Access to special care dentistry, part 8. Special care dentistry services: seamless care for people in their middle years - part 2.

This article about special care dentistry in the middle years considers people who have Down's syndrome and cerebral palsy and those who have cardiac and respiratory disease. The increased life expectancy of people with Down's syndrome, currently 50-60 years, is reflected in the changing population profile and needs of these individuals. The preventive and dental treatment of most people with Down's syndrome and cerebral palsy can be met in general dental practice. However, those people with profound disability, anxiety or learning disability may require either a shared approach to care or referral for specialist care. Cardiac and respiratory disease occur commonly in the general population both in middle and older age groups and the dental team will meet increasing numbers of people with these conditions. The procedures and drugs used in dentistry can aggravate heart disease and it is important that the dental team are aware of the common cardiac conditions and their management, as well as how to best manage the oral care of this group. Also, they have a role to play in the provision of oral health advice, smoking cessation and dietary advice. This is particularly important as poor oral hygiene has been linked to respiratory pathogen colonisation and dental plaque may act as a reservoir for aspiration pneumonia in susceptible individuals.