CDA Essentials 2019 • Volume 6 • Issue 6

12 | 2019 | Issue 6 CDA at W ork According to Dr. Heather Carr, chair of the working group and a practising dentist in Halifax, the research identified dentists’ two main training and knowledge needs: 1. Developing best practices to enhance dental care provision for patients with specific disease/condition types, such as mental illness, Alzheimer’s/dementia, and Autism Spectrum Disorder. 2. Developing best practices and protocols to help determine when to: a) treat patients with intellectual and cognitive disabilities b) refer patients with intellectual and cognitive disabilities c) not treat patients with intellectual and cognitive disabilities. We asked Dr. Carr to tell us more about the research findings, and how they will be used to improve access to dental care for these vulnerable patient groups. The research focused on specific patient groups defined to dentists as follows: In children, intellectual disabilities include: • a reduced ability to understand new or complex information • difficulties applying new skills • a reduced ability to cope independently In children, developmental disabilities include: • an intellectual disability combined with other severe chronic disabilities that can be cognitive, physical, or both (e.g., Autism SpectrumDisorder, cerebral palsy, epilepsy, and/or Down syndrome). In adults and seniors, cognitive development challenges involve: • a decline in cognitive abilities, such as memory and thinking skills (e.g., Alzheimer’s and other types of dementia). Defining Patient Groups ➲ Can you tell us a little more about the specific challenges dentists face when treating patients with disabilities? Heather Carr (HC) : Most persons with disabilities are just like other patients who need minor accommodations to receive dental treatment. Unfortunately, some dentists are hesitant to provide care to a person with a disability as they may have had minimal experience and formal training in this area. A common concern is the possibility of a noncompliant patient, which can often be related to behavioural issues. This can be challenging for the dental team, patients and caregivers, especially if there are time constraints during a busy day at the dental office. There can also be difficulties in communicating oral health care instructions to patients and their caregivers before and after appointments. ➲ What kind of support are dentists looking for? HC: The research indicated that many dentists are looking for resources to help them care for patients who have specific cognitive diseases or conditions through written guidelines or best practices, conference courses and web-based learning modules. ➲ Are best practices specific to a particular disability or condition? Or are there general principles that apply to treating patients with disabilities? HC: In my experience, there are certain treatment approaches that work for all patients, including persons with cognitive disabilities. However, some strategies are specific to the type of disability an individual has, ranging from strategies for booking appointments at certain times of day to best practices for patient and caregiver communication and treatment. CDA is looking at evidence-based information to best address these questions. We are in the process of reviewing literature and existing resources about dental care for persons with Autism Spectrum Disorder, Alzheimer’s or other types of dementia, and are collaborating with experts in the field to develop appropriate resources that would help dentists and the dental team provide care for these groups of patients. We hope that these resources will be used by the entire dental team, laying the foundation for future work on improving access to dental care for other patient populations. ➲ Is caring for patients with intellectual or cognitive disabilities something general dentists should do, or are there specific requirements and skill sets, in terms of physical space, special equipment, or training to consider? HC: Over 80% of dentists who participated in the research said that treating patients with special health care needs is a part of their regular practice, and the majority felt that caring for patients with special needs is a shared responsibility.