Special Needs Care for People with a Mental Illness/disability

Dental workers require a positive and optimistic approach to patient management and care.

Guidelines include – consistency, reliability, regularity and familiarity with the same dentist.

Treatment factors:

• Pain control: consider and provide options for care that may be least stressful and painful to the client.
• Preventive care: is crucial for this client group.
• Active follow up: provide regular recall appointments.
• Dietary compliance: must be monitored during delivery of treatment.
• Drug side effects & interactions: awareness of current medication client taking and the possible interactions with other medications and drugs used in dentistry.
• Informed consent: careful explanation of treatment plan.
• Management of emergencies: ensure all staff are aware of occupational health and safety procedures, in particular, for the management of psychotic episodes.

Treatment Planning:

(Important Information to obtain with client permission through liaison between case workers, GPs and dental workers where possible)

• Medical histories (recent hospitalisations and dental history details including previous dental treatment at other clinics).
• Current medications client taking, dosages and any adverse side effects.
• Assessment of current psychological status.
• Assessment of client’s ability to participate in treatment, especially to perform oral hygiene.
• Contact details of current doctors including GPs and psychiatrists.
  (Walpington et al 2000)

Preventive Strategies (involving caseworkers and carers):

• Oral hygiene instruction with clients - get clients to watch, do and feel correct toothbrushing actions. (traditional educational methods using posters and model demonstrations have been less successful with this and other special needs groups)
  (Chalmers 2001).
• Promotion of home fluoride treatments
• Promotion of saliva-enhancing products e.g. sugar free chewing gum
• Discourage drinking of soft drinks
• Provide easy referral for a dental ‘checkup’ before further onset of disease which necessitates emergency and often more invasive treatment

Client Motivation

• Clients fear criticism and blame. Using a simple advice approach may not be very successful.
• Resistance to change may increase, reinforcing unhealthy behaviours.
• Health professionals may feel their words are being ignored and they are wasting their time.
• It is important to recognise that change is a slow and gradual process.
• The client should be encouraged to identify their own health needs and recognise lifestyle barriers, in order for them to develop realistic health goals.
• Health professionals can renegotiate these goals, understanding the difficulties this client group faces with compliance with preventive regimes.
• A compromised health goal may not be ideal but may be appropriate and achievable for the patient at that point in time
  (Freeman 1999).

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