The use of glass ionomer in special needs patients.

Placement of restorations for patients who are physically or intellectually disabled or mentally ill can pose considerable difficulties for the general practitioner. Access to the oral environment is often limited and patient tolerance and concentration may be reduced to rather brief periods of time. Oral hygiene routines may be less than ideal leading to a high caries rate. Enamel surfaces which do not normally become carious can develop broad but shallow lesions with a poorly defined outline. Selection of the most suitable restorative material will be important, with longevity of the restoration as the prime consideration. Other factors such as access, isolation of the lesion and patient co-operation must also be taken into account. Also, forces acting on restorative materials may be less than usual due to poor occlusion, teeth opposing dentures or being completely unopposed. Restoration by indirect techniques will often not be possible so the choice will be limited to the three plastic restorative materials normally used in restorative dentistry: amalgam, resin composite and glass ionomer. As a result of clinical experience it is suggested that glass ionomer will often be the material of choice. This paper describes five years experience with the resin-modified glass ionomers in an institutional practice which is limited to patients with special needs. Clinical significance Placement of restorations, with a reasonable expectation of longevity, can pose considerable problems for the patient with special needs. Resin-modified glass ionomer is a useful alternative material and has been placed with a high degree of success over a period of five years.