Caring for special needs patients in the dental office

Every day I get to treat at least one patient who has special needs, and honestly, they are my favorite patients. You might think the exact opposite, and believe me, until I gained experience, did some research, and attended some courses about special needs, I felt the same way!

If you’re stressed, so is your patient. Patients can sense how you’re feeling based on the way you present yourself. Your facial expressions, eyes, tone and pitch of your voice, and gestures give patients signals and they feed off of those. They’ll respond based on how you make them feel. You need to act confident, talk to your patients, and comfort them through their appointments. Remember, they’re nervous too.

© Tomasz Markowski –

I have toys and plush animals that I let patients hold during their appointments, and I also use these as oral hygiene instruction (OHI) tools. They’re friendly and create a comforting space for patients so they don’t feel alone. If a patient is very scared, I use a puppet to demonstrate everything first. You won’t get far in some appointments, but it is progress and they will improve by their next visit.

The energy you bring to an appointment will determine how that appointment will go. Be positive and friendly, and smile and talk to your patients! Let’s discuss my top five must-haves for appointments with special needs patients:

1. Cavitron

2. Flavored prophy paste

3. Blanket or lead apron

5 steps to creating a purpose-driven dental hygiene practice

On my first day of dental hygiene school in 1986, my class of 32 students sat nervously in an auditorium at the University of Texas. Juanita “Nita” Wallace, PhD, RDH, our program director, was about to give the welcome message. She entered the room in a way that inspired respect and awe. Her message was simple: “With all that you do in your profession, always put your patients’ interest first, and every other aspect of your career will fall into place.”

It was not until the end of my program that I would truly learn this lesson. As a student, I studied well and scaled teeth with passion. But up until that point, I’d never put anyone else before me—I was young. Meeting the clinical requirements for graduation was tough, as any dental hygiene student can attest. The pressures mounted, I fell behind, and I struggled to complete my clinical requirements for graduation. This led to lapses in clinical judgment, and I began “squeezing in” patients to meet the requirements, which led to stress and anxiety.

© Krittiraj Adchasai |

Four days before graduation, I was summoned to Dr. Wallace’s office. I was informed that I was not eligible to graduate and would be held back one semester. I was shocked. My family had already flown into town to watch my commencement. I had several job offers waiting for me. My life was shattered into a million pieces. I cried and begged to no avail. It was determined that, even though I had technically met the clinical requirements, I had not learned the most important lesson of all.

Helping dental patients with sleep apnea and breathing issues

Here’s a question you may not have asked lately. How many men, women, and children under your care have undiagnosed sleep-disordered breathing (SDB) issues? I believe this topic warrants more attention from dental professionals, so I’d like to share what I learned about SDB from personal experience. I bet some of you reading this are just like me, and more importantly, you see a lot patients who are like me.

My learning experience began one morning when my husband said, “Karen, you were snoring last night.”

I quickly replied, “No, I wasn’t.” I don’t snore!

After we bantered for a few minutes, I conceded. I asked, “Well, was the snoring at least quiet and feminine?” When he said no, I had to pick up my jaw off the floor. I couldn’t believe it. He was the one with sleep apnea. He wore the CPAP every night.

© Katarzyna Bialasiewicz –

What would my snoring mean for me? I was curious enough to take the next step, so I downloaded an app called SnoreLab. I now recommend this app to my patients so they can find out whether or not they snore. Not all snoring indicates sleep apnea. But if you do snore you need to find out whether or not you stop breathing for 10 seconds or more during these events referred to as sleep apnea. Breathing cessation, even for a few seconds at a time, reduces the oxygen traveling to cells and organs, which contributes to a domino effect that adversely impacts health.

What did I learn from my SnoreLab app when it recorded my snoring, and then ranked the snoring episodes as quiet, light, loud, or epic? Again, I had to pick up my jaw off the floor when I checked it. I made it all the way up to epic snoring! Definitely not feminine. Mind you, I was completely unaware that somehow my sleep had turned into a snoring frenzy.

Moving prevention forward

The role of preventive restoratives and innovative screening technologies in caries risk management in SEARHC dental clinics

Oral health encompasses the stability of, and absence of diseases in, all structures in the mouth—from the teeth to gingival tissues, tongue to the hard palate, and other buccal and lingual tissues. Among the most preventable and reversible diseases that dental professionals see are caries and periodontal diseases.1,2 Regular visits to oral health-care professionals, combined with good hygiene that begins at a very young age, can prevent and curtail tooth decay and gum disease.

Unfortunately, several factors can increase an individual’s caries risk.3,4 These include genetic predisposition to caries and periodontal diseases, different strains of caries active bacteria that can be transmitted from person to person and which may be localized to specific geographic areas and populations, difficulty accessing inexpensive fresh fruits and vegetables and healthy foods, and lack of running water. An inability to access dental care in geographically dispersed locations also contributes to caries disease risk. Combined, these factors create barriers to good oral health.

The SEARHC caries risk program

In Southeast Alaska, however, dentists, dental hygienists, and primary dental health aides and therapists (levels 1 and 2) affiliated with the Southeast Alaska Regional Health Consortium (SEARHC) dental clinics have incorporated a multilevel approach for preventing, arresting, and treating caries disease.5 Even before CAMBRA (Caries Management by Risk Assessment) was established as the standard for caries risk assessment through disease indicators, protective protocol, and clinical interventions,6 SEARHC dental professionals began addressing the caries disease problem differently after realizing we weren’t winning the fight against cavities by drilling and filling. Rather than treat cavities according to a surgical model, we sought to treat caries disease according to a medical model, and spent considerable time researching and exploring available caries preventative and therapeutic products.

3 hidden benefits of clear aligner therapy relating to airway health

Clear aligners are becoming increasingly popular. Are you aware that by offering clear aligner therapy (CAT), you may also help patients breathe, sleep, and thrive? Obstructive sleep apnea (OSA) is a common disorder.1 According to the American Sleep Apnea Association, an estimated 22 million Americans are suffering from OSA, with two-thirds of the moderate to severe cases remaining undiagnosed.2 Recently, dentists have been called upon by the ADA as the “only health professionals” with the experience to prescribe oral appliance therapy.3 The question is, should CAT be considered an oral appliance to combat sleep-disordered breathing (SDB)? This article will review the three essential hidden benefits of CAT that may help patients breathe better while also giving them a beautiful smile:

1. Changing the morphology of the arch form and width

2. Increasing oral cavity volume

3. Proper tongue placement

Changing morphology of arch form and width

If we take the time to disclose the cause of disease, we can then focus on proper treatment modalities. The root cause of most crowded malocclusions is a result of three conditions: improper arch form, improper arch width, and improper buccolingual inclination (figure 1).

What should hygienist do about subpar dentist?

Dear Dianne,

I work in a group practice with four general dentists. Three of the doctors do very nice dentistry and seem to take a lot of pride in their work. However, the other dentist does some of the worst dentistry I’ve ever seen. I’m talking about crown margins I could park my car under, composites that do not match, restorations that leak and fall out, and more. When this doctor checks my patients, I cringe when I have to reappoint them with him.

This dentist has been out of dental school for 10 years, so it’s not like he’s old and decrepit. Sometimes, I wonder how he ever graduated with such poor skills.

Don’t get me wrong—he’s a nice guy, but his dentistry sucks! I would not want him to even adjust a filling in my mouth. Several of my coworkers have noticed the poor quality of his dentistry as well.

My question to you is, what is my ethical obligation to my patients? Should I steer them away from his schedule? Should I say something to the senior doctor about what I’ve observed?

Northern RDH

Dear Northern,

As you are aware, hygienists are in the best position of all the staff members to judge the quality of a dentist’s work. With your instruments, you get to explore margins of restorations subgingivally, and you chart when you observe recurrent decay, failing restorations, or any other dental need. Hygienists certainly recognize when dentistry is high-quality or substandard.

Many hygienists are employed in offices where the dentists are fully engaged in advanced dental procedures that require many hours of continuing education. These dentists often push themselves to attain the precision needed to excel in those specialized areas. Some become over-the-top perfectionists who feel that all of their employees should have the same zeal as they do. Believe me, I know what I’m talking about. They have the bar set so high that nobody can please them. Staff turnover is common in these situations.

Occupational noise-induced hearing loss: What dental hygienists need to know

An increasing number of dental professionals now experience significant hearing loss. The issue of noise-induced hearing loss received little attention in the educational arena until recently, but the tide is turning with more academic institutions now addressing the need for hearing protection.

Risk for compromised hearing

Despite this increased awareness, many clinicians today are grappling with compromised hearing. Typically, occupational noise-induced hearing loss occurs when the human ear is subjected to loud noises over long periods of time. Although everyone’s occupational exposure is different, it is now understood that the cumulative effects of exposure to 85 dB over an eight-hour day will affect human hearing.1

It’s not just how often you use a power scaler. The problem is compounded by noise from the suction, the sound of the high-speed handpiece in the next cubicle, and the compressor or lab grinder down the hall. Lifestyle choices and genetics also play a role in accelerating hearing loss.

Since noise-induced hearing loss is cumulative over time, many dental professionals are not well prepared for a future that involves hearing loss. Along with having to cope with diminished hearing, the cost of assistive hearing devices, commonly known as hearing aids, causes sticker shock for many people.

© Melpomenem |

Exfoliative cheilitis and lip damage: A clinical overview for dental hygienists

In an appearance-conscious world, patients today are increasingly concerned about their outward appearance. Various media have heightened public awareness of appearance, making patients very aware of any variations in what is deemed “normal.” The mouth and lips are so prominent that when there are abnormalities, patients want our help—both to fix their appearance and address concerns about cancer and other abnormal disease states. That is why chronic lip peeling, lip scaling, and ulcerative lesions of the lip will bring patients into a dental practice searching for answers.

Lip abnormalities

Abnormalities of the lips and their various causes include the following:

• lip injuries

• exfoliative cheilitis

• basal cell and squamous cell carcinoma

• angular cheilitis

• cheilocandidiasis

• parafunctional causes, such as lip smacking, lip biting, and chronic lip licking

• circumoral dermatitis

• chronic chapped lips

• mouth breathing resulting in lip fissures

• allergy-type reactions from lip products, toothpaste, and dental products

• metal allergy reactions

• food sensitivity

• damage from sun exposure

• contact dermatitis and skin diseases such as lichen planus, scleroderma, and pemphigus/pemphigoid

An abnormal outward appearance of the lips usually demands an etiology for the patient. Hygienists can begin by asking questions to narrow the prospect of the offending product or disease state.

Reporting lack of infection control in dental practice

The newest dental office in town promotes itself as a heavenly oasis. In the waiting area, written in embellished cursive, is a sign that promises a relaxing dental visit and invites patients to ask about add-on services such as Botox and teeth whitening. Lavender aromatherapy greets patients when they arrive, and the sounds of Enya can be heard throughout the spacious office. A customized saltwater aquarium lines the side wall. The plump waiting room chairs sit on ornately carved wooden legs.

The front desk team wears matching sweaters with their names embroidered on them that are color-coordinated with the beige and black accents of the office. The lower level of the office is a dedicated training facility and conference room, complete with a drink station and large-screen television. The clinic has a total of 12 rooms, six operatories on each side, that line a long, winding hallway. The beige walls are accented by white Corinthian columns, and grapes droop from the latticework overhead, imitating a Grecian garden.

I had just completed the Occupational Safety and Health Administration (OSHA) infection control training and was conducting a mock inspection of this office accompanied by a safety officer, a hygienist. At the start she confided that she had concerns about some of this office’s infection control practices. I thought, “Surely I’m not going to find much in such an immaculate palace.”

However, by the end of the assessment, the practice had amassed an inordinate number of “opportunities” for correction. Some of the things we observed were running the ultrasonic without the lid on (with a glass of orange juice sitting nearby), not changing out barriers or disinfecting surfaces between every patient, and team members exiting restrooms without washing their hands and then setting up cookies for arriving patients.

Can dental hygiene production coexist with compassion?

Words like “production” and “goals” used in reference to hygiene departments can create contention. After all, we are health-care providers, not salespeople, so why do the numbers matter?

Some might say that a focus on increasing production is not in the best interest of the patient. How many times have we heard or thought, “It’s all about production and making money, but my concern is for the patient”? Should it be our production numbers or the numbers of lives we are able to touch that measure us? What I have learned is that these two measures are not mutually exclusive, and in fact work in concert with each other.

For those of you who don’t agree, I understand. I once felt the same way. My change of view does not imply that I support overtreatment or suggesting services that are not necessary. We are not in the business of selling. We are oral health prevention specialists who have the responsibility to inform and educate patients. We are often the first in the office to build relationships with our patients and to see the signs of, or risks for, disease. We help guide the patient to the best possible treatment or prevention strategies ethically, responsibly, and as early in the process as possible.

© Syda Productions –

Are we meeting patients’ needs?

It can be easy for us to ignore the concept of the numbers, retreat to the operatory, and perform what is on the schedule for that day to the best of our ability. But is the scheduled treatment in the best interest of the patient? I think about the countless times that I’ve worked harder instead of smarter, with much discomfort to myself and probably my patients, performing heroic measures that spanned far beyond what a prophy is supposed to be.