Stories at the dentist

When a patient with intellectual disabilities is anxious, they may become defensive and refuse treatment. As a result of this, the treatment may have to be abandoned or the patient may need to be sedated in order to complete simple dental treatments. The need for sedation is a common problem in special care dentistry and carries increased risks, a longer recovery time and increases the cost of the procedure to the NHS.

Some patients experience dental anxiety because they have difficulty expressing their fears to the dentist. The inability of patients to understand what is about to happen or to express their feelings makes a visit to the dentist frightening and stressful. In particular, dentists may find it difficult to explain their treatment plan with patients with intellectual disabilities in a way that they can understand. Whilst it is good practice to obtain informed consent or assent from all patients prior to their treatment, clinicians are often unsure if a patient with intellectual disabilities has understood what will happen during a procedure. Consequently, patients with intellectual disabilities find it more difficult to make healthcare decisions.

Aims and Objectives

Personalised scenarios (social stories) are used extensively in various situations, such as visiting new places, keeping to routines and to help allay the concerns of people with Intellectual Disabilities. We aim to use this technique with individual patients with intellectual disabilities. A computer based communication system containing a personalised social story will be developed with the aim of enabling people with intellectual disabilities to better understand dental procedures. In doing so, we aim to reduce anxiety for both patients and clinicians, and enable patients to be more involved in the decision making process.

This research brings together the disciplines of Dental Public Health (Professor Ruth Freeman), Human Communication Technology (Professor Annalu Waller) and Health Psychology (Professor Gerry Humphris) to evaluate if improved communication strategies with patients with complex communication needs will increase patient participation and reduce dental anxiety. This exploratory work uses computer-based communication systems (Waller), analysis of dental-patient communication using the Verona CoDes (Humphris) and reviews short segments of video footage using Video Interactive Guidance (VIG) to assess dental practitioners' thoughts on the communication interaction (Freeman). This is an innovative approach to dental healthcare that will revolutionise the way dentists and individuals with intellectual disabilities and communication difficulties interact in the clinical setting.

Impact

To increase access to dental care for those with complex communication needs and/or profound intellectual disability.