In our practices we all encounter special needs patients and their families. Many dentists excel in managing the challenges present in caring for special needs patients, but what about their families?

This is the second installment (if you missed it, read Part 1 here) of a few tips I have learned in more than thirty years of caring for thousands of special needs patient’s and their families.

During the examination

• Unless there is a reason not to do this, show the family you are not afraid of the patient.  If the patient does not object show this by touching the patient.  Pats on the arm or shoulder reassures the patient and family of your acceptance.
• Offer accompanying family members the opportunity to sit while you are visiting with them in the operatory.
• If it is obvious that you are not able to do an examination then you may choose not to transport the patient to the dental chair.  This may save some strenuous effort on the part of the family.
• Clinically, patients may present with extreme accumulation on their teeth, halitosis and evidence of acute and chronic disease.  This may be embarrassing to family members who are charged to provide oral home care.  I have learned that it doesn’t help to place blame or point fingers. Best is to evaluate the real potential for oral home care and counsel accordingly.  Make sure the family member knows what are reasonable expectations for home care.  Find something to compliment in their efforts.  They will appreciate it.
• Look for ways to lessen any guilt and fear they may have concerning oral home care.  You may be surprised how a few kind words about your appreciation of their efforts towards home care relieve family members of anxiety.  Expect all they can do and keep the oral care directives in perspective to the total patient care needs. 
  
• Family members may not know if the patient is having pain or infection and they may worry about this.
  1. Address these areas to the family:
     1. Pain
     2. Mastication limitations related to the teeth
     3. Oral home care
• Talk to family members about your examination.  Show them how you look for edema, palpate for swollen lymph nodes, check for tooth mobility, edematous gingival tissues, apical tenderness, missing restorations, caries, observe the bite and watch for oral guarding.  As family members learn of your attention to details that they have little knowledge of their concerns are lessened.
• Ask about the patient’s diet to gain insight into the investment of time the family must give this matter.   It may be a point where you can praise the family’s effort.
• Don’t expect more from the family than what you can expect from the patient.  If the patient is totally uncooperative it is hard to expect much from the family in terms of oral home care.  Let the family know you understand this.
• Look for something for everyone to love about the patient.  It might be their smile, or pretty hair, or cool shoes or great laugh or whatever.  Find something positive to comment on and mean it. Thank the family member for bringing the patient to the office and tell the patient that the family is showing their love for them by doing that.
• If not completely inappropriate ask the patient’s permission to talk to the family on their behalf during the evaluation period.  Even if the patient cannot respond thank them for allowing this.
• If the family is required to hold the patient still it is difficult to communicate when restraining a patient.  Have your staff do this so the family can focus on the discussion with you.
• When looking into the mouth on a sedated patient offer the family member the opportunity to view the oral cavity with you.  Remember that this may be one of the few times they can actually see what is going on.  Point out the good things you see first then address the issues that require attention.  Find something good to say.  The family will appreciate that.
• Help the family by making a Youtube video of you yourself demonstrating oral home care to the patient.  Show in the video how you want the teeth brushed, how to get to certain areas and what to look for when evaluating the patient.  Point out areas of risk or teeth that require special attention.  How to manage prosthetics is helpful also.  These videos should be shared with caregiving staff if the family will so that.  The video is an irrefutable source of caregiving instructions that families can make available to caregiving staff.
• Be an advocate for the patient to caregivers.  Families will benefit from your counsel on behalf of the patient.

After care

• When visiting with families after sedation tell them first how the patient is doing. That’s the first thing they want to know.  Then tell them about the dental care you provided.
• Make sure after care instructions are written and reviewed with family members.   Ascertain who is responsible for the immediate and long term oral care and counsel appropriately.

Helping the families of special needs patients is something we all can do, and by doing a few little things your impact can go a long way.

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