Katie Melko, MSDH, RDH
Every day I get to treat at least one patient who has special needs, and honestly, they are my favorite patients. You might think the exact opposite, and believe me, until I gained experience, did some research, and attended some courses about special needs, I felt the same way!
If you’re stressed, so is your patient. Patients can sense how you’re feeling based on the way you present yourself. Your facial expressions, eyes, tone and pitch of your voice, and gestures give patients signals and they feed off of those. They’ll respond based on how you make them feel. You need to act confident, talk to your patients, and comfort them through their appointments. Remember, they’re nervous too.
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I have toys and plush animals that I let patients hold during their appointments, and I also use these as oral hygiene instruction (OHI) tools. They’re friendly and create a comforting space for patients so they don’t feel alone. If a patient is very scared, I use a puppet to demonstrate everything first. You won’t get far in some appointments, but it is progress and they will improve by their next visit.
The energy you bring to an appointment will determine how that appointment will go. Be positive and friendly, and smile and talk to your patients! Let’s discuss my top five must-haves for appointments with special needs patients:
1. Cavitron
2. Flavored prophy paste
3. Blanket or lead apron
4. Oral hygiene instruction/nutrition education
5. Recare plan
Everything can be altered to fit a patient’s needs and age. If a patient can tolerate a Cavitron and has heavy buildup, I use a Cavitron to help reduce time in the chair and clinician fatigue.
I love to explain all the products and equipment I’ll be using and how they work. This is a bonding time that allows patients to become more comfortable and realize you won’t hurt them. I also offer prophy paste flavors so that they feel like they have some control over the appointment.
I’ve noticed over time that patients on the autism spectrum feel much more comfortable with the apron on or a blanket over them. The weight gives them relief and helps them feel relaxed. Then, depending on the situation, I try to have enough time to discuss OHI and nutritional education with parents, patient, and caregivers.
Recare
Recare appointments are usually every three months for adults and six months for children, with some exceptions, of course. Many caregivers and parents tell me that brushing and flossing are a struggle because the patient wants to be independent, or the patient refuses to brush or receive help brushing.
When they visit the dentist, however, parents and caregivers are surprised at how cooperative patients can be. I like to use positive reinforcement. I always talk to patients about their oral hygiene and express the importance of brushing and flossing and allowing someone to help them. This can go either way; the talk either works or it doesn’t. Regardless, patients are more likely to be compliant with positive reinforcement as opposed to being scolded.
Home care
When discussing home care, it is case-by-case on what will work best for a patient. Here are some things I see regularly:
1. Dexterity issues—I suggest a tennis ball or molded clay on the toothbrush handle or an electric toothbrush.
2. The patient cannot brush—I recommend toothbrushes that bend so caregivers can manipulate to a better angle.
3. Reach brand flossers work well—These are for caregivers when picks are too small and patients bite them, or string floss is not something they feel comfortable with.
4. Caregivers do not attempt oral hygiene—They are not comfortable in the mouth or they don’t know what to do. I demonstrate and offer oral aids to help. Then I have the caregiver show me what they’re doing, and this allows me to see where they struggle.
5. The patient is noncompliant—This is where I explain to patients that they are doing a good job, but they’re still missing some areas. We want to help them avoid cavities.
6. It’s important to help the patient brush—I usually recommend Listerine Agent Cool Blue. This way patients can see where to brush. This has been a game changer for my patients because it also makes brushing fun.
Treating patients with special needs is very rewarding, especially when you see improvement over time and they bond with you as their provider. Be patient, be kind, smile, and talk to your patients during their appointments. I love to give positive reinforcement and remind them they’re doing a great job. I move slowly because fast-paced movements can lead to fear and a patient may regress.
Have fun with your special needs patients and you will see that a little guidance and preparation can make all the difference between a bad appointment and a successful appointment. Now, go out there and tailor your appointments and let me know if this article helped and made a difference in your day!
Katie Melko, MSDH, RDH, is a public health hygienist at Community Health Center Inc. She graduated from Fones School of Dental Hygiene at the University of Bridgeport in 2016 with an MSDH. She has practiced dental hygiene since 2009.
