Objective:Geriatric and special care dentistry (GSD) aims to improve oral health of seniors or adults disabilities facing barriers to care. This is coherent with the philosophy of “compassion relief.” Tzu Chi Singapore's Free Clinic exemplifies this through promoting health via various avenues to reach out. This article aims to provide a demographic analysis of patients with special care needs (PSCN), including age, gender, race, medical diagnoses, and treatment rendered. The patients were appraised on their complexity with the British Dental Association case mix model.Materials and Methods:PSCN seen by a dentist in Tzu Chi Singapore from November 2016 to December 2017 were recorded. The profiling of patients was done retrospectively.Results:Fifty-five dental PSCN were treated over 82 visits. 58.2% were seen in the free clinic, 27.3% in nursing homes, and 14.5% in oral health day programs for adults with intellectual disability. Their average age was 61.2 years, and the clinic was attended by patients of different races. Their medical profiles were grouped into seven categories, and the average case mix total banded score was 21.6, indicating that the average patient had “severe complexity”. A few themes relevant to Singapore were discussed, such as specialist GSD clinics, accessing dental services, socioeconomic status, state versus charity healthcare, and provision of future GSD services.Conclusions:Charity dental services such as free clinic can capture a niche of complex patients who may become marginalized in an established public healthcare.

AimsThere are currently neither onsite services nor any known studies that addresses oral health of persons with special care needs (PSCN) within disability activity centers in Singapore. This study aims to report on the oral health status, disability‐related barriers, and assess how these barriers limit care pathways.Methods and Results29 PSCN from a multiethnic mixed disability day activity center were screened over two days. Their ages ranged from 18‐59 years old (mean: 31.3). Proportion of Chinese, Malay and Indian ethnicity was 69.6%, 26.7% and 10.3% respectively. 11 were female. Only three PSCN were dentally fit, the average required almost four treatments each. 65.5% had “poor” to “very poor” oral hygiene. The mean number of decayed, missing and filled teeth were 2.8 (95% CI: 1.3‐4.1), 1.9 (95% CI: 1.2‐3.1), and 1.9 (95% CI: 1.2‐3.1), respectively. DMFT had a moderate positive (Pearson's) correlation with age (rp = 0.4549, P < .05). The average British Dental Association (BDA) total banded score was 16.97, categorized as “moderate complexity.” 51.7% were wheelchair users, while 41.3% needed support. Pharmacological behavioral management had to be considered for 17.2%. The odds ratio was 10 and relative risk 5.26 for requiring additional behavioral modifications and requiring more than average treatment.ConclusionThis multiethnic cohort of mixed disabilities displayed considerable unmet dental needs and a conflux of barriers to care. Pathways to care and study limitations are discussed.

Background: Geriatric and special care dentistry (GSD) involves oral health care for seniors and individuals with disabilities. Due to ethical issues, finances, waiting times, treatment versatility and so on, conscious sedation (CS) may have a place to optimise the delivery of care. Objectives: This article identifies considerations for implementing CS in GSD services in Singapore. Methods: Taking the form of a health policy brief, this review (a) defines the situation for patients with special-care needs and justified the need for dental CS, (b) makes reference to practices from countries with established dental CS services, (c) states and evaluates available CS techniques for the GSD centre in Singapore and (d) discusses action plans and considerations for implementation. Results: Demographic analysis revealed that 23.8% of the GSD patients could have benefitted from CS, or 44.7% of all patients who required behavioural management. The key advantages of CS included enhanced safety, more teeth saved and a reduction in general anaesthesia wait, amongst others. Conventional dental CS techniques included midazolam via various routes, nitrous oxide and ketamine. To establish a CS service, key points of consideration need to be conceptualised first, such as adequate training, perception of patients and providers, operational costs, facilities and developing guidance specific for oral health professionals. Conclusion: A local CS service will be beneficial for GSD patients in view of the challenges faced. A group of experts and stakeholders is needed to provide practical consensus.

Silver diamine fluoride 38% (SDF) may possess therapeutic effects beyond desensitization, caries prevention and arresting. We report the case of a 41-year-old male with intellectual disability. He had generalized gingivitis on a reduced periodontium and presented with enlarged gingiva with mobile teeth, particularly on the upper anterior and upper left. The inflammation could not be fully resolved despite multiple debridement treatments. Due to prevalent demineralization and hypersensitive teeth on the upper left area, SDF was applied. This not only reduced the perceived hypersensitivity, but significantly improved his periodontal condition and tooth mobility over the applied areas. We discuss the potential of SDF beyond its current use.