A pattern for the establishment of a unit for the dental treatment of the handicapped patient in the community based on such a unit in Hertfordshire.

Abstract

In 1978 the Hertfordshire Area Health Authority converted a ground floor dental surgery with the specific aim of providing a comprehensive dental service to the handicapped in the Community. This article describes the criteria used in the design and location of the unit and, briefly, how an efficient patient flow is achieved. The routine dental treatment of the handicapped patient has always posed problems real and artificial for the dental surgeon. Problems can be simply classified into: (1) Medical. (2) Management from the patient's point of view, including access to surgery, dental chair, and transportation. (3) Management from the Dental Surgeon's point of view. (4) Economics. (5) Time, which is closely related to economics. The Community Dental Service is responsible, as part of its duties, for the provision of dental care for both physically and mentally handicapped children and adults living in the Community. In 1978 the Hertford shire Area Health Authority decided that dental facilities for these children and adults were inadequate and began work on the conversion of a ground floor dental surgery to cope with their special needs. The following criteria were considered to be basic essen tials : Situation of Unit (1) The site of the surgery would have to be centrally located in the county with good road and public transport access. (2) As some patients would be treated under general anaesthetic on a day-care basis good access to a nearby General Hospital would be essential in case of emergency and possible utilization of in-patient facilities. (3) The unit must be on the ground floor with adequate access for wheelchairs. The standard wheelchair is 42 inches long, 25 inches wide, 36 inches high (handles to floor) and 20 inches high from seat to floor. Hence to turn a wheelchair through 360 degrees needs 54 inches clearance. Using figures for an average adult, the average reach of such an adult in a wheelchair is 60 inches vertically, 30 inches long and 48 inches diagonally from the floor. Therefore for wheel chair manoeuverability a hall way would have to be at least 60 inches wide in order to allow two way traffic, and doors would have to be 30 inches wide to allow adequate access 1-3.