**4.2 A growing specialty**

In only a few years, Special Care Dentistry has grown to be the seventh largest specialty out of 13 in the United Kingdom, It has achieved this success by recognising the knowledge, skills, and experience of dentists working in the field and accrediting their specialist status. As of December 2010 there were 226 specialists on the dental register (Figure 2) and a number of junior dentists in training to become future specialists(General Dental Council, 2010).

Source: General Dental Council (2010)

Fig. 2. Number of Dental Specialists Registered with the UK General Dental Council, December 2010

A growing body of knowledge on the management and care of patients across their life course is emerging through the specialty of Special Care Dentistry. The specialty association 'The British Society for Disability and Oral Health', has developed a series of relevant

The new specialty was approved by the General Dental Council in 2007 and the specialist list opened in 2008 (General Dental Council, 2008). Initially dentists with relevant expertise

Impairment and disability were defined in the broadest of terms, thus Special Care Dentistry is concerned with providing and enabling the delivery of oral care for a diverse client-group with a range of disabilities and complex additional needs and includes people living at home, in long stay residential care and secure units, as well as homeless people. Interestingly, in parallel with the creation of the specialty there has been significant emphasis nationally on meeting the needs of *vulnerable* groups such as people with a

In only a few years, Special Care Dentistry has grown to be the seventh largest specialty out of 13 in the United Kingdom, It has achieved this success by recognising the knowledge, skills, and experience of dentists working in the field and accrediting their specialist status. As of December 2010 there were 226 specialists on the dental register (Figure 2) and a number of junior dentists in training to become future specialists(General Dental Council,

Fig. 2. Number of Dental Specialists Registered with the UK General Dental Council,

A growing body of knowledge on the management and care of patients across their life course is emerging through the specialty of Special Care Dentistry. The specialty association 'The British Society for Disability and Oral Health', has developed a series of relevant

417

771

0 200 400 600 800 1000 1200 1400

1276

were 'grand-parented' onto the specialist list on the basis of their competence.

disability.

2010).

**4.2 A growing specialty** 

Source: General Dental Council (2010)

Dental & Maxillofacial Radiology Oral and Maxillofacial Pathology

Oral Microbiology

Oral Medicine Dental Public Health

Endodontics

Periodontics Prosthodontics Oral Surgery Orthodontics

Special Care Dentistry Paediatric Dentistry Restorative Dentistry

December 2010

guidelines for the care and management of people with a disability (http://www.bsdh.org.uk/guidelines.html). Furthermore, through the journal of the association the 'Journal of Disability and Oral health' and helpful publications such as in the British Dental Journal in 2008 (Dougall and Fiske, 2008d, Dougall and Fiske, 2008f, Dougall and Fiske, 2008e, Dougall and Fiske, 2008a, Dougall and Fiske, 2008g, Dougall and Fiske, 2008c, Dougall and Fiske, 2008b, Lewis et al., 2008b, Lewis et al., 2008a), they provide a really helpful basis for practical care of people with learning disabilities. The underlying ethos has a number of key themes and is worth reiterating. First, that people providing care share common values, a commitment to adhere to accepted clinical and professional standards and above all operate within the best interests of the service user. Second, that all individuals have a right to autonomy as far as possible in relation to decisions made about them. Third, good oral health has positive benefits for health, dignity and self-esteem, social integration and general nutrition as the impact of poor oral health can be profound.

#### **4.3 Future challenges**

Whilst it is recognised that the advances in Special Care Dentistry are significant, there is much action required to promote oral health of people with learning disabilities, build capacity of the dental team and ensure that there is access to high quality evidence-baed care provided in a timely manner as outlined below.

#### **4.3.1 Research**

Dental and oral research amongst people with learning disabilities is much needed to improve our evidence base in promoting oral health and the delivery of patient care, but it is sadly lacking. There is little published evaluation of actions to improve service delivery, patient satisfaction and outcomes. Lack of funding for dental research is a general problem and the challenges of undertaking research, particularly amongst adults because of the challenge of obtaining informed consent. The Mental Capacity Act (UK Parliament, 2005) and subsequent guidance (Department of Health, 2008), provide the opportunity for consultees to be identified for research involving adults who lack the capacity to consent; this can either be a 'personal consultee' or a 'nominated consultee'. Local informants will be identified via local organisations. They will be chosen to reflect the diversity of the local disabled population in relation to sex, cultural and ethnic diversity, age and social status. The consultee may act in place of the person alongside a person with a learning disability or as a substitute. This approach requires high level ethics committee scrutiny and research governance approval and is likely to further add to the time, cost and complexity of the research process. Nevertheless it is very important in supporting people with a learning disability that high quality research is undertaken.

#### **4.3.2 Monitoring oral health**

There is clear need for methods of assessing the levels of need in this section of the population whether through dental and epidemiological surveys, dental information systems in practices or other means. As dental practice management software becomes more adept at capturing epidemiological data, clinicians should become adept in recording these data during clinical consultations, thus possibly avoiding the need to invest in specific surveys and providing ongoing monitoring data on oral health (Gallagher, 2005).

Disability and Oral Health 361

the oral health of people with learning disabilities are not actively addressed. This will most probably require the support of information systems to patient complexity and the time involved in care provision. Improving oral health treatment services may have significant financial implications, thus it is important that there is a strong emphasis on prevention throughout life, with a view to reducing the need for hospital admissions and expensive

Oral health is fundamental to wellbeing and this is particularly the case for people with learning disabilities for whom dental treatment may prove challenging. Good oral health begins from birth with a healthy diet, good mouth hygiene and access to fluoride products which strengthen teeth against decay. It may require the active support of parents and carers in assisting with tooth brushing. Regular dental checkups, at least once per year, are advised to monitor oral health and identify disease at an early stage when it may more easily be treated. There should be access to dental services with specialised support for those with more profound learning disabilities of for whom dental care presents a challenge. In the UK the specialty of special care dentistry provides such care normally on referral from dental practitioners. It is important that dedicated oral health services are established to serve the needs of patients with disabilities or conditions which mean that they require

This chapter has arisen out of work with UK dental professionals, policy makers, researchers, clinicians and most importantly people with a disability. It is hoped that this chapter will inform the future of oral health care for many who experience disabilities and

Alborz, A., McNally, R., Swallow, A. & Glendinning C. (2004). From the Cradle to the Grave:

practitioners in Leicestershire, UK. Community Dental Health, 25**,** 248-252. Boyle, C. A., Manley, M. C. & Fleming, G. J. (2000). Oral midazolam for adults with learning

British Dental Association (2008). Casemix toolkit: training pack. London: British Dental

British Society for Disability & Dental Health [BSDH], Diana Memorial Fund & Faculty of

A literature review of access to health care for people with learning disabilities across the lifespan. Report to the Service Delivery and Organisation Resaerch and Development Programme. London: National Co-ordinating Centre for the Service Delivery and Organisation Research and Development Programme (NCCSDO). Baird, W. O., McGrother, C., Abrams, K. R., Dugmore, C. & Jackson, R. J. (2008). Access to

dental services for people with a physical disability: a survey of general dental

Dental Surgery (2001). Clinical guidelines & integrated care pathways for the oral health care of people with learning disabilities. London: Faculty of Dental

care under general anaesthetic.

**5. Conclusion** 

'special care'.

**7. References** 

**6. Acknowledgments** 

they will benefit from good oral health.

Association.

Surgery.

disabilities. Dental Update, 27**,** 190-2.

#### **4.3.3 Networks of care**

Gallagher and Fiske (2007) highlighted the importance of developing networks of care to ensure that primary dental care practitioners are supported in their provision of routine care and have access to specialist support and advice as required for their patients. These networks must actively be developed to ensure that dental care for people with a disability does not just become the preserve of specialists. There is not sufficient workforce capacity for this to be undertaken. Whereas there had been substantive progress to building specialists in special care dentistry and train future consultants, and some progress towards building the skills of generalists in the care of special care patients, there has been little action on creating Dentists with a Special Interest in Special Care Dentistry (Department of Health et al., 2009); this is an important step to be considered in reshaping dental services into care pathways.
