Understanding Special Care Dentistry
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.
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.
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.
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 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.
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.
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.
|Types of impairment||Estimated numbers affected|
|Visual impairments||2 million|
|Hearing impairments||8.7 million|
|Mobility impairments (wheelchair users)||500,000|