A B S T R A C TMany people with special needs (PSN) have difficulty having good oral health or accessing oral health services because of a disability or medical condition. The number of people with these conditions living in community settings and needing oral health services is increasing dramatically due to advances in medical care, deinstitutionalization, and changing societal values. Many of these individuals require additional supports beyond local anesthesia in order to receive dental treatment services. The purpose of this consensus statement is to focus on the decision-making process for choosing a method of treatment or a combination of methods for facilitating dental treatment for these individuals. These guidelines are intended to assist oral health professionals and other interested parties in planning and carrying out oral health treatment for PSN. Considerations for planning treatment and considerations for each of several alternative modalities are listed. Also discussed are considerations for the use of combinations of modalities and considerations for the repeated or frequent use of these modalities. Finally, the need to advocate for adequate education and reimbursement for the full range of support alternatives is addressed. The Special Care Dentistry Association (SCDA) is dedicated to improving oral health and well being of PSN. The SCDA hopes that these guidelines can help oral health professionals and other interested individuals and groups to work together to ensure that PSN can achieve a "lifetime of oral health."

It has been reported that healthcare providers often lack the skills set to provide care for people with disabilities, leading to inequalities in health and reduced access to health care. Newly graduating dentists are likely to see a significant number of patients with special healthcare needs in the course of their practicing lives. However, there is evidence of national and international variation in the availability of education and training at the undergraduate level in this important, emerging area. The quality and content of undergraduate education in Special Care Dentistry has been shown to correlate with students' confidence and their expressed willingness, towards providing care for patients with special healthcare needs in their future practice. The aim of this study was to use information from a three-round Delphi process, continued into a face-to-face meeting, to establish consensus on what constitutes the essential core knowledge, skills and attitudes required by a newly qualified dentist so that they are able to deliver patient care to diverse populations following graduation. A high level of agreement was established amongst an international panel of experts from 30 countries. The final core items identified by the panel showed a paradigm shift away from the traditional emphasis on medical diagnosis within a curriculum towards an approach based on the International Classification of Functioning (ICF) with patient-centred treatment planning for people with disabilities and special healthcare needs according to function or environment. Many of the core skills identified by the panel are transferable across a curriculum and should encourage a person-centred approach to treatment planning based on the function, needs and wishes of the patient rather than their specific diagnosis.

Coordinating care among health care providers in a patient with Trisomy 21 and NF1 is essential for a reliable and predictable outcome. However, as neurofibromas are often known to recur, the treatment risks and advantages should be reviewed prior to surgical intervention.

This paper presents the case of a child with severe mental retardation and a history of oral self-injurious behavior (SIB). While the behavior was refractory to a number of dental interventions, some success was achieved through a combination of behavioral therapy techniques and therapeutic touch (a relaxation technique). Etiologies of SIB are discussed, along with descriptions of alternatives to traditional dental therapy for this difficult problem.

No abstract