Looking after the oral health of people with special needs

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looking after the oral health of people with special needs
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Looking after the oral health of people with special needs is challenging, rewarding and a life calling for Dr Emma Jay. By Frank Leggett

To maintain and improve the oral health of people with special needs can be a complex undertaking, requiring calming strategies and an unhurried approach. It requires specialised equipment and a purpose-built clinic to provide the best possible care while tailoring procedures to suit each individual. Access to full hospital general anaesthetic with post operative admission rights is essential. As people are living longer with comorbidities, it is common to liaise with medical specialists, such as haematologists and oncologists.

“Every patient is different and every day there’s a new story,” says Dr Emma Jay, who owns and runs The Special Needs Dentistry Practice, situated in the Sydney suburbs of Willoughby, Bondi and Miranda. Her work focuses on the oral health problems of geriatric patients, patients with intellectual disabilities, and patients with other medical, physical, or psychiatric issues. This includes planning dental work for those with swallowing disorders, phobias, anxiety, depression, chromosomal disorders, Parkinson’s disease, Huntington disease, autism spectrum conditions, cerebral palsy, paralysis and brain injuries.

The growing need

When Dr Jay fitted out her special needs practice from scratch in Willoughby in 2019, she wasn’t sure if she would ever be busy enough to work full time. Her caring attitude and willingness to adapt to the patient’s needs received a positive response and created a growing, dedicated client list. Today she divides her time between her three practices and is busier than ever.

“I’d love to expand to another location,” she says. “I’d also love to put on another dentist. Back in 2004, a group of us decided that special needs should become a specialist area in Australia. We approached the Dental Board, did a series of determinations and presented case studies. We were able to register and received a qualification through the Royal Australasian College of Dental Surgeons in Special Needs Dentistry. Presently, there are a lot of dentists graduating from the master’s program that developed from the initial program. I’d love to have one of them on board.”

As part of a graduate certificate in health sciences (developmental disability), Dr Jay has undertaken additional study in autism spectrum disorders and mental illness. She coordinated the largest restorative general anaesthetic waiting list for adults with special needs in NSW from 2000 to 2011. She was also part of the only oral-motor function therapy (saliva control and feeding issues for children) and Rett syndrome multi-disciplinary management teams in NSW.

Strategies of care

When visiting the dentist, people with special needs can react in vastly different ways, so Dr Jay turns to the families and carers to gather information.

“We request as much individual information as they can provide,” she says. “By providing me with a summary of what works and what doesn’t work, I have the best chance of a successful, non-threatening appointment.”

The needs of each patient are very different, but there are strategies with an evidence base. People with dementia often respond to a catchy song with the instruction. Dr Jay has also found weighted blankets to be very helpful for most types of anxiety, offering a comforting pressure that doesn’t leave the patient feeling exposed.

“Some patients don’t like it but I generally ask them to give it a try,” she says. “If it’s too much, we just take it off.” 

Back in 2004, a group of us decided that special needs should become a specialist area in Australia. We approached the Dental Board, did a series of determinations and presented case studies. We were able to register and received a qualification through the Royal Australasian College of Dental Surgeons in Special Needs Dentistry.

Dr Emma Jay, founder, The Special Needs Dentistry Practice

As her patients can have unusual body shapes, Dr Jay also has a patient lifter, knee-break dental chair, and pillow, neck and knee supports to help keep them comfortable. A portable X-ray machine is used for its ability to reach unusual angles, and the OPG can be set low with wheelchair access. A narrow firm mouth prop allows for an examination in people whose occlusion is virtually closed. The surgeries have dimmable lights to provide a calming atmosphere. A big hit has been the newest member of staff—a toy poodle support dog.

“We follow the ADA support animal guidelines,” says Dr Jay. “When patients enter the clinic, they are informed that they can meet our support dog. About 50 per cent like dogs and find it reduces anxiety.”

Intellectual disabilities

Patients with intellectual disabilities may not understand why this person is mucking around in their mouth and be unable to explain their fears. 

“I use clear, simple words with a low tone of voice,” says Dr Jay. “If the dental chair is too overpowering, I have a soft bench where I can examine them. If they don’t want to come inside the clinic, I’ll go to their car and examine them there.”

The examination starts slowly, maybe checking around their jaw or gently brushing their teeth. The patient is given choices as it’s important they have some control over the situation. It might be allowing them to choose a favourite colour toothbrush or pictures of fruit for the corresponding prophy paste. This helps to overcome a feeling of helplessness and lets them see familiar items with which they can associate.

Support staff

When working in a special needs practice, the support staff play a vital role in making each patient’s visit pleasant and successful. When dental assistant Jack Hill was looking for challenging yet rewarding work, he instinctively knew he would find it with Dr Jay.

“My time at The Special Needs Dentistry Practice has been better than I ever imagined,” he says. “Every patient has different expectations and requirements. It can be difficult to be prepared for the variety of situations and you need to adjust quickly. It’s important to take extra time to really know your patients; the smallest details can make a huge difference. I love seeing improvements in our patient’s health, behaviour and overall wellbeing after every visit.”

At The Special Needs Dentistry Practice, it’s all about finding solutions to unique problems for people in unique situations.

“Of course, not all problems can be fixed but we can make inroads to prevent further problems from happening,” says Dr Jay. “In my work, the one thing that really stands out is the people who come to the practice with my patients; the amazing families and support people. They are just incredible.”  

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