Tooth loss can be disabling and handicapping. It has a profound impact on the lives of some people, even those who are apparently coping well with dentures. The profession needs to consider how it can prepare people for the effects of tooth loss.

The impact that dental anxiety can have on people's lives is wide-ranging and dynamic.

This first article in the series will define special care dentistry, who requires it and why? It considers recent legislation and its impact on the primary care practitioner, including reasonable adjustments to the way in which dental care is delivered. It offers practical tips to encourage access to the dental practice and transfer to the dental chair and advice on techniques to aid access to the oral cavity for patients with a range of impairments.

As a profession we have a responsibility to ensure that the oral health needs of individuals and groups who have a physical, sensory, intellectual, medical, emotional or social impairment or disability are met. In the UK, over 200,000 adults have profound learning disabilities and/or complex medical conditions. Adults with a disability often have poorer oral health, poorer health outcomes and poorer access to services than the rest of the population. This paper examines the need for Special Care Dentistry based on a review of published literature, surveys and health policy, and suggests how services might be delivered in the future. Existing models of good practice reveal that established clinicians working in this field have a patient base of between 850 and 1,500 patients per year and work across primary care and hospital settings, liaising with colleagues in health, social services and the voluntary sector to ensure integrated health care planning. On this basis, a conservative estimate of 133 specialists is suggested for the future, working in networks with Dentists with Special Interests (DwSIs) and primary dental care practitioners. A skilled workforce that can address the wider needs of people requiring Special Care Dentistry should be formally recognised and developed within the UK to ensure that the needs of the most vulnerable sections of the community are addressed in future.

AimsTo investigate experiences and expectations of parents/siblings of adults with Down Syndrome (DS) regarding oral healthcare, and explore factors impacting on access and experience of dental care for this group. Design A two phase qualitative and quantitative study using in-depth interviews with a convenience sample of six parents/siblings, and a postal questionnaire of 200 parents/siblings of adults with DS who are members of the Down Syndrome Association. Results The main themes elicited from the qualitative interviews related to concern, experiences, parents'/siblings' attitudes, preferences and information. The response rate from the postal questionnaire was 63.5%. Adults with DS attended the dentist regularly but received little restorative treatment. Experience of oral healthcare was influenced by the attitudes and skills of dental health professionals; stigma; and relatives' expectations of dentists, their oral health beliefs, information and support received, knowledge and priorities. Parents/siblings wanted dentists to be proactive in providing more information on oral health issues in collaboration with other health and social care professionals. Conclusions Whilst most adults with DS visited the dentist regularly, relatively little treatment had been provided. Parents highlighted a need for appropriate and timely oral health information early in their child's life, and access to dentists who were sympathetic, good communicators and well-informed about DS.

Epilepsy is a common symptom of an underlying neurological disorder. The seizures can take a variety of forms. Both the condition and its medical management can affect oral health. Prevention of oral disease and carefully planned dental treatment are essential to the well-being of people with epilepsy.

RESEARCH prostheticsAim To establish how widespread the emotional effects of tooth loss are. Method A questionnaire, distributed to 100 edentulous people undergoing routine prosthetic care in the Department of Prosthetic Dentistry at Guy's, King's and St Thomas' Dental Institute (GKT), was used to explore the emotional effects of tooth loss. Results Ninety four people completed the questionnaire of whom 42 stated that they had experienced difficulties in accepting the loss of their teeth. In comparison with people who had no difficulties in accepting the situation, these people were: more likely to feel less confident about themselves; more likely to feel inhibited in carrying out everyday activities; and less able to accept the inevitable change in facial shape which occurs following the loss of teeth. Additionally, they took longer to come to terms with their tooth loss (All these differences were statistically significant). Just over three-quarters of the people who were unprepared for the loss of their teeth, felt that an explanation from the dentist prior to dental extractions would have helped. Conclusion The impact that tooth loss can have on people and their lives should not be underestimated. In this study it affected 45% of the participants. It is well established that people with dentofacial abnormalities experience social consequences including greater degrees of social avoidance and being perceived as possessing negative personality characteristics. 1 Even minor facial abnormalities can result in social stigma. 2 Visible disfigurements are recognised as having a profound effect on individuals 3 and, according to French, hidden impairments (such as total tooth loss) can cause an equal amount of stress. 4 Indeed, people with facial disfigurement are among those people who are covered by the 1995 Disability Discrimination Act. 5 While Bergendal acknowledged total tooth loss as a serious life event, 6 and the impact of dental ill health on daily living is well recognised, 7-10 it is only recently that attention has been paid to the emotional effects of tooth loss. A qualitative study into the emotional effects of total tooth loss revealed a wide range of reactions. 11 The main themes identified in relation to tooth loss were: bereavement; loss of self confidence; concerns about appearance and self image; tooth loss as a taboo subject which could not be discussed with other people; keeping tooth loss secret; the need for prosthodontic privacy; behaviour change; premature ageing; and a lack of preparation for the loss of teeth. A further qualitative study among people with partial tooth loss uncovered a similar pattern of emotional reactions. A feeling of having lost part of one's self was an additional finding in the partially dentate group. 12 The researchers were surprised at the depth of feeling that existed among the participants of these two studies, particularly, as they were all coping apparently well with dentures. The subjective view was that these feelings were experienced by a significant prop...

Objectives-To collect information from principal carers ofpeople who had died at home with cancer; to identify areas ofsupport which need improvement.Design-Semistructured interviews with carers two to four months after the death.Setting