Special care is an approach to oral health care that is tailored to the specific needs of persons with a variety of medical, disabling, or mental conditions. Consider a person with diabetes who is at increased risk of gum disease; a young child who needs dentures because of a genetic disorder, a person with arthritis who is unable to hold a toothbrush. Dentists and other health professionals must often develop innovative approaches to serve these patients. The treatment challenges are heightened by the diversity among special care populations.

Why do patients need special care?

Some people need routine oral health care, but have physical limitations or conditions that require delivery of care beyond the routine. Oral health care staff, for example, might need to learn wheelchair transfer, some sign language to communicate with deaf patients, or how to manipulate adaptive oral hygiene devices and instruct patients in their use. Persons with conditions such as Down syndrome, Alzheimer's disease, or autism, as well as the homebound and institutionalized may require innovative approaches to routine oral health care.

Other patients have medical and oral conditions that call for extraordinary oral health care and require dental professionals to have specialized knowledge. A broad range of acquired and genetic craniofacial defects such as cleft lip and palate or bone loss from trauma or surgery often require extensive reconstructive and therapeutic procedures that involve a number of health specialists. Other disorders such as ectodermal dysplasia and osteogenesis imperfecta directly affect tooth and maxillofacial development and demand specialized treatment.

Many systemic diseases, including diabetes mellitus, AIDS, and SjÓgren's syndrome, and certain medical treatments have oral health implications. A dentist might need to develop a treatment strategy for an organ transplant patient, determine the best anesthetic alternative for a patient with heart disease, or develop an oral health plan for a patient prior to cancer treatment. Beyond their impact on general health, oral cancers and their treatments can also leave patients with eating, speaking and swallowing difficulties. In addition, many drugs cause oral health problems, such as gum overgrowth associated with long-term phenytoin use or xerostomia that results from many over-the-counter and prescription medications.

In managing special care patients communication is essential among all members of the health care team, including oral health professionals. With the increasing numbers of patients who require special care and the far-reaching effects of the Americans with Disabilities Act, there is a pressing need for awareness and understanding of oral health special care issues among all medical, dental, and rehabilitation communities.

How can I get more information?

Many organizations provide information and support for special care patients and health practitioners. The National Oral Health Information Clearinghouse (NOHIC) is a central resource to help access this information. NOHIC is a service of the National Institute of Dental Research, one of the National Institutes of Health.

The clearinghouse directs both patients and professionals to the best sources of information and materials on specific special care topics in oral health. NOHIC maintains a database that provides descriptions and ordering information for publications, audiovisuals, and other printed material. It also has information on organizations involved with special care. In addition, the clearinghouse produces and distributes materials including fact sheets, brochures, and information packets.

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Reprinted with permission from the
National Oral Health Information Clearinghouse
Bethesda, MD 20892-3500
Tel. (301) 402-7364 - Fax. (301) 907-8830

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