Sassy Wyatt is a disability blogger and journalist. Here, she shares how she has adapted to life’s challenges and discusses how you can make a difference to the next visually impaired patient who puts their trust in you and your practice

Sassy Wyatt was not always visually impaired. She was fully sighted until just before her 16th birthday. She explains: ‘Due to my deteriorating medical condition, uveitis iritis, I did not lose my sight fully until I was 23.’

She is now carving out a career as a writer, ‘challenging stereotypes through education and humour: empowering others to be more disability confident’.

She says: ‘Confidence is like a muscle; you have to stretch it and build it up over time. Confidence and self-esteem affects everyone, from the young to the old, and when you live with a disability and face barriers to access constantly this can negatively impact on both of these facets. Not only do I share the good aspects and experiences of my daily life in my blogs, but I also share the unfavourable and adverse thoughts, feelings and communications I encounter. It makes people feel less alone – particularly when we live in a world where everything is picture perfect and Insta-worthy. It’s imperative to showcase all dimensions of life.’

This is where her humour comes in. As Sassy says herself: ‘Humans connect through storytelling and humour. It also leaves a lasting impact when you know you have not only made someone think, but made them smile or laugh in the process’.

In the UK, there are almost two million people living with sight loss. Of these, around 360,000 are registered as blind or partially sighted. Here, Sassy kindly shares some thoughts on what you and your dental team can do to make appointments a seamless experience.

Can apprehension and unfamiliarity be a barrier for visually impaired people seeking dental care?

For the majority of us, we bask in familiarity and comfort. Although ‘change’ is constant, people inherently don’t like it. I guess adding visual impairment into that mix can cause apprehension and unease if you are visiting a dental surgery for the first time. It’s learning and remembering not only how to get there but also the layout of the building once you arrive. Where is the reception desk? Where is the seating area? Will the staff be accommodating and friendly?

How important is it for visually impaired people to get a warm reception at a dental practice?

It’s imperative that visually impaired people receive a warm welcome at a dental practice – not least because we are humans too and want to be treated like everyone else! However, we may require assistance and have to pluck up the courage to ask for such – whether that is filling out paperwork, finding the bathroom, or even finding the dentist’s surgery.

How did you choose the dentist you attend?

Choosing a dental practice came down to accessibility and my ease of access for getting there alone (with the help of public transport). I also looked online for good reviews and ratings from other patients – there is no point in me planning a route only to find that staff are unhelpful, rude or uncaring.

I booked my first appointment at the orthodontist I attended face-to-face, but I also asked the receptionist to make a note of it on the computer, as I wanted to make all staff members aware for when I might possibly speak or interact with new members of staff in the future. I also shared this information openly and requested my appointments to be given to me via email – an accessible format for me.

This worked out very well and it also helped me build a great rapport with not only the receptionist, but all members of staff, too.

How important is it that team members help to orientate you on arrival?

If a visually impaired person is entering the dental practice for the first time, they may do one of three things.

1. Turn up to their first appointment with a sighted person. This could be a friend, partner or even a personal assistant (although most individuals do not have or need one). This person may sighted guide them and give them basic orientation and mobility to familiarise them. It gives the visually impaired person reassurance and confidence for future appointments – particularly if they will be attending alone.

2. The visually impaired person may call the dental practice ahead of time to give the staff notice. Making staff aware not only make conversations or transactions smoother, but this also may be where a visually impaired person may infer that a little guidance or visual description would be appreciated when they arrive.

3. A visually impaired person may enter the building using a mobility aid, such as a cane or guide dog, and using orientation and mobility skills they have learnt over the years, will locate the reception alone. If they seem to hesitate, look unsure or confused, it may be that they cannot see or figure out where the reception desk is situated. In this instance, verbally communicate that you are a member of staff, and ask if they would like assistance.

This can do one of two things – give them reassurance that they are on the right track, therefore they will use the sound of your voice to locate you and/or the desk or, they may confirm that they need assistance, so approaching them and allowing them to follow you, or grasp your elbow – to be sighted guided – would work.

How important is it for all team members to introduce themselves?

Introducing yourself to a visually impaired patient is really useful. Not only are you making us aware that you are conversing with them, but it also allows visually impaired people to (over time) recognise your voice.

A quick ‘hello Sassy, it’s Jenny' always works for me. I’m not suggesting that every member of staff in a dental practice introduces themselves but, as long as you say the patient’s name before you start talking to them, it makes us feel at ease and builds great rapport.

Does it help if a dentist talks through procedures?

I think it’s extremely useful for the dentist to explain what they are doing, and how the visually impaired person can communicate with them (if necessary).

Generally, sighted people don’t know what’s going on when a dentist’s fingers are in their mouth. Common practice dictates dentists communicate what they are doing, including explaining what hand signals to use if the patient is uncomfortable or needs a break. It’s just about putting communication into practice and understanding – a little goes a long way.

How can teams help VIPs to visualise the necessary practices to ensure good teeth cleaning, gum health, interdental cleaning and so on?

Because visual impairment is a spectrum, some patients might be able to see hand gestures and visual explanations. However, to err on the side of caution, giving verbal descriptions of how to best use dental floss or brush teeth would likely be more effective.

For example, dental nurses could show the length of dental floss needed, place it in their hands and explain how they should hold it and, through specific directions, go through the procedure.

Are there any common mistakes to be avoided?
I have had instances where healthcare professionals have deliberately distracted my guide dog, and I have had to chastise her and correct her behaviour, even though she was clearly in harness and working. Depending on the situation, I am likely to explain and educate why they should not distract her and the negative consequences it can have on our partnership. As a disability awareness and inclusion consultant this is my job, I feel it’s best to explain to empower others around me leaving them feeling disability confident, rather than confused or affronted because I have snapped at them.

I must stress, however, not everyone wants to spend their life educating others around them about their specific disability, disability awareness or how to treat people like a human being.

Disabled people just want to go about their day like everybody else, and no matter what aid, assistance or communication style we use, we (as a community), are not there to make you feel better about your lives, or put you at ease, just because people don’t know how to act properly around us.

I see you’ve had braces. Why did you choose to have orthodontic treatment?

I never felt particularly comfortable about my smile, so at the age of 14 I sought orthodontic treatment. Unfortunately for me, my orthodontist was working in a dental practice that went bust so my braces came off far too early. Very quickly the retainer I owned no longer fitted my mouth so I stopped wearing one and within the space of a few months, my teeth crossed back over, and were worse than what they had been before. It didn’t help that I had negative remarks about this throughout my teenage years. Going blind made me more self-conscious about my teeth. I could feel them with my tongue but I could no longer see what people behaved like when they saw them. By 2016, I was in a long-term relationship and I had saved enough money, so thought it was time to try again. My braces went on for two years and I now can’t wait to marry my fiancé in 2020 with straight teeth.

Should dentists offer guidance on aesthetic dental treatment to visually impaired patients?

Just because we may not be able to see everything, it doesn’t mean that we don’t want to look good.

I may not have been able to see my teeth for years, but I could feel them with my tongue, and all I wanted was for them to be straight. Offering your professional advice, as long as it’s not done in a condescending way, is always likely to be appreciated.

What can dental teams do to make dental care more accessible?

Being more inclusive is quite simply communicating effectively, putting what is asked of you into practice and establishing a warm relationship between yourself and your patient. If a visually impaired person asks for their appointments to be given via email a week beforehand, then please do this.

Again, although the law has now changed surrounding appointments and receiving information in an accessible format, healthcare services are still not fully aware or up to date on this. Offering your patient leaflets and appointments in their preferred format – large print, Braille or electronic – empowers all of us to have control over our own healthcare and not have to rely on someone else.

If the practice is being decorated, refurbished or re-organised, let your visually impaired patients know ahead of time – particularly if this is ongoing. It not only give them peace of mind, but will also allow them to ask questions or assistance if necessary to orientate themselves in the new environment.

How important is Ida your guide dog in your life?

Ida is my key to independence. She is as stubborn, strong and assertive as I am, and she is exactly what I need in my life. Although I was a long cane user for many years before applying for a guide dog, she honestly gave me back my confidence and sense of adventure – something I hadn’t even realised I was truly missing until our partnership began.

Guide Dogs, the charity, do an amazing job of matching you to the dog. The waiting list is the longest process you will ever go through, because they take everything into consideration – your walking speed, your work ethic, your lifestyle and even your personality.

I needed a dog that could handle chaotic environments but could also be independent. There are days where I am sitting for hours and hours working away and she spends the time curled up, fast asleep, or playing with her toys. However, the second I get ready to walk out the door, she leaps into action and is raring to go.

How inclusive is your practice?

  • Accessible/level access to some part of the building
  • No heavy doors to push or pull
  • Easy access to the reception desk and seating area – without cluttered aisles or walkways Accessible cloakrooms
  • Roll-in and transfer space for wheelchair users
  • Grab rails
  • Lowered sinks and hand-drying facilities
  • An emergency cord that is always free (dangling and touching the floor, in reach of persons and not tied or obstructed by anything else)
  • Clear aisles and walkways in surgeries
  • A clear space where the patient can put their belongings and lie their assistance dog out of the way. For wheelchair users, this would translate to having manoeuvrability to gain access to the bench and self transfer.

Tips on offering assistance

When I first started attending my orthodontist, I was a white cane user and, during that time, I became a guide dog user. This gave me far more stability and independence. By this time, I had also created a mental map in my mind of the layout of the building.

However, as I had asked to be sighted guided during my first few appointments, this became general practice during each appointment. I feel that because staff (in particular my dental nurse) had guided me so often, even becoming more confident and comfortable in doing so, it put greater confidence in the other team members.

Sighted guiding is not for everyone – it’s always better to ask. Not every visually impaired person is assertive in asking for help or assistance, so you may be supporting them more than you realise just by asking the question.

It’s better to offer assistance, and be politely rejected by a visually impaired person, who is capable of getting around independently, than watching them struggle with the potential for an accident to occur.

You can ask questions such as:

  • ‘Would you like any assistance at all?’
  • ‘How can I best support you during your appointment?’
  • ‘Do you mind my asking, how much can you see? I would like to have an understanding so I can best assist you if you were to need it.’
  • Offer assistance and wait for the response.

If sighted guiding is required:

  • You should position yourself to the empty hand of the visually impaired person, allowing them to take your elbow. (They would gently grasp just above your elbow as if they are holding a glass)
  • Stay half a pace ahead of the visually impaired person and giving clear directions when guiding. For example, ‘turn left’ or ‘turn right’ and ‘we are approaching the door’
  • If the door is awkward, cumbersome or heavy, give verbal instructions, Pushing the door open and letting the visually impaired person know if the hinge is on the right or left. This way they can assist you by pushing the door open if their arm is free.
  • Never push a visually impaired person ahead of you, or steer them from behind. It’s both dangerous and annoying.
  • When approaching a chair, place your guiding arm on the back of the seat, and allow the visually impaired person to trail and follow your arm to find the seat.
  • When approaching the dental chair placing your arm on the armrest or the centre of the chair, verbally communicating that the headrest is in front of them and the foot rest is behind them and that they will need to turn 180° to sit into the chair.
  • If applicable, walk directly to the chair, allowing the visually impaired person's leg to graze the side of the chair (side on, you can then communicate that the chair is down to their right-hand side.

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