Chicago Midwinter 2016: Treating patients with special needs

Special needs patients oftentimes require a special kind of care, according to a session at the recent 2016 Midwinter Meeting in Chicago. With the number of people with autism rising sharply, it's important for all dental professionals to know how to best care for a patient with special needs.

According to presenters Marvin Berman, DDS, and Kirk Kollmann, DMD, both of whom are pediatric dentists in Chicago, patients with special needs come with a unique set of challenges -- and rewards -- and it is wise for practitioners to prepare for treating these patients. Sooner or later, Dr. Berman said, dental professionals will need to treat such a patient, especially considering 1 out of every 68 kids born today has autism.

"What is going to happen now? One out of 68 kids," Dr. Berman said. "That's more kids than a pediatric dentist can take care of. It's your responsibility to take care of some of these children -- and to take care of them in a caring and competent way."

Below are six things that Drs. Berman and Kollmann think everyone should know about treating patients with special needs.

1. See these patients more frequently

"When you have special needs people, you've got to see them more frequently," Dr. Berman said. "Maybe three or four times a year."

There are several reasons why Drs. Berman and Kollmann suggested more frequent visits for these patients. Perhaps most important, it's much easier to prevent more complex conditions in these patients than to treat them after the conditions have developed.

It's also important to follow up, so they don't forget who you are. That way, when they return to your practice, you don't have to start again from square one, and they will hopefully already be more comfortable and familiar with you.

"I cannot tell you enough the importance of checkups with these kids. Call them up. Keep the lines of communication going, so it's not like they're a virgin every time," Dr. Berman said.

However, Dr. Berman warned that insurance does not always cover the extra visits, and sometimes parents can't afford to pay. In those instances, he believes dentists should treat the patients anyway.

"You may ask who's going to pay for it? And sometimes the answer is nobody," he said. "Sometimes the patient will pay for it; sometimes they can't cover it."

2. Be mindful of scheduling

Dr. Berman frequently reminded the session attendees that while you only treat the patient for a couple of minutes, parents are responsible for them most of the time.

"If you have a special child, can I tell you how much time it takes to get him out of bed?" he said.

Therefore, Drs. Berman and Kollmann try to have patients with special needs come at normal times, especially in the afternoon, and their schedule is heaviest between 1 p.m. and 3 p.m.

3. Keep patients engaged at all times

Some of these patients won't make the connection between one event and another, so it's important to tell the patient every step you're taking. Otherwise, the patient may begin to panic.

"With a normal patient, you can just go from here to here to here ... but with special needs patients you need to transition," Dr. Berman said. "Everything is like a little announcement each step along the way. If you skip too many steps, they will start to get wary and back away."

Using a mirror is helpful so the patient can see what is going on as you explain, Dr. Berman said. It is also necessary to keep the patient engaged, such as using a sing-songy or funny voice.

"You've got to keep them occupied. ... Silence is deadly," he said. "Some of the patients don't like yelling or singing, but most of them do. They like singing. They like rhyming. ... You've got to keep it going or else they're going to freak out on you, especially for a child with a short span of attention."

4. The cure for caries may have to do with Down syndrome

Patients with Down syndrome often have a very dry mouth, grind their teeth frequently, and their tongues are typically very big and fissured. However, despite all their oral health dilemmas, those with Down syndrome hardly have any caries.

"Maybe they have a factor that renders them caries-immune," said Dr. Berman, suggesting that researchers may want to look into the correlation.

5. Don't do it alone

Patients with special needs require extra care, and Dr. Berman stressed the importance of having other dentists and assistants to help treat these patients.

"You can't do this by yourself," he said. "You need people. That's the theme of the afternoon. And you need to have absolute dedication from the people you work with."

In Drs. Berman and Kollmann's Dentistry for Kids practice, everyone is willing and able to do whatever is needed to help the patients, even if it requires doing some treatment from the floor or singing at the top of their lungs.

Dr. Berman also emphasized the need to have enough staff to treat the patient safely. In Drs. Berman and Kollmann's practice, they have an action position where every limb is being covered by a person who isn't holding down a patient but can press back a limb if it would interfere with the patient's or professional's safety.

"You have to have enough people to hold the child there and keep them safe. You have to be in control," Dr. Berman said.

6. Caring for special needs patients is rewarding

Finally, both Drs. Berman and Kollmann believe treating patients with special needs is highly rewarding. While they do have some difficult patients and days, they believe the satisfaction they get from treating these patients is well worth any difficulties.

"Having practiced for 55 years, there's nothing like coming home when you have a kid that won't sit for anyone else, but they'll sit for you," Dr. Berman said. "When they ask how was your day, you don't have to say, 'Same old, same old.' It's never the same old, same old."