Who needs special-care dentistry?

Everyone needs to be able to have dental care. However, some people need special facilities or services to have this care provided. People with physical disabilities may have problems getting into the surgery or even into the dental chair. People with learning disabilities may become overanxious at the thought of going to the dentist or may need extra reassurance. People suffering from severe medical problems may need extra precautions or care. Dental teams are able to take account of all these things when providing dental care.

Who can provide treatment?

Many dentists will happily treat people with special dental needs in their surgery. However, some people find it hard to get to the surgery and so other arrangements may be made by the practice: for example, home visits and special health centres. Some people need a specialist service. The local Community Dental Service or some health centres will also help people needing specialist care and may be able to offer possible treatment alternatives, such as sedation or general anaesthetic.

How do I arrange specialist care?

Usually the patient’s dentist or doctor is responsible for referring them to the clinic best suited to their needs. Normally, the dentist or doctor will write a referral letter and send it, with any hospital letters and x-rays, to give the dental team an idea of the patient’s dental history.

What do the dental team need to know?

The dental team will need to know the patient’s medical history and about any medicines they are taking. This includes any inhalers and regularly prescribed medicines from the doctor. The dental team will also need to know the name of the family doctor and hospital consultant, and about any recent operations and allergies the patient may have.

It is also helpful if the dental team know about any concerns or anxieties the patient has, so that they can help to make the patient feel at ease. This information can be given by the patient’s parents or care giver. However, some patients do prefer to communicate directly with the dentist. Some patients may have other special needs: for example, the help of an interpreter or translator, or to have a guide dog. Dentists are prepared for working in these situations.

When is the best time to be treated?

Some patients prefer to be seen at certain times of the day depending on their needs. For instance, evening appointments may not be suitable for patients who tire easily or may spend the day worrying. Some patients rely heavily on routine and may need regular appointments at the same time.

How accessible are treatment clinics?

Practices should offer facilities for wheelchair users, including access to the practice, and ground-floor surgeries. If wheelchair access is particularly important, contact the surgery and ask if this is something they are prepared for. Some clinics have specially adapted surgeries for patients with mobility problems.

What about children’s dental treatment?

Children with learning disabilities or other medical conditions may be referred to a specialist dental service by their doctor or dental team. It is important to take children to see the dentist at an early age. A low-sugar diet is also important, as they may be more likely to have tooth decay due to having problems with brushing and through taking medication. Make sure they have fizzy drinks, and sugary foods and drinks, just at mealtimes, and in moderation.

Why is medication an issue?

Many patients with disabilities have to rely on medication to keep their condition under control. It is therefore important to ask the doctor to prescribe sugar-free medicines, especially if they are syrups.

It is important to tell the dental team about any medication that the patient is taking, in case the treatment is affected or the team need to take any extra precautions.

Is there anything to make brushing easier?

For some people, moving their arms or hands can be a problem, which makes effective cleaning difficult. It is important to reach all the areas of the mouth to clean effectively. A toothbrush with a small to medium head size with soft to medium bristles is usually recommended. There are special handgrips and other adaptations which can be fitted to manual toothbrushes to make them easier to hold.

In some cases, electric or ‘power’ toothbrushes are recommended for people with mobility problems. They are also helpful to people with learning difficulties as they can be a novelty and therefore encourage brushing. The dentist or dental team will be able to offer advice and practical help on brushing and general mouth care.

Is sedation available?

Intravenous sedation (an injection) is an effective way of treating most nervous patients. The drugs given can relax and calm the patient, so treatment can be carried out with the dental team and patient still able to talk to each other. There are certain things that affect a patient’s suitability for this type of sedation. These include weight, age and medical condition. This would all be discussed during the consultation. Sometimes the patient would need to be referred to a specialist clinic for this treatment.

What other help is available?

Relative Analgesia (RA) can also help patients get through their treatment more easily. Here, nitrous oxide and oxygen are breathed in through a nosepiece. It is the safest and simplest form of sedation and is often the one most suitable for both children and people with special needs. However, this is not appropriate for everyone – especially people with limited understanding, cerebral palsy or multiple sclerosis.

In some cases, the dental team prefer to use other ways of calming the patient. These can include simply talking, visiting the practice to meet staff, or even hypnosis. These can all be effective in making the patient less anxious.

How often should I visit the dental team for care?

It is important to visit the dental team regularly. This would normally be every six months, but some people need to visit less often and others more often. The dental team will be able to tell you.

The dentist may also recommend appointments with a dental hygienist, who will remove plaque and tartar from the teeth and offer advice on how to brush effectively and keep your mouth clean and healthy. The dental team may also offer advice to care givers about the dental care of others. It is very important to build a relationship between the dental team, the patient and their care giver. This can help greatly with people who have severe learning difficulties. Short but regular appointments seem to work better at building trust between the patient and the dental team than long appointments at irregular intervals.

What toothpaste should be used?

It is recommended that children up to three years old use a toothpaste that contains at least 1000ppm (parts per million) of fluoride. Over the age of three, a toothpaste that contains 1350 to 1500ppm of fluoride is recommended. If the dentist thinks that the patient is particularly at risk of tooth decay, they may prescribe a toothpaste or fluoride varnish which contains a higher level of fluoride to offer more protection.

What treatment might I have to pay for? 

Special treatment may be available under the National Health Service (NHS) or might have to be paid for privately, depending on the practice. It is important to ask for an after treatment plan check-up and an estimate of charges at the time of the check-up. This will avoid confusion over payment later. NHS treatment is free for people getting benefits. If the patient is on a very low income, but does not claim any benefits, they may get help with charges by filling in an HC1 form. You can get this from either the dental practice or a doctor’s surgery. You may also be able to get help towards eye tests among other things.

The Community Dental Service does not provide free treatments. NHS charges are made for NHS treatments (free for those getting certain benefits) and there are also charges for any private treatment carried out. In some cases treatment needing laboratory work, such as dentures, bridges and crowns, will also be charged for.


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