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Special Needs - Special Attention

A special day.St Helen’s Dental practice was established in 1984. Over the years we have seen a full spectrum of patients including those with special needs. Since opening Meredyth Bell has worked closely with families who have members with Cerebral Palsy, Downs Syndrome or Autism as well as those confined to a wheel chair.

The practice approach has developed over the years to try to match the patient’s needs and capabilities. It is our experience that the most severely special needs patient who has a 100% reliance on a carer generally will have an excellent standard of oral health care and diet. The practice - with hygienist support - has always encouraged good diet and oral hygiene. For those unable to indulge in snacking and selecting their own tit-bits can contribute to a caries-free mouth.

Our main concern throughout is the oral hygiene and we try to explain to the parents and carers the problems that the children with special needs will experience in the eventual loss of their natural dentition, and the challenge of needing dental prostheses – false teeth.

We also have noticed that those patients who have parents or carers who are in constant attendance have a much higher standard of oral hygiene than those who are cared for on a more ad-hoc basis. The practice has a policy of encouraging active participation in tooth brushing and where we can enthuse the carer, the results are noticeably much better than when we have no contact at all with the hygiene supervision. We find that electric toothbrushes are a godsend to many carers.

We encourage families to attend as a unit. This has multiple benefits in as much as its an occasion to come out together, there's always a lot of laughter, banter and fun and the special needs patient seems to benefit from all these aspects including integrated oral hygiene instruction from the hygienist.

Every year the practice has a visit from Mayfield School which caters for those young people who are very severely special needs. The practice has wheelchair access. The idea behind the visit from the dental point of view is that under more relaxed circumstances students can come in and experience the practice environment. The dentist and the dental team can then concentrate solely on helping them.

The school has its own curriculum targets for the visit including an experience of the workplace, addressing health and hygiene issues, community awareness and - like us - an attempt to allay the fears that many students have relating to dental visits.

Special patients – special day.

The recent visit to our practice involved eight special needs children whose problems ranged from severe autism to behaviour problems and learning difficulties. All were ambulant and some were more articulate than others. We split them into two groups of four with their attendant teachers.

The session started off with role-play. All the student were invited to become dentists for an hour, and were encouraged to put on rubber gloves, masks and protective eye cover. The initial problems of putting on rubber gloves was soon overcome, so much so, that the idea of regular changing gloves between patients became extremely popular and we were hard pushed to keep up with the supply of surgical gloves! Once the students were dressed up they were then invited to assume various roles on a rotational basis. One could be a patient, one could work the aspirator, another worked the chair controls and the fourth held the hand of the patient for "reassurance".

In the ensuing hilarity the students became familiar with suction, the noise, the chair, the lights, lying back in a chair, and having their mouths examined. It also was an opportunity to show the effects of neglected oral hygiene and the comments from their peers were excepted by the ‘patients’ with much better grace than if they had been delivered by the dentists themselves.

As a further incentive the students were invited to participate in role reversal and consequently I was allowed to sit in the chair and have my teeth polished. It was particular touching that one of the students insisted on holding my hand as she felt I'd be quite nervous. In fact she was quite right as I had put enormous faith in my colleague who was allegedly guiding the student holding the drill towards my mouth and you're never sure who you can trust at times like these!

The whole exercise was aimed at removing any fear of instruments, noise or appearance associated with surgeries and dentistry. We then pushed the barriers a little further back by inviting students to have impressions taken of their lower teeth. This was the piece de resistance of the visit and one student who has severe emotional problems became the star of the occasion and showed such enthusiasm that we were unable to move her from the chair at the end of the session. (Study models to be forwarded at a later date).

Whilst this was going on there were also demonstrations of tooth brushing, examples of good diet, and sheets depicting ‘good food’ given out showing plenty of bright attractive pictures. We had the opportunity make up a goody bag, for each student to take away with them, which contained apples, sugar free sweets and other oral health care products.

One of the students had found her niche in reception and was able to use the intercom much to the delight of the other students in surgery who responded to the challenge of answering telephones and conveying messages with commendable skill. Our temporary receptionist flowered in reception and was soon offering our booked- in patients the chance to purchase items from the practice shop and also sang songs to them. This was a delightful episode not only for our reception team but also for all the patients that were due to have appointments and treatment.

Was this a successful visit? I feel that it’s something that is well worth repeating if only because low self image children became outward going. Poor self-perception gave way to enormous self-confidence, we had young people standing in queues to put on Loupes and rubber gloves and we also attracted two volunteers for Saturday jobs.

This success of this visit depended largely upon the willingness and support of the school and their very dedicated teachers. The enthusiasm and the warmth they engendered before their charges came to the practice enabled the students to have a very receptive attitude on entering the premises. The success also greatly depended upon the enthusiasm and commitment of my team who enjoyed the interchange and the chance to show their care and dedication to young patients. The result was an exhilarating and informative experience, the practice had a feel good factor for days and the students who visited us are now comfortable with dentists and dentistry. The visit was both humbling and rewarding.

Meredyth Bell MBE

A special day.

 

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