Special Care Dentistry

There is no ‘one size fits all’ in dentistry. Our approach is tailored to the unique needs of the individual and we work as a team with patients and caregivers to determine how we can meet and surpass any challenges there may be to providing care and achieving good oral health.

Dr. Friedman and Dr. Ari, both have extensive experience in working with special needs patients.

Services we provide to special needs children;

  • Regular Dental Check Ups
  • PGSI Program
  • Dental Treatments
  • Dental Treatments under sedation or General Anaesthesia

Adapting Oral Hygiene Recommendations for Individuals with Special Health Care Needs

Children or adults with special health care needs (SHCN) may require adaptations to achieve optimal oral health care. Modi- fications may be needed in order to provide oral hygiene care at home and in the dental office. The purpose of this commu- nication is to give a brief overview of modifications that may benefit your patients with special health care needs.

While many providers may be familiar with these adaptations, the purpose of this communication is to place a focus on this population, remind pediatric dental providers of these tech- niques, and provide this information for those pediatric den- tists who may not know this information or are not currently comfortable seeing this population in their practice. It is also to provide resources on oral hygiene adaptations for your caregiv- ers of individuals with SHCN.

Here is a compilation of different adaptations, tips and tricks to help the provider ultimately help the parents and caregivers of individuals with special healthcare needs. These simple adapta- tions can have everlasting effects on individuals with SHCN’s oral health care and overall health and quality of life.

Toothbrush adaptations:

For those who are able to brush their own teeth, an electric toothbrush may make brushing easier and more efficient once they adapt to it. However, for individuals that are unable to ac- complish brushing using a traditional or powered toothbrush, there are simple ways to modify brushing with different tools, instruments, and positioning. Here are some quick and easy tips to modify a toothbrush to make it more usable for different abilities.

1. Expanded grip capability. For some individuals, adding a larger grip to the toothbrush allows them to hold and manipulate the brush themselves. This can be done by:

  • Purchasing a brush with a larger handle. Some com- panies already produce toothbrushes with a bigger handle for better gripping.
  • Making a slit into a tennis ball and sliding the bottom of the toothbrush handle into the tennis ball.
  • Sliding the bottom of the toothbrush into a bicycle handle grip or any type of rubber or even foam tubing.
  • Wrapping a small cloth around the bottom of the brush.
  • Attaching a Velcro strap around their hand and the toothbrush or a wide elastic or rubber band around the hand and toothbrush for added stability, ensuring they are not too tight.

2. Change to toothbrush shape or dimensions. Some indi- viduals might require changes to the shape of the tooth- brush to make it angled for better access to their teeth. This can be done by:

  • Purchasing a brush that is bent to a more useful angle for brushing. Some companies produce bendable brushes available at local convenience stores.
  • Running the toothbrush handle (avoiding the bristles) under hot water so that you can gently bend the plastic according to your needs.
  • Other individuals might need a longer brush to better reach their mouth to be able to brush on their own. To elongate the toothbrush materials can be added, such as taping several popsicle sticks to the bottom of the brush or adding some type of tubing to the bottom.

 

Toothbrushing adaptations for caregivers:

    1. For those individuals who are unable to complete oral hygiene tasks independently, a challenge for their caregiver may be keeping their mouths open long enough to accomplish tooth brushing. Caregivers can buy commercial products to use at home, such as the Open Wide Mouth Rest (Specialized Care
      Co, Hampton, N.J.), available at various websites. Other com- mercial products widely available include the molt mouth prop and bite block. Practitioners should inquire what caregivers are using to accomplish oral hygiene and discuss proper safety pre- cautions of these products. Caregivers can also make their own device to help keep their children’s mouths open with common household items. Examples of these are a clean rubber door stopper, three to four popsicle sticks taped together, or a rolled moistened cloth.

      Some individuals are not able to complete oral hygiene tasks independently. And some may move or struggle, making completing oral hygiene difficult for their caregivers. Here are several positioning techniques to consider that may assist the caregiver.

 

  1. Caregiver sitting in a chair. One way to make brush- ing easier is to sit in a chair and position the individual sitting on the floor facing away from you in between your legs. This is very simple and allows you to have easy access and control. Position the individual in between your legs while you sit in the chair. If they begin to move, you can lighten tighten your legs or even wrap your legs around them. Position one hand under the chin so that their head is reclined for better access and visualization to the mouth.
  2. Using a couch/ bed/ floor. While you sit on the couch or bed, position the individual to have their head on your lap. This allows you easy access and control. Position the individual’s hands by their sides. If they move a lot, cross the individual’s hands and have a second individual hold the hands. If you do not have a second individual, you can position your legs so that they cross over the individuals’ arms. Use one hand to support the head and place the chin up for visualization.
  3. Using a bean bag chair. Have the individual sit in a bean bag and then you are able to position yourself behind him or her. Position yourself behind the individ- ual- either sitting or standing depending on how tall the individual is on the bean bag. Position the individuals’ arms to the side. If the individual is moving, then have a second individual help hold the arms. Position your hand under the chin to lift and support the head.