Every hygienist wants to provide the best care for patients, but sometimes, we don’t know exactly how to do that when it comes to a patient with special needs. Hygienists tend to immediately feel at least some anxiety about the appointment with a special needs patient due to the unknown.
How will the patient react in certain circumstances? How should I talk to them? What is their level of comprehension or understanding? What actions could I take to improve their visit? What else do I need to change in order to accommodate them better?
A special education teacher who works with students who have mild to severe disabilities provided insights for this article; he gave me some helpful instructions when accommodating patients of all ages with special needs.
Make it Positive!
First and foremost, you want each visit to be a positive experience. Every hygienist wants that for patients, of course, but consider making this more important than the procedures you will perform.
Sometimes, it’s more important to forget about the codes you need to get done and instead focus on the patient. If the first appointment ends up just being a consult, that’s excellent! You are one step closer to being able to provide the best, individualized treatment for that patient!
If all you can do with that patient is talk with them or their caregiver, what a great opportunity to create a relationship with them. By establishing yourself and your office as one that takes care of the patient over all else, they will have a great experience. Not only will they want to come back, but they will be more encouraged to work toward the goals and recommendations discussed during the appointment.
Trust They Know Best
Some adult patients may be able to tell you exactly what they need or want. Not all disabilities prevent patients from accurate communication, and when they can clearly communicate, we must listen. A patient knows themselves, and a guardian knows their ward. We should trust that information. No matter how much studying we do, a patient will always know their own disability more than we do, so use that information to adapt the appointment for their needs.
One patient with autism spectrum disorder arrived for treatment and pretty much laid down the law. I was caught a little off guard but appreciated that he relayed to me his expectations. In his case, he said he didn’t like it when a clinician talks too fast or interrupts him. He asked for me to let him know if someone would be coming in or out of the room as he didn’t like interruptions or people coming in, standing, or sitting behind him. He asked me to avoid loud noises and explain procedures before doing them.
All of these requests were completely realistic, and I adjusted the appointment to allow myself the time to accommodate him and make him more comfortable.
Consult with Their Caregiver
If the patient is unable to relay requests or expectations about the appointment, ask their caregiver. A caregiver, guardian, or parent is one of the best resources we have for the special needs patient. They know what the patient likes, what they don’t like, what’s upsetting to them, signs they are getting agitated, what reduces their stress or anxiety, as well as many other things that a dental provider would not be able to know or guess within the hour we have with them.
If the patient you are treating is a child, always ask the parents how to best accommodate their child during the appointment. It is best to have this information going into the appointment instead of gathering it when the patient is in your chair.
The caregiver will be able to tell you if the patient is nonverbal, for example, or if they’ve had difficulty finding a compatible dental provider. They can explain how the disability presents and what is “normal” or “not normal” (typical behavior of the patient at home vs. with new people during appointments). All information can be used to make the appointment go more smoothly.
Plan Ahead of Time
Most patients or guardians who are setting up an appointment will discuss any special needs before coming in for the appointment. This is an excellent opportunity for the front office to ask questions or for them to consult with the hygienist and doctor, perhaps scheduling a phone call for the clinicians to inquire more about the patient. If your office does not allow time for the specific clinician to make inquiries about the patient, enlist the front office if more information is needed.
During the telephone conversation, you could ask the patient/caregiver any questions about the special needs, the temperament of the patient, things to avoid, and accommodations to make. You also have the perfect opportunity to tell them your office protocol and what they can expect from you. Open communication is the only way we can ensure the patient has an appropriate appointment where their dental and overall health concerns are met.
This is also a great time to make referrals. If the patient has a severe disability that your office is not specialized to accommodate, instead of taking up their time, possibly traumatizing the patient and/or using insurance benefits, you could discuss the possibility of referring to a specialty office that would better meet their needs.
A specialty office may be better suited for patients who cannot be moved from a wheelchair or motorized chair, patients who have troubles staying in a leaned back position for long periods of time, pediatric patients who need more accommodations specific to children, or patients who need a dental home that can provide sedation for treatment.
Tabling Your Dental Spiel
Have you ever been so passionate about your OHI that, even as you were delivering your rehearsed speech, you knew your patient wasn’t going to do any of it? We all know the conversation points we should hit with each patient.
Sometimes, though, that’s not the most important thing. Appointments with special needs patients may look the same as other appointments, but for the most part, we want to be tailoring them to that specific patient. This might mean that discussions of interdental cleaning, nutrition, or periodontal disease don’t happen right at first or even during the first few visits. These discussions definitely do need to happen at some point, and, of course, we’re not going to sacrifice their health because of any disability.
But it does mean that other health accommodations might take priority. Make personalized adjustments to best benefit the patient. These adjustments might mean that, instead of focusing on removing all calculus and biofilm, the clinician focuses on ensuring the patient has good home care techniques, has the appropriate tools to maintain oral health (electric toothbrush, interdental aids specific to the patient’s needs, chemotherapeutic agents, etc.), or creating positive experiences in the dental office.
A great option is using motivational interviewing. Ask the patient (or their caregiver) why they are here at your dental office. What can we do for them? How can we help them on their journey toward oral and overall health? If they need to take that first appointment to talk to us about what they need, the poor experiences they’ve had in the past, and what they want at this office, that is the start to a great patient-clinician relationship.
Communicate Expectations with the Doctor
When it comes to patients with special needs, you need to have the time to properly make accommodations for their disability. This comes with the support of your doctor. If you don’t already know your doctor’s protocol on caring for special needs patients, have a discussion with him or her. Talk about both of your expectations and how an appointment should go.
I am lucky to work with an amazing doctor who prioritizes care over production. He trusts me to make the best decisions for the patient, and if that involves taking an hour to just talk with the patient or their caregiver, then he is fully supportive.
Though most doctors understand the necessity of making modifications to the appointment, not all value the same quality of care. An employer may focus on the financial aspect of an appointment as opposed to a hygienist’s focus on providing strategies for oral health and the most optimal patient-clinician relationship. To reduce any friction between you and your employer, have this discussion beforehand. Go through the patient’s information, layout your plan, and ask what he or she thinks about it.
Providing the Best Care
In the end, every health care worker wants the best for every patient regardless of any circumstance. After consulting with the special education teacher and understanding that they carefully plan, make meticulous accommodations, prioritize the learning of their students, and adjust their teaching styles to better equip the students to be successful, I realized it is not so very different than what we as hygienists want to achieve.
After incorporating these tips into an appointment with a patient with special needs, we will be able to provide excellent care, accommodations, and equity, allowing each patient to walk away feeling like he or she was well taken care of.
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