1. A
s part of my previous role working at Oaklands
School Edinburgh for children with additional
learning needs, I worked alongside a
consultant paediatric dentist and two dental nurses. The
team also liaised on a regular basis with other healthcare
professionals: speech and language
therapists, school nurses, teaching
staff members, parents and carers in
order to maximise understanding,
and to support each individual
child’s needs. This enabled us to
deliver the best possible care for the
children.
One of the most crucial parts
of treating special care patients
is through acclimatisation to
the dental clinic. This can
be a lengthy and ongoing
process in building up
communication and trust
through familiarisation to the
dental environment and the
team within it. For example,
‘a person with a learning
disability or challenging behaviour who does not
have the capacity to understand what is required of them
in the dental setting is therefore unable to co-operate.
In such an instance, acclimatisation and behavioural
techniques can be used to develop rapport and trust and
to gain co-operation. Empathy alongside practicality
is often the best way to approach the challenge of
providing oral care for patients with
a disability.’1
As the dental clinic was
based in school, this setting
gave the dental team an
advantage; we were able to
build up a rapport with pupils,
not just in the surgery but also
in the classroom environment.
The pupils grew to recognise that
we were part of the establishment.
An individualistic approach was
required when acclimatising with
a view to potential treatment. This
proved to be a lengthy process for
some of the patients over a number
of visits and tell-show-do played
a large part of the acclimatisation
process.
DH&T26 April 2012
It’s the small things
When treating children
requiring specialist
care, it is important to
adopt a team-orientated
approach, says
Rebecca Gumm
One of the most crucial parts of
treating special care patients is
acclimatisation to the dental clinic
‘
‘
thebigISSUE
Image:Thinkstockphotos.com
Rebecca Gumm has nine years’
experience working as a dental nurse
in general dental practice/ hospital
environments. She pursued a career
and successfully completed a course
in dental hygiene and has 12 years’ experience as a
hygienist, working in the community dental services and
in general dental practice and currently works in the
hospital services. She also has previous experience in a
hospital and corporate setting.
With hygienist and partner, Mark Thurston, she has
formed a registered company – Wow Dental – and is
planning to open a general dental practice in the West
Midlands in 2013, with a heavy emphasis on prevention.
Keep it simple
• Use simple, slow clear language
• Without jargon
• Show what was explained
• Use eye contact
• Smile a lot
• Use background music, accompanied
by singing
• Ensure praise for good behaviour

2. Tactile and sensory
For visually impaired pupils, the level of communication
was tailored to a more tactile, sensory approach. Large
toothbrushing models and toothbrushes were used and
we had a horse puppet called Harry, with a big smile and
teeth. We also used The Story of Tommy Tooth, a general
children’s book from which Harry the Horse Visits the
Dentist is adapted. We also focused on other senses for
these patients who are heightened, eg: smells of nice
GCC strawberry toothpaste were inviting! One child
took particular interest in linking colours together, he
recognised that the gloves were the same colour as the
toothbrush and this helped to increase his compliance
when he visited the surgery. Sometimes, it can be the
small things that can be the key to communication. To
gain access to the patients’ mouths, often toothbrushes
were used as a familiar object. I observed that some
patients disliked the glare from the mouth mirror and
dental light. A useful tool to aid visibility and to help
overcome this barrier was the DentLight.
The visits tended to be interactive, playing with
the equipment, eg: 3-in-1 syringe, suction, polishing
handpiece, inflatable dental chair. The aim was to make
this a fun experience. We were able to combine this
approach with other forms of communication, involving
sign language and boardmaker, which is a software
design program with picture communication symbols
(PCS). Part of the pupils’ curriculum incorporates
boardmaker (www.mayer-johnson.com). There are a
vast number of PCSs available. It is interactive with
many activities for each individual child to access
through their learning. This proved to be a valuable
communication tool in the dental clinic. The PCSs were
used to aid show-and-tell time, enhancing compliance .
Take a seat
A large proportion of the pupils at Oaklands were
fed via a feeding tube so, following discussion with
the specialist paediatric consultant, and speech and
language therapists, we decided to set up regular clinics
for this purpose. The objective was to demonstrate and
discuss oral hygiene and dietary needs in conjunction
with parents/carers input.
For toothbrushing:
• Correct seating position is vital
• The patient needs to be sat in forward facing in an
upright position
• Chin tucked in so that all fluids drain forward and are
not aspirated
• A methodical approach is adopted whereby the teeth
are brushed in quadrants
• Use a dry brush, a small quantity of SLS-free
toothpaste is mashed into the bristles, to avoid lumps
• The patient’s body should be well supported and joints
and muscles be in the rest position.
Alborg1
advises that, for patients with spasticity, the
chin should be as close to the chest as possible, and the
hips and legs should be flexed and separated to achieve
maximum relaxation.
As part of National Smile Month 2010, I worked with
the team to organise a smile fun day at Oaklands. I felt
that this would be a good way to communicate with not
just the pupils and staff, but also with parents/carers .
The event had press coverage from the local North
DH&T 27April 2012
Rebecca Gumm is looking into ways to
continue to make use of the ‘Harry the
Horse’ books to enhance the oral health
of children with additional needs, and
would be delighted if anyone interested
in developing the books or with
suggestions could please contact her
via the magazine.
Email julie.bissett@fmc.co.uk
Edinburgh News which, in turn, helped to boost the
school’s profile. Working closely with other staff
members in school as well as our team including the
oral health promoter proved to be very successful. The
end result encompassed a fantastic dental exhibition,
comprising lots of information on oral health, an
interactive smart board game incorporating boardmaker
PCSs, and a raffle to raise money for the school. This
proved to be a fantastic day out for everyone. DH&T
References
Fiske, J., Dougall, A., Lewis, D. A clinical guide to special
care dentistry (2009) BDJ Books : London.