Monday, 2 November 2015

Special-needs dentists bring smiles

They are trained to treat geriatric patients and those with behavioural issues
By Kok Xing Hui, The Sunday Times, 1 Nov 2015

When Ms Malene Karunanidhi fell and cracked her front teeth at the age of seven, a private dentist refused to treat her.

He said his tools were too sharp.

Ms Malene has Rett syndrome, a rare genetic disorder, and her parents think the dentist was afraid of hurting her. She also has an intellectual disability, would fidget and would not open her mouth for treatment.

Now 26, Ms Malene sees Dr Tay Chong Meng every six months, and greets him with a hug.

"He's a godsend," said her mother Pushpa Karuppiah, a 53-year-old property agent.

Dr Tay, 38, is the first of four special-needs dentists in Singapore trained to handle geriatric patients and those with behavioural issues due to conditions like autism, cerebral palsy and intellectual disability.

After earning a postgraduate degree in special-needs dentistry from the University of Melbourne in 2012, he returned to practise at the National University Hospital.

Besides knowing which teeth filling would harden the quickest when dealing with an impatient patient, dentists like him also have to coax people to get into their dental chairs.

The Ministry of Health started a full scholarship for postgraduate training in geriatric and special-needs dentistry in 2008. So far, six spots have been taken up and four of the dentists have graduated and started their practices.

The Dental Specialists Accreditation Board is also studying whether special-needs dentistry can soon become a recognised dental speciality. There are currently only seven recognised specialisations, including orthodontics and paediatric dentistry.

In the past, special-needs patients visited general dentists, and those who were hard to manage had to go under general anaesthesia to get their dental issues fixed at one go.

About 40 per cent of Dr Tay's patients have behavioural special needs. He spends their first visit familiarising them with his clinic, tools and staff. "Once they are in the room, I introduce them to the chair, tell them what I have to do. I've to explain every single step and I repeat it each visit. I build it into a routine."

It takes twice as long to treat someone with behavioural issues, said Dr Tay, who prefers not to put patients under general anaesthesia due to health risks. He estimates that only 5 per cent of cases would need it, "and some can't fast before GA".

Dr Joanna Ngo, 30, who graduated last year and splits her time between Khoo Teck Puat Hospital, the Institute of Mental Health and the National Dental Centre, sees one or two special-needs patients a day. She said they can be unpredictable, noting how an autistic patient sat still in one visit, then yanked her (the dentist's) hair in another.

But for parents like Ms Malene's, these dentists have brought relief.

Said Madam Pushpa: "Other dentists might not have the patience for a child like her. Or they are not aware of the disabilities, so they don't feel comfortable... They're afraid and we're afraid."

Taking time to build rapport
By Kok Xing Hui, The Sunday Times, 1 Nov 2015

Once, a man in his late 20s was referred to Dr Joanna Ngo, 30, for dental treatment under general anaesthesia. He had badly decayed teeth and was deemed uncooperative by the polyclinic that referred him.

The man, who has cerebral palsy, was not willing to open his mouth when he visited polyclinic dentists despite needing root canal treatments and fillings.

"On the first visit, I had a chat with him and realised that he's quite intelligent. It turned out that him being uncooperative had a reason - his mouth area is very sensitive," said Dr Ngo.

In that first hour-long visit, she coaxed him into opening his mouth long enough for a cleaning and a small filling.

Before sending the patient home, Dr Ngo told his parents she needed time to build rapport with him and help him get used to dental procedures to avoid the use of general anaesthesia.

The man's dental issues could have been fixed in two to three hours by putting him under general anaesthesia - instead of the eight visits with Dr Ngo so far and counting.

But she said that any surgery could lead to complications and, worse, his dental problems could re-emerge, with him and his parents not knowing how best to take care of his teeth.

"You can go for general anaesthesia, anyone can, but there's no behavioural training. The patient doesn't learn how to behave in the dental chair," added Dr Ngo, who practises special-needs dentistry at Khoo Teck Puat Hospital, the Institute of Mental Health and the National Dental Centre.

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