What are the therapeutic paths and resources available in Italy when those who turn to the dentist need specific attention. The first visit is essential
Sitting in a dentist’s chair can be an unpleasant experience for many. But for a person with disabilities or specific needs it risks becoming a traumatic situation. Having precise numbers on these patients is not easy. According to the latest Istat data available (Knowing The World of Disability: People, Relationships and Institutions; 2019) in Italy for people who, due to health problems, suffer from serious limitations that prevent them from carrying out usual activities they are about 3 million and 100 thousand (5.2% of the population). The elderly are the most affected: almost 1.5 million people over seventy-five (that is, more than 20% of the population in that age group) are disabled and 990 thousand are women. Instead pupils with disabilities almost 300,000 attend Italian schools.
A recent discipline
Everyone needs special attention but it was only in the 1980s that special dentistry was born (Special Care Dentistry), a discipline that deals with prevention and treatment of odontostomatological pathologies in individuals with special needs, such as people with intellectual disabilities, those with diseases that reduce their mobility or collaboration, the elderly with chronic disabling diseases, people with diseases that make dental treatment critical and socially disadvantaged people.
The state of the art
What is the situation in our country on this issue? What are the treatment paths and resources available? A series of indications are contained in the
recommendations written in 2017 by the Technical Group for Dentistry (GTO)
, in collaboration with the Ministry of Health. The document governs the provision of adequate dental care and services for patients with disabilities, based on the assumption that in these cases, methods and times other than the standard ones are required as regards both prevention and diagnosis, and then treatment in the strict sense. For the therapy necessary, from time to time, modeling itself on each individual patient with frailty on the basis of his real needs and concrete possibilities of collaboration. In many cases, for example, patients are expected to be included in a multidisciplinary team where, in addition to the dentist and the dental hygienist, there is a close collaboration and sharing of the problem with other specialists, he explains. Marco Magi, president of the Italian Society of Odontostomatology for the Disabled (Sioh), founded in 1985 for the dental assistance of children with disabilities, which over the years has managed to cover all branches of dentistry.
How to make the visit
The first visit is of fundamental importance: In the first visit, the type of service delivery is chosen, the care needs and the type of anesthesia are defined local, sedation or general, adds Marco Magi. When the dentist finds a disabled person in the chair, first of all he must carefully evaluate his level of autonomy and his ability to collaborate. In fact, it is necessary to distinguish between patients who are able to collaborate and have a certain level of autonomy; those poorly cooperating and autonomous; who, although not autonomous, collaborates in whole or in part, and finally those who are unable to collaborate. The recommendations also suggest some good practices: in case of need periodontal treatment, for example, the non-surgical approach is always preferable. When conservative treatments are necessary, it is better to carry them out in a single session. If, on the other hand, it is necessary A surgery better to do it at the end of the session, to avoid bleeding or other obstacles. It’s still, before using the prostheses it is particularly important to evaluate the degree of collaboration of patients for their management and cleaning skills. Each treatment must be performed according to the possibility of maintenance and hygiene.
The importance of controls
At the end of the planned therapeutic path, it is necessary schedule periodic recall and control appointments. Can all this be guaranteed in dental centers? Over the years, the prevention of oral diseases and the increased functional and aesthetic needs have assumed a correct importance. thanks to the specialists, but also thanks to parents, voluntary associations, caregivers and all those who care for people with disabilities. Consequently, theand hygienic conditions and dento-periodontal health (carious lesions, plaque, tartar and gingivitis) have significantly improved. Studies on frail subjects have shown that if the patient is included in an effective follow-up program, excellent results are obtained in terms of prevention and control of relapses, even if the chances of success always remain strictly linked to the general conditions of the patient and his collaboration, not least to the training and knowledge of dental staff towards the fragile subject, Magi answers.
The problem of training
Training remains one of the sore points of special dentistry: In Italy, unfortunately, no specific training is required – underlines President Sioh -. It would be desirable that every dentist, maxillofacial surgeon, dental hygienist, study assistant nurse follow a training course and continuous post-graduate updating: masters, university specialization courses. In our country, it is easy to say, public structures should be strengthened with trained and sensitive colleagues who deal with special dentistry.
Centers dealing with special dentistry
The Italian dental offices that deal with special dentistry they are both public, university and / or hospital structures, where, for the most part, fellow associates of the Italian Society of Dentistry and odontostomatology for the handicap work. There are about forty dental centers with the Sioh logo in Italy (here the list region by region). The doctors and dentists who work there, they specialize in prevention and dental care for people with disabilities. For these patients they are provided services, both outpatient, day hospital and in hospital. The treatments offered are general dentistry, conservative dentistry, odontostomatological surgery and maxillofacial surgery.
Treatments for children and the elderly
In particular, some of these dental offices offer specific treatments for children with rare diseases, with brain damage, for the elderly and for patients with Down syndrome. On the territory Affinch the clinics uniformed nationally in taking charge of patients with special needs, the Technical Group for Dentistry – GTO (established by Ministerial Decree 15 March 2018, at the Ministry of Health), has entrusted the professor Laura Strohmenger, Professor of Dentistry at the University of Milan, assisted by other experts, to draw up a document that would provide recommendations for special dentistry. The purpose of the document is to give the Services present on the national territory effective indications to improve the quality of dental care skills. From a practical point of view, offering precise recommendations on the care of patients with special needs, the document focuses on theattention is also paid to the accessibility of the dental centers themselves.
Universal design
The latter is based on the universal design concept, ie a design of structures suitable for everyone, but which, at the same time, must not require large-scale adaptations. In fact, this means that, already in the design phase, they are prepared large spaces without architectural barriers, well lit and soundproofed in such a way that the privacy of patients is respected. The ministry asked us to make the document because both in the public and in the private sector this health need and the related therapeutic needs are unclear – says Laura Strohmenger -. These patients need many healthcare professionals together, precisely trained and often operating theaters are needed to allow for therapies.. To this end, the document prepared valid and useful for to have it received by the regions and the health directorates of the country’s health structures, which in this way can allow an adequate organization of spaces, specific operators and times.
October 29, 2021 (change October 29, 2021 | 18:06)
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