Managements of Special Health Care Needs Patients from Dental Assistant Point ()
1. Introduction
1.1. What Does a Dental Assistant Mean and What Is Their Job Descriptions
Dental assistants are specialized health care workers who provide direct support to the dentist. Well Educated dental assistants may be delegated to do other procedures that do not require the professional skill and judgment of a dentist. Dental assistants may require a minimum education which includes two academic years [1].
A Dental Assistant can work with different dental professional categories. A Dental Assistant can cover duty with Dentists, Hygienists, Prosthetists, Specialists or oral Health Specialists. Generally, any professional working in dentistry may need a Dental assistant during their daily clinic. Dental assistant usually has the most diverse role in a dentistry practice, and really need to stay on their toes [2]. The primary responsibility of the assistant is to prepare the Clinic and the examination room for patient appointments by sterilizing instruments and ensuring all necessary materials and equipment are ready for the doctor to start the work. They also assist during their procedures by handling the instruments and anticipating the equipment and the materials needed throughout the appointment. The Dental Assistant may also be responsible for greeting patients as they arrive, submitting billing details to the insurance company and scheduling the patient’s next appointment before they leave the clinic [3]. Other duties and responsibilities include:
● Update and maintain client’s dental records and take and process X-rays of patients.
● Perform routine dental cleanings and assist the dentist with any procedure.
● Schedule patient appointments and help to advise patients on recommended oral hygiene.
The job description of the dental assistant like other medical health workers involves direct contact with the patient and their legal grading. It is easy to do the job if you deal with an educated patient, more difficulty rise when there is a gap in the explanation either from the dental assistant’s side or the patient side. The dental department may hire a coordinator to deal with the patient who will have significant benefits to the department and the patient [4]. The department of the dentist may hire a special dentist who is specialized to deal with SCHN patients [5] [6].
1.2. What Is Special Health Care Need Mean (SHCN)
SHCN patients are defined by any physical, developmental, mental, sensory, or behavioral, condition that requires specialized services or programs. The condition may be congenital, developmental, or acquired through disease, trauma, or environmental cause and may impose limitations in performing daily self-maintenance activities or substantial limitations in a major life activity [7] [8].
2. Methods
PubMed®/MEDLINE search using the terms: special needs patient, disability, disabled patients/persons/children, Special patients/Dental treatment dentistry, Special care health needs and oral health; fields: all; limits. Papers for review were selected from the result list of articles and from references within the selected search. The article search was done during the period of 2009-2021. When data did not appear sufficient or were inconclusive, recommendations were based on expert and/or consensus opinions by experienced researchers and clinicians. Systematic and non-systematic reviews, studies on a series of cases and research articles were considered to structure this article.
3. Literature Review
Passed on the National Survey of Children’s Health in 2017-2018, approximately 13.6 million children (18.5 percent) had a special health care need [9]. 26.6% had functional limitations, 19.9% were consistently or significantly impacted by their health condition, and 46.0% were sometimes/moderately impacted by their health condition(s). Since there is a significant improvements and development in medical cares SHCN are living longer and require extended medical and oral care [10].
SCHN patients at childhood age increase the risk of having urgent medical care including oral health care [11]. Difficulties may be due to serious reasons which may include finding a dentist who is willing to provide care, child’s cooperation, and transportation and communication issues [12] [13].
SHCN patients rely mostly on free government coverage to pay for their medical and dental care. Lack or delay of treatment may lead to an increase in the need for costly care health issues [14].
Language and cultural considerations and other barriers may interfere with the oral health care of SCHN patients. Communication skills are essential for SCHN patients and can be accomplished by trying different methods which may include interpreters, written materials, and lip-reading [8]. Lack of knowledge from parents, Dentists and dental assistant also play a significant role in dealing with SCHN patients [15].
SHCN patients significantly require additional considerations for behavior guidance which include the patient’s mental development, level of education, patient cooperation in medical procedure, type of therapy or procedure as these can complicate or delay the delivery of the needed care. The use of basic behavior guidelines may help to recognize and manage SCHN patients [16] [17].
4. Recommendations
The management of SCHN may include several steps which need to be implemented and consider. Steps may include the Evaluation of the General Health issues of the patient and then the Evaluation of the Oral Health process. Evaluation of behavior difficulties of the patient, Planning and establish the best dental treatment case by case. The evaluation of General Health issues help the dental assistant to provide a complete health history which can be obtained or fulfilled by the parents of the patient this information may include medical history, medications in use, abnormal laboratory test or any health problems. Clear medical history is essential before moving to the treatment process plan. Evaluation of Oral Health process and the reasons of consultation must be considered before performing the clinical examination. X-ray or At least one panoramic must be taken before the exam. Evaluation of Behavior difficulties of the patient is the most relevant aspect in this protocol. For that, So we suggest that the behavioral will be based on the amended Frankl scale (Table 1), which considers the level of cooperation of the patient; and the scale developed by Houpt and co-workers (Table 2), based on patient movement during the procedure or examination The application of the scales can give a good indicator as to whether outpatient care can be performed or not [18]. After completing the steps of the clinical assessment, the best treatment plan for each patient must be drawn and classified. During the planning and establishing the best dental treatment the dental assistant and the dentist should not assume that patients with difficult communication skills have associated intellectual disability, unless it is specified and reported [19].
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Table 1. Frankl scale for evaluating behavior modified by De Nova Garcia, 2007 [18].
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Table 2. Scale for evaluating movement (Houpt and Co-Workers 1985). Modified by De Nova Garcia, 2007 [20].
5. Conclusion
This article is made to set the challenge that dental assistants face when dealing with s SHCN patients. Like other parts of the community, a system must be designed for this category of patient. A Well trained dental assistant can handle the multi task and perform a significant role in the dental department. The number of this category of patients significantly increased every day with new and rear cases. The dental assistant must keep herself self-updated about the patient’s situation and adopt a technique to deal with SCHN patients.