Special Care Patient Reflection

Providing care with someone who has both epilepsy and autism you go into treatment

expecting the unexpected. However, knowing my patient pretty well made it to where I was

able to sort of gage how the clinical session might go, and it went pretty smoothly. I mentioned

in my previous report that having the walls and door around the chair was going to be very

beneficial for my patient, and it was. He was able to let his guard down a little and even joke

with me because he felt more comfortable not having a lot of people around that could hear

and see everything happening. I asked my patient if he wanted music to be playing during his

treatment and he said he didn’t hear anyone else listening to music and he didn’t want to be

the only one, so we didn’t end up playing music which is fine because he seemed more relaxed

than I thought he would be. I made sure my patient knew everything that I was doing or was

planning on doing next so he knew what to expect and could ask questions if he had some. I

used the “tell-show-do” instruction with him which seemed to work well. I asked how he was

feeling many times during his treatment, so if he ever needed a break or needed treatment to

be finished for the day we could be done. Sometimes he will push his limits a little and try to do

more than he should and then end up not feeling well, so I was trying to avoid that by offering

breaks to him. He actually did well at accepting the breaks I would offer him which surprised me

because he was so focused on getting the treatment done and not wanting to slow me down.

His gingiva was very inflamed and he bled a lot because of it. He didn’t like the thought of

blood in his mouth so we did do a rinse between every one or two teeth when scaling was

completed. We luckily didn’t run into any medical issues. The only issue we had was at the first

appointment towards the end he started to not feel very good. He felt a little dizzy and
uncomfortable so we stopped treatment a little early. He believes it was due to the blood he

was losing, so he sat up for a few minutes and drank some water and felt better. I was hoping

to avoid using anesthesia on my patient, but did talk with him about the process prior to the

appointment just in case it would be something he would be comfortable with. He was slightly

hesitant because he had never had it before, but did agree to it if he did end up needing it to

finish his treatment. We ended up not needing to use local anesthesia, but did use the oraqix

for him. It did help enough to not need anesthesia, but his gingiva was still a little sensitive.

My patient accumulates plaque very quickly. His first appointment and second appointment

were within a week of each other and within that time frame he already had heavy plaque

buildup on teeth that I had finished scaling. At his first appointment I showed him the proper

way to brush, proper way to floss, and recommended the perio-aid to help with plaque along

the gingival margin. When he came back for his second appointment and I saw how much

plaque he had built up in that time frame, I knew we needed to change some of his home care

that I originally suggested. He mentioned he was having troubles flossing at home so he

decided to just stop trying and he forgot how to use the perio-aid. Since I do know my patient

well, I should have remembered he has troubles with hand-eye coordination, so flossing and

the perio-aid are not going to be the easiest things for him to use. I suggested the end-tuff

brush instead of using the perio-end because its not as technique sensitive and has less of a

chance of hurting his already sensitive gingiva. I ended up giving him a mechanical toothbrush

to help with plaque removal instead of a manual one because that also is helpful with plaque

removal and requires less technique as well. He also got some phos-flur mouth rinse which is

something he can easily use to help with the demineralization he had on a lot of his teeth.
I wish I would have remembered at his first appointment to find things that would work better

for his hand-eye coordination instead of overwhelming him with things he might struggle with

and make him feel incompetent. Its definitely a learning experience because I really need to

focus more on personalizing home care for each patient.

I am a pretty empathetic person, and I know that will be beneficial during my career especially

when I see special care patients. I want to accommodate to make them feel comfortable with

the treatment and with me as their clinician. Having a special care patient during school is very

beneficial to all of us. We put the needs of our patient first (which we should already be doing),

but to another level. We do anything we can to keep them comfortable during their treatment

whether it be physically or mentally, and we need to be prepared for any unexpected things

that could happen. Like mentioned above; knowing my patient before he came in made it to

where I knew what things might work for him and what things might not. However, I won’t

always know my patients that come in for treatment; that’s why it’s going to be important for

me to do some quick research before they come in if I find out they have a medical condition so

I know how to best prepare for them. I also see how important it is to let them ask questions,

and for me to also ask questions to them so I have a good understanding of anything they need.

My goal with every patient, but especially special care patients is to really engage them when

they first arrive. Maybe I can see certain accommodations that might be needed based on they

physical health, or I can see how their stress is when they arrive. I will make sure every patient

knows I am on their team and want to help them in any way possible. My special care client left

his last appointment feeling comfortable and low stressed. He left with a clean dentition, the
proper home care techniques specific to him, and he told me he learned some new things. I

would consider that a success.