Jessica Lee

DH 222A

Special Care Report

For my special care patient, I treated a patient named Russell. Russell is a patient who is

legally blind. He has been blind his whole life. He is not sure what type of blindness this is. I

don’t know if he has total vision loss or some perception of vision. I have yet to meet this patient

myself. “Total blindness is a term used to describe those who have complete lack of light

perception, documented as no light perception (NLP). Only about 15% of people with eye

disorders have total blindness, the majority of those with visual impairment have some level of

vision” (Lee 2023). It is likely that the patient is not totally blind but will come to find out once

we do the medical history review. This can change the course of modifications that need to be

made. I believe he is taking medication, but I am unsure if it is related to blindness, or some

other condition. This was not stated in the previous medical history. As far as I could see in my

research, the patient should not need a medical consultation for blindness alone.

Many people who are blind have a hard time achieving and maintaining their oral health.

Without vision, they are unable to identify many problems that may not necessarily cause pain

such as bleeding gums, swollen tissues, or lesions. In this instance, I would recommend the

patient come in at least every 6 months. “Because they are unable to recognize early stages in

oral disease, they could fail to receive prompt treatment and people with visual impairments

access dental care less than people whose vision is not impaired” (Ahmed 2022). If periodontal

disease is present, then I will recommend the 3-month recall, emphasizing the importance of us

maintaining his oral health together. It will also allow us as providers to provide more visual
inspections as the patient would be unable to perform it. Something I thought to be interesting

was that there is a correlation between causes of ocular disease and dental caries. Patients with

visual impairments also have been shown to have bruxism and occlusal wear. However since

these patients cannot readily identify these, it is important for them to come in often to monitor

those factors as well. Ultimately if the patient has a lot of attrition, it may be a good idea to get

them a nightguard to protect their teeth at night.

To modify my treatment, I plan on speaking with Russell and asking him directly what

works for him. I will offer guidance to the operatory as needed. Any consents, forms and

treatment plans will be read aloud. I will explain what I’m doing before each step and explain

what he might expect in terms of sensation, noise, or smells. I will use more verbal cues or

physical touch such as a pat on the shoulder so he will know I’m communicating directly with

him. I will also ask him how I can help and what works best for him because patients know

themselves best. For Russell, I do believe it will be interesting to give OHI. I believe for him an

electric toothbrush would be best as it may be hard for him to get the best access and angles with

a manual brush. I will demonstrate them and ask if he can feel the difference between the 45-

degree angulation and what he has been doing. I will probably recommend the Tepe rubberized

interdental picks to clean in between his teeth. These seem like the safest option and less likely to

cause gingival trauma and easier to use. I will also ask if he would like to record any of our

conversation surrounding oral hygiene instructions or his treatment plan so that he essentially has

a copy that he can understand. “Modifications for the dental team to consider when treating

visually impaired patients include speaking clearly while facing the patient; creating

medical/dental history forms, brochures, and other printed materials in a large, bold print; and

offering to assist the patient when filling out forms. In addition, providing ample lighting in
walkways and operatories, escorting the patient from the reception area to the dental treatment

chair” (Palich 2018).

After meeting and treating Russell, I came to find that he does not take any medications

for his disability. He does take Lipitor for high cholesterol and Flomax for his enlarged prostate.

Also he is not sure of the type of blindness he has but he described to me that he can see some

flecks of light but that’s about it. I thoroughly interviewed him for the medical history because I

wanted to ensure accuracy, so I read everything line by line to him. When escorting Russell, he

preferred to grab the back of my arm and walk directly behind me so he would know where

exactly to go to avoid any obstructions. He also declined to record during of conversations

surrounding findings and treatment planning.

Russell presented with severe recession, bone loss, and heavy attrition. At home he uses

an electric toothbrush and toothpaste two times daily and uses floss or dental tape, he is also

scrubbing while the electric toothbrush is on. There was some evidence of tissue trauma from the

floss and severe recession. When I went over OHI, I asked him to show me how he brushes and

flosses so I could observe. Upon this, I started to demonstrate how he should brush at more of a

45-degree angle and ask him if he could feel the difference and hen had him demonstrate back to

me. I just helped guide his hand so he could feel how the angle should be both inside the mouth

and with his hand. I recommended that he does not scrub while the brush is on and use very

gentle pressure as he guides the toothbrush along. I also demonstrated using the Tepe rubberized

interdental brush, because it will cause less tissue trauma and fit the embrasure space better than

regular floss. This was the biggest modification I had to make because usually I can show a

patient their tissue and what healthy tissue looks like. I had to use descriptive language so he

could understand what was going on. He was very receptive and understood what I was saying.
Another modification was talking a lot. Letting him know I was leaving the room, what I was

doing and when, where we needed to go, guiding him through the clinic etc. I recommended he

come every 3 months due to the severity of his condition. We had also discussed looking into a

night guard due to the level of attrition. Russell had some financial concerns. I told him 3-4

months was okay but really 3 months is best. I told him he should get a consultation with the

doctor as well for a nightguard just to see what the cost may be and if there are payment plans

because it would benefit him.

Overall this was a positive experience for me. I feel more prepared to treat a patient with

a similar condition in the future. I feel as though it would be beneficial for any student, and I

would be interested in treating other special needs during school so we can get the practice and

support while we are students. Russell was also a great patient and I hope he continues to come

to LCC for future students to experience and learn.

References:

Ahmed, T. A., Bradley, N., & Fenesan, S. (2022). Dental management of patients with sensory

impairments. British dental journal, 233(8), 627–633. https://doi.org/10.1038/s41415-022-5085-x

Lee, S. Y. (2023, January 21). Blindness. StatPearls [Internet].

https://www.ncbi.nlm.nih.gov/books/NBK448182/#:~:text=Introduction,have%20some%20level
%20of%20vision.

Palich, R. (2018, May 30). Promoting oral health among the visually impaired - dimensions of

dental hygiene: Magazine. Dimensions of Dental Hygiene | Magazine.

https://dimensionsofdentalhygiene.com/article/promoting-oral-health-among-the-visually-

impaired/#:~:text=Modifications%20for%20the%20dental%20team,patient%20when%20filling

%20out%20forms.