How to create an inclusive practice
Featured Products Promotional FeaturesPosted by: Dental Design 19th July 2024
Caring for patients with additional needs requires understanding and adaptability.
Students in England will soon be able to take British Sign Language as a GCSE.[i] It will be taught in schools from September 2025 and will be open to all pupils. As we move towards an ever more inclusive society, dental professionals must ensure that patients with additional needs have access to the same level of oral health services and expertise as others. Understanding their unique challenges, adapting techniques, and creating a welcoming environment can help create a positive dental experience for these patients.
Dental patients with additional needs can encompass a wide range of disabling conditions including intellectual disability, dementia, physical limitations, movement disorders, behavioural disorders, and chronic medical conditions. Many of these individuals can be treated in routine dental settings with minimal special accommodations or with interventions that are well within the scope of most dental professionals.[ii]
Some patients with additional needs do, however, require interventions that go beyond the scope of routine behaviour management techniques. These techniques can include desensitisation, anti-anxiety medications, therapeutic immobilisation, sedation and general anaesthesia.ii
Unmet needs
Under the Equality Act 2010, public sector organisations have to make changes in their approach or provisions to ensure that services are accessible to disabled people as well as everybody else. People with learning disabilities might have difficulty with reading or writing, explaining symptoms and understanding new information. They have higher levels of gum disease, greater gingival inflammation, higher numbers of missing teeth, increased rates of edentulism, higher plaque levels, greater unmet oral health needs, poorer access to dental services and less preventative dentistry. They are often unaware of dental problems and may be reliant on their carers.[iii]
Similarly, under the Accessible Information Standard[iv] dental surgeries that provide NHS services must ensure that people who are deaf are provided with information in a format that makes sense to them. This also applies to hearing parents that have deaf children or deaf parents with hearing children.
Indeed, effective communication is crucial.[v] It’s important to take the time to establish a rapport and build trust with patients with additional needs and their carers. The dental team should use simple and clear language, visual aids, and alternative communication methods if necessary. They should be encouraged to express their concerns or queries, ensuring their participation in the decision-making process.[vi]
Sensory considerations
Many patients with additional needs may have heightened sensory sensitivities,[vii] making dental visits overwhelming. It is important therefore to be mindful of the clinic environment by minimising noise levels, using natural lighting, and providing comfortable seating. Practices should consider allowing extra time for patient appointments to help alleviate any stress or anxiety.
Visual supports can help to aid understanding and reduce anxiety. Using stories or creating illustrated step-by-step guides to explain dental procedures and routines may help some patients. These tools can provide reassurance and a sense of familiarity, making the experience more predictable and less intimidating for patients with additional needs.iii
Dental professionals can implement techniques to make the dental experience more sensory-friendly. For example, using desensitisation techniques, gradually introducing patients to the dental environment, and involving them in play therapy to familiarise them with dental tools and equipment.iii
Collaboration with carers
Collaboration with carers is vital to providing comprehensive care.[viii] Dental professionals should encourage open communication and provide carers with educational resources, such as instructional videos or printed materials, to help them maintain optimal oral hygiene practices at home.
Positive reinforcement[ix] can also significantly impact a patient’s experience. Dental teams can offer praise and rewards for cooperation and positive behaviour during dental visits. This reinforcement can help to build a trusting relationship and reduce anxiety in subsequent visits.
Oral hygiene can present a challenge for many patients with additional needs, including those with sensory or motor dysfunction. Recommending the right oral hygiene products for our patients is essential for their oral health. The FLEXI range of interdental brushes from TANDEX can help some patients with additional needs as they are easier to grip and less tricky to use than string floss. Each product’s handle is flexible, and the brush can be bent into the perfect shape to clean in between the teeth. Available in 11 different sizes, the line presents a solution for each individual patient, for a comfortable and effective clean. Given that patients with additional needs are more prone to tooth decay,iii the brushes can be used to apply PREVENT GEL too, a product which contains 0.12% chlorhexidine and 900ppm fluoride which offers antibacterial and enamel strengthening properties.
Caring for patients with additional needs in the dental setting requires understanding, empathy, and adaptability. By implementing effective communication strategies, creating a sensory-friendly environment, collaborating with carers, and tailoring treatment plans, dental professionals can provide optimal dental care to this vulnerable population. With this knowledge and approach, patients with additional needs will receive the treatment they deserve, contributing to their overall well-being and quality of life.
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[i] British Sign Language GCSE: Everything you need to know. Gov.uk. December 2023. Availanble at: https://educationhub.blog.gov.uk/2023/12/21/british-sign-language-gcse-everything-you-need-to-know/ Accessed April 2024
[ii] Dougherty, N. (2009), The dental patient with special needs: a review of indications for treatment under general anaesthesia. Special Care in Dentistry, 29: 17-20. https://doi.org/10.1111/j.1754-4505.2008.00057.x [Accessed January 2024]
[iii] Oral care and people with learning disabilities. UK Government. November 2019 https://www.gov.uk/government/publications/oral-care-and-people-with-learning-disabilities/oral-care-and-people-with-learning-disabilities [Accessed April 2024]
[iv] Accessible Information Standard. NHS England. August 2017. Available at: https://www.england.nhs.uk/about/equality/equality-hub/patient-equalities-programme/equality-frameworks-and-information-standards/accessibleinfo/ Accessed April 2024
[v] Lang EV. A Better Patient Experience Through Better Communication. J Radiol Nurs. 2012 Dec 1;31(4):114-119. doi: 10.1016/j.jradnu.2012.08.001. PMID: 23471099; PMCID: PMC3587056. [Accessed January 2024]
[vi] Vahdat S, Hamzehgardeshi L, Hessam S, Hamzehgardeshi Z. Patient involvement in health care decision making: a review. Iran Red Crescent Med J. 2014 Jan;16(1):e12454. doi: 10.5812/ircmj.12454. Epub 2014 Jan 5. PMID: 24719703; PMCID: PMC3964421. [Accessed January 2024]
[vii] Sensory Issues. Autism Speaks. Available at: https://www.autismspeaks.org/sensory-issues Accessed April 2024
[viii] Talking to patients’ relatives and carers. DDU Journal. 2019. Available at: https://ddujournal.theddu.com/issue-archive/spring-2019/talking-to-patients-relatives-and-carers Accessed April 2024
[ix] Cherry, J. Positive Reinforcement and Operant Conditioning. Very Well Mind. March 2023. Available at: https://www.verywellmind.com/what-is-positive-reinforcement-2795412 Accessed April 2024
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