This blog post is part of our series on ‘Helping Others’ – ahead of the 5th annual Lumino Day – held on May 5th 2018.
If you or someone you care for has a special need or a disability, going for a visit to the dentist can pose extra challenges. There are however some things which may make the experience an easier one for everyone.
“When booking appointments for special needs patients, it’s incredibly important that the whole practice knows what’s happening and when they are coming in,” says Dr Fraser Borland, who works out of Lumino Pearl Dental Centre in Remuera, Auckland and Lumino Wairau Park.
Visiting the dentist can be unsettling for the person you care for. Fraser says communicating clearly about the purpose of the appointment and scheduling that appointment for when is most convenient for the patient is ideal.
Fraser has worked with special needs patients in the past and says it’s important to realise that there is wide variation in the type of disability a patient may have, and each patient will require a slightly different approach.
A carer may even come in and meet the team in advance of the patient’s first visit, “this way we can get a heads up for any special issues which may arise during the visit.”
“The carer can in that way also start to introduce the dentist, nurse and build familiarity with the practice and the people the patient is going to be coming into contact with, all in advance of the appointment” says Fraser.
Many practices have wide doors, ramps, and accessible toilets. When choosing a dental practice, ask if these are available; they are signs a practice is thoughtful about the needs of people with mobility needs.
It may be important to note that the patient may need extra time for their treatment and booking during a “quieter” time might be beneficial.
“I think that it is imperative that the patient be booked in at a quiet time as some of these patients hate being in a new environment as it is, let alone with a waiting room full of people,” says Fraser.
As a dentist, it’s important to do your ‘homework’ on a special needs patient, says Dr Naomi Ting of Lumino Tamatea.
“Getting a thorough medical and dental history is important, and making an assessment on how they’ll cope in the dental chair (or if other measures including sedation) may need to be considered,” she says.
Naomi says it’s also important to consider the barriers in dentist-patient communication.
“Assessing cooperation and behavioural traits is important in planning considerations of treatment needed,” she says.
“For some patients, we can sometimes do an initial assessment in the waiting or consult room so the environment is more comfortable and the patient does not feel concerned about the clinical dental room.”
Fraser agrees, saying he would often meet with a special needs patient in a non-clinical setting, “for example, in the waiting room or a side room with no clinical features, which may spook the patient.”
He adds that he always makes an extra special efforts to communicate clearly with special needs patients.
“Communication is the single most important thing with them.”
It’s also important for the patient to know what is expected of them, says Fraser.
“If you tell the patient you’re only going to look, make sure you only look, most patients with special needs like routine and deviation from plans is going to not end well!”
“Every dentist will have their own way of communicating. If, as often happens, there is a patient who is completely non-verbal or just doesn’t want to talk to you there is a system called a storybook, where the patient is introduced to the idea of the dentist and what is expected of them at the dentist”, he says.
Treating special needs patients takes compassion and understanding, especially when they are anxious or overwhelmed with the experience.
“Some patients whom become agitated, will not cooperate no matter how hard we try to convince them otherwise, in this case you need to know which battles to fight, sometimes it’s totally pointless to try prolong an appointment,” says Fraser.
“In cases that you think the fight is not completely lost, it is advisable to include the carer in any conversations with the patient to convince them to open,” he says.
“Sensory issues are some of the hardest things to combat in dentistry as dentistry is such a visceral activity with lots of different smells, sounds and what the some patients would consider as toys,” says Fraser.
“The best way to get round this is via a look, show, do technique where we first show them the drill for example, out the mouth without water, we then show them what it does – for example – pretend to drill teeth in patients teddies or carers mouths, then slowly introduce the drill into their mouth for 5 seconds, then 10 seconds etc until they are comfortable with the implement in their mouth,” he says.
If the patient is distressed and needs calming down, a good option is to use Nitrous Oxide (laughing gas).
“This can work absolute miracles in a wide range of patients and was one of the go to tools at my disposal,” says Fraser.
Lumino The Dentists is working hand-in-hand with Carers NZ for the fifth annual Lumino Day, one of the largest free dental events in New Zealand with thousands of dollars of free dental treatment given away each year.
It’s a day set aside to provide an opportunity for a deserving group of people in the community to visit their local Lumino dentist and have their basic dental treatment done for free.
We thank Carers NZ, Dr Fraser Borland and Dr Naomi Ting for their assistance with this article.