In practice - Mentally challenged people
Make sure you know who is responsible for caring for patients with a (severe) mental disability and write down the contact details in the file. You can ask patients with a mild intellectual disability if they would like to inform their parents or supervisors about the treatment. Write down the contact details.
Involve the parents, caregivers or counselors in case of anamnesis, examination and treatment. They know the behavior and communication possibilities of the patient and know what he can understand. They can also show you how the patient can best be approached: how he experiences the least insecurity and discomfort. Ask for previous experiences in similar situations. Ask what behavior you can expect. Institutions are often associated with a behavioral expert, who can advise you on how best to approach the patient.
Consult with the parents or caretakers if you are explaining your patient or that they are doing this. Then speak well what you are going to do, so that they can explain and guide it well.
When planning a visit or treatment, discuss how the parents or caregivers can prepare the patient for it. Also think about what you can do yourself in preparation. Draw the supervisors on aids for people with a VB to prepare for the visit to the doctor.
It is important that the patient experiences rest and safety in the practice room during the treatment. Make sure that no unexpected things happen. This ensures predictability. Then the patient keeps hold (control) on his situation. Table provides points for attention for this. The following box contains tips on language use.
Basic rules for dealing with people with intellectual disabilities in practice
- Choose a favorable time if possible, in consultation with the patient and parents or supervisors
- Make sure the patient does not have to wait; Waiting in an unknown and sometimes restless room increases the tension
- Provide an environment that suits the client: one can be a quiet and irritable environment, but one with music for the other
- Make contact with your patient; you only focus on the possible supervisor (s)
- Provide clarity and structure: tell step-by-step what you are going to do to the patient; use the tell-show (feel-) do method: first tell what you are going to do, let it feel on the hand, and then really do it
- Radius itself equips, talk calmly, trade quietly, breathe calmly; patients respond to all kinds of signals of unrest
- Communicate easily and concretely, about the here and now
- Let patients with a low mental level physically experience that it is safe, by humming, singing a song, giving a hug or a blanket
- Reward positive behavior; ignore negative behavior
- Treat as painlessly as possible
- Build up the treatment slowly; for example start with five counts, then count ten and gradually expand
- Speak a signal when you stop or briefly interrupt the examination or treatment; also agree that you will also stop immediately and offer a moment of rest when the patient raises his hand; stick to these agreements so that you gain and retain trust
- Let patients with a low mental level physically experience that it is safe, by putting your arm around their shoulders and supporting their head when the dental chair goes backwards; with your other hand you can possibly stroke the cheek, tickle; this offers you contact, comfort and distraction, all of which contributes to the feeling of safety
- Announce actions
- Adjust your pace to what the patient can handle
- Notice and name signals of anxiety; go into it and think of solutions that reduce anxiety and tension and give some control to the patient; that offers safety
Language use in the dental practice
- Do not ask at entry: "how are you?" This question is too broad. An answer can take a long time and yield nothing. Say rather: "nice that you are there."
- Do not say, "It does not hurt." What is stuck is the word "pain." That just triggers and strengthens the fear.
- Do not use the word 'pain', but say, for example, 'the jab is not nice, you feel it.'
- Do not say if the anesthetic is given: "That's done." For someone with a VB, the word "ready" might mean: "everything is over, you can leave." Say: "We have stunned, now we are going. .. '
- Do not say to an autist: 'sit down', because he does not know where to sit. Say rather: 'sit down here' while you point the treatment chair.
- If you want to specify a time, use an indication that the patient understands. 'Afternoon' or 'about 3 hours' is often not understood. Well: 'when eating', or: 'this afternoon with tea.'
After the contact
Discuss the consultation or the treatment with the family or supervisors, if there is permission. If a patient with a mild intellectual disability is responsible for a new appointment, make that appointment immediately, or contact him in the meantime. When you refer the patient, you ask permission to be allowed to state with that referral that the patient may need more time because of an intellectual disability.
Ang-obstruction and sedation during a (dental) procedure
In this section, we will discuss in more detail how you can deal with anxiety in patients with intellectual disabilities. You can do a lot without sedating (soothing) medication.
It is important to treat pain-free. Resources for this are (from light to heavy):
- Anesthetic gel (surface anesthesia, works within a few minutes);
- Local anesthesia (anesthesia of a nerve);
- Sedating medication;
- Overall anesthesia.
The table below gives points for attention when dealing with anxious patients with intellectual disability in the dental practice. Whether sedation is needed, you should consult with parents, carers or supervisors beforehand. Sedating medication can be used before and / or during the procedure.
Points of attention when dealing with anxious patients with an intellectual disability in the dental practice
|To observe||- Pay attention to heart rate, breathing, facial color, movements (feet), muscle tension and cramping|
|Recognize and appoint||- Show that you see the signals, verbally and non-verbally; with that you acknowledge the fear; you can touch the patient's hand and say that you see that it is exciting and that you understand it|
|Making fear concrete||- If a patient says he finds it scary, ask him what he finds scary or feels the worst; with that you make the fear concrete for one thing, for example for anesthesia|
|Give peace and confidence||- Go to signals of fear and acknowledge the fear: 'that is not nice, but you can do that', or: 'together we will make sure that it works', or:' you find it scary, I understand that, but we have the time, we take it easy '|
- Give the patient the direction or any control by giving him rest and time; then: treat pain-free
- During stress during treatment: recognize, acknowledge and come up with a solution
- 'You can pinch my hand very hard', or: 'during the stupefying you can call very hard au, that gives nothing'
- You can arrange a time (10 seconds); tell them you are going to ask how it feels (break time)
- You can also agree on a sign: 'if you raise your hand, we stop for a moment'; You react immediately when that happens, so that the patient gets trust