Welcome to PART II of our dental care and disability blog series, where we break down what you need to know about how to keep good oral hygiene when you or your loved one has a disability. PART I was all about the basics, so if you haven’t checked that out, be sure to take a look. As with the previous article we sat down with Keith Libou, D.M.D. of Delta Dental of New Jersey to answer all our questions about disability and dental care. This time we are focusing on dentists – how do you get the most out of your visits? How do you choose the right one for you? Let’s dive in so you can make the most of your next visit.
Disability and Dental Care PART II – All About Dentists
Are dentists talking about treating people with disabilities and special needs and if so, what are the conversations?
Absolutely! More dentists today are looking at how to evolve their practices to include patients with special needs.
There is a huge need for dentists who treat patients with disabilities – and who can do so in community settings. According to the U.S. Census Bureau, 24 million Americans not living in institutions have a “severe” disability. Some disabilities are also more prone to oral health problems.
At the same time, some dentists may feel uncomfortable treating special needs patients. Not all dental schools provide extensive clinical exposure to special needs patients. That’s kept some practitioners from readily accepting patients with disabilities.
Fortunately, there are many resources available today to prepare dental students and practicing dentists to treat special needs patients. Dental students can take courses and do clinical rotations in special needs settings. Practicing dentists can attend continuing education programs offered by organizations such as the National Institute of Dental and Craniofacial Research.
These programs help more dentists feel prepared to treat people with disabilities. Discomfort, as well as clinical expertise, are among the biggest barriers dentists must overcome to treat people with various disabilities. While dentists have the training and ability to treat most patients, these programs help them realize how to leverage their existing skills to better serve these patients and their practice.
Are there any types of adaptive equipment dentists use to serve people with disabilities and special needs? If so, what are they and how do they help?
Usually little or no adaptive equipment is needed. More often, dentists will adapt the office environment and how they interact with their patients. (Dentists may, however, show patients how to adapt their own oral hygiene equipment – such as toothbrush and floss – so they are easier to use.)
Many dental offices and their operatories are wheelchair accessible. Staff members receive training in how to safely transfer patients from the wheelchair to dental chair. Offices are switching to dental chairs with movable armrests for easier access.
Dentists can even treat patients without removing them from their wheelchairs. Sometimes they will use a sliding board behind the patient’s back to support the head and neck.
Other examples of adaptations to make the dental visit easier for patients with disabilities include:
- Modifying the length of appointments. Many offices offer longer (or shorter) visits as needed.
- Encouraging comfort items for patients with anxiety or behavioral disabilities. Dentists urge anxious patients to hold a family member’s hand, or clutch a stuffed animal or blanket.
- Moving dental instruments behind patients who are prone to seizures. This helps prevent injuries in case of a seizure. Dentists also may attach dental floss to clamps and other devices used during treatment so they can be removed quickly if necessary.
- Minimizing distractions such as sights and sounds. Music may also calm some patients.
- Using a clear face shield during dental treatment for patients who are hearing-impaired. Dentists try to keep all treatment within the patient’s field of vision.
Since some patients with disabilities have behavior problems, seizures, or other issues that can result in uncontrolled movement, the subject of restraint sometimes comes up. Most dentists prefer not to physically restrain a patient. In some cases, general anesthesia may be used instead. Practitioners should understand whether it is appropriate to obtain consent from a patient or a patient’s guardian before they perform any procedures that may require restricting a patient’s movements.
Are there any complications surrounding cosmetic dentistry (i.e. braces, Invisalign, etc.)?
In the past, many patients with disabilities couldn’t take advantage of orthodontic treatment because of their physical or developmental challenges. Now, thanks to new technologies and training, many patients with disabilities can benefit from these treatments. Organizations like the American Association of Orthodontists can help parents and patients find providers who treat those with disabilities.
For patients with disabilities, some treatments may work better than others.
For patients with cerebral palsy
Traditional braces can be a distraction and cause some patients increased anxiety. Removable aligners give them a greater feeling of control. Plus, it makes brushing and flossing easier.
For patients with autism and Asperger’s syndrome
They may “play” with a removable device, taking it in and out of the mouth many times a day. Traditional braces may work better because they cannot be removed.
For patients with Down syndrome
Most orthodontists recommend braces because their cases are frequently too complicated for clear aligners. Protective sealants and/or smaller hygienic brackets can help make oral hygiene easier.
Some patients may also benefit from dental prostheses to replace missing teeth or parts of the jaw and palate. For patients with epilepsy, however, a prosthesis could become a choking hazard during a seizure. It’s vital to select a prosthetic that can’t be damaged or displaced during an epileptic attack.
Since some people with disabilities can’t necessarily voice their discomfort, what’s the best way for a parent to monitor their child’s dental health?
The best way is to be vigilant about their oral hygiene.
Teach them how to brush and floss. Learn the best procedures for helping them if they can’t do these tasks on their own. Good oral hygiene helps prevent dental problems. And be sure to schedule regular dental visits. This helps catch small problems before they grow into bigger, more painful ones.
Changes in a child’s behavior can indicate pain, but it may not be clear where the pain is coming from. General signs of pain can include moaning and crying, shivering, a lack of cooperation, more difficulty sleeping or eating, or facial expressions like grimacing.
More specific indicators that your child is suffering dental discomfort include excessive salivation and putting hands inside the mouth more often. Parents can also look for physical signs of dental discomfort, such as bad breath, gum recession, or bleeding gums.
If you suspect your child is suffering from dental pain, contact your dentist immediately. Dental issues can lead to serious health consequences for people with many disabilities.
How can someone be sure that some medicines the dentist uses won’t have an adverse effect on someone who is medically fragile or is prone to allergies?
The most important thing you can do is make sure the dentist has the patient’s complete medical history, including all medications and to coordinate with the appropriate physician prior to prescribing medications.
Dentists receive extensive training in how medications, anesthesia, and materials used during treatment could affect certain patients. Some of these can cause serious problems. Latex allergies, for instance, can be life threatening. Certain local anesthetics can cause seizures in some people. Medications may also interact with antibiotics or with pain medication, rendering them less effective.
It is imperative that you tell the dentist about all of the patient’s physical and medical conditions, medications, and allergies. This will enable your dentist to create a safe treatment plan for your loved one, and, if necessary, communicate with the patient’s physician.
If you had a piece of advice for people with disabilities or their parents on how to maintain strong dental health, what would that advice be?
Practice good oral hygiene every day! That means brushing and flossing, eating a healthy diet, and limiting sugar-filled foods and drinks. Schedule regular dental visits for exams and professional cleaning. Preventive measures such as fluorides and sealants help, too.
Good hygiene practices are important for everyone. For people with disabilities, they are especially critical. Many people with special health needs are at greater risk for oral health problems. And oral health problems can negatively impact their overall health.
Good oral hygiene can help keep your loved one healthier overall.
If you’re looking for dental insurance, please reach out to Delta Dental of New Jersey.
ABOUT THE AUTHOR
KEITH LIBOU, D.M.D.
Chief Clinical Officer
Dr. Libou joined Delta Dental of New Jersey in 2014. Prior to joining Delta Dental, he served as Chief Dental Officer at Dental Care Alliance (DCA), while also overseeing DCA’s affiliated multi- location group practice in Pennsylvania as Dental Director. From 1998 to 2000, Dr. Libou was Vice President of Operations and National Dental Director at Oral Health Services, and prior to that he served as Dental Director of the Eastern Region at Cigna Dental from 1995 to 1997.
Dr. Libou has been a practicing dental clinician and academic. He has strong network management experience and a great understanding of the principles of evidenced-based dentistry and the connection between oral health and the overall wellbeing of an individual. Dr. Libou is directly involved in establishing strategy for Delta Dental of New Jersey to integrate the rapidly evolving evidence about the oral-systemic relationship into its dental benefit programs. He led a pilot program involving dentists performing in-office HbA1c testing for diabetes, and most recently wrote the request to the American Dental Association’s Code Committee to assign a code for dentists to perform point-of-care HbA1c blood testing in dental offices. The code was approved and became effective January 1, 2018. He also has oversight of the dental consultants, professional relations department, and overall network and clinical support.
With over 15 years of experience in large group practices, Dr. Libou is licensed to practice dentistry in New Jersey, Pennsylvania, and Connecticut. With experience on both the clinical and insurance sides of dentistry, Dr. Libou brings with him extensive knowledge of dental managed care and the dental benefits industry.
Dr. Libou studied biology at the State University of New York at Binghamton and he later graduated from the University Of Pennsylvania School Of Dental Medicine where he earned his D.M.D.