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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:
 

  1. Describe five main factors in disease prevention for persons with special needs.

  2. 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.