Dental Management of Patients with Physical Challenges

Dr. PJ Murphy, Clinical Assistant Professor, UBC

Recent data suggests that more than 20% of the general population qualify as having some kind of physical challenge, be it a mobility or sensory deficit. Data also suggests that individuals with physical challenges have an increased incidence of oral disease.

In this episode of CDA Oasis Live, Dr. John O’Keefe, Director of Knowledge Networks CDA, invites Dr. PJ Murphy, Clinical Assistant Professor at UBC, to unpack the key considerations when accommodating a patient with physical challenges in the dental office.

Here are the big takeaways from the discussion:

• It is important to view physical challenges with a broad lens and not just limit our view to patients in wheelchairs. Common deficits include hearing and visual issues, orthopaedic issues, arthritis, scoliosis, neuromuscular disorders, cystic fibrosis, cerebral palsy, and patients who have had a stroke.
• We should never assume that a patient with physical challenges needs our help. Many of them are incredibly independent and it is important to first ask if they need assistance.
• The journey starts before the patient even gets to the office. Do they have transportation? Can they access the front door of the office? Can they access the elevator?
• Waiting room/reception:
  • Is there adequate room in the hallways and reception area for a wheelchair to maneuver?
  • Are there handrails to assist mobility?
  • Is there adequate lighting?
  • Is the floor non-stick and suitable for wheelchairs and walkers?
  • Is there adequate signage for people with impaired hearing?
• Washroom
  • Raised toilet and an alert button
  • Adequate lighting
  • Arm/hand rails
• Inside the operatory
  • Open design to accommodate wheelchairs
  • Flexibility – want enough space to transfer the patient to the operatory chair or to treat the patient in the wheelchair if necessary.
• Treatment
  • Lack of gag reflex can be a problem in patients with neuromuscular deficits where there is an increased risk of aspiration pneumonia. Must be careful with the airway. Generally these patients will not be treated fully supine.
  • Important to have plenty of aids to keep the patient comfortable – pillows, rolled towels etc.
• Referral
  • When it comes to accommodating patients with physical challenges, it is important that every office is accessible to a certain degree. This minimum requirement is mandated on a provincial basis.
  • That said, it is not uncommon for a patient with physical challenges to be referred to another office where their needs may be served better.

We hope you find the conversation useful. We welcome your thoughts, questions and/or suggestions about this post and other topics. Leave a comment in the box below or send us your feedback by email.

Until next time!
CDA Oasis Team

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