Dental Care for Patients with Special Health Care Needs in Canada

Dental Care for Patients with Special Health Care Needs in Canada
Tara Y. T. Chen, Dr. Austin Mardon

Introduction
    Patients with special needs, such as intellectual and developmental disorders, face barriers to receiving proper dental care (Lee & Chang, 2021). They are often at a higher risk of developing dental caries or gingivitis compared to non-disabled patients (Lee & Chang, 2021). Fortunately, there are many ways that caregivers and dental teams can assist these patients and ensure the maintenance of proper oral health. 

Barriers to dental care
    Patients have a decreased ability to communicate dental pains and concerns, resulting in delayed access to dental treatments (Lee & Chang, 2021). Dentists often rely on the caregiver to address dental concerns, but due to limited communication abilities, caregivers may still struggle to understand the needs of these patients (Lee & Chang, 2021). This significantly impacts the oral health of patients with special health care needs and adults with intellectual disabilities have a 31% prevalence of tooth loss compared to 3% of non-disabled adults (Kinnear et al., 2019). Often, these patients have significantly more eating problems, abnormal diets and issues with brushing teeth, leading to an increased risk of developing caries (Lee & Chang, 2021).  
    Additionally, dentists may not be available to treat patients due to a lack of confidence, educational experience or training in working with patients with special health care needs (Vozza et al., 2016). Dentists may also be less willing to treat these patients if they are uncooperative during the dental treatment (Vozza et al., 2016). Alternatively, some dentists provide these patients with general anesthesia to minimize uncooperativeness and more frequent dental visits of three times a year to ensure healthy teeth (Vozza et al., 2016). 

Advice for caregivers
    According to the Canadian Dental Association, babies should be brought to the dentist within their first year of life or within six months of the appearance of their first tooth (Canadian Dental Association [CDA], 2022). Caregivers should use fluoridated toothpaste and provide a safe environment to perform dental care at home (CDA, 2022). It may be helpful for the caregiver to demonstrate tooth brushing on themselves before attempting it on the individual. Afterwards, the toothbrush can slowly come close to the individual, and progressively interact with the individual’s lips, gums and teeth (CDA, 2022). This ensures that the experience does not produce a state of shock or cause an association of fear with toothbrush. The process is similar for adult patients where caregivers should be patient, gentle and encouraging. Dentures should also be cleaned daily and brought to the dentist if there are damages (CDA, 2022). 

Advice for dental teams
    According to the Canadian Dental Association, dental teams should be familiar with the patient’s medical history and needs before the appointment. The patient may have varying levels of attention, communication skills, impulse control, fine motor skills and more. It may also be helpful to ask the caregiver for advice before the appointment (CDA, 2022). 
    Some patients may have anxiety when entering new environments. Sending the patient images or videos of the clinic may help them familiarize themselves with the location and tools (CDA, 2022). Alternatively, meeting the patient in-person before the appointment to provide a tour of the facility may minimize stress and allow the team to learn the personality of the patient (CDA, 2022). 
    Similar to caregivers, dentists should perform procedures slowly and explain the processes. They should speak in a reassuring tone and speak with simple, non-medical language to provide a pleasant experience (CDA, 2022). Avoiding distractions by keeping only the essential staff in the room and removing non-relevant dental instruments may improve the attention and cooperativeness of the patient (CDA, 2022).

Conclusion
    Despite the barriers to oral health care, patients with special health care needs can be supported by caregivers and dental teams. By being patient, explaining procedures and minimizing anxiety, patients can undergo dental procedures to maintain proper hygiene and minimize dental caries (Lee & Chang, 2021). 

References
Canadian Dental Association. (2022). Getting Started: Tips for Parents, Caregivers and the 
Dental Team. http://www.cda-adc.ca/en/oral_health/cfyt/special_needs/getting_started/default.asp
Kinnear, D., Allan, L., Morrison, J., Finlayson, J., Sherriff, A., Macpherson, L., Henderson, A., 
Ward, L., Muir, M., & Cooper, S. A. (2019). Prevalence of factors associated with edentulousness (no natural teeth) in adults with intellectual disabilities. Journal of intellectual disability research : JIDR, 63(12), 1475–1481. https://doi.org/10.1111/jir.12628
Lee, J., & Chang, J. (2021). Oral health issues of young adults with severe intellectual and 
developmental disabilities and caregiver burdens: a qualitative study. BMC oral health, 21(1), 538. https://doi.org/10.1186/s12903-021-01896-3
Vozza, I., Cavallè, E., Corridore, D., Ripari, F., Spota, A., Brugnoletti, O., & Guerra, F. (2016). 
Preventive strategies in oral health for special needs patients. Annali di stomatologia, 6(3-4), 96–99. https://doi.org/10.11138/ads/2015.6.3.096

Biographies
Tara Y. T. Chen is a third-year undergraduate student studying medical sciences at the University of Western Ontario in Canada. In the past, she has presented her research on psoriasis treatments at the Western Student Research Conference 2021 and has written several science academic books. 
Dr. Austin Mardon is an assistant adjunct professor at the John Dossetor Health Ethics Centre at the University of Alberta, and the founder and director of Antarctic Institute of Canada.