How to create an inclusive practice

06 June 2024

Jacob Watwood suggests measures dental practices can implement for patients with additional needs.

Students in England will soon be able to take British Sign Language as a GCSE. It will be taught in schools from September 2025 and open to all pupils. As we move towards an ever more inclusive society, dental professionals must ensure that patients with additional needs have access to the same level of oral health services and expertise as others. Understanding their unique challenges, adapting techniques, and creating a welcoming environment can help create a positive dental experience for these patients.

Dental patients with additional needs can encompass a wide range of disabling conditions, including intellectual disability, dementia, physical limitations, movement disorders, behavioural disorders, and chronic medical conditions. Many of these individuals can be treated in routine dental settings with minimal special accommodations or with interventions that are well within the scope of most dental professionals.

Some patients with additional needs may require interventions that go beyond the scope of routine behaviour management techniques. These techniques can include desensitisation, anti-anxiety medications, therapeutic immobilisation, sedation and general anaesthesia.

Unmet needs

Under the Equality Act 2010, public sector organisations must change their approach or provisions to ensure services are accessible to disabled people and everybody else. People with learning disabilities might have difficulty with reading or writing, explaining symptoms and understanding new information. They have higher levels of gum disease, greater gingival inflammation, higher numbers of missing teeth, increased rates of edentulism, higher plaque levels, greater unmet oral health needs, poorer access to dental services and less preventative dentistry. They are often unaware of dental problems and may rely on their carers.

Similarly, under the ‘Accessible Information Standard,’ dental surgeries that provide NHS services must ensure that people who are deaf receive information in a format that makes sense to them. This also applies to hearing parents who have deaf children or deaf parents with hearing children.

Indeed, effective communication is crucial. It’s important to take the time to establish a rapport and build trust with patients with additional needs and their carers. The dental team should use simple and clear language, visual aids, and alternative communication methods if necessary. They should be encouraged to express their concerns or queries, ensuring their participation in the decision-making process.

Sensory considerations

Many patients with additional needs may have heightened sensory sensitivities, which can make dental visits overwhelming. Therefore, it is important to be mindful of the clinic environment by minimising noise levels, using natural lighting, and providing comfortable seating. Practices should consider allowing extra time for patient appointments to help alleviate any stress.

Visual supports can help to aid understanding and reduce anxiety. Some patients may benefit from using stories or creating illustrated step-by-step guides to explain dental procedures and routines. These tools can provide reassurance and a sense of familiarity, making the experience more predictable and less intimidating for patients with additional needs.

Dental professionals can implement techniques to make the dental experience more sensory-friendly. These include desensitisation techniques, gradually introducing patients to the dental environment, and involving them in play therapy to familiarise them with dental tools and equipment.  

Collaboration with carers

Collaboration with carers is vital to providing comprehensive care. Dental professionals should encourage open communication and provide carers with educational resources, such as instructional videos or printed materials, to help them maintain optimal oral hygiene practices at home.

Positive reinforcement can also significantly impact a patient’s experience. Dental teams can offer praise and rewards for cooperation and positive behaviour during dental visits. This reinforcement can help to build a trusting relationship and reduce anxiety in subsequent visits.

Oral hygiene can challenge many patients with additional needs, including those with sensory or motor dysfunction. Recommending the right oral hygiene products for our patients is essential for their oral health.

The Flexi range of interdental brushes from Tandex can help some patients with additional needs as they are easier to grip and less tricky to use than string floss. Each product’s handle is flexible, and the brush can be bent into the perfect shape to clean in between the teeth. Available in 11 different sizes, the line presents a solution for each patient for a comfortable and effective clean. Given that patients with additional needs are more prone to tooth decay, the brushes can also apply Prevent Gel, which contains 0.12 per cent chlorhexidine and 900ppm fluoride, which offers antibacterial and enamel strengthening properties.

Caring for patients with additional needs in the dental setting requires understanding, empathy, and adaptability. By implementing effective communication strategies, creating a sensory-friendly environment, collaborating with carers, and tailoring treatment plans, dental professionals can provide optimal dental care to this vulnerable population. With this knowledge and approach, patients with additional needs will receive the treatment they deserve, contributing to their overall wellbeing and quality of life.

References available on request.