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Learning disabilities and dental care


Written by Dr Nigel Carter OBE
Wednesday, 25 Jan 2012 10:26

Everyone in the UK has a right to comprehensive, quality dental care. The oral health of those with learning disabilities can often be put at risk because of poor communication and a general understanding of their needs. An individual with a learning disability may not wholly understand or appreciate the importance of keeping a healthy mouth, which can be difficult when it comes for dental professionals or carers trying to get the individual to corporate with a healthy day-to-day routine. People with special needs may also become overanxious at the thought of going to the dentist or may need extra reassurance while people suffering from severe medical problems may need extra precautions or care. To address this there are several things we as the profession could do.

First and foremost, we should ensure that people with learning disabilities have the opportunities to learn about their oral health and that information is provided in ways that take communication difficulties into account. Plain English literature or picture-based books are available which are targeted at people with learning difficulties and their carers, with the addition of video and visual support which, along with carefully monitored supervision can be a great help to those with special needs gaining an understanding about oral health.

People with severe learning and communication difficulties may also not be able to express discomfort or pain in usual ways. Carers must be aware of this and sensitive to changes in behaviour or well-being that indicate pain, illness or unhappiness. Some patients prefer to be seen at certain times of the day depending on their needs. For instance, evening appointments may not be suitable for those patients that tire easily or may spend the day worrying. Some patients rely heavily on routine and may need regular appointments at the same time.

People with mental illness often avoid dental care, and their oral hygiene may be impaired, with consequential periodontal disease and caries. Their medication may produce adverse oral effects, such as dry mouth due to a lack of saliva (with increased risk of caries) and oral dyskinesias - an involuntary repetitive movement of the mouth and face. Dental management commonly involves ensuring good oral health care, which may involve the support of a carer, delaying treatment until there is relative psychiatric equilibrium, keeping appointments short, and oral or intravenous sedation could all be required.

People with special needs are those whose dental care is complicated by a physical, mental, or social disability. Barriers to the access of dental services for them, which most of us take for granted, remains a consistent problem - one that has dogged those with special needs for decades.

Those with learning difficulties tend to receive less oral health care than the general population, and just like all of those who do not see their dentist regularly, they may have oral problems that can affect systemic health. Improving oral health for people with special needs is possible mainly through community based dental care systems. Education of patients and parents or carers with regard to prevention and treatment of oral disease must be planned from an early stage. This will minimise disease and operative intervention since extractions and surgical procedures in particular often produce major problems.

All the best,

Nigel


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NigelA good blog. We are currently running a project with the New Ideas advocacy in Coventry to give a voice to people with learning difficulties, and their carers, to understand their views on oral health and dental services in Warwickshire.Several of the points you mention have also been raised in our workshops. At one level it comes down to treating patients with respect and patience but there are also practical steps dentists and carers can take to improve the oral health of people with lear


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