabilities have an urgent need of effective preventive measures, their ability to accomplish such measures themselves is severely limited. Training programs that stimulate oral motor function and oral sensory perception can improve oral clearance. Frequency of meals and choices of food can be influenced by increased knowledge among care staff and the individuals themselves. Different kinds of cognitive support can also enable people with disabilities to independently make healthy food choices, and cognitive support and assistive devices can facilitate oral hygiene and use of fluorides. Impaired oral clearance leads to increased caries risk but, at the same time, increases the effect of fluorides. Tooth brushing with toothpaste is a population-based strategy used by most people. When supplemental fluoride is needed more frequent use of tooth brushing with fluoridated toothpaste or a higher concentration of fluoride becomes a useful method, well known by people with disabilities and care staff.
Hagman-Gustafsson ML, Holmén A, Strömberg E, Gabre P, Wårdh I. Who cares for the oral health of dependent elderly and disabled persons living at home? A qualitative study of case managers' knowledge, attitudes and initiatives. Sweden Dental Journal 2008;32(2):95-104.
In 1999 a new law in Sweden granted people receiving a certain level of supportive care from the community the right to receive a free, in-home oral health assessment. Subsequent appraisal has disclosed that far from all eligible people, especially those living at home, have undergone such an assessment. Of fundamental importance to the success of this scheme is the active involvement of case managers in identifying those who are eligible for assessment. The aim of this study was to investigate case managers' knowledge of and attitudes to the oral health of their clients and the initiatives they take to ensure that dependent elderly and disabled persons living at home have access to oral health care. Their knowledge of the 1999 law was limited. In general there were no procedures in place to ensure that the oral assessments were undertaken and that records were kept. The case managers considered that they should not be responsible, although they could not suggest a more appropriate instance. The potential role of regular oral health assessment in prevention of oral diseases was not discussed at all in the interviews. The current systems for monitoring oral health are tailored primarily to institutionalized care. In future many more dependent people will continue to live at home with support from community home care assistants and relatives. It is important that oral health care activities, as well as research, are modified accordingly.
Jones J, Griffiths J, McClusker N, Rooney C, Hilton S, Hunter L. Proposals for a dental care professional qualification in special care dentistry: results of a UK survey.Journal of Disability and Oral Health 2009;10(3):115-121.
The study investigated demographic details, scope of practice, mandatory training, opportunities for Continuing Professional Development (CPD) and interest in a post-qualification course in Special Care Dentistry (SCD) amongst dental hygienists and dental therapists working in the United Kingdom. The study showed that training courses in SCD for dental hygienists and dental therapists are likely to be highly valued and well-attended provided that funding issues are resolved. The authors suggest that such courses should, ideally, be overseen by one group and that closer links between dental hygiene/therapy and dental undergraduate training should be developed.
Nunn J, Gorman T. Special care dentistry and the dental team. Vital for the Whole Dental Team 2010;7(Summer): 22-25. (http://www.nature.com/vital/journal/v7/n3/pdf/vital1186.pdf)
Special care dentistry is that specialty of dentistry that aims to facilitate oral care for people with an impairment or disability, for example, those who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of these that means accessing conventional dental care presents challenges.