Authors: John Morgan, Bonnie F. Zimble
|
Preventive Care in Special Care Dentistry:
The Disease Prevention Program at Tufts Dental Facilities
Serving Persons with Special Needs
Special Care in Dentistry
John Morgan, DDS
Tufts University School of Dental Medicine, 2008
|
|
Study
Questions:
-
Describe five
main factors in disease prevention for persons with special needs.
-
List and
describe the eight key components to preventive care for persons with
special needs.
Factors in Disease Prevention for Persons
with Special Needs
People with special needs have more dental disease and more
missing teeth than the general population. They also have reduced
access to oral health diagnostic, preventive, interceptive, and
treatment services. Even when treatment services are available, they
can be complicated and costly to perform. It is therefore critical that
everything possible be done to prevent dental
diseases for these individuals.
The following information is from the
Tufts
Dental Facilities (TDF). Here are key
factors to consider for patients in the TDF system:
- Constant monitoring is required in the
areas of:
- Homecare effectiveness
- Disease progression
- Identification of new disease processes
- Progress of current dental
treatment plans
- Patients often cannot
communicate problems they are having with their dentition
- Patients often have physical
limitations that prevent them from performing home care procedures
- Patients are reliant on others
to provide home care and to arrange for dental visits
- Many patients have complex medical conditions that
may be exacerbated by poor dental health or have dental conditions that
may be affected by systemic diseases or syndromes
“These factors underscore the
importance of standardizing prevention programs as much as possible to
help assure the highest level of dental health for our
patients.”
Key Components to Preventive Care
Here is more information from the Tufts Dental Facilities
(TDF):
|
Key Components to Preventive
Care |
|
Documentation |
All procedures, diagnoses, and supporting information for
diagnoses must be documented in the patient record, including
documentation of verbal oral hygiene instruction (OHI) and distribution
of written
OHI
|
|
Radiographs
|
A full mouth series should be taken every 3-5
years, and bitewings every 6-12 months. Many patients are not able to
tolerate intraoral x-ray procedures; sometimes a panoramic film can be
obtained. For patients who cannot have films taken in the outpatient
clinic, a referral to the operating room program is
indicated.
|
|
Dental
prophylaxis |
Includes scaling of natural teeth as indicated,
removal of stains, polishing of teeth, and review of oral hygiene
methods |
|
Toothbrush
prophylaxis |
In some circumstances scaling and rotary
instruments may not be used safely. The benefits of the toothbrush
prophylaxis include removal of plaque, desensitization of the patient,
and evaluation of the patient’s oral region for conditions that may not
be identifiable by the patient or
caregiver
|
|
Deep scaling and root
planing
|
The diagnosis of periodontal disease must be documented and
supported by complete periodontal charting and radiographs; when this
documentation is not possible, the diagnosis should be supported by
representative probing depths and/or a clinical description
establishing the indication for deep
scaling
|
|
Oral Hygiene
Instruction |
Oral hygiene methods must be reviewed, in most
cases with the caregiver. The distribution of written oral hygiene
materials is also essential.
|
|
Nutritional
counseling |
Required as indicated. Education of
patient/caregiver about cariogenic food/drink is essential. The
distribution of a list of the most common (and also unexpected) dietary
sources of tooth decay is helpful.
|
|
Risk
Assessments |
Help direct practitioners in deciding what
preventive measures to recommend. Many developmentally disabled
patients will fit in to the high-risk category of susceptibility to
dental disease. A risk assessment should be recorded at least annually
and should correlate to the risk category.
|
|
People who viewed this content, also viewed...
