Stories at the Dentist.

A major challenge facing the health and wellbeing of people with intellectual disabilities is the level of anxiety experienced by both the disabled patient and the dentist. When a patient with intellectual disabilities is anxious, they may become defensive and exhibit challenging behaviour when the dentist attempts to treat them. As a result of this, the procedure may have to either be abandoned or the patient sedated. The need for sedation is a common problem in dentistry as patients with intellectual disabilities often require a general anaesthetic for simple dental treatment. This carries increased risks, a longer recovery time and increases the cost of the procedure to the NHS.

One reason for patients' anxiety is the difficulty in communication between patient and dentist. In particular, it can be difficult for dentists to provide patients with intellectual disabilities with information about the treatment they require in a way that they can understand. An inability to understand what is about to happen or to express feelings makes a visit to the dentist frightening and stressful. In addition, it is considered good practice to obtain informed consent or assent from all patients. However, clinicians are often unsure if a patient with intellectual disabilities has understood explanations of procedures. It is difficult for people with intellectual disabilities to understand how abstract information relates to them with the result that, compared to the general population, patients with intellectual disabilities find it significantly more difficult to make healthcare decisions.

This study aims to develop a computer based communication system to support people with intellectual disabilities to understand dental procedures with the aim of reducing anxiety for both patients and clinicians, and to enable patients to be more involved in the decision making process. The system will run on a tablet device, e.g. an iPad. The system will automatically generate a story about a dental procedure which is personalised to the patient. This will allow the dentist to explain the procedure to the patient using a graphical interface. The patient will be able to use the system to ask questions about the procedure and express their feelings.

We know that improved communication reduces the anxiety in both the patient and the dentist. This research will investigate whether giving more information to patients with intellectual disabilities improves the outcomes for: (i) the patient; (ii) the practitioner; and (iii) the health service by reducing the time and the resources required to support patients with intellectual disabilities. While this has the potential to produce benefits across the health service, this study will focus on dental health.

People with ID are more likely to experience anxiety at the dentist. The resulting problems of challenging behaviour and the need for sedation require increased resources. We will develop new technology that supports better communication between people with Intellectual Disabilities (ID) and dentists. This system will have the potential of reducing both the resources needed to treat people with ID and, more importantly, the risks associated with the need to resort to general anaesthesia when patients are anxious or exhibit challenging behaviour. We will disseminate the results of this research by targeting:

People with Intellectual Disabilities (ID), their family and support staff are the main beneficiaries of our work. Our approach to working with people with ID is unique in that they are actively involved in the research. This active involvement by a hard-to-reach population is exciting as we know from mainstream research that early user involvement increases the successful adoption of technology, a major issue with Assistive Technology. Some participants may be involved in dissemination activities in collaboration with the NHS, e.g. as speakers at workshops or as spokespeople at public dissemination events. The study will have a direct impact on family and support staff, providing strategies to reduce anxiety of those for whom they care. These strategies may be generalisable to other situations in their lives. We will create an online community. We will engage interested parties to reduce the chasm between innovation and adoption of new technology. In addition, we will run workshops in collaboration with disability charities to present our results to people with ID, their families and support staff. This will raise awareness of the importance of using accessible interactive information with people with ID to support their involvement in medical (and other) decision making.

Medical Practitioners: This work is a result of collaborative teaching on special needs training for newly qualified (foundation level) dentists in Scotland. Together, we have identified the potential that communication technology has to support better interaction between professionals and patients. Local dental practices will act as test beds to develop a working prototype. The research outcomes will contribute to good practice for special needs dentistry, with practical support and guidance on how to include people with ID in decisions making, in particular health care. This will feed into the national training programme for foundation level dentists, providing a unique dissemination route for uptake in Scotland and further afield. We will also strengthen our links with general medical training and will seek contribute to the training on ID through our links with the local learning disability nurses.

General Public: Publicity features in newspapers, radio and television will be used to raise the public awareness of the abilities and needs of people with ID and the Assistive Technology they use. We will use the STEM program to present work done in the study to schools in the North East of Scotland. The study will be presented during the Dundee Science Festival to the general public through an interactive exhibit. The work would also be presented at the Dundee Sensation's Café Science program where researchers from the local unviersities are invited to present their work.

Industry: We have a strong track record of working with industry to transfer research into commercial products. We have an industrial partner who will support us in any future commercialisation. By developing this software as an application for a tablet computer we have the additional option to sell the software as a commercial application on an online tablet market place (such as the Apple App Store or Android Marketplace). We already have a non-disclosure agreement in place with our industry partner who will have first refusal on licensing this software through the NHS.