Imagine you are in pain, you need help, but it's a CHAIR that is the major barrier to you getting the healthcare you need. Sounds unfair doesn’t it? But for the patient with severe obesity accessing dental services, this can be their reality. Because if they exceed the safe dental chair weight limits (typically around 140kg depending on the chair model), they may need to be referred for dental management using a bariatric dental chair which can accommodate higher weight limits of up to 455kg. In Australia, this also means referral to be seen by a Special Needs Dentist like myself, as typically this is where the limited numbers of bariatric dental chairs are located.

It's a strange circumstance to be acutely experiencing problems sometimes your colleagues have never encountered. This was something I noted in the early stages of my specialist dental practice in Special Needs Dentistry, I was seeing clinical issues that were less known. Why? For my general dental colleagues, because of the current referral pathways, they may not have been exposed before to the dental management of people living with severe obesity. However, if we are to improve their access to dental services, we need to know the perspectives about barriers and enablers from the perspectives of the entire dental team – general dentists, oral health therapists, support staff including dental assistants and reception. And also perspectives from special needs dentists given their prominent role due to current referral pathways. We didn’t have this information previously. So we carried out focus groups with dental teams who had been exposed to patients with severe obesity, for example, in regional and rural settings, due to investment in a bariatric dental chair.

What were some of the interesting findings? Barriers included multiple clinical challenges. Both clinician and support staff participants reported work health and safety including ergonomic concerns with poor positioning and musculoskeletal strain. Naturally, this also leads to treatment provision barriers. There were a number of issues around safety of dental care and dental treatment planning modifications for people living with severe obesity. In addition, problems with how and why patients are being referred currently were raised by participants, because this only worsened the access barriers due to long specialist waiting times.

It wasn’t all bad news. The participants in this study suggested a number of enablers to dental management such as guideline development, increasing the availability of bariatric dental chairs, making environmental changes in our dental clinics to improve safety and educating patients with severe obesity and the entire dental team in the future. Who can lead this education? Special needs dentists can make a start particularly given their role in advocacy and experience with this often vulnerable patient group. 

Where to now? Having these suggestions and evidence allows for us to put in measures and frameworks to make this better. Implementing strategies can improve the dental management for people living with severe obesity so we can make it less difficult for them to receive dental care in the future.