Special Care Dentistry – How Dental Therapists are contributing to caring for the neurodiverse and those with special needs.

Cat Edney talks to two Special Care Dental Therapists about their role

Very occasionally, a job of the rarest variety is posted on NHS jobs; Special Care Dental Therapist. 

These roles are rare but also highly regarded in the Dental Therapy world as incredibly rewarding.  My own experience of working in special care was limited to a precious few months during my training at Kings College London, some Therapists however have taken this role and have flourished.  With Dental Therapy becoming increasingly utilised in general practice,  I wanted to find out more about how the Therapist role is used within the Special Care Team and how Dental Therapy can help to manage the demand for this service within the NHS. 

Andrea Powell is in community Special Care in Wales, Vikki Griffiths works in the Liverpool Dental Hospital

Can you tell me more about your work? 

VG

I work predominantly as a Dental Hygienist / Therapist on a Special Care Department at Liverpool Dental Hospital. I work alongside special care Consultants and specialty Dentists, registrars and dental students. 
I am the only Dental Therapist on special care, and all of the above refer patients to me for a range of dental treatments. 

Working on special Care is really different to seeing patient’s in general dental practice – I have to do a lot of pre-treatment planning before my patients arrive. I have to check any correspondence from referring dentists, previous treatment history.  Some patients with learning disabilities have triggers which I need to know about before they come into the surgery.  I also review blood reports  (if required), radiographs and if the patient has any additional needs such as the use of a hoist, Saturn turner, bariatric trolley or Ambulance transport. Some of the patients I see require extra time and attention and I am lucky I have that on my side – each appointment with me is a minimum one hour long – I extend this if required again dependent on the patients’ needs and requirements. I also have a Patient Group Direction set up so this helps appointments run smoothly and allows me a little freedom when treating my patients.

AP

In community I see children from low socio-economic groups and ethnic minority areas.  Some of these children are in the “at risk” category most of them have a high caries rate due to poor diet/oral hygiene education at home.

Some of the patients I see are adults with additional needs, such as Down’s Syndrome, Global development delay, patients who are peg fed and other forms of neuro diversity.

What kinds of patients do you see? 

VG

Each day is different on Special Care! – I see a wide variety of patients from young to elderly adults. The patients I treat usually have very complex medical histories – so it’s really important for me to liaise with my senior colleagues, especially at the moment as I am new to working in special care.

I treat patients with learning disabilities this can range from mild to severe, blood disorders such as hemophilia or von Willebrands, Patients with cancer – this varies from blood cancer (myeloma, leukemia or lymphoma) other cancers of the body or head and neck cancers. I also see patients who have very complex medical histories. This list is endless!  

Did you do any further training to be able to treat special care patients? 

VG

I didn’t have any additional training other than my Diploma in Dental Hygiene and Therapy when I started at the hospital.  However, I did have over 10 years hospital experience as a specialist Dental Nurse – this could have been a factor why I was successful with my application?! Who knows!

I am currently looking into courses to help build my knowledge and skills base. I looked into a special care course but, the Diploma in special care dentistry is currently only open to Dentists – which is disappointing and I’m hoping this changes or another course directed at Hygienists/Therapists is developed. Inhalation sedation is something I would like to provide to a selection of my patients, so this is a course I’m keen to complete soon. 

AP 

I didn’t have any further training.

What sorts of treatment do you normally provide? 

VG

I use my full scope of practice when treating patients on Special care, although Hygiene treatment forms the basis of the referrals I receive, each patient usually needs restorations, impressions, and radiographs in addition to this. 

Sometimes my treatment is simply just acclimatizing a patient and carrying out Oral Hygiene and building appointments up from this to the more complex treatments.   

AP

The treatment I provide ranges from oral health education and acclimatisation to full mouth restorations due to caries, referring anything not in my scope of practice to other dental colleagues.

Do you feel these patients could be seen in general practice? 

VG
During the time I have worked on special care there has probably been one or two patients who I felt could have been seen in general practice. 
All of the patients seen on SCD at Liverpool are referred in by their GDP and each referral is accessed by the consultant to ensure their suitability. Sometimes patients come in with an unstable condition and then it stabilises throughout the treatment plan. Each patient is usually accessed and once treatment plans are completed if suitable they are referred back to their GDP.  This is to ensure the service is accessible to the patients who require it. 

AP

I do believe that some of these patients could be seen in general practice along with their family members.  The main reason for seeing them in a community setting is time.  There are no financial elements when working in the community which allows time to be used more freely.  

What are your top tips for managing special care patients? 

VG

       ·         Never underestimate the effect a smile can have on a patient.

       ·         Have patience and understanding for your patients.

       ·         Sit and Listen to your patient. 

       ·         Never assume!

       ·         Your Dental Nurse is invaluable when treating special care patients – they have magic powers!! 

AP

My top tips for seeing patients with neurodiversity and special needs in general practice would be continuity and patience.  Neurodiversity and special needs are, as we know, a spectrum so one label does not fit all individuals.  What works well for one patient can vary hugely to the next.  I feel that you can get a feel for how things will go on a first visit.  Try, where possible to have the same DCP from start to finish to build a rapport with your patient, much the same was as we do on a day-to-day basis with all patients.  Give your time and understanding without limits.  

Don’t clock watch, give yourself long appointments, it is better to have too much time that is not needed than too short a time and feel rushed, this will be picked up by the patients and can hamper your best efforts.

How do you feel about your job?

VG

I love my job! As cliché as it sounds I feel I am in my dream job. Although it isn’t always sunshine and rainbows I enjoy the diversity and the challenge I feel as a clinician. I have learned so much in the last 8 months and I don’t feel I have even scratched the surface yet!  No two days are the same on Special Care …. ever! 

AP

I love working with patients with extra needs as I know that I am giving them care where in general practice they may not have the surgery space or time as we all know, the pandemic has greatly increased our appointment lengths so waiting lists are longer.

I get an enormous sense of well being doing my job.  My job satisfaction is right up there.  I enjoy going to work, knowing that I am going to see some of my favourite patients who are genuinely pleased to see me too.

How can the dental community better serve patients with special needs or neurodiversity? 

VG

From what I’ve experienced, Dental community dental services do a brilliant job of treating patients with special or additional needs and adapting to their needs.

I think there should be an option for patients to see CDS on a regular basis not just a ‘treatment only’ basis as I feel the patients would benefit from regular continuity of care, especially as the clinicians who work in community are so skilled. 

AP

Many dentists have all said that they would be happy to see patients in practice if the individual with extra needs was tolerant of dental care, but feel that any person whose needs are more complex would be referred to the community setting as they know that time is not an issue.

Some parents feel that they would like their child to be seen with the family dentist where possible so as not to single out the child for their differences/extra needs.  However, on the flip side, some parents feel that their child will be better looked after in a community setting.

There are no right or wrong answers here and a conversation needs to be had with the care giver, patient (where possible) and DCP to place the patient in the best dental setting for each individual.