omsres said:
What do you guys think of treating special needs patient, eg Downs, CP, other forms of MR. In dental school we had the option of treating these patients if we wanted. I was fairly apprehensive about this in dental school and I really didn't gain any experience. However in my residency I didn't really have a choice.
I have to say that the experience has been nothing but positive. The patients and the parents are usually very appreciative. It makes you want to take super good care of them. It can be very challenging and you have to have a lot of patience. Now I seem to be the go to guy whenever one comes in. Usually I reluctantly accept it, but always walk out feeling really good. Anybody else have any thoughts?
I never really treated special needs patients as a dental student with the exception of a rotation I did in the pediatric dentistry department at a children's hospital. Special needs patients are often referred to pedodontists. I also saw a few at a pedodontist's private clinic one summer where I did a few weeks of observation/ "shadowing" .
Even though I had done volunteer work with Down Syndrome teenagers when I was in high school, I never realized how some of these patients are often so neglected by the "caregivers" (if you can call them that
) they have at their group homes/ institutes.
I only really got a realistic picture of the situation of the living conditions these patients face when I started my residency program. For the most part it is very frustrating, because the majority of the caregivers lie about how they brush the teeth of these patients everyday when the evidence proves otherwise. They really don't seem to care much. And sadly, quite a number of these cases have to be referred to the OR under general anesthesia for a comprehensive exam and full mouth extractions are sometimes indicated.
It is true that these patients are a challenge when it comes to gaining their confidence in you. However, once you do manage to establish a rapport, even if you can't do a complete exam and treatment, it can be a rewarding experience. Some of them are so loving towards you. I have had a few of them wrap their arms around me and give me kisses. As corny as it sounds, those experiences touch me.
I think the key to success with special needs patients, is to at least establish some sort of rapport at the beginning. If you can get the patient to sit still in the chair and at least open the mouth for a while for the first appointment, you may say it is was a successful appointment. Once you at least establish some sort of trust, you can have the patient come again (if possible) and attempt to do a more careful exam and at least a cleaning. If after all attempts, the patient is totally uncooperative (even after being pre-sedated prior to appointments), and can't be seen in the OR ( there is a limit of 2 years between each appointment in the OR), you tell the caregivers that the only thing you can do is to keep a watch for any signs of pain or infection which would require emergency care. Unfortunately, that is really the maximum you can do sometimes.
Sometimes, I have assistants who place these patients in the chair and then approach me with negative comments such as , " Oh, be careful with that patient because she spits a lot, " or " the chart shows that no one has been able to examine this patient before, " or "why don't we simply have them sent to the OR,". I try not to listen to any of these comments and if anything, these comments actually push me to strive even harder to handle the patient with the best of my abilities. And sometimes, when I do manage to handle the patients I have been warned about, I feel a great satisfaction. You have to at least try!!!!
I know it isn't pleasant to deal with patients losing control of their bowels
(this happened to me) or vomiting on you, but you have to simply remind yourself that these patients are still human beings and require even more compassion, patience and understanding than most of your patients. You have to tell yourself that these people are sort of like God's messengers or angels sent to live amongst us to teach us something about ourselves and humanity...
I think you become even more thankful for the simple things you have been blessed with when you have such patients. You feel thankful for your independence...for having full use of your faculties and senses ( eyesight, hearing, voice) and then you realize that all your so called "petty" problems plaguing your mind are really not problems at all.
So when you face a special needs patient , just say to yourself, "this person was sent to me by God so that I could become more appreciative of my health as well as those of my children (if you have some) that are physically and mentally healthy."
I tried it the first time and he pulled it out before it hardened. The second time I had to just hold it in there and he would not breathe through his nose! He wouldn't put his tounge over the tray and of course BAM! Barf all the way down my shirt and pants! It was absolutely DISGUSTING! Oh well. The joys of assisting, right?
