• The Journal of the Korean dental association
• /
• v.49 no.12
• /
• pp.732-738
• /
• 2011

Special needs patient are one of the underserved dental patient groups in Korea. However, Lack of attitudes to oral care and the knowledge of health professionals are identified as barriers to oral health for people with disabilities. Health authorities have a key role in ensuring that the need for a comprehensive dental services is met. This review may help oral health professionals understand the dental considerations according types of disabilities and provide appropriate and necessary dental care for special needs patients.

• The Journal of the Korean dental association
• /
• v.53 no.11
• /
• pp.779-788
• /
• 2015

Individuals with special needs include those with behavioral issues, developmental disorders, cognitive disorders, congenital or genetic disorders, or systemic disease. These conditions may place them at increased risk for oral diseases. Dental management of patients with special needs require in-depth understanding of the background of disability and available behavioral guidance theories. Therefore dental team members need more training in the theory and practice of behavior management principles, which might lead to a clinical experience that is more respectful of the dignity and independence of patients with special needs. The dental professional should be flexible to modify the behavior management approach according to the individual patients needs. Also a family/care-giver centered approach based on their preferences and concerns, the patient's challenging behaviors, and related medical problem can serve to improve the treatment planning and oral health management of dental patients with special needs. This article focuses on uncooperative behavior and behavior management, which help practicing dentists to understand their role in the care of patients with special needs.

• The Journal of the Korean dental association
• /
• v.53 no.11
• /
• pp.770-778
• /
• 2015

This article discusses how to conduct treatment planning and decision making in special needs dentistry. Special needs patients often lack cooperative ability during dental treatment and have a deteriorated oral health status. To overcome the limitation in communication with special needs patients and solve their complicated dental problems, dentists need to have extensive preoperative information about the patients and their caregivers. Treatment procedures should be organized in a patient-centered and cost-effective manner. Additionally, clinical outcomes need to be predicted taking into consideration of the patients' condition. The clinical experience of committed dentists is another factor that enhances the benefits of extensive treatment in special needs patients with many limitations. The insightful treatment decision-making of dentists will contribute to improving the oral health of special needs patients despite the various obstacles.

• The Journal of Korea Assosiation for Disability and Oral Health
• /
• v.6 no.2
• /
• pp.77-83
• /
• 2010

This article discusses the issues of benefit and risk associated with outpatient general anesthesia and deep sedation for the special need dental patients. The purpose of administering anesthesia for patients with special needs is to provide effect dental treatment. But there are many complications such as sore throat, nausea and vomiting, airway trauma, airway obstruction and hypoxic brain damages, etc. In order to decrease incidence of complication, before general anesthesia meticulous patient evaluation is much important. But, there are a number of factors that make it difficult to accurately assess the anesthetic risk for many people with special needs. These include limited medical workups, uncooperative behavior, and difficulties in postoperative cares, etc. But Judging from several years experience of many contries, it appears that the incidence of mortalities for people with special needs in dental setting is minimal and the incidence of morbidity is limited. In the long run, the delivery of general anesthesia and deep sedation for people with special needs can be considered a very safe and successful procedure.

• The Journal of Korea Assosiation for Disability and Oral Health
• /
• v.15 no.1
• /
• pp.14-22
• /
• 2019

The aim of this study was to determine the factors contributing to the barrier of dental treatment for special needs patients perceived by the main caregivers of the patients. A questionnaire was developed with three parts: patient-related factors, caregiver-related factors, and factors for treatment barriers. Patient- and caregiver-related factors were analyzed for correlations with the barrier factors. Fisher's exact test and Chi-square test were used at the level of 0.05. A total of 52 caregivers (mean age [SD]=50.2 [11.5] years) for the patients with intellectual and cognitive disabilities (mean age [SD]=38.9 [21.3]) responded to the questionnaires. Oral hygiene status, need for assistance in tooth brushing, and cooperation for tooth brushing were correlated with the level of treatment cooperation of the patients (p<0.05). The above three factors were also correlated with the treatment barrier despite patients presenting oral symptoms (p<0.05). Two thirds of the caregivers felt the treatment cost as severe or a considerable financial burden. For patients, insurance types and need for assistance in tooth brushing, and for caregivers, education levels and financial status were significant factors contributing to financial burden (p<0.05). There were background factors of the patients and their caregivers associated with access to dental treatment for special needs patients. Deficient cooperative skills and financial burdens were the main obstacles to treatment access. Tooth brushing skills and oral hygiene status can be proxy measures to cooperative ability for dental treatment.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.19 no.4
• /
• pp.191-199
• /
• 2019

Background: Patients with special health care needs are more likely to develop health problems, including dental problems. Dental treatments require a good level of communication with the patient. Therefore, in these patients, sedation and general anesthesia are an extremely humanistic approach for comfortable and successful treatment. In patients with special needs, there is no standard anesthetic approach due to varying clinical conditions. The aim of this study was to provide literature content about the anesthetic approaches used by us in patients with special needs. Methods: The medical records of 710 patients with special health care needs treated under general anesthesia or sedation were reviewed retrospectively. Demographic data, the American Society of Anesthesiologists classification, Mallampati score, anesthesia duration, anesthesia type, anesthetic and analgesic agents used, dental treatment performed, secondary diseases, and complications in the perioperative period were recorded. Patients were evaluated under five groups: Down syndrome, other syndromes, psychiatric disorders, physical disabilities, and complicated medical story. Results: Among the patients evaluated, 47.5% were females and 52.5% were males (mean age $15.76{\pm}11.17$ years), and general anesthesia and sedation were administered in 72.9% and 22.1% patients, respectively. The mean duration of anesthesia was $43.20{\pm}35.85$ min. Simple dental treatments were performed in all groups, and the most common complications were observed in the other syndromes group. Conclusion: Complications can be reduced by utilizing the appropriate anesthetic approach and taking serious precautions in patients with special needs.

• The Journal of Korea Assosiation for Disability and Oral Health
• /
• v.15 no.1
• /
• pp.7-13
• /
• 2019

The aim of this study was to clarify the barriers of dental treatment for special needs patients felt by dentists and to determine the dentist-related factors contributing to the obstacles in treatment planning and decision making. Questionnaires were distributed and responded by dentists working at five public-based special care clinics in South Korea. Factors divided into three parts (dentist demographics, clinical factors, and educational and administrational factors) were assessed and analyzed for correlations between dentist-related factors and dentist-felt burdens for special care treatment. Fisher's exact test and Chi-square test were used at the level of 0.05. A total of 34 dentists responded to the questionnaires. Almost all dentists had obstacles in the treatment of special needs patients in terms of the patients' lack of cooperation (94.1%), proxy communication with caregivers (94.1%), payment reward system (63.6%), deficient workforce (67.7%), and others. The longer dentists had been practicing for special needs patients, the more they were dissatisfied with the reward system and a longer time was spent for communication with patients and their caregivers (p<0.05). For specialists, more obstacles were experienced in treatment planning due to a deficiency in the clinical information obtained from their patients compared to general practitioners (p<0.05). A total of 82.4% of the respondents approved of mandatory educational programs for special care dentists. There were practitioner-based factors related to the amount of obstacles felt by special care dentists. To overcome the treatment barrier of special needs patients, in-depth education and training are required in special care dentistry.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.17 no.2
• /
• pp.91-103
• /
• 2017

General anesthesia is commonly used to facilitate dental treatment in patients with anxiety or challenging behavior, many of whom are children or patients with special needs. When performing procedures under general anesthesia, dental surgeons must perform a thorough pre-operative assessment, as well as ensure that the patients are aware of the potential risks and that informed consent has been obtained. Such precautions ensure optimal patient management and reduce the frequency of morbidities associated with this form of sedation. Most guidelines address the management of pediatric patients under general anesthesia. However, little has been published regarding this method in patients with special needs. This article constitutes a review of the current literature regarding management of patients with special needs under general anesthesia.

• Journal of Korean Public Health Nursing
• /
• v.13 no.1
• /
• pp.114-127
• /
• 1999

In order to care the persons who are dying a nurse should first solve her / his own conflicts about death. and be aware of their own concepts of death and dying. In order to find out patient's spiritual needs and to give better spiritual nursing care. a nurse should know her / his own spiritual needs and be aware of their own concepts of spiritual nursing problems. To improve nurse's understanding towards death and dying and nurse's knowledge towards spiritual needs and spiritual nursing care. 14 weeks(two hours a week) spiritual nursing care education was given to 3th grade baccalaureate nursing college student. Before and after spiritual nursing care education. 30 items of prepared questionare focused on the attitudes toward death and dying was asked. Pre and post results are as follow ; 1. The dying patient's emotional and physical needs. There was no significant difference between pre and post educated groups. Both of the situations. they agreed upon$(69.64\%)$ that the dying patients have high emotional and physical needs to solve. 2. Telling the truth of dying process. There was no significant difference between pre educated group$(53.33\%)$ and post educated group$(55.95\%)$. 3. Attitudes of medical personnels. There was no significant difference between pre$(51.49\%)$ and post educated groups $(53.87\%)$. These responses indicate that nursing college student didn't have enough experiences on dying patients care. 4. General attitudes on death and dying. Number of nursing students who were thinking positively toward death and dying were Increased (pre $39.68\%$. post $45.44\%$) and who were thinking negatively toward death and dying were also decreased (pre $37.30\%$. post $33.93\%$). 5. Attitudes toward mechanical assistance for life-expanding of helpless patient. There was a significant difference between pre and post educated groups. About $34.13\%$ of them approved upon mechanical assistance for life and about $33.14\%$ of them disapproved. 6. Attitudes of family members of dying patient. There was no significant difference between pre and post educated groups. About $45.24\%$ of both groups, agreed upon that the family members feel annoyed with dying patients and about $22.42\%$ of both groups disagreed. Whether they received the spiritual nursing education or not, they were aware of that the family members feel annoyed with dying patients. 7. Special facility and educational preparation for dying patient. There was a significant difference between pre$(82.14\%)$ and post$(90.87\%)$ educated groups. These responses indicated that after they received the education, they felt more about the necessity of special facility and educational preparation for the death and dying patients. 8. Special facility and welfare system for the old. There was a significant difference between pre$(58.33\%)$ and post$70.64\%$ educated groups. There responses indicated that after they received the education, they felt more about the necessity of special facility and welfare systems for the old.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.21 no.1
• /
• pp.71-80
• /
• 2021

Background: The options for stabilization appliance therapy for masticatory muscle pain include soft occlusal and hard stabilization appliances. A previous study suggested that hard stabilization appliance therapy was effective for patients with local myalgia who developed long facets on their occlusal appliances. The objective of this study was to identify patients in whom a soft occlusal appliance should be used to treat masticatory muscle pain by analyzing the type of muscle pain present and patient factors that influenced the effectiveness of this treatment. Methods: The study included 42 patients diagnosed with local myalgia or myofascial pain according to the Diagnostic Criteria for Temporomandibular Disorders Diagnostic Decision Tree. The analysis of patient factors included variables believed to be associated with temporomandibular disorders. First, a temporary screening appliance was used for 2 weeks to assess each patient for bruxism during sleep. Soft appliance therapy was then started. For each patient, the effectiveness of the appliance was evaluated according to the intensity of tenderness during muscle palpation and the treatment satisfaction score at one month after starting treatment. Results: Data from 37 of the 42 patients were available for analysis. Twenty-five patients reported satisfaction with the appliance. In logistic regression analysis, the odds ratio for reduction of facet length was 1.998. Nineteen patients showed at least a 30% improvement in the visual analog scale score. The odds ratio for local myalgia was 18.148. Conclusion: Soft appliance therapy may be used in patients with local myalgia. Moreover, patients who develop short facets on the appliance surface are likely to be satisfied with soft appliance therapy. Soft appliance therapy may be appropriate for patients with local myalgia who develop short facets on their occlusal appliance.