29 January 2024

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Management of oral health in special needs patients

Gianna Maria Nardi

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The person with disabilities needs assistance that meets the criteria of efficiency and effectiveness of the operational prevention protocols, which respond to the personalization of therapeutic paths considering the critical issues caused by physical, sensorial, cognitive disabilities which must include particular attention to participation active and responsible caregiver.

In the public and private sectors, it would be appropriate to provide dedicated environments that allow managing the management difficulties in some cases of autism spectrum disorders or severe intellectual disabilities or multiple disabilities. Often, despite the fact that appropriate environments are not provided, it is the sensitivity, preparation, clinical experience and creativity of professionals and the active collaboration of caregivers that manages to overcome operational difficulties.

Dedicated technological innovations help innovative clinical procedures, which allow operational protocols to be easy in time and accepted by fragile patients, as they are minimally invasive.

The prevention of oral pathologies is necessary, as for all assisted people, but precisely by virtue of the fragilities present, it is necessary to prepare appropriately trained health workers to provide safe and effective operational protocols that allow problems in the oral cavity to be intercepted early and intervened. with close and continuous follow-ups, involving caregivers in the responsibility for the success of the health journey.

To personalize therapies and involve the special needs patient and caregivers as much as possible, communication adapted to all conditions of fragility will be appropriate, and home therapies will be agreed upon in the most convenient timing and choice of tools.

If we refer to the control of mechanical bacterial biofilm at home, there are different opportunities, including manual, mechanical, sonic and hydrosonic toothbrushes and the choice must be agreed with the assisted person if possible, otherwise with the caregivers.

For the control of biofilm in the supra-crestal spaces, rubber brushes are certainly a valid aid for the caregiver, or for the sensorially disabled person, in order to avoid any damage to the gingival tissues during the operation.

For the chemical control of bacterial biofilm, where possible, spray mouthwashes with various remineralising molecules or for the control of inflammation for daily use, mouthwashes, toothpastes and gels with ozonated olive oil which has an anaesthetic, anti-inflammatory and anti-edema action (IALOZON ).

For fragile patients who have difficulty expectorating, it is better to choose food supplements, which can be swallowed peacefully (RIOCOL). Lesions on the enamel, intercepted early, can be treated, up to ICDAS 2, in a non-invasive way with the use of peptides. But it is essential to choose prevention procedures very carefully with the aim of achieving compliance, thinking, without pity, of treating complex patients with different frailties.