• Finger guard or semi-rigid mouth prop extremelly useful for inital dental assessment. Precaution: to secure it from finger detachmentand risk of swollowing.

• Semi-solid Mouth Rest, wider for adults and more narrow for disable children with limited mouth opening. Can be used also by parents or carers. Gentle insertion with horizontal position and then slow rotation in order to release dental arches.

• Special caution when using mouth rest (even asemi-soft one) in elderly, frail patients with TMJ problems and/or involuntary mandible movement (eg. Parkinson’s disease). Increased risk of TMJ disfunction. Practical tip – to place mouth rest as pictured above with horizontal position and then gently and slowly rotate to semi- or fully vertical position.

• High risk and prevalance of caries – commonly related to poor oral hygiene and sugary diet, may be also linked to less than normal amounts of saliva, medications containing sugar, or special diets that require prolonged bottle feeding or snacking

• Tooth erosion – linked to acidic diet (coke), frequent vomiting or gastroesophageal reflux (Prader-Willi syndrome, alcohol misuse, eating disorders)
• High risk of severe and generalized periodontal disease due to inadequate oral hygiene and/or impaired immune systems or connective tissue disorders (Down syndrome, diabetes, immune deficiences, HIV)
• Gingival overgrowth as a side effect from medications such as calcium channel blockers, phenytoin sodium, and cyclosporine (epilepsy)
• Oral mucosa abnormalities: laceration, ulceration, denture stomatitis (candydiasis, fungal infections), angular cheilitis, viral infections usually due to the herpes simplex virus (HIV, immune deficiences)
• chronic lips ‘cracks’
• Acute and urgent dental problems: pain, abscess, swelling, tooth wear, self-inflicted injury, acute and chronic dental trauma (learning disabilities, cerebral palsy)
• Accidental trauma to the face and teeth (intellectual disability, seizures, abnormal protective reflexes, or muscle incoordination)
• Hypo- or hypersalivation, inadequate quality and quantity of saliva (Preder-Willis syndrome, learning disabilities)
• Dry mouth syndrome, drugs induced xerostomia (Sjogren syndrome, diabetes, sarcoidosis), BMS
• Mouth ulceration with systemic origin associated with: medications, haematological problems, autoimmune diseases, bone marrow transplants, chemotherapy, etc.
• Acute mucositis
• Atypical facial pain, neuralgia (CVA, neurological and endocrynological problems)
• Neuropathic pain, myofacial pain, trigeminal neuralgia
• Facial muscles dysfunction: hypotonia or hypertonia which contributes to malocclusion and tooth grinding, particularly in people with cerebral palsy
• Chronic parafunctions, bruxism: habitual teeth grinding, clenching,  is a common occurrence in people with cerebral palsy or severe intellectual disability. In extreme cases, bruxism leads to severe tooth abrasion, flat biting surfaces and pulp exposure/pulpitis (learning disabilities, Prater-Willis syndrome)
• Hypodontia (Down syndrome, Williams Syndrome)
• Developmental abnomalities of mandible and maxillary bones
• Delayed, accelerated, or inconsistent tooth eruption in children with growth disturbances
• Premature loss of permanent teeth due to periodontitis or congenital disorders (hypophosphatasia)
• Tooth anomalies may vary in the number, size, and shape of teeth. People with oral clefts or other congenital conditions (Down syndrome, ectodermal dyspalsia) may experience congenitally missing, supernumerary or malformed teeth.
• Complex orthodontic problems, severe malocclusion, teeth rotations and displacements
• Poor fit between the upper and lower teeth, and crowding of teeth in people with developmental disabilities
• Developmental orofacial conditions
• Xerostomia
• Long-term smoking habit, often excessive amount, especially between individuals with mental health problems, depression, anxiety, schizophrenic disorders, etc. This helps controls themselves  and keep calm. Some mental health units or even hospital wards, allow patient with mental health issues to continue their smoking habit. A main role as a dentist – smoking cessation advice and provision of information about local smoking cessation team

Step-wise restorative technique or so-called “therapeutic sealants” can be in selected cases suitable in patients with special needs

To make it clear to the patient that ‘decay and gums diseases’ are preventable !