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A B S T R A C TMany people with special needs (PSN) have difficulty having good oral health or accessing oral health services because of a disability or medical condition. The number of people with these conditions living in community settings and needing oral health services is increasing dramatically due to advances in medical care, deinstitutionalization, and changing societal values. Many of these individuals require additional supports beyond local anesthesia in order to receive dental treatment services. The purpose of this consensus statement is to focus on the decision-making process for choosing a method of treatment or a combination of methods for facilitating dental treatment for these individuals. These guidelines are intended to assist oral health professionals and other interested parties in planning and carrying out oral health treatment for PSN. Considerations for planning treatment and considerations for each of several alternative modalities are listed. Also discussed are considerations for the use of combinations of modalities and considerations for the repeated or frequent use of these modalities. Finally, the need to advocate for adequate education and reimbursement for the full range of support alternatives is addressed. The Special Care Dentistry Association (SCDA) is dedicated to improving oral health and well being of PSN. The SCDA hopes that these guidelines can help oral health professionals and other interested individuals and groups to work together to ensure that PSN can achieve a "lifetime of oral health."

Dental fears and phobias trouble patients with and without special needs, and they are a problem for dentists, as well. This article reviews current research and literature related to methods used to alleviate dental fear and concludes that while some important psychological methods are available, much work is left to be done in this area. It is clear that there is an important role for psychological and behavioral input to the dentist–patient interaction. While dental phobia represents a class of special needs itself, patients with other important disabilities (e.g., physical or cognitive impairments) are sometimes comorbidly phobic, a condition often missed or misdiagnosed by treating practitioners. Office‐based techniques that focus on relaxation, breathing, imagery, hypnosis, and effective use of operatory language are described. The methods advocated here can be used with patients having mild or moderate cognitive impairments. Readings are recommended for the dentist or auxiliary practitioner interested in learning these techniques.

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The development of a new system for annual evaluation of faculty members is described. A narrative of the procedure, including accounts of the problems encountered, is used to show that such a process is too complex and too close to the fundamental identity of a dental school and the self-image of faculty members to be created in a one-time, rational effort or imposed by administrative edict. The process required five years to complete and involved an intermediate model. The goals of the new performance appraisal system were to minimize the extreme rating inflation and significant discrepancies from one chair rater to another that had existed previously. It was also a goal that the new system would create rich and effective feedback for faculty and would orient faculty members toward the mission of the school as a common focus. In achieving these goals, it is the authors' perception that faculty members at this dental school value procedural justice (fairness in the process), that evaluation is a political process, and that a performance appraisal system grounded in organizational mission rather than individual tasks of faculty members fits the emerging career model of knowledge professionals.

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This article is a refinement of verbal reactions to O'Toole's and Corsino's remarks at a national conference on Access to Oral Health Care held at the headquarters of the American Dental Association in August 2005. The article consists of two parts, each part an answer to specific questions. The first is a reaction to Corsino's explanation of Patthoff's concept of Universal Patient Acceptance. Acceptance is supported and endorsed, and a case is made for the importance of a clear and accurate explanation of Universal Patient Acceptance, as it has a much greater likelihood of being embraced by dentists than "access" seems to have. A review of relevant codes of ethics in dentistry reveals mixed and uneven support for Universal Patient Acceptance. The second part of this article compares the way that the profession of psychology views access and acceptance with the way that dentistry seems to view them and concludes that, if dentistry is to remain a caring profession rather than a commercial enterprise, acceptance must be embraced.