Meeting the Growing Demand For Special Care Dentistry in An Ageing Singapore

As Singapore’s population continues to age, the demand for special care dentistry is rising — particularly among patients with dementia and neurological conditions. According to Dr Shenna Ho, Head and Associate Consultant in the Special Care Dentistry, Department of Restorative Dentistry at the National Dental Centre Singapore (NDCS), this trend reflects the broader demographic shift towards an older population with increasingly complex healthcare needs.

Patients with cognitive or physical impairments face distinct oral health challenges. Many are unable to manage their own oral hygiene and may struggle to cooperate with caregivers attempting to assist them. At the same time, these individuals often have multiple medical conditions that require attention, placing significant strain on caregivers and resulting in oral health being deprioritised.

The situation is further complicated by behavioural changes associated with dementia, which can make daily oral care difficult, as well as the effects of polypharmacy. Certain medications may cause dry mouth, increasing the risk of dental decay and accelerating oral health deterioration.

To address these challenges, dental teams play a crucial role in supporting not only patients but also their caregivers. “Equipping caregivers with the knowledge and skills to manage oral care is essential,” Dr Ho noted, highlighting the importance of practical guidance tailored to each individual’s needs.

At NDCS, care delivery for patients with special needs is grounded in a multidisciplinary and interprofessional approach. Treatment planning involves close collaboration with the patient’s family and caregivers, ensuring that dental care aligns with the individual’s overall medical condition and long-term care trajectory.

Input from a wide range of healthcare professionals — including neurologists, geriatricians, speech therapists and occupational therapists — is often incorporated to tailor treatment plans appropriately. This collaborative model allows for necessary modifications to be made, ensuring that dental interventions are both suitable and patient-centred.

Caregivers remain central to maintaining oral health, particularly for patients with dementia. Establishing oral care as part of a consistent daily routine can help improve cooperation, although challenges may still arise. Dr Ho advises caregivers to remain patient and persistent, recognising that resistance may vary from day to day. Seeking professional advice can also help identify underlying issues, such as pain or discomfort, that may contribute to a patient’s reluctance to accept oral care.

As patients with dementia may have difficulty communicating discomfort, caregivers are encouraged to watch for behavioural changes that could signal dental problems. These may include restlessness, aggression, refusal to eat, altered eating habits, increased drooling, sleep disturbances, or pulling at the face.

Dental teams also adopt specific strategies to improve the patient experience during clinical visits. The presence of a familiar caregiver can provide reassurance and valuable insight into the patient’s preferences and behaviours. Scheduling appointments at times when the patient is most alert and comfortable can further enhance cooperation.

In addition, minimally invasive treatment approaches are often preferred. Techniques such as silver diamine fluoride therapy and atraumatic restorative treatment can reduce the need for drilling, making procedures more tolerable for patients with dementia.

When planning care, dentists must carefully balance preventive, restorative and comfort-focused considerations. A rational, patient-centred approach is essential — one that takes into account the individual’s medical condition, functional ability and social circumstances. This ensures that treatment decisions are made in the patient’s best interests, prioritising quality of life alongside clinical outcomes.

As the need for special care dentistry continues to grow, a coordinated approach involving dental professionals, medical teams and caregivers will be key to ensuring that vulnerable populations receive appropriate, compassionate, and effective oral healthcare.

To view the original article from Dental Asia, click here.