PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

characteristic of services for disabled children until after the Second World War.
During the 1950s there was a move towards normalizing the lives of 'handicapped'
children. This movement set about making major changes in the lives of affected
children and adults but cannot yet be considered as completely successful. The move
to normalization came about largely for ideological, legal, and probably in some
countries for financial reasons.


The philosophy of this movement, which originated in Sweden, centered on the idea
that an impaired person should live in an environment as near normal as possible.
This involved residing in home-like residences and attending schools, work places,
and recreational programmes that were part of the community. On the basis of this
ideology, many mildly impaired people were moved out of long-stay institutions into
community homes. This movement was fostered by the belief that institutionalization
retarded emotional and cognitive growth. De-institutionalization would also reduce
the state's expense in maintaining impaired people, and the onus would be shifted to
parents, private charities, and local authorities. Contemporary concepts within this
movement are embodied in social role valorization⎯that is, the concept of social
devaluation of which social exclusion, for whatever reason, is just one aspect.


While most people would agree with the principle of normalization, inadequate
funding has produced a less than satisfactory alternative in community care and
disastrous consequences for some mentally ill people and those with whom they
interact. While many children and adults with impairments were resident in long-stay
institutions the provision of dental services was relatively efficient. With the move to
normalization, children were often returned to parents/guardians or housed by social
services in homes in the local community, thereby placing an additional burden on
these families or carers to organize dental care.


Alongside this programme has been the move to integrate as many children as
possible into mainstream education. This may mean that these children are not as
readily identifiable as was the case when they attended 'special schools' and thus may
miss out on the opportunity to receive the prioritized dental care they need. For
teenagers, it has become apparent that some managers of the adult training centres
that they attend feel that, as part of normalization, their clients should receive 'normal'
dental care, that is, from a general dental practitioner. This would be desirable,
provided general dental practitioners were happy to provide this service. The
evidence to date is that this is not generally the case. In the meantime, teenagers and
young adults could lose out by not continuing to receive the special dental services
that the publically funded service has been able to offer, simply because it is felt by
their advocates that this runs contrary to the philosophy of 'normalization'.


Consent for dental care


A treatment plan for a child (less than 16 years of age in most jurisdictions) requires
the consent of a parent before embarking upon active treatment. This is often by
implied consent; that is, the parent brings the child to the surgery and the child sits in
the chair, the implication being that the parent has consented to treatment. This is no
different to the scenario with an impaired child. The United Nations Convention on
the Child requires that children's rights are protected and in this context, cognizance
taken of the child's views on whether they wish treatment to be carried out. As with

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