Serving Those With No Voice: Special Needs Dentistry

We hear the term “special needs” a lot. It’s often in reference to children whose physical or psychological condition requires a particular adaptation so they can access a facility or service. The term dates back to the Adoption and Safe Families Act of 1997, if not earlier, and the need to legally define children who needed more attention in foster care due to a disability.[1]

Special Needs Dentistry
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Not everyone cares for the term. “I was confused with all the ‘special needs’ this and that,” said the mother of a special needs child, who has an impairment herself. “‘Disability,’ I was and am completely used to, both as a person with disabilities and as a professional working in the field … but ‘special needs’?”[2]

While some people do not care for it, “special needs” has long since entered everyday vocabulary. It is used in this article without any assumptions about those to whom it may refer. And there is no denying that physically and mentally challenged people are not always able to use facilities and services that most people take for granted.

This is as true for dentistry as anything else – and maybe more so. “There are very few dentists nationwide who deal with special needs patients,” said Dr. Zeyad Mady, who has made special needs dentistry a centerpiece of the Center for Dental Anesthesia, his practice in Alexandria VA. “In fact, the lack of willingness and the competence of dental care providers to treat patients with special health care needs, as well as the hurdles these providers face themselves, remain barriers to provide special needs access to dental care.”[3]

The need is there; the balance of this article examines the reasons why.

More Vulnerable

Everyone is susceptible to dental problems, of course. But people with disabilities, some of whom cannot communicate easily, may be more vulnerable than most. “Studies have shown that individuals with special health care needs have more risk of developing dental problems and untreated dental diseases compared with their healthier counterparts,” Dr. Mady notes.[4]

Broadly speaking, dental patients falling into the special needs category include people with:

  • Down syndrome
  • ADHD
  • Dental phobia
  • Muscular dystrophy
  • Alzheimer’s disease
  • Medically complex conditions
  • Blindness
  • Epilepsy

A handful of dental professionals have advocated for special needs dentistry as far back as 1981. “In the United States, Special Care Dentistry has been described as ‘an approach to oral health management tailored to the individual needs of people with a variety of medical conditions or limitations that require more than routine delivery of care,” wrote Ronald L. Ettinger and several colleagues in 2004. Special care or special needs dentistry, he added, “‘encompasses preventive, diagnostic, and treatment services.’”[5]

Dr. Mady further refines the term: “To me, ‘special needs’ means the inability to cope with a traditional dental office setting, whether it is voluntary or involuntary.”[6]

This segment of dental patients, Dr. Mady says, remains underserved by the profession. He noticed this early in his career. “Every time a patient with special needs was on our schedule, we would all accept compromised oral health and dentistry, and say, ‘we can only do the best we can,’” he recalls. “That wasn’t good enough for me. I sought out the partnership with some amazing mentors in our area that dealt with a lot of special needs patients, and together we were able to prove that excellent dentistry can be provided to all special needs patients with no compromise.”[7]

The Center for Dental Anesthesia

After the mentor retired in 2015, Dr. Mady partnered with other dentists and health care professionals to assume operation of The Center for Dental Anesthesia. Together they renovated the CDA with state-of-the-art technology to provide a more comprehensive approach to dentistry, including patients with special health care needs.[8]

The Center for Dental Anesthesia is equipped to handle all special needs dentistry patients:

  • The entire facility is wheelchair accessible
  • Dental chairs and equipment adapted for physically disabled patients
  • Private, non-threatening consultation rooms
  • Accurate medical and dental assessment
  • Personalized treatment plans
  • Monitored “spa” recovery rooms

All areas of special needs dentistry, Dr. Mady explains, require experience, training and facilities, since any single condition may bring with it increased medical concerns. “That is why a team approach is always a necessity,” he said. “This team should include both dental and medical professionals to thoroughly assess cases and make sure they all receive the best care possible. All patients with special needs must have equal access and high-quality treatment that focuses on patient safety, patient-centered care, and treatment of all dental needs.”[9]

Those With No Voice

With some twelve million children in the United States classified as “special needs,” the necessity for a practice like the Center for Dental Anesthesia is clear.[10]

The CDA provides a full range of dental services to the general public, and its team values all their patients. But they are proud to be one of the few practices in the country that serves disabled patients. “There is a sense of completion when you know that you have helped a patient who has no voice, and is unable to express their total satisfaction,” Dr. Mady says. “When we look in the eyes of our patients after treatment, we know they appreciate us as do the families that come to see us from all over the country.”[11]

The Center for Dental Anesthesia in Alexandria is committed to treating patients with many different special needs, and believes that no one should be without professional dental care. Each member of the CDA team has years of experience in providing dental healthcare to special needs patients. Please call our office to schedule an appointment.




[1] Adoption and Safe Families Act of 1997: “What Does ‘Special Needs’ Mean?”, referred to hereafter as “What Does…?”

[2] Quote: “The Difference Between Special Needs and Disability”

See also, “3 Reasons to Say ‘Disability’ Instead of ‘Special Needs’”

and “’Special needs’ is an ineffective euphemism”

[3] Interview with Dr. Zayed Mady, DDS, FAGD, FICOI, March 2019, referred to hereafter as Interview.

[4] Interview, and “Oral Health for Families with Special  Health Care Needs”

See also “Special Care Dentistry: A professional challenge”

[5] Quote: “Dentistry for Persons with Special Needs: How Should It Be Recognized?” by Ronald L. Ettinger, B.D.S., M.D.S., D.D.Sc., and Jane Chalmers, B.D.Sc., M.S., Ph.D., and Heather Frenkel, B.D.S., Ph.D., in the Journal of Dental Education. August 2004.

The authors cite “National Oral Health Information Clearinghouse. Glossary of terms. In: Oral health care for people with developmental disabilities: information for patients and professionals. Rockville, MD: National Institute of Dental and Craniofacial Research, National Institutes of Health, U.S. Department of Health and Human Services, July 2003.”

[6] Interview.

[7] Interview.

[8] Dr. Mady, April 5, 2019.

[9] Interview.

[10] Number of children: Interview, and “What Does…?”

[11] Interview.


Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


Medically Complex Dental Cases

Everyone deserves good dental health, and good dental health care. Getting it, however, can be difficult for some people. Illness or disease, and certain psychological conditions, can make it a challenge just getting to the dentist’s chair. They can also make the patient more susceptible to oral complications, and to compromised dental health. Such circumstances are broadly grouped as medically complex cases, which are a specialty of the Center for Dental Anesthesia in Alexandria.

Special Needs Dentistry
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Dentistry posts from CDA? Click here.

The link between oral health and general health is by now firmly established. “The oral cavity has been described as ‘the window to general health,’” wrote Dr. Shawn F. Kane, who notes that many health care professionals consider this obvious. “The oral cavity is also the intersection of dentistry and medicine, semi-independent professions that share the same common goal of improving the health and quality of life of patients.”[1]

Yet medically complex cases can be a serious obstacle to obtaining proper dental care. These cases include:

  • Cancer
  • Post-Traumatic Stress Disorder (PTSD)
  • Diabetes
  • Heart disease/high blood pressure
  • Kidney disease
  • Allergies
  • Epilepsy, tremors, and palsy

People contact the Center for Dental Anesthesia with all of these issues. This blog post describes how medically complex conditions impact oral health, and what can be done about it – with a special focus on cancer and post-traumatic stress disorder (PTSD).

There are an estimated 1.4 million new cases of cancer in the United States every year. Modern medicine can work miracles in cancer patients, but it comes with many side effects. Some of these are common knowledge: most of us know that chemotherapy and radiation treatment can lead to fatigue, nausea, and hair loss. Less well known are its effects on oral health.[2]

Chemotherapy side effects on oral health include:

  • Tooth decay and gum disease
  • Mouth sores
  • Mouth bleeding
  • Dry mouth (xerostomia)
  • Difficult swallowing
  • Malnutrition and dehydration.

Patients with medically
complex cases need one-
on-one attention and a
relaxing dental
environment. Dr. Mady is
pleased to provide safe
sedation dentistry to his
patients with additional
medical needs.

Patients and dentists alike should know about these side effects, as well as the emotional issues and other special needs the patient may have. Up to one-third of cancer patients receiving treatment develop some kind of oral complication that can make it hard for them to talk and eat. These issues can, in turn, further affect the patient’s health, as well as their social and psychological well-being.[3]

While most of these are transitory, and clear up when treatment ends, others may continue. Tooth decay in particular can become a significant issue.

Radiation therapy to the head and neck area can be especially harmful to oral health, with side effects that include:

  • Tooth decay and gum disease
  • Mouth sores
  • Breakdown of hard and soft tissues
  • Infection
  • Difficulty swallowing
  • Malnutrition and dehydration

Fortunately, the effects of cancer treatment on oral health can, in many cases, be minimized or even prevented with good dental hygiene before and during the treatment. Regular brushing and flossing, rinsing with anti-bacterial and baking soda solutions, drinking plenty of water, and eating bland foods, all can help. It’s also a good idea to see the dentist a month or so before radiation therapy begins, if possible. That way existing problems, like new cavities, can be addressed.[4]

The team at the Center for Dental Anesthesia can provide detailed suggestions.

Historically, Post-Traumatic Stress Disorder has been known as “shell shock” or “combat fatigue.” But the condition is not unique to military veterans; it can occur in anyone. PTSD is a reaction to experiencing or witnessing a traumatic event, such as violent crime or abuse, an automobile accident, a natural disaster, or war. This post uses the term “trauma survivor” in reference to people with PTSD. [5]

Not everyone who experiences a traumatic event will develop PTSD. Most, in fact, will not. But with a new generation of American servicemen and women engaged in foreign conflicts, Lisa Mayo, the dental hygiene program director at Concorde Career College in Texas, foresees an increase in reported cases. “Gone are the days when you saw PTSD on a medical history only once in a blue moon,” she cautions. “This disorder will begin presenting in your practices more frequently than ever before due to the military climate set in motion on 9/11.”[6]

A number of health issues are associated with PTSD, including sleep disorders and substance abuse, alcohol in particular. These issues frequently contribute to oral health problems in trauma survivors, such as periodontitis and bruxism.

As treatment begins, it is important that dentists establish a good relationship with trauma survivors, perhaps an even better relationship than with other patients. But trauma survivors are not likely to reveal the condition without prompting. Dentists should screen for it, and try to identify it, by including a question about PTSD on health history forms. Understanding from the outset that a patient is a trauma survivor can help make the patient more comfortable, determine whether any procedures are particularly difficult, and lead to better outcomes.[7]

The chairside manner of the dentist is critical. Establishing a calm, neutral environment is advised, but may not be enough. “The treatment phase can be challenging,” say authors Noel Kelsch and Marhya Kelsch. “Time in the chair may need to be adjusted, and the plan should incorporate flexible, short appointments.” A trauma survivor may once have been pinned down, for example; the dentist chair can mimic the experience and become an inadvertent trigger.[8]

Other ways dentists can make treatment easier for trauma survivors include:

  • Give the patient as much control and choice about treatment as possible
  • Encourage questions, and discuss any concerns before treatment begins
  • Understand the patient may require a support person in the examination room
  • Allow for leeway; let the patient know the treatment can stop whenever necessary[9]

When dental teams and other health care providers understand the issues associated with trauma survivors, patients are more likely to have positive experiences and successful outcomes. They will enjoy the benefits of good dental health, to which they are entitled.

Dental Success
Cancer and PTSD are only two of the medically complex cases that can adversely affect oral health. Prevention is always better than defensive health care, but unfortunately, it is not always possible to achieve.

The goal of any dental practitioner is the patient’s well-being and the success of the dental treatment. At the Center for Dental Anesthesia in Alexandria, our special needs dentistry addresses medically complex cases with one-on-one attention in a stress-free dental environment.

We also offer family and cosmetic dentistry.


End Notes
[1] Oral health and general health: See, for example,
Quote: “The Effects of Oral Health on Systemic Health,” by Shawn F. Kane, MD, FAAFP, FACSM.

[2] Number of new cancer patients each year: “Oral Complications of Cancer Treatment: What the Dental Team Can Do,” cited hereafter as “Oral Complications.”

[3] “Oral Complications,” and “Dental and Oral Complications of Cancer Treatment – Facts,” cited hereafter as “Facts.”

[4] “Oral Complications” and “Facts.”

[5] “What Is Posttraumatic Stress Disorder?” From the American Psychiatric Association website; no author credited.
“Trauma survivor” term is suggested by, and borrowed from, “Trauma Survivors in Medical and Dental Settings,” a Western Massachusetts Training Consortium pamphlet, available online at
Referred to hereafter as “Trauma Survivors.”

[6] “Shell Shocking Impacts From PTSD,” by Brittany Morgan Getz, RDH, Emily R. Holt, RDH, Samantha Harpenau, Rey Gabriel Carandang.
Quote: “Patients with Post-Traumatic Stress Disorder,” by Lisa Mayo, RDH, BSDH, MHA, .
The author cites the American Psychiatric Association handbook Diagnostic and Statistical Manual, Fifth Edition [DSM-5], for prevalence of PTSD among U.S. adults.

[7] “Identifying and Treating Patients with PTSD,” by Noel Kelsch RDH, RDHAP, AS, BS, and Marhya Kelsch LCSW, MSW, BSW, AA. Cited hereafter as “Identifying and Treating…”

[8] “Trauma Survivors.” Quote: “Identifying and Treating…” p. 5.

[9] Bullet points adapted from “Trauma Survivors.”


Additional Sources

Dental Treatment in Medically Complex Patients

Heart Disease and Your Oral Health

The Mouth and Heart Connection

Dental Care of Cancer Patients Before, During and After Treatment and

12 Facts You Can’t Ignore

Relieving Your Dental Anxiety At Center for Dental Anesthesia

Relieving Your Dental Anxiety At Center for Dental Anesthesia

Hello Alexandria dental blog visitors, welcome to the Center for Dental Anesthesia blog. We provide sedation dentistry and other services to patients in the surrounding area.

A patient of ours recently expressed fears about her upcoming root canal. She was anxious about the pain she might experience and worried about getting work off for the multiple office visits to complete the procedure. We assured her that painful root canal procedures are a thing of the past with modern dentistry.

With the latest technology and anesthetics, a root canal (endodontic treatment) is no more painful than receiving a filling. Most root canals can be completed in one or two office visits.

If you have been neglecting your teeth because of fears or concerns about a particular procedure and have not been to your Alexandria dentist recently, we encourage you to schedule an exam, cleaning, and consultation today.

At the Center for Dental Anesthesia, we offer sedation dentistry and special needs dentistry, including serving patients with physical and mental disabilities. Schedule an appointment with us today.

Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


Tooth Bleaching Fact And Fiction

Alexandria Teeth Whitening and Veneers You have probably seen ads for lightening products contain terms such as “white brite,” “22 carbamide peroxide” and “peroxide teeth.” How do you separate tooth bleaching fact from fiction?

Some tooth whitening dentists will guarantee fantastic results for any patient that desires a whiter smile. At Center for Dental Anesthesia, we only recommend tooth bleaching for patients that are good candidates for the process. We invite you to speak with us at our Alexandria office. Not all teeth whitening systems are appropriate for every person.

Don’t be fooled by smile whitening hype and risk poor results. If you have existing cosmetic dental work such as crowns, bonding, partial dentures or bridge work, it is essential to talk to a legitimate professional about worry-free teeth whitening.

If you have all-natural teeth that are dull or stained, tooth whitening may brighten your smile. If you have several crowns in the front of your mouth, veneers, or gums that have receded, conventional teeth whitening procedures may not be successful.

Porcelain veneers may be a better solution for you. There are several brands of veneers such as Lumineers by Cerinate, da Vinci and Mac. The vast majority of veneer recipients are pleased with the results. Porcelain veneers not only brighten your smile, they can provide many other improvements.

Veneers are sometimes called “instant orthodontics” because they can repair tooth misalignment and gaps as well as provide instant teeth whitening.

Schedule a consultation by calling 703-379-6400. I look forward to meeting you and discussing your unique smile.

For more details about our services including: sedation dentistry, teeth whitening, or orthodontics, call 703-379-6400.


Contact Center for Dental Anesthesia:703-379-6400

Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia


New Protein For Dental Implant Patients

Prince William County Dental Implants Hundreds of Prince William County dental implant recipients have replaced missing teeth with jaw-bone anchored tooth implants. Unlike a dental bridge, a tooth implant consists of a titanium post inserted into the jaw bone. The bone meshes with the post to create a strong base for the natural-looking prosthetic tooth and crown that attaches to the post.

Dental implants are usually the ideal restoration for Prince William County people who want to replace a missing tooth. There is a problem, however, if the jaw bone is too thin at the implant site.

When a tooth is extracted, the bone loses the blood circulation at the former site of the root. Consequently, bone recession often occurs. If the recession is extensive, there is not enough bone to hold the dental implant post.

Bone grafting can augment the bone at the implant site and provide the bone density necessary for a successful implant. This is usually effective, but it does require time for the new bone to generate. A new discovery may provide a quicker solution for regenerating bone.

Researchers at the Georgia Health Sciences University College of Dental Medicine have identified a protein that quickly stimulates the production of new bone. The research team, led by Dr. Ulf M.E. Wikesjo, implanted bone morphogenetic protein in test subjects and discovered that “more new bone formed within four weeks than with conventional bone grafting.”

This protein will require extensive testing before it is available for Prince William County dental implant patients. However, I am pleased at the prospect of an additional method for making dental implants possible for my Prince William County patients with missing teeth and jaw bone recession.

We offer cosmetic dentistry, dental implants, Invisalign clear braces, and snoring and sleep apnea treatment. Call Center for Dental Anesthesia at 703-379-6400.


Contact Center for Dental Anesthesia:


Location (Tap to open in Google Maps):

5284 Dawes Ave
Alexandria, Virginia