19: Dental Hygiene Care for Clients with Special Care Needs

Dental Hygiene Care for Clients with Special Care Needs

Every person has unique abilities and needs. Two of every five clients treated in the oral health care environment may require a modified care plan because of special care needs. These special care needs may be transient, for example, pregnancy or a broken foot, or may be lifelong, for example, end-stage renal disease or intellectual and developmental disabilities. With ongoing health care reforms and better access to care for underserved populations, dental hygienists will be serving increased numbers of persons with special care needs in a variety of settings. The National Institute of Dental and Craniofacial Research describes persons with special care as those with genetic or systemic disorders that affect oral, dental, or craniofacial health; whose medical treatments cause oral problems; or whose intellectual or physical disabilities complicate oral hygiene or dental treatment.

General Considerations

Lifespan Approach to Care

Principles of growth, development, and maturation

1. Growth includes physical and functional maturation

2. Growth is generally a continuous and orderly process but can be modified by numerous factors (e.g., nutritional deficiencies)

3. Different parts of the body grow and mature at different rates

4. Critical periods exist in growth and development

5. Hormonal changes can alter:

6. During growth and maturation, a person’s perception of self and that of self in relation to others change

7. Health status generally progresses from acute illness to chronic illness

8. Transition from one life stage to another is gradual and not necessarily based on chronologic age

9. Biologic age is not synonymous with chronologic age

10. Signs of aging can appear at any age

The U.S. health care system (see the section on “Providing oral health care” in Chapter 20)

Incidence and Prevalence of Individuals with Special Needs

National statistics on incidence and prevalence figures are difficult to compile because of:

More than 60 million persons (1 in 5 persons) are considered disabled as defined by the Americans with Disabilities Act; of these, approximately 1 million are children younger than 6 years old

In the United States, 32.5 million persons are considered to have a severe disability

Table 19-2 identifies the most common chronic conditions in the older adult population

TABLE 19-2

Leading Chronic Conditions in the Older Adult Population

Noninstitutionalized Nursing Home Residents
Arthritis Arthritis
Hypertension Heart disease
Hearing impairments Mental illness
Heart disease Paralysis

The most common disabilities in the United States are caused by cardiovascular disease, back problems, arthritis, asthma, and diabetes

The prevalence of disability increases with age

The most frequently reported chronic conditions that cause disability are diabetes, arthritis, cardiovascular disease, hypertension, cancer, spinal curvature, and back impairments

Of individuals with developmental disabilities, 80% live in community-based residences or at home with families

The Dental Hygienist and Individuals with Special Needs

Recognize physical, mental, medical, social, and oral needs

Communicate with clients and caregivers in a positive, appropriate, nondiscriminatory manner

Communicate with other professionals and team members to facilitate planning, implementation, and coordination of care

Plan, implement, and evaluate community-based and office-based programs

Adapt dental hygiene care plans, interventions, and evaluations to meet clients’ special needs, considering:

Identify and eliminate potential barriers to care

Assess one’s own attitudes, values, and commitment to provision of oral health services to these clients

Evaluate local, state, regional, and national trends for their potential impact on the provision of oral health care

Advocate oral health promotion and disease-prevention programs, full use of dental hygienists, and development of sound research so that evidenced-based care is provided in oral health care programs

Potential Barriers to Oral Health Care


1. Financial

2. Transportation and geography

3. Physical facilities

Psychosocial concerns

1. More than 50% of persons in the United States express positive attitudes toward older adults and persons with disabilities, and yet most really perceive them as “different” and “inferior”

2. Society perceives disabilities, differences, and disease states before recognizing similarities

3. Feelings of guilt, anxiety, apathy, inadequacy, embarrassment, depression, anger, and resentment about special needs interfere with attempts to seek care

4. Fear of or inability to comprehend dental procedures, antisocial or atypical behavior, or dependency on oral health care providers interferes with provision of care

5. Basic daily needs and activities are often overwhelming and can lower the priorities for oral health care

6. Perception of self-image and worth can affect care planning

Provider philosophy and provision of care

1. The Americans with Disabilities Act requires that public and private dental offices serve persons with disabilities, that treatment is provided on the same basis as for nondisabled persons, and that dentists make reasonable modifications to facilitate access

2. Despite the Americans with Disabilities Act, surveys indicate that approximately 20% of dentists are unwilling to treat persons who are physically or mentally challenged

3. Reasons given for not treating individuals with special needs include:

Communication and cultural concerns

Medical concerns

Mobility and stability concerns

Specific Conditions

See Chapters 8 and 9.

Intellectual and Developmental Disabilities (IDD)


Incidence—2% to 3% of the U.S. population (57.7 million total), depending on criteria


Etiology—acquired (12%), inherited (13%), unknown (75%)

Signs, symptoms, and clinical manifestations

Oral manifestations

1. Most oral health problems are not inherent to the disability but are related to extrinsic factors (e.g., neglect by caregivers or lack of coordination leading to poor oral disease control)

2. Decayed-missing-filled surfaces (DMFS) scores comparable with those of the general population, but the “decayed” component may be higher because of lack of professional treatment (Figure 19-1)

3. Higher prevalence of periodontal conditions, probably related to poor oral hygiene and lack of regular care

4. Higher incidence of malocclusion and deviations in tooth eruption is associated with craniofacial syndromes or growth abnormalities (Figures 19-2 and 19-3)

5. Some instances of enamel dysplasia, more commonly seen in those with severe mental deficiencies resulting from severe prenatal or perinatal defects or insults

6. Some instances of physical self-abuse, if severely impaired

Fetal Alcohol Spectrum Disorders (FASD)

Definition—an umbrella term describing a pattern of malformations caused by maternal alcohol consumption during pregnancy, characterized by prenatal and postnatal growth deficiency, dysmorphic facial features, and central nervous system (CNS) dysfunction including fetal alcohol syndrome (FAS), alcohol-related neurodevelopmental disorders (ARND), and partial fetal alcohol syndrome (PFAS)

Incidence and prevalence


Signs, symptoms, and clinical manifestations

Treatment—depends on specific anomalies and organ systems affected

Oral manifestations

Down Syndrome

Definition and etiology

Incidence—most common chromosomal abnormality (1 in 800 live births; but varies with maternal age); approximately 400,000 individuals in the United States affected

Signs, symptoms, and clinical manifestations

Oral manifestations (Figure 19-5)

1. Relative mandibular prognathism as a result of a small nasomaxillary complex

2. Dry skin and thick, dry, fissured lips

3. Open mouth posture, with a protrusive, fissured tongue

4. Hyperplasia of the adenoids and tonsils

5. Altered salivary gland mechanism (decreased flow)

6. Increased susceptibility to severe periodontal disease of early onset, especially in anterior areas; may be related to host immune defects (e.g., periodontitis as a manifestation of a systemic disease)

7. Delayed eruption of teeth and abnormal tooth development

8. Higher incidence of congenitally missing teeth

9. Small tooth crowns with short crown–root ratio

10. Enamel dysplasia (Figure 19-6)

11. Malocclusion—anterior open bite or cross-bite, posterior cross-bite, malocclusion common

12. Attrition

13. High palatal vault (Figure 19-7)

Autism Spectrum Disorders (ASD)


Incidence and prevalence

Etiology—different theories

Signs, symptoms, and clinical manifestations

Treatment—variety of approaches tried with varying success

Oral manifestations—none directly associated with the syndrome; difficult behaviors, feeding problems, and poor cooperation are challenges to dental care

Attention Deficit Hyperactivity Disorder (ADHD)


Incidence and prevalence

Etiology—unknown, but may be related to:

Categories—areas of CNS function affected

Signs, symptoms, and clinical manifestations


Oral manifestations—none directly associated

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Jan 1, 2015 | Posted by in Dental Hygiene | Comments Off on 19: Dental Hygiene Care for Clients with Special Care Needs

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