Latest update: September 15th, 2013
A recent study from the Tufts University School of Dental Medicine found that people with intellectual and other developmental disabilities are more prone to dental disease than the general population and that further research is required to identify effective interventions.
The study, based on the electronic dental records of 4,732 patients who receive dental care from Tufts Dental Facilities Serving Persons with Special Needs, found that even when provided with access to care, some individuals are unable to tolerate complex dental procedures, which compounds the problem.
By sensitizing children with special needs to dental and other medical procedures, some practitioners are able to implement best practices at an early age, eliminating the costly need to perform routine dental cleanings in hospitals while under anesthesia.
Children with special needs have higher rates of poor oral hygiene, gingivitis, and periodontal disease than the general public. According to the Data Resource Center for Child and Adolescent Health, parents identify preventive dental care as the most prevalent of these children’s unmet health care needs.
Most dentists are unwilling to treat youngsters with special needs because they lack the necessary training. Low Medicaid reimbursement rates create another barrier to care.
This is a typical case: A year ago, no one could have imagined that Joel would be able to sit in a dentist chair.
The 10-year-old, who has an autism spectrum disorder, has benefited from a sensory integration and desensitization program from a team of professionals at Premier HealthCare (PHC), a member agency of YAI.
Joel really isn’t that different than most children. Just the thought of a dental visit increases his anxiety. Even walking by a dental room upset him. In the past, he had to be anesthetized or wear a restraining device to limit his movement in the dentist’s chair.
“Working with children with special needs early on is really going to help in the long run,” said Dr. Beth Diviney, Ph.D., BCBA, is a Behavior Consultant who is part of a multi-disciplinary desensitization team at PHC which has had success working with special needs children at an early age.
“We’ve seen that after they observe a sibling or peer sitting in a dental chair, and then learning what the routine is and what the expectations are . . . they are gradually willing to do what needs to be done to tolerate a procedure without the use of restraint or medication. We make it fun.”
The desensitization program is tailored to the individual patient. A comprehensive assessment identifies psycho-social history, abilities, skills set, fears and potential sensory issues. Observation is another critical component, especially if the child is non-verbal. The team develops a strategy and formulates a plan before implementation begins.
“Sensory integration calms the patient down,” said Abigail Tayamen-Macatangay, OTR/L, Supervisor of Occupational Therapy at PHC. “Knowing that Joel responds to sensory stimulation has helped us make the experience of going to the dentist, less frightening.”
An OT Assistant worked with Joel for over a year. She would bring Joel to an OT Treatment Room prior to his dental appointment. She found that putting on a weighted vest and rocking on a therapy ball comforted Joel. He also would squeeze some putty or a handball. Joel perceived the occupational therapy as fun and he felt safe with OT in the familiar treatment room.
After months of sensory integration, Joel moved from the OT room to just outside the dental room. He rocked on a therapy ball and he had a favorite puzzle to ease his anxiety. Later, the therapy ball was moved inside the dental room. While Joel was initially frightened by the chair, he finally sat on the edge of the chair after a string of sensory lights were placed around his shoulders and in his lap.
Eventually, Joel sat in the dental chair with the dentist and her assistant in the room. He tolerated the instruments and even seemed to enjoy the vibrating sensation in his mouth. Of course, it was comforting for him to know that his OT Assistant was just a few steps away.
Dr. Sun Won was then able to give Joel a mild dental cleaning, thanks to the team approach.
“I never thought I’d see him in the chair; it was such an ordeal,” she added. “He didn’t want to be there.”
Collaboration among the nursing team, dentist, dental assistant, behavior analyst, occupational and possibly a physical therapist was critical to the program’s success, and even some of the professionals had their doubts. “None of us were trained to collaborate in this way,” Dr. Diviney said. “Each discipline is accustomed to doing its part; if you’re a dentist, you may have a dental assistant in the room, but not a room full of other professionals.”
It takes a tremendous amount of time and patience, but the results are nothing short of amazing when the professionals collaborate on such a close level.
Parents or the person accompanying the child to the dentist’s office also play a major role in desensitation. Parents or caregivers can help prepare a child for the visits by showing pictures of the dentist, tooth brushes and other dental instruments, and gently massaging the face near where a dentist may eventually be working. They even stay in the dental suite with the child during a cleaning or dental procedure.
Today, Joel no longer needs the therapy ball before his dental appointments. He still enjoys the sensory lights, a vibrating toothbrush in his hand, and a container filled with raw rice, beans and beads, known as a rice bath to get him through procedures.
Josefina, Joel’s mother, couldn’t be happier with the results.
“He’s much calmer now,” she said. “He’s OK with going to see the dentist.”
During one dental visit, the team invited Josefina into the room, where her son was sitting calmly in the chair, ready for his appointment. As Dr. Won examined Joel, she kept saying, “’I can’t believe it.’”
About the Author: Dr. Chrystalla Orthodoxou, Chief of Dentistry for Premier HealthCare, has over 15 years experience treating individuals with developmental disabilities. She has developed and implemented the use of desensitization and behavior techniques to help children and adults patients with special needs. She has lectured extensively on using these techniques to deliver quality dental care to patients with severe anxiety, phobias, and sensory processing disorders. She currently serves on the New York State Office for People With Developmental Disabilities Task Force for Specialty Care Dentistry and is a clinical faculty member of the dental department at North Shore Long Island Jewish Hospital.
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