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delivery of oral health care. The dentist and staff always should be prepared to manage a medical emergency. Patient communication When treating patients with SHCN, similar to any other child, developmentally-appropriate communication is critical. Often, information provided by a parent or caregiver prior to the patient’s visit can assist greatly in preparation for the appointment.8 An attempt should be made to communicate directly with the patient and, when indicated, to supplement communication with gestures and augmentive methods of communication during the provision of dental care. A patient who does not communicate verbally may communicate in a variety of non-traditional ways. At times, a parent, family member, or caretaker may need to be present to facilitate communication and/or provide information that the patient cannot. According to the requirements of the AwDA, if attempts to communicate with a patient with SHCN/parent are unsuccessful because of a disability such as impaired hearing, the dentist must work with those individuals to establish an effective means of communications. Planning dental treatment The process of developing a dental treatment plan typically progresses through several steps. Before a treatment plan can be developed and presented to the patient and/or caregiver, information regarding medical, physical, psychological, social, behavioral, and dental histories must be gathered37 and clinical examination and any additional diagnostic procedures completed.Informed consent All patients must be able to provide signed informed consent for dental treatment or have someone present who legally can provide this service for them. Informed consent/assent must comply with state laws and, when applicable, institutional requirements. Informed consent should be well documented in the dental record through a signed and witnessed form.Behavior guidance Behavior guidance of the patient with SHCN can be challenging. Because of dental anxiety or a lack of understanding of dental care, children with disabilities may exhibit resistant behaviors. These behaviors can interfere with the safe delivery of dental treatment. With the parent/caregiver’s assistance, most patients with physical and mental disabilities can be managed in the dental office. Protective stabilization can be helpful in patients for whom traditional behavior guidance techniques are not adequate.39 When protective stabilization is not feasible or effective, sedation or general anesthesia is the behavioral guidance armamentarium of choice. When in-office sedation/ general anesthesia is not feasible or effective, an out-patient surgical care facility might be necessary.Preventive strategies Individuals with SHCN may be at increased risk for oral diseases; these diseases further jeopardize the patient’s health.3 Education of parents/caregivers is critical for ensuring appropriate and regular supervision of daily oral hygiene. The team of dental professionals should develop an individualized oral hygiene program that takes into account the unique disability of the patient. Brushing with a fluoridated dentifrice twice daily should be emphasized to help prevent caries and gingivitis. If a patient’s sensory issues cause the taste or texture of fluoridated toothpaste to be intolerable, a fluoridated mouth rinse may be applied with the toothbrush. Toothbrushes can be modified to enable individuals with physical disabilities to brush their own teeth. Electric toothbrushes and floss holders may improve patient compliance. Caregivers should provide the appropriate oral care when the patient is unable to do so adequately.A non-cariogenic diet should be discussed for long term prevention of dental disease.40 When a diet rich in carbohydrates is medically necessary (e.g., to increase weight gain), the dentist should provide strategies to mitigate the caries risk by altering frequency of and/or increasing preventive measures. As well, other oral side effects (e.g., xerostomia, gingival overgrowth) of medications should be reviewed.Patients with SHCN may benefit from sealants. Sealants reduce the risk of caries in susceptible pits and fissures of primary and permanent teeth.41 Topical fluorides may be indicated when caries risk is increased.42 Interim therapeutic restoration (ITR),43 using materials such as glass ionomers that release fluoride, may be useful as both preventive and therapeutic approaches in patients with SHCN.41 In cases of gingivitis and periodontal disease, chlorhexidine mouth rinse may be useful. For patients who might swallow a rinse, a toothbrush can be used to apply the chlorhexidine. Patients having severe dental disease may need to be seen every two to three months or more often if indicated. Those patients with progressive periodontal disease should be referred to a periodontist for evaluation and treatment.Preventive strategies for patients with SHCN should address traumatic injuries. This would include anticipatory guidance about risk of trauma (e.g., with seizure disorders or motor skills/coordination deficits), mouthguard fabrication, and what to do if dentoalveolar trauma occurs. Additionally, children with SHCN are more likely to be victims of physical abuse, sexual abuse, and neglect when compared to children without disabilities.44 Craniofacial, head, face, and neck injuries occur in more than half of the cases of child abuse.45 Because of this incidence, dentists need to be aware of signs of abuse and mandated reporting procedures.Barriers Dentists should be familiar with community-based resources for patients with SHCN and encourage such assistance when appropriate. While local hospitals, public health facilities, rehabilitation services, or groups that advocate for those with SHCN can be valuable contacts to help the dentist/patient address language and cultural barriers, other community-based resources may offer support with financial or transportation considerations that prevent access to care.34