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What considerations are there for special needs patients?

Preparation can help a special needs patient get ready to visit the dentist. Considerations and questions to ask your dentist during the initial appointment are suggested below.

Physical and mobility concerns

  • Where is the best place to park, or to enter the building?
  • Can the office hallways or clinical rooms accommodate the patient’s means of movement?
  • Would someone from the office be available to help with access?

Health information

  • Does the patient have allergies, medical conditions, medications and had previous surgeries?
  • Who is the patient’s primary care physician?  Have this contact information available in case the dentist needs additional information.

Office environment

  • Is there something that the dental team could do with lighting, sounds or music that could help with the patient in case there are sensory issues?
  • Will there be a service animal?

Emotional needs

  • Is there a time of day that is best suited for the patient’s appointment?
  • What should the dental team know about the patient’s emotional needs in order to better communicate with and care for the patient?

While it may seem there is a lot to consider before an initial dental visit, the above information is valuable for creating a safe and welcoming environment to care for the special needs patient.

Toothpaste: when should kids begin using it and how much should be used?

Baby teeth are at risk for decay as soon as they first appear which is typically around six months. The good news is that tooth decay is preventable! Starting at birth, clean your child’s gums with a soft, infant toothbrush or cloth and water.

When your child’s teeth begin to come in, brush baby teeth twice a day with a child-size
toothbrush and “smear” of fluoridated toothpaste according to the American Academy of Pediatric Dentistry.

For 2 to 5-year-olds, dispense no more than a “pea-size” amount of fluoridated toothpaste and help your child brush. Remember that young children do not have the coordination to brush their teeth effectively. Children should spit out and not swallow excess toothpaste after brushing.

Comparison of a smear (left) with a pea-sized (right) amount of toothpaste.

Who ‘owns’ a patient’s dental records?

The dentist owns the records, but the patient owns the information contained in the records.

As such, the patient has a right to examine and/or obtain a copy of their records at any time.

Statute 146.83, Patient Access to Health Care Records provides a patient (or person authorized by the patient) has the right to inspect his or her own dental records during regular business hours if he or she gives reasonable notice to the dentist of a desire to inspect and submits a signed statement of “informed consent” stating the purpose of the inspection, the type of information sought, the name of any person authorized to inspect or receive the information and the date.

The patient may obtain copies of the dental records by paying a reasonable copying cost defined in WI statute shall the dentist want to charge. A person authorized to inspect or receive the information on behalf of a patient includes a parent, guardian, custodian or an agent. The dentist is not required to and should not relinquish physical possession of the original records.

But the dentist has the absolute legal duty to comply with the request for a copy or transfer of the records to whomever the patient desires with little or no interference.

If I go for a cleaning twice a year, does the dentist have to examine me each time?

Examinations and X-rays are important tools a dentist uses to assess and maintain a patient’s oral health.

Exams must be done at least once a year by a dentist for patients being seen by a dental hygienist without the dentist present. State statute doesn’t dictate how often exams must be performed if the dentist is always present, but that is most likely because it is assumed that if the dentist is present he or she is performing examinations.

From a liability standpoint, a dentist should examine a patient on a “regular” basis. The WDA recommends dental offices set forth individual office policies on frequency of dental examinations.

Also, other factors may influence how often a dentist needs to examine a patient. For example, a dentist should conduct an exam before performing any clinical treatment, since an exam will help determine the proper course of treatment to be followed. In addition, patients may need to be seen more frequently if they have serious or ongoing oral health issues (Source).

Are there laws about how often X-rays must be taken & exams performed in the dental office?

X-rays are often a part of dental exams, and while there is no statutory direction as to how often a dentist must take X-rays, or perform a thorough exam, there is a general liability issue.

Dentists should take X-rays in a “reasonable” time span to justify that he or she didn’t disregard a patient’s oral health care.

While a patent’s desire for a certain level of autonomy in making such a decision as to delay or decline an exam is understandable. a clinical examination, which often includes x-rays, is necessary in order for a dentist to collect diagnostic information that is vital to assess and facilitate a patient’s oral health.

Dental examinations help to diagnose disease before it becomes hazardous to your health. In addition, regular examinations can save patients money by finding problems while they are small and before they become expensive to repair, or in some cases, impossible to repair.

Dental X-rays are also very important as they allow the dentist to detect problems that cannot be seen by the naked eye. These problems include: loss of bone supporting the teeth (periodontal disease), cysts (sacks of fluid that form on the roots of teeth), cancerous and non-cancerous tumors, and decay that occurs between the teeth.

By using an X-ray to make certain no pathology is present, the dentist can help save the patient time, expense, pain, money and possibly avoiding additional treatments in the future. In some cases, when dental x-rays show the location of cancerous growths, X-rays can be responsible for saving a life.

While dental patients have the right to refuse any treatment, including exams and x-rays, dentists must follow recommended guidelines and use his or her professional judgment in reviewing  the patient’s unique situation to determine what is clinically best for the patient.

Dentists have an obligation to maintain and enhance a patient’s oral health within the standard of care, and from a liability standpoint a patient cannot consent to treatment that is outside that standard of care. Should a patient decline to have an exam and or X-rays, the dentist is also permitted to decline to provide a requested cleaning and may ask that the patient find another dentist.

The relationship of patient and dentist is a very special one, and should exist only so long as both parties are fully confident that a continuing relationship will contribute to the dental care that will provide satisfaction to both parties.

When either of the two parties has less than complete confidence in such a relationship, then it may become necessary to terminate that relationship.

Prevention is always better than treatment.  By actively preventing disease and decay through regular home care, professional dental cleanings and regular, comprehensive exams, patient and dentist together will be able to maintain a healthy, beautiful smile. (Source)

How do I know how much my treatment will cost?

The WDA strongly encourages dental patients to ask about the cost of treatment prior to having the procedures done. A variety of factors help determine the cost of procedures (which are not standardized across offices), such as where in the state the practice is located, dentist and staff training, overhead costs and whether the office accepts a particular type of insurance. To get an idea of what dental offices are charging in your area, patients may wish to consider seeking out consultation from several other local dentists. However, the cost of a procedure should not be the final determination as to which office you choose, but one where the doctor-patient relationship is most comfortable.

It is important to have a complete treatment plan and financial arrangements in place before moving forward with needed dental work.

Do I need dental insurance to see the dentist?

Many think if they don’t have dental insurance, they can’t visit the dentist. Those who plan accordingly can realize long-term savings that routine dental exams and cleanings provide when problems are detected early.

Personal household budgeting is an effective way to save for dental care. Just like people budget for gas and groceries, heat and electricity, TV and phone service, setting aside a little money each month into a designated account for dental care allows them to get the care they need – without insurance.

The WDA Own Your Smile message highlights the affordability and value of choosing a healthy smile over other lifestyle expenditures.

Prevention includes regular visits to your dentist, which can identify and halt disease in its earliest stages and save money in the long run, good daily oral hygiene at home and limited consumption of sugary snacks and acidic soft drinks (regular and diet).

The WDA also maintains a list of low-cost dental clinics throughout the state as a public service.

Is it legal to perform teeth whitening services in malls, salons and places other than a dental office?

If you visit a dentist, he or she must first examine you to determine if teeth whitening is appropriate for you. The Wisconsin Dentistry Examining Board says, “It is essential that a dentist examine and diagnose a patient before proceeding with teeth whitening or delegating that procedure to anyone within a dental office.”

The Wisconsin Department of Justice, however, doesn’t consider teeth whitening as practicing dentistry. This makes it legal for non-dentists who have no education or skill in all the other important aspects of oral health to do teeth whitening outside a dental office and without a dentist’s diagnosis.

The WDA recommends patients consult with a dentist to see if teeth whitening is right for them and, if so, have the treatment done by a dentist or under the supervision of one. Click here to read more.

Do dental assistants have to be licensed or certified in Wisconsin?

The state of Wisconsin does not issue licenses, certificates or registrations to dental assistants. Dentists and dental hygienists are the only licensed dental professionals in the state.

Dental assisting programs may grant attendees completion certificates, but that is not the same as being licensed or certified by the state. Visit the American Dental Assisting Association’s Web site for more information.

At what age should a child be seen by a dentist?

The WDA, American Dental Association and American Academy of Pediatric Dentistry recommend children be examined by a doctor of dental surgery (DDS) or dental medicine (DMD) within six months of the eruption of the first tooth and no later than age 1.

According to a February 2005 Children’s Dental Health Project report, low-income children who have their first dental exam by age 1 are less likely to visit emergency rooms for oral health problems or require restorative care. In addition, 5-year-olds who had their first dental visit at age 1 have incurred oral health-related costs at a rate about one-half that of their peers who don’t see a dentist until age 5.