Receipt of dental care and barriers encountered by persons with disabilities.

A study was conducted to describe the receipt of dental care by patients with disabilities and to understand their perspective with regard to barriers to dental care. Subjects for this study were recruited among patients with disabilities seen at Carolinas Rehabilitation's outpatient clinic. A questionnaire consisting of 66 questions was completed by 344 subjects; with the topics related to both medical and dental care. Among the study population, 57.2% of subjects reported being seen by a dentist within the last 12 months, versus 67.3% before they became disabled. The last dental appointment was a routine examination for 59.5% of the respondents. Since becoming disabled, 16.6% of subjects reported problems receiving dental care. Financial challenges were the primary problem followed by physical accessibility issues. Further research is required to discover how barriers to care can be overcome to assure that those with disabilities receive adequate dental care.

Complications associated with anesthesia administration for dental treatment in a special needs clinic.

The goal of this study was to identify and quantify complications occurring with the administration of anesthesia for the dental treatment of patients with special needs. Anesthesia providers completed a standardized evaluation form, delineating possible complications for 202 consecutive ambulatory patients receiving anesthesia in a special needs clinic. Statistical analysis of four types of administered anesthesia showed that the overall complication rate was 23.8%. Evaluation of the data showed complications that were considered either mild (95.8%), or moderate (4.2%), while no reports of severe complications occurred. Airway obstruction and nausea/vomiting were the most frequently encountered complications. Variables found to affect the incidence of anesthetic complications included ASA classification, anesthetic technique, Mallampati airway classification, and type of dental procedure performed. An evaluation of the results of the study showed that the majority of complications that occurred with anesthesia during care of patients with special needs were mild and did not lead to severe adverse events. Our findings show that anesthesia administered during dental treatment for patients with special needs is safe and effective.

A new classification system for dental treatment under general anesthesia.

The provision of comprehensive care for patients with special needs using dental general anesthesia (DGA) has changed over time, and now includes more complex procedures and the participation of many services. As a result, it is necessary to integrate, organize and describe all of the procedures that are carried out in different DGA settings. The aim of this study was to propose a systematic classification for dental treatment procedures be delivered under DGA, and to compare this classification system with an existing system. This new classification system has three distinct components: type, frequency and length of time needed to complete dental procedures for both primary and permanent teeth. A wide range of oral surgery procedures and endodontic treatment was also included. A retrospective cohort study utilizing 84 subjects was used to develop and compare the two classification systems. When comparing the different categories of procedures by both classifications, there were significant statistical differences between them (p < 0.05). Oral health care for patients with special needs has evolved, with more complex and extensive interventions that require teamwork by personnel from different dental or medical specialties. The classification system in this study includes detailed information regarding the procedures involved in the DGA. This helps to provide a clear understanding and specific information that enables the comparison of clinical experiences across populations where a DGA has been used for patients with special needs.

Oral healthcare of clients with learning disability: changes following relocation from hospital to community.

OBJECTIVE: To investigate changes in the oral healthcare of adults with learning disability after transference from long stay hospital care to community-based care. SUBJECTS: Adults with learning disability who were former residents of a single long stay hospital and who had been resettled into the community during the period April 1995 to April 1998. DESIGN: Structured questionnaire with a covering letter sent to community-based carers. Hospital notes were reviewed to assess oral healthcare received as in-patients. RESULTS: There was a 68% response rate to the questionnaire from community-based carers with details obtained from 106 out of a possible 157 subjects. As residents in the hospital, all subjects were examined regularly by a dentist--yearly for edentulous and six-monthly for dentate individuals. However, attendance patterns were less regular as residents in the community. In the community, individuals were also less likely to receive operative dental treatment. Although oral hygiene regimes were generally on a daily basis only 37% of the subjects and/or their carers had received oral health education from dental professionals in the community. CONCLUSION: Changes from institutional living to community-based housing for adults with learning disability may be associated with changes in dental attendance and treatment patterns.

Estudio de la eficacia de dos tratamientos antiplaca y antigingivitis en un grupo de discapacitados psíquicos / Efficacy of two antiplaque and antigingivitis treatments in a group of young mentally retarded patients

Introducción: La utilización de métodos de control químico de placa se hace necesaria en los pacientes de alto riesgo como los disminuidos psíquicos para controlar la higiene oral. Material y métodos: 37 individuos con retraso mental y con altos niveles de placa y de gingivitis fueron divididos en 2 grupos. El grupo I realizó un enjuague diario con Triclosánzinc durante 8 semanas, mientras que el grupo II recibió un spray de clorhexidina al 0,2 por ciento durante 2 semanas. Ambos grupos fueron evaluados al inicio del estudio, a la segunda semana y a la octava semana. Resultados: En el grupo I se obtienen reducciones significativas en el índice de placa a la segunda semana y reducciones altamente significativas a la octava semana tanto en el índice de placa como el gingival. En el grupo II se obtienen reducciones altamente significativas en ambos índices a la segunda semana, manteniendo una reducción todavía significativa a la octava semana. Conclusiones: El uso de colutorios de triclosán-zinc, así como de sprays de clorhexidina pueden ser eficaces como métodos coadyuvantes al cepillado dental para el control de la placa y la gingivitis en los disminuidos psíquicos (AU)

Providing dental care for special patients: tips for the general dentist.

BACKGROUND: Nearly 20 percent of the U.S. population has some type of disability, with approximately 12 percent of the population considered to have severe disabilities. The provision of dental care to such patients requires consideration beyond routine approaches. OVERVIEW: This article discusses techniques, such as establishing a relaxing treatment environment, that can be used to accommodate special-needs patients in the general dental practice. It provides background information on the current special-needs population in the United States, and it describes the oral care approaches used in a residential care facility vs. a general dental practice. The article concludes with tips for integrating this special patient population into a general dental practice. CONCLUSIONS AND PRACTICE IMPLICATIONS: As the U.S. population with special needs increases, more general dentists are likely to find that such patients require their services. While the prospect of accommodating the needs of patients with disabilities may seem daunting initially, such treatment actually can be incorporated into a general dental practice easily. The practitioner treating patients with disabilities likely will find that he or she needs special equipment less than compassion and tolerance.

The patient with Alzheimer's disease.

Victims of Alzheimer's disease show a gradual and steady deterioration in memory, orientation, emotional stability, language capacity, abstract thinking, motor skills, and, ultimately, self care. Cognitive and motor deficits are accompanied by a gradual inability to perform adequate oral hygiene. Alzheimer's disease also interferes with the patient's ability to communicate dental symptoms of pain or dysfunction, and progressive deterioration of cognition interferes with the patient's ability to tolerate most therapeutic interventions. When treating patient's with Alzheimer's disease, oral health care providers must develop timely, preventive, and therapeutic strategies compatible with the patient's physical and cognitive ability to undergo and respond to dental care. They should strive to achieve those goals with the same ethical, moral, and professional standards of care as may be appropriate in the management of any other patient.