**DISABILITY ACCESS AND COMMUNICATION** **11th July 2025** **UWA DMD2** **Dr Jee-Yun Leung** BDSc(Hons) MSc(SCD) DSCD(RCSEng) DClinDent(SND) MRACDS(SND) FANZASND Specialist, Special Needs Dentistry Senior Lecturer, The University of Western Australia Consultant, Maxillofacial and Dental Surgery Department, Fiona Stanley Hospital # **DISABILITY ACCESS AND COMMUNICATION** **11th July 2025** **UWA DMD2** **Dr Jee-Yun Leung** BDSc(Hons) MSc(SCD) DSCD(RCSEng) DClinDent(SND) MRACDS(SND) FANZASND Specialist, Special Needs Dentistry Senior Lecturer, The University of Western Australia Consultant, Maxillofacial and Dental Surgery Department, Fiona Stanley Hospital # BARRIERS TO ACCESSING ORAL HEALTHCARE - Patient-related factors - Care-related factors - Professional factors - Health system factors # **BARRIERS TO ACCESSING ORAL HEALTHCARE** - Patient-related factors - Care-related factors - Professional factors - Health system factors **BARRIERS TO ACCESSING DENTAL CARE – PATIENT RELATED FACTORS** - **Perceived need for oral care** - **Inability to express need for oral care** - **Competing health priorities** – finances, time - **Emotional, psychological, social and financial cost** - **Behavioural challenges and cooperation issues** - **Anxiety** – difficulty rationalising fears - **Legal and ethical barriers** - **Capacity to consent** - **Need for best interest decisions or case conferences** - **Time required for referrals, sectioning, Office of the Public Advocate, consultation with third parties** - **Inability to arrange or attend appointments without support** - **Reliance on others** - **Transport (ambulance, maxi-taxi, wheelchair accessible)** - **Need for domiciliary care** - **Specific oral issues adding to treatment complexity (e.g. self-injurious trauma, microstomia, eruption patterns)** - **Number of appointments / amount of treatment required to maintain oral health** - **Sweet snacks used as rewards** - **High calorific diet / sugary medications required** - **PEG feeding → calculus accumulation** - **Inadequate oral hygiene and substantial dependence on others for daily oral maintenance** ## **BARRIERS TO ACCESSING DENTAL CARE – PATIENT RELATED FACTORS** - **Perceived need for oral care** - **Inability to express need for oral care** - **Competing health priorities** – finances, time - **Emotional, psychological, social and financial cost** - **Behavioural challenges and cooperation issues** - **Anxiety** – difficulty rationalising fears - **Legal and ethical barriers** - **Capacity to consent** - **Need for best interest decisions or case conferences** - **Time required for referrals, sectioning, Office of the Public Advocate, consultation with third parties** - **Inability to arrange or attend appointments without support** - **Reliance on others** - **Transport (ambulance, maxi-taxi, wheelchair accessible)** - **Need for domiciliary care** - **Specific oral issues adding to treatment complexity (e.g. self-injurious trauma, microstomia, eruption patterns)** - **Number of appointments / amount of treatment required to maintain oral health** - **Sweet snacks used as rewards** - **High calorific diet / sugary medications required** - **PEG feeding → calculus accumulation** - **Inadequate oral hygiene and substantial dependence on others for daily oral maintenance** **BARRIERS TO ACCESSING DENTAL CARE – CARER RELATED FACTORS** - **Lack of awareness** of need for oral care - **Knowledge, experience and skills** of carers - **Attitudes** towards oral care - **Value** placed on oral care - **Overwhelmed** with burden of complex medical and day-to-day care - **Lack of staff** rostered to take patient to dentist and provide daily oral hygiene - **High staff turnover** and contractual agency staff (responsibility, familiarity) - **NDIS regulations** on restrictive practices if client refuses toothbrushing, scale & cleans - **Relatives requiring time off work** - **Age/frailness** of family members (e.g. parents who are primary carers) ## **BARRIERS TO ACCESSING DENTAL CARE – CARER RELATED FACTORS** - **Lack of awareness** of need for oral care - **Knowledge, experience and skills** of carers - **Attitudes** towards oral care - **Value** placed on oral care - **Overwhelmed** with burden of complex medical and day-to-day care - **Lack of staff** rostered to take patient to dentist and provide daily oral hygiene - **High staff turnover** and contractual agency staff (responsibility, familiarity) - **NDIS regulations** on restrictive practices if client refuses toothbrushing, scale & cleans - **Relatives requiring time off work** - **Age/frailness** of family members (e.g. parents who are primary carers) **BARRIERS TO ACCESSING DENTAL CARE – PROFESSIONAL FACTORS** - Lack of dentists with adequate **skills and training** - * Lack of dentists **willing** to treat people living with disability - Lower **remuneration** relative to other aspects of dentistry - **Discrimination and attitudes** towards disability (lack of patience) - Oral health problems **failing to be recognised**, discussed or considered by medical or other allied health practitioners (**‘diagnostic overshadowing’**) - Increased commitments and financial responsibilities with **specialty training** ## **BARRIERS TO ACCESSING DENTAL CARE – PROFESSIONAL FACTORS** - Lack of dentists with adequate **skills and training** - Lack of dentists **willing** to treat people living with disability - Lower **remuneration** relative to other aspects of dentistry - **Discrimination and attitudes** towards disability (lack of patience) - Oral health problems **failing to be recognised**, discussed or considered by medical or other allied health practitioners (**‘diagnostic overshadowing’**) - Increased commitments and financial responsibilities with **specialty training** **BARRIERS TO ACCESSING DENTAL CARE – HEALTH SYSTEM FACTORS** - Strict **eligibility** criteria - **Cost** of dental care - Lack of **funding** for services - Long **waiting lists** for public dental care or specialised SND services - Not all buildings/surgeries are disability **accessible** - **Equipment** required: hoist, wheelchair recliner, bariatric chair, portable dental equipment - Lack of clear and specific **public health policy** addressing dental needs for those with disability ## **BARRIERS TO ACCESSING DENTAL CARE – HEALTH SYSTEM FACTORS** - Strict **eligibility** criteria - **Cost** of dental care - Lack of **funding** for services - Long **waiting lists** for public dental care or specialised SND services - Not all buildings/surgeries are disability **accessible** - **Equipment** required: hoist, wheelchair recliner, bariatric chair, portable dental equipment - Lack of clear and specific **public health policy** addressing dental needs for those with disability # CONSEQUENCES OF BARRIERS - **Localised problems** - Decay, gum disease, attrition, fungal/bacterial infections, pain, poor appearance, loss of teeth - **Unwanted outcomes** - Extractions instead of fillings, increased severity of periodontal disease, lack of functional replacement of extracted teeth - **Functional difficulties with eating, drinking, smiling, speech** - **Aesthetic concerns, loss of self-confidence and dignity** - **Complications related to dental procedures** - Bleeding, post-op infections, ONJ, aspiration - **Urgent, systemic health issues** - Sepsis, compromised airway, swallowing difficulties, malnutrition, dehydration, aspiration pneumonia - **Crisis point with behaviour** - **Complications related to sedation and GA** - **Psychological trauma from invasive dental procedures undertaken without adequate preparation** - **Increased financial burden on individuals, families and the health system** # **CONSEQUENCES OF BARRIERS** - **Localised problems** - Decay, gum disease, attrition, fungal/bacterial infections, pain, poor appearance, loss of teeth - **Unwanted outcomes** - Extractions instead of fillings, increased severity of periodontal disease, lack of functional replacement of extracted teeth - **Functional difficulties with eating, drinking, smiling, speech** - **Aesthetic concerns, loss of self-confidence and dignity** - **Complications related to dental procedures** - Bleeding, post-op infections, ONJ, aspiration - **Urgent, systemic health issues** - Sepsis, compromised airway, swallowing difficulties, malnutrition, dehydration, aspiration pneumonia - **Crisis point with behaviour** - **Complications related to sedation and GA** - **Psychological trauma from invasive dental procedures undertaken without adequate preparation** - **Increased financial burden on individuals, families and the health system** Single rectangular label with the word "ACCESS" on an orange background **UN CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITY (CRPD) 2006** - Ratified by Australia in 2008 - Aims to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. - Article 25 addresses health and commits State Parties to provide: - PwD with the **same range, quality and standard** of free or affordable health care and programmes as provided to other persons; - Health services needed by persons with disabilities **specifically** because of their disabilities - Health services as close as possible to people’s own **communities** - Require health professionals to **provide care of the same quality** to persons with disabilities as to others, including - on the basis of free and informed consent - through the use of ethical standards - training to raise awareness of the human rights, dignity, autonomy and needs of persons with disabilities. # **UN CONVENTION ON THE RIGHTS OF PERSONS WITH DISABILITY (CRPD) 2006** - Ratified by Australia in 2008 - Aims to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity. - Article 25 addresses health and commits State Parties to provide: - PwD with the **same range, quality and standard** of free or affordable health care and programmes as provided to other persons; - Health services needed by persons with disabilities **specifically** because of their disabilities - Health services as close as possible to people’s own **communities** - Require health professionals to **provide care of the same quality** to persons with disabilities as to others, including - on the basis of free and informed consent - through the use of ethical standards - training to raise awareness of the human rights, dignity, autonomy and needs of persons with disabilities. # ACCESS - Four key areas: - Access to the **building** - Access to the **dental surgery** - Access to the **dental chair** - Access to the **mouth** # **ACCESS** - Four key areas: - Access to the **building** - Access to the **dental surgery** - Access to the **dental chair** - Access to the **mouth** **ACCESS TO THE BUILDING** - Disability Discrimination Act 1992 (Cth) - Makes it against the law to discriminate against a person because of disability when providing goods, services or facilities, or access to public premises. - Direct discrimination (e.g. refusal of entry) - Indirect discrimination (e.g. staircase is only entry way) - Requires businesses to make **reasonable adjustments** to enable a person with disability to access goods, services or facilities ## **ACCESS TO THE BUILDING** - Disability Discrimination Act 1992 (Cth) - Makes it against the law to discriminate against a person because of disability when providing goods, services or facilities, or access to public premises. - Direct discrimination (e.g. refusal of entry) - Indirect discrimination (e.g. staircase is only entry way) - Requires businesses to make **reasonable adjustments** to enable a person with disability to access goods, services or facilities **ACCESS TO THE BUILDING** - It is not against the law to discriminate in providing access to goods, services or facilities if it can be demonstrated that making the required adjustments would cause **unjustifiable hardship** - Before claiming that adjustments will create unjustifiable hardship, businesses should: - thoroughly consider how an adjustment might be made - estimate the cost of making the adjustment and whether any financial or other assistance is available - consider the potential benefit or detriment of the adjustment for - any specific person concerned - the business - the community - discuss this directly with any person involved - consult relevant sources of advice. - It is not against the law to discriminate in providing access to goods, services or facilities if it can be demonstrated that making the required adjustments would cause **unjustifiable hardship** - Before claiming that adjustments will create unjustifiable hardship, businesses should: - thoroughly consider how an adjustment might be made - estimate the cost of making the adjustment and whether any financial or other assistance is available - consider the potential benefit or detriment of the adjustment for - any specific person concerned - the business - the community - discuss this directly with any person involved - consult relevant sources of advice. # ACCESS TO THE BUILDING – REASONABLE ADJUSTMENTS - **Reasonable adjustments** - Parking, ramps, mindful of kerbs - Gradient, well-lit and signposted, parking space dimensions - Improving signage and lighting - Simple rails and ramps - Entrance: door width, level threshold, door opening, position and design of door handles - Above ground floor: Installing stair lifts or wheelchair lifts - **Making appointments and communication:** - Allowing longer for an appointment - Providing interpreter support, writing things down – or providing written information orally - Communicating in an accessible way – producing information leaflets in large type/font, audio information, or texting/emailing/writing appointment times. - Contact details of reliable taxi company with wheelchair-accessible cars ### **ACCESS TO THE BUILDING – REASONABLE ADJUSTMENTS** - **Reasonable adjustments** - Parking, ramps, mindful of kerbs - Gradient, well-lit and signposted, parking space dimensions - Improving signage and lighting - Simple rails and ramps - Entrance: door width, level threshold, door opening, position and design of door handles - Above ground floor: Installing stair lifts or wheelchair lifts - **Making appointments and communication:** - Allowing longer for an appointment - Providing interpreter support, writing things down – or providing written information orally - Communicating in an accessible way – producing information leaflets in large type/font, audio information, or texting/emailing/writing appointment times. - Contact details of reliable taxi company with wheelchair-accessible cars # ACCESS TO THE SURGERY – REASONABLE ADJUSTMENTS - **Reasonable adjustments** - Reception and waiting room - height of reception desk - clear signage - non-slip flooring - appropriate seating (chairs with arm rests, space for wheelchairs) - Corridors: - no clutter - width ### **ACCESS TO THE SURGERY – REASONABLE ADJUSTMENTS** - **Reasonable adjustments** - **Reception and waiting room** - height of reception desk - clear signage - non-slip flooring - appropriate seating (chairs with arm rests, space for wheelchairs) - **Corridors:** - no clutter - width # ACCESS TO THE SURGERY – REASONABLE ADJUSTMENTS **Surgery:** - wheelchair access and spacing for manoeuvrability **Facilities:** - **Toilet** - Picture of toilet on blue door - Space - Transfer bars - Raised seat - Alarm - **Emergency escape** - Signage - Visual alarms, - Accessible exits **Floors:** - Matte, even-coloured flooring Image showing a hallway with a blue door, an accessible toilet with a person using it, and a crossed-out image of checkered flooring. - **Surgery:** - wheelchair access and spacing for manoeuvrability - **Facilities:** - **Toilet** - Picture of toilet on blue door - Space - Transfer bars - Raised seat - Alarm - **Emergency escape** - Signage - Visual alarms, - Accessible exits - **Floors:** - Matte, even-coloured flooring # ACCESS TO THE DENTAL CHAIR – REASONABLE ADJUSTMENTS - **Reasonable adjustments** - Arrange room to allow for wheelchair to be brought alongside dental chair to aid easier transfer - Treat patient in their own wheelchair - Use headrest attachment - some wheelchairs recline - “Banana board” to allow transfer - only 5% of wheelchair patients use wheelchair 100% of the time, many can transfer independently **DISCUSS WITH PATIENT/CARER/RELATIVE** Figure showing a manual chair, a powered chair, and a powered chair with reclining function. Also includes an image of a banana/transfer board used to 'slide' into the dental chair. ## **ACCESS TO THE DENTAL CHAIR – REASONABLE ADJUSTMENTS** - **Reasonable adjustments** - Arrange room to allow for wheelchair to be brought alongside dental chair to aid easier transfer - Treat patient in their own wheelchair - Use headrest attachment - some wheelchairs recline - “Banana board” to allow transfer - only 5% of wheelchair patients use wheelchair 100% of the time, many can transfer independently **DISCUSS WITH PATIENT/CARER/RELATIVE** **ACCESS TO THE DENTAL CHAIR – EQUIPMENT IN SND FACILITIES** *Equipment in SND facilities* **Hoist** Four images showing the use of a hoist to assist a patient into a dental chair, with dental staff operating the equipment. ### **ACCESS TO THE DENTAL CHAIR – EQUIPMENT IN SND FACILITIES** - Equipment in SND facilities - **Hoist** # ACCESS TO THE DENTAL CHAIR – EQUIPMENT IN SND FACILITIES - Equipment in SND facilities - Wheelchair recliner / tipper - Bariatric chair Figure showing various dental access equipment including a wheelchair recliner and a bariatric chair. - Wheelchair recliner / tipper - Bariatric chair **ACCESS TO THE DENTAL CHAIR – EQUIPMENT IN SND FACILITIES** - Equipment in SND facilities - “Break-leg” facility to ease transfer - Portable turntable Figure showing a portable turntable for transfer of a patient with good upper body strength and a break-leg chair allowing easy access for people with mobility issues. - “Break-leg” facility to ease transfer - Portable turntable **ACCESS TO THE DENTAL CHAIR** ```mermaid flowchart TD A[Can treatment safely be carried out in the patient’s wheelchair without reclining?] -->|Yes| B[Dental Chair?] A -->|No| C[Would patient feel comfortable transferring and lying supine in the dental chair?] C -->|Yes| D[Can the patient transfer to the dental chair without assistance?] D -->|Yes| E[Dental Chair] D -->|No| F[Transfer Board] C -->|No| G[Wheelchair Tipped?] G -->|Yes| H[Transfer Board/Host not suitable] G -->|No| I[Hoist] ``` Ramirez L, Dickinson C. Wheelchair users: A guide. B Dent J. 2018;224(6):408-12 ## **ACCESS TO THE DENTAL CHAIR** ```mermaid flowchart TD A[Can treatment safely be carried out in the patient’s wheelchair without reclining?] -->|Yes| B[Dental Chair?] A -->|No| C[Would patient feel comfortable transferring and lying supine in the dental chair?] C -->|Yes| D[Can the patient transfer to the dental chair without assistance?] D -->|Yes| E[Dental Chair] D -->|No| F[Transfer Board] C -->|No| G[Wheelchair Tipped?] G -->|Yes| H[Transfer Board/Host not suitable] G -->|No| I[Hoist] ``` Ramirez L, Dickinson C. Wheelchair users: A guide. B Dent J. 2018;224(6):408-12 # ACCESS TO THE MOUTH - **Key barriers:** - Intellectual disability or challenging behaviour - Muscle tone or control (frailty, spasticity, hypotonia, dystonia) - **Strategies:** - Acclimatisation and behavioural techniques - Empathy - Use of headlight if dental chair light unable to reach mouth (e.g. wheelchair / bed / domiciliary setting) - Semi-upright position: chronic obstructive airway disease and congestive cardiac conditions. - Ask how many cushions patient uses to sleep at night, and adjust chair to similar position. ## **ACCESS TO THE MOUTH** - **Key barriers:** - Intellectual disability or challenging behaviour - Muscle tone or control (frailty, spasticity, hypotonia, dystonia) - **Strategies:** - Acclimatisation and behavioural techniques - Empathy - Use of headlight if dental chair light unable to reach mouth (e.g. wheelchair / bed / domiciliary setting) - Semi-upright position: chronic obstructive airway disease and congestive cardiac conditions. - Ask how many cushions patient uses to sleep at night, and adjust chair to similar position. # ACCESS TO THE MOUTH - Create body postures that ensure body is well-supported, with joints and muscles in rest position. - Spasticity: chin should be as close to chest as possible, hips and legs flexed and separated to achieve maximal relaxation - Cushions or beanbags if difficulty achieving above posture (eg. RA, MS, cerebral palsy) - Mun-H-Centre (Sweden) = National Resource Centre for oro-facial aids → set of 4 cushions to provide non-steady anatomical support Image showing a person using supportive cushions for positioning, alongside a catalog of specialized pillows and cushions for orofacial support. - Create body postures that ensure body is well-supported, with joints and muscles in rest position. - Spasticity: chin should be as close to chest as possible, hips and legs flexed and separated to achieve maximal relaxation - Cushions or beanbags if difficulty achieving above posture (eg. RA, MS, cerebral palsy) - Mun-H-Centre (Sweden) = National Resource Centre for oro-facial aids → set of 4 cushions to provide non-steady anatomical support # ACCESS TO THE MOUTH - Uncontrolled movements (exaggerated bite reflex, uncontrolled muscle spasms): - Place equipment in a position will not get knocked - Finger bite support / rubber spatula - OpenWide® foam mouth rest - Unbreakable mirror heads, plastic mirrors - Cheek retractor - X-ray arm able to reach mouth - Suction able to reach mouth (extended piping tube length) - Spittoon – if unable to reach, use kidney dishes or cups - Uncontrolled movements (exaggerated bite reflex, uncontrolled muscle spasms): - Place equipment in a position will not get knocked - Finger bite support / rubber spatula - OpenWide® foam mouth rest - Unbreakable mirror heads, plastic mirrors - Cheek retractor - X-ray arm able to reach mouth - Suction able to reach mouth (extended piping tube length) - Spittoon – if unable to reach, use kidney dishes or cups # ACCESS TO THE MOUTH - Assess risks to your own health and take necessary precautions - Avoid prolonged periods in positioned conferring stress to spine - Seated dentistry - Standing: Footstool, bend at knee (c.f. waist) - Four-handed dentistry - Occupation hazards - Manual handing - Poor posture - Assess risks to your own health and take necessary precautions - Avoid prolonged periods in positioned conferring stress to spine - Seated dentistry - Standing: Footstool, bend at knee (c.f. waist) - Four-handed dentistry - Occupation hazards - Manual handing - Poor posture Title slide with the word "COMMUNICATION" **COMMUNICATION** - **Definition**: A complex system of sending, receiving and interpreting messages. - A two-way process, involving a sender and receiver - **Effective communication**: Signals sent = signals received - **Importance**: Fundamental to good clinical practice - Informed consent - Provide appropriate preventive advice - Facilitate patient rapport and trust - Minimise misunderstanding and complaints # **COMMUNICATION** - **Definition**: A complex system of sending, receiving and interpreting messages. - A two-way process, involving a sender and receiver - **Effective communication**: Signals sent = signals received - **Importance**: Fundamental to good clinical practice - Informed consent - Provide appropriate preventive advice - Facilitate patient rapport and trust - Minimise misunderstanding and complaints # ELEMENTS OF COMMUNICATION - 3 Elements: **Words (VC) + tone of voice (NVC) + body language (NVC)** BUT if: **VC ≠ NVC → NVC believed** Fig. 1 'The communication triangle' denoting the percentage value of elements of communications. Source: reference 1 ## **ELEMENTS OF COMMUNICATION** - 3 Elements: **Words (VC) + tone of voice (NVC) + body language (NVC)** BUT if: **VC ≠ NVC → NVC believed** **BARRIERS TO COMMUNICATION** ## **BARRIERS TO COMMUNICATION** **COMMUNICATION DIFFICULTIES** - Difficulty when communicating verbally, visually or in writing - Difficulty interpreting the speech and actions of others - Difficulty expressing one’s own thoughts and feelings ## **COMMUNICATION DIFFICULTIES** - Difficulty when communicating verbally, visually or in writing - Difficulty interpreting the speech and actions of others - Difficulty expressing one’s own thoughts and feelings **CONDITIONS WITH COMMUNICATION DIVERSITY** - Developmental and cognitive disorders - Intellectual disability - Autism spectrum disorder - Dementia - Neurological disorders (e.g. ABI, stroke/TIA, Huntington’s Disease, MND) - Communication disorders - Speech and/or language delay, disorder or impairment - Expressive and/or receptive language disorder - Stuttering or dysfluency - Semantic/pragmatic disorder (affects individual’s use of language for social purposes) - Central auditory processing disorder (affects individual’s listening and understanding of language) - Dyslexia - Sensory impairment - Hearing, visual impairment - Poor control over vocal apparatus or muscle movements needed to speak clearly/quickly (verbal dyspraxia) - E.g. Cerebral palsy, Parkinson’s disease, laryngeal surgery, stroke/TIA - Difficulty focusing / paying attention - E.g. ADHD, anxiety - Intoxication/overdose or drug withdrawal - Lack of experience, stimulation or opportunity to talk to other people ## **CONDITIONS WITH COMMUNICATION DIVERSITY** - **Developmental and cognitive disorders** - Intellectual disability - Autism spectrum disorder - Dementia - Neurological disorders (e.g. ABI, stroke/TIA, Huntington’s Disease, MND) - **Communication disorders** - Speech and/or language delay, disorder or impairment - Expressive and/or receptive language disorder - Stuttering or dysfluency - Semantic/pragmatic disorder (affects individual’s use of language for social purposes) - Central auditory processing disorder (affects individual’s listening and understanding of language) - Dyslexia - **Sensory impairment** - Hearing, visual impairment - **Poor control over vocal apparatus or muscle movements needed to speak clearly/quickly (verbal dyspraxia)** - E.g. Cerebral palsy, Parkinson’s disease, laryngeal surgery, stroke/TIA - **Difficulty focusing / paying attention** - E.g. ADHD, anxiety - **Intoxication/overdose or drug withdrawal** - **Lack of experience, stimulation or opportunity to talk to other people** **COMMUNICATION DIVERSITY** ## **COMMUNICATION DIVERSITY** **See the Person Not the Disability** **PERSON FIRST LANGUAGE** **PERSON CENTERED LANGUAGE** | INCORRECT | CORRECT | |-----------|---------| | HANDICAPPED OR DISABLED PEOPLE | PEOPLE WITH DISABILITIES | | HE IS MENTALLY RETARDED OR A MORONIC | HE HAS A DEVELOPMENTAL OR INTELLECTUAL DISABILITY | | SHE IS WHEELCHAIR BOUND | SHE USES A WHEELCHAIR | | MIDGET OR DWARF | A PERSON OF SHORT STATURE | | HE SUFFERS FROM HEARING LOSS | HE IS HARD OF HEARING | | NORMAL OR HEALTHY PERSON | PERSON WITHOUT A DISABILITY | | HANDICAPPED PARKING OR BATHROOM | ACCESSIBLE PARKING OR BATHROOM | | HAS OVERCOME THEIR DISABILITY OR CHARACTERIZED AS INSPIRING | PERSON WHO IS SUCCESSFUL OR PRODUCTIVE | | THE BLIND OR SUFFERS FROM VISION LOSS | PERSON WHO IS BLIND OR VISUALLY IMPAIRED | Illustration showing two stick figures: one labeled "Autistic Person" and the other "Person With Autism". ## **See the Person Not the Disability** **PERSON FIRST LANGUAGE** **PERSON CENTERED LANGUAGE** | INCORRECT | CORRECT | |-----------|---------| | HANDICAPPED OR DISABLED PEOPLE | PEOPLE WITH DISABILITIES | | HE IS MENTALLY RETARDED OR A MORONIC | HE HAS A DEVELOPMENTAL OR INTELLECTUAL DISABILITY | | SHE IS WHEELCHAIR BOUND | SHE USES A WHEELCHAIR | | MIDGET OR DWARF | A PERSON OF SHORT STATURE | | HE SUFFERS FROM HEARING LOSS | HE IS HARD OF HEARING | | NORMAL OR HEALTHY PERSON | PERSON WITHOUT A DISABILITY | | HANDICAPPED PARKING OR BATHROOM | ACCESSIBLE PARKING OR BATHROOM | | HAS OVERCOME THEIR DISABILITY OR CHARACTERIZED AS INSPIRING | PERSON WHO IS SUCCESSFUL OR PRODUCTIVE | | THE BLIND OR SUFFERS FROM VISION LOSS | PERSON WHO IS BLIND OR VISUALLY IMPAIRED | **SENSORY IMPAIRMENT** - **Affects:** - Access to dental care - Communication and interactions within the dental setting - Can result in dental anxiety - **Includes:** - Hearing impairment - Visual impairment - Deafblindness ## **SENSORY IMPAIRMENT** - **Affects:** - Access to dental care - Communication and interactions within the dental setting - Can result in dental anxiety - **Includes:** - Hearing impairment - Visual impairment - Deafblindness **HEARING IMPAIRMENT** **Smiling Signs Auslan Resources** The Smiling Signs Auslan Resources are a collection of accessible videos in Auslan and easy English. These resources aim to make oral health and dental treatments easy for everybody to understand, including members of the Australian Deaf community. This Smiling Signs Auslan Resources are created by dental students from the University of Western Australia in partnership with the Australian Dental Association and Deaf Australia. All Auslan interpretations were completed by Ramas Molfan, a NAATI-qualified Deaf interpreter from Hands to Communicate. Follow Smiling Signs Auslan on Instagram or YouTube to learn more! **Access Plus WA Deaf Inc** *Auslan Everywhere* **Audio Call:** (08) 9441 2677 **Video Call:** 0434 599 813 **Email:** enquiry@accessplus.org.au **Office Address:** 34 Dodd St, Wembley WA 6014 [Home] [About Us] Webpage screenshot showing "Smiling Signs Auslan Resources" and "Tooth Decay & Preventive Treatment" video thumbnail, with contact details for Access Plus WA Deaf Inc. ### **HEARING IMPAIRMENT** #### **Smiling Signs Auslan Resources** The Smiling Signs Auslan Resources are a collection of accessible videos in Auslan and easy English. These resources aim to make oral health and dental treatments easy for everybody to understand, including members of the Australian Deaf community. This Smiling Signs Auslan Resources are created by dental students from the University of Western Australia in partnership with the Australian Dental Association and Deaf Australia. All Auslan interpretations were completed by Ramas Molfan, a NAATI-qualified Deaf interpreter from Hands to Communicate. Follow Smiling Signs Auslan on Instagram or YouTube to learn more! #### **Access Plus WA Deaf Inc** *Auslan Everywhere* **Audio Call:** (08) 9441 2677 **Video Call:** 0434 599 813 **Email:** enquiry@accessplus.org.au **Office Address:** 34 Dodd St, Wembley WA 6014 [Home] [About Us] # HEARING LOSS - **deaf** vs **Deaf** - **Deaf** = people who have been deaf prior to learning to talk (pre-lingual). - Sign language tends to be first language - Strong and close Deaf community with its own culture and sense of identity - **deaf** = “hard of hearing”, “hearing impaired” - People who do not hear very much - Level of deafness is defined by the quietest sound a person can hear - Can be congenital, inherited, or acquired (accident, disease, ageing) - Affects 1/6 of the Australian population ### **HEARING LOSS** - **deaf** vs **Deaf** - **Deaf** = people who have been deaf prior to learning to talk (pre-lingual). - Sign language tends to be first language - Strong and close Deaf community with its own culture and sense of identity - **deaf** = “hard of hearing”, “hearing impaired” - People who do not hear very much - Level of deafness is defined by the quietest sound a person can hear - Can be congenital, inherited, or acquired (accident, disease, ageing) - Affects 1/6 of the Australian population # HEARING IMPAIRMENT – COMMUNICATION METHODS - **Identification**: hearings aids, pre-typed note or card, speech - Ask preferred method of communication - Ideally communicate directly to make appointments - C.f. National Relay Service - **Hearing aids**: - Do not assume patient can hear you - Ensure are switched on for communication - **Language service providers** - Lip-speakers - Auslan interpreters (c.f. family member) - Preferred interpreter? - **Communication aids** - Text machines, iPad/laptops, SMS (c.f. phone calls), pen & paper, cue cards - **Lip-reading** - Speak clearing in normal cadence and tone ### **HEARING IMPAIRMENT – COMMUNICATION METHODS** - **Identification**: hearings aids, pre-typed note or card, speech - Ask preferred method of communication - Ideally communicate directly to make appointments - C.f. National Relay Service - **Hearing aids**: - Do not assume patient can hear you - Ensure are switched on for communication - **Language service providers** - Lip-speakers - Auslan interpreters (c.f. family member) - Preferred interpreter? - **Communication aids** - Text machines, iPad/laptops, SMS (c.f. phone calls), pen & paper, cue cards - **Lip-reading** - Speak clearing in normal cadence and tone # HEARING IMPAIRMENT **Table 2 Hearing impairment – tips for improving communication** - Position yourself with your face to the light so you can be seen clearly and face the patient so they can read your lips. Remove your facemask or wear a clear face shield to facilitate lip reading - If you are using communication support always remember to talk directly to the person you are communicating with, not the interpreter - Minimise background noise (such as music), distractions and interruptions - Allow extra time for the person to respond - If what you say is not understood, do not keep repeating it. Try saying it in a different way instead - Speak clearly but not too slowly, do not exaggerate your lip movements, and use natural facial expressions and gestures - Avoid jargon and unfamiliar abbreviations - Resist the urge to shout – it will not help, is uncomfortable for a hearing aid user and looks aggressive - Lower the pitch of your voice – it is more effective than raising the pitch as people lose high pitch hearing first - Use gestures for visual feedback, such as a thumbs up for ‘you are doing well’ - Be prepared to write down what you have to say or have pre-prepared written prompts to save time - Check that the person you are talking to can follow you. Be patient and take the time to communicate properly - Make appointments and communicate with the patient through texting Stealth Clarity FFP3 Transparent Face Mask x 5 PK ### **HEARING IMPAIRMENT – TIPS FOR IMPROVING COMMUNICATION** **Table 2 Hearing impairment – tips for improving communication** - Position yourself with your face to the light so you can be seen clearly and face the patient so they can read your lips. Remove your facemask or wear a clear face shield to facilitate lip reading - If you are using communication support always remember to talk directly to the person you are communicating with, not the interpreter - Minimise background noise (such as music), distractions and interruptions - Allow extra time for the person to respond - If what you say is not understood, do not keep repeating it. Try saying it in a different way instead - Speak clearly but not too slowly, do not exaggerate your lip movements, and use natural facial expressions and gestures - Avoid jargon and unfamiliar abbreviations - Resist the urge to shout – it will not help, is uncomfortable for a hearing aid user and looks aggressive - Lower the pitch of your voice – it is more effective than raising the pitch as people lose high pitch hearing first - Use gestures for visual feedback, such as a thumbs up for ‘you are doing well’ - Be prepared to write down what you have to say or have pre-prepared written prompts to save time - Check that the person you are talking to can follow you. Be patient and take the time to communicate properly - Make appointments and communicate with the patient through texting **DEAF CULTURE** - People must face each other to have a conversation - Eye contact is essential - Extra room for signing space - Lighting is important (visual language) - Pointing is a regular and necessary way of referencing (not rude/abrupt) - Is normal to lightly tap someone’s shoulder or upper arm to get their attention ### **DEAF CULTURE** - People must face each other to have a conversation - Eye contact is essential - Extra room for signing space - Lighting is important (visual language) - Pointing is a regular and necessary way of referencing (not rude/abrupt) - Is normal to lightly tap someone’s shoulder or upper arm to get their attention **VISUAL IMPAIRMENT** - Legal blindness = cannot see at 6m what someone with normal vision can see at 60m, OR field of vision is <20 degrees in diameter - Low vision = permanent vision loss that cannot be corrected with glasses and affects their daily functioning - 2016: 384,000 people in Australia → 2030 projection: 564,000 people ### **VISUAL IMPAIRMENT** - Legal blindness = cannot see at 6m what someone with normal vision can see at 60m, OR field of vision is <20 degrees in diameter - Low vision = permanent vision loss that cannot be corrected with glasses and affects their daily functioning - 2016: 384,000 people in Australia → 2030 projection: 564,000 people **VISUAL IMPAIRMENT** - Identification: specialised glasses, carry white cane, guide dog - Ascertain how much residual vision they have, and their preferred method of communication - Provide tactile feedback: handshake on meeting, guiding by offering patient to hold your elbow, warning if any steps coming (and how many). - Guide dogs: ask if will remain in waiting room or accompany into surgery - Speaking: face patient, ensure no strong back lighting that interfere with residual vision - Keep patient informed of each step: anticipate sudden noises or sensations, describe procedures in terms of sound/feel/taste/smell - Printed material (letters, appointment cards, information sheets): matte paper, font size 14+, text in mixed case (c.f. capitals) - Identification: specialised glasses, carry white cane, guide dog - Ascertain how much residual vision they have, and their preferred method of communication - Provide tactile feedback: handshake on meeting, guiding by offering patient to hold your elbow, warning if any steps coming (and how many). - Guide dogs: ask if will remain in waiting room or accompany into surgery - Speaking: face patient, ensure no strong back lighting that interfere with residual vision - Keep patient informed of each step: anticipate sudden noises or sensations, describe procedures in terms of sound/feel/taste/smell - Printed material (letters, appointment cards, information sheets): matte paper, font size 14+, text in mixed case (c.f. capitals) # DEAFBLINDNESS - Combined sight and hearing loss - Causes: Rubella, Ushers syndrome, CHARGE syndrome, ageing - Two distinct cultural groups: - Born blind, lose hearing as adults: tend to continue to use speech as their main communication and have a variety of hearing devices - Born deaf and lose sight as adults: use sign language to communicate Historical photograph of a woman holding flowers, likely depicting a person with deafblindness. ### **DEAFBLINDNESS** - Combined sight and hearing loss - Causes: Rubella, Ushers syndrome, CHARGE syndrome, ageing - Two distinct cultural groups: - Born blind, lose hearing as adults: tend to continue to use speech as their main communication and have a variety of hearing devices - Born deaf and lose sight as adults: use sign language to communicate **DEAFBLINDNESS** - Most common forms of communication: - Speech, oral and aural communication - Sign language / Auslan: including a variety of ways of receiving sign language (close range, visual frame/field and tactile) - Deafblind fingerspelling - Alternative and augmentative communication e.g. touch cues, pictographs, key word signs - Print or braille, including print on palm, computer, SMS text and email - Most common forms of communication: - Speech, oral and aural communication - Sign language / Auslan: including a variety of ways of receiving sign language (close range, visual frame/field and tactile) - Deafblind fingerspelling - Alternative and augmentative communication e.g. touch cues, pictographs, key word signs - Print or braille, including print on palm, computer, SMS text and email **DEAFBLINDNESS** - Identification: carry white and red cane - Ask preferred method of communication: may have residual hearing or sight - Approach gently, tap arm to inform you are there, do not walk off leaving patient stranded - Additional communication support required will depend on when the dual sensory loss was developed - Identification: carry white and red cane - Ask preferred method of communication: may have residual hearing or sight - Approach gently, tap arm to inform you are there, do not walk off leaving patient stranded - Additional communication support required will depend on when the dual sensory loss was developed # NEUROLOGICAL CONDITIONS - Affects communication in different ways depending on the area of brain affected - Almost any acquired brain injury may cause memory problems → language, spatial-perceptual and retention span difficulties - Commonly occurring neurological communication impairments: - **Dysarthria** = weakness/lack of control in muscles required to produce speech (motor speech disorder) - **Dyspraxia/apraxia** = difficulty or impossibility of making certain voluntary motor movements (neurological condition) - **Aphasia** = difficulty comprehending speech ## **NEUROLOGICAL CONDITIONS** - Affects communication in different ways depending on the area of brain affected - Almost any acquired brain injury may cause memory problems → language, spatial-perceptual and retention span difficulties - Commonly occurring neurological communication impairments: - **Dysarthria** = weakness/lack of control in muscles required to produce speech (motor speech disorder) - **Dyspraxia/apraxia** = difficulty or impossibility of making certain voluntary motor movements (neurological condition) - **Aphasia** = difficulty comprehending speech **APHASIA** - Damage to portion of brain responsible for speech → impaired ability to process language - Usually occurs after stroke, head injury, brain tumour - Does not affect intelligence, but can affect all 4 modalities of language (reading, writing, comprehension, expression) - Affects each person differently, and communication difficulties can change from day to day or hour to hour ### **APHASIA** - Damage to portion of brain responsible for speech → impaired ability to process language - Usually occurs after stroke, head injury, brain tumour - Does not affect intelligence, but can affect all 4 modalities of language (reading, writing, comprehension, expression) - Affects each person differently, and communication difficulties can change from day to day or hour to hour # DYSARTHRIA - Group of speech disorders resulting from neurogenic disturbances in muscular control → paralysis, weakness or uncoordination of speech musculature - Often occurs in neurological conditions (e.g. cerebral palsy, MS, MND, stroke) - **Parkinson’s Disease** associated with “**hypokinetic dysarthria**” - Reduced respiratory support for speech and rigidity of respiratory muscles → reduced volume and monotone, breathy, whispery, harsh voice quality. - Distinctive features: difficulties initiating speech, lack of fluence, frequent pauses, word blocks, repetition of syllables followed by short rushes of speech - Easier during “on periods” when medications (levodopa) working - Masked facies ### **DYSARTHRIA** - Group of speech disorders resulting from neurogenic disturbances in muscular control → paralysis, weakness or uncoordination of speech musculature - Often occurs in neurological conditions (e.g. cerebral palsy, MS, MND, stroke) - **Parkinson’s Disease** associated with “**hypokinetic dysarthria**” - Reduced respiratory support for speech and rigidity of respiratory muscles → reduced volume and monotone, breathy, whispery, harsh voice quality. - Distinctive features: difficulties initiating speech, lack of fluence, frequent pauses, word blocks, repetition of syllables followed by short rushes of speech - Easier during “on periods” when medications (levodopa) working - Masked facies **DYSARTHRIA AND APHASIA** - Avoid being condescending - treat them as the mature adult (s)he is - Ensure patient only doing one thing at a time (e.g. not walking and talking) - Reduce distractions and background noise - Ensure eye contact, so facial expressions / gestures can provide clues about the message - Speak with a normal voice, but slightly slower speed than normal - Give only one piece of information at a time - Give patient time to reply - Watch person as they talk, and avoid writing notes simultaneously - Do not finish the person’s sentences for them. However if they get stuck for words, help them search for words - Ask direct questions (e.g. “do you want a cup of tea” vs “what would you like to drink?”) - Closed “Y/N” questions are easier to answer than open questions requiring a full answer - Augment speech with gestures (e.g. thumbs up/down) or visual aids. Pen and paper can be useful if person finds it easier to read/write/draw than speak. - Check you have both understood (do not pretend). Repeat the part you did understand so the speaker does not have to repeat entirely. ### **DYSARTHRIA AND APHASIA** - Avoid being condescending - treat them as the mature adult (s)he is - Ensure patient only doing one thing at a time (e.g. not walking and talking) - Reduce distractions and background noise - Ensure eye contact, so facial expressions / gestures can provide clues about the message - Speak with a normal voice, but slightly slower speed than normal - Give only one piece of information at a time - Give patient time to reply - Watch person as they talk, and avoid writing notes simultaneously - Do not finish the person’s sentences for them. However if they get stuck for words, help them search for words - Ask direct questions (e.g. “do you want a cup of tea” vs “what would you like to drink?”) - Closed “Y/N” questions are easier to answer than open questions requiring a full answer - Augment speech with gestures (e.g. thumbs up/down) or visual aids. Pen and paper can be useful if person finds it easier to read/write/draw than speak. - Check you have both understood (do not pretend). Repeat the part you did understand so the speaker does not have to repeat entirely. **ALTERNATIVE OR AUGMENTIVE COMMUNICATION (AAC)** - **AAC** = any type of communication strategy for people with a range of conditions who have significant difficulties speaking - Help alleviate the pressure to speak → allows person with speech difficulties to be more relaxed and come across in a more intelligible manner - Two main types: - **Unaided AAC** = do not require use of an external aid. - Gestures (e.g. blinking, pointing, raising head, thumbs up/down), facial expressions, Auslan - **Aided AAC** = external aid used - High technology systems = iPad, tablet, speech generating device, switch - Low technology systems = real objects, communication books, pen & paper, pictures ## **ALTERNATIVE OR AUGMENTIVE COMMUNICATION (AAC)** - **AAC** = any type of communication strategy for people with a range of conditions who have significant difficulties speaking - Help alleviate the pressure to speak → allows person with speech difficulties to be more relaxed and come across in a more intelligible manner - Two main types: - **Unaided AAC** = do not require use of an external aid. - Gestures (e.g. blinking, pointing, raising head, thumbs up/down), facial expressions, Auslan - **Aided AAC** = external aid used - High technology systems = iPad, tablet, speech generating device, switch - Low technology systems = real objects, communication books, pen & paper, pictures **ALTERNATIVE OR AUGMENTIVE COMMUNICATION (AAC)** **Proloquo2Go** **Makaton** **Talking Mats** **Easy Read** **Proloquo2Go** **Makaton** **Talking Mats** **Easy Read** **INTELLECTUAL DISABILITY** Three aspects to good communication with patients with complex communication issues: - Use communication techniques - Communicate with key support professionals and family members - Recognise that “behaviours of concern” or “challenging behaviour” is better viewed through the lens of communication ## **INTELLECTUAL DISABILITY** Three aspects to good communication with patients with complex communication issues: - Use communication techniques - Communicate with key support professionals and family members - Recognise that “behaviours of concern” or “challenging behaviour” is better viewed through the lens of communication **INTELLECTUAL DISABILITY** - Communicate using the style patient/carer has identified as their **preferred style** - **Communicate directly** with the patient, and provide opportunity for accompanying supporters to be involved - **Do not speak down** to people with ID, or refer to their IQ or “mental age” - Spend a few minutes conversing in their preferred communication style before the clinical assessment/treatment. Invite feedback. - If procedure is lengthy, **take breaks**. Involve patient/support person in deciding how to keep patient comfortable. - Use a portable device or tablet, show videos, or use pictures to **explain procedures**. - E.g. Your Dental Health – Oral Health Video Resources - Dual Read Guide - Communicate using the style patient/carer has identified as their **preferred style** - **Communicate directly** with the patient, and provide opportunity for accompanying supporters to be involved - **Do not speak down** to people with ID, or refer to their IQ or “mental age” - Spend a few minutes conversing in their preferred communication style before the clinical assessment/treatment. Invite feedback. - If procedure is lengthy, **take breaks**. Involve patient/support person in deciding how to keep patient comfortable. - Use a portable device or tablet, show videos, or use pictures to **explain procedures**. - E.g. Your Dental Health – Oral Health Video Resources - Dual Read Guide **INTELLECTUAL DISABILITY** Dual Read Guide https://www.ada.org.au/Your-Dental-Health/Oral-Health-Video-Resources Screenshot of a webpage titled "Oral Health Video Resources" from the Australian Dental Association (ADA) website, featuring navigation tabs for different age groups and a section titled "Pro tips for better brushing" with an image of a toothbrush. Adjacent to it is a guide titled "oral health & intellectual disability: a guide for dental practitioners," showing a woman holding a pink umbrella and sections on diet, tooth decay, and oral hygiene tips. **Dual Read Guide** https://www.ada.org.au/Your-Dental-Health/Oral-Health-Video-Resources # AUTISM SPECTRUM DISORDER ## Health & Dental Autism Training Program The Autism Association is excited to launch the first online training program for health and dental professionals in Australia. Alongside a number of dentists and health professionals throughout Perth, we have developed a new training program for the health and dental sectors to provide you with knowledge and resources to improve access and health care experiences of people with Autism. A finalist in the Excellence in Innovation category at the WA Disability Support Awards 2021, the training program includes a catalogue of resources that fall under the headings detailed below. Once you have finished the training modules, you will receive a certificate of completion. ### Autism Online Training Modules Here you will find the 5 online training modules for you to complete at your own pace: - Understanding Autism - Strategies - Inpatient Care - Outpatient Care - Discharging a Patient ### Resources Here you will find all health and dental resources created and referenced in the training modules for you to download and use. Autism Association logo with laurel wreath and ribbon reading "Finalist in Excellence in Innovation Award 2021" # **AUTISM SPECTRUM DISORDER** ## **Health & Dental Autism Training Program** The Autism Association is excited to launch the first online training program for health and dental professionals in Australia. Alongside a number of dentists and health professionals throughout Perth, we have developed a new training program for the health and dental sectors to provide you with knowledge and resources to improve access and health care experiences of people with Autism. A finalist in the Excellence in Innovation category at the WA Disability Support Awards 2021, the training program includes a catalogue of resources that fall under the headings detailed below. Once you have finished the training modules, you will receive a certificate of completion. ### **Autism Online Training Modules** Here you will find the 5 online training modules for you to complete at your own pace: - Understanding Autism - Strategies - Inpatient Care - Outpatient Care - Discharging a Patient ### **Resources** Here you will find all health and dental resources created and referenced in the training modules for you to download and use. **AUTISM SPECTRUM DISORDER** - Definition: Spectrum of pervasive developmental disorders that usually begins in the first 30 months of life. Three characteristics: - Poor social skills - Ritualistic and compulsive behaviour - Abnormal speech and language (communication) Triad of ASD diagram showing three domains: Social Interaction, Communication, and Activities and Interests, each with illustrative icons and brief descriptions. ## **AUTISM SPECTRUM DISORDER** - Definition: Spectrum of pervasive developmental disorders that usually begins in the first 30 months of life. Three characteristics: - Poor social skills - Ritualistic and compulsive behaviour - Abnormal speech and language (communication) **AUTISM SPECTRUM DISORDER** | Difficulty in Social Communication | Love of Routines | Sensory Sensitivity | |--- |--- |---| | • Facial expressions or tone of voice • Jokes/sarcasm • Common phrases and sayings • Metaphors • Avoid eye contact • Appear deaf • Start developing language, then abruptly stop talking | • Rules can be important • May be difficult to take a different approach once they have been taught the ‘right’ way to do it • Practice repetitive actions | • Can affect any of the 5 senses: smells, textures, tastes, loud noises, bright lighting • Hypersensitive (cry out in pain to slight things) or hyposensitive (need to look for toothache that may not feel) • Radio, steriliser, handpieces (sound / vibration), light (room / chair / loupes), suction, perfume, taste (prophy, MW, alginate) • Moving dental chair • Cannot always tell where it hurts | | Difficulty in Social Communication | Love of Routines | Sensory Sensitivity | |---|---|---| | • Facial expressions or tone of voice • Jokes/sarcasm • Common phrases and sayings • Metaphors • Avoid eye contact • Appear deaf • Start developing language, then abruptly stop talking | • Rules can be important • May be difficult to take a different approach once they have been taught the ‘right’ way to do it • Practice repetitive actions | • Can affect any of the 5 senses: smells, textures, tastes, loud noises, bright lighting • Hypersensitive (cry out in pain to slight things) or hyposensitive (need to look for toothache that may not feel) • Radio, steriliser, handpieces (sound / vibration), light (room / chair / loupes), suction, perfume, taste (prophy, MW, alginate) • Moving dental chair • Cannot always tell where it hurts | **AUTISM SPECTRUM DISORDER** **Preparation:** - Personal profile - “About me” information – likes, dislikes, topics of interest, means of communication, behaviour management - Behaviour Support Plan or Consistent Approaches documents - Social story - Steps at dentist introduced prior to appointment by carer - Personalise - Photos of actual room, equipment, staff - Appointment time - Avoid peak hour, waiting Illustrated social story titled "This is a story about David going to the dentist," showing sequential panels of David’s visit, including arrival, greeting staff, sitting in the chair, dental examination, and leaving with a reward. ### **Preparation:** - Personal profile - “About me” information – likes, dislikes, topics of interest, means of communication, behaviour management - Behaviour Support Plan or Consistent Approaches documents - Social story - Steps at dentist introduced prior to appointment by carer - Personalise - Photos of actual room, equipment, staff - Appointment time - Avoid peak hour, waiting **AUTISM SPECTRUM DISORDER** **Communication:** - Stages broken down - “Tell-show-do” approach - Speak directly and no metaphors - Short, precise and literal instructions - Communication tools and visual supports (augment with visual aids): - Photos - Pictures/symbols - Written words, flow charts, lists - Communication passports - Show visually as well as verbally - Allow time to process and understand instruction - Avoid distractions - “single mindedness” - One activity at a time - Discuss only one topic at a time - Echolalia Visual guide for tooth brushing steps with icons and text: toothpaste on toothbrush, brush teeth, top teeth 1 minute, bottom teeth 1 minute, rinse. Also includes icons for dentist, toothbrush, nurse, shot, tooth decay, mouth, drill, medicine. Example of a communication passport showing preferences: “I like...” with icons for coffee, going for walks, spaghetti; “I don’t like...” with icon for being left in front of the TV. ### **Communication:** - Stages broken down - “Tell-show-do” approach - Speak directly and no metaphors - Short, precise and literal instructions - Communication tools and visual supports (augment with visual aids): - Photos - Pictures/symbols - Written words, flow charts, lists - Communication passports - Show visually as well as verbally - Allow time to process and understand instruction - Avoid distractions - “single mindedness” - One activity at a time - Discuss only one topic at a time - Echolalia # DEMENTIA ## CPD modules for dental practitioners Partnership in Care - a series of Continuing Professional Development tools designed to support dentists treating people living with dementia. These education modules encourage dentists to continue treating people living with dementia, to focus treatment on preventative methods and have a strong emphasis on quality of life. ### Module 1 This project was funded by the Dementia Australia National Quality Dementia Care Initiative with support from J.O. & J.R. Wicking Trust. Video thumbnail showing "ADA Alzheimer's M1 Ageing" with Australian Dental Association logo and "Understand Alzheimer's Educate Australia" text. # **DEMENTIA** ## **CPD modules for dental practitioners** Partnership in Care - a series of Continuing Professional Development tools designed to support dentists treating people living with dementia. These education modules encourage dentists to continue treating people living with dementia, to focus treatment on preventative methods and have a strong emphasis on quality of life. ### **Module 1** This project was funded by the Dementia Australia National Quality Dementia Care Initiative with support from J.O. & J.R. Wicking Trust. DEMENTIA Three toothbrushes (pink, purple, blue) with text below: "Better Oral Health in Residential Care" and "Professional Portfolio" etc. ## **DEMENTIA** **DEMENTIA** - **Definition**: Progressive neurodegenerative syndrome, in which there is deterioration in memory, thinking, behaviour, and ability to perform everyday activities. - **Clinical Manifestations**: - Memory loss - Language impairment (some revert to mother tongue) - Disorientation and confusion - Personality changes (mood, aggression) - Psychiatric symptoms (apathy, depression, psychosis) - Sight and vision problems (reading, judging distance, shiny/patterned objects) - **Definition**: Progressive neurodegenerative syndrome, in which there is deterioration in memory, thinking, behaviour, and ability to perform everyday activities. - **Clinical Manifestations**: - Memory loss - Language impairment (some revert to mother tongue) - Disorientation and confusion - Personality changes (mood, aggression) - Psychiatric symptoms (apathy, depression, psychosis) - Sight and vision problems (reading, judging distance, shiny/patterned objects) **DEMENTIA** - Appointment time: - Ideally morning, but not too early - When less likely to wait - Appointment reminder, possibly involving relative/carer - Signage: dental clinic, names of dental staff - Noise reduction - Familiar carer to remain in sight - **Appointment time:** - Ideally morning, but not too early - When less likely to wait - **Appointment reminder**, possibly involving relative/carer - **Signage**: dental clinic, names of dental staff - **Noise reduction** - **Familiar carer** to remain in sight # DEMENTIA - Understand preferences of patient: - Preferred name - Previous hobbies/interests/occupation - Carer who knows them best - Things that make them worry/anxious - Find out what was popular when patient was in their early 20's (talking point) - Keep language simple and to the point - Yes/No questions - May revert to first language Collage of iconic 1950s figures including Marilyn Monroe and Elvis Presley - **Understand preferences of patient:** - Preferred name - Previous hobbies/interests/occupation - Carer who knows them best - Things that make them worry/anxious - **Find out what was popular when patient was in their early 20's** (talking point) - **Keep language simple** and to the point - **Yes/No questions** - **May revert to first language** **DEMENTIA** - Be kind and reassuring. Do not talk down or be patronising. - Maintain their respect and dignity - Good verbal and non-verbal communication - Eye contact - Be relaxed/calm - Gently hold hand or put arm around shoulder to comfort them - Give verbal cues (“I am your dentist” vs “do you remember who I am?”) - Constant reassurance - Be kind and reassuring. Do not talk down or be patronising. - Maintain their respect and dignity - Good verbal and non-verbal communication - Eye contact - Be relaxed/calm - Gently hold hand or put arm around shoulder to comfort them - Give verbal cues (“I am your dentist” vs “do you remember who I am?”) - Constant reassurance # DEMENTIA If unable to voice pain/discomfort → possible indicators of dental problems ## BEHAVIOURAL - Refusal to eat/drink (especially hard/cold foods) - Frequent pulling at face or mouth - Leaving previously worn dentures out - Increased restlessness, moaning, shouting - Disturbed sleep - Refusal to partake in daily activities - Aggressive behaviour - Bruxism ## PHYSICAL - Drooling - Redness - Swelling - Ask carers if have spotted any “holes” ### **Indicators of Dental Problems** If unable to voice pain/discomfort → possible indicators of dental problems #### **BEHAVIOURAL** - Refusal to eat/drink (especially hard/cold foods) - Frequent pulling at face or mouth - Leaving previously worn dentures out - Increased restlessness, moaning, shouting - Disturbed sleep - Refusal to partake in daily activities - Aggressive behaviour - Bruxism #### **PHYSICAL** - Drooling - Redness - Swelling - Ask carers if have spotted any “holes” **OTHER SOURCES OF INFORMATION** Pro-Tip Videos, Factsheets, Watch Your Mouth podcast, and Teeth.org.au logo # **OTHER SOURCES OF INFORMATION** **SUMMARY OF COMMUNICATION METHODS** - Gesture – hand gestures, facial expression - Signing – Makaton, Signalong, British Sign - Language, individual methods such as blinking - Symbols – pictures which represent word e.g. Widget Software - Photographs – to depict a subject - Objects – to depict a subject or action - Drawings – used to illustrate what needs to be communicated - Writing – used to relay information - Alternative and Augmentative Communication (AAC) devices – e.g. communication boards, light writers, computers or voice output devices - Speech – it is essential to speak to the individual, (even if they have no speech) in addition to using other communication methods as appropriate # **SUMMARY OF COMMUNICATION METHODS** - **Gesture** – hand gestures, facial expression - **Signing** – Makaton, Signalong, British Sign - **Language**, individual methods such as blinking - **Symbols** – pictures which represent word e.g. Widget Software - **Photographs** – to depict a subject - **Objects** – to depict a subject or action - **Drawings** – used to illustrate what needs to be communicated - **Writing** – used to relay information - **Alternative and Augmentative Communication (AAC) devices** – e.g. communication boards, light writers, computers or voice output devices - **Speech** – it is essential to speak to the individual, (even if they have no speech) in addition to using other communication methods as appropriate # CONCLUSION - Communication is important! Do not pretend that you understand. - Ask your patient their **communication preference** - **Do not assume** intellectual disability - Communicate **directly** to the patient - Speaking **louder** usually does not help → aggressive - Take the **time** to communicate well - **Explain the procedure beforehand**, the more information the better - **Minimise distractions** - Consider **holistically** what would make the patient feel included (understanding vs condescending) - Person may not consider their impairment a “disability”, but rather a cultural difference or societal issue Three-panel illustration comparing "Reality", "Equality", and "Justice" using figures on boxes to reach over a fence. # **CONCLUSION** - Communication is important! Do not pretend that you understand. - Ask your patient their **communication preference** - **Do not assume** intellectual disability - Communicate **directly** to the patient - Speaking **louder** usually does not help → aggressive - Take the **time** to communicate well - **Explain the procedure beforehand**, the more information the better - **Minimise distractions** - Consider **holistically** what would make the patient feel included (understanding vs condescending) - Person may not consider their impairment a “disability”, but rather a cultural difference or societal issue **REFERENCES** - Ramirez L, Dickinson C. Wheelchair users: A guide. B Dent J. 2018;224(6):408-12 - Dougall A, Fiske J. Access to special care dentistry, part 1: Access. Br Dent J. 2008;204:605-16. - Dougall A, Fiske J. Access to special care dentistry, part 2: Communication. Br Dent J. 2008;205(1):11-21 - British Society for Disability and Oral Health, Royal College of Surgeons of England Faculty of Dental Surgery. Clinical Guidelines and Integrated Care Pathways for the Oral Health Care of People with Learning Disabilities. London. 2012. - Breslin M, Cook S. No turning back: posture in dental practice. Vital 2013;10:23-25. # **REFERENCES** - Ramirez L, Dickinson C. Wheelchair users: A guide. B Dent J. 2018;224(6):408-12 - Dougall A, Fiske J. Access to special care dentistry, part 1: Access. Br Dent J. 2008;204:605-16. - Dougall A, Fiske J. Access to special care dentistry, part 2: Communication. Br Dent J. 2008;205(1):11-21 - British Society for Disability and Oral Health, Royal College of Surgeons of England Faculty of Dental Surgery. Clinical Guidelines and Integrated Care Pathways for the Oral Health Care of People with Learning Disabilities. London. 2012. - Breslin M, Cook S. No turning back: posture in dental practice. Vital 2013;10:23-25. THANK YOU! Any questions? Jeeyun.leung@uwa.edu.au # **THANK YOU!** Any questions? 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