I have several individuals on my caseload that have significant anxiety and behavioral issues with interactions with doctors, nurses, dentists, dental assistants, and staff completing oral hygiene or nail care routines. These individuals are at cognitive and adaptive level in the upper profound range of mental retardation. I have already tried positive reinforcement with preferred edibles and non-edibles, positive environmental changes ,preferred music, alternate treatment location, etc., walk-thru when no services needed, medical-dental leisure kit to increase familiarity with topics, and goal training. None of these interventions have been effective to date, and they usually require sedation and medical immobilization or in some cases general anesthesia. Does anyone have any additional ideas |