New oral health and disability guide for dentists

2 August 2019

The ADA recently endorsed a new guide for dental practitioners – Oral Health and Intellectual Disability, which takes a new approach to building understanding between dentistry and the disability support sector.

Part of the Your Dental Health project, the guide is a collaboration between dentists, doctors, disability support workers and families and has been established to achieve optimum oral health outcomes for individuals with a disability. Inclusion Melbourne, the Centre for Developmental Disability Health (CDDH, Monash Health) the Australian Dental Association (ADA), and the Australian Society for Special Care in Dentistry (ASSCID), along with representatives from the allied health sector have developed the guide detailing key components, protocols and recommendations for all health professionals and family members relating to oral health and intellectual disability.

Working with patients with intellectual disability may require interdisciplinary consultation and engagement with complexity in their communication and treatment planning. These factors can often lead dentists in the first instance to recommend hospitalisation and the use of general anaesthetic. However, the Your Dental Health team has found that interdisciplinary consultation – coupled with a modest amount of disability sector knowledge – can lead to significantly smoother treatment, the removal of barriers, and wonderful health outcomes for people with intellectual disability.

Interdisciplinary consultation goes beyond simply engaging with GPs and special needs dentists, though the Your Dental Health project team does indeed support increased interaction between dentists, GPs and special needs dentists. It also entails understanding the disability support sector, a sector that is sometimes perceived as ambiguous, confusing and unreliable.

When the Your Dental Health team surveyed 100 dentists at the 2017 Australian Dental Congress, they found that most dentists wanted to build their practice to be more inclusive of people with intellectual disability. However, these same dentists also noted significant concerns about consent from non-verbal patients, an important consideration given Australia’s complex legal guardianship arrangements, relationships with supported accommodation providers, protocols for engagement with support professionals and carers, and ongoing treatment planning.

Disability support experts from a range of organisations have ensured the Oral Health and Intellectual Disability guide includes a concise overview of evidence-based support practices, access points, and the hierarchical and reporting structures that exist within the disability support sector.

One such practice is Supported Decision Making, a set of principles and techniques that a number of researchers and policy professionals have begun to codify in practice and legislation globally in a range of jurisdictions. At its core is a long-term approach involving a circle of supporters assembling to promote the centrality of the voice, will and preferences of the person with intellectual disability.

The Your Dental Health project celebrates the right of people with intellectual disability to receive the right support to achieve good oral health. It champions the potential of local dentists in private practice and community dental practices to avoid unnecessary hospitalisation and build strong long-term relationships with a cohort that is often marginalised due to perceived risks and complexity. It also seeks to emphasise an inter-professional approach in which all collaborators understand the role each participant plays in the oral health experience of the individual patient, the role of person centred care, the impact of culture, behavioural issues and living arrangements on healthcare delivery and the impact of oral health on overall health for individuals with a disability.

Driving the application of the principles in the guide are two forms (available in hard copy and online) for adjacent practitioners that channel communication and advice toward effective ongoing support.

The guide is supported by a suite of resources that dentists – and supporters – can use in conversation with patients, available here. The Oral Health and Intellectual Disability guide is available from this site or hard copies can be obtained from the ADA.

* article by Richard Zylan (ADA member) and Nathan Despott (Inclusion Melbourne)