16: Special Needs Patient Care

CHAPTER 16 Special Needs Patient Care


Disability is a permanent or long-term condition, including physical, medical, psychological, and/or mental limitations, that requires individual consideration in planning treatment. Risk factors for NOT achieving oral health are listed when involved.

See Chapters 6, General and Oral Pathology: common medical diseases and disorders; 10, Medical and Dental Emergencies: emergency protocol; 11, Clinical Treatment: modifications of dental treatment; 9, Pharmacology: drug therapies and antibiotic premedication, substance abuse.

Levels of Function

Assessment of functional level involves evaluation of ability to perform activities of daily living (ADLs) such as bathing, eating, dressing, speaking, walking. The higher the functional level, the greater the ability to take care of themselves. ADL assessments have different rating scales and four levels. First level (I) refers to highest level of function, and last refers to lowest level (IV). If guide dog is being used, do not pet or interfere with dog; ask how to handle the dog.

See Chapter 18, Ethics and Jurisprudence: informed consents and those who have lower functioning levels.

Common Barriers to Healthcare

Americans with Disabilities Act (ADA) helped improve access to healthcare. Includes laws that govern wheelchair access to public buildings and restrooms, barrier-free public buildings, improved telecommunications for hearing- and vision-impaired individuals. Prohibits discrimination on basis of disability in employment, government, public accommodations, education, commercial facilities, telecommunications, and transportation. Dental offices are viewed as places of public accommodation. Special needs patients still face many barriers.

Patient with Communication Disorders

Patients with communication disorders are either NOT able to make speech sounds because of structural disease or damage, or NOT able to understand language or form thoughts into words. Related in discussion to disabilities in later sections.


Sex image Male image Female During an intraoral examination of a new patient, generalized moderate gingivitis is noted. The patient has not had dental radiographs taken for 2 years. He is unable to keep his mouth open, and communication with him is difficult.
Chief Complaint Unknown
Medical History

Current Medications diazepam (Valium) 10 mg tid Social History

Patient with Sensory Impairment

Patient with sensory impairment has loss of sight or hearing that makes communication and other daily living issues difficult. Sensory impairments often occur as result of infection, trauma, or disease, but some may be inherited.


Sex imageMale image Female Patient has kept regular dental visits and was seen 3 months ago for his routine maintenance appointment. On intraoral examination the newly hired dental hygienist finds that he has a very red marginal gingiva around #20, which is a full crown.
Chief Complaint “My gums are really bleeding on this tooth!”
Medical History

Current Medications None Social History Post office employee

Cognitive Disabilities

Common cognitive disabilities include intellectual disability (mental retardation), cerebral palsy, autism, attention deficit–hyperactivity disorder or attention deficit disorder, learning disorder, Alzheimer’s disease. Mental illness is considered separately in the next section.

A. Intellectual disability (mental retardation): MOST common developmental disability (Box 16-2).

B. Cerebral palsy (CP): limitation ranges from mild to severe.

Jan 1, 2015 | Posted by in Dental Hygiene | Comments Off on 16: Special Needs Patient Care
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