Dental care can be challenging for anyone, with phobia of visits to the dentist being very common and understandably so—dental surgeries can be intimidating places, with unfamiliar people, noises and equipment. For those with intellectual disability, it is important to make dental visits as easy as possible so that phobia or fear does not develop.
First dental visits and experiences are crucial—initial impressions can leave a lasting impact and it is important to remember this. Ideally a first dental appointment should be an examination where the patient is pain-free and simply have their mouths and teeth looked at by the dentist. Unfortunately, for many patients their first visit to the dentist may be as an emergency patient, if they have a toothache. This immediately causes them to associate the dentist with an unpleasant sensation (pain) and if they have to have a large filling or a tooth extracted, it can leave a traumatic impression of the dental profession with the patient.
A regular routine of dental examination should therefore be established from a young age. This helps the patient to become used to a dental surgery incrementally if necessary—initially perhaps visiting the room and meeting the dentist and nurse, progressing eventually to lying back in the dental chair and allowing instruments such as the mirror to be placed in the mouth. A routine is important—familiar staff greeting the patient on arrival, a consistent and familiar chain of events that the patient can learn to cooperate with it.
When making initial or any dental appointment, for a patient with intellectual disability or otherwise, it is good to phone the clinic before the appointment to discuss any specific needs or to make the staff aware of things that can be done to make the appointment easier. Some people get intimidated by a noisy, full waiting room or become nervous waiting for their appointment, so it is best in these circumstances to arrange for the first appointment of the day. An empty room could be requested to wait in if necessary. Others may not like lying fully reclined in the chair, they may have a complicated medical history, require wheelchair access or prefer natural light as opposed to the bright chair light—a lot of such preferences or needs can be accommodated. Phoning ahead can give the staff time to prepare, which can lead to a happier patient and a better overall experience of a dental visit.
Phoning ahead can also make staff aware of the individual needs of the patient and their level of intellectual disability. This is important in terms of everything from greeting the patient, to the level of treatment that can be provided. Whilst the dental staff can make an assessment of the patient from the visit, parents, relatives and carers all have much greater knowledge of the level of understanding of the patient, and their capabilities and limitations in terms of accepting treatment. Preparation of the patient prior to the appointment—explaining what the visit with entail, from arrival to finish, can reduce fear and enable the patient to cope better with a dental visit. Explanation of the room, the different sensations and practising lying back to be examined can all make a subsequent visit run more smoothly.
For some patients, a dental examination can be very difficult to cope with—and if the patient is in pain, maybe even more so. Options of specialist referral, sedation and general anaesthetic may all need to be considered. As with all patients, the priority lies with what is in their best interests.