Special Care Dentistry

Janice Fiske, Chris Dickinson, Carole Boyle, Sobia Rafique, Mary Burke

• Publisher: Quintessence Publishing
• Year: 2019
• ISBN:
  9781850973522
• Edition: 1
• Topic: Médecine
• Subtopic: Dentisterie

People who have a mild or moderate disability - whether physical, sensory, intellectual, mental, medical, emotional, or social in nature - can and should receive dental care in mainstream clinics and private practices. In most cases, however, the average clinician has no training or experience in treating this population of patients. This book examines the principles governing special care dentistry and provides knowledge, information, and practical advice for the entire dental team to facilitate its delivery.

Chapter 1

Understanding Special Care Dentistry

Aim

The aim of this chapter is to explain what is meant by Special Care Dentistry, who requires it, why he or she requires it and who can provide it.

Outcome

After reading this chapter you should have an understanding of what is meant by Special Care Dentistry and the part that you can play in its delivery.

Introduction

The main purpose of this book is twofold:

• Firstly to remove the stereotypes and myths that can surround people who require Special Care Dentistry, and
• Secondly to provide the dental team with knowledge, information and practical tips that will encourage them to undertake Special Care Dentistry.

What is Special Care Dentistry?

Special Care Dentistry is concerned with providing and enabling the delivery of oral care for people with an impairment or disability, where this terminology is defined in the broadest of terms. Thus, Special Care Dentistry is concerned with: The improvement of oral health of individuals and groups in society who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of a number of these factors.

It is defined by a diverse client group with a range of disabilities and complex additional needs and includes people living at home, in long-stay residential care and secure units, as well as homeless people. Clearly, not every individual encompassed by this definition requires specialist care and the majority of people can, and should, be treated by the primary dental care network of general, personal and salaried dental services.

The Ethos of Special Care Dentistry

The ethos of Special Care Dentistry is its broad-based philosophy of provision of care. It achieves the greatest benefit for patients by taking a holistic view of oral health, and liaising and working with all those members of an individual’s care team (be they dental, medical or social) to achieve the most appropriate care plan and treatment for that person through an integrated care pathway.

Special Care Dentistry is proactive to the needs of people with disabilities rather than solely reactive. Recognising that some groups of people are unable to access oral healthcare unaided, to express a desire or need for oral healthcare or to make an informed decision about its benefits to them, Special Care Dentistry includes screening, preventive, and treatment programmes tailored to meet the specific needs of groups or individuals.

Its guiding principles are that:

• All individuals have a right to equal standards of health and care.
• All individuals have a right to autonomy, as far as possible, in relation to decisions made about them.
• Good oral health has positive benefits for health, dignity and self-esteem, social integration, and general nutrition and the impact of poor oral health can be profound.

Definition of Disability

Disability is difficult to define. Words mean different things to different people. While some people prefer to be referred to as “disabled people” (as it clarifies that their disability is related to society’s barriers), others prefer to be called “people with disabilities” (emphasising that they are people first and disabled second). However, there are also cultural differences in the use of terminology. For example, as Nunn points out, in African languages there are words to describe observable impairments like lameness but no overarching generic terms. Some cultures consider names as stigmatising, and in the UK the terminology “mental retardation” is considered to be stigmatising and unacceptable, whereas in the USA it is considered acceptable and is a currently used term.

The language of disability can be confusing. It is continually changing, reflecting developments in legislation and understanding of the complex issues surrounding it. Whilst there are different causes and different types of disability it is important to remember that everyone with a disability is an individual with their own set of needs and wants.

In the UK, terms in general use are impairment and disability, where:

• Impairment refers to a medical condition or malfunction
• Disability refers to the restrictions caused by society through discrimination, ignorance or prejudice.

Within this book, the term disability will be used to refer to all those people who require Special Care Dentistry, including those with complex medical conditions.

Demography of Disability – One in Four of Us

It is estimated that between 8.6 and 10.8 million people in Great Britain are disabled (see Table 1-1) and that the life of one in every four adults in the UK will be affected by disability, either through experiencing a disability or caring for someone close to them who has a disability.

Table 1-1 Incidence of disability

Types of impairment	Estimated numbers affected
Visual impairments	2 million
Hearing impairments	8.7 million
Mobility impairments (wheelchair users)	500,000
Learning difficulties	1 million
Invisible or "hidden" impairments	250,000
Arthritis	8 million
Mental health impairments	1 in 4 of the population

The number of people with a long-term illness, health problem, or disability which limits their daily activities or work increased significantly between the 1991 and 2001 surveys. Census data for England and Wales indicate that almost 9.5 million people (18.2% of the population) self-report a long-term illness, health problem, or disability which limits their daily activities or work. Disability tends to increase with age and multiple disabilities are more likely to occur in old age with approximately two-thirds of all people with a disability being over 65 years of age. The prevalence and common causes of disability for the different age groups are shown in Table 1-2.

Table 1-2 Age, prevalence and common causes of disability

Age group	Prevalence of disability	Common causes of disability
< 16 years	4.3%	Genetic and congenital disorders
16–49 years	9.65%	Trauma (e.g. spinal and head injuries) Neurological (e.g. multiple sclerosis)
50–64 years	26.6%	Musculoskeletal disorders (e.g. osteoarthritis) Cardiorespiratory disorders (e.g. ischaemic heart disease and obstructive airway disease) Neurological disorders (e.g. stroke)
65+ years	51.5%

There is no single register for disability, and a proportion of people with disability have multiple impairments and/or medical conditions so that the categories of disability and impairment may overlap. For example, people with learning impairments have an increased prevalence of associated disabilities such as physical or sensory impairments, behavioural differences and epilepsy. Furthermore, with ageing, people with learning disabilities also have a higher rate of dementia than the general population.

The Disability Discrimination Act (DDA) 1995

Within the terms of the UK DDA 1995, a disabled person is defined as someone who has a physical or mental impairment that has a substantial and long-term adverse effect on his or her ability to carry out normal day-to-day activities. The DDA 1995, together with related Codes of Practice, introduced measures aimed at ending discrimination and giving rights to disabled people. It was introduced in phases (see Table 1-3).

Table 1-3 The phases and requirements of the DDA 1995

Phase	Requirement
1. December 1996	It became unlawful for service providers to treat disabled people less favourably for a reason related to their disability
2. October 1999	Providers were required to make reasonable adjustments for disabled people such as providing extra help or making changes to the way they provide their services
3. October 2004	Required service providers to assess obstacles and make reasonable adjustments to the physical features of their premises to overcome physical barriers to access

Essentially it requires that providers must:

• Take reasonable steps to change policies, practices and procedures which make it unreasonably difficult or impossible for disabled people to use their services.
• Take reasonable steps to remove or alter physical features which could be a barrier to disabled people using their services.
• Provide the service in an alternative way if the removal of such barriers is impossible, for example, where planning consent to adapt a listed building is withheld. In the case of ...