Perspectives of the public dental workforce on the dental management of people with special needs.

BACKGROUND: People with special health care needs continue to have difficulties accessing regular dental care partly due to oral health professionals feeling they lack the knowledge and experience to provide treatment to these individuals. METHODS: Qualitative interviews and focus groups provided an insight into the types and nature of supports that oral health professionals working in the Australian public dental system desired and felt may improve their willingness and/or ability to treat patients with special needs. RESULTS: Although participants did not identify one group of patients with special needs that were more difficult to treat, they did report a feeling of being unsupported. Clinicians felt that improved training and access to ongoing education in Special Needs Dentistry, opportunities for greater support from specialists or other health professionals, either through networking or other media such as telehealth, and fostering a more supportive clinical environment, particularly in relation to appointment lengths and productivity pressures, may improve their willingness and ability to treat patients with special needs. CONCLUSIONS: Additional support, in the form of greater interaction with specialists and reduced time and productivity pressures, may improve the willingness of oral health professionals in the public dental system to treat patients with special needs.

Oral impact of gastro-oesophageal reflux disease: a case report.

BACKGROUND: This case report describes the dental management of a 30-year-old male with cerebral palsy and dyspraxia. Recall examination identified multiple erosive carious lesions despite previous oral hygiene and dietary related instruction. A comprehensive approach to patient management was required to identify the aetiological factors associated with the continued loss of tooth structure. METHODS: The identification of the aetiological factors required a detailed medical history and clinical examination, as well as liaison with the patient's general medical practitioner. Preventive measures were adopted prior to restorative intervention in order to stabilize and remineralize the dentition. RESULTS: Medical intervention for gastro-oesophageal reflux disease (GORD) and a targeted prevention programme resulted in remineralization of all carious exposed dentine with stabilization of the dentition. CONCLUSIONS: Patients with cerebral palsy are known to have a higher incidence of GORD as well as problems with swallowing, vomiting and recurrent chest infections. Long-term gastric acid attacks can contribute to dental erosion, and dental professionals may be the first to diagnose silent GORD. The successful treatment of erosion caused by GORD requires a multidisciplinary and minimal intervention approach.